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The Impact of Transportation on Health: Evidence, Practice and the Case for Mode Shift

Loel Solomon, Ph.D.Vice President, Community HealthKaiser Permanente

Transportation Research BoardWashington, D.C.January 27, 2011

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About Kaiser Permanente

• Founded in 1945• America’s oldest and largest private,

nonprofit healthcare organization • 8.6 million members • 14,600 physicians representing all

specialties • 167,300 employees• Operations in 9 states and D.C.

• 35 Medical Centers and 431 Clinics

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Active Transportation: At the Heart of Our Health Mission

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Impacts on Health: Air Quality

• Pollutants from autos

• 8,800 premature deaths a year in CA

• Air pollution is a known trigger for asthma attacks

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The High Cost of Polluted Air

• Failing to meet federal air quality standards led to nearly 30,000 hospital admissions and emergency room visits in California over the period 2005-2007

• Illnesses costing almost $200 million per year

• Kaiser Permanente’s share: $30 million

The Impact of Air Quality on Hospital SpendingJohn A. Romley, Andrew Hackbarth, Dana P. GoldmanRAND Corporation, 2010

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Impacts on Health: Traffic Safety

• Leading cause of death for people ages 4 to 34• People of color are disproportionally impacted

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Smart growth promotes safety

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20

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Smartest Growth

Source: Reid Ewing et al (2003); as reported by Todd Litman, Victoria Transportation Institute 2009

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Impacts on Health: Access to Care and Services

• Transportation is access• In an auto-centric society, many are left out:

• People of color have limited access to cars

• Poverty compounds the problem

• Elderly and disabled populations drive less

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Impact on Health: Physical Inactivity

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The Impact of Inactivity on Our Clinical Priority Areas

Clinical Area Prevalence/Incidence

• Overweight and Obesity 4,400,000

• Asthma 95,000• Cancer 25,000 new cases/yr• Chronic Pain 250,000• Coronary Artery Disease 165,000• Depression 415,000• Diabetes 450,000• Heart Failure 80,000

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Impacts on Health: Physical Activity

• Increase in obesity risk per hour in a car: 6%

• Walking and biking reduces obesity

• Public transit riders are more physically active

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Driving is a risk factor for obesity

10%

14%

27%

18%

0%

5%

10%

15%

20%

25%

30%

First Quartile Second Quartile Third Quartile Fourth Quartile

Vehicle Miles Traveled

% o

bese

(BM

I>30

)

Source: Lopez-Zetina, Health and Place, 2006

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Data from the 2001 National Household Travel Survey (N=3,312) show that 29% of public transit users achieve the Surgeon General’s recommendation of 30 minutes or more of physical activity a day while walking to and from transit. Racial/ethnic minorities reported even greater percentages of achieving the recommended level of activity.

18%

33%

41% 39%

0%

10%

20%

30%

40%

50%

White AfricanAmerican

Asian/PacificIslander

Hispanic

Public Transit Users

Perc

ent w

alke

d 30

+min

utes

/day

Source: Besser L, Dannenberg A. Walking to public transit: Steps to help meet physical activity recommendations. American Journal Preventive Medicine 2005; 29(4): 273‐280.

Nat’l Avg. (10%)

Every trip on public transit begins and ends with a walk

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• Existence of physical features (e.g. sidewalks, crosswalks, traffic control devises)• Perceived safety from traffic and crime• Availability of services and goods (e.g. school, work, retail) nearby• Accessibility/availability of public transit (i.e. transit users walk to/from transit)• Access to public open space, parks, and recreation areas• Existence of traffic calming and greater distance from high levels of vehicle traffic• High density neighborhoods

Source: Active Living Research, 2010

Active Living Research: Factors associated with active transportation

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Increase access to recreation facilities and open spaces, including parks and community gardens.

Build and maintain parks and playgrounds that are safe and attractive for playing, and in close proximity to residential areas.

Improve access to outdoor recreational facilities

Access to Facilities

Implement a traffic enforcement program to improve safety for pedestrians and bicyclists.

Enhance traffic safety in areas where people are or could be physically active.

Traffic Safety

Promote walkable communities and enhance community access to transportation elements that prioritize the interconnection between walking, bicycling and mass transit

Promote increased transit use through reduced fares for children, families, and students, and improved service to schools, parks, recreation centers, and other family destinations.

Improve access to public transportation.

Public Transit

Support walk-to-school and Safe Routes to School (SRTS) programs; expand trails, bicycle lanes and connections.

Collaborate with school districts anddevelopers to build new schools inlocations central to residential areas andaway from heavily trafficked roads.

Support locating schools within easywalking distance of residential areas

School Siting

Expand trails, bicycle lanes and connections; improve safety for bicyclists and pedestrians.

Plan, build, and maintain a network of sidewalks and street crossings thatcreates a safe and comfortable walkingenvironment and that connects toschools, parks, and other destinations.

Enhance infrastructure supportingwalking

Walking Supports

Expand trails, bicycle lanes and connections; improve safety for bicyclists and pedestrians.

