incorporating health into the planning and design of transportation improvements

Learning Objectives

Understand the relationship between public health and transportation planning

Health impact assessment

Best practices

Lessons learned

What factors determine our health?

Family health history

Source: Healthy Community Design – Making the Healthy Choice the Easy Choice (part of the CDC Healthy Community Design Checklist Toolkit)

Behaviors/lifestyles

Source: Healthy Community Design – Making the Healthy Choice the Easy Choice (part of the CDC Healthy Community Design Checklist Toolkit)

Built environment

The growing cost of health care is a global megatrend

CDC projects that by 2017, 19% of our GDP ($3 trillion) will be spent on health care

One-third of adults and 17% of children in the US are obese

Adult obesity rate could reach 43% of the population by 2018

Medical costs associated with obesity is ~$147 billion

We could save ~$5.5 billion in health care costs related to obesity if one in 10 adults started a walking program

Physical inactivity and unhealthy diet are second only to tobacco use as the main cause of premature death in the US

How we design communities reinforces the epidemic of obesity, diabetes, high blood pressure, heart disease, asthma, orthopedic, and psychological disorders

We have changed how much we walk or bike.

Source: CDC, 2000

walked or biked to school in 197466% of children

Source: CDC, 2000

walked or biked to school in 200013% of children

ConsequencesAdult Obesity Rate by State, 1995

1991

Source: Making Healthy Places: Designing and Building for Health, Well-Being, and Sustainability – Richard J. Jackson MD MPH AIA(Hon)

ConsequencesAdults with Diabetes Rate by State, 1995



Source: http://www.americashealthrankings.org/reports/annual

The Solution

We need to reverse the trend—prevention vs. treatment

Public health is no longer solely the business of health professionals

Relationship between the built environment and health– Strong connection between transit rich communities and better

health outcomes– Health is a competitive advantage for cities and their economic

development efforts– Opportunities to be healthy are influencing what people want

in their communities, workplaces, schools and public spaces

“Health is where we live, not a doctor’s office.”

—Dr. Richard Jackson, MD, MPH

What is Healthy Community Design?

HealthA state of complete physical, mental, and social well-being and not merely the absence of disease

Healthy Community DesignPlanning and designing communities and the built environment in a way that makes it easier for people to live healthy lives

Benefits of healthy community design Improve air and water quality

Lower the risk of traffic-related injuries

Easier to include physical activity into everyday life

Increase access to healthy food

Increase social connectivity and sense of community

Ensure social equity for all community members

Promote good mental health

Who is beginning to incorporate HCD in the planning and design process?

Transportation Agencies

USDOT

FHWA

FTA

State DOT’s (FL, MA, OR)

MPO’s

“Transportation is an important part of the built environment and significantly influences physical activity and well-being, safety and the ability of community members to access destinations that are essential to a healthy lifestyle.”—USDOT Volpe Transportation Center

Who is beginning to incorporate HCD in the planning and design process?

Federal, State and Local Planning Agencies

HUD/USDOT/EPA Sustainable Community Plans

Choice Neighborhoods

Comprehensive Plans

Corridor Studies

Complete Streets

Redevelopment Plans

Zoning/Design Guidelines

How should Healthy Community Design be applied to transportation projects?

Apply the principles of HCD into the transportation planning process—holistic approach that can be used to determine which design solutions work best

Establish health indicators (metrics/measures) to assess and evaluate effectiveness

Partner with health agencies/organizations

A Healthy Corridor “Shift the focus from moving cars to connecting people”

Barriers

Curb cuts

Traffic volume and speed

Roadway dimensions

Lack of sidewalks and bike lanes

Lack of access to healthy food

Undesirable land uses (fast food, car dealerships/repair shops, liquor stores, gas stations)

Multiple landowners

Multiple jurisdictions

Linear, not nodal

Lot size

DOT standards—metric for success is moving cars efficiently

Not enough density to support mixed-use

Lack of political and civic leadership in making corridors healthy places

Access to local health data

A Healthy Corridor

Attributes

People before cars

Sites for community building—local arts and culture, gathering and celebration

“Place-focused“— emphasize visual appeal, connectivity, and authenticity

Connect to green space and nature

Mix of uses

Multiple modes of transportation (walking, cycling, automobiles, and transit)

