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October 23, 2012 Webinar

Transportation and Health Transcript

The Federal Highway Administration (FHWA) Office of Planning, Environment and Realty's (HEP) Surface Transportation Environment and Planning Cooperative Research Program (STEP) ended on September 30, 2012. For current HEP research information, please see HEP's research web site.

Event Started: 10/23/2012 6:00:00 PM

Please stand by for realtime transcript. thank you for standing by, the conference will begin shortly. Ladies and gentlemen, thank you for standing by. At this time all participants are in a listen-only mode. Later we will conduct a question and answer session. If you require assistance please press star and then zero at any time. Today's call is being recorded. I will now turn the conference over to Sarah Washburn. Good afternoon everyone and thank you for attending the webinar on transportation. This morning I will share a few announcements with you pick if you wouldn't nine putting your poems on mute so we don't have outside noise. As the operator mentioned, we will be having a question-and-answer session after the presentation. In the meantime, feel free to enter any question as you have in the chat pod on the lower left of the screen. We will open up the phone lines for questioning after addressing the questions in the chat pod. the slides are available for download. Just highlight the name of the file you want to upload and then save to my computer. What that I would like to get our presentation started with James Greason. Good afternoon on behalf of of the office of planning I would like to thank you for participating in this webinar on transportation and health.

In the next few minutes, I will share what makes FHWA efforts to conduct the research to understand the relationship between surface transportation and the environment. Next slide. Between 2006 and 2012 federal highway transportation environment and planning co-opted of research, we will call it step, are focused on national research, planning in -- the program sought to improve the understanding of complex relationships between surface transportation can't planning and the environment. the report that we will discuss today was funded by the step program. It identifies best practices learned and help you strengthen the links between health and transportation in your week -- work. In July of 2012, Congress passed a moving ahead for the 21st century. The bell authorize funding for FHWA to strengthen transportation and environmental decision-making. The step program on map 21 will continue, I will make a note here what we call step, will certainly be a research effort that will continue with pretty much the same objectives that we had envisioned. The details of the program are still being finalized and we will share that with the public in the next few months. However, as I said earlier, the key components to identify projects that you see on the screen and the program will continue.

I dry your attention to the 2nd and 3rd bullet there. And prove transportation planning and environmental decision-making court nation processes. Minimize and reduce the potential impact of highway infrastructure, operations and surface transportation on the environment. There is inherently and environmental health aspect of this in terms of health and transportation. We will note that as key objectives. Although map 21 does not explicitly identify health as part of the transportation process, some provisions can be used to improve the overall health of the community. Map 21 we'll provide help for a ability of activities that support health such as vestry and, bicycle and non- motorized transportation can't safety routes to school, recreational trails, transportation enhancement activities, environmental mitigation and air quality improvement programs. the eligibility of these programs, some do not exist anymore -- [Indiscernible] during this webinar I encourage you to ask questions and learn what other people are taking in the holistic approach of environmental planning. I would now like to introduce Fred Bauer, on the planning capacity overview to cool provide an overview.

Thank you Jim, good afternoon everyone, as Jim mentioned, with the FHWA office-supply and, I would like to recognize a few folks on the line. This is, thank you to our peers that are presenting today, the information you have is great here we really appreciate it here I would also like to thank the team for their efforts in putting together the team as we move forward and I would also like to thank Sarah Washburn for putting the webinar on, not once but twice. Thank you everyone. Just quickly mention that FHWA is currently working with the center to identify best practices for metropolitan planning organizations, or MPO, and stay devotees to integrate public health into the transportation planning. The goals of this research is due help MPO is in other transportation agencies and partners, including federal health -- with the end result in to help your communities. Today's presentation well primarily focus on the new white paper entitled metropolitan area transportation planning for healthy communities. This office -- state of holders -- area transportation process. FHWA in the center are developing a companion report on integration of health into stay devotees, as I mentioned before. the white papers along with the results of the other research will be shared throughout the transportation's health field, as part of future presentations like this one.

Do this research FHWA will support a new partnership between the DOT and they said -- Center of disease control. It will essentially create a web index, to evaluate the health effective transportation policies, program and infrastructure.

I would now like to turn it over to Bill Lyons, bill?

Thank you Fred. This is Bill Lyons at the DOT bolt the center in Cambridge. I think, cirque are did we want to put up the results of the first to pull questions?

Okay. The third question, you will see up on your screen. Asks which transportation topics are you most interested in? It lists several choices and please indicate multiple choices if you are interested in one or more or even all of them. That would be very helpful. Okay? Looks like a very strong weighted toward active transportation, walking, and bicycling. If you could leave that one up and we will put up the next one. How long have you been aware of or working on connections between health and transportation? We will put that up and I will continue with my introduction. As Fred mentioned, this webinar focuses on the insights and best practices from research that the bulk the center has contacted for federal highways. 12 they center as part of the U.S. Department of Transportation and the research and special programs administration. We spent quite a bit of our time supporting the other parts of the department and our group here at double the center, we work primarily for the federal highway and FDA planning offices. We are also federal service to work with other federal agencies and state and local governments. Are interest in the interest section of transportation and health goes back many years to early convening that we did with. Experts panel of public health, center of disease control, MPO, Department of Transportation and transit agencies, development of a comprehensive research bibliography and research in the advisory group that initiated the Robert Wood Johnson agency. We have been working several years with another part of federal highways on a valuation of the non- motorized pilot program which funds for community $25 million each to do innovative well walking and biking projects. and produce the report to Congress in may, and included some analysis of health benefits resulting from the non- motorized projects conducted, the health part of it was conducted with help from CDC. The purpose of this paper is really, as a white paper to explore an emergent topic. Particularly looking at health considerations are mainstreamed within the Metropolitan transportation planning process. We would like to identify opportunities and challenges to go further. As Fred mentioned, the MPO paper and the DOT paper now underway are going to provide part of the foundation for a new initiative with U.S. disease and center of disease control to develop a tool to help devotees. For the white paper, the audiences specifically DOT's, MPO's and partners and we may not only traditional transportation partners but also public health stakeholders. The metropolitan paper is in it's final review and we hope to have it out and available in the next several weeks or, we are just beginning to speak devotees follow-up phase two, report that we will talk a little bit of toward the end of the webinar.

