In response to burgeoning national interest in using health impact assessment (HIA) as a tool to factor health into policy decisions, the Health Impact Project and other leading health organizations will convene a first-ever National HIA Meeting this week from April 3 through April 4 in Washington, D.C. Policy-makers, public health professionals, community-based organizations, researchers and elected and appointed officials from across the country will hear the latest on how HIA can be used to inform policy decisions outside health in areas such as planning, transportation, housing, agriculture, energy, education and the environment. Community leaders and policy-makers want to protect the health of their communities, but they need sound, objective data to identify what could help or hurt people’s health in order to guide their decision-making.

The meeting is being organized by The California Endowment, the National Network of Public Health Institutes, the Centers for Disease Control and Prevention Healthy Community Design Initiative and the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts.

NewPublicHealth spoke with Aaron Wernham, MD, director of the Health Impact Project.

NewPublicHealth: The first ever national HIA meeting is coming up. Who is coming to the conference, and what do you think the key sessions will be?

Aaron Wernham: Well, we really aimed for a broad audience. HIA practitioners as well as people who have been interested in starting to use HIA but just haven’t really begun will all be in the audience. A lot of people from related public health fields will be coming. We’ve also created programming that will be relevant and interesting to people outside the health sector because HIA is really a bridge that aims to help practitioners collaborate with people in a great many sectors, such as transportation planning or housing or energy policy.

NPH: What do you think some of the hallway conversations might be?

The first national meeting on Health Impact Assessment begins April 3 in Washington, D.C., and interest is so high that registration has been at capacity for weeks. The meeting capitalizes on the growing interest in health impact assessments (HIAs) and will convene policymakers, public health professionals, HIA practitioners and anyone with an interest in learning more about the value of health impact assessments.

In advance of the meeting NewPublicHealth spoke with Arthur Wendel, MD, MPH, team lead for the Healthy Community Design Initiative at the Centers for Disease Control and Prevention. The Initiative is helping to plan the upcoming HIA conference.

NPH: What is the overarching goal of the Healthy Community Design Initiative?

The first national meeting on Health Impact Assessment begins April 3 in Washington, D.C., and interest is so high that registration has been at capacity for weeks. The meeting capitalizes on the growing interest in health impact assessments (HIAs) and will convene policymakers, public health professionals, HIA practitioners and anyone with an interest in learning more about the value of health impact assessments.

In advance of the meeting NewPublicHealth spoke with Arthur Wendel, MD, MPH, team lead for the Healthy Community Design Initiative at the Centers for Disease Control and Prevention. The Initiative is helping to plan the upcoming HIA conference.

NewPublicHealth: What started your interest in helping to create healthy communities?

Arthur Wendel: When I was in eighth grade I wrote a research paper on alternative transportation and fuels of the future, and through that process I learned about alternative fuels and some of the impact it was having on public health. I started there. When I went to college, I did a public policy and chemistry degree and I wrote my thesis on air pollution and public health. I simultaneously got my MD and MPH degrees and worked on another project that was related to alternative fuel vehicles and public health and saw that one way policies could change was through public health efforts and I wanted to be a part of that. So here I am.

NPH: What is the overarching goal of the Healthy Community Design Initiative?

Arthur Wendel: Our mission is to understand and improve the relationship between built environment and public health. We deploy very traditional public health tools and practices towards that mission, thinking about the essential public health services. One thing we’re working on now is an evaluation of walking to transit—how much people walk to transit, how many minutes of physical activity do they get. We've also looked at the impact of hybrid vehicles on pedestrian fatalities to see whether or not they’re different than their conventionally fueled counterparts, given that they’re quieter and some people may have trouble hearing the hybrids approaching.

NPH: Tell us about the Initiative's interest in health impact assessment (HIA)—a tool that looks at potential health impacts of policies and projects in other sectors?

