Sunnyvale Highway Data Analysis for Injury

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Sunnyvale Highway Data Analysis for Injury Powered By Docstoc
					Buford Highway: A Case Study

Welcome to the Buford Highway case study. The purpose of working through this case
study is to give you the opportunity to experience the HIA process. Remember, each
HIA is different and this is just one example.

Work with your team to complete the questions at the end of each section. Please do not
move to the next step until you have heard the presentation about that step.

Begin by reading the background information about Buford Highway, reviewing the
information given in the presentation, and answering the questions related to the
screening process.

                       BACKGROUND INFORMATION
Buford Highway is an automobile-oriented corridor near the urban fringe of Atlanta with
post-World War II style development (low density, low connectivity, and low land-use
mix). The area has strip malls, multi-unit housing, a noticeable lack of pedestrian
amenities, and is bisected by a seven lane highway. The street layout has high design-
speeds for automobiles, long blocks, few intersections, few crosswalks, and many cul-de-
sacs. This area is a classic example of suburban, low density, auto-oriented development
seen in many areas across the country.

Many of the residents surrounding Buford Highway in DeKalb County, Georgia are new
immigrants, with 25% living outside the U.S. prior to 1995 (see Figure 1 for additional
demographic information). The average family size is also large with an average of 3.44
people per household. Many households lack automobiles or only have one automobile
available per family, meaning that transit-dependency and pedestrian activity is high,
despite the lack of pedestrian facilities. This increased presence of a transit-dependent
population in an area that has been designed and built primarily for automobile travel has
lead to increasing conflicts between pedestrians and automobiles. Along an 8 mile section
of Buford Highway there are on average 19 pedestrian injuries and 4 pedestrian fatalities
per year.

Many developers are interested in turning the auto-orientated development around Buford
Highway into a smart growth community (high density, mixed land-use, high street
connectivity) that is pedestrian orientated. However, in order to do this they must
demolish the existing low income housing. While there will be a net increase in density
(number of units available) most of the plans call for housing that is substantially more
expensive. The DOT is also willing to make certain changes to improve the pedestrian
infrastructure as long as it does not impede automobile traffic flow.

A staff of 2 public health professionals and 2 planners who can dedicate 50% of their
time for 1 year has been assigned to this project. Some additional help from architects
and transportation professionals is also available but there is no money to pay them for
their time. The plans for the development project are currently in the conception stage
and it is estimated that you will have a year to provide recommendations to the DOT,
stakeholders, and developers.

Figure 1. Comparison of the Distribution of Demographic Factors in the Atlanta
MSA and the Buford Highway Project Area
                             Buford Highway Project    Atlanta
% Male                       60%                       49.4%
Age 0-17                     18.9%                     26.6%
     18-29                   28.3%                     18.1%
     30-39                   23.3%                     18.4%
     40-49                   10.9%                     15.7%
     50+                     8.6%                      21.2%
White (includes Hispanic)    47.3%                     63.0%
Black (includes Hispanic)    20.8%                     28.8%
Asian                        4.8%                      3.3%
Hispanic/Latino (any race)   49.8%                     6.5%
Foreign-born                 62.0%                     10.3%
Non-U.S. residency in 1995   25.7%                     4.1%
(age ≥5)
Highest ed completed H.S or  51.3%                     40.4%
less (age ≥25)
Avg annual household         $45,511                   $51,948
Below poverty                15.8%                     9.2%
Total (N)                    14,000                    4,112,198

                              Figure 2. Map of Study Area

Figure 3. Example of Poor Pedestrian Infrastructure

Figure 4. Pedestrians Walking along Buford Highway

                   Figure 5. Example of Pedestrian-Worn Footpaths


It is time to apply what you have learned about screening to the Buford Highway case.

1. Could there be significant health impacts related to redeveloping this area?
___YES ___NO

2. Use the diagram of health determinants below to determine which health impacts are
most likely to be affected.





                         Figure 6. Determinants of Health

3. Would you complete a rapid, intermediate on comprehensive assessment for Buford

Highway? Why?







Due to the high rates of pedestrian injuries and fatalities the DOT has decided to make
changes to the design of the highway including: adding sidewalks, crosswalks, and
converting the center lane to a full median. Developers have also submitted plans to
develop greenspace, add intersections, reduce the total number of parking spaces, and add
office and commercial space as well as thousands of housing units.

                    Figure 7. Buford Highway before Renovations

                      Figure 8: Buford Highway after Renovations

1. What ground rules would you set for the Buford Highway HIA (temporal,
geographical and population)?

Temporal (length of time, ex. week-long survey, 5 year analysis, etc.):


Geographical (area looked at, ex. street block, entire city, etc.):


Population (subgroup of people, ex. children, residents, etc.):



2. What resources are currently available? What other resources are needed to ensure
success? Are there untapped resources that you could garner, if needed?





