How people travel influences health in a variety of ways, due to factors such as air quality, physical activity levels, safety, and access to healthy food and medical care. Land use, transportation, and health-related decisions are made by a range of actors and agencies at different organizational levels. These entities may collaborate to develop effective planning tools, policies, and incentives in order to influence public health outcomes.
Linking access to healthy food and active transportation options can lead to better public health outcomes | Flickr user jimforest
By including public health agencies in land use and transportation planning and decisionmaking processes, the resulting policies and development support not only traditional mobility and economic development goals, but the wider range of impacts of transportation on public health.
Columbus Area Complete Streets Toolkit and Checklist
Mid-Ohio Regional Planning Commission (Columbus, OH MPO)
The Mid-Ohio Regional Planning Commission (MORPC) adopted a Complete Streets policy and accompanying toolkit in 2010. Complete streets are designed to be accessible to people of all ages and abilities, and support all travel modes, supporting active, healthy lifestyles. They typically include sidewalks, safe crossings, bicycle lanes, automobile lanes, parking, and accommodations for transit (see the Complete Streets/Routine Accommodationsection).
The MORPC toolkit is intended to help elected officials and development teams take a broader approach to how they plan, design, and implement projects. One especially notable element is MORPC's coordination with five local health districts to develop the toolkit, which provides resources for local governments to understand the connection between Complete Streets and healthy communities. The health districts assisted MORPC with surveying local governments and providing local best practice examples, which resulted in new partnerships between local and regional officials and public health districts.
As part of the policy, all projects receiving Federal funding through MORPC must also complete a Complete Streets checklist. Considerations on the checklist include traffic generated by surrounding land uses, transit access, bicycle and pedestrian infrastructure, and connectivity to nearby destinations.
Active Living Ramsey Communities Initiative
Ramsey County, Minnesota
Active Living Ramsey Communities (ALRC) is a multi-disciplinary initiative that aims to integrate physical activity into the daily lives of residents through the built environment. ALRC is driven by a coalition of representatives from local government agencies, business leaders, community groups, health industry leaders, and local residents. It works to influence programs, projects, policies, design processes, partnerships, and community awareness in order to increase opportunities for daily physical activity.
The coalition works with communities to incorporate active living principles into local comprehensive plans, and has produced several resources that demonstrate how land use policies can be used to improve public health. For example, the Comprehensive Planning and Active Living Toolkit includes recommendations and model language to develop health-focused parking, mixed-used development, and design guidelines. ALRC's goals and strategies are included in Ramsey County's 2030 comprehensive plan, and Ramsey County voted to incorporate ALRC's active living principles (as found in ALRC's 2008-2012 strategic plan) into all County department work.
A family walks on a trail amid greenspace in Ramsey County, Minnesota | Ramsey County "Go Ramsey Communities"
Program on Health, Equity, and Sustainability
San Francisco Department of Public Health, San Francisco, CA
The San Francisco Program on Health, Equity, and Sustainability (PHES) is an inter-disciplinary team within the city's Department of Public Health that promotes healthy environments and works to incorporate health considerations into all city policy making. Modeled on the Health in all Policies approach, PHES develops broad partnerships with public agencies, private organizations, and residents.
PHES activities include participating in city-wide and neighborhood-level planning and decisionmaking; providing assessment tools and technical assistance; and conducting research. PHES has played a role in several land use and transportation initiatives, including neighborhood bicycle and pedestrian plans; the incorporation of health analysis into environmental impact reports; the development of a pedestrian safety geodatabase; and community- and project-level health impact assessments.
Tools and methods to measure the potential health impact of projects, plans, or policies support evidence-based policy making and help incorporate health considerations into a broader range of public policy objectives. Long used in Europe and Australia, health impact assessments (HIA) are increasingly being used in the United States to influence land use and transportation planning and decisionmaking. A HIA is a set of methods and tools to evaluate the health impact of public policy decisions. The methodology for the HIA includes the standard six-step HIA assessment. While HIAs are the most commonly known health assessment tool, there are several other tools that address connections between land use, transportation, and health.
Atlanta BeltLine Health Impact Assessment
Center for Quality Growth at Georgia Tech, City of Atlanta, Centers for Disease Control and Prevention, Rollins School for Public Health at Emory University, and Fulton County Department of Health and Wellness
Currently under construction, the Atlanta BeltLine is a 22-mile multi-use trail (primarily located on former rail beds) that encircles the City of Atlanta. Between 2005 and 2007, the Center for Quality Growth at Georgia Tech conducted a Health Impact Assessment (HIA) of the then-proposed BeltLine. Several recommendations focused on coordinating adjacent land uses to improve public health outcomes, including prioritizing the development of parks and greenspace over retail and residential uses.
In 2012, the HIA team and its partners evaluated the impacts of conducting the original HIA on the development of the BeltLine. The 2012 assessment found that the original HIA influenced public policy as well as land use and project decisions for the area adjacent to BeltLine. For example, greenspace was the first construction activity along the BeltLine. Also, the U.S. Environmental Protection Agency cited the HIA when it awarded $7 million in grant funding for brownfield clean-up and greenspace development. The BeltLine Corridor Environmental Study Team added health and connectivity considerations to the alternative analysis evaluation criteria of both the Federal and State environmental impact statements/reports, and is also adding a health metric to a decision support tool to guide future funding and development decisions. HIA researchers note that public health outcomes have yet to be measured.