Arthur Wendel: We’ve been engaging in HIAs since 2003, and we funded one state to develop an HIA capacity-building pilot program in 2008, added three states in 2009... We are now funding 6 HIA programs throughout the U.S. In 2008, we published a research article that showed 27 completed HIAs in the U.S. and by 2010, we had worked with organizations like Pew to track 150 HIAs that were either completed or in progress, so that it’s growing by leaps and bounds almost to the extent that it’s hard to keep up with the all the HIAs that are going on in the U.S.

We work with the Health Impact Project extensively. We’ve worked with them to develop good methodology and deploy that.

NPH: What is your role in the Inaugural HIA meeting next month?

Arthur Wendel: We’re partial funders and we have an HIA grantee preconference meeting with Health Impact Project on April 2, the day before the conference begins. Our grantees and their grantees are going to meet for the first part of the day separately, do our own thing, and then the second part of the day, we’re going to have a joint session between the two grantee groups to be able to talk about what’s going on in the different regions and specific topic areas of interest among the partners. So we’re intermingling the grantees so they can learn from each other. For the main conference, we’re helping with the planning and moderating the HIA 101 session and we are fielding session speakers.

NPH: What HIA subset does the Initiative focus on?

Arthur Wendel: We’ve tried to focus on healthy community design, though the full practice of HIA is of interest to us in general and we’re helping to develop good strategies for engaging in health impact assessment across the U.S.

NPH: How does the work of your office break down?

Arthur Wendel: At this point 10-15% or so is research. Another 10-15% is trying to improve surveillance and assessment activities, engaging with other partners that are doing surveillance work such as surveys where we can include built environment questions. A substantial chunk of our work – perhaps half, is on health impact assessment, particularly, being able to think about how to translate some of the evidence and surveillance information to inform policy. And then the last part is the evaluation component, and in that phase we engage with organizations such as Safe Routes to School and Complete Streets.

NPH: How far along are you in terms of making stakeholders aware of what’s available to improve health in communities?

Arthur Wendel: That’s part of the reason why we’re engaging in the health impact assessment arena. Because it is a mechanism for communities who are interested in engaging in these issues to do something applied and real, and so for the six communities that we’re funding, which include some states, it allows them to try out working in this area and to do a health impact assessment along those topics. After an HIA, once those partnership relationships are established, it can provide options for other working experiences.

NPH: Who are your early adopters for the built environment concept?

Arthur Wendel: It is different people community to community. In general, planners tend to be pretty involved and on the ball with some of these issues. We’ve had a relationship with the American Planning Association (APA) for some time. One of the things that we do with them is sponsor a health impact assessment online training module and it’s the most popular online training module that APA has. So that’s a group that tends to be a little more engaged in these issues. It does vary from community to community. With local public health departments, some will see this as an important issue to help move their community forward in some of their outcomes and some are still trying to sort out exactly what HIA means.

NPH: Given that the US is made up of urban, rural, suburban and hybrid communities, are there some overarching design principles for the built environment?

Arthur Wendel: There are some design principles that kind of overarch that whole area and I think that there have certainly been examples of good approaches even in rural areas of implementing solutions that work. I can think of a – safe routes to school program that happened in an area about twenty miles from my rural hometown where they built an asphalt sidewalk from basically the general store to the K-12 school that facilitates walking from that school to the population center in the “downtown” in a town of about 200. So, there are certainly some challenges with rural environments. The farms, for instance, are going to be difficult to have the infrastructure for walking and biking. But for most of the population, there are opportunities to build healthier communities and even in rural settings, there are some opportunities for changes.

NPH: When you start with school children, can you build the built environment into their thinking from a very early age?

Arthur Wendel: Yes, and that’s why I think the safe routes to school concept is a critical piece. It brings together youth who have got eighty years of their life ahead of them, potentially. It brings together transportation, it brings together public health and kids can’t drive on their own, so if they’re going to take ownership of their own transport, they have to do something that’s either walking or bicycling or rollerblading. We’ve partnered with the Safe Routes to School National Partnership and the National Center for Safe Routes to School. That’s a critical component for improving community design.

