Critical Evaluation of Atlanta Beltline Health Impact Assessment

The Atlanta Beltline Health Impact Assessment is a report that documents the potential health impacts of Atlanta Beltline. The Atlanta Beltline is a project that aims at reshaping the city of Atlanta with new transit infrastructure, trails, and parks, among other significant developments. The project will redevelop a 22-mile loop of an unused freight line located two to four miles of the city center and will affect 45 communities. In 2005, the multidisciplinary team undertook a health impact assessment. The aim was to integrate health concerns into the final decision by envisaging potential “health outcomes,” updating stakeholders and the citizens about the health impact, and offering practical recommendations to curb possible undesirable health outcomes. The report carefully outlined the methodology used in assessing health impact, their findings as well as recommendations. This paper seeks to give a critical evaluation of the aspects of the report. 

Summary of the Report

The project’s advisory committee assembled a team of experts with a background in planning and public health. To initiate the HIA, researchers first established and understanding of the Beltline given the complexity of the project that had been developing for several years and was anticipated to be built over 30 years (Ross & West, 2012).  Since the team required an influential foundation on which to base their evaluation findings, they identified the Atlanta Development Authority’s Beltline Redevelopment Plan as a rational and publicly endorsed body that had earlier been approved local authorities.

The project would draw its funding from the Tax Allocation District (TAD) and since the projects could on spend bond money and be allocated funds within the confines of the project. Several environmental regulatory, funding, zoning, and planning decisions, were essential for the redeveloped of the Beltline. 

Researchers chose the study area, which was decided to be on a 0.5-mile buffer around the beltline TAD. The research team then undertook to scope. Scoping is a federally mandated process for identifying issues related to the project. The HIA report noted that the HIA team undertook to scope, which involved a postal and web survey as well as desk-based research. During this phase, the vulnerable and most affected populations, parameters of assessment, and possible health outcomes were identified. 

The study, which placed a 0.5-mile buffer along the Beltline divided the study area into five planning areas and the year 2000 Census report, as well as mortality data, were used to examine the populations (Ross & West, 2012).  In its analysis, the study found variations in mortality, poverty, survey employment status, age, race, and car ownership. For the county and state, the Behavioral Risk Factor Surveillance System data was used but stratified by race. The research identified older adults, renters, carless, and people of low economic status as the vulnerable population. These groups were identified after the calculations of a vulnerability score. 

In identifying crucial health effects, issues were identified from analyzing newspapers, reaching out to members of the community, and developing a rational framework (Ross & West, 2012).  The study also surveyed people the communities around the Beltline. The team identified several crucial issues that could affect the population of the area under study. In addition, these are access to social equity, safety, social capital, physical activity, and the environment (Ross & West, 2012).  The environment in this context involves air quality, noise, and water management.

Critique of Health Outcomes

The HIA report found that the Beltline project would be associated with a decrease in physical inactivity, asthma, diabetes, coronary heart disease, mental distress, high blood pressure, obesity, low fruit and vegetable consumption, and binge drinking. The health outcomes were identified after an analysis of BFRSS data (Ross & West, 2012). The BFRSS data is collected through telephone surveys. Moreover, the health outcomes identified by the study are related in that they are lifestyle diseases that can be overcome by improvement in mobility, physical activity, and access to better foods, which are part of the goal of the Beltline project (Ross & West, 2012).  

In a different analysis of the mortality rate within the Planning Area, the study found that the crude death rate (per 100,000 Population) was highest in the heart diseases with Southwest of the Beltline leading with 236.5 persons per 100,000 Population (Ross & West, 2012).  In the Northside, the rate stood at 159.1, 131.6 in the North East, 178.8 in the Southeast, and 209.8 in the Westside (Ross & West, 2012).  Furthermore, other conditions that deserve attention by the Beltline project such as diabetes, homicide, influenza, and pneumonia rank low in the crude death rate.

The cerebrovascular diseases which have similar risk factors as the health outcomes aimed by the HIA rank third in crude death mortality at an average of 43.6 per 100,000 Population (Ross & West, 2012).  From the comparison of mortality and health outcomes identified in the study, it is evident that the health outcomes are well informed. This argument is supported by the fact that they can be solved by the goals of the Beltline Project, which consist of creating parks, pedestrian ways, and improving mobility by light rail (Ross & West, 2012).  