As far as our approach, we like to use the word holistic. We could also call a comprehensive. We are really looking for at the beginning of the research was MPO is that aren't just dealing with one or two of these topics, dealing with them in a traditional way, air-quality is required under the clean air amendments. For stay devotees and MPO's that are in areas, that is a very well established and traditional approach, but MPO's are not necessarily thinking of that as health but except in the most abstract way. It is definitely a technical responsibility that they have to reduce transportation related emissions. Safety another core goal. Reinforced by federal requirements and federal programs including those under map 21 and active transportation. Not just traditional walking and biking, but considering how that can be part of a multi- of mobile transportation system and specifically, physical act of the from active transportation contributes to reduction in Obi city and disease levels. Our approach is to build from best practices, two go out and see who is doing what and who the invaders are and what the best practices are. From that to adapt and design a framework that peers can use that we can replicate some of the approaches.

We are looking for an approach to these different aspects of health that combines them and considers him goals related to healthy communities and using this approach to mainstream consideration of health in the planning process. the next slide is a little bit hard to read on the right side you see the standard model of transportation planning. Whether it is by Metropolitan planning or state Department of transportation, it is encourage the federal requirements, it is part of the daily life of MPO's for a public health folks, some of this may seem quite detailed here I guess the thing to focus on is the key pieces there. The first box, vision, vision plan. Fourth block, long-range plan, federal requirement to produce a 20 year plan. Then the tip, transportation improvement program, the for your investment program of devotees and finally at the very bottom the monitoring and performance measures. Those are what we consider key decision points of the process. In conducting this analysis we looked at a broad range of questions with our MPO appears. Motivation, why are you doing this? and Corporation and planning process, where, what, what stages? Public involvement, exactly where did you bring it in? What were the early actions you took? Were they technical, database, as you look at models or was it much more a policy level or an institutional level or was it a combination of those? Did you make structural changes to your planning process? Did you at introduce a healthful at the very beginning that influenced everything else? Did you introduce health-related performance measures? Really where did you bring it in? Is it a structural change? Then we mean not something that is just temporary or one-time only, but something that is really heading toward the long-term planning cycle. If you look at all of the arrow's in our diagram you will see that it is really one big feed back loop. You monitor performance and you go back and you informed your vision and scenario planning and use that to guide your plan and begin again. This is the world of DOT's and MPO's. We wanted to talk to the peers and find out as innovators exactly where in this process they have been incorporating health.

From that, produce a revised framework for adapting MPO and later DOT planning to seriously incorporate health. So, at the end of the day the MPO could brand itself not only as a mobility, congestion and infrastructure maintaining organization but also one that is contributing to a healthy community.

for our methodology for the first white paper and the socket one. We begin with a context that is really the world which MPO and DOT's are planning. Federal cost state can't and local policy funding programs, regulations, mentioned the clean air amendments, also includes titles six, environmental justice and the FDA and federal highway planning. Those really set the field for what MPO is an DOT's do. Many go beyond that to adapt to their particular needs but that is a level of commonality reflected in the diagram that we just looked.

We should emphasize that this research is not based on a national scandal or survey. We very selectively conducted a white paper and look for innovators and use those to build up a picture of what an overall frame work would look like considering health. the white paper that is intended to open up a very important and challenging topic and to identify what is possible from a limited set of innovators.

We are very fortunate to have our for excellent support of, innovative peers from MPO's presenting. But, first I am going to turn it over to my colleague, ceilidh packet to give you a look at some of our insights from the census. As Hayley begins, Sarah, can we are in those polls up again?

Sure, this as Hayley, I am a committee the planner. I will walk through a few details on the framework that was laid out or first we are looking at why MPO's became involved in these health initiatives in the first place. Overwhelmingly we found that it was about partnership. Our relationship with health departments, often that led to involvement but there are many other sources of motivation. a big one was federal partnerships. There is partnership such as sustainable communities, America's great I'd days -- ordered out of doors, have all encourage MPO's to a line with health and transportation. Other MPO's got involved because there were state or federal levels -- regulations that considered health topic. Considering safety, air quality and health impacts for environmental testis populations were some of the things.

There is also some state regulations that had encourage MPO's to become active. Another popular motivation that was Grant's, or technical assistance for MPO's. The center for disease control, the American public health Association and the Robert Wood Association are a few of the organizations that offer support for MPO stews pursue these activities.

Many types of motivation exist. Once MPO's have this idea to start innovating health into activities, they need to start by defining and documenting the connection between health and transportation. Their boards and constituents understand there is an important relationship between the two. It is also the foundation for the communication and partnership. Those MPO is that really enlist the help of their partners, partners bring a big one in terms of really action. They have look for partners that range from the local to the national. There is often organizations at the state and national levels that conduct pilots that have Rod MPO's. Partners are really helpful in terms of building political support.

Also among the public in the region, again that foundation and message from the partners help the MPO's get support to advance later with some structural changes that we will discuss.