3. Who are the internal and external partners you would include?




4. What priorities and strengths do you think each partner will bring to the table?







5. How would you involve the community? Who are your stakeholders? What are some
pros and cons of having them involved?






Before starting your assessment you would gather information on the health outcomes
that you think the project or policy will impact. Depending on the availability and quality
of data, you must make a decision on whether to perform qualitative or quantitative
assessment for each identified health outcome.

For the Buford highway case study, qualitative analyses were performed for
   o air pollution
   o automobile level of service
   o economic growth, gentrification and crime
   o social capital and crime

Quantitative analyses were performed for
   o pedestrian injury and fatality

                              YOU HAVE A CHOICE
1. Perform qualitative assessment for the variables listed above (go to page 12)


2. Perform the quantitative assessment for pedestrian injury and fatality (go to page 21)

                         QUALITATIVE ASSESSMENT

Air pollution
Several factors affect the amount of pollution that is given off by motor vehicles such as
vehicle type, age, speed, driving conditions, atmospheric conditions, and time spent
idling. Larger vehicles and vehicles with lower fuel mileage generally produce more
pollution; however these factors are less influential than particulates from the wear of
brake pads and tires and evaporating fuel from unsealed gas tanks. Diesel powered
vehicles also emit more harmful byproducts than vehicles of similar size powered by
gasoline; diesel exhaust contains several hundred different organic and inorganic
compounds, many of which have been designated as toxic. Light-duty diesel engines can
emit 50 to 80 times more particulate mass than gasoline engines and heavy-duty trucks
emit 100 to 200 times more particulate mass. Slower traffic is often associated with
higher vehicle emissions per mile traveled because vehicles stalled in traffic spend more
time running and emit more exhaust. In addition, the air pollution emissions of short trips
are disproportionately high in relation to total vehicle trips and miles traveled since these
trips tend to be short and involve cold starts (starting a cold engine) that emit high levels
of pollution.

Some of the potential health effects of air pollution include: headache, loss of alertness,
respiratory system irritation, coughing, reduced lung function, aggravation of asthma,
lung damage, restricted activity days, chest pain (for those with heart disease), and
decreased learning ability in school children. In very high doses, air pollution can lead to
permanent lung damage, asthma-related hospital visits, coma and death.

The redevelopment plan calls for adding a center median (estimated improvement in
traffic flow) and adding several new signalized crosswalks (estimated moderate reduction
in traffic flow). After the changes the new residents may walk more to local destinations
but it is uncertain what mode of transportation the new residents will take. The local
metropolitan planning organization estimates that there will be a 5% increase in
automobile traffic and a 5% increase in the number of bus trips. Currently 50% of the
buses are diesel busses.

                        AIR POLLUTION WORKSHEET
Please fill in the table below identifying:
      All relevant populations that will be affected
      Positive and negative health outcomes that would result
      Your degree of certainty with respect to each health outcome

Population and population     Predicted health impacts                Risk of impact
subgroups                     (Positive and negative)                 definite (D) probable
                                                                      (P) speculative (S)

Automobile Level of Service
The redevelopment plan is likely to reduce the number of automobile crashes due to
traffic calming, however reducing the flow of traffic could lead to other negative health
outcomes. For instance, reducing the number of lanes may slow down ambulance
response times which could decrease an individuals’ chance of survival from a
cardiopulmonary event. Using national data, it was estimated that 10,811 individuals
living in the county would be hospitalized for cardiovascular diseases in any given year
(1.6 visits per 100 people). One study found that increasing response time from 5 minutes
to 8 minutes (for 90% of the calls) would decrease survival by 2-3% and there was an
additional 2% decrease in survival when response times increased from 8 minutes to 14
minutes. However, decreased response times were not found to affect survival rates for
individuals who suffered from traumatic injury or those involved in road traffic accidents.
In addition to distance and traveling conditions, numerous other factors have been found
to affect ambulance response times such as the geographical distribution of ambulance
stations, availability of vehicles to respond, and the use of ambulances for routine patient

In the county the average response time for a 911 call was 23.6 minutes and it was 14.7
minutes for a priority (life threatening) call. The police chief attributed the slow response
times to the 90 vacancies in the police department, population growth, and the large area
covered by the county. The police chief did not believe the long response time was due to
road conditions.