Access to healthy and affordable food

Connect residents to economic opportunities

Typical Corridor

Healthy Corridor Audit | Baseline Indicators

Residential Land Use

Number of residential units

Type of residential housing

Condition of residential units

Burned, boarded up, or abandoned units

Average monthly rent

Average home price

Residential Demographics

Average income

% below poverty level

Race

Obesity percentage

Asthma rate

Accident rate (crashes, injuries, fatalities)


Non-Residential Land Uses

Presence of the following:– Commercial land use– Industrial land use– Religious structures– Civic/Government owned structures– Primary or secondary schools– Anchor institutions– Healthy food retailers– Neighborhood retail– Locally-owned businesses


Public Spaces, Sidewalks and Bike Amenities Undeveloped or Underdeveloped land

Number of publicly accessible parks

Number of annual programs in public spaces

Presence of sidewalks

Sidewalk conditions

Trails

Opportunities for physical fitness

Trees shading walking areas

Natural environmental features

Public lighting

Benches

Are people being physically active (walking, jogging, biking)

Litter Garbage cans

Connectedness to adjacent neighborhoods

Bike accommodations

Bike racks


Transit and Road Characteristics

Transit options

Number of travel lanes

Speed limit

Distance between safe pedestrian crossings

On street parking

Number of curb cuts

Traffic control devices

Massachusetts Case Study

MassDOT | Arsenal Street Corridor Study

RFP Scope: “Analyze public health impacts including data for asthma, myocardial infarction, congestive heart failure, stroke, and hypertension; levels of pediatric and adult obesity; levels of pediatric and adult depression; levels of pediatric and adult diabetes; levels of pediatric asthma; and injuries and fatalities related to vehicle crashes, to the extent these data sources are available.”

MassDOT | Arsenal Street Corridor Study

Data gathering (Town, MAPC and MA Department of Public Health)

Health indicators:– Land use: mixed use, residential, commercial, industrial, public spaces, vacant parcels,

sites subject to change – Transportation: traffic counts, roadway characteristics, signals, transit, sidewalks and

crosswalks, bike accommodations, curb cuts, roadway safety.– Demographic: income, race, employment, tax revenue, home ownership, home values– Environmental: brownfields, noise, air pollution– Public health: obesity, asthma, chronic heart diseases, diabetes, depression – Community assets: schools, day care centers, health care institutions, open space,

healthy food establishments, community centers, places of worship, fitness clubs, locally-owned businesses.

Health evaluation criteria:– Safe and multi-modal transportation– Community connectivity– Healthy living– Healthy economy– Affordable housing

Arsenal Street Corridor StudyPublic Health Assessment | Baseline profile

Limited public health data at corridor level

Community-wide data indicates that the top three health concerns affecting Watertown include:– Obesity and inactive living– Poor self-management of chronic disease– Mental health issues


Obesity and inactive living– Direct connection between obesity/inactive living and stress,

mental health, and chronic disease– Having better places to walk promotes more active living and

weight loss

Key statistics– Watertown (17.6%) has a higher rate of obese students compared

to the state average (16.3%) (MassDPH)– Watertown has a high prevalence of obesity and lack of physical

activity among adults compared to neighboring communities (Belmont, Cambridge, Waltham) (MassCHIP)


Poor self-management of chronic disease– Lack of understanding of how to manage and prevent

chronic disease

Key statistics– According to Massachusetts Healthy Aging Data Report,

Watertown has a number of aging indicators that are worse than the state average

% ever had a heart attack

% with heart disease

% with congestive heart failure

% with osteoporosis

% with glaucoma

% women with breast cancer

% men with prostate cancer

% with anemia

% with benign prostatic hyperplasia

Watertown 5.7 46.3 25.2 21.8 25.5 12.1 16.2 54.8 42.8

State 5 44.1 24.8 21.7 25.1 10.3 14.6 48.7 40.9


Mental health issues– There is a close link between mental health and physical health

Key statistics– Watertown has a higher percentage of people who reported being

diagnosed with depression (31.6%) compared to the state (28.6%) (MassCHIP)

