Integrated Transport and Health Impact Modelling Tool (ITHIM)

ITHIM refers to a range of related models and tools developed at CEDAR to perform integrated assessment of the health effects of transport scenarios and policies at the urban and national level. The health effects of transport policies are modelled through the changes in physical activity, road traffic injury risk, and exposure to fine particulate matter (PM2.5) air pollution. Some versions of ITHIM also predict changes in CO₂ emissions. ITHIM is being used in research and by health and transport professionals to estimate the health impacts of scenarios, compare the impact of travel patterns in different places, and model the impact of interventions. ITHIM works either as a stand-alone model, or it can be linked with other models (e.g. transport, health, economic).

Figure 1: The general overview of the ITHIM model. Picture is from ITHIM version 2 (see version description below). Arrows show the flow of data inside the mode. (PM = fine particulate matter air pollution, GBD = Global Burden of Disease study).

ITHIM models exposure to physical activity by comparing distributions of weekly physical activity under different scenarios. Walking, cycling and other types of physical activity are combined as MET hours per week of activity. Outcomes affected by physical activity include various cardiovascular diseases, depression, dementia, diabetes, breast cancer, and colon cancer. ITHIM also models health changes through the all-cause mortality. A comparative risk assessment method is used to estimate how changes in population physical activity result in changes in health burden.

Road traffic injuries are modelled using a risk, distance and speed based model. Differences in risk by gender and age are also included. This approach allows ITHIM to look at how absolute numbers of injuries and injury risks could change for different transport modes as travel distances between modes changed.

Fine particulate matter (PM2.5) air pollution risks are calculated for the general population (background rates) as well as mode specific rates for different transport modes. The exposure changes for population are based on comparison of local generated PM2.5 emissions and concentrations in the study area. In ITHIM version 2 also the personal exposure to air pollution while walking and cycling is taken into account.

The health effects of ITHIM are presented as disability-adjusted life-years (DALY) and number of attributable deaths. Background burden data for study areas are estimated from Global Burden of Disease studies.

ITHIM versions

Below are listed the main ITHIM versions and key studies that have been published with those versions.

ITHIM 1: First version of ITHIM was implemented as a spreadsheet model in Microsoft Excel. ITHIM version 1 had all three pathways (physical activity, injuries and air pollution). Physical activity variation between people was modelled with simple point estimate approach. ITHIM 1 has been used to model scenarios for the UK and the USA (Woodcock et al. 2009, 2013, Maizlish et al. 2013).
ITHIM 1 for California: ITHIM for California is developed by Dr Neil Maizlish and is used to predict benefits of climate mitigation strategies of shifting commuter travel from personal passenger vehicles to walking and bicycling and/or to electric vehicles and biofuels (low carbon driving). See more here:
ITHIM 2: The second version of ITHIM was developed to take better into account uncertainties and variability in key input data in the calculation. ITHIM version 2 was implemented with Analytica software (http://en.wikipedia.org/wiki/Analytica_%28software%29) and the uncertainty & variability was modelled by using Monte Carlo simulation. Key publication is the London cycle hire paper published in 2014 .
ITHIM 3: The third version of ITHIM is under development in R in collaboration with the University of Wisconsin and other partners. The code base is hosted here and here . In the METAHIT project we developing ITHIM 3 for England.
ITHIM Global: In the TIGTHAT project we are laying the foundations for a health impact assessment tool that will be readily applied to a wide variety of urban settings in Low or Middle Income Countries to estimate health impacts of transport choices.
Impacts of Cycling Tool (ICT): The ICT generates scenarios using individual level travel survey data and we will include this functionality within ITHIM 3. The code base is available here

We are moving towards making all our models open source. Other models are available on request.

