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Walking, Biking, Electric Driving: What are the Health Benefits of Sustainable Transportation Alternatives? Neil Walking, Biking, Electric Driving: What are the Health Benefits of Sustainable Transportation Alternatives? Neil Maizlish, Ph. D, MPH, Epidemiologist California Department of Public Health Center for Chronic Disease Prevention and Health Promotion Presented at the Center for Healthcare Policy and Research UC Davis Medical Center, Sacramento March 21, 2012 1

Climate Change and Public Health • Climate change no. 1 public health threat in Climate Change and Public Health • Climate change no. 1 public health threat in 21 st Century • California 12 th largest greenhouse gas emitter in world • Transportation is the largest source of GHGs in California – 38% of total (179 MMT CO 2 E in 2003) • Personal passenger vehicles account for 30% (79% of 38%) • How can we reduce GHG emissions in transportation? • Increase efficiency of vehicles and fuels • Reduce vehicle miles traveled (less trips, mode switching (SOV to mass transport), walking/bicycling (active transport) ? ? 2

Smart Strategies Solve Multiple Problems • Strategies to reduce GHG emissions impact health • Smart Strategies Solve Multiple Problems • Strategies to reduce GHG emissions impact health • Do the strategies generate health co-benefits? Chronic Disease/ GHGs Obesity Epidemic • Do the strategies generate harms? • What strategies yield significant health co-benefits? • How do we measure this? 3

Groundbreaking Health Co-Benefits Research • 2009 London Study: estimated the health impacts of alternative Groundbreaking Health Co-Benefits Research • 2009 London Study: estimated the health impacts of alternative strategies for reducing carbon dioxide emissions from transport. • Lower carbon driving • Lower carbon emission motor vehicles/fuels • Increased active travel • Replacing urban car and motorcycle trips with Dr. James Woodcock walking or bicycling • Shift from 10 to 30 minutes/day of walking and bicycling: 19% Cardiovascular Disease 15% Diabetes 13% Breast Cancer = 8% Dementia 38% CO 2 Emissions _________ * Woodcock J, Edwards P, Tonne C, Armstrong BG, Ashiru O, Banister D, et al. Public health benefits of strategies to reduce greenhouse-gas emissions: urban land transport. The Lancet 2009; 374: 1930 -1943. 4

Can the London Active Transport Model Be Adapted for Regional Transportation Plans in California? Can the London Active Transport Model Be Adapted for Regional Transportation Plans in California? California Department of Public Health • Partner with MTC (regional MPO) and BAAQMD to apply the London model (aka ITHIM) to the Bay Area • Test the feasibility • Develop a tool kit and technical resources to assist other MPOs apply the model to their geographic area 5

The Model Integrates Bay Area Data on Health and Travel Physical Activity Travel Survey The Model Integrates Bay Area Data on Health and Travel Physical Activity Travel Survey Traffic Injuries Health Survey Air Pollution Vehicle Emissions Model Air Shed Model Travel Demand Model ITHIM U. S. Census Traffic Collisions Health Statistics Scenario vs. BAU Scenarios · Premature Deaths · Years of Life Lost · Years Living with Disability 6

Active Transport and Low Carbon Driving Scenarios 1. Bay Area Benchmarks (Leading Cities) • Active Transport and Low Carbon Driving Scenarios 1. Bay Area Benchmarks (Leading Cities) • Scenario: All Bay Area cities achieve by 2035 the walking and biking levels of the 2009 Bay Area leaders (SF, Oakland, Palo Alto, Berkeley, Mtn. View, Rohnert Park, Morgan Hill) Cities with high levels of walking and biking to work 2. Replace short car trips with active transport • 45% of 2006 Bay Area car trips were < 3 miles • 60% of car trips were < 5 mi • Scenario: 1/2 of trips <1. 5 miles walked and 1/2 of trips 1. 5 to 5 miles bicycled 3. Attaining Carbon and Physical Activity Goals (C/PAG) • Back cast the amount of active transport time and distance to reduce car VMT and increase active transport to optimum levels (no more than average commute time to work ~25 minutes); land use and infrastructure exist to support changes 4. Low Carbon Driving (LCD) • Fuel efficiency increases, low carbon fuels and low/no emissions cars and light trucks become more widespread, but there are no changes in physical activity or driving patterns 7

Daily Active Travel Times and Distances for a Typical Resident BAU = Business-as-Usual Daily Active Travel Times and Distances for a Typical Resident BAU = Business-as-Usual

Summary of Bay Area Scenarios: Active Transport and Low Carbon Driving Active Transport Scenarios Summary of Bay Area Scenarios: Active Transport and Low Carbon Driving Active Transport Scenarios • 2 -3 fold increase in walking (2. 6%-4. 3% of distance mode share) • 4 -16 fold increase in bicycling (2. 9%-10. 7% of distance mode share) • Carbon reduction goal has 15% of distance mode share from active transport • 4%-15% decrease in car VMT Low Carbon Driving • Penetration of gas-electric hybrid vehicles and light duty diesels, increased biofuels usage and the penetration of electric vehicles (Pavley I&II) • BAU/incremental changes 16. 5% decrease • Electrification and biofuels (9%-33. 5% decrease) 9

