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Metropolitan Area Transportation Planning for Healthy Communities

Chapter 2: Context

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The information in this chapter provides an important context or "starting point" for examining the case study Metropolitan Planning Organizations (MPOs) and also provides a resource for peer MPOs and partners interested in expanding how public health is considered in the metropolitan area transportation planning process. The context is also useful for U. S. Department of Transportation (USDOT) staff working with MPOs and their transportation and public health partners on a broad range of regulatory, grant, technical assistance and research programs. Many of the programs, processes, and actors detailed in this chapter are also identified as important elements in the case studies. The other programs described present opportunities for supporting future efforts to bring health considerations into the metropolitan area transportation planning process nationwide.

This chapter also outlines the Federal transportation planning requirements, focusing on opportunities and flexibilities for MPOs to pursue health-related activities. The elements of the Federal planning framework described in this report continue under reauthorization of the Federal surface transportation law, Moving Ahead for Progress in the 21st Century Act (MAP-21), signed by the President on July 6, 2012. At the time this report was completed, the USDOT had not issued guidance to implement new planning requirements arising from MAP-21. This chapter references MAP-21 to identify changes to programs that may be relevant to integrating health into transportation planning.

Key Actors and Roles

This section describes and discusses the broad range of roles and responsibilities played by agencies involved in consideration of public health in the metropolitan area transportation planning process, including MPOs and their partners, the USDOT agencies that provide oversight of Federal transportation planning processes and manage related programs, and other Federal and State agencies. It is intended to provide a resource for peer MPOs and their partners interested in bringing public health considerations into their transportation planning processes, and to provide insights into the potential for these institutions to play supportive roles in encouraging consideration of health in the future.

The Federal transportation planning requirements authorized under the Safe, Accountable, Flexible Efficient Transportation Equity Act: A Legacy for Users (SAFETEA-LU), and continued under MAP-21, establish a broad framework with roles and responsibilities for MPOs. MPOs are responsible for conducting transportation planning for the almost 500 Census-defined urbanized areas with populations over 50,000. An MPO's collaborative roles include conducting a continuing, cooperative, and comprehensive ("3-C") planning process for metropolitan-wide multimodal transportation systems. The defined process includes strategic planning, as reflected in the vision plans and required long range plans, financial planning, programming of funds in Transportation Improvement Programs (TIPs), public participation, and a broad range of other collaborative and technical activities. U.S. DOT designates as Transportation Management Areas (TMAs) the urbanized areas with populations over 200,000; MPOs that plan for TMAs have additional planning and programmatic responsibilities under Federal regulations and receive a certification review by FHWA and FTA to ensure that the planning requirements of 23 U.S.C. §134 and §49 U.S.C. 5303 are being satisfactorily implemented.[5]

The Federal requirements set a broad and consistent framework for all MPO and partner roles that are then adapted and expanded to respond to additional regulations, policies, needs and priorities that can be defined at State, regional or local levels. The end result is that there is consistency and flexibility in the roles MPOs and partners play nationally in determining whether and how to consider public health in on-going metropolitan area transportation planning. There is an important contrast between relationships related to air quality between MPOs and State Departments of Transportation (DOTs) or air quality agencies (in nonattainment areas), which are formally defined, and the relationship between MPOs and State or county public health or human service agencies. Public health agencies and other health stakeholders do not have a formally defined role in the Federal transportation planning requirements. Although the decision by MPOs to collaborate with public health agencies may be required or otherwise encouraged by States or local governments, it is more likely that the collaboration that characterizes the four case studies in this report is a matter of choice among participating agencies to meet locally determined goals, needs, and priorities.

Federal requirements for metropolitan area and statewide transportation planning provide a helpful and flexible foundation that MPOs and partners can adapt to respond to local requirements, policies, goals, priorities, and choices to consider public health.

The case studies highlight the roles and responsibilities that the MPO and its transportation and public health partners have developed for planning and governance to bring public health into the on-going metropolitan area transportation planning process. In all cases, this involves adaptation of the Federal planning requirements to plan for healthy communities -- an emerging local priority -- in addition to meeting a broad range of other transportation goals, from maintaining infrastructure, improving safety, and reducing traffic congestion to meeting future mobility needs.

This section briefly outlines the roles of the players in transportation planning for healthy communities, considering both requirements and opportunities in the planning regulations.

Federal Agencies

Federal agencies have several opportunities to support regional interest in consideration of public health, within the current Federal regulatory and programmatic frameworks.


Role: The Federal Highway Administration (FHWA) and the Federal Transit Administration (FTA) have oversight responsibility to ensure that metropolitan area and statewide transportation planning and expenditure of Federal transportation funds meet Federal transportation planning and other Federal and State requirements. FTA and FHWA also offer technical assistance, program guidance, and training, and support research on a broad range of transportation topics.

