Public health and transportation practitioners are increasingly recognizing the relationship between the built environment and the physical, social, and mental health of communities. As one important component of the built environment, transportation has a significant influence on physical activity and well-being, safety, and the ability of community members to access destinations that are essential to a healthy lifestyle. Metropolitan Planning Organizations (MPOs) have the responsibility to work collaboratively with their partners to plan multimodal transportation systems within their metropolitan planning areas (MPAs). This responsibility presents tremendous opportunities to capitalize upon established and emerging linkages between transportation and public health. The Federal Highway Administration (FHWA), in its efforts to offer technical assistance to MPO planners and partners, is examining how MPOs throughout the United States can effectively consider the health impacts and benefits of transportation projects to help achieve healthy communities.
The purpose of this white paper is to identify an integrated and flexible approach to how MPOs and their partners can consider aspects of health during the transportation planning process. In addressing this purpose, the U.S. Department of Transportation (USDOT) Volpe National Transportation Systems Center (Volpe Center) developed a framework for how MPOs and partners can successfully approach health within metropolitan area transportation planning. Applying research from case studies of four MPOs, the white paper provides this framework on how to approach successful consideration of health, focusing on a "holistic" or comprehensive approach to health integrated into key points in the MPO planning process. Other products from this white paper include the identification of innovations, successes, challenges, and lessons learned that can serve as a resource for MPOs across the country.
The audience for the white paper is MPOs and their partners, nationwide, who are interested in incorporating direct and substantial consideration of public health into their transportation planning and decisions. The case studies contribute to an expanded understanding of successful approaches that MPOs and their transportation and health partners might take. The white paper is also a resource guide for MPOs and their partners, and for FHWA to use in developing technical assistance.
In examining the implications of metropolitan area transportation planning for healthy communities, this white paper takes a specific focus on planning for transportation and related community design with explicit consideration of health-related impacts. The project team defines a holistic approach that MPOs might take to consider community health across the broad set of health topics identified above. This report considers both how MPOs can approach health as an explicit and direct goal for their broad, interdisciplinary planning, and how they can consider health during all stages of the metropolitan area transportation planning process. The white paper research examines how MPOs can consider health in planning for the regional multimodal transportation system through collaboration with traditional and non-traditional partners, refinement of institutional roles and responsibilities, and technical analysis.
The research assesses how MPOs are applying this approach to ensure that transportation policies, strategies, and investments contribute to community health. MPOs with such a holistic approach would explicitly and directly identify health as a long range regional goal for transportation, going beyond related goals that are universally considered by MPOs, such as safety and air quality. The MPOs in the case studies are distinguished from their peers in that they go beyond consideration of safety as a core transportation topic and air quality as a Federal requirement to reduce emissions. Instead, these MPOs consider these topics alongside others with health implications, such as physical activity or access to health-related destinations. This broader approach adds healthy communities to the purpose of transportation planning and investments, and to the mission of the MPO and its partners.
The holistic approach to health for transportation planning involved consideration of the following areas:
1. Active transportation
Transportation systems that encourage walking or bicycling can help people to increase physical activity, resulting in significant potential health benefits and disease prevention. Transportation planners can increase opportunities for nonmotorized or "active" transportation by planning for infrastructure that is safe, convenient, and attractive to transportation system users. They can also plan for highway and transit modes that have strong intermodal connections to active transportation to encourage the use of multiple modes. Although the link between activity and related illnesses (such as obesity, diabetes, and heart disease) is important to an MPO focus on physical activity, MPO planners can focus on measures of transportation-related outcomes, such as increases in nonmotorized mode share or minutes spent walking or bicycling. The public health partners of MPOs can then use these transportation measures in further technical analysis of medical outcomes, such as levels of obesity or to calculate changes in community-level morbidity (disease) or mortality (death), for example, using the Health Economic Assessment Tool.
Users of all modes of transportation should be safe with minimal risks of injury or fatality. Injuries related to vehicle crashes are one of the most significant and immediate threats to human safety. Planners can ensure that safety measures extend to all transportation modes, and to intermodal connections, so that all system users can benefit from a safe transportation system. Planners can also focus on protecting vulnerable road users, including older and younger residents who rely on walking or bicycling. The critical step for MPOs to move from traditional consideration of injury and fatality measures to a more holistic approach to health is the inclusion of safety goals in combination with the other broad community health considerations.