I deal with this a little bit in my own neighborhood. I’ve got a first grade son we walk to school and there are no sidewalks. It’s a challenge. Cars are going by at 35-40 mph even though it’s a 25 mph residential area. It does not feel safe and I worry about what that’s going to do for kid’s physical activity as they get older. I see my own son, when he doesn’t get enough physical activity, he doesn’t behave as well and I think about that on a population level. And motor vehicle crashes are the leading cause of death for that age group, and so, making sure that they have got a way to walk to school safely is critical.

NPH: How much has the recession impacted on progress of the built environment?

Arthur Wendel: Well, it’s a double edge sword, isn’t it? Because it also increases demand for things like transit and walking and bicycling, which are cheaper forms of transportation than driving your car when gas is $4 a gallon? So there tends to be some popular enthusiasm for better community design. It’s an opportunity in an economically constrained environment to try and be able to think strategically about what we can and can’t do and how to make decisions that will help for the next time there’s a recession so that environment is composed in such a way that it makes it easier for people to get out of that financial bind.

NPH: Why are destinations for the walkers, bikers, runners, so pivotal to the built environment?

Arthur Wendel: when we originally created our zoning laws, they were done to separate noxious industrial pollution from residential areas. Because we’ve got environmental laws in this country and because we’ve shifted some of our economy away from heavy duty industry to commerce and other sorts of industries, we had the opportunity to put these things back together in a way that won’t adversely impact the population’s health through environmental pollution. By thinking strategically about how to do that we can start to think about how to improve physical activity, reducing motor vehicle injuries and essentially make our society more livable.

NPH: Many new walkable communities seem to cater to the highest incomes. How can the concept be more inclusive?

Arthur Wendel: Demand is so high, that’s why prices are going up. People see this as a need, something that they want. But I also think it’s an opportunity for communities that can afford this to take advantage of that increased demand by implementing policies that facilitate the inclusion of affordable housing units or other ideas to try and minimize as much displacement as possible and help keep communities intact and make sure things are equitable as their neighborhoods are developed. I think that, overall if we want to improve health in the U.S., we’ve got to move towards communities that allow healthy choices to be the easy choice, but there are some policy crutches that we can do to make sure that equity is not challenged at the same time. There has to be the right mix of jobs and services in the area that support people of all income scales. You can’t always have a high end grocery in one place; you have to have something that has affordable, healthy food as well.

NPH: When do you want participants to take away from the Inaugural National HIA Meeting?

Arthur Wendel: I think the most important thing that they should leave knowing is who to go to in their community to partner with to make it better. Whether it’s their planner who came to the meeting, or their local public health department. In addition, we’d like them also to feel comfortable with their respective partner on how to move things forward in their community and potentially have a tool that they’ve heard about, and something they’ve learned at the meeting that they can use to test out the waters. Health impact assessment is an opportunity to do that.

In this country we spend about $2.6 trillion on healthcare costs, and the majority of that is public dollars in some shape or another. I’ve often heard said that physical activity, if you could bottle it, would be one of the best drugs to be able to give to people to help prevent a myriad of illnesses from diabetes to heart disease to some types of cancer. Obviously, we can’t bottle physical activity; you can’t even put it in the water so everybody just drinks it. But we do have the opportunity to change communities, to get people physically active, to provide an opportunity for them to engage in activity safely, and to help improve the likelihood that people won’t be run over or killed as they’re going from place to place. And I think that health impact assessments and other policy changes around community design are critical ways of going forward.

Sixteen years ago, Deb Hubsmith was on her daily drive after work and another vehicle violently smashed into the passenger side of her car. Her car was totaled. As the crash took place, Hubsmith vowed to herself that if she survived, she'd give up owning a car for good. Hubsmith, who told her story here, went on to found and direct the Safe Routes to School National Partnership and spearhead a national movement to create healthier, more walkable communities where children can walk or bike to school every day.