Arsenal Street Corridor StudyPublic Health Assessment |

Public health contributors– Public transit options

• MBTA 70 and 70A bus services• MBTA rapid transit and commuter rails accessed via bus services

– Access to ped/bike facilities• Sidewalks on both sides• Presence of on/off road and shared bike lanes

– Signalized intersections

– Mixed use development

– Parks/Trails and school play grounds

– Street trees

Arsenal Street Corridor StudyPublic Health Assessment

Public health barriers– Bus service is at/over capacity– Lack of bus stop amenities– Insufficient pedestrian safety features (signal, ADA compliance,

sidewalk accommodations)– High crash locations– Congestions and delays– Excessive curb cuts– High automobile traffic volume and noise levels – Lack of public-health conducive land uses (vacant land, automobile

service establishments, large format retail)

Arsenal Street Corridor | Public Health Contributors

Arsenal Street Corridor | Public Health Barriers

Building

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What determines health?

Healthcare Genetics Social, Environmental, Behavioral Factors

20% 60%20%

Based on: Slide from The American Healthcare Paradox, Lauren Taylor; Original Source: McGinnis et al, 2002

OUR NEIGHBORHOODS SHOULD NOT BEHAZARDOUS TO OUR HEALTH.

Why do we do this work as planners?

Counseling & Education

Clinical Interventions

Long-Lasting Protective Interventions

Changing the Context to make individuals’ default decisions healthy

Socioeconomic Factors

Smallest Impact

Largest Impact

“Eat healthy, be physically active”

Rx for high blood pressure, high cholesterol, diabetes

Vaccinations, cessation treatments (e.g. for smoking)

Fluoridation, tobacco tax,

smoke-free laws

Income, Race, Education

Complete streets, speed limits, walkability, access to green space

Housing, Zoning, Economic Development

Examples from Other Sectors

Traditional Public Health

CDC Health Impact Pyramid

Slower vehicle speeds make people feel safe and encourage them to be active and walk and bike more. For example, we know that is you are hit by a car going 25 mph, you have a less that a 1 in 10 chance of being killed; at 40mph, you have a nearly 7 in 10 chance of being killed.

It’s not right that residents of certain neighborhoods have to experience speeding vehicles and be at greater risk for severe injury and death while others do not.

To change this, the officials, planners and public health professionals should use community strategies like traffic calming and slower speed limits to reduce speeding.*

* Adapted from Talking about Health in All Policies, Dorfman & Krasnow, Berkeley Media Studies Group

Speed Limit HIA

• Adopt slow zone policy or enact local legislation

Policy Change

• Reducing design speeds used as part of local engineering guidance and regulations

Systems Change

• Traffic calming measures like speed humps, neighborhood traffic circles, and chicanes

Environmental Change

Sources: Adapted from The National Association of County and City Health Officials definition of PSE Changes

Targets of Change


Housing insecurity results from individuals and families can no longer afford to live in stable and safe housing. Sadly, housing insecurity is issue in our community and having real effects. For instance, children who experience housing insecurity have been associated with poor health, lower weight, and developmental risk.

We can’t address the housing insecurity problem working in isolation. We need to work with partner in housing and community development to incorporate health criteria into our housing priorities.

Working together, we can address the issue of housing insecurity and fix multiple problems at the same time. It will create more stability in people’s lives, improve childhood outcomes, and strengthen our economy.*

Housing Production Plans

Healthy Neighborhood Fund HIA

• Adopt inclusionary zoning policy

• Develop HPP with health element

Policy Change

• Use Managing Neighborhood Change Approach (Anti-Displacement Strategies Toolkit)

Systems Change

• Use or leverage resources to increase affordable housing choices



Targets of Change

People are healthier when they have a say in how in their neighborhoods are maintained and how they change.

We need to engage residents, especially those who do not typically participate in neighborhood activities, so that we can make improvements like fixing sidewalks and parks so that everyone feels as part of the neighborhood.

To do that, the officials, planners and public health professionals should work with residents to support mutual goals that create inclusive and resilient neighborhoods.*


Photovoice

• Record and reflect on community strengths and concerns

• Promote critical dialogue and knowledge about important issues through group discussion of photographs

• Reach decision-makers

Placemaking

Allows people to create places and streets which are healthy, safe, active, and useful.