Considerations: FHWA and FTA have offered limited technical assistance dealing directly with broadly-based public health considerations of transportation plans and decisions. This includes the national experts' workshop on transportation planning and health[6] and a companion annotated bibliography[7] developed by the Volpe Center for the FHWA-FTA Transportation Planning Capacity Building program, as well as this report and a forthcoming companion report on public health considerations in statewide transportation planning. FHWA and FTA provide extensive technical assistance to MPOs, DOTs, and public transit agencies in health-related areas of safety, air quality management, and access for disabled and underserved populations. Although these topics have implications for health and are part of the comprehensive or holistic approach to healthy communities defined for this report, they have not typically been identified as directly "health related."

FHWA and the Volpe Center have collaborated closely with CDC on the evaluation of the SAFETEA-LU Nonmotorized Pilot Program that invested approximately $100 million in four pilot communities to demonstrate and report to Congress on the potential for shifts to active transportation and a range of outcomes, including public health.[8]

Opportunities: FHWA and FTA could create new technical assistance capacities or guidance to encourage and support planning for healthy communities. FHWA can also take a lead role in fostering partnerships with other Federal agencies to encourage and support collaboration by their State and local grantees or other constituents for Federal programs. The Partnership for Sustainable Communities fosters exactly this type of cross-Federal, State, Regional, and local collaboration. A similar type of effort could be encouraged, perhaps related to this Partnership, or formally or informally, through a direct relationship between USDOT offices and Federal agencies with health-related programs, including the Department of Health and Human Service, particularly the U.S. Centers for Disease Control (CDC), the U.S. Department of Agriculture (USDA), and the EPA, to help transportation agencies expand their capacity to plan and invest in transportation that contributes to healthy communities.

U.S. Centers for Disease Control and Prevention

Role: The Federal requirements for the metropolitan area and statewide transportation planning processes do not describe a formal role for CDC similar to those identified for coordination between other Federal, State, or local transportation agencies. Through the National Center for Environmental Health, CDC manages a Healthy Community Design Initiative (see U.S. Department of Health and Human Services: Centers for Disease Control and Prevention) to consider health-related strategies in planning, transportation, and land-use decisions. The initiative targets local governments and non-governmental organizations (NGOs) and provides education on tools, such as Health Impact Assessments (HIAs), promotes connections between health and community design and conducts related research, and works with communities to build partnerships between transportation, land use, and public health stakeholders. CDC has provided several grant programs to communities at the local government level for public health through community prevention programs, including Communities Putting Prevention to Work and Community Transformation Grants / Healthy Communities Program. The Federal Programs, Initiatives, and Funding Sources section contains links and more details on these grant programs.

Considerations: There is no formally established relationship between MPOs, DOTs and the CDC concerning transportation and related land use planning. Many MPOs may be unaware of related research, funding, and other programmatic initiatives.

Opportunities: Through the Healthy Community Design Initiative, local government prevention grants, research grants, and other partnerships through local or State health agencies, CDC has started partnering with or directly supporting the health-related activities of MPOs. The case studies in this report showcase several successful examples. CDC's research and tools can also be valuable for MPOs interested in planning for healthy communities.[9]

Federal Resource, Regulatory, Tribal, and Land Management Agencies

Role: Federal resource, regulatory, tribal, and land management agencies comment through the National Environmental Policy Act (NEPA) process for individual transportation projects and consult with MPOs and States regarding environmental impacts of transportation projects.[10] The Regulatory and Programmatic Framework section contains greater detail on NEPA and its health implications. Land management agencies and Tribes manage and plan for transportation projects within or impacting their jurisdictions. The EPA is responsible for ensuring that States and regions produce plans that meet the air quality standards of the Clean Air Act Amendments (CAAA) and are making required progress toward attainment of clean air standards (see below). Consultation with resource agencies for environmental mitigation includes development of agreements, assessment of impacts of plans and projects, planning for air quality and Environmental Justice, and smart growth and community design.

Considerations: Resource agencies often are involved in transportation planning at specific stages or for individual project components that would impact their area of jurisdiction. This may limit the holistic consideration of overall human health impacts. Also, many resource agencies focus on specific natural resources, such as wetlands and watersheds, although most agencies have programs that connect these resources with human well-being and quality of life. Many MPOs do not have Federal Lands or Tribal reservations that fall within the MPO's Metropolitan Planning Area (MPA), or they may not have relationships with Federal agencies that already consider human health impacts.

Opportunities: Several Federal resource and regulatory agencies have incorporated the protection of human health and well-being into their missions and have established programs in related areas such as disease prevention, Environmental Justice, and smart growth and community design for active transportation and access. Federal land agencies have participated in initiatives such as Let's Move Outside and America's Great Outdoors. These consider the health benefits of active transportation and access to public spaces. The National Park Service has a public health program that is beginning to consider transportation impacts, and the U.S. Fish and Wildlife Service and other land management agencies are also considering transportation and health intersections. All of these agencies may have capacity and resources for considering health impacts of infrastructure projects, which may be transferrable to MPO-scale planning. The sections above provide additional descriptions of these activities, including those of HUD, EPA, and the USDA.