NewPublicHealth caught up with Deb Hubsmith to talk about why safe routes to school are critical for the nation’s health.

NewPublicHealth: Why are safe routes to school important for the nation's health and quality of life?

Deb Hubsmith: The trip to school is a trip every child in America makes. Safe Routes to School is the only federal funding that is dedicated to infrastructure and programs that help kids be able to walk and bike to school in their daily life. By building sidewalks and pathways and safer street crossings, and focusing on safe routes to school, we can change the built environment and also change the culture. This creates opportunities for safe and healthy physical activity for children across the country.

NPH: How did you come to found the Safe Routes to School National Partnership?

Deb Hubsmith: I’ve always cared a lot about the environment and public health. After I got into a car accident 16 years ago, I decided to try living life without a car. It was very difficult to do this. So, I became an advocate for transportation choices. I started off by working with parents and teachers and advocates at the local school in my community. We worked on ways to get kids to school safely by walking and biking, and by carpooling and busing. I became interested in how this could be done on a larger scale, so I started working within the county. When I heard that Congressman Oberstar was looking for ways to improve safe routes to school and walking and biking in America, I had the great fortune of meeting him and having the opportunity to run a national pilot program for safe routes to school in Marin County, Calif. In that program, in one year we increased the number of kids walking and biking to school by 57 percent. This made national news.

The childhood obesity epidemic was rising at that time, and Mr. Oberstar wanted to do something to help all of America, so I worked with his staff on crafting federal legislation, and the Safe Routes to School program was included in the transportation bill in 2005. I launched the Safe Routes to School National Partnership at the same time because I knew we needed a grassroots organization to truly build a movement. This movement needed to be diverse, with partners from health, education, equity, environmental and transportation organizations. Now, our national partnership includes about 600 organizations.

NPH: You've said the concept of safe routes to school has reached the point where it's become a true movement. How did this shift come about?

In advance of the Inaugural Health Impact Assessment Meeting, the American Society of Law Medicine and Ethics (ASLME); Network for Public Health Law; Public Health Law Association (PHLA); and the Public Health Law Research Program are hosting a webinar, "Learning More About Health Impact Assessments," on Thursday February 16, from 1 p.m. to 2 p.m. (EST).

Health impact assessments (HIAs) bring together scientific data, health expertise and public input to identify the potential—and often overlooked—health effects of proposed laws, regulations, projects and programs. HIAs provide decision-makers with the information they need to advance smarter policies to help build safe, healthy, thriving communities.

HIAs may focus on health issues for projects and policies that don’t automatically raise health concerns for planners, such as transportation, urban planning, agriculture, education and energy.

The webinar will provide a basic overview of health impact assessments; examine the development of an innovative HIA tool; and explore the legal authority authorizing, supporting or prohibiting HIAs.

Presenters include:

• Aaron Wernham, MD, director of the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and the Pew Charitable Trusts
• Harmony Gmazel, MS, land use planner for the Tri-County Regional Planning Commission in Lansing, Mich.
• Erin Fuse Brown, JD, MPH, deputy director of the Network for Public Health Law – Western Region at Arizona State University’s Sandra Day O’Connor College of Law

The webinar is free and open to anyone interested. Register here by 1 p.m. (EST) on February 14. Instructions will be sent to participants.

Recommended:

• Watch a video interview with Aaron Wernham about health impact assessments
• Read a Q&A with Aaron Wernham about health impact assessments from this year’s American Public Health Association annual meeting

The startling new National Association of Area Agencies on Aging report, "The Maturing of America," concludes that many communities are unprepared for their quickly aging populations, with "nowhere near the level of progress that has to be made to ensure that communities are livable for people of all ages." Last week at the New Partners for Smart Growth Conference, a panel discussed the challenges our nation will face as it ages and how we can better design communities to be healthier and more accessible for all age groups.

