Lessons from Latin American Cities RESULTS BRIEF No. 1 September 2020

Urban transformations and health: Results from the TransMiCable evaluation

The TrUST research project seeks to understand how TransMiCable and the urban transformations that accompany this intervention impact people’s health. This study is part of the SALURBAL project, and Neighborhood emerges from a health in all policies approach to satisfaction advocating for sustainable, active, safe, and inclusive mobility. This policy brief presents results from the evaluation Free Air of the multi-dimensional transformations observed time quality in the areas of influence of TransMiCable in Ciudad Bolívar, . Research was carried out between 2018 and 2020 with residents of Ciudad Bolívar and San Cristóbal, with a multidisciplinary team and a mixed-methods approach. Transport Physical activity Understanding these transformations and the way in which they are experienced by local residents allows for a timely assessment of the project and will guide future interventions. Quality Security of life

RESULTS FROM THE TRANSMICABLE EVALUATION 21 Health in all policies

Transport: a basic service and social determinant of health

Health in All Policies is an approach that seeks to understand and transform the way in which urban environments affect health, in order to promote more inclusive and healthy cities (1). Social determinants of health are the daily conditions in which people live, move, and work (2), as determined by the urban environment (3). Inaugurated in December 2018 System length: 3.43 km The case of TransMiCable in Ciudad Bolívar allows Number of cabins: 163 us to evaluate the impact of rapid urban expansion Number of stations: 4 and the specific challenges faced by an Daily passengers pre-pandemic: 21,000 Daily passengers during the pandemic: unincorporated neighborhood on the social 10,000-15,000 determinants of health (4, 5, 6).

Intersectoral governance: Transport and urban renewal

TransMiCable system and interventions in Ciudad Bolívar In 2007, community leaders in Ciudad

Bolívar were inspired by Medellín and 6 mobilized to demand the construction 3 of a cable car system (7). This activism was fundamental to sustaining the 1 2

project through multiple government 5 administrations. 4

The implementation of TransMiCable 1. Illimani Park 4. Manitas Station cable car system and accompanying 2. Paradise Lookout Station 5. John Paul II Station urban renewal interventions reduce 3. Lookout Point 6. Tunal Station segregation by connecting this community with the rest of the city Physical improvements Local markets and increasing access to to homes Community centers urban services. Geomorphological Citizen services office hazard reduction Recreational and cultural Tourist office infrastructure

2 URBAN TRANSFORMATIONS AND HEALTH TransMiCable makes Changes in travel time within the mobility easier area of impact of TransMiCable

180 170 -21.6 min. 160 80% of trips made by Ciudad 150 (-15.0%) Bolívar residents are by public 140 130 transport (8). 120 110 -10.6 min. The average travel time of Ciudad 100 90 (-12.0%) Bolívar residents by public trans- 80 port is 59.3 minutes each way. 70 -15.5 min. 4.4 min. 60 Time (Minutes) 50 (-43.9%) (21.5%) The average time of compulsory 40 30 and non-compulsory trips for 20 TransMiCable users decreased by 10 0 22 minutes per trip. p-value 0.005 0.056 0.001 0.008 Time savings are greater in waiting time than in time spent in T0 * T1 ** T0 T1 T0 T1 T0 T1 a vehicle. Total Time in vehicle Waiting time Walking

Satisfaction levels

12% of the adult population started using the “The time that my husband saves in going up from TransMiCable regularly. the Tunal station is 50 minutes compared to the feeder bus service. That is the best, that he has time to share with us as a family” Satisfaction with in Ciudad Bolívar Resident rose from 4.4/10 to 5.4/10.

Satisfaction with the TransMiCable is 8.7/10.

The main expectations with the arrival of TransMiCable focused on reduced travel time, improved safety (in the vehicle), and travel comfort. After the cable car's implementation, these expectations were exceeded

* T0: Baseline measurement ** T1: Follow up measurement after the intervention

RESULTS FROM THE TRANSMICABLE EVALUATION 23 TransMiCable gave us Average free time leisure activities in more free time the last month per person

“Before, we had a 45-minute commute. With TransMiCable, we have a journey of 13 minutes. We have 30 minutes to rest. In my case, I would leave at 4am to catch transport, now I can easily leave at close to 5am” Resident realized in a month # of leisure activities 8.4 8.7 8.1 5.7

T0 T1 T0 T1 Ciudad Bolívar San Cristóbal

“This project is being visited by the Secretariat of Housing and it will be finished soon. It gives a lot of joy; it gives Participants from Ciudad Bolívar reported good image, and it will change inhabitants’ an increase in time spent on activities quality of life: they won’t have to get dirty that are not work or household chores. anymore, and it’s very beautiful" Resident

TransMiCable transformed our neighborhood

41% of participants in Ciudad Bolívar increased their satisfaction with the neighborhood.