State Agencies

State Departments of Transportation

Role: State DOTs are responsible for planning, programming, and project implementation for transportation within their State, and for meeting the joint Federal transportation planning requirements. State DOTs also often take responsibility for the design, construction, operation, or maintenance of highway and other State multimodal transportation facilities, and they are responsible for project selection authority outside of metropolitan areas. State DOTs prepare Statewide Long-Range Transportation Plans (SLRTP), which typically provide policy directions for the statewide multimodal transportation system, and Statewide Transportation Improvement Programs (STIPs), which are designed to advance progress toward achieving the State's goals. SLRTPs and STIPs incorporate metropolitan area plans and TIPs developed at the MPO level.

Considerations: There is no Federally defined responsibility for State DOTs to include broadly based public health in their transportation plans, programs, or projects. In comparison, SAFETEA-LU-and now MAP-21-does require MPOs and DOTs to consider a series of "planning factors," including: economic vitality, safety, and energy conservation, and overall quality of life

Pedestrian market with tents on a street closed to thru traffic.

Market in Boulder, Colorado. Source: / Austin Brown

Cover of the Tennessee Statewide Nutrition and Physical Activity Plan, with an image of three shadowed figures walking up a hill.

Tennessee Statewide Nutrition and Physical Activity Plan. Source: Eat Well, Play More Tennessee

There are multiple key actors involved in considering public health in the metropolitan area transportation planning process.

(see the Planning Factors section). Many health and transportation issues, such as opportunities for active transportation and access to healthy food, are most typically addressed through policies, programs, or projects initiated at the local or regional level. However, as demonstrated in some of the case studies, this can also be supported through State initiatives such as that described in the Nashville Area MPO example.

Opportunities: State DOTs have the flexibility to choose to bring broadly based health-related policy initiatives or programs into the transportation planning process, including through their SLRTP or public involvement processes. In cases where health issues have gained notice at the State level, DOTs may play leadership roles working with other State agencies; for example, responding to directions from a governor or State legislature to bring health into transportation programs. This report provides examples of this State-level direction.

Also, to support coordination between multiple MPOs, DOTs can help to link health issues, data, and innovative programs occurring throughout the State. Through their responsibility for transportation planning in non-metropolitan areas, DOTs can encourage rural areas to develop transportation strategies that support healthy communities, for example, through access to medical care or other human services. Finally, DOTs may have the ability through their respective State Planning and Research Program to offer research support or technical assistance to MPOs, regional planning agencies, local governments, or others who are working to connect health and transportation.

Other State Agencies

Role: In addition to DOTs, other State agencies may have active roles in the development of SLRTPs or individual project selection for STIPs; these may include natural resource, wildlife, parks, and air quality agencies. Many DOTs receive policy directives or goals from the governor's office or through formal or informal collaboration with State departments, for example, through incorporation of statewide economic and demographic forecasts in transportation plans. However, most State agencies have no formal or required role in transportation planning. While they may not have formal roles in statewide transportation planning, State health or human service departments oversee many areas related to health and transportation, and can offer resources and technical assistance to individuals, communities, or municipalities.

Opportunities: States with policy momentum to connect health and transportation may have greater involvement from State agencies in the transportation planning process, whether through collaboration and cooperation, or formal regulations and policies. These State agencies may be interested in participating as stakeholders in the statewide or metropolitan planning processes, such as through serving on advisory committees or commenting upon plans and programs. The case studies describe the importance of a broad range of involvement by State agencies, providing funds or other resources, and policy guidance to MPOs working on transportation and health. They can also serve as a bridge to link MPOs with health advocates and agencies at the regional level. State health agencies may be able to identify the most pressing health issues at the State level and opportunities for transportation strategies to address these issues. State agencies can offer high-level support and assistance for MPOs on health projects. For example, parks and recreation agencies can be important partners for MPOs on active transportation, and State education departments can help with Safe Routes to Schools initiatives.

Regional and Local Agencies

Metropolitan Planning Organizations

Role: For purposes of this summary, MPOs form the primary unit for transportation planning at the regional level. Each urbanized area with a population of more than 50,000 people is required to designate an MPO. MPO policy boards consist of local elected officials, and often, officials of public transportation agencies, and State transportation officials.[11] MPOs plan within an MPA, which must contain the urbanized area and all contiguous areas likely to become urbanized over the next 20 years.[12] The MPA boundaries may also encompass larger nonattainment or maintenance boundaries for air quality conformity purposes.

Considerations: Some transportation and health issues are best addressed at the local level, considering the specialized needs and destinations at the community scale, as well as the common role of cities and counties in planning for land use and managing pedestrian and bicycling facilities. MPOs may not be equipped to develop detailed local community transportation plans, but they may often offer technical assistance or partner with local governments and community groups to create plans for corridors or activity centers and work with individual local areas to ensure collaboration and coordination. MPOs may also help local governments and community groups to advance individual communities' goals, those shared among communities, or those that might also support agreed-upon broader regional goals.