Partners are also able to leverage funding and support outreach. a lot of the grants that come up that we will mention later, are ones that MPO's were able to compete more favorably because they had several partners. Then again, MPO's have been able to find way for health partnership participate in the activity on a more informal basis. Those are all some of the early actions.

from there, one chimp euros have established this connection and build a base of support, they pursue structural changes. We defined structural changes as more formal changes that bring health and two the transportation planning process. Often the small and modest strategies that have to benefits. a -- safety is another one that has a lot of hope that fits in a good way to build support. Structural changes may include bringing health and to projects, into your selection criteria, keeping and thinking about funding, advisors that have health experts on the advisory committees. There are several ways that show this will have Fuhrman and send continue through the MPO planning process. Within structural changes, we also look at ways in which MPO's can integrate health into the decision-making process. This means they are using help to decide where to spend their money and what project to pursue.

Ones changes are quantified into something, well a long-range plan, it can become fully integrated into MPO's programming culture. Some of the examples may include, integrating health and two the goals, adding performance measures, or considering project selection criteria. So can't now we will be able to turn to you the most adjusting part of our presentation which will be hearing from our wonderful peers. Again we are grateful that they are able to join us today. We will be hearing from Nashville area and PO, the Sacramento area Council of governments, the Puget Sound regional Council and the San Diego Association of governments. Before we go any further, many more details and links to important research and documents for each of these peers will be able to be found in our white paper. I encourage you to go there for more information. Again, the findings we have noted so far are really based on the work these peers have done. Thank you a lot for joining us.

We will join with Leslie Meehan, she is the director of healthy communities. Today at.

Today I will give a brief overview of how we include health an art regional transportation planning in the Nashville Tennessee area. a few years ago we were getting ready for our long-range plan update which we have to do every four or five. We wanted to start the conversation with our stakeholders and the public that transportation is no longer thinking about streets and how quickly we can move cars from point a to point B. But really, how can we look at the whole impact of the transportation system. So we started talking about things beyond just congestion, but the trip times, out that involves housing choices and where children go to school. Looking at increase costs for energy and even food. Looking at air quality. All of these things are interlude related and linking them back to outlook else in the increase costs we have to treat chronic disease in our nation.

One of the ways that we use visual's like this to engage stakeholders in the public in the conversation was to really talk with them about some of the things that we are saying in terms of national trends in local trends. This graphic is one that seems to resonate with folks. What you see is the green line is the vehicle miles traveled as checked by the U.S. Department of Transportation. This goes back to 1962. So you can see that over the few decades we have been increasing the number of miles that we drive as a nation. If you look at the purple or blue line, that is the adult obesity rate that is tracked as by the disease control. You can see that these two trends have similar trend lines, so that we are really starting to see a relationship between some of the transportation choices that we are making in the impact on our health. One of the things that we did was move over to adopt our 20 35 plan which we adopted in December of 2010. We conducted a random dial survey of 1100 households over 10 counties over the national area. Nashville area. We got into some pretty rule areas of the southeastern part of the United States. We asked several question about transportation can't one of them were if you are in charge of the spending transportation dollars, I would you do it? What we heard was first, folks wanted more emphasis on mass transit. They did not always want to ally on a card to get around. They also wanted more facilities for walking and bicycle. They wanted to walk for some of the shorter trips if it was safe and convenient year finally, they chose the last allocation of dollars on building roads and fixing roads. That was there last priority. We turned what we heard from the public into policy by adopting the three policy that you see on the screen. We created a bold new vision for mass transit. We adopted support for active trip -- transportation and walkable communities and we placed an emphasis on preserving and enhancing our existing roadways by going back and doing stuff like adding sidewalks, improving crosswalks, rather than spending money on new facilities.

One of the components of the long-range transportation plan was a regional vision for bike weighs in a regional vision for sidewalks. You can see these visions as a spread out over the seven counties of the MPO area. Each of these systems contain about a thousand miles of facilities. We not only needed to figure out how we would pay for building out this vision, but we also needed to figure out how to prioritize it. One of the things we really wanted to do was to try to priorities -- priorities facilities in areas where we saw a more higher incidence of disease and those related to abuse of the or because we have a larger obesity problem in the United -- southeastern United States. We soon learned that it can be challenging to get that kind of data at a sub county level. So as a substitute we turn to census data and at the time we only had that to thousands consensus data, this was back about four years ago that we did this ranking. We looked at tracks that have higher than average types of data or low income, minorities in adults over 65. We over laid those three ETA sets on top of each other and that is the map that you see on the right of your screen with the areas in red. Are thinking was that if we could prioritize our side white, bikeways and greenways in these areas, we would be providing an opportunity for physical are vivid he and we would also be providing transportation options for groups that are statistically less likely to have access to a personal automobile. It wasn't a perfect system, but this was our first approach and saying how we could look at health and equity as part of the transportation planning process.

We then went on to look at the criteria that we use for our overall long-range transportation plan and we developed a new criteria for our urban surface Jasper Tatian dollar. Which is essentially the bread and butter for MPO's to use for roadway improvements in their region. We took 70% of those STP dollars and created a new system. 60 of those 100 points related back to it active transportation, complete streets and basically improving personal health and environmental health. You see those categories on your screen in orange. Polity growth, sustainable development, model options, safety and security in mitigating congestion. All of these have separate subcategory's and I am happy to share the standard version of you this criteria with you. But basically you can see that we increase the emphasis that transportation projects should have incorporating consideration for physical activity and health. This Germanic league change the types of projects we saw come in for the plan. We had about 500 projects submitted by local government that were competed for $6 billion over all and an estimated transportation dollars that we would receive over the next couple of decades.

About 400 of these projects were roadway projects. 75% of those came in with sidewalks and bikeways included as part of the proposed project you're in the adopted plan 70% of the project include sidewalks and bike lanes and this was up from an estimate 2% in our previous 2030 plan we adopted in 2005.

