1. Health and Transportation
Pro Walk Pro Bike, September 2012
CDR Arthur Wendel, MD, MPH
NCEH/EEHS/HCDI
dvq6@cdc.gov
www.cdc.gov/healthyplaces
National Center for Environmental Health
Division of Emergency and Environmental Health Services

2. Healthy Community Design Initiative (HCDI):
 Mission: To understand and improve the relationship
between community design and public health through:
 Surveillance
 Health impact assessment and other mechanisms to improve
policies
 Research, evaluation and best practice dissemination
Live Longer / Walk More

3. Case Patient – “Pete”
 10 year old male is brought to his physician by his
parents because of difficulty in his classroom

4. Problem List
 Teacher describes fidgeting, being
boisterous, but notes sustained
effort with tasks
 Overweight
 BP 120/81 - prehypertensive
 No exercise – recess and gym cut
due to budget problems, mom
drives to school
 Symptoms of depression
 Daily intake of cola
Images:
http://managetheunmanageable.blogspot.com/2011/03/students-who-are-easily-distracted.html
http://catherinelramstetter.wordpress.com/research-on-school-recess/

5. Treatment Plan
 Join sports team
 Meet with nutritionist
 Teacher fills out ADHD assessment

6. Three Month Follow-Up
 No major improvements
 Baseball team requires 40 minutes more driving. Lack
of time leads to fast food consumption
 ADHD assessment reflects some problems, but not
diagnostic
 Still has some symptoms of depression

7. 30 Years Later
 On multiple medications for hypertension, diabetes,
cholesterol
 Drives kids to school for safety concerns

8. Percent of U.S. GDP spent on Health Care
25%
20%
15%
10%
5%
0%
1960 1970 1980 1990 2001 Projected Projected
2010 2019
https://www.cms.gov/NationalHealthExpendData/25_NHE_Fact_Sheet.asp

9. Public Health Impacts of Physical Inactivity
 36% of adults report no leisure-time physical activity and
82% do not meet current federal guidelines for physical
activity and muscle strengthening.1
 88% of U.S. adolescents do not meet current aerobic and
muscle strengthening guidelines.2
 Estimated medical cost of physical inactivity: $75 billion per
year.3
 Physical activity lowers risk for4
•Premature death •Depression
•Coronary heart disease •Colon cancer
•Stroke •Breast cancer
•Hypertension, •Unhealthy weight gain
•Type 2 diabetes
1. CDC National Health Interview Survey
2. CDC Youth Risk Behavior Surveillance System 2009
3. http://www.cdc.gov/chronicdisease/resources/publications/aag/nutrition.htm
4. U.S. Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans. October 2008.
http://www.health.gov/paguidelines/.

10. How do people get exercise?
 Leisure
 They walk
 They ride bicycles
 Utilitarian
 They walk
 They ride bicycles
Ham, J of Physical Activity and Health, 2009.
ACS, 2007

11. Cost Effectiveness
 Bonus! IPCC finds that active transportation
interventions are cost-effective measures for
mitigating climate change
http://www.who.int/hia/examples/trspt_comms/hge_transport_lowresdurban_30_11_2011.pdf

12. The 10 Essential Public Health Services

13. Concordant Health Strategies
 CDC’s Winnable Battles
 Motor vehicle injuries
 Nutrition, physical activity, and obesity
 National Prevention Strategy
 Creating safe and healthy community environments
 Active living
 Healthy eating
 Injury- and violence-free living
www.cdc.gov/winnablebattles
www.healthcare.gov/prevention/nphpphc/strategy/report.pdf

14. CDC’s Transportation Policy Recommendations
 Make cars safer and less polluting
 Support robust public transportation
 Create infrastructure and programs to increase active
transportation
 Design communities for health – e.g. Complete Streets
 Protect healthy choices
 Require research and surveillance
 Support professional development and job creation
www.cdc.gov/transportation

15. Surveillance
 Benchmarking Bicycling and Walking
 http://www.peoplepoweredmovement.org/site/index.php/site/memberservices/2012_benchmarking_report/
 Community Design Module in the National
Environmental Public Health Tracking Network
 http://ephtracking.cdc.gov/showCommunityDesign.action