The assessment gave a clear justification for why the outcomes were selected and why the possible health effects that were considered. Though the assessment did not give a clear argument on why other illnesses in the Beltline were not chosen, it is easy to see why they were not considered and how they have been reflected in the overall Beltline project (Ross & West, 2012).  

One of these illnesses is malignant neoplasms, which ranks second in mortality at an average crude death rate of 142.7 per 100,000 Population (Ross & West, 2012).   Malignant neoplasms are commonly known as cancers. Malignant neoplasm displays aggressive features such as invading and destroying adjacent tissues. The most common risk factor for malignant neoplasms is exposure to chemicals, radiation exposures, sun exposure, and family history, among others. The difficulty associated with taming cancers means that the study’s lack of attention on alleviating it is justified.

However, there is no rationale for why the study did not consider a reduction in HIV as a health outcome. The Beltline Study area seems to have been burdened by HIV, as evidenced by the crude death rate of 43.5 per 100,000 Population (Ross & West, 2012).  The figure is roughly nine times higher than the national average, which stood at 4.9. The state of Georgia had a crude death rate of 8.3, the City of Atlanta had 39.8, while Fulton county’s rate was 25.3 (Ross & West, 2012).   The Beltline project does not consider its influence on the HIV rate or spread. Improved mobility from the revamped transit system in the project could mean a spread of HIV to other regions.

Mureithi, Isdory, and Sumpter, (2015) who investigated the impact of human mobility on HIV transmission, found that though the movement had little impact on the overall increase in HIV cases in a region, mobility slightly increased HIV incidences rates in regions that had initially low prevalence areas (Mureithi et al., 2015). Improvement in mobility along the 22-mile loop would likely transmit the HIV incidents from the Southwest side, whose death rate is 52.6, too low prevalence areas like Northside, whose death rate stands 10.6, five times less (Mureithi et al., 2015). 

The study argues that binge drinking can be potentially influenced by Beltline development. The study does not give a rationale for this choice of health outcome. The study correctly identified that the Beltline project could attract convenience stores, independent stores, and chain grocery stores, which translate to access to healthy foods (Mureithi et al., 2015). However, on the downside, the emergence of liquor stores along the Beltline could mean access to alcoholic drinks, further heightening binge drinking, which seems to have burdened more whites than blacks.

According to Statista (2019), Americans aged 18 to 29 bought alcohol from convenience stores. In an earlier study by Friese and Grube (2008), it was noted that Native American youth were more likely to have gotten alcohol from a store compared to White youth. It thus follows that the Beltline project will have an insignificant impact on binge drinking as long as convenience stores are present along the Beltline.

Critique of Evidence used to Support HIA conclusions

The description of health outcomes in HIA depends on the quality and type of evidence used and can either be quantitative or qualitative evidence. The Atlanta Beltline report used a wide array of evidence, including measurement of physical conditions, epidemiologic analysis, and surveys for modeling and environmental conditions as well as an expert opinion. During scoping, the report gathered data from administrative sources, unpublished reports, published literature, and other sources that collect data for routine monitoring purposes.

The use of qualitative evidence in HIA is necessary as it gives a context-specific picture of people’s lives. The Beltline research team used a participatory framework to gather qualitative data. This was through surveys, interviews with members of the community, meeting with stakeholder organizations as well as meeting with elected officials.

National Research Council et al. (2011) noted that participatory approaches that energetically engaged stakeholders in the HIA process yielded rich information and provided opportunities for stakeholders, including community members, to guide the questions raised and share in the overall understanding of conclusions. Evidence from qualitative approaches has been largely cited in the report. 

The Beltline HIA report has used a large body of quantitative evidence. This information includes census and mortality data that have informed the starting position of the assessment. External quantitative evidence has been used to rationalizing recommendations by the report. Where specific additional information is needed, the report has included the quantitative data from the survey conducted by the HIA team.

Where data has been used, there seems to have been a causal relationship between variables, but the methodology used to reach the data is missing. This puts the validity of the estimates and data as well as recommendations into questions. For example, potential health effects such as obesity, injuries, and high blood pressure, among others, have been estimated, but the quantitative approaches for analysis such as calculation, percentages of the illnesses in a population by gender or race are absent.