We took the other 30% of that STP allocation and we divided it up in the following manner. We took 15% and reserved it for an active transportation program that would enable us to find additional sidewalks, bike lanes, greenways and we did a project last year, we awarded a projects with $2.5 million and we estimate we will have another $115 million to this program to award over the next couple of decades. We took 10% and took the last 5% allocated up for intelligent transportation systems doing things like signal timing and pedestrian countdowns so that we can use technology to help us manage our roadway systems.

Next up for us is a regional travel survey that we are doing right now. We called it the middle 10 transportation and health study. We are asking questions not only about transportation but health. We have 6000 health polls that are participating. We are asking basic questions, such as height and weight of the members of the household. Assessment of health, diet, and sedentary time. We are asking 600 adults who are participating in a sub study to answer additional questions about their food cost security and environment hear car they able to find fresh and affordable wood in the neighborhood. How much physical activity do they get as part of the transportation and leisure here, they are also using a Jew -- GPS unit that measures there output. They wear this for four days. This enables us together data on travel behaviors, the modes people using, how much physical act of a the they are getting from those modes and how that all relates to things like choices for food, and commuting to jobs. We are hoping that this data set will help shed will light on the relationship between transportation and health in our region and also help us to benchmark the policies that we just passed so that we can continue to collect this type of data over the next couple of decades or thank you very much.

Thank you. We are now going to introduce Matt Carpenter. He is from the Sacramento Council of Government. Hello, I just want to start by expressing my appreciation for the opportunity to be a case study of healthy community planning. My presentation will cover highlights from our planned efforts.

First a few words of background on my region. In my region, the Sacramento area Council of government. the Sacramento area shows a good cross-section of people across our country. There is a good balance of urban and rural. Also a good diversity of natural environment.

One example is that we have increasingly become something of a can be in or four diversity of regional issues. This is made part -- possible -- the relationship between public health and transportation is one of these issues has become a convenient for -- over time. There are two primary areas to define are focused, one is air quality in the second is a relationship between physical environment and activity. for these areas there is a lot of work to be done in terms of air quality, they American lung Association, our region had is the fifth worst area for ozone. While for physical activity, that California physical fitness report reports one third of our school age children are already overweight. And other study by the University of California demonstrates a connection between obesity and low density suburban development in our region. the findings include evidence of lack of sidewalks, bicycle lanes and inadequate public transportation's our barrier to accessing schools, shopping and recreation. Involvement in healthy community started with the blueprint. It was the vintage -- it may come as no surprise to the webinar participants that this demonstrates strong environmental equity. However, back in 2004 when the plan is adopted they're really was a lot of Haas from the public and elected officials how strong the connections are.

the blueprint really change the dialogue in the Sacramento region when it was adopted you're are looking back we believe that two key ingredients work the foundations of its success. First the planning process, the second was a real commitment to information basement -- include using state-of-the-art improvement tools for cast and models to measure and monitor performance and then applying these tools at different scales of analysis. The slide simply a list rates the ability to go from a regional travel model all the way down to neighborhood sketch tools. In one of the sketch planning tools, will allow for a more integrated air quality and public health module. Overtime this project will we see is critically important as we can test future development areas and engage new stakeholders. In addition to providing technical tools to measure the relationship between health, transportation and air quality. the bullpen every also change the way that it is funded. Prior to the blueprints we acquired funds by population. Today bonds are based on blueprints.

It is over a hundred million dollars in flexible state and funds in every two years. Awards are awarded to competitive process. the process is really evolved over time and in the last two funding rounds the application process is about an initial screening and evaluation of performance outcomes.

Many of the performance outcomes directly support healthy community outcomes. the key question really asked on this applications, is, can the transportation investment offer a strong performance outcome. It included consideration of health benefits by looking at whether or not the project increases in transit or active transportation mode share or does it demonstrate increased safety through reducing collision, improving air quality or does the project support more compact use of development projects that can support active transportation. The funding application demonstrates performance and quantitative and qualitative evidence. Under this performance outcome approach to regional funding, we have already seen a large increase in a words to projects that offer alternatives to driving alone.

Per example, last year, approximately 50% of the projects funded had a strong transit or active transportation component. the momentum for the blueprint really provided an important foundation for the much apologized for Tatian plan and sustainable community strategy that followed you're the MPS up as we call it was the region long transportation plan that will build both federal requirement and state requirement to receive bonds. the new MPS PPS is the first plant to be fully based on the footprint vision in the first plant to implement the new state statute, California statute 275 or region. That Bill 375 is a statute that develops an integrated land-use and housing strategy to reduce greenhouse gas emissions derived from passenger vehicles.

Although the legislation does not require that, the discussion of greenhouse gas emission really led to an innovative mining effort. This effort really do our process demonstrated more clearly how health, transportation and air quality all relate.

[Indiscernible] prior plans had simply had a brief stand along appendix for public health, but the new plan, it actually includes both well strategy to expand transportation options that can lead to improve public health. That is one example.

At a broad level, MPS incorporates many of the same principles that guided the blueprint efforts in these principles are foundation for the plans: Settings and performance outcome to measure. As you can see, these per principles are familiar and cover many dimensions of integrated planning of that provide healthy community. for MTV as CS, it test how will the principle was supported. Key questions we asked was cannot be measured with available data are tools? Can be monitored over time? Is the indicator clear enough to be understood by a broad audience? In addition to the primary responses listed, per example, the plan includes a number of indicators for environmental Justice areas. These indicators include transit and -- this measure was offered to demonstrate the importance to -- for example, the plan measured access to healthcare employment but not yet to healthcare services. Other metrics that are being worked on, include access to stores with fresh Protec's and more measures of her find flexibility. the six principles guiding this is also the priorities for healthy communities. First emphasizing operations and maintenance over more expensive capacity improvements. The benefits for healthy communities every, operation improvement contain a higher level of intelligent transportation networks. [Indiscernible] these IT as investments are cost-effective and include everything from technology to make intersections safer to increase travel information that can support more transportation and bike chirps. The maintenance emphasis puts more money towards repair to improve the condition of our roadways. Strategy in the plan includes ways to do road maintenance that more comprehensible, so bike travel can benefit.

