Land Use, Transportation

1
Land Use, Transportation Public Health

• Collaborating For Healthy Communities Workshop
• Anthony Iton M.D., J.D., MPH
• Alameda County Public Health Director Health
  Officer

2
City Reports
3
BARHII Framework
4
Mortality
Life expectancy
5
(No Transcript)
6
(No Transcript)
7
Chronic disease
Infectious disease
Injury (intentional and unintentional)
Mortality
Disease and Injury
Access to health care
10 15
Genetics
10 15
8
67
9
Causes of Differences in Health Outcomes

• Genetics 10-15
• Access to health care 10-15

15 15 only 30
What causes the other 70???
10
Smoking
Medical Model
Nutrition
Physical activity
Disease and Injury
Mortality
Risk Behaviors
Individual health knowledge
70 ??
11
Source California Health Interview Survey, 2003
12
Includes adults who report no light, moderate, or
vigorous physical activity Source California
Health Interview Survey
13
Source California Health Interview Survey, 2003
14
(No Transcript)
15
(No Transcript)
16
Is This All About Personal Responsibility???

• The Medical Model Assumes that Risk Behaviors
  are the Missing 70

17
The Obesity Epidemic
18
The Basic Problem

• More TV, video, computers
• More car travel
• Fewer PE classes
• Fewer safe walking/bike routes
• Lower perception of safety

• More foods available everywhere
• More meals out with bigger meals
• More large volume sugar-sweetened beverages
• Aggressive food advertising

Decreased Energy Expenditure
Increased Energy Intake
19
Hardee's introduces new Mega-Calorie Monster
Thickburger
Supersizing of the Food We Eat

• 1,420 calories
• 107 grams of fat
• 7.1 hours of moderate walking

20
(No Transcript)
21
(No Transcript)
22
Obesity Trends Among U.S. Adults between 1985 and
2003

• Definitions
• Obesity having a very high amount of body fat in
  relation to lean body mass, or Body Mass Index
  (BMI) of 30 or higher.
• Body Mass Index (BMI) a measure of an adults
  weight in relation to his or her height,
  specifically the adults weight in kilograms
  divided by the square of his or her height in
  meters.

23
Obesity Trends Among U.S. AdultsBRFSS, 1985
(BMI 30, or 30 lbs overweight for 5 4
person)
24
Obesity Trends Among U.S. AdultsBRFSS, 1986
(BMI 30, or 30 lbs overweight for 5 4
person)
25
Obesity Trends Among U.S. AdultsBRFSS, 1987
(BMI 30, or 30 lbs overweight for 5 4
person)
26
Obesity Trends Among U.S. AdultsBRFSS, 1988
(BMI 30, or 30 lbs overweight for 5 4
person)
27
Obesity Trends Among U.S. AdultsBRFSS, 1989
(BMI 30, or 30 lbs overweight for 5 4
person)
28
Obesity Trends Among U.S. AdultsBRFSS, 1990
(BMI 30, or 30 lbs overweight for 5 4
person)
29
Obesity Trends Among U.S. AdultsBRFSS, 1991
(BMI 30, or 30 lbs overweight for 5 4
person)
30
Obesity Trends Among U.S. AdultsBRFSS, 1992
(BMI 30, or 30 lbs overweight for 5 4
person)
31
Obesity Trends Among U.S. AdultsBRFSS, 1993
(BMI 30, or 30 lbs overweight for 5 4
person)
32
Obesity Trends Among U.S. AdultsBRFSS, 1994
(BMI 30, or 30 lbs overweight for 5 4
person)
33
Obesity Trends Among U.S. AdultsBRFSS, 1995
(BMI 30, or 30 lbs overweight for 5 4
person)
34
Obesity Trends Among U.S. AdultsBRFSS, 1996
(BMI 30, or 30 lbs overweight for 5 4
person)
35
Obesity Trends Among U.S. AdultsBRFSS, 1997
(BMI 30, or 30 lbs overweight for 5 4
person)
36
Obesity Trends Among U.S. AdultsBRFSS, 1998
(BMI 30, or 30 lbs overweight for 5 4
person)
37
Obesity Trends Among U.S. AdultsBRFSS, 1999
(BMI 30, or 30 lbs overweight for 5 4
person)
38
Obesity Trends Among U.S. AdultsBRFSS, 2000
(BMI 30, or 30 lbs overweight for 5 4
person)
39
Obesity Trends Among U.S. AdultsBRFSS, 2001
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data 2024 25
40
Obesity Trends Among U.S. AdultsBRFSS, 2002
(BMI 30, or 30 lbs overweight for 5 4
person)
(BMI ?30, or 30 lbs overweight for 54 person)
No Data 2024 25
41
Obesity Trends Among U.S. AdultsBRFSS, 2003
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data 2024 25
42
Obesity Trends Among U.S. AdultsBRFSS, 2004
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data 1519 2024 25
43
(No Transcript)
44
(No Transcript)
45
(No Transcript)
46
SPECIAL REPORT Volume 3521138-1145 March 17,
2005 Number 11 A Potential Decline in Life
Expectancy in the United States in the 21st
Century S. Jay Olshansky, Ph.D., Douglas J.
Passaro, M.D., Ronald C. Hershow, M.D., Jennifer
Layden, M.P.H., Bruce A. Carnes, Ph.D., Jacob
Brody, M.D., Leonard Hayflick, Ph.D., Robert N.
Butler, M.D., David B. Allison, Ph.D., and David
S. Ludwig, M.D., Ph.D. ABSTRACT Forecasts of
life expectancy are an important component of
public policy that influence age-based
entitlement programs such as Social Security and
Medicare. Although the Social Security
Administration recently raised its estimates of
how long Americans are going to live in the 21st
century, current trends in obesity in the United
States suggest that these estimates may not be
accurate. From our analysis of the effect of
obesity on longevity, we conclude that the steady
rise in life expectancy during the past two
centuries may soon come to an end.
47
(No Transcript)
48
What About The Environment?
49
?
Disease and Injury
Risk Behaviors
Mortality
Neighbor- hood Conditions
50
The Neighborhood Context
51
(No Transcript)
52
(No Transcript)
53
Non-Motorized Trips 1977-1995
Nationwide Personal Transportation Survey - USDOT
54
Overall Compared to 1969 Americans drive
- 88 farther to shop - 137 farther for
errands
Mega-Mileage Moms