The report has cited relevant evidence. The articles have been retrieved from a wide array of journals pertinent to the subject matter of the report, such as the Transportation Research Record, Noise and Health, Pediatric Exercise Science, Preventive Medicine, and Environmental Health Perspective, among others. In addition, given that the report was published in 2007, most of the evidence used was current. That is, the articles were largely published between 1997 and 2007. A few of the articles date between 1980 and 1996; nevertheless, they still are relevant to the study.

The evidence used in the report has been cited using the Chicago Referencing style (Chicago Manual of Style, 2020).  However, there exist several discrepancies, and not all evidence has been cited in a standard citation format. The Chicago reference style requires that in journal articles or any other publication with four or more authors, one should list up to ten in the reference list (Chicago Manual of Style, 2020).

However, for more than ten authors, only the first seven are listed in the reference list, followed by et al. (Chicago Manual of Style, 2020). The Beltline report seems to have gone against the citation list by listing only two authors, followed by et al.

Moreover, some of the items in the referencing list seem to have left out vital information about the evidence cited. For example, the citation “CDC (2005)” only contains the title but lacks information about where the information was retrieved from. The NHTSA reports cited in the reference list are inconsistent with some containing report numbers while other lack. The citation “Miedema, N” lacks details ranging from the year of publication to the site it was retrieved from. This shows that though the citation appears in the reference list, there is a likelihood it has not been used in the report.

Critique of Recommendations Made

The Atlanta Beltline report made several recommendations that will be implemented over the 30-year period to completion. The recommendations are largely in line with the report findings and have a clear rationale behind them. However, some are questionable and ought to be revised. 

The recommendation by the report for a diversity of housing types and prices with the aim of improving access, social capital, and the environment is disputable. In addition, this argument is informed by the reasoning that neighborhood diversity does not guarantee positive outcomes. Put differently, neighborhoods inhabited by people from diverse ethnic and racial groups did not always guarantee good relations among them (Dixon, Durrheim, & Tredoux, 2005).

Dixen et al. (2005) argued that residents from racially diverse neighborhoods exhibited lower levels of trust, altruism ad cooperation compared to residents in homogenous neighborhoods. Some researchers have pointed out the fact that difficulties facing African American children in integrated schools could be resolved if they were in the majority or predominantly-black schools. 

Berrey (2003) went a step further and argued that “neighborhood diversity” was often used as an excuse for exclusion and displacement of minority and poor residents from regions undergoing redevelopment. The history of prejudice, discrimination, and inequality and fear, means that diversity along the Beltline could lead to misunderstandings and conflict rather than positive interactions. The recommendation will, therefore, not achieve racial diversity.  

The report has also recommended for access to healthy foods in the Southeastern areas. This area has a predominantly black population. While the paper has given a solid argument for lack of access to healthy foods among the black, the recommendations are unlikely to yield positive outcomes. In a study by Gosliner et al. (2018) involving 231 grocery stores, 621 small markets, and 622 convenience stores in 225 neighborhoods, it was found that fresh produce in grocery stores was rated high quality (97 percent fruits and 98 percent vegetables).

However, small markets and convenience stores were found to have poor quality. Allowing for street vendors whose produce has quality is questionable means that the black community access to healthy foods will still be below average compared to the white population. The perception of the black community towards large grocery stores is also negative.

Kumar et al. (2011), who investigated the perception of African Americans towards large chain stores, found that “food is directed to the area” was a recurring theme. Most perceived low quality low priced food as directed into the area even when it was of high quality (Kumar et al., 2011)

Another faulty recommendation of the report relates to housing. The report recommended that new development ought to complement the current neighborhood by constructing transitions between low-rise development, commercial properties, and offering assistance to at-risk households. The recommendation may not auger well with investors whose model of development may seek to maximize profits.

Funding housing for low income and at-risk households can be very difficult (Ross & West, 2012). The Beltline report recommendations must give clear strategies for solving affordable housing. In the long run, the project will have to initiate subsidies, which can be difficult.

Moreover, unless investors are given incentives, they cannot build homes that are reasonably priced to low-income families. This is because lenders loan money for housing development based on the property’s expected income. If the Beltine project sets affordable rents, there might be a large gap between the money required to build and the money lenders and investors provide hence stalling affordable housing goals.

The report has recommended that green roofs. The recommendations cite benefits to access, physical activity, built environment, and social capital. While green roofs are cited as beneficial, they are unnecessary in this case. The report does not give a rationale for advocating green roofs. Moreover, green roofs tend to be more expensive than traditional options. This is largely attributed to the fact that buildings with green roofs require extra support to accommodate the increased load.