Atlanta's Historic Fourth Ward Park along the BeltLine opened in 2011. The park doubles as a water retention facility. | Atlanta BeltLine Partnership
Health Impact Assessment of the TransForm Baltimore Comprehensive Zoning Code Rewrite
Johns Hopkins University and the City of Baltimore
In 2010, the City of Baltimore released a draft update to the citywide zoning code; this was the first comprehensive update since 1971. Johns Hopkins University collaborated with the Baltimore City Health Department to perform a health impact assessment of the draft code - one of the first examples in the United States of an HIA of a zoning code. The HIA compared the proposed changes to the 1971 zoning code, and focused on how the updates would influence public health factors such as obesity, pedestrian safety, nutrition, and crime. Goals of the HIA were to influence the final version of the zoning code and to ensure that healthy recommendations were implemented through the appropriate location of zoning districts.
The HIA recommended several changes that relate to land use and transportation, including:
Sacramento Area Recommended Protocol for Evaluating the Location of Sensitive Land Uses Adjacent to Major Roadways
Sacramento Metropolitan Air Quality Management District (SMAQMD)
The Sacramento Metropolitan Air Quality Management District (SMAQMD) "Recommended Protocol for Evaluating the Location of Sensitive Land Uses Adjacent to Major Roadways" is a voluntary guidance tool for use by local planners, decisionmakers, and developers to consider the health impacts of development locations. The tool provides a methodology for assessing and disclosing the potential cancer risk of locating sensitive land uses (such as residential developments, schools, etc.) near roadways where particulate levels may be high. The tool uses emissions and traffic data specific to the Sacramento region that can be used to screen a site-specific project to determine the need for a heath impact assessment, and then provides a methodology to conduct these assessments. Strategies to mitigate the health implications of a project's site - including design considerations and vegetative plantings - are also included in the tool.
States are increasingly identifying the intersection of transportation and land use as an opportunity to advance State-level public health goals. To that end, States have incorporated public health considerations in their statewide transportation planning and implementation approaches, particularly by promoting active transportation options such as walking and bicycling, and reducing automobile-centric development patterns.
Massachusetts Healthy Transportation Compact and GreenDOT Implementation Plan
Massachusetts Department of Transportation (MassDOT)
As part of transportation reform legislation adopted in 2009, the Massachusetts Healthy Transportation Compact (HTC) directs the Massachusetts Department of Transportation (MassDOT) to coordinate with the State Office of Health and Human Services to achieve positive health outcomes by coordinating land use, transportation, and public health policy. The HTC includes directives for State transportation and public health agencies to leverage and coordinate State and Federal programs, increase mobility options, and decrease greenhouse gas emissions.
In response to the HTC, the 2012 GreenDOT Implementation Plan provides a long-range, interdisciplinary framework that directs all MassDOT business activities to improve public health outcomes over the next eight years. The GreenDOT Implementation Plan includes land use strategies to use MassDOT-owned property for transit-oriented development (TOD), and a goal to triple the mode share of bicycling, walking, and public transit (each) by 2030. To measure the progress of the mode share goal, MassDOT is piloting a Personal Miles Traveled metric for pedestrians, bicyclists, and transit users. The PMT data will be collected for one year and include all trips in order to accurately reflect user's daily traveling behavior. The PMT data will be used to better coordinate statewide transportation planning and land use in order to reduce dependence on driving.
Tennessee Office of Community Transportation
Tennessee Department of Transportation (TDOT)
The Tennessee Department of Transportation (TDOT) established the Office of Community Transportation (OCT) in early 2013 to better coordinate local land use decisions with State transportation planning. In addition to lower infrastructure costs, TDOT anticipates that OCT involvement in land use decisions will help reduce the automobile-centric focus of future growth, and improve public health by providing opportunities for active transportation such as walking and bicycling. The OCT will be supported by a current update to the State long-range transportation plan, which will elevate the importance of bicycle and pedestrian facilities in project planning and design.
The Columbia River Pedestrian Bridge in Nashville, Tennessee connects two greenways | Greenways for Nashville
Four satellite offices staffed with planners from the OCT Community Planning section will work with local communities to promote regional considerations in comprehensive plans as they relate to the State transportation system. Considerations include ensuring that future growth is integrated with existing State infrastructure as much as possible, and that new infrastructure is developed in a coordinated, cost-effective manner that reduces sprawling, isolated development patterns. OCT planners assist with articulating the implications of land use and transportation decisions in the planning process as well as with establishing local partnerships, potentially with local public health agencies.
North Carolina Department of Transportation (NCDOT)
Health is one of the five "pillars" of the North Carolina Department of Transportation's (NCDOT) statewide bicycle and pedestrian plan, WalkBikeNC. Currently in draft form, the health section of the plan was developed in collaboration with Active Living by Design, a program of the North Carolina Institute for Public Health at the University of North Carolina-Chapel Hill. The plan focuses on increasing the accessibility to and connectivity of pedestrian and bicycling facilities (such as sidewalks and trails) in communities throughout the State, and improving health outcomes by integrating active mobility in everyday life.
Health-related strategies of WalkBikeNC include the development of performance measures; the incorporation of health impact assessments into transportation projects; and the inclusion of health practitioners in transportation project scoping and development processes.
Contact: Lauren Blackburn NCDOT Bicycle and Pedestrian Division