Complete streets is an important aspect and one of the strategic priorities for the limited expansion fund that are available. It is a strategy for the plan for both urban and roll focus. Complete streets in urban areas that include sidewalks and bike lanes is one example. Wall and roll areas it includes regional trail connections and core doors on county roads that have unsafe intersection. It should also be noted that the plan includes strategy for further incentive buying street safety. We do this the regional funds. For example, applications -- [Indiscernible] it is encouraging that we are saying more and more example of innovative work. Expanding transit is also an important strategy. The plan has a focus on higher frequency use -- essentially the plan emphasizes that with limited plan, the plan also includes new transit options to attract choice riders, these include bus, and street investments. Equally important is an emphasis on improve pedestrian connection to the transit stops or station. We often call this the last mile. That being where it is important to make pedestrian connections to transit in order for it to succeed. We have linked this to the HUD sustainable grant. The grant were consists of a number of elements including five case studies to examine the barriers and opportunities to transportation.

Many of the stakeholders have an increase in health, especially health equity. When of the benefits identified has been -- the obvious benefit from such site is that they are compact and make use of developments. Developments that are typically providing good access to healthcare and increased opportunities for active transportation. On the flip side, the trade-off include that many of the sites are near busy road sites or industrial areas that increased exposure to air contaminants. the land-use connection between where we grow and the potential for healthy communities is also a focus of the MTV as CS. a these types describe describe Ford distinct landscapes that lead to really different outcomes. You see them illustrated on the slide and color. They include centers and corridors can't establish communities can't developing communities and roll residential communities. These centers and core doors are very diverse and scaled. They range from central business district to Sacramento to small downtown cities. These are higher density of course and have mixed land use in our region. To no surprise, the centers and core doors in the area with the most transit of biking and walking today and have the greatest future potential as well. As the slide shows the large difference between the four community types.

In addition to supporting more mobility options, roads directed to centers and corridors have other methods for health as well. a key benefit is the total cost of transportation perk household would also be less.

By emphasizing the scope benefit Robinson support to get more growth from centers and core doors for the transportation options can support that.

the rural urban connection strategy is a nether planning measure that supports healthy community. Like many other planning agencies, this doesn't represent a diverse rural landscape. There is growing interest in our region on how best to translate judicial he urban approaches to transportation to roll areas. and how to match urban needs to real -- rural resources. One example of the urban world growth connection is exploring the local food production and access as part of the project. It is estimated that 2% of what has been in growing in the region is consumed locally. Overall though disconnect of what the region grows in what the region consumes. We look in places for environmental communities in particular do not have good access to healthy produce. Another dimension of the active work -- roll areas of our region. I mentioned earlier are complete street efforts that include rural investments. Other rocks inventions contained non- medical strategies that better link isolated road residents to healthcare facilities in the regions health and town.

In terms of planning relationships, the state region is still experiencing a revolution of how health issues are connected. And planning healthy communities across a region, is what we say setting the table for future outcomes. These outcomes well increasingly increase -- I want to end by sharing a few lessons learned so far. These lessons really e-echo some of the points that some of our partners made at the beginning of the webinar. The first is the importance of what partnerships play as a way for our planning agencies to start working on health. We have started to realize the benefits by listening. Through that we have been able to make process -- progress quicker than if we started from scratch. There was already considerable would work that was under way. Do these collaborations we are leveraging knowledge -- as we look ahead we see many new initiatives underway. One of the exciting efforts will be working with regional care providers. and other lesson that we have learned is seemingly unrelated federal or state statutes can introduce health into discussion. For our region bill 375 -- passenger vehicle greenhouse gas emission, brought the unexpected outcome to the attention of public health. Finally linkages between -- a to highlight a few examples, the MTP, we see the benefit of the linkages in both education and broadening support for health initiatives that would otherwise not have a high visibility platform. Again, I really appreciate the opportunity to participate on this panel. I welcome your questions today or later and look forward to future collaboration to advance healthy communities.

Thank you, Matt. Again, I would like to her mind all participants if you have questions add them to the chat box and we will get to them. Next we will turn to the Puget Sound regional Council for that we have Doctor Anthony Chan and Robin Mayhew, that program manager at PSC.

Thank you, hello from S Seattle, beautiful sunny Seattle you're IM here, also joining Doctor Chan who is the director of health at Tacoma Pierce County health Department here I am going to do the bulk of the discussion, really what we are doing today is a different angle on telling a story and it really is the evolution of how the MPO has continued to integrate are different planning functions and how we brought public health into the fold as they convene are. I heard a lot of people using that term today and I think that is a key point is that metropolitan planning organizations bring in a number of stakeholders. So, we are going to tell a story about the evolution of planning in our region. Some of the motivation and how now it is starting to finally take hold in terms of our projects, decision-making and transportation planning level. Some lessons learned.

the Puget Sound regional Council has a large area, including four counties. We have over 80 jurisdictions, cities and counties -- towns. We also have transit agencies, counties and tribes as well as the state agencies. We combine our regional long term focus on economic development transportation planning, including population, housing and transportation data. GIS mapping as well as we serve as the U.S. Census data for the region. So we have a rich source of information to provide for decision-makers.

the number of plans that have occurred over time that did not have any mention really of public health other than traditional air quality work that we talked about include some -- the vision documents I should mention, our vision documents that show land use and economic development. Not until 2004 at did we start having a discussion about health issues in transportation and in other areas of our planning. So there was a document called what does health have to do with growth management, economic development and transportation? That was published in 2004. The environmental impact statement that we did for our vision 2040 document that was published in 2008 actually was the first time when we really started to dig into a number of health aspects in terms of air and water quality, public utilities can't buy or mental health can't noise and environmental justice.