Many MPOs work closely with community groups to address transportation issues to produce favorable social, economic, and environmental impacts. MPOs could invite public health officials to participate in technical committees or serve as non-voting members on technical advisory boards or on public involvement committees. However, public health officials often work for municipal or county governments and may be difficult to involve in a metropolitan area transportation planning process, particularly if there are a number of jurisdictions within the area, or if it is particularly large in terms of population or geographic area.

Opportunities: The metropolitan scale provides MPOs with several opportunities to consider and address transportation and health issues in areas such as:

Furthermore, MPAs often align with the boundaries of regional planning associations (RPAs) or Councils of Government (COGs), and MPOs often have formal institutional relationships with these organizations (e.g., a COG might serve as the MPO for a metropolitan area). These organizations often have responsibilities for land use, active recreation, housing, and other public health-related issues. The integration of transportation systems with other planning components can support the creation of communities with accessible, healthy destinations. MPOs are often well-situated to coordinate with RPAs or COGs, or their member cities and counties, on these issues and to partner with public health officials on integrated regional health plans. Finally, MPO board members who are local elected officials can identify and communicate local needs for enhanced safety, access to healthy destinations, or physical activities within their communities, including as part of a regional network. The MPO can then identify broad regional needs or specific projects that might address multiple local needs for healthy communities. For example, despite local responsibility for land use and leadership on many health issues, health related transportation frequently crosses local jurisdictions (such as with walking or bicycling, transit connections, access to medical offices, and sales of healthy food).

Public Health Agencies

Role: There is no explicit mention of a role for county or city public health agencies as part of the Federal transportation planning framework. These agencies could participate as general stakeholders or local government agencies to be consulted during the long-range planning process, or their clients might participate through the public involvement process required for DOTs and MPOs.

Considerations: Without requirements for or mention of public health agencies in the planning regulations, MPOs may not consider or engage public health agencies without a specific motivation or unless the public health agencies themselves express direct interest in participating, whether through technical committees or public involvement processes. Also, some MPOs may not have active public health agencies within their regions, or the public health agencies may not be aware of the benefits of participating in transportation planning. Participation may be limited by lack of technical capacity or of staff availability relative to other, more established responsibilities.

Opportunities: Several MPOs have effectively engaged public health agencies with a formal role in the planning process, as demonstrated in the case studies. Public health representatives have informed active transportation planning, provided data, served on advisory committees, and offered guidance for projects and programs. One of the Federally-required planning factors[13] (explained in more detail later in this report) encourages MPOs to consider quality of life and intersections with local planned growth; public health agencies may be able to offer a unique perspective, directly related to the holistic approach to public health identified in this report. Public health officials may also help MPO staff to develop planning strategies and programming that can best promote health benefits of transportation. This can be a co-benefit alongside other established transportation goals, including:

Public health agencies can play important roles in extending the capacity of MPO staff and technical processes to consider health and related areas such as those described.

Certainly the inverse is true as well; transportation planning agencies can assist public health agencies to include important transportation considerations in community public health plans, programs and investments. For example, the location of medical facilities might consider access for all, regardless of whether patients or staff has access to an automobile.

Local Governments

Role: Municipal and county governments submit projects for consideration in the MTP or the TIP, and they may also be the implementing agency for capital projects on local roads. Elected officials from local governments, or their designated representatives, generally form the majority of the Executive or Policy Boards of MPOs; these officials are responsible for approving the long range plan, planning work program, public involvement process, and making the project selection decisions reflected in the TIP. Local governments also maintain land use jurisdiction within their municipal borders; they plan for and govern future development, and make decisions of coordination with neighboring jurisdictions as well as with the larger region.

Considerations: Local governments may not recognize or focus on the connections between transportation and health, among their multiple responsibilities. They may also be reluctant or politically unable to change complex and established current land use policies.

Opportunities: Many of the priority strategies to connect transportation and public health are closely tied with local land use practices. Connections between neighborhoods, to active transportation infrastructure, and to medical destinations and healthy food must occur at the local level and can be greatly facilitated (or limited) by policies from local governments. Local governments can therefore be a critical partner in long-term planning for transportation infrastructure that is compatible with planned land uses. Local governments can also institute programs as partners with the MPO, such as Safe Routes to Schools and programs that encourage physical activity. Flexibility in Federal transportation funding sources can support compatible local and regional preferences.

Local governments can greatly enhance MPO capabilities by encouraging certain types of new development, such as nonmotorized infrastructure attached to new neighborhoods or grocery stores or medical services in underserved areas or near existing transit or trails.

Non-Profits, Advocacy, and Other Non-Governmental Organizations

Role: Non-profit, advocacy, and other NGOs include groups and organizations formally or informally organized around neighborhoods, Environmental Justice issues, modal interests, or health topics. The transportation planning framework provides opportunities for these groups to participate in the development of MTPs, TIPs, SLRTPs, and STIPs, as well as other planning activities of the MPOs and DOTs. MPOs and their partners must plan for and mitigate adverse environmental impacts upon Environmental Justice communities, which generally involve consultation with community representatives.

