alPHa

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Building for HealthFrom Vision to reality
Developing Tools to Evaluate the Health Impacts
of Land Use and Transportation

• alPHa

Dr. Lawrence Frank, President, LFC, Inc. and
Bombardier Chair Sustainable Transportation
University of British Columbia
www.act-trans.ubc.ca
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The built environment affects our health
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Transportation , travel choices and outcomes
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WorkingAcross Sectors
Dr. Lawrence Frank
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The Energy Balance Equation
Energy In
Energy Out
Body Weight
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Obesity Trends Among Canadian AdultsHPS, 1985
(BMI ? 30, or 30 lbs overweight for 54 woman)
Source Katzmarzyk PT. Can Med Assoc J
20021661039-1040.
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Obesity Trends Among Canadian AdultsNPHS, 1994
(BMI ? 30, or 30 lbs overweight for 54 woman)
Source Katzmarzyk PT. Can Med Assoc J
20021661039-1040.
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Obesity Trends Among Canadian AdultsCCHS, 2000
(BMI ? 30, or 30 lbs overweight for 54 woman)
Source P.T. Katzmarzyk, Unpublished Results.
Data from Statistics Canada. Health Indicators,
May, 2002.
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Obesity Trends Among Canadian Adults Provinces
(measured) CCHS, 2004 Territories (self-report)
CCHS, 2002
Data from Statistics Canada.
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Change is Inevitable. In a progressive Country
change is constant.Benjamin Disraeli, 1867
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Position Statement on Urban Planning Public
Health

• Peel Health will provide leadership community
  support to ensure that public health
  considerations are integrated into the future
  urban growth development of the Region so that
  vibrant safe communities are created that
  protect enhance the health of all members of
  the community while increasing their quality of
  life.
• Seattle / King County - Developing an evidence
  based tool to guide local decision making on land
  use and transportation Investment based on the
  health and climate change impacts

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Purpose

• Purpose of this project Develop an
  evidence-based, prototype health assessment tool
  using local data
• Goal provide greater opportunities for active
  living in the Peel Region. 
• Priorities can be used at the secondary and
  block plan level (development review) or to
  evaluate broader scale planning / development
  alternatives

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.
Proximity
2 KM
1 KM
Connect- ivity
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Blair, et al, 1996 Surgeon Generals Report 10
years ago
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The Current Evidence

• An association exists between community design
  and health, environmental, and energy indicators
• As walkability increases (compact, mixed use,
  connected streets) so does walking, overall
  physical activity, and transit use
• As walkability increases obesity decreases and so
  does per capita vehicle use and associated air
  pollution, greenhouse gas, and energy consumption

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Measuring Urban Form
Proximity Density and Land Use Mix
Directness Street Network Connectivity
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Low Walkability Postal Code Buffers with High
Proportions of the Elderly
Josh Van Loon and Larry Frank
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Land Use, Transportation, Air Quality Health
Study

• King Countys
• HealthScape
• Study

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Walkability

• Mixed Use
• Density
• Street Connectivity
• Amount of Retail

Census Block Groups
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Residential Buffer
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OZONE - AIR POLLUTION
LIVE
WORK
Volatile Organic Compounds Intersection
Density Where People Live (n2467)
Volatile Organic Compounds and Retail Use Where
People Work (n2467)
Controlled for gender, income, age, total
number of vehicles in the house VOC differences
across quartiles significant (plt0.001
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The Choice to Walk Larger Numbers Stronger
Relationship
Assessed at Place of Residence
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A 5 Increase in Walkability is associated with
a

• 32 increase in minutes of walking and biking
• A ¼ pt reduction in BMI
• About ½ kilogram
• A 6.5 reduction in per capita vehicle miles
  traveled
• A 5.5 percent reduction in ozone precursors
• Oxides of Nitrogen and Volatile Organic Compounds

Frank et al 2006. Many Pathways from Land Use to
Health. Journal of the American Planning
Association.
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Walking for Non-Work Purposes

• Over a two-day period the odds of someone
  reporting a walk trip increased by
• 20 percent for each additional park in their 1
  kilometer network buffer
• 21 percent for each additional educational
  facility within their 1 kilometer network buffer

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Transit for Work Purposes

• Over a two-day period the odds of someone
  reporting a transit trip decreased by
• 16 percent with each ¼ mile increase in the
  distance to transit from the place of residence
• 32 percent with each ¼ mile increase in the
  distance to transit from the place of employment
• 45 percent with each additional household vehicle