We have a note about the triple bottom line, vision 20 40 talks about people, prosperity and planet. Again, the seams of sustainability are brought out in our vision document and it is our him brawl of policy tool for implementation of the plans including our transportation plan.

As Robin pointed out, vision 20 40 is an integrated growth and economical and transportation strategy. The document includes a regional goal around environment and has five multi- County policies related to active living and health. These MPP's consider health and regional planning and decision-making including how to include pleaded environments, construction building and facilities that are healthy to live in and encourage regional farming and food production. Improve mobility for pedestrians, bicyclist had drivers and passengers. Build homes and jobs closer together a long with shopping cart services and recreational activity. There is also a vision 2040 health document which highlights the importance of addressing health and to take a quote from it, vision 2040 recognizes the relationship between a healthy environment can't both the natural environment and healthy people.

Thank you Doctor Chan. Again implementing 2040, transportation 2040 is the direct result of implementing vision and that is how we frame our transportation 2040 document that was implemented by our board in 2010.

We have put a lot of emphasis in our environmental impact statement on this transportation 2040 document on health, proximity and degree of risk of exposure to hazardous materials can't noise, air quality and climate change, water quality and hydrology, availability and access to recreational parks, personal safety and access related safety. So automatic old contrasted and biking and walking, as well as development of bicycle and sidewalks, pedestrian friendly development and their contributions. Looking at the contributions to as a collective it in the general we'll billing of populations as well as emergency medical services, social connections, for mental well-being.

So we are starting to finally see that this is an evolution that is occurring where our transportation document was learning from the policy document, so in 2008 vision 2040 was adopted in 2010 the transportation document started to bring some of the policy integration into the transportation plan.

Moving parallel to all of the transportation policy were several health-related grants which provided opportunity for action and synergy. For those of you in public health may be familiar with these grants. One is the achieve grant of which objective is to develop an implement policies that sustain healthy eating in adults and youth. the communities putting it to work grant, which addresses to prevent double leading types of death, tobacco. The Puget Sound Council developed a bicycle pedestrian toolkit for local use and implementation as part of that grant. The growing trends of community grant, which is a sustainable community fund, includes consideration of equity and affordable housing. Then the community transportation grant which is funded under affordable care and focuses on breaking down very use of health including active transportation component perk across the four county region there is significant collaboration between our health jurisdiction and even though some of these grants were granted to individual counties, they were worked in a way that the whole region could benefit from them.

Thank you. Another piece going back to transportation 2040 which was adopted in May of 2010 which was a direction for staff to go back and figure out how to develop and in valuation framework for high our ties in projects and programs that was consistent and implemented vision 2040. I have here the mission statement. To do that we developed a fighter his Asian working group which included board members from all of our boards including Doctor Chan who is on our gross management board. Again, this idea of triple bottom line has been incorporated into what are now nine measures that took us about a year to have to get here, but through a lot of work and looking at a hundred 74 policies that are incorporated into vision 2040, we came up with nine what I would call sustainable measures that are now actually the screens for which we are doing a test run of all of the projects in our long range of plans. That is over 800 projects.

They are going through an analysis right now and I have a detailed summary of what each of these measures incorporate, but one thing that is important to understand is that health is woven into every measure and it is has a bolstering affect on all of these measures. Social equity and access to opportunity, this measure addresses the extent of what projects improve mobility and reduce negative impact. Some of the questions and points include the projects to avoid new negative environmental health impacts or physical barriers to these populations. That is just one example of the many different places where we incorporate health factors into these nine measures and we are going to be rolling out a report in the next two months to our boards and it will be interesting how our future plan updates will hopefully be incorporating this type of scrutiny. Again, multiple dimensions for every transportation that would help emphasize our triple bottom line of people, prosperity and planning.

This is our wrap up slide and I invite Doctor Chan to chime in, but one thing I heard him say multiple times. It is really important to be at the table and have the diverse stakeholder opinion and that kind of in a measured manner, as he is done, move some of these ideas forward in a positive in the mainstream approach, if you will. So that these strategic points, I have observed him doing successfully.

I think some of the other speakers have mentioned, institutionalizing some of these measures into the planning as well as the documents in the process have been very important.

Yes. Also the leveraging wanting opportunities, we have discovered a number of different opportunities if we bring in the dimensions of health, all of a sudden the expansion of opportunities for funding has increased. That is an opportunity as well.

Regarding point number five, as Jim mentioned in terms of map 21 and some of the other national directives going on, this is very good opportunity for us to make sure we leverage those.


In terms of number six, I think what you are seeing are in this webinar is the -- even though the different MPO's in the different parts of the country there are a lot of similarities of what they are going and hopefully they will allow other MPO's to build on the momentum that has been set by the MPO's.

Okay. That pretty much wraps up our key points.

Thank you so much Robin and Anthony. I will now turn things over to Steph and bands who is a regional planner to wrap us up and share his story are.