Considerations: Many health-related NGOs have not traditionally formed relationships with MPOs, nor are they required to participate in the transportation planning process. However, the mutual benefits of partnerships between NGOs and MPOs, as evidenced through the case studies in this report, provide incentives for these organizations to participate in transportation planning. NGOs or other community groups with an interest in both health and transportation could include nonmotorized advocacy groups, parent organizations at schools, medical associations, or groups representing transit dependent neighborhoods.

Opportunities: Local organizations may have the best understanding of the impacts of transportation projects upon health in their communities. MPOs can work with representatives of local NGOs and other groups to identify and measure the potential health-related costs and outcomes of proposed transportation plans and projects. Local NGOs are also valuable partners for collecting data, tracking the impacts of transportation projects, and educating the public about how to use new and existing transportation systems to achieve the most public health benefits.

At a broader scale, many State and national non-profit and advocacy organizations have established research and education programs that connect transportation with public health. These organizations can help MPOs gain support for planning for healthy communities. Some organizations may also provide funding or technical assistance for transportation and health programs, assessments of transportation projects for health impacts, or studies to track health benefits of transportation plans over time (see NGO Advocacy, Research, and Programs). The case studies describe the important contributions this broad category of organizations can make to transportation planning for healthy communities.

Regulatory and Programmatic Framework

The Federal framework for metropolitan area transportation planning, as defined in SAFETEA-LU and the joint transportation planning requirements and continued under MAP-21, includes important elements that can support efforts by MPOs and their partners to include consideration of public health. Although there are no formal requirements that MPOs and their partners consider public health directly, the Federal planning framework includes numerous elements that support MPOs that decide to consider public health in metropolitan area transportation planning. The key elements of the planning process, as described in this section, continue under MAP-21. This section is intended to provide a context and cross-reference to the Federal transportation planning framework to assist MPOs interested in expanding how they consider health. Although the USDOT had not updated planning requirements to reflect MAP-21 changes at the time of this report, this section references specific sections of MAP-21 that may be relevant to consideration of public health in metropolitan area transportation planning.

This section also provides examples of important recent State regulations pertaining to adaptation of metropolitan area transportation planning to consider health. The Federal and State regulations provide significant potential support and flexibility for MPOs interested in planning transportation systems, programs, and projects with benefits for public health.

Metropolitan Area Transportation Planning Products

Metropolitan Transportation Plan

Existing Framework: Under the Federal planning requirements, MPOs must prepare a Metropolitan Transportation Plan (MTP) that includes strategies and actions to guide transportation system development over a minimum 20-year planning horizon, updated at least every five years (four years for air quality nonattainment and maintenance areas). The MTP should provide strategic direction based on goals, policies, needs, and priorities for all of the region's transportation projects, and consider projected costs and availability of funding sources. Federal regulations require that certain elements be included in the MTP, such as demand analysis, environmental mitigation, congestion management process (for MPOs serving TMAs only), air quality conformity, and the eight broad planning factors. In practice, MTP contents flexibly include many additional emphases and elements, tailored to support the goals and direction of each metropolitan area.

Opportunities: MTPs present an important opportunity for stakeholders from around the metropolitan area to come together and establish a joint vision and goals for the region's transportation system, which can incorporate healthy community strategies. The Federal planning requirements encourage development of a long range vision or consideration of alternative scenarios as part of determination of the long term direction reflected in the MTP.

Document Who Develops? Who Approves? Time/Horizon Contents Update Requirements
UWUP MPO MPO 1 or 2 Years Planning Studies and Tasks Annually
MTP MPO MPO 20 Years Future Goals, Strategies and Projects Every 5 Years (4 years for non-attainment and maintenance areas)
TIP MPO MPO/Governor 4 Years Transportation Investments Every 4 Years
LRSTP State DOT State DOT 20 Years Future Goals, Strategies and Projects Not specified
STIP State DOT US DOT 4 Years Transportation Investments Every 4 Years

People around a map, with one man pointing at the map.

Source: / Dan Burden

Metropolitan area transportation planning products and requirements can be vessels to formalize or communicate health considerations.

Federal planning regulations call for MPOs to consider safety, environment, local planned growth, and quality of life issues in the formulation of their MTPs;[14] these emphases continue under MAP-21. MPOs are able to reflect these planning factors in regional goals and objectives, in transportation policies, programs, and strategies, and in project selection criteria that can help implement healthier communities.

The following are some examples of potential goal areas that MPOs could include in MTPs that could contribute to improved public health. These are not contained in Federal requirements but rather reflect some best practice examples, as identified in Chapter 3: Case Studies.