Methods for Assessing Health Outcomes for Active Transport • Comparative Risk Assessment Disease Burden Methods for Assessing Health Outcomes for Active Transport • Comparative Risk Assessment Disease Burden = Attributable Fraction × Disease Burden ↓ Percent change in disease rates from BAU due to shift in exposure distribution in the alternative scenario • • RR is the relative risk of the health outcome at the given exposure level For physical activity, exposure, x, is the hours per week spent in walking and bicycling (and all other physical activity), For air pollution, exposure, x, is the concentration of fine particulate matter (PM 2. 5) Burden of Disease Disability Adjusted Life Year, DALY, is a measure of premature mortality and disability based on the years of life lost, YLL (years of expected life - age at death) + years lived with a disability, YLD 10 DALY = YLL + YLD

Meta-analyses for Assessing Health Outcomes for Active Transport • Physical Activity • Based on Meta-analyses for Assessing Health Outcomes for Active Transport • Physical Activity • Based on strong quantitative evidence of a link between exposure pathways and health outcomes, the following health outcomes were chosen: Condition Studies included Breast cancer Cardiovascular disease 19 cohort studies, 29 case control studies 18 cohort studies (459, 833 people, 19, 249 cases) Colon cancer 15 cohorts (7873 cases) Depression Cohort study (10, 201 men, 387 first episodes physiciandiagnosed depression) Diabetes 10 cohort studies (301, 211 people, 9367 cases) Relative Risk 0. 94 0. 84 Women: 0. 80 Men: 0. 86 Exposure (Metabolic Equivalents)* each additional h/wk 3 hrs walking per week (7. 5 METs/wk ) 30. 1 METs/wk 30. 9 METs/wk 1 0. 83 0. 72 Kcal/wk <1000 -2499 2500+ 0. 83 10 METs/wk * Metabolic Equivalent is amount of energy expended of a person at rest (1 MET = 1 kcal/kg/hr) 11

Health Impacts of Active Transport Scenarios Change in disease burden Change in premature deaths Health Impacts of Active Transport Scenarios Change in disease burden Change in premature deaths Cardiovascular Dis. 6 -15% 724 -1895* Diabetes 6 -15% 73 -189 Depression 2 -6% <2 Dementia 3 -10% 63 -218 Breast cancer 2 -5% 15 -48 Colon Cancer 2 -6% 17 -53 Road traffic crashes 10 -19% 60 -113 12 * Range reflects range of physical activity in scenarios

Annual Health Benefits of Active Transport and Low Carbon Driving in the Bay Area: Annual Health Benefits of Active Transport and Low Carbon Driving in the Bay Area: Predictions from the ITHIM Model Source of Health Benefit or Harm (Scenario 3: Active transport 15% of miles traveled) Scenario 4 13

Annual Aggregate Reductions in Passenger Vehicle Greenhouse Gas Emissions from Different Transport Scenarios 2000 Annual Aggregate Reductions in Passenger Vehicle Greenhouse Gas Emissions from Different Transport Scenarios 2000 Baseline 27. 9 MMTCO 2 45% Reduction 2035 Goal # Based on car VMT*BASSTEGG emission factor * Per capita reduction of 26% † Adjusted for double counting of mode choice BAU, Business-as-Usual; LCD, Low Carbon Driving; TD, Top Decile of Cities; AT C, Active Transport Carbon Goal 14

Summary of Findings A shift in active transport from a median of 4. 4 Summary of Findings A shift in active transport from a median of 4. 4 to 22 minutes/day (2% to 15% mode share): • Disease reductions 14% of heart disease, stroke, and diabetes 6 -7% of dementia and depression 5% of breast and colon cancer • Major public health impact • Adds about 9. 5 months of life expectancy • $1. 4 to $22 billion annual Bay Area health cost savings 15

Summary of Findings • Injuries é 19% of injuries to pedestrian and bicyclists • Summary of Findings • Injuries é 19% of injuries to pedestrian and bicyclists • Physical activity accounts for almost all the health benefits; air pollution < 1% • ~15% reductions in CO 2 emissions • Low carbon driving is not as important as physical activity for generating health co-benefits Together, low carbon driving and active transport can achieve California’s carbon reduction goals and optimize the health of the population + = 16

Acknowledgments • The Team • Linda Rudolph, CDPH (conceived the project), Sacramento • Neil Acknowledgments • The Team • Linda Rudolph, CDPH (conceived the project), Sacramento • Neil Maizlish, CDPH, Richmond • James Woodcock, UKCRC Centre for Diet and Activity Research (CEDAR), UK • Sean Co, Metropolitan Transportation Commission, Oakland • Bart Ostro, Centre for Research in Environmental Epidemiology (CREAL), Spain • Amir Fanai and David Fairley, Bay Area Air Quality Management District, San Francisco • Other Contributors • Caroline Rodier, Urban Land Use & Transportation Program, UC Davis • Dr. Phil Edwards and Dr. Zaid Chalabi, London School of Hygiene and Tropical Medicine • Colin Mathers, World Health Organization, Geneva • Other staff from MTC, UCD, CDPH, Mike Zdeb (University at Albany, NY) • Partial funding and grant support • The California Endowment, Oakland • Kaiser Permanente – Northern California Community Benefits Programs, Oakland • Public Health Law and Policy, Oakland, CA • Public Health Institute, Oakland 17

Contact Information Neil Maizlish (Neil. Maizlish@cdph. ca. gov) Report available at: http: //www. cdph. Contact Information Neil Maizlish (Neil. [email protected] ca. gov) Report available at: http: //www. cdph. ca. gov/programs/CCDPHP/Documents/ITHIM_Technical_Report 11 -21 -11. pdf 18 N Maizlish – 10/24/11