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Developing Analytic Forecasting Methodologies for Health Impact Assessment. Rajiv Bhatia, MD, MPH San Francisco Department of Public Health. Presentation Overview. The Distinction Among Assessment of Existing Conditions vs. Monitoring vs. Forecasting Three Examples:

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Developing analytic forecasting methodologies for health impact assessment

Developing Analytic Forecasting Methodologies for Health Impact Assessment

Rajiv Bhatia, MD, MPH

San Francisco Department of Public Health


Presentation overview
Presentation Overview Impact Assessment

  • The Distinction Among Assessment of Existing Conditions vs. Monitoring vs. Forecasting

  • Three Examples:

    • Existing Forecasting Method

    • New Method Based on Existing Research

    • New Method Based on New Research

  • Implications for Alaska HIA

Rajiv Bhatia

Alaska Health Impact Assessment Training 2008


Example 1 assessment and mitigation of roadway air pollution impacts on sensitive uses
Example 1 Impact Assessment: Assessment and Mitigation of Roadway Air Pollution Impacts on Sensitive Uses

  • State and National air quality standards concern limited pollutants

  • Regional monitoring does not capture intra-urban variation in exposure

  • Regulations limit tailpipe emissions per mile but not vehicle intensity

  • Local agencies do not regulate air quality land use conflicts related to high volume roadways

Rajiv Bhatia

Alaska Health Impact Assessment Training 2008


Available health effects assessment methods for air quality assessment
Available Health Effects Assessment Methods For Air Quality Assessment

  • Dose response functions can associate area-level air quality exposures with health effects

  • Air quality dispersion models and other techniques can assess roadway related air quality exposure based on:

    • Vehicle Flow, Speed

    • Emissions

    • Meteorology

    • Relationship between Facilities and Sensitive Receptors

Rajiv Bhatia

Alaska Health Impact Assessment Training 2008


Estimating mortality impacts from exposure to pm 2 5 based on carb cr functions
Estimating Mortality Impacts From Exposure to PM Assessment2.5 based on CARB CR Functions

Mortality = R0• [exp(-*∆PM2.5 -1) ] • P

  • R0 = Baseline Mortality Rate

  •  = Coefficient Derived from Relative Risk

  • P = Affected Population

Rajiv Bhatia

Alaska Health Impact Assessment Training 2008


Spatial extent of vehicle pm 2 5 all vehicle sources using cal3qhcr west oakland ca
Spatial Extent of Vehicle PM Assessment2.5 All Vehicle Sources using CAL3QHCR—West Oakland, CA

Rajiv Bhatia

Alaska Health Impact Assessment Training 2008


Applications
Applications Assessment

  • Location of Sensitive Uses

  • Transportation System Planning

  • Indoor Air Quality Ventilation Standards

Rajiv Bhatia

Alaska Health Impact Assessment Training 2008


Example 2 quantifying the health benefits of a living wage
Example 2 Assessment: Quantifying the Health Benefits of a Living Wage

  • Few analyses health benefits of labor policies Plausible relationship meditated through material needs

  • Consistent association among high quality epidemiologic studies on income and health looking at multiple health outcomes

Rajiv Bhatia

Alaska Health Impact Assessment Training 2008


Data required for impact analysis
Data Required For Impact Analysis Assessment

  • The baseline income of the population targeted by the living wage

  • The estimated income gains of workers benefiting from the new wage

  • A dose response function between income and health outcomes

Rajiv Bhatia

Alaska Health Impact Assessment Training 2008


Inclusion criteria for studies providing dose response relationships
Inclusion Criteria For Studies Providing Dose-Response Relationships

  • English language peer reviewed literature 1990-1998

  • Studies of income and mortality, hospitalizations, or health status indicators

  • Subjects representative of the U.S. general population

  • Income measured at the household, family or individual level

  • Longitudinal design

  • Statistical adjustment for age and gender year of income ascertainment provided

  • Income applied as a continuous variable

Rajiv Bhatia

Alaska Health Impact Assessment Training 2008


Estimated Health Effects Due To Living Wage Income Gains For Workers With A Current Family Income of $20,000

Rajiv Bhatia

Alaska Health Impact Assessment Training 2008


Example 3 area level model of pedestrian vehicle collisions
Example 3 Workers With A Current Family Income of $20,000: Area-level Model of Pedestrian Vehicle Collisions

  • Transportation Analyses in EIA provides little analysis of Pedestrian Safety Impacts:

  • Vehicle-pedestrian injuries and fatalities are preventable.

  • Key area-level environmental determinants of collisions include:

    • Traffic volumes

    • Traffic speed

    • Pedestrian activity

Rajiv Bhatia

Alaska Health Impact Assessment Training 2008


Vehicle pedestrian injury collisions san francisco california census tracts 2001 2005
Vehicle-pedestrian injury collisions: San Francisco, California census tracts (2001–2005)

An Environmental Approach:

Evident area-level patterns – correlate with the freeway network, concentrations of streets with heavy arterial traffic, pedestrian activity centers (e.g., downtown, Golden Gate Park).