ITHIM related projects

We are collaborating on many international research and policy collaborations involving ITHIM these include:

USA: Global Health Institute, University of Wisconsin-Madison
USA: Nashville, Tennessee, Nashville Metropolitan Planning Organization
USA: Portland, Oregon Department for Public Health
Malaysia: Kula Lumpur, United Nations University – International Institute for Global Health
Canada: Newfoundland University
Brazil: Sao Paulo, University of Sao Paulo.
USA: California, Center for Climate Change and Health, Public Health Institute
India: Delhi and Visakhapatnam, Indian Institute of Technology, Delhi

ITHIM email list and ITHIM community

ITHIM is currently used by several researchers and authorities in number of cities, regions and countries (including USA, Canada, Malaysia, Brazil, India). ITHIM email list is the list in which developers of ITHIM will share the news from ITHIM community with other users and interested parties. We expect to send one email every 2-3 months. You can sign in for the list below.

Dr Caroline Shaw, Department of Public Health, Senior Lecturer
Email caroline.shaw@otago.ac.nz

Research interests and activities: Caroline is a Public Health Medicine Specialist and epidemiologist. She teaches the postgraduate paper in Environmental Health and is also involved in undergraduate teaching and curriculum development in the medical degree. Her current research is at the interface of transport, health and climate change, particularly around the health opportunities offered by decarbonising the transport sector. She has undertaken research in the ethnic and socio-economic determinants of health, cancer control, population screening and obesity prevention..

Publications

Shaw, C., Randal, E., Keall, M., & Woodward, A. (2018). Health consequences of transport patterns in New Zealand’s largest cities. New Zealand Medical Journal, 131(1472), 64-72. Retrieved from https://www.nzma.org.nz/journal

Randal, E., Keall, M., Shaw, C., Russell, M., Woodward, A., Chapman, R., & Howden-Chapman, P. (2017). Why New Zealand transport policy needs to encourage walking and cycling. In P. Howden-Chapman, L. Early & J. Ombler (Eds.), Cities in New Zealand: Preferences, patterns and possibilities. (pp. 107-114). Wellington, New Zealand: Steele Roberts Aotearoa.

Shaw, C., Keall, M., & Guiney, H. (2017). What modes of transport are associated with higher levels of physical activity? Cross-sectional study of New Zealand adults. Journal of Transport & Health, 7(Part B), 125-133. doi: 10.1016/j.jth.2017.09.010

Shaw, C., Hales, S., Edwards, R., Howden-Chapman, P., & Stanley, J. (2017). What can fuel price increases tell us about the air pollution health co-benefits of a carbon price? Journal of Transport & Health. Advance online publication. doi: 10.1016/j.jth.2017.11.002

Gurney, J. K., McGlynn, K. A., Stanley, J., Merriman, T., Signal, V., Shaw, C., Edwards, R., … Sarfati, D. (2017). Risk factors for cryptorchidism. Nature Reviews Urology, 14, 534-548. doi: 10.1038/nrurol.2017.90

Chapter in Book – Research

Journal – Research Article

Gurney, J. K., Stanley, J., Shaw, C., & Sarfati, D. (2016). Ethnic patterns of hypospadias in New Zealand do not resemble those observed for cryptorchidism and testicular cancer: Evidence of differential aetiology? Andrology, 4(1), 82-86. doi: 10.1111/andr.12121

Gurney, J., Shaw, C., Stanley, J., Signal, V., & Sarfati, D. (2015). Cannabis exposure and risk of testicular cancer: A systematic review and meta-analysis. BMC Cancer, 15, 897. doi: 10.1186/s12885-015-1905-6

Pega, F., Shaw, C., Rasanathan, K., Yablonski, J., Kawachi, I., & Hales, S. (2015). Climate change, cash transfers and health. Bulletin of the World Health Organization, 93(8), 559-565. doi: 10.2471/BLT.14.150037

Shaw, C., Hales, S., Howden-Chapman, P., & Edwards, R. (2014). Health co-benefits of climate change mitigation policies in the transport sector. Nature Climate Change, 4(6), 427-433. doi: 10.1038/nclimate2247