Encourage walking and bicycling for transportation and recreation through improvements in the built environment

Enhance infrastructure supportingbicycling

Bicycling Supports

Leadership for Healthy CommunitiesIOM Recommended Action StepsCDC Recommended Strategies Strategy

Sources:1. Centers for Disease Control and Prevention, Recommended Community Strategies and Measurements to Prevent Obesity. July 2009.2. Institute of Medicine’s (IOM) Local Government Actions to Prevent Childhood Obesity. September 2009. 3. RWJF, Leadership for Healthy Communities Action Strategies Toolkit. May 2009.

Consensus on Active Transportation as Obesity Prevention Strategy

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Active Transportation: A Key Element of the Nation’s Health Reform Strategy

• Patient Protection and Afford Care Act (aka Health Reform)• Let’s Move! and the Interagency Task Force on Childhood Obesity• DOT/EPA/HUD Interagency Partnership on Sustainable Communities • National Prevention Strategy (Draft)

• SD1: Healthy physical, social and economic environments • SD8: Active living • SD9: Injury-free living

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National Prevention Strategy: Active Living (SD8)

• Encourage the design and development of neighborhoods that combine homes, workplaces, shopping, schools, transportation and other services so that residents have opportunity to conduct everyday activities by walking, biking and other active transportation modes. Recognize model environments.

• Facilitate access to safe, well-lit, attractive and affordable places for physical activity including shared spaces such as parks and playgrounds, community centers, schools, fitness centers and outdoor recreation venues.

• Implement workplace policies and environmental changes that support all individuals, including individuals living with disabilities, to be physically active (e.g., shower facilities, bicycle racks and walking paths, attractive and easily accessible stairwells).

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Kaiser Permanente Strategies to Support Active Transportation

• Community Health Initiatives• Organizational practices and facility design/siting• Collaboration with other funders

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Kaiser Permanente Supports Intensive HEAL Interventions in 39 Communities

Atlanta, GA

Prince George’s County, MD

Cleveland, OH

Denver, CO

Commerce City, Park Hill, Lincoln Park

Colorado (statewide)

6 HEAC Sites

Santa Rosa

Portland, OR

Clark County, WA

Modesto

Richmond

Community Health Initiative sites

Joint initiatives with other funders

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Common Active Transportation Strategies in CHI Sites

• General Plan amendments• Complete streets• Safe Routes to School• Parks, trails and other active public spaces• Social marketing and other programmatic interventions

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Denver B-Cycle Program

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Being the Benchmark: Green Guide for Health

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Kaiser Permanente Master Planning Standards

•Usable open space for staff and patients to promote activity and social capital

• Child play areas• Exercise paths / par courses• Jogging / Walking pathways• Bicycle pathways• Community or staff gardens• Picnic or farmer’s market areas.• Outdoor group meeting/activity spaces

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Kaiser Permanente Building & Design Standards

• Site Circulation – Pedestrian• Provide landscaped buffers between busy roadways and pedestrian walkways.• Provide at least one covered walkway for times of inclement or hot weather. • Provide adequate lighting along pedestrian routes.• Provide safe crosswalks.• Provide non-slip and non-trip walking surfaces.

• Site Circulation – Vehicular• When bicycle pathways are required, segregate them from vehicular traffic. (Segregate bicycles and vehicles

to provide a safe and pleasant path for bicycle travel. Avoid “mid-block” crossings that may not be anticipated by drivers.)

• Site Parking• Provide bicycle parking at main building entrance.

• Building Planning and Layout – Stairs• Locate stairs for convenience and easy movement between floors for staff and members.• Locate and design stairs to encourage use over elevators.

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Key Enablers of Active Transit: Incentives and Amenities for our Workforce

• Commuter Flex Spending Account (FSA)• Transit subsidies (up to $50/month) • Emergency Ride Home programs• Preferred carpool/vanpool parking• Rideshare assistance • Shuttles to transit• Bike lockers and bike racks• Showers

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Every Body Walk!

• Championed by senior Kaiser Permanente leaders• Every Body Walk! Website

• Scientific and medical information on walking • Interactive maps with safe walking routes• Links to local bike/ped groups• Calendar of organized walking events• Rich, interactive, shareable video content• Social media promotion

• KP Walk! targeting employees and physicians

www.everybodywalk.org

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Convergence Partnership

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The Transportation Prescription

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General Recommendations

• Prioritize investments in public transportation

• Prioritize pedestrian and bicycling infrastructure

• Encourage equitable transit-oriented development by incentivizing integrated land use and transportation planning

• Create incentives and accountability measures

• More local flexibility to meet local needs

www.convergencepartnership.org

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General Recommendations (cont’d)

• Prioritize investment in high need areas

• Make sure job opportunities are available for low-income people

• Support the development of cleaner bus/truck fleets and invest in freight rail infrastructure

• Advance safety for all travelers

• Support policies and programs that increase access to healthy foods

• Give low-income rural communities greater access to public transportation funds

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The Road Ahead: Working in the Nexus

Healthy People Healthy Environments

Thriving Local Economies

ACTIVE TRANSPORTATION

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Thank You!

Email: [email protected]

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ADDITIONAL SLIDES

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Walk There! Portland, OR

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Met Branch Trail: Washington, D.C.

Photo credit: District Dept of Transportation

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Safe Routes to School

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Bike Trails and Walking Paths

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Denver B-Cycle Program

the impact of transportation on health: evidence, practice ...burleyj/trb_afb40/mtgs/annual/... ·...

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