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The American Public Health Association has collected a variety of case studies that demonstrate how communities of all types and sizes are addressing the intersection of public health and transportation. These Health Impact Assessments offered decision-makers an opportunity to ensure that health and equity were considered when shaping transportation policy and systems.  Here are several examples of HIAs conducted to evaluate transportation projects:

Example 1: Health Impact Assessment of a Freeway in San Francisco (California)

PODER (People Organizing to Demand Environmental & Economic Rights) is leading a community-based effort to improve environmental health in the Excelsior neighborhood of San Francisco. Concerns about disproportionate, adverse traffic-related health exposures, including air pollution, traffic noise, and safety hazards led PODER to work with researchers in the San Francisco Department of Public Health’s (SFPDH) Program on Health, Equity and Sustainability and the UC Berkeley School of Public Health (UCB). Together they conducted a community-based health impact assessment (HIA) of traffic and the transportation system in this neighborhood which has led to local governmental action to re-assess truck routes and transportation system design in the neighborhood.

Example 2: Atlanta (Georgia) Beltline Health Impact Assessment

In Atlanta, authorities used a health impact assessment (HIA) to guide plans for a major redevelopment along the city’s beltline. The results of the study encouraged city officials to fund design elements such as improved transit services, access to green space and healthy foods, new opportunities for physical activity, and affordable housing, in response to health considerations.

Example 3: Non-Motorized Transportation Pilot Program (NMTPP)

The Federal Highway Administration (FHWA) funded four communities across the U.S. in an effort to demonstrate the benefits from improved walking and bicycling networks. Some of the outcomes that are tracked include changes in 1) vehicle and transit use; 2) rates of walking and bicycling; and 3) health and environmental measures. The four communities are listed below; additional information is available by clicking the links:

Example 4: Safe Routes for Seniors (New York)

In 2003, The NYC Department of Transportation partnered with Transportation Alternatives to create the Safe Routes for Seniors campaign, aiming to address the disproportionately high rate of senior pedestrian fatalities in NYC, and encourage senior citizens to walk more. Their recommendations focused on taking into account the sensory and physical changes that occur with age when designing streets and included installing medians and high-visibility crosswalks, repairing and extending curbs and pedestrian ramps, keeping streets as flat as possible, and increasing the time allowed for pedestrians to cross the street. Since the implementation of this program, pedestrian fatalities and crashes in all areas included in the campaign have decreased by 9% to 60%.

Example 5: Bicycle Transportation Alliance (Oregon)

The Bicycle Transportation Alliance strives to create healthy and sustainable communities by promoting the use of bicycles as a mode of transportation, with the idea that this shift will benefit the environment, livability, and community health. The Alliance works through both advocacy and education to achieve this goal. BTA offers biking safety courses in 4th through 7th grade classrooms and pedestrian safety courses made available to both adults and youth. Through these courses students are able to learn about traffic rules, bikes and helmets, and develop informed expectations regarding pedestrian and vehicle behavior in school and pedestrian zones. BTA is also active in promoting Oregon’s Bike + Walk to School Program, which reaches out to children and their families through school districts in an attempt to encourage the safe use of active transportation to and from school.

Example 6: Urban Street Design Guidelines (North Carolina)

Charlotte, NC, has worked to integrate its Urban Street Design Guidelines (USDG) into zoning and subdivision codes, which would require developers to follow them, ensuring a well-connected network of complete streets. USDG allows for flexibility in the implementation of complete streets in order to ensure that each street is completed in the most useful and efficient way possible. At the end of 2009, Charlotte had completed 16 complete streets projects and was in the middle of 18 more. Successes so far include 11 modified intersections (with 10 more planned), 15 new sidewalks (40 more planned), and over 50 miles of bike lanes.

Example 7: PLACE: Policies for Livable, Active Communities and Environments (California)

The PLACE Program was developed by Los Angeles County Public Health Department in 2006  in response to the growing prevalence of chronic conditions associated with the built environment—such as obesity, respiratory illness and diabetes—among LA residents. The program works to initiate policy change that will reduce the number of individuals and communities subject to poor air quality, physical inactivity, and poor nutrition by improving the built environment. In order to do so, PLACE has provided grants to five separate city government and non-profit agencies to help them pursue development projects in their own communities. Previous successes include the creation of a Bicycle and Pedestrian Master Plan as part of a health and wellness component of one city’s General Plan.