It is a great pleasure for me to be a part of this great group of people who are doing such fabulous work around transportation planning and public health. I will talk about our close collaboration with the county health and -- how that helped us really begin to address the public health digit -- issues in a substantial way. A lot of this work is still ongoing and I think we still need to realize some of the benefits, but, it is the institutionalized they should of these issues through our work through this collaboration which is the story we have to tell here. the context in which we are doing this is from a planning perspective is our regional comprehensive plan. This is our document, our blueprint document it is comprehensive adjusting all of these issues that you see on the screen. From urban warm through social equity. the key policy framework that came out of this in telling about much of the work we do is the smart growth policy framework. Our strategy for growth going forward has to be where we grow within our existing urbanized areas creating more compact mixed-use communities that have more housing and transportation options. It was in the process of developing this policy framework that we first began to hear from our public health stakeholders that in the early to thousands. This plan was adopted in 2004. That is when the health public health issues first came to our attention and we started to pay attention to it in some way. Then the public health context is framed by this slide that I got from our Health and Human Services agency. I like to talk about the three four 50, the behaviors that result in disease and result in over half of that else in San Diego County. of those three he gave use, tobacco use, poor diet and no exercise really have a connection to build an environment and planning issues. Many of you are aware, a broad body of resource in the public health and planning feel about this connection between health and the built in environment. The county really started to focus on that so that they can have an impact on these for diseases. Do that they engaged us because they realize that we weren't the can been or is of someone setting discussion with land use in court nation or they could really have an impact in the San Diego region. So, by that we realize that we have shared objectives. We are trying to promote communities with a high quality of life and health and we do that through providing housing and transportation and access to healthy foods, L. the two -- access to health. It is the formula for increased public health. Because of this cooperation, we were fortunate to be able to be purchased pay the county and that committee putting prevention to work. They receive $60 million, for health prevention to fight obesity -- obesity. Healthy nutrition, healthy schools and healthy places have become the grant focus areas. We did that by adapting our usual process of how we engage the region and in our partnerships that local agencies in implementing plans through stakeholder injury -- engagement, incentives, by developing consensus around regional policies and programs and providing technical assistance work as a regional planning agency we have a control over a large amount of state and federal transportation. We have no land-use authority. It is important that we collaboratively with there local jurisdictions to implement our plan and having public health agency of people engaged in that process is part of the way we are doing that more effectively around these health issues. So what did we do under the grant? There was six components to it. Really a lot of interesting work that I don't have time to go into right now. I will give you an overview. Under healthy community mapping and modeling we were able to develop a healthy community analyst that map 20 different factors about the built-in environment that affect public health. Such things as sidewalk availability, access to food, access to recreation, access to public transportation. We were also able to incorporate a health module into our tool that we will use to help local jurisdictions do their local planning and also for us to look at the planning in the San Diego region. That planning tool will now output impacts of those planning decisions on the obesity levels. the regional planning policies and metrics component of the plan was where we engaged our stakeholder in developing drafts, policy recommendations that we can incorporate into our next regional transportation plan and regional comprehensive plan update here could broad range of potential policy decisions that our board of directors can address, affecting all of those components in our regional comprehensive plan. Not just transportation but urban form, housing, public facilities and the rest. So, out of this work we now have a number of proposed policies and related metrics that can be incorporated in the next plan. The healthy community campaign was where we really focused on the incentive component of this. We pushed about $700,000 in grants out to local jurisdictions and travel -- to incorporate them to encourage health and planning activities and they did wide Friday of things from encouraging active transportation considering the health impacts of that to improving access to healthy foods through enabling community gardens can't to a wide range of others. the school component, the safe route to school for the first time give us the opportunity to be engaged with schools and local jurisdictions to help them take advantage of the funding opportunity that exists around safe roads to school. Do a better job of coordinating this effort as well as under the safe Routes to school we are able to push out small grants to local jurisdictions, school, for school and planning activities. The active community -- active computer -- commuters transpiration -- as well as the walk to school Day activities and had a significant increase in activity. Then, finally, the regional bike plan component of it enabled us to create a reasonable -- as well as develop some promotional activities for the regional by program. There is a video can't as well as pressures that will be rolling out in the near future here. So, it was a huge amount of work that was involved in this and a lot of lessons learned but I want to focus on a few that I think are very important. When the county first started in gauging in the abuse of the prevention work through a program called the child the -- childhood of these to be -- so when they came to us and asked us to help participate as well. We were fortunate to have those two leaders be participants. One on the Board of Directors in one on the policy adviser committee. I think it is really important to engage officials and make them be that champions of this activity. As will it is very important to build relationships and partnerships between key personnel in the agency. At human services of folks working at these issues came to us and took the time to understand what we were doing. Encouraged us to participate in their activities and out of that grew a close collaboration on a personal level that created a bond between the two organizations. As we were doing this we knew that this was really two different worlds that had not really collaborated much in the past and so different languages, different processes -- so we had to work together to understand how it each agency approach their work and find areas where we could work together. and develop programs and projects were health and transportation share those common interests. Largely around the active transportation component but also around land-use that affect access. Not only creating complete streets were people can walk and ride bikes, but creating communities for people have access to food, recreation, L. services, etc. The other thing is going back to the large body of research that is available. Really we tried to focus on doing things where there was strong evidence in this research that says these things will be affected. Focus on the things that you can report with strong research and I should give a plug at this point to a local organization active with than research in San Diego which has quite a lot of work Inc. urge in this kind of research and compiling it in a way that is very accessible to policy makers.

Going forward, because of this partnership we were able to as well, partner again with a community of transportation grant where over the next couple of years we will be implementing our strategic plan. Taking those policies and metrics and incorporating them into the update of our regional comprehensive plan. Will be able to respond to our recent -- we are working now for the first time on health impact assessments that we like to call health benefit -- again doing that through a robust process of stakeholder engagement where we engaged not only our local partners in government but also health care providers, community-based organization in all of the folks that have some role to play in helping create a built-in environment that supports good public health. So we are excited about this work and happy to answer any questions that anybody might have about the we are doing here.