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Access to jobs
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Predictors of Obesity

Coefficient

t
-
Ratio

P
-
Value

Age

0.012


0.000

6.00
-
4
.71

0.000

Education

-
0.080

-
4.75

0.000

-
0.057

Income

-
2.04

0.034

Walk Distance

-
0.049

2.875

0.003

Car Time

0.001

-
5.65

0.000

Land Use Mix

-
2.035

3.930

0.000

0.311

Black Male

5.09

0.000

Black Female

0.372

-
11.3

0.000

White Female

-
0.871

-
2.22

0.026

Constant

-
0.497

Frank, L., Andresen, M., and Schmid, T., Obesity
Relationships With Community Design, Physical
Activity, and Time Spent in Cars. American
Journal of Preventive Medicine. June 2004.

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Obesity Results Driving and Walking

• Every additional 30 minutes spent driving per day
  translates into a 3 percent increase in the
  likelihood of obesity
• Time spent driving increases as walkability
  decreases
• Every additional Kilometer (.6 miles) walked
  translates into 4.8 percent reduction in the
  likelihood of being obese
• Distances walked increases with walkability

Frank, L., Andresen, M., and Schmid, T., Obesity
Relationships With Community Design, Physical
Activity, and Time Spent in Cars. American
Journal of Preventive Medicine. June 2004.
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Obesity Results Mixed Use

• A white male 5 10 on average weighs 190 lbs in
  the least mixed use and 180 lbs in the most mixed
  use environments of Atlanta
• A 10 pound difference

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Physical Activity Findings

• Deployed activity monitors on 523 participants
• People in the most walkable areas of Atlanta are
  2.4 times more likely to meet the 30 minutes per
  day of moderate activity recommended by the U.S.
  Surgeon General
• 37 in the most and 18 in the least walkable
  areas of the region met this basic requirement

Frank, Lawrence, D., Schmid, Tom, Sallis, James
E., Chapman, James, Saelens, Brian. (2005).
Linking Objectively Measured Activity with
Measured Urban Form. American Journal of
Preventive Medicine. Volume 28, No. 2S.
(see www.act-trans.ubc.ca)
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LOGISTIC REGRESSION ANALYSES PREDICTING THE ODDS
OF WALKING AT LEAST ONCE OVER 2-DAYS
NS not significant, plt.05 (95), plt.01
(99), plt.001 (99.9)
controlling for socio-demographics and stratified
by age group (Averaged over 2 day period)
Urban Form Relationships with Walk Trip
Frequency and Distance among Youth Lawrence
Frank, PhD, Jacqueline Kerr, PhD, Jim Chapman,
James Sallis, PhD, American Journal of Health
Promotion
plt.05, plt.01, plt.001
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Nutrition and Transportation Study (NEAT)

• Energy Balance equation Calories in Vs Out
• Evaluating Relative effects of physical activity
  and where people go for food on Body Weight
• Nutrition and Transportation Study (NEAT)
• Funded by Robert Wood Johnson Foundation (April
  2006-07)
• Results from the SMARTRAQ Atlanta Study
• Shows different relationships between physical
  activity and food outlet visitation on Body Mass
  Index

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Differences Across Gender Ethnicity Reported In
2004
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WHAT ABOUT WHERE PEOPLE GO FOR FOOD?

• Using Travel Survey and Physical Activity Data
• Walkability
• Physical Activity
• Food Outlet Visitation
• OUTCOME BMI

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BMI MODELS ACROSS GENDER
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BMI MODELS ACROSS RACE
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Causation?Controlling for Neighborhood
Preference
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Neighborhood Preferences and Trade-Offs
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Lot Size and Drive Time
Stated Preference (Q3a, Q3b, Q3c)
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Latent Demand Lot Size and Drive Time

• 33 of the people who live in neighborhoods that
  are far away (15-18 miles) from work, school, and
  other important destinations would rather live on
  smaller lots and be closer to these destinations.

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Street Design and Travel Options
Stated Preference (Q8a, Q8b, Q8c)
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Latent Demand Street Design and Travel Options

• 34 of the people who live in neighborhoods with
  cul-de-sacs would prefer the increased travel
  options of a connected grid, even if it means
  there are more people from other neighborhoods
  walking and driving on their street.