Rebecca Hunter, MEd, of the University of North Carolina Institute on Aging and the Centers for Disease Control and Prevention (CDC) Healthy Aging Research Network, said we’re currently facing a "perfect storm" when it comes to aging:

• Baby boomers are starting to reach “older adult” status
• There is a vast increase in the “oldest old,” or age 85 and above
• The economic downturn means we are less and less prepared for the health and social consequences of this trend

We are moving into an era when at least one in five Americans will be age 65 and older, said Hunter. "We need to ensure our communities are livable for all people."

The National Prevention and Health Promotion Strategy provides a new, health-in-all policies approach to prevention, requiring the efforts of many federal agencies (17 to be exact) and other stakeholders. Good community design, with sidewalks, adequate lighting and traffic-slowing devices, improves the walkability of communities and promotes physical activity. Increasing access to healthy, affordable food options provides people with the opportunity to make healthy choices about what they eat.

The Strategy launched in June 2010, as a product of the National Prevention Council, a body of 17 federal departments that for the first time have been mandated to find opportunities for collaboration and coordination around prevention, health and wellness.

At this week’s New Partners for Smart Growth Conference, Corinne Graffunder, Director of the National Prevention and Health Promotion Strategy at the Centers for Disease Control and Prevention, along with colleagues from the U.S. Department of Agriculture (USDA), Environmental Protection Agency (EPA) and the Department of Housing and Urban Development (HUD)participated in a panel to discuss their respective roles in the National Prevention Strategy – and how the Strategy intersects with smart growth principles.

>>Follow our coverage of the New Partners for Smart Growth Conference, from a public health perspective, here.

“This is meant to be more than just a document,” said Graffunder. “The Council is an ongoing leadership body that will continue to figure out how to make this work.”

Graffunder also emphasized that it is the National Prevention Strategy—not a federal strategy. That means it recognizes the critical role of partners beyond the government, from the business, non-profit and state and local government sectors.

"Designing Healthy Communities,” a four-part series funded in part by the Robert Wood Johnson Foundation, debuts this month and next on many Public Broadcasting stations. The program looks at the impact the built environment has on key public health problems such as obesity, diabetes, heart disease, asthma, cancer and depression. In the series, host Richard Jackson, MD, MPH, professor and chair of environmental health science at the UCLA School of Public Health, connects bad community design with burgeoning health costs, then analyzes and illustrates what citizens are doing about this crisis by looking upstream for innovative solutions.

NewPublicHealth recently caught up with Dr. Jackson, who will also be a featured speaker at the New Partners for Smart Growth Conference in San Diego next week, leading a session on “Health as a Messaging Tool.” Dr. Jackson received the New Partners for Smart Growth Lifetime Achievement Award in 2008.

Follow NewPublicHealth coverage on-site at the Smart Growth conference here and on twitter @RWJF_PubHealth.

NewPublicHealth: What prompted the "Designing Healthy Communities" series?

Dr. Jackson: My background is that I’ve worked in environmental health in one form or another for over 30 years. I started out as a pediatrician and have become more and more focused on the whole mix of environment and health and the outcomes and the impacts on our population, acute impacts such as asthma, car injuries, all the way through to chronic diseases, cancer and birth defects, and I’ve investigated all of them. And then beyond chronic diseases, long-term health impacts such as endocrine disrupters in the environment and health effects of global climate change.

I spent nine years as the Director for the National Center for Environmental Health and I was State Health Officer for California for a year and a half, and I’ve become increasingly convinced that I’m sitting at the end of the disease pipeline waiting for somebody to come in the door with obesity-related diabetes, with injuries related to a bad urban design or for that matter a lack of adequate crosswalks. Asthma and even heart disease are related to very poor air quality. That it is not feasible for the future of our country. When I was a young doctor, seven percent of all the money in the United States that was going to medical care. It’s now more than 17 percent, and the U.S. is still ranked about number 50 in life expectancies worldwide.

