Excerpt
A second example of a failure to anticipate the health effects of policy and planning decisions is
apparent in examining the health effects of transportation infrastructure. The Interstate Highway Act of
1956 introduced the development of a transportation infrastructure that has had multiple implications for
health, both favorable and unfavorable. Over the last several decades, the transportation infrastructure
has focused on road-building, private automobiles, and transportation of goods and has resulted in “an
unprecedented level of individual mobility and facilitated economic growth” (APHA 2010, p. 2). It has
shaped land-use patterns throughout the United States and has had implications for air quality, toxic
exposures, noise, traffic collisions, pedestrian injuries, and neighborhood physical and social features
potentially linked to health (Frank et al. 2006).
Transportation accounts for 30% of U.S. energy demand, and in 2008, tailpipe emissions from
motor vehicles and impacts from fuel production contributed an estimated $56 billion in health and
related damages (NRC 2010).1 The costs partly reflect transportation-investment decisions that are
focused on maximizing the safety and efficiency of automobile use and have resulted in important
efficiencies in motor-vehicle transportation. The decisions have also led to transportation systems that
discourage pedestrian and bicycle travel because of sheer distances between destinations, lack of adequate
infrastructure for pedestrian travel, and increased hazards associated with pedestrian traffic—for example,
unsafe pedestrian crossings and absence of pedestrian routes that are separate and safe from motor
vehicles (APHA 2010). Personal and societal costs of the transportation decisions include nearly 34,000
deaths in 2009 due to motor-vehicle collisions; more than 12% of the deaths were of pedestrians (NHTSA
2010). The emphasis on motorized transport has been associated with more driving (Ewing and Cervero
2001; Frank et al. 2007), less physical activity (Saelens et al. 2003; Frank et al. 2005, 2006; TRB 2005),
higher rates of obesity (Ewing et al. 2003; Frank et al. 2004; Lopez 2004), and higher rates of air
pollution (Frank et al. 2000; Frank and Engelke 2005; Frank et al. 2006). A partial accounting of costs
associated with the health effects, shown in Table 2-1, totals about $400 billion in 2008.
There is evidence that adverse health effects associated with transportation disproportionately
affect members of racial and ethnic minorities and those in lower socioeconomic strata and thus
contribute to persistent racial, ethnic, and socioeconomic disparities in health (Houston et al. 2004;
Apelberg et al. 2005; Ponce et al. 2005; Wu and Batterman. 2006; Chakraborty and Zandbergen 2007).
In the absence of systematic assessment of health effects and their associated costs, the implications of
transportation decisions for health and health inequities cannot be factored into the process of making
decisions about transportation infrastructure. As a result, the health-related effects and their costs to
individuals and society are hidden or invisible products of transportation-related decisions.
https://www.nap.edu/catalog.php?record_id=13229
Description
Factoring health and related costs into decision making is essential to confronting the nation’s health problems and enhancing public well-being. Some policies and programs historically not recognized as relating to health are believed or known to have important health consequences. For example, public health has been linked to an array of policies that determine the quality and location of housing, availability of public transportation, land use and street connectivity, agricultural practices and the availability of various types of food, and development and location of businesses and industry.
Improving Health in the United States: The Role of Health Impact Assessment offers guidance to officials in the public and private sectors on conducting HIAs to evaluate public health consequences of proposed decisions — such as those to build a major roadway, plan a city’s growth, or develop national agricultural policies — and suggests actions that could minimize adverse health impacts and optimize beneficial ones.
Several approaches could be used to incorporate aspects of health into decision making, but HIA holds particular promise because of its applicability to a broad array of programs, consideration of both adverse and beneficial health effects, ability to consider and incorporate various types of evidence, and engagement of communities and stakeholders in a deliberative process. The report notes that HIA should not be assumed to be the best approach to every health policy question but rather should be seen as part of a spectrum of public health and policy-oriented approaches.
The report presents a six-step framework for conducting HIA of proposed policies, programs, plans, and projects at federal, state, tribal, and local levels, including within the private sector. In addition, the report identifies several challenges to the successful use of HIA, such as balancing the need to provide timely information with the realities of varying data quality, producing quantitative estimates of health effects, and engaging stakeholders.
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