Nair, N., Sarfati, D., & Shaw, C. (2012). Population screening for abdominal aortic aneurysm: Evaluating the evidence against screening criteria [Review article]. New Zealand Medical Journal, 125(1350). Retrieved from http://www.nzma.org.nz/journal

Nair, N., Shaw, C., Sarfati, D., & Stanley, J. (2012). Abdominal aortic aneurysm disease in New Zealand: Epidemiology and burden between 2002 and 2006. New Zealand Medical Journal, 125(1350). Retrieved from http://www.nzma.org.nz/journal

Sarfati, D., Shaw, C., Blakely, T., Atkinson, J., & Stanley, J. (2011). Ethnic and socioeconomic trends in testicular cancer incidence in New Zealand. International Journal of Cancer, 128(7), 1683-1691. doi: 10.1002/ijc.25486

Shaw, C., Blakely, T., & Tobias, M. (2011). Mortality among the working age population receiving incapacity benefits in New Zealand, 1981-2004. Social Science & Medicine, 73(4), 568-575. doi: 10.1016/j.socscimed.2011.06.003

Blakely, T., Shaw, C., Atkinson, J., Cunningham, R., & Sarfati, D. (2011). Social inequalities or inequities in cancer incidence? Repeated census-cancer cohort studies, New Zealand 1981-1986 to 2001-2004. Cancer Causes & Control, 22(9), 1307-1318. doi: 10.1007/s10552-011-9804-x

Carter, K. N., Shaw, C., Collings, S., Blakely, T., & Richardson, K. (2011). The SoFIE-Health study: Are the results comparable to the New Zealand population? Australasian Epidemiologist, 18(1), 26-32.

Cormack, D., Sarfati, D., Harris, R., Robson, B., Shaw, C., & Blakely, T. (2010). Re: ‘An overview of cancer and beliefs about the disease in indigenous people of Australia, Canada, New Zealand and the US’ [Letter]. Australian & New Zealand Journal of Public Health, 34(1), 90-91. doi: 10.1111/j.1753-6405.2010.00481.x

Carter, K., Barber, P. A., & Shaw, C. (2010). How does self-reported history of stroke compare to hospitalization data in a population-based survey in New Zealand? Stroke, 41, 2678-2680. doi: 10.1161/STROKEAHA.110.598268

Carter, K., Shaw, C., Hayward, M., & Blakely, T. (2010). Understanding the determinants of consent for linkage of administrative health data with a longitudinal survey. Kōtuitui, 5(2), 53-60. doi: 10.1080/1177083X.2010.516440

Cunningham, R., Shaw, C., Blakely, T., Atkinson, J., & Sarfati, D. (2010). Ethnic and socioeconomic trends in breast cancer incidence in New Zealand. BMC Cancer, 10, 674. doi: 10.1186/1471-2407-10-674

Shaw, C., Atkinson, J., & Blakely, T. (2009). (Mis)classification of ethnicity on the New Zealand Cancer Registry: 1981-2004. New Zealand Medical Journal, 122(1294). Retrieved from http://journal.nzma.org.nz/journal/122-1294/3578/content.pdf

Shaw, C. (2009). (Non)regulation of marketing of unhealthy food to children in New Zealand [Viewpoint]. New Zealand Medical Journal, 122(1288). Retrieved from http://journal.nzma.org.nz/journal/122-1288/3431/content.pdf

Carter, K. N., Hayward, M., Blakely, T., & Shaw, C. (2009). How much and for whom does self-identified ethnicity change over time in New Zealand? Results from a longitudinal study. Social Policy Journal of New Zealand, 36, 32-45.

Cunningham, R., MacDonald, J., McLean, M., & Shaw, C. (2007). An outbreak of infectious syphilis in Wellington, New Zealand. New Zealand Medical Journal, 120(1260). Retrieved from http://journal.nzma.org.nz/journal/120-1260/2680/content.pdf

Sarfati, D., Blakely, T., Shaw, C., Cormack, D., & Atkinson, J. (2006). Patterns of disparity: Ethnic and socio-economic trends in breast cancer mortality in New Zealand. Cancer Causes & Control, 17, 671-678.