Example 8: Health Impact Assessments in the United States

The Health Impact Project offers an interactive map of Health Impact Assessments that have been implemented throughout the United States. You can choose a region of the map and see what projects are occurring in that area, or customize the map by filtering the projects by status, organization type, decision-making level, and sector.

Example 9: Caño Martin Peña Health Impact Assessment (San Juan, Puerto Rico)

The Icahn School of Medicine at Mount Sinai’s Pediatric Environmental Health Specialty Unit in New York City conducted an HIA to inform Puerto Rican policy makers on their decision to fund a comprehensive development plan for improving sanitation infrastructure, as well as dredging and removing heavily polluted sludge from a two-mile stretch of the Caño Martin Peña. The assessment’s purpose is to ensure that public health information and community health concerns are considered in the decision-making process.

Example 10: Madison Heights Health Impact Assessment (Arizona)

This Health Impact Assessment was conducted on the redevelopment of Madison Heights, a public housing unit near Phoenix, Arizona. It examines the potential health effects of the development proposal through access to transportation, access to recreation, youth engagement, crime, and safety.

Example 11: Health Impact Assessment on Liquor License Expansion (Kansas)

The Kansas Health Institute conducted an assessment examining the potential positive and negative health effects of proposed legislation that expands liquor licenses to grocery and convenience stores in Kansas. The study analyzed eight health issues related to this bill including alcohol consumption; alcohol consumption in youth; Driving Under the Influence (DUI) arrests; alcohol-related traffic accidents; alcohol-related traffic deaths; alcohol-related traffic deaths in youth; crime, and Sexually Transmitted Diseases (STDs).

Example 12: The Ohio Housing Finance Agency’s Health Impact Assessment report on affordable housing

This HIA will inform the revision of compliance rules and policies for housing inspections, both within OHFA's state-level compliance standards, and at the federal level. It will also guide decisions on a proposal to improve interagency coordination and streamline the current system for housing inspections on affordable housing units.

Example 13: Illinois Public Health Institute’s HIA report examines sugary drinks ban for food stamps

This Health Impact Assessment concluded that food stamp recipients in Illinois would be more likely to reduce their purchases of sugar-sweetened beverages as part of a voluntary program that incorporates a mix of incentives for purchasing healthier foods and beverages, restrictions on sugary beverages, and nutrition education.

Example 14: Shared-use Roosevelt: Unlocking Opportunities

Through this community-oriented project called Shared-use Roosevelt, made possible through a Health Impact Assessment, we see how a neighborhood benefits when diverse partners work together on a common goal: making school district properties accessible to the community. By opening up a vacant lot, a wellness center, and a greenhouse to the public, neighbors are able to come together, families can access healthier food and recreation opportunities, and a neighborhood can build itself up.

Example 15: Kern County’s Land-Use & Transportation Plan

Kern County, California is a central to America’s agriculture industry, but it’s also home to high rates of poverty and poor health outcomes. Rural areas like Lamont face especially high rates of asthma, obesity, cardiovascular disease, and cancer. With support from the Health Impact Project and The California Endowment, the community conducted a health impact assessment (HIA) to inform land use and transportation decisions at the county level.

Example 16: Health Impact Assessment Helps Families Replace Unsafe Manufactured Housing

In Curry County, along Oregon’s southern coast, numerous families live in poverty, and over thirty percent of county residents live in manufactured homes that have exceeded their intended lifespan. Forty percent of the manufactured homes are substandard and didn’t qualify for improvement services provided by the U.S. Department of Housing and Urban Development and the state of Oregon.

County officials recognized that families living in older manufactured homes were suffering more frequently from injuries like falls and from respiratory conditions such as asthma; they decided to launch a health impact assessment to inform a proposed pilot project called the Housing Stock Upgrade Initiative. The initiative would provide lower-cost loans or other funds to make repairing or replacing a manufactured home more affordable to Curry County residents.

Contributed by Lia Thompson, University of Kansas, Community Tool Box Intern.