Photo Credit: Principle+

Incremental, small-scale improvements

Local ideas for local planning challenges

Short-term commitment and realistic expectations

Low-risk, with a possibly of high reward

Tactical Urbanism by The Street Plans Collaborative

Photovoice + Placemaking

• Develop community/public engagement guidance (promote adult education approach)

Policy Change

• Support training of municipal staff and residents in photovoice

Systems Change

• Use available materials to make short-term changes and test ideas



Targets of Change

HEALTH STARTS LONG BEFORE ILLNESS, IN OURHOMES, SCHOOLS, AND JOBS

Council of Governments: Chief Elected Officials of each town serve on MetroCOG’s Board of Directors

Federally Designated Transportation Planning Organization (MPO)

Provide a range of services to the six member municipalities

Stratford

Fairfield

EastonTrumbull

Bridgeport

Monroe

About 316,000 people live in the MetroCOG Region

145 square miles in area

Located between New York & Boston

Bordered by Long Island Sound

Healthy Community Design: Greater Bridgeport

Obesity and access to physical activity and healthy food were concerns identified by focus group participants and interviewees. Walkability of communities, nutritious school lunches, and accessible and affordable recreational areas were all issues identified as important for changing the environmental landscape to support obesity prevention.

Healthy Eating, Physical Activity, and Overweight/Obesity. Greater Bridgeport region focus group participants and interviewees reported that obesity is emerging as a serious community issue, and with it, rising cases of chronic diseases. Survey data indicate that 57% of adults in the region are either overweight or obese. In addition to time constraints, the infrastructure itself – having the healthy choice be the easy choice – was discussed among many assessment participants.

Recreational Facilities. According to focus group participants and interviewees, the region has a geography and infrastructure that supports health, although accessibility is an issue for some. Safety concerns constrain physical activity in Bridgeport which has a large number of parks. Participants identified lack of time as another barrier to physical activity.

Source: Greater Bridgeport, CT Community Health Assessment. April 2013.

71% of Bridgeport residents reported themselves as obese or overweight, greater than state (59%) or national (63%) averages

36% of Bridgeport residents reported themselves as obese greater than state (21%) or national (27%) averages

81% of Bridgeport residents reported that they participated in physical activity on a regular basis

East End: 33% of residents reported that they were obese.

East Side: 40% of residents reported that they were obese.

Source: City of Bridgeport, 2011. Bridgeport Community Allied to REACH Health Equity (Bridgeport CARES): Results of a Community Health Assessment.

Improving Community Health

Goal: Reduce and prevent obesity by creating environments that promote healthy eating and active living in the Greater Bridgeport Region

Objective: By 2016, increase by 2% the number of adults engaged in moderate physical activity for at least 30 minutes a day for 5 days a week

Strategy: Increase/enhance access to and the number of places to get physical activity in the region

Indicators:– Number of adults engaged in moderate physical activity for at

least 30 minutes a day for 5 days a week– Number of new locations to get safe access to physical activity

created

Source: Greater Bridgeport Region Community Health Improvement Plan (CHIP) Report, June, 2013.

Barnum Station Study: Project Objectives

Increase the availability of housing options in a transit-supportive location

Improve transit and promote transit-oriented development (TOD) in East Bridgeport

Improve access to jobs, education, and services

Decrease per-capita vehicle-miles-travelled (VMT) and transportation-related emissions for the corridor

Increase participation and decision-making in developing a long-range vision for the area around Barnum Station

Street Level Station Design

Station Area Infrastructure Improvements

Land use patterns present a challenge to integrating bicycle & pedestrian infrastructure

Most principal roads have sidewalks, but many need repairs

No designated bicycle facilities or infrastructure

A linear park along the Yellow Mill Channel would provide a facility for active transportation, and complement future projects

East Bridgeport Development Corridor

Compact development within walking distance of Barnum Station

Mixed-use and market-driven development on appropriate sites

Apply complete street principles to the road network

Integrate open space within the pedestrian circulation network

Improve public transit access and service.