Another potential side effect of the traffic calming would be that motorists divert from
the highway to side streets. This could lead to an increase in traffic as well as automobile
and pedestrian injuries on these streets since they were not designed to accommodate
large flows of traffic. The amount of traffic on side streets would be dependent on the
connectivity of these side streets to other major roads, thus it may affect some streets
more than others.

The local metropolitan planning organization stated that during peak traffic times Buford
Highway has a good Level of Service (LOS) and with the proposed changes the LOS
during peak times would be reduced to fair after the proposed changes. Reducing the
LOS on Buford Highway will likely increase traffic which could lead to road rage,
obesity (due to increase sedentary activity), and decreased physical activity for those
individuals who have to spend more time in their automobiles. However, it is also
possible that individuals who currently use Buford Highway during peak times would 1)
choose an alternate route 2) try taking public transportation, or 3) make their trip during
non-peak hours.

                      AUTOMOBILE LOS WORKSHEET
Please fill in the table below identifying:
      All relevant populations that will be affected
      Positive and negative health outcomes that would result
      Your degree of certainty with respect to each health outcome

Population and population     Predicted health impacts                Risk of impact
subgroups                     (Positive and negative)                 definite (D) probable
                                                                      (P) speculative (S)

Economic Growth, Gentrification, and Crime
Gentrification has been defined as “the unit-by-unit acquisition of housing, displacing
low-income residents by high-income residents” and it is independent of the structural
condition, architecture, tenure, or original cost of the housing. Gentrification typically
occurs slowly over many years as the original population is replaced by a new population
with a different social class, culture, income level, and lifestyle.

Gentrification usually has a differential impact on those that own their homes versus
those that are renting either homes or apartments. Those that are renting may face greater
pressures to move to other areas to find affordable housing as the average rent prices
increase in the area. Thus gentrification has a disproportionately negative affect on
renters who are typically in the lowest income brackets. Gentrification is exacerbated in
areas when lower density housing developments replace higher density housing units,
when efforts are not made to provide affordable housing, and when urban reinvestment is
not made available to existing residents.

The peer reviewed literature regarding the impacts of gentrification on crime has been
mixed. One theory predicts that crime rates will fall as higher income individuals replace
those with lower incomes because rates of crime are lower in groups with higher
incomes. In addition, the new residents often improve and renovate their property which
can install greater neighborhood pride, they may form neighborhood patrols to help
decrease crime rates, and they often have more political clout to get other improvements
(increased police presence, better lighting, etc.) from the local government.

However, another theory predicts that crime will rise because the individuals with higher
income are now seen as targets for crime related activity. In addition, the social
disruption that occurs from displacement may destroy social ties within the neighborhood
leading to decreases in the neighborhood’s collective efficacy (joint belief of the
neighbors ability to reach their goals) and thus lead to increased crime.

A study that examined 14 neighborhoods found that personal crime rates decreased after
gentrification while there were no changes in property crime arrests. However, another
study found that aggravated assault and murder rose while property crime declined in
gentrified areas.
The redevelopment plan is expected to lead to increased economic growth and vitality in
the area. The plan also calls for an increase in housing units from 1,000 units to 2,000
units with 5% of the new units being subsidized housing saved for the current residents.

           Figure 9: Summary of Neighborhood Impacts of Gentrification

Positive                                    Negative
Stabilization of declining areas            Displacement through rent/price increases
Increased property values                   Secondary psychological costs of
Reduced vacancy rates                       Community resentment and conflict
Increased local fiscal revenues             Loss of affordable housing
Encouragement and increased viability of    Unsustainable speculative property price
further development                         increases
Reduction of suburban sprawl                Homelessness
Increased social mix                        Greater take of local spending through
Decreased crime                             Commercial/industrial displacement
Rehabilitation of property both with and    Increased costly and changes to local
without state sponsoring                    service
Even if gentrification is a problem it is   Displacement and housing demand
small compared to the issue of urban        pressures on surrounding poor areas
decline and abandonment of inner cities
                                            Loss of social diversity (from socially
                                            disparate to rich ghettos)
                                            Increased crime
                                            Under-occupancy and population loss to
                                            gentrified areas
                                            Gentrification has been a destructive and
                                            divisive process that has been aided by
                                            capital disinvestment to the detriment of
                                            poorer groups in cities

Please fill in the table below identifying:
      All relevant populations that will be affected
      Positive and negative health outcomes that would result
      Your degree of certainty with respect to each health outcome

Population and population     Predicted health impacts                Risk of impact
subgroups                     (Positive and negative)                 definite (D) probable
                                                                      (P) speculative (S)

Social Capital and Crime
“Social capital" is a term often used to describe the amount of formal and informal social
networks, group membership, trust, reciprocity, and civic engagement in a neighborhood.
Putnam described how these “networks of civic engagement foster sturdy norms of
generalized reciprocity and encourage the emergence of social trust” (Putnam, 1995). A
decline in American civic engagement over time has been witnessed through reduced
participation in various civic associations and more notably a decrease in the proportion
of Americans who socialize with their neighbors. In adults, higher levels of social capital
and social connectedness have been linked to decreased risk of mortality (all cause,
ischemic heart disease, and cardiovascular disease), higher levels of self-rated health,
physical activity, and a lower prevalence of mental health problems.