• Family chauffeur

• Average minutes per day spent in car
• - Women overall 64 minutes
• - Single mothers 75 minutes

Surface Transportation Policy Project 2000
55
We have changed how much we walk or bike

• Percent of children who walk or bike to school
• 1974 66
• 2000 13 (CDC, 2000)

56
Supersizing Vehicle Travel
From 4000 to 10,000 VMT per person
Bureau of Transportation Statistics, U.S
Department of Transportation, Transportation
Statistics Annual Report, 2004
57
Percentage of Trips in Urban Areas Made by
Walking and Bicycling, 1995
Pucher J and Dijkstra L. Promoting Safe Walking
and Cycling to Improve Public Health Lessons
From The Netherlands and Germany. AJPH,
September 200393(9)1509-16.
58
The Health Impacts of Land Use Planning

• Air pollution
• Car crashes
• Pedestrian injuries
• Water quality
• Mental health
• Social capital
• Physical activity

Credit Dr. Richard Jackson
59
Urban Sprawl, Physical Activity, Obesity, and
Morbidity
Those living in Sprawling counties were likely
to walk less (p.004), weigh more (phave a greater prevalence of hypertension
(p.018) than those living in compact counties.
(average six pound difference)
Ewing R et al American Journal of Health
Promotion 18 (1) Sept/Oct 2003
60

• People who live in neighborhoods with a mix of
  shops and businesses within easy walking distance
  have a 35 lower risk of obesity.

Larry Frank, et al, American Journal of
Preventative Medicine
61
Sprawl and Physical Activity

• sprawl

• ? trip distances
• ? vehicle trips
• ? walking

? overweight ? obesity
Credit Dr. Richard Jackson
62
California Population Growth and Transportation
1970-2000
63
From 1990-2000, the Average Time it Took to Get
to Work Went Up by 14

1990 and 2000 Censuses
64
Traffic Death Rate
Ewing, Schieber and Zegeer 2003
65
Land Use Pattern Affects TravelHigher Density
Can Reduce Vehicle Trips
Significant reduction as we go from 3-4
units/acre to over 20 units/acre
Vehicle Trips
Walking Trips
MTC 1990 Household Travel Survey
66
Distribution of Retail Food Outlets in Alameda
County
67
Disease and Injury
Risk Behaviors
Neighbor- hood Conditions
Mortality
Institutional Decision- Making
68
Race/ethnicity
Class
Gender
Disease and Injury
Risk Behaviors
Neighbor- hood Conditions
Institutional Decision- Making
Mortality
Social Inequalities
Immigration status
69
(No Transcript)
70
Healthy City/Community Principles
Center for Civic Partnerships
71
Smart Growth Principles
Source Smart Growth Online www.smartgrowth.org/ab
out/principles/default.asp
Center for Civic Partnerships
72
(No Transcript)
73
Is This About Personal Family Responsibility?

• YES

• But it also about our collective responsibility
  to create safe and healthy neighborhoods for our
  residents.

• And there are effective strategies!

• Many of them have been employed by folks right
  here in this room!

74
Medical Model
Socio-Ecological
HEALTHCARE ACCESS
-Bay Area Regional Health Inequities Initiative