Shaw, C., Blakely, T., Sarfati, D., Fawcett, J., & Peace, J. (2006). Trends in colorectal cancer mortality by ethnicity and socio-economic position in New Zealand, 1981-99: One country, many stories. Australian & New Zealand Journal of Public Health, 30(1), 64-70.

Shaw, C., Blakely, T., Sarfati, D., Fawcett, J., & Hill, S. (2005). Varying evolution of the New Zealand lung cancer epidemic by ethnicity and socioeconomic position (1981-1999). New Zealand Medical Journal, 118(1213). Retrieved from http://journal.nzma.org.nz/journal/118-1213/1411/content.pdf

Shaw, C., Blakely, T., Crampton, P., & Atkinson, J. (2005). The contribution of causes of death to socioeconomic inequalities in child mortality: New Zealand 1981-1999. New Zealand Medical Journal, 118(1227). Retrieved from http://journal.nzma.org.nz/journal/118-1227/1779/content.pdf

Shaw, C., Blakely, T., Atkinson, J., & Crampton, P. (2005). Do social and economic reforms change socioeconomic inequalities in child mortality? A case study: New Zealand 1981-1999. Journal of Epidemiology & Community Health, 59, 638-644. Retrieved from http://jech.bmjjournals.com/cgi/reprint/59/8/638

Journal – Research Other

Sarfati, D., Shaw, C., McLeod, M., Blakely, T., & Bissett, I. (2016). Screening for colorectal cancer: Spoiled for choice? New Zealand Medical Journal, 129(1440), 120-128. Retrieved from http://www.nzma.org.nz/journal

Sarfati, D., Shaw, C., & Simmonds, S. (2010). Inequalities in cancer screening programmes [Commentary]. International Journal of Epidemiology, 39, 766-768. doi: 10.1093/ije/dyq039

Blakely, T., Sarfati, D., & Shaw, C. (2009). What proportion of cancer is due to obesity? [Editorial]. New Zealand Medical Journal, 122(1290). Retrieved from http://journal.nzma.org.nz/journal/122-1290/3478/content.pdf

Shaw, C., Cunningham, R., & Sarfati, D. (2008). From screening criteria to colorectal cancer screening: What can New Zealand learn from other countries? [Viewpoint]. New Zealand Medical Journal, 121(1279). Retrieved from http://journal.nzma.org.nz/journal/121-1279/3186/content.pdf

Journal – Professional & Other Non-Research Articles

Sarfati, D., Shaw, C., McLeod, M., Blakely, T., & Bissett, I. (2016). Response to Cox letter [Letter]. New Zealand Medical Journal, 129(1446), 116-118. Retrieved from http://www.nzma.org.nz/journal

Murray, P., & Shaw, C. (2015). Comparing the incomparable: Studies of echocardiographic rheumatic heart disease prevalence [Correspondence]. Lancet Global Health, 3(4), e192. doi: 10.1016/s2214-109x(15)70076-8

Hill, S., Shaw, C., Harris, R., & Lindberg, K. (2006). Ethnic differences in nicotine use: Chromosomes or colonisation? [Letter]. New Zealand Medical Journal, 119(1228). Retrieved from http://journal.nzma.org.nz/journal/119-1228/1825/content.pdf

Conference Contribution – Published proceedings: Abstract

Shaw, C., Hales, S., Edwards, R., & Howden-Chapman, P. (2017). Health co-benefits of policies to mitigate climate change in the transport sector: Systematic review. Journal of Transport & Health, 5(Suppl.), (pp. S107-S108). doi: 10.1016/j.jth.2017.05.268