Create a Yellow Mill Greenway including multi-use paths

Preserve neighborhood scale and character

Economic strategy integrated with TOD planning

Source: Stantec

Stakleholder Feedback

Need for improved pedestrian routes and safe routes to schools

Increased retail and local service shops

Expansion and enhancement of park space along the Yellow Mill Channel and Creek

Source: Stantec

Active Transportation

Improve intersections with amenities and pedestrian facilities by emphasizing complete streets and a balanced approach to pedestrian, transit and vehicular travel

Construct the Yellow Mill Greenway to connect the Lake Success Eco-Business to Bridgeport Harbor

Bicycle lanes and pedestrian paths along both sides of the Yellow Mill Channel and Creek

Complete street strategies include bicycle and pedestrian facilities, improved sidewalks, streetscapes and traffic calming measures

Provide a new pedestrian walk from Ogden Street across Yellow Mill Creek via a new pedestrian bridge

Source: Stantec

Source: Greater Bridgeport, CT Community Health Assessment. April 2013.

Healthy Community Design & Public Health:Stratford

63% of Stratford residents reported themselves as obese (27%) or overweight (35%)

23% of Stratford residents reported no leisure time physical activity in the past month

“It’s a difficult town to be a pedestrian in.”

“The way the cars go whizzing by you, it’s unsafe. There really should be a sidewalk there.”

“I have lived in other areas where I waved to my neighbors and that’s it. But here, the neighbors really care.”

Stratford Center Revitalization Plan

Mixed-use and pedestrian-oriented development with a range of housing options in proximity to Stratford’s Rail Station

Generational diversity and less reliance on personal vehicle use

Encourage walking, bicycling, and transit use by locating multiple destinations and trip purposes within a quarter- and half- mile of each other

Facilitate the adaptive re-use of existing buildings and infill development

Ensure that new development is consistent with and enhances the nearby streetscape and the community’s historic character

Zoning Regulations that allow desired development within the TOD Overlay District

Source: Stantec

TOD Ordinance

Sidewalks constructed along the frontage of all public streets

Main entrances connected by a continuous network of sidewalks

Designated crosswalks and pedestrian-oriented paving treatment at internal and external intersections

Street trees, pedestrian amenities and adequate lighting

Source: Stantec

“Superblocks”—very large blocks of over 1000 feet with no internal paths or streets accessible for public use

Obstructs pedestrian and bicyclist circulation

Source: Stantec

Source: Stantec

¾ mile off-road trail from the train station to a local park

¼ mile connection from a residential neighborhood to the high school & Stratford Center Train station

to the commercial district

Train station to a residential neighborhood

Source: Stantec

Complete Streets Planning for Stratford Center

Safety and access for all ages, abilities, and modes

Better connections between residential and commercial areas

Improve access to and between public transit systems

Develop safe routes to school

Design interventions that create a sense of place, reflect the character of Stratford’s different neighborhoods, and evoke a sense of safety and vibrancy

Soften existing barriers (e.g., I-95 and rail corridor)

Embrace Stratford’s cultural arts, history and natural resources

Integrate traffic calming measures to slow traffic and encourage active transportation in key areas

“It’s a difficult town to be a pedestrian in.”

“The way the cars go whizzing by you, it’s unsafe. There really should be a sidewalk there.”

Lessons Learned

Lessons Learned

Pedestrian and bicyclist safety is paramount—typically no debate about improvements to pedestrian and bicyclist facilities

Understand the transportation infrastructure: inventory the availability and condition of sidewalks, crossings and amenities.

Safe connections for pedestrians and cyclists to destinations (transit, parks, shopping, jobs) will make physical activity a part of life, rather than a leisure activity.

Lessons learned

Direct relationship between public health and the built environment

Include health professionals in the planning process

An interdisciplinary team (planners, designers, engineers, developers and health care professionals) bring varied expertise, collaboration and curiosity

What seems simple to one discipline is ground breaking for another

Health can be a catalyst for capacity building

Establish health indicators and be specific about health outcomes

Warning: Finding health data is difficult—be clear on the limitations

incorporating health into the planning and design of transportation improvements

Government & Nonprofit