So, we’re not doing something right, and I would assert that what we’re not doing right is we’re failing to really operate in the realm of prevention. We’re not going far enough upstream in thinking about what things are affecting our health. What I would assert is a big driver that’s affecting our health but it’s also affecting our happiness, our prosperity, and our future is how we have built America. We have built it for the needs of cars and other short-term needs, maximizing sale of commodity foods of various kinds and we have not built it with an eye towards people and an eye towards future generations.

I co-wrote a book ten years ago called “Urban Sprawl and Public Health,” and then became much more focused on these issues of built environment and co-wrote a textbook, where we very deeply document the impact of the built environment on everything that you would imagine, but also further upstream to obesity and lack of fitness, and even further upstream to unhappiness, to depression, and we began to think that just as this damaged environment can have multiple negative health outcomes, creating health environments should have positive health outcomes. And that’s why the television series is called “Designing Healthy Communities."

Ten years ago there really was very little recognition of this issue, but that’s changing. There were almost 300 sessions that either had the words “built environment” or “land use” at the last American Public Health Association National Meeting in early November in Washington, DC.

NPH: What’s driving that increasing interest?

Yesterday’s “Intersection of Transportation and Health” workshop, a day for the health-o-philes at the Transportation Research Board Annual Meeting, underscored the concept that transportation plays a critical role in determining health outcomes. Brian Raymond, MPH, Senior Policy Consultant, Kaiser Permanente Institute for Health Policy, outlined several important ways transportation affects health:

• injuries and accidents from motor vehicle crashes;
• poor air quality its effects on asthma and a myriad of other health conditions;
• impact on physical activity, for better or worse (depending on whether automobiles or public transit are the focus); and
• “access to the necessities of life,” providing a way to get to jobs and economic opportunities, to access health care options and to readily and regularly access fresh, health foods.

Air pollution and motor vehicle crashes get a lot of attention, and thus have a lot of research behind them, said Andrew Dannenberg, MD, MPH, Affiliate Professor at the University of Washington and consultant on the Centers for Disease Control and Prevention (CDC) Healthy Community Design Initiative, who presented on research priorities for transportation and health. Though more research is needed on access and physical activity, some interesting trends are beginning to emerge. Some of the statistics revealed at the workshop include:

• Three trillion vehicle miles are traveled in the U.S. each year, according to the Federal Highway Research Administration.
• Between 1990 and 2009 the vehicle miles traveled for passenger cars and trucks has increased by 39 percent, said David Ragland, PhD, MPH, Director of the Safe Transportation Research and Education Center at the University of California at Berkeley.
• Every additional hour spent in a car is associated with a 6% increase in the risk of obesity, and every kilometer walked is associated with a 5% decrease in obesity risk, said Raymond.
• Thirty-six percent of adults don’t report any leisure time physical activity; 88% don’t meet federal guidelines for the recommended amount of activity.
• The estimated medical costs of inactivity top $75 billion per year.
• Walking and biking are the top leisure physical activities of choice in the U.S., and are also the top utilitarian physical activities.
• Public transit users walk a median of 19 minutes daily getting to and from transit stops. Nearly 30 percent of transit users exceed the 30 minutes of recommended physical activity per day.

Some resources shared at the workshop included:

• CDC’s Designing and Building Healthy Places (check out their Healthy Community Design Checklist and Health Impact Assessment page).
• Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and the PEW Charitable Trusts.
• Safe Transportation Research and Education Center at UC Berkeley’s "Transportation and Health: Policy Interventions for Safer, Healthier People and Communities” report.
• The Transportation Prescription: Bold New Ideas for Healthy, Equitable Transportation Reform in America, a report from PolicyLink, the Prevention Institute and the Convergence Partnership.
• Partnership for Sustainable Communities, an interagency partnersip between the U.S. Department of Housing and Urban Development, Department of Transportation and Environmental Protection Agency.