19% of participants in Ciudad Bolívar identi ed neighborhood parks that they had not previously identi ed, and they assigned these parks the highest rating.

4 URBAN TRANSFORMATIONS AND HEALTH TransMiCable gave us cleaner air

Inhaled dose per trip in transport microenvironments )

-1 40 30 10 20 x 10 less

eBC (µg trip 30.8 27.3 13.8 13.1 16.6 15.6 1.6 0 )

-1 80 60 5 (µg trip 40 x 2.5 20 less

PM 50.1 85.4 40.6 56.1 39.1 51.7 10.2 0 - 2500

) 2000 -1 1500 9 1000 x 500 less CO (µg trip 2419 2011 2131 2458 1772 2170 255 0

T0 T1 T0 T1 T0 T1 T1 Integrated transport system Pedestrian Feeder bus TransMiCable

In 2018, the annual average concentrations of PM2.5 (fine particulate matter) in Ciudad Bolivar were 20ug/m3, which exceeds the annual recommended maximum of the World Health Organization (9).

Exposure to PM2.5, eBC (soot) and CO (carbon monoxide) in TransMiCable cabins is lower than in other transport microenvironments (feeder bus, SITP, or informal vehicles).

The inhaled dose per trip is less for trips that include the cable car.

Simulated inhaled dose per trip

400 200 14000 p-value<0.0001 p-value<0.0001 p-value<0.0001 12000 Feeder bus + TransMilenio 300 150 10000 8000 200 100 6000 100 50 4000 TransMiCable + TransMilenio 2000 0 0 0

PM2.5(µg) eBC(µg) CO(µg)

RESULTS FROM THE TRANSMICABLE EVALUATION 25 With TransMiCable, Levels of moderate and vigorous physical activity we are more active are higher among TransMiCable users

“This is our Ilimaní park where neighborhood kids Average daily minutes of Moderate or come to enjoy recreational activities. We hope Vigorous Physical Activity* they get more involved in these activities because there are many who are getting 60 involved in drugs” Resident 50

40

We observed an increase in moderate and vigorous physical activity in parks 30 in Ciudad Bolívar.

20 57.6 45.0 29.1 10

0 Public Private TransMiCable Transport Transport

SOPARC **: Moderate or Vigorous Physical Activity observed in parks p<0.001 p=0.002 The park renovation (of Illimani and % Manitas) created space for socializing 100 and physical activity. 90 80 70 57.8 60 72.8 50 84,4 85.0 40 30 20 42.2 27.2 10 15.6 15.0% 0 T0 Ilimaní T1 T0 Manitas T1 ** SOPARC is a direct observation instrument for evaluating parks and Physical Activity recreation areas, including levels of physical activity of park users. Sedentary Moderate or Vigorous

6 URBAN TRANSFORMATIONS AND HEALTH TransMiCable improved our quality of life

Health-related quality of life

100 90 80 Health-related quality of life 70 increased by 3.9 points 60 among participants from 50 Ciudad Bolívar.

Score 40 30 Health-related quality of life 20 51.8 56.2 64.2 66.3 53.3 52.7 62.0 64.6 increased among women in 10 Ciudad Bolívar by 4.4 points; 0 in men there was no change. T0 T1 T0 T1 T0 T1 T0 T1 Women Men Women Men Ciudad Bolívar San Cristóbal

“TransMiCable is critical because around here everything had been totally abandoned by the authorities. But right now, you can see another reality, and it is very nice to have a better quality of life” Resident