Many MPOs use their MTPs as a public communications or education tool to relay a message or priority for transportation system needs and benefits. The goal of the tool may be to build public support for a new transportation initiative or to solicit funding through legislation to address pressing regional needs. MTPs can also communicate metropolitan priorities related to health through including health benefits in the MTP objectives and selection criteria for reviewing projects, thus building a compelling case for programs and investments based in part on broad support for community health. Communicating priorities and benefits related to health may attract support from population sectors and stakeholders that are not traditionally involved in transportation planning, broadening the perspectives included in planning process, and ultimately, the base of support for decisions.

Transportation Improvement Program

Existing Framework: MPOs must prepare a financially-constrained TIP that lists all capital and non-capital surface transportation projects, along with total project costs and funding sources, updated every four years. The TIP is meant to provide a comprehensive listing and description of all transportation programs and projects in the area, including those funded by Federal and non-Federal sources. Projects may only be included if full funding can be demonstrated to complete and operate each project. Small-scale projects may be grouped by function, geographical area, and work type.

Opportunities: At a minimum, the TIP must list and describe all projects and funding sources, but many MPOs also use their TIPs to connect these projects with overall metropolitan priorities and goals presented in the MTP. TIPs often group projects by mode, especially if their primary funding source is mode-specific, or to map projects by geographic area. These modal associations can help illustrate the extent to which a metropolitan area chooses to fund and include multimodal transportation options that promote active transportation.

Geographic Information Systems and maps can show projects that connect work centers and residential areas to health-related destinations, such as medical or human services facilities, or whether projects disproportionately impact population groups protected by Environmental Justice provisions, for example, through adverse health effects. TIPs can also group projects in a way that demonstrates investment in safety improvements.

Federal Transportation Regulations

Transportation planning in the United States was previously guided by SAFETEA-LU, the Federal transportation legislation passed in 2005, and by its predecessor legislation, and the joint planning requirements developed by FHWA and FTA to implement the legislation. MAP-21 continues key planning elements that are relevant to public health, as identified in this report. All recipients of Federal transportation funds must follow the regulations contained in Title 23 of the Code of Federal Regulations (CFR). These regulations are determined by legislation contained in Title 23 of the United States Code (USC), which is amended with each new transportation reauthorization and includes current programs that provide Federal funds for transportation. While specific regulations and emphases have evolved in the past few reauthorizations, the basic framework of Federal funding allocation and planning requirements have remained very consistent. The general framework includes significant flexibility for MPOs and their partners to address new policies and emerging issues, such as healthy communities, whether identified at Federal, State, metropolitan, or local levels.

Public Involvement

Existing Framework: In addition to working with other transportation agencies, Federal regulations require consultation with the public, resource and regulatory agencies, and other stakeholders. MPOs must develop and document a public participation process for public review and comment at key decision points of the transportation planning process, and must explicitly consider and respond to public input. MPOs also must make transportation plans and project information available to the public in a timely manner, with appropriate feedback mechanisms. MPOs are also expected to employ visualization techniques in public participation and in development of plans.[15]

Opportunities: The Federal requirement for MPOs to solicit and consider public input for all transportation plans and projects has three specific opportunities for healthy communities:

  1. MPOs can consult stakeholder groups with interest in transportation and health issues. These can include local public health departments, hospital or medical groups, active transportation interest groups, and research and advocacy groups (in areas such as public health, food access, or park access). The groups can help MPOs identify adverse health impacts and adjust project plans to improve health benefits.
  2. MPOs may attract greater support and participation from resource and regulatory agencies through promoting the inclusion of public health benefits in transportation plans and programs. The resource agencies may have an interest in benefits such as reduced air or water pollution, reduction of Environmental Justice concerns, or overall design for healthy communities through improved facilities for walking and bicycling, with resultant increases in physical activity.
  3. MPOs can better engage the public and increase levels of public support through including and promoting strategies within their plans and programs that enhance healthy communities. Public health benefits may attract support from senior citizens who need to access medical appointments or residents interested in better park access or other opportunities for physical activity. Transportation plans with clear health connections may be more interesting and relevant for members of the public and applicable to a wider range of quality of life issues.

Title VI and Environmental Justice

Existing Framework: Title VI of the Civil Rights Act of 1964 prohibits discrimination based upon race, color, and national origin. Specifically, 42 USC §2000d states that "No person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance."[16] Presidential Executive Order 12898 on "Federal Action to Address Environmental Justice in Minority Populations and Low-Income Populations" places further emphasis upon Title VI protections, stating that "each Federal agency shall make achieving environmental justice part of its mission by identifying and addressing, as appropriate, disproportionately high and adverse human health or environmental effects of its policies, programs and activities on minority populations and low-income populations."[17] FHWA Overviews of Title VI and the Executive Order on Environmental Justice describe their relevance for transportation programs, policies, and activities.

FHWA and FTA include compliance with Title VI of the Civil Rights Act of 1964, Executive Order 129898, and the USDOT Order on Environmental Justice as part of their oversight of the metropolitan planning process conducted by MPOs. Federal planning regulations (23 CFR §450.334(a)(3)) require FHWA and the FTA to certify that in TMAs "the planning process . . . is being carried out in accordance with all applicable requirements of . . . Title VI of the Civil Rights Act of 1964, as amended (42 USC §2000d-1) and 49 CFR part 21."

