Rajiv Bhatia

An area-level model of vehicle-pedestrian injury collisions with implications for land use and transportation planning

There is growing awareness among urban planning, public health, and transportation professionals that design decisions and investments that promote walking can be beneficial for human and ecological health. Planners need practical tools to consider the impact of development on pedestrian safety, a key requirement for the promotion of walking. Simple bivariate models have been used to predict changes in vehicle-pedestrian injury collisions based on changes in traffic volume. We describe the development of a multivariate, area-level regression model of vehicle-pedestrian injury collisions based on environmental and population data in 176 San Francisco, California census tracts. Predictor variables examined included street, land use, and population characteristics, including commute behaviors. The final model explained approximately 72% of the systematic variation in census-tract vehicle-pedestrian injury collisions and included measures of traffic volume, arterial streets without transit, land area, proportion of land area zoned for neighborhood commercial and residential-neighborhood commercial uses, employee and resident populations, proportion of people living in poverty and proportion aged 65 and older. We have begun to apply this model to predict area-level change in vehicle-pedestrian injury collisions associated with land use development and transportation planning decisions.

Use of Health Impact Assessment in the U.S.

OBJECTIVES To document the growing use in the United States of health impact assessment (HIA) methods to help planners and others consider the health consequences of their decisions. METHODS Using multiple search strategies, 27 HIAs were identified that were completed in the U.S. during 1999-2007. Key characteristics of each HIA were abstracted from published and unpublished sources. RESULTS Topics examined in these HIAs ranged from policies about living wages and after-school programs to projects about power plants and public transit. Most HIAs were funded by local health departments, foundations, or federal agencies. Concerns about health disparities were especially important in HIAs on housing, urban redevelopment, home energy subsidies, and wage policy. The use of quantitative and nonquantitative methods varied among HIAs. Most HIAs presented recommendations for policy or project changes to improve health. Impacts of the HIAs were infrequently documented. CONCLUSIONS These completed HIAs are useful for helping conduct future HIAs and for training public health officials and others about HIAs. More work is needed to document the impact of HIAs and thereby increase their value in decision-making processes.

Growing the field of health impact assessment in the United States: An agenda for research and practice

Health impact assessment (HIA) methods are used to evaluate the impact on health of policies and projects in community design, transportation planning, and other areas outside traditional public health concerns. At an October 2004 workshop, domestic and international experts explored issues associated with advancing the use of HIA methods by local health departments, planning commissions, and other decisionmakers in the United States. Workshop participants recommended conducting pilot tests of existing HIA tools, developing a database of health impacts of common projects and policies, developing resources for HIA use, building workforce capacity to conduct HIAs, and evaluating HIAs. HIA methods can influence decisionmakers to adjust policies and projects to maximize benefits and minimize harm to the publics health.

Organochlorine pesticides and male genital anomalies in the child health and development studies

Increasing rates of cryptorchidism and hypospadias in human populations may be caused by exogenous environmental agents. We conducted a case–control study of serum levels of p,p′-dichlorodiphenyltrichloroethane (DDT) and its major metabolite, p,p′-dichlorodiphenyldichloroethylene (DDE), and cryptorchidism and hypospadias in the Child Health and Development Study, a longitudinal cohort of pregnancies that occurred between 1959 and 1967, a period when DDT was produced and used in the United States. Serum was available from the mothers of 75 male children born with cryptorchidism, 66 with hypospadias, and 4 with both conditions. We randomly selected 283 controls from the cohort of women whose male babies were born without either of these conditions. Overall, we observed no statistically significant relationships or trends between outcomes and serum measures. After adjusting for maternal race, triglyceride level, and cholesterol level, compared with boys whose mothers had serum DDE levels < 27.0 ng/mL, boys whose mothers had serum DDE levels ≥61.0 ng/mL had odds ratios of 1.34 [95% confidence interval (CI), 0.51–3.48] for cryptorchidism and 1.18 (95% CI, 0.46–3.02) for hypospadias. For DDT, compared with boys whose mothers had serum DDT levels < 10.0 ng/mL, boys whose mothers had serum DDT levels ≥20.0 ng/mL had adjusted odds ratios of 1.01 (95% CI, 0.44–2.28) for cryptorchidism and 0.79 (95% CI, 0.33–1.89) for hypospadias. This study does not support an association of DDT or DDE and hypospadias or cryptorchidism.