Shaw, C., & Russell, M. (2017). Benchmarking cycling and walking in six New Zealand cities: Pilot study 2015. Journal of Transport & Health, 5(Suppl.), (pp. S56-S57). doi: 10.1016/j.jth.2017.05.349

Keall, M., Chapman, R., Howden-Chapman, P., & Shaw, C. (2017). Encouraging cycling and walking in New Zealand: Evaluation of the Model Communities Programme [Invited]. In S. Mandic, C. Ergler & A. Moore (Eds.), Proceedings of the International Symposium Active Living and Environment: Towards a Healthier and More Sustainable Future. (pp. 28). Dunedin, New Zealand: University of Otago. [Abstract]

Russell, M., & Shaw, C. (2017). Benchmarking cycling and walking in six New Zealand cities. In S. Mandic, C. Ergler & A. Moore (Eds.), Proceedings of the International Symposium Active Living and Environment: Towards a Healthier and More Sustainable Future. (pp. 41). Dunedin, New Zealand: University of Otago. [Abstract]

Shaw, C. (2016). Will a carbon tax on fuel improve health? Journal of Transport & Health, 3(2, Suppl.), (pp. S36). doi: 10.1016/j.jth.2016.05.083

Shaw, C. (2016). Health co-benefits of climate change mitigation policies in the transport sector: Systematic review. Journal of Transport & Health, 3(2, Suppl.), (pp. S70-S71). doi: 10.1016/j.jth.2016.05.018

Shaw, C., Hales, S., Howden-Chapman, P., & Edwards, R. (2014). Health co-benefits of policies to mitigate climate change in the transport sector: Systematic review. Proceedings of the New Zealand Population Health Congress: Connecting Communities, Policy and Science. (pp. 115). Retrieved from http://www.pophealthcongress.org.nz/nzphc14/programme/programme

Sarfati, D., Shaw, C., Blakely, T., Atkinson, J., & Stanley, J. (2011). The unusual epidemiology of testicular cancer in New Zealand. Journal of Epidemiology & Community Health, 65(Suppl. 1), (pp. A295). doi: 10.1136/jech.2011.142976j.100

Carter, K., Shaw, C., & Blakely, T. (2009). Longitudinal studies, attrition, consent and selection bias: Big questions and some answers from the SoFIE study. Australasian Epidemiologist. 16(2), (pp. 28). [Abstract]

Shaw, C. (2009). Colorectal cancer screening in New Zealand: Implications to primary care.Proceedings of the Royal New Zealand College of General Practitioners Annual Scientific Conference: Myths and Realities of Primary Care. RNZCGP. Retrieved from http://www.rnzcgp.org.nz/rnzcgp-conference-2009/

Shaw, C., Blakely, T., & Tobias, M. (2009). Mortality among the working age population receiving incapacity benefits in New Zealand, 1981-2004. Australasian Epidemiologist. 16(2), (pp. 38). [Abstract]

Shaw, C., Blakely, T., & Atkinson, J. (2009). Trends in cancer in New Zealand by ethnic and socio-economic group, 1981-2004: Contributions to research, monitoring and surveillance. Australasian Epidemiologist. 16(2), (pp. 74-75). [Abstract]

Shaw, C., Blakely, T., Sarfati, D., Fawcett, J., & Peace, J. (2005). Trends in colorectal cancer mortality by ethnicity and socioeconomic position in New Zealand 1981-1999: One country, many stories.Australasian Epidemiologist. 12(3), (pp. 29). [Abstract]

Sarfati, D., Shaw, C., Blakely, T., & Atkinson, J. (2005). Socioeconomic and ethnic breast cancer mortality rates in New Zealand. Australasian Epidemiologist. 12(3), (pp. 30). [Abstract]

Conference Contribution – Verbal presentation and other Conference outputs

Shaw, C., & Russell, M. (2016, July). Benchmarking cycling and walking in New Zealand cities: Pilot study 2015. Verbal presentation at the 2Walk and Cycle Conference: Moving Toward Healthy Communities, Auckland, New Zealand.

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