Leyden’s (2004) research on social capital and walkable neighborhoods found that people
living in walkable, mixed-use neighborhoods had higher levels of social capital than
those in car-oriented suburban areas. Residents in more walkable communities were more
likely to trust others, be socially engaged, be politically active, and know their neighbors.
Increased levels of walking reinforce social capital by facilitating neighborhood social
interaction which decreases perceptions of danger.

Jane Jacobs, author of The Death and Life of Great American Cities (1961), was the first
to describe the concept of “eyes on the street,” where a greater density of residents and
different land uses may enhance feelings of safety and deter criminal activity by
increasing the presence of pedestrians and everyday visual surveillance. Ross and
Mirowski (2000) found that people who lived in the city of Chicago were more likely to
walk than were residents of the suburbs, small towns, and rural areas. She hypothesized
that increased density allows for walking for transport and applied Jacobs’ concept of
“eyes on the street” to describe how an organic process of community interaction and
involvement works to counteract fear for personal safety. By decreasing crime and
feelings of vulnerability and increased community interaction both can have significant
positive effects on social capital in a community.

Other researchers have correlated increased social capital with quantifiable reductions in
crime rates. Another study found that lower levels of fear for safety was associated with
higher levels of social trust. One researcher noted that social capital contributes to crime
prevention by helping to maintain social order. He described the conceptual link between
social capital and crime by suggesting “the safest communities are not those with the
most police and prisons but those with the strongest community structures” (Graycar,

In DeKalb County there were 4,018 crimes per 100,000 people in 2000. Over half of the
crimes (53.9%) were larceny, followed by burglary (20%), motor vehicle theft (17.5%),
robbery (5.5%), aggravated assault (2.6%), rape (0.4%), and murder (0.1%).

Please fill in the table below identifying:
      All relevant populations that will be affected
      Positive and negative health outcomes that would result
      Your degree of certainty with respect to each health outcome

Population and population     Predicted health impacts                Risk of impact
subgroups                     (Positive and negative)                 definite (D) probable
                                                                      (P) speculative (S)

                           Quantitative Assessment

Below are a series of questions related to assessment for injury reduction; please
complete them to the best of your abilities.

1. Where would you find baseline data on pedestrian and auto injuries?






2. Where would you find data on ways to reduce pedestrian and automobile injuries?






Step 1: Finding Baseline Data
In this case there was good enough baseline and effect estimate data for a quantitative
analysis. However, if you were unable to find this type of data in your own community
you would want to conduct a qualitative assessment instead. There are several places to
get data on injuries and fatalities depending on the level of detail you need for your study.

National data is available in the
   o Published literature
   o On-line at the Federal Highway Administration (FHWA) Website

Local level data is available at
   o The Department of Transportation
   o The Police Department

Available data usually includes date, time, number of injuries, number of fatalities, type
of collision, harmful event, lighting condition, road surface, and directions that the
vehicles were traveling at time of impact.

Problems with these types of data:
   1) Pedestrian injuries are often underreported so it is best to search in both databases
       and determine which collisions are duplicated or missed.
   2) Data is often missing, in the Buford case 38% of the data was missing from year
       1998 and 67% of the data was missing from 1999 in the DOT file.
   3) If they do not collect location information you cannot determine where the crash

For this case study, the Police Department dataset was used since it was more complete.
Also, because it included collision location it was possible to determine where each
collision occurred. As mentioned previously, along an 8 mile section of Buford Highway
there were on average 19 pedestrian injuries and 4 pedestrian fatalities per year. There
were also 250 automobile injuries and 0 automobile fatalities per year.