Bungalows may especially not handle the increased weight load from green roofs. The green roof demands extra maintenance to ensure it remains a thriving atmosphere. That is, it is treated as a garden requiring watering, feeding, and weeding. Moreover, the benefits of a green roof may not always be realized immediately (Ross & West, 2012).  For a project that relies on investors to fund its affordable housing system, this adds burden to already an already margin-reduced project.  


Critique of planned monitoring and evaluation of the HIA impacts

The project has outlined very little about its planned monitoring and evaluation. The plan to monitor the project is mentioned in bits at its recommendation (Ross & West, 2012).  Furthermore, the report plans to monitor particulate matter in likely hot spot areas such as high traffic spots in a bid to develop a requirement for mitigation that would be triggered by PM levels (Ross & West, 2012).

From a built environment standpoint, the Atlanta Beltline poses challenges regarding air pollution. For example, the Beltline utilizes corridors that are in close proximity to heavily trafficked roads. This means that cyclists or pedestrians have the potential to come into contact with emissions from nearby vehicles leading to respiratory illnesses. The situation may further be amplified if an individual using the beltline is exercising. This means that the decision by the HIA team to monitor air quality is well informed. 

The report also mentions that it would create “neighborhood watch programs” to monitor activities along the Beltline. However, enough literature seems to suggest that these programs do not work. In a meta-analysis by Bennett, Holloway, and Farrington, (2008), found that there was insufficient data to justify that the programs are associated with positive outcomes. The review found that the program was largely ineffective at preventing crime. Moreover, most people refused to attend community meetings in part since they lacked trust in their neighbors (Bennett et al., 2008). 

The report also noted that it would collect data on users of transit, trails, and parks as well as data on participation in related physical activity to evaluate the effectiveness of infrastructure development. However, the report does give details on how it will use this data (Ross & West, 2012).

Overall, the monitoring and evaluation plan of the Atlanta Beltline HIA is brief and does not give an in-depth strategy of how it plans to accomplish this segment. Additionally, it communicates little about what it intends to do with the data.


            The Atlanta Beltline HIA identified several implications arising from the health outcome, built envrrironmmt s well, and the noise vibration. The implications identified are positive and pertinent to the HIA.  For example, built environment has the potential for negative health incomes arising from the noise and pollution. The implications have been well articulated.


The report by the Atlanta Beltline HIA team has several shortcomings that must be addressed. This paper will recommend several of these failures in a bid to make the implementation of the paper worthwhile.

The Beltline HIA must utilize the evidence it cites. Moreover, it must cite appropriately. This will be essential in improving the credibility of the paper. Proper citation by listing sources appropriately shows the readers that proper research has been properly done. Besides helping readers track the sources used, it shows that the Beltline HIA team was responsible enough to give credit to other researchers and that they acknowledge their ideas. On the monitoring aspect of the report, the paper should give an in-depth analysis of how it aims at achieving the monitoring and evaluation of the report recommendations. Additionally, the paper must give further information on the quantitative evidence used, such as calculation or the analysis method used.

Overall the paper recommends:

  1. There is a need for the report to recognize other illnesses that may be amplified by improved mobility of the Beltline search as HIV. Mureithi et al. (2015) advise decision-makers that they should not underestimate or neglect the impact of human mobility on HIV transmission. It thus follows that the Atlanta Beltline project must integrate the effect of human mobility in the HIV/AIDS transmission-control programs.
  2. The project recommendation must avoid overemphasis on housing diversity. The Beltline project implementation team must tolerate minority groups that refuse housing diversification programs. The recommendation is informed by the fact that this community might thrive in homogeneity. 
  3. There is a need for housing investors to be awarded subsidies as well as incentives that promote the development of affordable housing. The project must issue tax-exempt bonds to assist in the accomplishment of growth in multifamily housing. Moreover, the project can offer financing for affordable housing through the Housing Opportunity Bond Funds, which have been proven to work in other parts of the world such as New York, Kuala Lumpur, and Hong Kong, among other cities. Alternatively, the project should set aside trust land to ensure affordability for those at risk for displacement and gentrification or as a result of the Beltline development (Berrey, 2003).
  4. The area around the Beltline seems to have abandoned buildings. These buildings, some of which are old, have asbestos roofing. The initial phase of the housing program should concentrate on asbestos removal, which has been associated with health risks such as asthma, respiratory issues, and even cancer. Until the 1980s, it was an often-used building material before its harmful effects were discovered. Green roofing can be prioritized later on.
  5. Amidst the failures of the “neighborhood watch program,” enough literature suggests that potential offenders might be deterred from committing a crime if they believe that the neighborhood watch program is associated with the improved police investigation and that law enforcement are likely to incapacitate offenders. The program should also aim at building confidence among members of the community. 
  6. The Atlanta Beltline project should adopt policies that curb the emergence of liquor stores along the Beltline. The policy should dictate the location of such stores or restrict the hours of operations. Moreover, the types and amount of alcohol sold should be reduced. The law enforcement officers patrolling the area must know the problem drinkers, problem bars, and problem neighborhoods. They must interact positively with liquor store businesses and other community stakeholders to enable joint solving of issues. Policies must also emphasize curbing the sale of alcohol to minors. Overall, curbing alcohol sales and business will help reduce cases of binge drinking.
  7. The Atlanta Beltline should be promoted as a health-oriented project. The project should uphold its campaign of increasing parks and jogging tracks along the Beltline. The campaign should further promote the Beltline as enhancing physical health, mental health, as well as nutrition and growth. This kind of promotion will help the communities along the area cooperate in weeding out vices that go against this campaign, such as binge drinking, casual sex, and drug peddling, among others. Health-promotion could be done in parks that offer physical activities. Moreover, gym and fitness centers should be incentivized to open shop along the Beltline.
  8. The monitoring plan for the project should be improved. The Beltline monitoring team should come up with metrics to weigh against the intended outcomes. The metric could range from costs to housing targets to stakeholder satisfaction, crime, and physical activeness, among others. The project should also be flexible in its recommendation. Flexibility is important since not all aspects of the project can be controlled. Moreover, not all outcomes will come out as expected. Giving some allowance for failure as well as a backup plan can help.


Overall, the paper has given a critical evaluation of the Atlanta Beltline project. The paper has identified shortcomings in the health outcome identified by the HIA team, such as the omission of HIV. The paper has also delved into the evidence used in the report. The paper identified discrepancies in the citation. The paper also identified the failures in qualitative evidence. The paper also identified gaps in the monitoring and evaluation section of the report. The paper has successfully outlined recommendations that the paper can undertake to cover the gaps identified. This will not only help the improvement of the readability of the report but the implementation of the recommendation previously identified.


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Berrey, E. C. (2003). Debating ‘Diversity’: A Slippery Symbol at the Heart of Neighborhood Redevelopment Politics. Paper presented at the Color Lines Conference, The Civil Rights Project, Harvard University,

Chicago Manual of Style. (2020). The Chicago Manual of Style, 17th Edition. The Chicago Manual of Style Online.

Dixon, J., Durrheim, K., & Tredoux, C. (2005). Beyond the Optimal Contact Strategy: A Reality Check for the Contact Hypothesis. American Psychologist60(7), 697-711.

Friese, B., & Grube, J. (2008). Differences in Drinking Behavior and Access to Alcohol between Native American and White Adolescents. Journal of Drug Education38(3), 273-284.

Gosliner, W., Brown, D. M., Sun, B. C., Woodward-Lopez, G., & Crawford, P. B. (2018). Availability, quality, and price of produce in low-income neighborhood food stores in California raise equity issues – CORRIGENDUM. Public Health Nutrition22(1), 184-185.

Kumar, S., Quinn, S. C., Kriska, A. M., & Thomas, S. B. (2011). “Food is directed to the area”: African Americans’ perceptions of the neighborhood nutrition environment in Pittsburgh. Health & Place17(1), 370-378.

Mureithi, E. W., Isdory, A., & Sumpter, D. J. (2015). The Impact of Human Mobility on HIV Transmission in Kenya. PLOS ONE10(11), e0142805.

National Research Council, Division on Earth and Life Studies, Board on Environmental Studies and Toxicology, & Committee on Health Impact Assessment. (2011). Improving Health in the United States: The Role of Health Impact Assessment. National Academies Press.

Ross, C., & West, H. (2012). Atlanta BeltLine HIA 0 Atlanta BeltLine Health Impact Assessment.

Statista. (2019, January 10). Purchase of Liquor at a Convenience Store in the U.S. by Age 2018. Statista.