Opportunities: In response to Title VI and Executive Order 12898 provisions, as well as for their own planning analysis, some MPOs evaluate health impacts that may result from transportation projects and programs, measurements of impacts, and strategies to avoid or mitigate those impacts. While FTA and FHWA call for MPOs to identify, measure, and avoid or mitigate adverse impacts for populations covered by Title VI and the Executive Order, MPOs may also choose to measure health impacts of their transportation projects that impact the general population. HIAs are one tool MPOs can use to identify health impacts associated with transportation projects; these are described in more detail in the Data and Tools section. The case studies demonstrate how some MPOs choose to integrate into their long-range goals and other planning processes the avoidance or reduction of negative health impacts associated with transportation projects.

Air Quality

Existing Framework: Air quality regulations, under Section 176 (c) (1) of the Clean Air Act Amendments of 1990 (CAAA), require that all new transportation projects conform to air quality plans created by or in conjunction with State air-quality agencies. These state plans implement attainment or maintenance of national air quality standards that are based on EPA's assessment of the health risks associated with emissions identified under the CAAA. MTPs and TIPs in nonattainment or maintenance areas must undergo conformity determinations from FHWA, FTA, and the MPO.

Opportunities: The provision of Federal transportation funds is connected to air quality attainment, which requires MPOs to carefully consider the air quality impacts of new and planned transportation projects in nonattainment or maintenance areas. Localized, transportation-related air pollution may be linked to health impacts such as asthma, diminished lung function, and cardiac impairments.[18],[19] The EPA has documented effective strategies used by MPOs to control air pollution on their State and Local Transportation Resources website.

Planning Factors

Existing Framework: 23 CFR §450.306 identifies eight planning factors that fall within the scope of the metropolitan area transportation planning process and that MPOs are required to address in their plans. While all of these are integrated into standard MPO planning activities, MPOs also can apply these factors to health-related transportation goals. Several of these planning factors present specific opportunities for integration with public health, consistent with the balanced approach taken in this report, as part of the metropolitan planning process:

Non-Transportation Federal Regulations

National Environmental Policy Act

NEPA requires that all projects that receive Federal funds go through a formal evaluation process to determine if they cause significant impact to the environment, defined broadly to include natural and cultural resources as well as human social and economic factors. Transportation agencies responsible for constructing new transportation infrastructure, funded with Federal dollars that are allocated through the metropolitan planning process, must complete environmental analyses that assess the affected environment and environmental impacts of proposed projects. The purpose of NEPA includes the protection of the natural environment to "stimulate the health and welfare of man" (42 USC §4321), to "assure for all Americans safe, healthful . . . surroundings," and to avoid "risk to health or safety" (42 USC §4331). Therefore, public health concerns are a significant consideration during the NEPA review process.

Agencies responsible for preparing NEPA documentation consider all potentially significant impacts to human health and use all available data to estimate the magnitude of those impacts. These impacts include health impacts on human populations, such as exposure to hazardous substances, air or noise pollution, multimodal transportation accommodation, and motorist and pedestrian injuries. The Center for Disease Control reviews NEPA documents on behalf of the Department of Health and Human Services.[22] Through requirements for public review and comment, the public has several opportunities to comment on health impacts that may result from a proposed project.

Other Federal Regulations and Guidance

Several other non-transportation regulations and guidance can directly or indirectly influence how metropolitan area transportation planning incorporates health considerations. The following are highlights of these regulations:

State Legislation

Several States have passed legislation and undertaken policies and programs to advance transportation and public health planning. Several States have specifically addressed Health Impact Assessments and added the use of these assessments as requirements or recommendations for transportation projects. Examples of related State initiatives include:

In addition to these regulations, States may have regulations pertaining to environmental impacts of transportation projects, such as greenhouse gas emissions or particulate emissions that have important health implications. States may also consider health impacts in their STIPs or other transportation plans (such as statewide corridor, freight, or rail plans). State agencies in States with active legislation linking transportation with health impacts or that consider health impacts within their current transportation planning may be a good resource for MPOs. [30]

Federal Programs, Initiatives, and Funding Sources

There are a number of Federal initiatives, task forces, and funding programs that support transportation strategies that improve public health. This section briefly documents these efforts, organized by the major actors: USDOT, its Federal partners, and other Federal agencies. This section focuses on Federal and national activity because of its relevance for all MPOs and metropolitan planning processes, although it is important to note that each State has its own statewide programs, initiatives, and funding sources that may be relevant to transportation planning and health for MPOs.Federal Partnership for Sustainable Communities logoFederal initiatives and resources can support a health focus in metropolitan area transportation planning. A group of girls stands around a bowl of lettuce with notepads. The Let's Move logo is also on the image.