Rajiv Bhatia

Alaska Health Impact Assessment Training 2008


Model development framework

Built Environment California census tracts (2001–2005)

:

street and land use

characteristics

Vehicle

-

Pedestrian Collisions

Population Characteristics

:

(

Number

):

number of residents and workers

,

pedestrian injury

socio

-

demographic characteristics

and death

Travel Behaviors

:

walking

,

public transit

,

private vehicle use

Model development framework

How do transportation, land use, and population factors

predict change in pedestrian injury collisions in San Francisco census tracts?

Rajiv Bhatia

Alaska Health Impact Assessment Training 2008


Vehicle pedestrian injury collision model
Vehicle-Pedestrian Injury Collision Model California census tracts (2001–2005)

  • Publicly available data (SWITRS, U.S. Census, SF Planning, SF MTA)

  • Traffic Volume, Street Characteristics – SF DPH/UC Berkeley

  • Continuous, census-tract level variables

  • Multivariate, linear regression model – predicts the natural log of vehicle-pedestrian injury collisions:

    ln(PIC) = b0 + ∑biXi

Rajiv Bhatia

Alaska Health Impact Assessment Training 2008


Vehicle pedestrian injury collision final model variables
Vehicle-Pedestrian Injury Collision Final Model Variables California census tracts (2001–2005)

  • Traffic volume (+)

  • Arterial streets (+)

  • Neighborhood commercial zoning (+)

  • Employees (+)

  • Residents (+)

  • Land area (-)

  • Below poverty level (+)

  • Age 65 and over (-)

Rajiv Bhatia

Alaska Health Impact Assessment Training 2008


Final Ordinary Least Squares Regression Model Vehicle-Pedestrian Injury Collisions: San Francisco, California, 2001-2005 (n=175 census tracts)

a Excludes grade-separated street segments inaccessible to pedestrians.

Rajiv Bhatia

Alaska Health Impact Assessment Training 2008


Comparing the simple bivariate model to our multivariate model approach
Comparing the Simple Bivariate Model to Our Multivariate Model Approach

Holding all covariates constant (as above), the model is equivalent to a power function with β=0.753.

Rajiv Bhatia

Alaska Health Impact Assessment Training 2008


Vehicle pedestrian injury collision model eastern neighborhoods plans eir analysis
Vehicle-Pedestrian Injury Collision Model: Eastern Neighborhoods Plans EIR Analysis

a Areas defined based on SF Planning boundaries, and census tracts used for the Eastern Neighborhoods Rezoning Socioeconomic Impacts analysis.

b Census Tract, Aggregate Traffic Volumes.

c Based on the Air Quality Chapter, Eastern Neighborhoods Pre-draft Environmental Impact Report, 2007.

d Population increases based on increased population and housing units projected in Rezoning Option B, detailed in the draft Eastern Neighborhoods Rezoning and Community Plans, Environmental Setting and Impacts, April 2007.

Rajiv Bhatia

Alaska Health Impact Assessment Training 2008


Vehicle pedestrian injury collision model eastern neighborhoods plans eir analysis1
Vehicle-Pedestrian Injury Collision Model: Eastern Neighborhoods Plans EIR Analysis

Predicted

% change in pedestrian injury collisions based on estimated changesin

resident population and traffic volume.

20%

21%

15%

24%

Rajiv Bhatia

Alaska Health Impact Assessment Training 2008


Vehicle pedestrian injury collision model application
Vehicle-Pedestrian Injury Collision Model: Application Neighborhoods Plans EIR Analysis

  • Land Use Development

  • Transportation Facilities Planning and Funding

  • Congestion Pricing and other Transportation Policy

Rajiv Bhatia

Alaska Health Impact Assessment Training 2008


A general approach to predicting health effects using epidemiological research
A General Approach to Predicting Health Effects Using Epidemiological Research

  • Develop Clear Analytic Objectives

  • Literature Review

    • Develop study criteria and data needs

    • Identify Sources

    • Establish Adequacy of Existing Reviews

    • Evaluate studies

    • Formal summary and documentation of review

  • Make qualitative inferences on health effects

  • If appropriate and feasible, quantify effects

    • Select or generate a summary effect measure

    • Estimate Baseline and Changes to “Exposure”

    • Predict Health Impacts (PAR, Forecasting)

  • Qualify certainty of assessment & predictions

Rajiv Bhatia

Alaska Health Impact Assessment Training 2008


Developing forecasting methods for alaskan hia
Developing Forecasting Methods for Alaskan HIA Epidemiological Research

  • Some environmental - health relationships may be generalizable from general population studies

  • HIA forecasting methods in Alaska probably requires new research environmental-health relationships

  • Data collection and monitoring will support long term research efforts

Rajiv Bhatia

Alaska Health Impact Assessment Training 2008


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