Integrating Human Health into Environmental Impact Assessment: An Unrealized Opportunity for Environmental Health and Justice

Objectives The National Environmental Policy Act and related state laws require many public agencies to analyze and disclose potentially significant environmental effects of agency actions, including effects on human health. In this paper we review the purpose and procedures of environmental impact assessment (EIA), existing regulatory requirements for health effects analysis, and potential barriers to and opportunities for improving integration of human health concerns within the EIA process. Data sources We use statutes, regulations, guidelines, court opinions, and empirical research on EIA along with recent case examples of integrated health impact assessment (HIA)/EIA at both the state and federal level. Data synthesis We extract lessons and recommendations for integrated HIA/EIA practice from both existing practices as well as case studies. Conclusions The case studies demonstrate the adequacy, scope, and power of existing statutory requirements for health analysis within EIA. The following support the success of integrated HIA/EIA: a proponent recognizing EIA as an available regulatory strategy for public health; the openness of the agency conducting the EIA; involvement of public health institutions; and complementary objectives among community stakeholders and health practitioners. We recommend greater collaboration among institutions responsible for EIA, public health institutions, and affected stakeholders along with guidance, resources, and training for integrated HIA/EIA practice.

Estimation of Health Benefits From a Local Living Wage Ordinance

OBJECTIVES This study estimated the magnitude of health improvements resulting from a proposed living wage ordinance in San Francisco. METHODS Published observational models of the relationship of income to health were applied to predict improvements in health outcomes associated with proposed wage increases in San Francisco. RESULTS With adoption of a living wage of

Protecting Health Using an Environmental Impact Assessment: A Case Study of San Francisco Land Use Decisionmaking

11.00 per hour, we predict decreases in premature death from all causes for adults aged 24 to 44 years working full-time in families whose current annual income is

Using community-based participatory research to design and initiate a study on immigrant worker health and safety in San Francisco's Chinatown restaurants.

20,000 (for men, relative hazard [RH] = 0.94, 95% confidence interval [CI] = 0.92, 0.97; for women, RH = 0.96, 95% CI = 0.95, 0.98). Improvements in subjectively rated health and reductions in the number of days sick in bed, in limitations of work and activities of daily living, and in depressive symptoms were also predicted, as were increases in daily alcohol consumption. For the offspring of full-time workers currently earning

Health impact assessment in San Francisco: Incorporating the social determinants of health into environmental planning

20,000, a living wage predicts an increase of 0.25 years (95% CI = 0.20, 0.30) of completed education, increased odds of completing high school (odds ratio = 1.34, 95% CI = 1.20, 1.49), and a reduced risk of early childbirth (RH = 0.78, 95% CI = 0.69, 0.86). CONCLUSIONS A living wage in San Francisco is associated with substantial health improvement.

Competitive Foods, Discrimination, and Participation in the National School Lunch Program

Laws and regulations for an environmental impact assessment enable a health impact assessment whenever physical changes in the environment may significantly affect health. In this case study, I describe 2 instances in which a local public health agency used the procedural requirements for an environmental impact assessment to account for societal-level health determinants that are not traditionally evaluated in land-use decisions. These examples show that a public health critique can contribute both to the scope of analysis in an environmental impact assessment and to substantive changes in land-use decisions. I have evaluated this health appraisal approach as a form of a health impact assessment and will make recommendations for law, research, and practice that support its technical, cultural, and political feasibility.