16. Deaths per 100,000 population
0.5
1
1.5
2
2.5
3
0
Florida
Louisiana
District of Columbia
Maryland
Mississippi
South Carolina
New Mexico
Arizona
New Jersey
Delaware
New York
North Carolina
Montana
Georgia
California
Rhode Island
Texas
Alabama
Nevada
Alaska
Arkansas
Hawaii
Michigan
West Virginia
Missouri
Tennessee
Pennsylvania
Kentucky
Colorado
Virginia
by State, 2009
Washington
Oregon
Illinois
Oklahoma
Maine
Minnesota
Vermont
Indiana
Kansas
Connecticut
Ohio
Massachusetts
Iowa
Utah
2009 (ARF). Available at http://www-fars.nhtsa.dot.gov/States/StatesCrashesAndAllVictims.aspx
Wisconsin
Idaho
North Dakota
New Hampshire
Source: National Highway Traffic Safety Administration (NHTSA). Fatality Analysis Reporting System (FARS).
Nebraska
Per Capita Pedestrian Deaths from Motor Vehicles
South Dakota
Wyoming

17. Aligned Solutions
 Proven Safety Countermeasures (FHWA)
 Medians and Pedestrian Refuge Areas in Urban and Suburban Areas
 Road diets
 Pedestrian hybrid beacons
 Corridor access management
 Physical Activity and Community Design:
Recommended Strategies from the Community Guide
 Community scale urban design and land-use policies are
recommended
 Street scale urban design and land-use policies are recommended
http://safety.fhwa.dot.gov/provencountermeasures/
http://www.thecommunityguide.org/pa/environmental-policy/index.html

18. Health Impact Assessments
 Health Impact Assessment (HIA)
 HIA is a systematic process that uses an array of data sources and
analytic methods and considers input from stakeholders to
determine the potential effects of a proposed policy, plan,
program, or project on the health of a population and the
distribution of those effects within the population. HIA provides
recommendations on monitoring and managing those effects.
- National Research Council, 2011
 Steps
 Screening
 Scoping
 Risk Assessment
 Recommendations
 Reporting
 Evaluation

19. HIA as a Pre-op Physical for
Communities
http://www.phoenix5.org/hum
or/CartoonOperation.html

20. HIA of the Tumalo Community Plan
Deschutes County, OR (2010)
 Examined: Health impacts of the draft Tumalo Community Plan,
which was a part of the County Comprehensive Plan Update
 Findings:
 Need to implement safety measures for pedestrians/bicyclists
crossing US Hwy 20 and to decrease traffic collisions
 Development of trail system linking recreational areas would
decrease environmental pollution, preserve natural areas, and
increase physical activity
 Impact: Revised plan was adopted by the
Board of County Commissioners; temporary
recommendations started
 Notable: Worked closely with
transportation to ensure recommendations
were feasible

21. Next Steps
 Define a metric
 Develop surveillance
 Look for Health Impact Assessment opportunities
 Help with selection criteria
 Connect with health officers

22. Health Impact Pyramid
Education
Increasing
Increasing Clinical
Interventions Individual
Population
Effort Needed
Impact
Long-lasting Protective
Interventions
Changing the Context to make
Individuals’ Default Decisions
Healthy
Socio-Economic Factors
Frieden, AJPH, 2010

23. Thank You
CDR Arthur M. Wendel, MD, MPH
dvq6@cdc.gov
For more information please contact Centers for Disease Control and Prevention
1600 Clifton Road NE, Atlanta, GA 30333
Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348
E-mail: cdcinfo@cdc.gov Web: www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official
position of the Centers for Disease Control and Prevention.
National Center for Environmental Health
Division of Emergency and Environmental Health Services

24. Resources for more information
 Online course, built in partnership with APA:
http://professional.captus.com/Planning/hia
 Minimum Elements and Practice Standards for Health
Impact Assessment: (http://www.humanimpact.org/doc-
lib/finish/11/9)
 National Research Council report on HIAs in the US:
(http://www.nap.edu/catalog.php?record_id=13229)
 http://www.healthimpactproject.org/
 http://www.cdc.gov/healthyplaces/hia.htm