Step 2: Finding an Effect Estimate
The next step would be to find an effect estimate for injury reduction. The changes that
the DOT was planning on making are called “traffic calming” measures since they serve
to slow down traffic and make it safer for pedestrians. When these traffic calming
measures are placed into an area the number of injuries and fatalities that will be
prevented can be calculated using Collision Reduction Factors (CRFs). The best place to
find collision reduction factors is in the published literature or on the FHWA website. For
example, putting in sidewalks has a CRF of .65 for pedestrians; in other words putting in
sidewalks would be expected to reduce the number of pedestrian injuries and fatalities by

However, there were several problems with calculating CRFs for Buford Highway. One
of the biggest problems was that the DOT planned on putting in several different CRFs at
one time. This was a problem when attempting to calculate a total CRF since most of the
published literature only looks at one CRF at a time. By using a formula which was
provided by senior transportation engineers it was possible to add several CRFs together.
For this assessment we are going to use the formula below:

CRFt = CRF1 + (CRF2 ) (1-CRF1) + (CRF3) (1-CRF1) (1 – CRF2)
      Where CRFt = CRF of combined countermeasures
             CRF1 = CRF for the first countermeasure
             CRF2 = CRF found the second countermeasure
             CRF3 = CRF for the third countermeasure

For example to calculate the reduction in pedestrian injuries from adding sidewalks and
medians you would find their respective CRFs (Figure 10) and put them into the formula

CRFt = CRF1 + (CRF2 ) (1-CRF1)
CRF1 = 0.55
CRF2 = 0.65

CRFt = 0.55 + (0.65)(1 - 0.55)
CRFt = 0.55 + (0.65)(0.45)
CRFt = 0.55 + 0.29
CRFt = 0.84

Therefore you would expect an 84% reduction in pedestrian injuries and fatalities through
the installation of sidewalks and medians.

  Figure 10: Collision Reduction Factors Associated with Different Types of Road

        Improvement Measure                                      Pedestrian
                                                                 Collision CRF
        Replacement of two-way left-turn lane with raised             55%
        Sidewalks                                                     65%
        Added/improved pedestrian crosswalks                          19%

Now it’s time for the real assessment! Take all three Collision Reduction Factors from
Figure 10 and calculate the total collision reduction factor for pedestrian collisions.

CRFt = CRF1 + (CRF2 ) (1-CRF1) + (CRF3) (1-CRF1) (1- CRF2)
CRF1 =
CRF2 =
CRF3 =

CRFt =
The next step is to use the total expected collision reduction factors and determine the
expected accident reduction (the estimated number of pedestrians injured or killed each
year after putting traffic calming measure in place) and the total number of injuries and
fatalities prevented.
         EAR = BCR – (BCR x CRFt)
         EAR = expected accident reduction
         BCR = baseline collision rate
         CRFt = CRF of combined measures

Once again using the sidewalk and median example we found a total collision reduction
factor of 84%. As mentioned earlier, there were 19 pedestrian injuries and 4 pedestrian
deaths on average every year.

Pedestrian injuries:
       EAR = BCR – (BCR x CRFt)
       BCR = 19
       CRFt = .84
       EAR = 19 – (19 x .84)
       EAR = 19 – 16
       EAR = 3

Thus, after the medians and sidewalks were installed, you would have an expected
accident reduction of 3 pedestrian injuries a year (16 less).

Pedestrian deaths:
       EAR = BCR – (BCR x CRFt)
       BCR = 4
       CRTt = .84
       EAR = 4 – (4 x .84)
       EAR = 4 - 3
       EAR = 1

After the medians and sidewalks were installed you would expect 1 pedestrian fatality per
year (3 less).

Now it’s your turn to calculate the expected accident reduction for
1) Pedestrian injuries
 2) Pedestrian deaths

The CRFt you will use in this assessment is the one you calculated earlier which included
adding sidewalks, crosswalks, and center medians.

Pedestrian injuries:
       EAR = BCR – (BCR x CRFt)
       BCR =
       CRFt =


Pedestrian deaths:
       EAR = BCR – (BCR x CRFt)
       BCR =
       CRFt =


Step 3: Sensitivity Assessment
Another important part of performing quantitative assessment involves performing
sensitivity assessment. For instance, studies show that adding sidewalks has a range of
injury reduction from 65% to 75% and reducing speed limits have been found to reduce
injuries by 15% to 30% (see Figure 11). Thus, to perform a sensitivity assessment you
would replicate the assessment using both the highest and lowest values to get a range of
possible values.

                  Figure 11: Researched Collision Reduction Factors
         Measure                     Reported Collision Reduction                 Source
         Replacement of two-         45%         All collisions                   (1)
         way left-turn lane          43%         Injury collisions
         with raised median          78%         Pedestrian fatalities
                                     25% -       All collisions                   (2)
                                     41% -       Pedestrian collisions            (3)
                                     90%         Pedestrian fatalities            (4)
         Sidewalk                    68%         Pedestrian collisions            (5)
                                     50-90%      “Walking along                   (6)
                                                 roadway” pedestrian
         Added/improved              25%         Pedestrian collisions            (5)
         pedestrian crosswalk
                                     25% -           All collisions               (7)
                                     48%             (unsignalized
                                                     intersections only)

