The mission of the Center for Health Policy is to collaborate with state and local government and public and private health care organizations in policy and program development, program evaluation, and applied research on critical health policy issues. The views expressed are those of the authors and do not necessarily reflect the positions of Indiana University and the Center's partner organizations or funders. In 1986, the World Health Organization (WHO) called on policy makers to “be aware of the health consequences of their decisions and accept their health responsibilities” [1].
In 1995, the Commission of the European Communities, in article 129 of the European Union treaty, determined the Health Impact. Yet it is only in the last few years that HIAs have been part of policy, project and. HIP is leading a national initiative to promote the use of health impact assessments in the United States [3].
A literature review is conducted to collect secondary data from other studies and HIAs. However, city planners have recently made connectivity and community cohesion through transportation a priority, as evidenced by the expansion of the Monon Trail, the Cultural Trail, and a new project to improve the route's bikeability. The focus of the HIA will be on predicting the impact of bus service expansion (tripling of routes, hours and days of operation) on physical activity, obesity and diabetes.
It is important to note that health impact assessments are new in the United States.
Physical Activity
Increase the accountability of project planning and selection to ensure infrastructure that supports active transportation and other forms of physical activity. Healthy City Design; Transport end users; Health professional associations; INDTO; Indy Connect; AARP; and the Marion County Health Department. Living closer to transit increases the use of public transportation, even with personal transportation available [19].
Profiling the existing physical activity status of Hoosiers was obtained from the CDC SMART data of the US list of three positives and three negatives regarding health that could result from increased use of public transportation. Expand complete streets programs in the region (programs that promote walking/cycling with more sidewalks, bike lanes and bike racks).
Additionally, to determine the impact of the project, conduct a survey of Marion County residents regarding the expansion of bus service. Indianapolis area and this HIA assessed the impact this change could have on increased physical activity in Marion County. People who use public transportation spend 19 minutes a day walking to and from transit stops and can more easily reach the CDC-recommended 30 minutes of daily physical activity.
IndyGo's bus expansion plan has a potential impact on obesity levels in Marion County and the HIA will make recommendations. Unfortunately, obesity rates in the United States have increased rapidly in recent years.
Obesity
Stakeholders invested in obesity prevention include: people who are obese or overweight; health care providers who care for obese patients, including doctors, nurses, and dieticians; school corporations interested in preventing childhood obesity; and the Marion County Health Department. Census, Centers for Disease Control and Prevention (CDC), IndyConnect, IndyGo, and the Marion County Health. In addition, primary data were collected from interviews with key informants, including a collaborator on the 2005 Marion County Obesity Needs Assessment and a member of Indianapolis Metropolitan Planning.
Based on a study by Finkelstein, Fiebelkorn, and Wang [30], obesity-attributable medical expenses for Hoosier adults were approximately $1.6 billion, which included Medicaid and Medicare expenditures of $522 million and. Obesity in Marion County The most recent information available on obesity in Marion County is from the 2005 Adult Obesity Assessment, conducted by Marion County Health. The rise in obesity and diet-related diseases may be worse in some communities due to limited access to affordable, nutritious food.
Increasing access to affordable, healthy food is an important strategy in reducing obesity rates and increasing overall health within the population. By tripling bus service in Marion County, access to healthy food will increase; this is especially so. The HIA provides a baseline for the health status of Marion County residents, however the specific impact of expanding bus services on resident health can only be monitored and evaluated after the project is completed.
We propose that the health indicators assessed for this HIA (obesity rates, access to healthy foods) be reassessed two years after the expansion of bus services and. Additionally, a survey of Marion County residents on bus service expansion, including frequency of bus service use, reason for use (eg, work, grocery shopping, etc.), distance or blocks of assessed walking distance to and from the bus station, satisfaction with services and areas in need of improvement. We found that 35% of residents in Marion County are overweight and an additional 26% were obese.
Those most affected by obesity were vulnerable populations, especially black women and those in the lower economic status. We recommend expanding the bus system in Marion County to help residents have greater access to healthy food options, increase their level of physical activity and mobility, and reduce obesity rates.
Diabetes
Individuals with diabetes or at risk for diabetes in Marion County were the population examined. No tobacco use Stakeholders invested in diabetes prevention and treatment include: people with diabetes or at risk for diabetes, especially if they do not have access to a vehicle;. Diabetic retinopathy is a common complication of diabetes that affects the small blood vessels of the retina, leading to impaired vision over time.
According to the results of the 2009 Behavioral Risk Factor Surveillance System of Indiana, adults aged 35 to 44 reported that a doctor-diagnosed diabetes had affected their eyes. The results showed that a large proportion of IndyGo riders belong to vulnerable populations with a higher risk of diabetes: 65% of riders were African American (compared to 31% Caucasian); 70% of riders earned less than $25,000 a year;. Improve bus access, especially in areas with a high incidence of diabetes (the north central area of Marion County has the highest incidence of diabetes) to enable residents to get to the doctor.
Raise awareness of diabetes and how it relates to public transport by creating a fact sheet that highlights the most relevant information. In addition, greater bus availability will allow residents, especially those without access to a car, to travel to health facilities, diabetes education classes, diabetes support groups and other helpful resources, further reducing diabetes rates in the county. Physical Activity Guidelines for Americans, 2008, United States Department of Health and Human Services, Office of Disease Prevention and Health Promotion: Washington, DC.
Heath, G.W., The role of the public health sector in promoting physical activity: national, state and local applications. Frank, L.D., & Kavage, S., The National Plan for Physical Activity: The Enabling Role of the Built Environment.