RESULTS FROM THE TRANSMICABLE EVALUATION 27 TransMiCable increased “In terms of safety inside the cabins, that has improved a lot; one feels very safe, our sense of security one is seated, calm. This system has many means of security: internal camera, each station has police officers, and there are applications where you Victimization and perceived insecurity report any incidents” Resident 100 90 80 70 60 In 2019, 18.5% of homicides in Bogotá 50 occurred in Ciudad Bolívar. 40 The annual homicide rate in Ciudad 30 Bolívar is 25.6 per 100,000 inhabitants. 20 After the implementation of TransMiCa- 10 51.8 56.2 64.2 66.3 53.3 52.7 62.0 64.6 ble, perceived insecurity decreased 0 among residents of Ciudad Bolívar. Residents of Ciudad Bolívar reported a T0 T1 T0 T1 T0 T1 T0 T1 decrease in the number of homes Perceived Perceived victims of theft and robbery. Victimization Victimization insecurity insecurity

Ciudad Bolívar San Cristóbal

TransMiCable decreased our mistrust in public institutions

The percentage of people reporting low or no Among TransMiCable users, levels of trust in the government dropped from 93% mistrust of neighbors dropped from 62% to 86%. to 58%. The percentage of change in the perception of TransMiCable has reduced mistrust in the mistrust among TransMiCable users was 10%. local government.

100 100

80 80

60 60

40 40 62.2 63.5 92.8 86.8 78.5 78.3 62.1 57.9 92.6 82.1 76.8 77.9

20 % of population that 20 % of population that report low or no trust report low or no trust

0 0

T0 T1 T0 T1 T0 T1 T0 T1 T0 T1 T0 T1 Neighbors Government Police Neighbors Government Police

8 URBAN TRANSFORMATIONS AND HEALTH Intended and unintended TransMiCable Ripple Effects effects of TransMiCable

“At a certain hour in the morning it arrives, and everyone Neighborhood “The panorama seen from the cable car cabins is pushing for a seat. The solution is to send the buses is very beautiful”. faster and more often”. aesthetics TransMilenio zonal service “In the Tunal station, there is daily disorder: robberies, Community “I really like it because TransMiCable attendants come there is no common courtesy, there is no signage, you networks and greet you, no one pushes other people”. cannot walk because of all of the street vendors”.

“TransMiCable has been a great help for everyone “We have photos of foreigners enjoying the TransMiCable because before I used to take almost an hour to travel Travel time Transport Social capital Tourism and we locals enjoy it too”. from the station. That has already changed”.

“I think that the best option would be to either extend the “How wonderful to come in tired after a tough [inter-modal] transfer time, or offer a feeder bus, as a way to Availability of means TransMilenio commute and take the TransMiCable. get cheap transport”. of transport Enjoyment Sitting down properly, as it should be, and before you know it you’ve already arrived at your stop”.

“Sometimes it is very windy, and it moves the cable car Delay due to “Before they used to say: "Oh no, I'm not going to cabins. This slows down the movement a little and the Ciudad Bolívar" but now anyone wants to come to ride arrives a bit behind schedule”. weather conditions Ciudad Bolívar, even if it is only to ride TransMiCable. They come with another mindset when they visit”. Neighborhood pride “The conditions of the Tunal station are not suitable for Information for the TransMiCable system because there is no clear route “For me, that is like flying in an airplane”. or orientation”. using the system

“A person who earns minimum wage sometimes must pay New up to three rides because when they arrive at the station Transfer times the 40-minute transfer time has expired”. challenges “The recyclers break the garbage bags, take out the best for themselves and leave the rest of the trash here”.

TransMiCable - Community Persistent barriers “The key has been TransMiCable, not the surrounding areas”. “We need a hospital, another CAI [Inmediate Attention dialogue Center/Police]. There is only one Supercade [citizen services office] in Manitas for all the people there. “A major difficulty has been the lack of information when the service stops and the Tunal station becomes Suspension of service “In TransMiCable you see order, common courtesy, not congested during peak hours”. Coexistence like in the TransMilenio”. Civic culture “I really like it because in TransMiCable you come and “The police don’t really accompany citizens as they they greet you, the person does not push over the other make it seem”. Police presence person”.

“It is a very strong security system, with internal and Security external cameras. You travel very safely, and you can sleep Transport safety “The route is shorter, it is more time for the family, inside the cabin”. Free time you rest more”.

RESULTS FROM THE TRANSMICABLE EVALUATION 9 TransMiCable and sustainable transport in urban renewal

Lessons learned

The evaluation of TransMiCable and its urban transformation highlights the importance of public transport as a social determinant of health, and the importance of a health in all policies approach for building healthier cities.