(1) Parsons P, Waters MI, Fincher J. Georgia study confirms the continuing safety advantage of raised
    medians over two-way left-turn lanes. 2000. Presented at the fourth national conference on access
    management, Portland, Oregon.
    Ref Type: Generic

(2) National Cooperative Highway Research Program. Roadway safety tools for local agencies: A
    synthesis of highway practice. 2003;

(3) Centre for Transportation Research and Education ISU. Iowa's statewide urban design standards
    promote improved access management. 2005;

(4) Bretherton. Gwinett County DOT. 6-15-2004. 6-15-2004.
    Ref Type: Personal Communication

(5) Shen J. Development and application of crash reduction factors: A state-of-the-practice survey of
    state departments of transportation. 2004. Transportation Research Board annual meeting.
    Ref Type: Generic

(6) National Cooperative Highway Research Program. A guide for reducing collisions involving
    pedestrians. 2003; Volume 10 of
    NCHRP report 500 2003

(7) Federal Highways Administration and Institute of Transportation Engineers. Toolbox of
    countermeasures: Toolbox of countermeasures and their potential effectiveness to make intersections
    safer. 2005;

Step 4: Listing Assumptions
Finally, it is important that you list all of your data sources and assumptions so that others
can judge the value of your work.

Assumptions for Injury Assessment on Buford Highway:

   1. Traffic calming measures used to calculate individual CRFs that have been used
      in different parts of the country will have the same effect along Buford Highway.
   2. The residents will use the new sidewalks and crosswalks.
   3. If the traffic is diverted onto other streets, there will not be an increase or decrease
      in pedestrian injuries on those streets.
   4. The CRFs were directly applied to the number of expected accidents per year
      without taking into account how the accident occurred, since this data was not
      available for pedestrian accidents. Data was not available on the number of
      pedestrian accidents that occurred due to improper crossing, which could have an
      effect on expected injury reductions if pedestrians continue to cross improperly
      after the built environment is modified.
   5. It was assumed that the best available estimates for CRFs were used, which
      included personal communication with local transportation agencies, realizing
      that the level of predictive certainty for most of the CRFs is unknown. The
      NCHRP (2005) found a medium-high level of certainty for reducing the number
      of lanes and adding raised medians, a medium-low level of certainty for marked
      crosswalks, reducing the speed limit, and adding a pedestrian refuge island, with
      all other pedestrian improvements getting an unknown rating.

Remember it is important that reporting is considered from the beginning. You want to
be establishing relationships with people you will be reporting to, telling them about their
project and updating them along the way. This shouldn’t just be thought of at the very
end of the process.

1. Based on the analysis you conducted earlier, create a draft list of recommendations for
mitigating the expected negative health impacts and promoting potential positive health



2. What process would you use to prioritize these recommendations?



3. Who do you think should receive a report or presentation for Buford Highway? What
type of format do you think will be the most effective for each group? How can you most
effectively present the data you collected in the report?




4. What responses do you think you’ll encounter when presenting the results of this



1. What kind of data would you collect for each type of evaluation?

Process:   a)

Impact:    a)

Outcome: a)

2. What types of evaluation would you use for this case study?




                                        ANSWER KEY

1. Do you think that there will be significant health impacts related to redeveloping this
area? Yes, there will likely be significant health outcomes.

2. Which health impacts do you think will be most likely to be affected?
The ones that will most likely be affected are pedestrian and automobile injuries and
fatalities, physical activity, air pollution, noise pollution, gentrification, social capital,
crime, and automobile level of service.

3. Would you complete a rapid, intermediate on comprehensive assessment for Buford
Highway? Why? Intermediate to comprehensive. There are likely to be significant health
impacts, there is potentially unfamiliar information, the results are likely to be valued by
the stakeholders and decision makers, there is dedicated staff who will be able to gather
sufficient data, due to the high rates of injuries and fatalities it is worth the time to
perform the HIA, and since there is a long time period to deliver recommendations this
would likely be an intermediate or comprehensive HIA.


1. What ground rules would you set for this case (temporal, geographical or population)?
For the geographical ground rules you need to determine what section of the highway
you’re going to examine since it runs for hundreds of miles. The most logical selection
for this HIA would be the section of the highway that is being redeveloped since they are
not redeveloping the entire highway. For this project you also need to select the
population that is likely to be most affected by the changes. The people living along the
highway and those that walk along the highway are probably the groups that will be most
affected by the changes. For this case study a ½ mile radius from the highway was chosen
since that is the distance that people would be expected to walk to access transit and
shopping. Additional information was also gathered about the number of people who
drive along the highway each day. Time limits for the assessment were set at 1 year since
significant reductions in injuries and fatalities would be expected over that time period.