Thank you,.

I am very mindful of the clock and wanting to leave some, a little bit of time for questions. So I will go through the last couple of closeout slides very quickly. the MPO white paper which contains comprehensive case studies of all of the presentations today with links to their source God documents, partners, are synthesis is done in going through final review. We have had a great round of comments from the center of disease control, the American health Association, federal highway, FDA. We are wrapping up those comments, finalizing that and then it will be available on the web link which is on the next page. I would say in the next month, hopefully. The statewide paper is under way so stay tuned for that. I think we are seeing early research, some differences between the OT's and MPO your kid is not as easy to go and find a single person and say tell us everything we know about health and the state. Are our particular efforts related to programs, save Routes to school programs, a lot of interesting and promising things, but I think it will not be as easy to point to that diagram with the standard DOT and MPO planning process and say, it is mainstream. It will be different, it should be useful but it will be different. Next slide. A couple of references that we use going into the state DOT paper. These are things that will be has done. One on state transportation and in other on a comprehensive database of all transportation plans covering all aspects of synthesis reports. These were both very important foundations for the state DOT paper. Also, we began with a round of conversations with some very important partners both on the transportation and on the hillside to get get their suggestions about good possible case studies. We are just beginning of a structured interviews after early research and we are will a way on this. Next slide. for further information on either of the projects, the state DOT or the Metro white paper, or related topics, do contacts are Fred or me. You see the e-mails there for us. What does the papers will be presented as soon as done on the capacity building website. You see the URL there. We will aggressively distribute them through our partner associations. Hopefully we have all of the e-mails of all of the participants. We will also be working through the TR be some committee on health. Possible next phases, these are things we have been identifying as possible areas for later research. More in-depth look at Roe communities. We will try to bring that up as much as we can in the DOT paper. Focus on safety and vulnerable populations. Walking bicycles and transit. I think of the presentations I'm thinking about specifically maps, I think you can see that performance measures are just a key way of bringing health considerations into transportation plans and decisions. I will wrap up at this point in bread and Jim, thank you for your support. Also are great MPO colleagues for it their partnership, and willingness to share their knowledge and experiences. I have a couple of poll questions up.

I will pull up these last poll questions. Here is question five. If you would like to look at that and answer. Then I will bring up questions six. When you are answering the poll questions, we will answer the chat box questions.

There is an office of policy here in DC in another office, if Candace is on the phone they can tell us who we are working with. I have to admit that the organizational chart for it CDC is as confusing as the DOT. We have a lot of helpful partners that CDC. Before we open the phone lines, the question on map 21 came in. Map 21 does not explicitly call out how there are a number of areas that it does promote health. Especially in safety can't safety has been beefed up and sustainability is a big part of that. Including the performance measures and Jim, you want to mention anything on that. John had written earlier, I'm not sure we understood it. Something about with air quality the enhanced -- do you envision in a chance meant -- the air quality and this is a referring to map 21, you should agree, yes. The way to look at that is, first of all in the scope of the process, in the metropolitan processes 1201, it talks about enhancing environment and it improves the quality of life in the transportation improvement in the state and local -- I think the quality of life as it relates to transportation health, with regard to how there are seven goals within the map 21. One of those goals is environmental sustainability. Within that it also has a relationship with the environment and health but the other one is congestion mitigation. Within that one there will be an establishment of measures by the Secretary for states to a dress if you will not only congestions but road mobile a missions. Within that you will get to the air polity side. Intern obviously encourage how they address that in terms of types of projects. I think you are good examples for our speakers in terms that are are ready worked in that arena. So that is the air quality efforts particularly in the health and transportation. I don't know if I answer that clearly for you. Then Sir if you want to talk about the poll question. Sure, it looks like we have a good split on the MPO is in terms of their level of work. Then for the question for health professionals, it seems like those that responded have some sort of relationship with health agency. Which is a good sign moving forward. Unfortunately we are running out of time and we don't want to keep you all here. So I am going to finish up by showing you a slide with the contact information or our speakers today. If you would like to contact them directly about anything, their information is also available in the download site. If you believe the webinar, please feel free to fill out and a valuation so we can get you thoughts on today's webinar and what we can do to improve it for you.

Operator can't do we have time to open the lines?

I do have one question. This is Candace, I think most people have gone. We have been working on health impact assessments in the economic tool is also available, people can contact you and they can send it to me. It looks like there may be more benefits can't just to let people know that it is out there. Great. Thank you Candace. Any other quick questions before we wrap it up?

Does anyone have any questions. I do not have any in the queue at this point.

This is Bill Lyons, I just wanted to add something to gems response on the map 21 and that really packs directly off of the peer presentation. What you found is that the flexibility and the federal planning requirements gives some valuable opportunities for MPO's and devotees that are interested in pursuing health to a greater degree to work off of. They be less requirements rather than opportunities as a way to look at it. That is really the focus that we are taking in the best planning practice and I think performance measures, I mentioned the performance of sand are. the planning based -- brand-new opportunities to go beyond MPO is a DOT's. Beyond those precisely defined federal goals and related performance measures there is an overall encouragement of performance-based planning. Which includes the opportunity to introduce something like health if that is a state or regional MPO local priority.

Great. Thanks Bill. Any other final questions before we log off today?

I have no further questions.

Thank you everyone. It was a pleasure to present. Thank you to the peers and we looked forward to a second round if time permits. Thank you everyone. You can log off at this point.

Take you. That concludes our conference today. You may now connect. [Event concluded]

Updated: 9/30/2012
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