3. Air pollution, with specific implications for human health
Under the Clean Air Act Amendments (CAAA) of 1990, the U. S. Environmental Protection Agency (EPA) has established standards for transportation-related pollutants: ground level ozone formed by volatile organic compounds and oxides of nitrogen, the primary ingredients of smog; carbon monoxide; particulate matter; and nitrogen dioxide. The standards are based upon EPA's assessment of the health risks associated with each pollutant on at-risk groups, including "children, the elderly, persons with respiratory illnesses, and even healthy people who exercise outdoors."
Transportation conformity ensures that Federal funding and approval goes to those transportation activities that are consistent with air quality goals. Conformity applies to transportation plans, transportation improvement programs (TIPs), and projects funded or approved by the FHWA or the Federal Transit Administration (FTA) in areas that do not meet or previously have not met the air quality standards in areas known as "nonattainment" or "maintenance" areas.
Although MPOs have well-established planning procedures to meet conformity requirements, MPOs that take the comprehensive approach described in this paper might go further to explicitly recognize that transportation plans and decisions produce air quality outcomes that have health implications and consequently, that air quality is an important component of transportation planning for healthy communities. An MPO's public health partners might use air quality and transportation data as inputs into health-specific analysis of local health impacts.
4. Access to opportunities for healthy lifestyles
Community design and transportation systems can support or inhibit residents in their pursuit of health-related activities. These activities may include access from neighborhoods and places of employment to stores or markets selling healthy food, medical offices, social service centers, and parks and active recreation facilities.
Access to health-related activities is especially critical for vulnerable populations, such as the elderly and children, as well as designated Environmental Justice communities (specifically low-income and minority populations). These populations often have low car ownership or high transit dependency, which planners must consider to target resources and develop transportation systems that assist these groups to access healthy destinations.
Community design integrated with transportation can also help people to age safely in place, or to safely access all of their nutrition, exercise, and medical needs throughout each lifecycle stage. This aspect considers changing mobility, health needs, safety, and the contribution of multi-modal transportation systems to offering a broad range of affordable transportation and housing options.
The white paper focuses on approaches to metropolitan area transportation planning that consider the topics explicitly and in combination, but does not include technical analyses of these topics individually, which would be beyond the scope of this white paper. The paper applies these topics in combination to consider how MPOs and their partners can collaborate in transportation planning to accomplish health-related goals, introducing a new explicit emphasis on community health for the metropolitan area's transportation planning and system.
As part of the goal of providing a technical resource for MPOs and partners, the report researches and summarizes relevant policies, regulations, literature, and technical tools to identify opportunities for integrating health considerations within MPO transportation planning. Using these regulations and policies as a foundation, the project team establishes a hypothetical framework for MPOs to incorporate health into the metropolitan planning process. The project team then tests and refines the framework by applying it to case studies of a range of MPOs to identify actual experiences in metropolitan area transportation planning.
The project team considered 12 MPOs that are leaders in linking health and transportation and selected the following four MPOs as case studies for this white paper: Nashville Area MPO; the Puget Sound Regional Council, responsible for the Seattle metropolitan area; the Sacramento Area Council of Governments; and the San Diego Association of Governments. The four case studies showcase innovative MPOs that demonstrate success at broadly and holistically considering public health in the metropolitan area transportation planning process. Their selection is on the basis of a history of transportation and health activities, institutionalization of activities into transportation plans and programs, leadership of MPO staff, receipt of health-related grants, and relationships with partners. Additional details on criteria for scanning and selecting MPOs are included in Chapter 3: Case Studies.
The project team conducted structured discussions (see Appendix B: Sample MPO Discussion Questions) by telephone for each case study with one or more MPO staff, generally the Executive Directors and Planning Directors. In some cases, the project team also conducted discussions with the MPO's health-related partners. The project team also reviewed relevant plans, studies, and assessments from each MPO to inform the case studies.
The white paper starts with an overview of actors and roles relevant to metropolitan area transportation planning and consideration of health. The white paper then provides context for linking transportation and health, including current transportation regulations, policy initiatives by the Federal government and national non-governmental organizations (NGOs) and data and tools. The project team provides each of these analyses as a resource for peer MPOs to demonstrate how required planning activities and roles provide flexibility and opportunities that support substantive integration of health into the metropolitan planning process. The following sections contain the MPO planning framework for considering public health, a synthesis of lessons and findings from analysis of the MPO planning processes featured in the case studies, and the four case studies themselves. The white paper concludes with implications and future research opportunities. All findings are drawn from research for this white paper, and in particular from the case studies.