2. What resources are currently available? What other resources are needed to ensure
success? Are there untapped resources you could garner if needed?
You currently have 2 staff that have half their time for a year as well as other
professionals who have agreed to provide unpaid help. To ensure success you will need
dedicated staff time which remains throughout the process, buy in from HIA staff
supervisors, the ability to communicate with non-traditional partners, and the ability to
organize the community and to work with community groups. Untapped resources could
include policy makers, community groups, and community members who care about this

3. Who are the internal and external partners you would include?
Partners would include local organizations and community groups that represent the
minority groups that live in this area, the community, the Department of Transportation,
the Federal Highway Administration, policy makers such as County Commissioners and
local mayors, and police departments. Ideally you will form a small tight working group
and have a larger group of individuals serving as an advisory panel.

4. What priorities and strengths do you think each partners will bring to the table?
You would expect the community groups and the community to be positive about the
changes since they are the ones who will most likely benefit from the changes. However,
there are likely to be community members who oppose these changes for various reasons.
The DOT and FHWA’s main concerns usually involve automobile level of service and
they do not usually invest a lot of money into non-motorized travel. There may be some
resistance to having public health officials and planners involved in their projects. Local
policymakers and police could either be supportive since they see the need for changes or
they could be unsupportive since they do not want attention brought onto a problematic

5. How would you involve the community? Who are your stakeholders? What are some
pros and cons of having them involved?
The cons involve time and money and having to find a way to incorporate their input with
the scientific analyses. The pros include getting buy in for the changes, determining if
anything was missed in the scientific assessment, and providing solutions to problems.
For instance, the community groups may be able to help educate the community how to
use the new pedestrian activated signals and encourage them to use crosswalks instead of
crossing in undesignated locations.


Air Pollution

Too little is known about potential congestion, traffic speeds in the project area, and
drivers’ responses to quantitatively predict air pollution effects. However, there may be
small changes in air pollution in the study area, individuals driving in cars and riding on
diesel buses, will be exposed to the most pollution. Since the study area is relatively
small a region-wide impact on air pollution will probably be negligible.

Population and population     Predicted health impacts                      Risk of impact
subgroups                     (Positive and negative)                       definite (D) probable
                                                                            (P) speculative (S)
People who live along the     Increased air pollution                       Speculative
highway (minority and
transit dependent)

People who drive along        Increased air pollution                       Speculative
Buford Highway                Increased time spent in cars                  Probable

Automobile Level of Service

While a large number of people in the County are likely to be hospitalized for
cardiovascular diseases it is unclear 1) how much longer if would take ambulances to get
to their destination if the changes were made to Buford Highway 2) if there is any
decrease in survival for response times over 14 minutes, and 3) how many ambulances
currently take Buford Highway. From what was indicated by the police chief, traffic does
not appear to be one of the major barriers faced by emergency response vehicles,
however reductions in the automobile level of service may still lead to reduced response
times. Therefore, with the current data it is not possible to quantify the expected decrease
in survival from cardiopulmonary events.

There is also not enough data on the amount of time that would be added onto drivers
commute time. If the delays were only a few minutes, significant changes in road rage,
obesity, and physical activity would not be expected. However, if the changes lead to
significant increases in travel time there could be noticeable health outcomes.

Population and population     Predicted health impacts                      Risk of impact
subgroups                     (Positive and negative)                       definite (D) probable
                                                                            (P) speculative (S)
People who drive along        Reduction in risk for automobile accident     Probable
Buford Highway                Road rage
                              Increased obesity                             Speculative
                              Decreased physical activity                   Speculative
                              Increased response time to cardiovascular
People who rely on            events which could decrease survival rates
ambulances                                                                  Speculative
                              Increased risk of pedestrian accidents on
People who live around        side streets
Buford Highway                                                              Speculative

Economic Growth, Gentrification, and Crime
The proposed plan would increase density and land-use, both of which have been linked
to lower crime rates. In addition, the plan would increase walkability which has been
linked to increased social capital and areas with high social capital have been found to
have lower crime rates. While 5% of the new units will be saved for current residents the
majority will be displaced. While the changes to the built environment suggest there
would be a decrease in crime rates it is unclear how gentrification would affect crime

Although gentrification will almost definitely occur, there is insufficient information
about the population being displaced to make certain estimates about how gentrification
will affect their health. For instance, there is no information about the availability of
affordable housing in other nearby areas or about the financial security of home owners
(can they afford the tax increase?). There is also no baseline data about the mental health
of this group or how the move will affect their ability to find new jobs or access
transportation to their old jobs.