Transportation interventions together with urban transformations are an opportunity to improve the health of communities. The TransMiCable experience has reduced residents' travel times; increased their free time; increased neighborhood satisfaction; reduced the inhaled dose of air pollutants; increased meeting places, socialization, and physical activity; and decreased victimization.

Providing sustainable transportation solutions to vulnerable populations is a way to improve multiple aspects of quality of life, demonstrates the government's willingness to serve the population from various angles, and helps reduce social inequities and, eventually, public spending.

Improved connectivity between modes of transport can improve travel experience and lead to better outcomes in sustainability, inclusion, and health.

Promoting community ownership of programs and infrastructure improves community participation (with decision makers, academia) throughout conceptualization, design, planning, and implementation stages.

The evaluation of TransMiCable highlights the importance of a gender perspective and community participation from the project’s conceptualization.

Learning from the intended and unintended effects of interventions is critical for improving similar approaches, redirecting efforts, and improving transportation and urban transformation projects.

Undertaking this policy evaluation as part of the SALURBAL project provides a unique opportunity to evaluate the relationship between sustainable transport and health in Latin America.

Joint efforts between academia, the community, and public institutions have the potential to achieve relevant, effective, and sustainable transformations.

10 URBAN TRANSFORMATIONS AND HEALTH TransMiCable, public transportation, and COVID-19

Public transportation continues to be a basic need for the TransMiCable target population. Providing sustainable transportation is a way to improve quality of life through the direct delivery of public goods and services.

The pandemic has highlighted the urgent need to reduce social and economic inequities to improve population health (10).

Providing regulated transport services is a way of guaranteeing compliance with biosecurity standards, as demanded by the crisis generated by COVID-19.

The pandemic has created opportunities for research and innovative thinking about urban policies and improvements to living conditions for the most vulnerable populations.

Public transport is essential for building healthier and more equitable cities, but it must be made safer with physical distancing, ventilation, short travel times, use of face masks, hand washing, and hand sanitizer.

RESULTS FROM THE TRANSMICABLE EVALUATION 112 Data Sources and Urban Transformations and Health: the Specifications (11): TrUST case of TransMiCable Study design: Environmental measurements: Quasi-experimental, longitudinal study Trips were carried out on feeder buses, regular bus, Mixed methods approach and informal transport to measure environmental Citizen Science and Ripple Effects Mapping pollutants. Consultation with community members and decision Physical activity in Illimaní, Manitas, Moralba and La makers Victoria parks was measured using SOPARC. Areas of study: Individual measurements: Radial buffers of 800 meters surrounding each Household surveys TransMiCable station Accelerometry Area of Intervention: Ciudad Bolívar Installation of mobile application "Muévelo" Control area: San CristóbaL. Travel diaries Walks around the neighborhood using the Stanford Population studied: Healthy Neighborhood Discovery Tool Adults who had lived in Ciudad Bolívar or San Cristóbal for at least two years prior to 2018, who did not plan to Gathering of Prioritization Following-up scientific of the most with action change residence over the following two years. data of important items. Intended participant's topics for the and unintended perceptions community effects. Sample: of their environment Multi-stage sampling. First, blocks were selected with a probability proportional to the density of Discussion of Socialization of findings with priorities properties. Second, every third home was systemati- other and proposition members of of solutions with cally selected. Third, selection of homes and partici- the key pants was random. community decision-makers 2052 individuals were surveyed in 2018, with a follow-up rate of 81.7% in 2019. Our Voice on TransMiCable Subsamples were created for accelerometry measu- Our Voice: Citizen Science for Health Equity rements, declared preferences, travel diaries, focus Results were accompanied by testimonies from the groups, and mobile application installation. residents of Ciudad Bolívar and San Cristóbal, who express in their own words the transformations created by TransMiCable.

Geographic location of photographic record via Stanford Healthy Neighborhood Discovery Tool app

Ciudad Bolívar San Cristóbal

12 URBAN TRANSFORMATIONS AND HEALTH ReferencES

1. Rudolph L, Caplan J, Ben-Moshe K, Dillion L. Health in all policies: a guide for state and local governments. Washington D.C.:American Publich Health Association; 2013.