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Prefers a Walkable Community Design
Maximum
2
1
Built Environment
High Walkability
Low Walkability
Neighborhood Preferences
3
4
Minimum
Prefers Auto - Based Community Design
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PREFERENCE VS NEIGHBORHOOD DESIGN
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Lawrence Frank and Co., Inc.
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Next Steps

• Applying the research
• To land development decisions
• To transportation investment decisions
• Development of an evidence based cost / benefit
  model
• Creating a Health Impact Assessment Tool
• Across multiple outcomes
• Physical activity and obesity links with disease
  onset
• Vehicle emissions and air quality links with
  respiratory based ailments
• Bottom line
• Increases in health care and environmental costs
  warrant careful investigation into ways to
  proactively reduce adverse health impacts of land
  development and transportation investment actions

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Application of Research Resultsto a Tool for
the Region of Peel
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Next Steps for Peel
Evidence / Best Practices Review (Nov 2007
April 2008)
Stakeholder Meetings / Forums (November 2007
May 2008)

• Develop methodological framework (Spring 2008)
• Database development (Spring Summer 2008)
• Descriptive Analysis (Fall 2008)
• Development of prototype model (Fall 2008)

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Springbrook Community Subarea 2 Block Plan
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Local Health Outcome Data

• Primary Data Source Canadian Community Health
  Survey (CCHS)
• Sampled over 2,000 Peel Region residents
• Relevant topics/questions include
• Height / weight / BMI / obese or overweight
  status
• Physical activity / walking and bicycling /
  sedentary activities
• Chronic conditions associated with obesity
  diabetes, high blood pressure, heart disease
• Mental health
• Respiratory Illness
• Could use regional travel surveys as secondary
  data source to estimate walk/bike/transit trips
  and other transportation patterns

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Peel Region Transportation (2001)
Source Peel Data Centre http//www.region.peel.o
n.ca/planning/pdc/data/transportation/tomorrow/tri
ps-by-mode.htm
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Alternatives Analysis The Chino Pilot

• Applied results of our past research to
  alternative development scenarios for 3
  neighborhoods in Chino
• Goal scale similar to Peel Region project

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Riverside Drive Alternative 1

• Trend Scenario

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Riverside Drive Alternative 2

• Residential Emphasis Scenario

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Riverside Drive Alternative 3

• Mixed-Use Node Scenario

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Riverside DriveResults
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Alternatives Analysis, part 2 King County, WA
HealthScape project and the PLACE3S model

• Goal
• Create a tool that can evaluate potential health
  and climate change impacts of land development
  actions
• Comprehensive plans
• Changes in development regulations
• Changes in neighborhood plans
• Transit-Oriented Development

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Base The PLACE3S Model

• Developed by the Sacramento Area Council of
  Governments (SACOG) / California Energy
  Commission
• Web-based application
• Parcel-based modeling structure
• Outputs can be fed back into regional travel
  model
• Works at a number of scales neighborhood level
  to regional
• Already measures impacts on a variety of
  indicators energy, transportation,
  jobs/economic development

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PLACE3S Model Development Process

• Build statistical models that express the
  relationship between urban form measures and the
  outcomes (CO2 from transport, physical activity,
  BMI)
• PLACE3S can calculate change in these urban form
  measures for development alternatives
• Outcomes will be added as PLACE3S indicators

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BOTH WHERE GROWTH GOES HOW IT IS DESGINED
MATTERS
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Zoning and Health

• Zoning was enabled by provinces and states for
  local governments to control land use to promote
  the health, safety and welfare of the public
  (1926).
• Euclidean zoning was conceived as a way to
  ensure the separation of noxious unhealthy uses
  from where people lived.
• Over three quarters of a century later, the
  separation of residential, retail, commercial,
  and industrial uses is a standard zoning
  practice.

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Impact Fees / Permitting Indirect Source Rule
San Joaquin Air Pollution Control District, CA

• Evaluates project level emissions from
  development
• Proposed developments must mitigate impacts of
  emissions over threshold or pay impact fees
• URBEMIS model used to predict emissions /
  estimate impacts of mitigation strategies
• Mitigation strategies include compact
  development, mixed land uses, interconnected
  street networks, sidewalks bike paths,
  transit-oriented project design/location.

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Nothing Great Was Ever Achieved Without
Enthusiasm Ralph Waldo Emerson