>>Follow continued coverage of the Transportation Research Board Annual Meeting from NewPublicHealth.org here.

Most of us get in our cars, subways, buses, trains and walking shoes without thinking much about the network of decisions and research that went into making that commute a little bit easier – and, more and more, healthier. This week, more than 11,000 transportation and transportation research professionals convene in Washington, DC for the Transportation Research Board Annual Meeting to discuss exactly those issues. Yesterday’s full-day workshop, “Intersection of Health and Transportation: What We Know, What We Don’t Know, and How We Can Better Integrate Health Considerations Into Transportation Decisions,” organized by the TRB Health and Transportation Subcommittee is a chance to look at how we drive, metro, walk and bike and how it affects our health.

One theme that emerged today included the critical role of cross-sector partnerships. Innovative new collaborative planning teams are springing up from local to national levels, including North Carolina’s Healthy Environments Collaborative, launched in 2006, with partners from the North Carolina Departments of Commerce, the Department of Environment and Natural Resources, the Department of Health and Human Services and the Department of Transportation, with the purpose of shaping policies that influence physical activity-friendly environments. On a national level, the Partnership for Sustainable Communities is an interagency collaboration between the U.S. Department of Transportation, the Department of Housing and Urban Development and the Environmental Protection Agency.

Presenters also spoke about the need to emphasize that strategies that support public health have co-benefits across a variety of issues, including a cleaner environment and safer roaders and motor vehicle injury prevention. Arthur Wendel, MD, MPH, Team Lead of the Healthy Community Design Initiative at the Centers for Disease Control and Prevention (CDC), discussed the alignment of physical activity and safety and motor vehicle injury prevention goals – common solutions include better medians and pedestrian refuge areas, more sidewalks and shared use lanes, and a more robust public transportation infrastructure.

Why is public transportation so critical to public health? Public transports’ links to physical activity and obesity have been well-explored. Nearly 30 percent of public transit users exceed the 30 minutes of daily recommended physical activity, simply as part of their everyday commute, said Dr. Wendel – compare that to the fact that 36 percent of the general population of U.S. adults get no physical activity at all.

Dr. Wendel also mentioned that health impact assessments are one important tool to help weave health considerations into transportation decisions. “Coming from a clinical background, I view it as similar to a pre-op physical to make sure your heart, lungs and kidneys will be able to survive the operation,” said Dr. Wendel. “Health impact assessments make sure the public’s health will come out better after a transportation decision.”

Leslie Meehan, Director of the Healthy Communities program of the Nashville Area Metropolitan Planning Organization, noted that unlike the proactive health impact assessment approach, most transportation decisions are made in a reactive planning mode, in response to the need to mitigate land use problems like roadway congestion. In fact, most of the measurement tools around transportation “focus on mobility – not quality of life or accessibility,” said Meehan. She described some of the challenges in shifting the thinking around transportation. The Healthy Communities program reached out to policymakers and decision-makers with the following messages, bringing to light the underlying health, social and economic implications of transportation:

• A CEOs for Cities report ranked Nashville among the worst cities in the country for residents’ time spent in traffic due to sprawl.
• Ninety percent of Nashville residents spent over 20 percent of their income on transportation.
• Nashville’s aging populations is leading to more people losing access to personal transportation.
• The steep upward trend in daily vehicle miles traveled closely mirrors the steep upward trend in the obesity rate over the past 40 years.
• There are economic implications of transportation-related health effects in that an unhealthy child cannot learn and an unhealthy worker cannot work.

In response, the Healthy Communities group championed a restructured funding mechanism that prioritizes health and safety concerns. As a result, 70 adopted roadway projects include sidewalks, bike lanes or shared-use provisions, compared to 2 percent in prior plans.

>>Check out TRBHealth.org to view emerging research in this area.

>>Follow NewPublicHealth coverage of the Transportation Research Board Annual Meeting here.