2. Roux AVD, Slesinski SC, Alazraqui M, Caiaffa WT, Frenz P, Fuchs RJ, et al. A Novel International Partnership for Actionable Evidence on Urban Health in Latin America: LAC-Urban Health and SALURBAL. Glob Chall. 2019;3(4):1800013.

3. World Health Organization. Subsanar las Desigualdades en una generación: alcanzar la equidad sanitaria actuando sobre los determinantes sociales de la salud. World health organization; 2009.

4. Guzman LA, Oviedo D, Rivera C. Assessing equity in transport to work and study: The Bogotá region. J Transp Geogr. 2017 Jan 1;58:236–46.

5. Guzman LA, Bocarejo JP. Urban form and spatial urban equity in Bogota, . Transp Res Procedia. 2017 Jan 1;25:4491–506.

6. Forero Hidalgo JA, Molano Camargo F. El paro cívico de octubre de 1993 en Ciudad Bolívar (Bogotá): la formación de un campo de protesta urbana. Anu Colomb Hist Soc Cult. 2015 Jun 17;42(1):115–43.

7. Hidalgo D, Velásquez JM. Cables aéreos: una solución de movilidadpara zonas marginadas. Blog Ciudades Sostenibles: División de Vivienda y Desarrollo Urbano (HUD) del Banco Interamericano de Desarrollo (2015) Available online at: https://blogs.iadb.org/ciudades-sostenibles/es/cables-aereos/ (consultado el 27 de septiembre de 2020).

8. Secretaría Distrital de Movilidad. Encuesta de Movilidad 2019.

9. Secretaría Distrital de Ambiente. Informe anual de Calidad de Aire en Bogotá. 2019.

10. Roux AVD, Barrientos-Gutierrez T, Caiaffa WT, Miranda JJ, Rodriguez D, Sarmiento OL, et al. Urban health and health equity in Latin American cities: what COVID-19 is teaching us. Cities Health. 2020 Sep 10;0(0):1–5.

11. Sarmiento OL, Higuera-Mendieta D, Wilches-Mogollon MA, Guzman LA, Rodriguez DA, Morales R, et al. Urban Transformations and Health: Methods for TrUST-a Natural Experiment Evaluating the Impacts of a Mass Transit Cable Car in Bogota, Colombia. Front Public Health. 2020 Mar 10;8:64. Authors

1. Facultad de Medicina de la Universidad de los Andes Tomás Guevara1 Olga L. Sarmiento1 Diana Higuera1 (Universidad de los Andes Medical School) 1 1 2.. Facultad de Ingeniería de la Universidad de los Andes Andrés Felipe Useche María Alejandra Rubio (Universidad de los Andes Engineering Department) 1,2 1 2 María Alejandra Wilches Paola Martínez Daniela Castaño 3. Observatorio de políticas públicas de la Universidad ICESI Daniela Méndez2 Lina Martínez3 Eliana Martínez4 (Public Policy Institute of Universidad ICESI) 1 1 2 4. Facultad de Salud Pública de la Universidad de Antioquia José David Pinzón Andrés Felipe Aguilar Ricardo Morales (Public Health School of Universidad de Antioquia) Leonardo Jiménez2 Luis Ángel Guzmán2 Julián Arellana5 5. Departamento de Ingeniería civil y ambiental de la Universidad del Norte Carlos Moncada6 Catalina Abaunza7 Daniel Fernández7 (Civil and Environmental Engineering Department of Universidad del Norte) 1 2 8 6. Facultad de Ingeniería de la Universidad Nacional de Colombia Andrés Medaglia Felipe Montes José David Meisel Phillip (Engineering Department of the Universidad Nacional de Colombia) Hessel1 7. Ministerio de Salud de Colombia (Ministry of Health of Colombia) 8. Facultad de Ingeniería de la Universidad de Ibagué Design: Jason Ricardo Fonseca Herrera (Engineering Department of Universidad de Ibagué)

These results are part of one of the urban policy evaluations carried out by TrUST was financed by the Wellcome researchers from the Urban Health in Latin America (SALURBAL) project. Trust, the Universidad de los Andes, This research seeks to understand the impact of policies and interventions the Universidad del Norte, the District from various sectors on the health and well-being of people living in Latin Planning Department of Bogotá, and American cities. The SALURBAL project is funded by the Wellcome Trust. Miniciencias. For more information, please see: https://drexel.edu/lac/data-evidence/policy-evaluations/