Population and population    Predicted health impacts                       Risk of impact
subgroups                    (Positive and negative)                        definite (D) probable
                                                                            (P) speculative (S)
Home owners                  Increased financial stability with             Probable
                             increased home value
                             Decreased financial stability due to tax       Probable
                             Decreased crime                                Speculative

Renters                      Homelessness                                   Speculative
                             Housing insecurity                             Probable
                             Decreased social capital                       Probable
                             Increased crime                                Speculative
                             Depression, anxiety, and other mental          Speculative
                             health problems

Social Capital and Crime
Many of the changes to the built environment would be expected to lead to increases in
social capital for the new residents (increased density, increased greenspace, and
increased walkability). However, any potential increases in social capital for the new
residents will likely take some time to occur as they get to know their neighbors. The
largest decreases in social capital for the current residents will occur when they are forced
to relocate to another location. Their disruption will likely vary by the distance of their
new housing from their existing housing and the number of people they know who move
with them to a similar location as well as the quality and amenities of their new

Population and population     Predicted health impacts                      Risk of impact
subgroups                     (Positive and negative)                       definite (D) probable
                                                                            (P) speculative (S)
Current residents             Decreased social capital                      Speculative
                              Increase risk of morbidity and mortality      Speculative

                              Increased social capital
New residents                 Decreased risk of morbidity and mortality     Speculative


1. Pedestrian Assessment: Total Crash Reduction Factor
       CRFt = CRF1 + (CRF2 ) (1-CRF1) + (CRF3) (1-CRF1) (1 – CRF2)
       CRF1 = .55
       CRF2 = .65
       CRF3 = .19

       CRFt = CRF1 + (CRF2 ) (1-CRF1) + (CRF3) (1-CRF1) (1 – CRF2)
       CRFt = .55 + (.65)(1 - .55) + (.19)(1 - .55)(1 - .65)
       CRFt = .55 + (.65)(.45) + (.19)(.45)(.35)
       CRFt = .55 + .2925 + .029925
       CRFt = .87

2. Pedestrian injuries: Estimated Accident Reduction
       EAR = BCR – (BCR x CRFt)
       EAR = 19 – (19 x .87)
       EAR = 19 – 16.53
       EAR = 2.47≈3

3. Pedestrian deaths: Estimated Accident Reduction
      EAR = BCR – (BCR x CRFt)
      EAR = 4 – (4 x .87)
      EAR = 4 – 3.48
      EAR = .5≈1


1. Potential Recommendations.
Make as many pedestrian improvements as possible, educate pedestrians about using
signals and crosswalks, encourage developers to reserve a certain number of new units
for low income residents, encourage developers to save greenspace, encourage green
development (LEED certified buildings) and make buildings physical activity friendly
(nice well lit stairs), and encourage policy makers to approve mixed use development.

2. What process would you use to prioritize these recommendations? You would
prioritize them based on the health impact they will have as well as their feasibility.

3. Who do you think should receive a report or presentation? What type of format do you
think would be the most effective? How can you most effectively present the data you
collected in the report?
Local organizations/community groups, the community, local businesses, the Department
of Transportation, the Federal Highway Administration, policy makers, and police
departments. The DOT and FHWA may want to read the full HIA report but you should
also have a presentation and a 1 pager (executive summary) available for those that do

not have the time to read the entire report. Have an interactive presentation for the
community and community groups since they will likely have a lot of questions and
feedback on the HIA. Policy and decision makers usually do not have a lot of time to read
full reports so have a quick presentation and a 1 page summary available to give to them.

4. What responses do you think you’ll encounter when presenting the results of this
Opposition from the community, community groups, local businesses, and possibly
policymakers (NIMBYs, NIMFYs – Not In My BackYard, Not In My FrontYard).
Transportation officials may not like other groups looking at the health effects of
highways – territory problems & highlighting the negative aspects of roads. For this case
study, some of the largest oppositions to the center medians were from local business
owners since they thought that they would decrease business. Always be ready to find
opposition where you may not expect it.


1. What kind of data would you collect for each type of evaluation?

       Process:  a) Correspondence
                  b) Meeting notes or personal log of experiences
       Impact:   a) Final copy of policy or plans
                  b) Interview decision makers
       Outcome: a) Injury data
                 b) Gentrification/income data

2. What types of evaluation would you use for this case study?
You should always try to at least collect process and impact evaluation data. Since this
information is very important and should not take a lot of time and resources to collect.
Your ability to collect outcome evaluation data is usually limited by the data that is
collected by other sources available to you. Additionally, staff time and the length of the
project may affect your ability to conduct an outcome evaluation.


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