Students from the Bancroft Elementary School weigh vegetables during the White House Kitchen Garden harvest party. Source: Let's Move

USDOT Programs

Three of the five main priorities identified in "Transportation for a New Generation," the USDOT Strategic Plan 2012-2016 are directly relevant to health: "safety," "livable communities," and "environmental sustainability." USDOT has a number of programs with linkages to public health and these priority areas, including:

Transportation Alternatives

The Transportation Alternatives (TA) program provides funding to States and MPOs to expand transportation choices and the enhance transportation experiences. There are several eligible categories of activities; categories with potential health implications include facilities for pedestrians and bicycles, and the provision of safety, educational activities and infrastructure for pedestrians, bicyclists, children, older adults, and persons with disabilities.

TA funding is apportioned to State DOTs with a portion sub-allocated to geographic regions, including MPOs that serve TMAs. MAP-21 also consolidates two programs with strong health and transportation connections into Transportation Alternatives: Safe Routes to School and Recreational Trails.[31]

Safe Routes to School (SRTS) is the first FHWA program to have health described as an official part of its purpose. The establishing legislation for the program states that its goal is "to make bicycling and walking to school a safer and more appealing transportation alternative, thereby encouraging a healthy and active lifestyle from an early age."[32] MAP-21 eliminates designated funding for SRTS, but SRTS projects are eligible for funding under the Transportation Alternatives program.[33]

The Recreational Trails Program (RTP) provides funds to the States for developing and maintaining recreational trails and trail-related facilities for nonmotorized and motorized uses. The assistance is provided through FHWA and administered by agencies in each State. Under MAP-21 States may opt out of the use of their RTP funds and transfer them to other uses.[34] In addition to the RTP funds distributed to States, many States have separate funding for trails, nonmotorized infrastructure, and other active transportation accommodations

Nonmotorized Transportation Pilot Program

The Nonmotorized Transportation Pilot Program (NTPP) was established by SAFETEA-LU Section 1807 to "demonstrate the extent to which bicycling and walking can carry a significant part of the transportation load, and represent a major portion of the transportation solution, within selected communities," and to demonstrate results related to improved health and environmental quality.[35] The program provided over $25 million to each of four communities for investment in nonmotorized infrastructure and outreach and education programs. A Working Group composed of the FHWA, the pilot communities, the Volpe Center, the Rails to Trails Conservancy, and the CDC was formed to coordinate research and outreach activities. NTPP reported results in a Report to Congress[36] in April 2012. The Working Group will continue to evaluate travel behavior changes from the nonmotorized investments and health and other outcomes for a report in 2013.

Congestion Mitigation and Air Quality

The Congestion Mitigation and Air Quality (CMAQ) program was "conceived to support surface transportation projects and other related efforts that contribute air quality improvements and provide congestion relief."[37] The program provides funds to State DOTs and MPOs for projects that reduce congestion and improve air quality. MAP-21 increases the potential health benefits of CMAQ by including particulate matter as a pollutant and by requiring MPOs serving a nonattainment or maintenance area with populations over one million people to develop a performance plan to ensure that CMAQ funds are used to improve air quality and congestion in the region.[38]

Highway Safety

23 USC §402 provides guidance and grant funding to State highway safety programs. Section 402 funds the State and Community Highway Safety formula grant program, and grants are awarded to States who have submitted a Performance Plan to FHWA. MPOs can work with their State DOT partners to learn more about the Section 402 grants. The National Highway Traffic Safety Administration (NHTSA) provides guidance for State safety programs with a strong emphasis on the safety of pedestrians and bicyclists.[39]

Metropolitan Planning

Metropolitan Planning (PL) funds "are available for MPOs to carry out the metropolitan transportation planning process required by 23 USC §134," including development of MTPs and TIPs, for inventories of the condition and capacity of routes, and predicting population, employment, and economic growth, and determining current and future transportation needs.[40]

MPOs exercise flexibility in working with their partners to determine how PL and other funds will be spent on transportation planning. For example, they could use funds to identify and evaluate health impacts or benefits resulting from current or planned transportation infrastructure or strategies, to collect related data, for forecasting, or for public and stakeholder outreach. They can also use these funds to plan for mitigation of related health impacts or to plan new facilities or programs that would improve access to healthy destinations. The case studies provide examples of the use of planning funds for innovative health-related activities. MPOs document how they use planning funds in their Unified Planning Work Program, which is an important resource for understanding transportation planning conducted in each metropolitan area.

Urbanized Area Formula Program

The FTA Urbanized Area Formula (5307) program funds transit capital, operations, and planning in Census-designated urbanized areas. Recipients include government agencies and publicly-owned transit operators. Eligible activities include: planning and design of transit projects and studies; capital investments in buses and fixed-guide way systems; job access and reverse commute programs; and safety and security for transit vehicles and stations. Urbanized areas with populations under 200,000 may also use 5307 funds for operating assistance. MAP-21 also adds flexibility to use 5307 funds for operating assistance in larger urbanized areas with populations over 200,000.[41]

Funds from the 5307 program can be targeted to add or improve transit service to help underserved populations access healthy destinations. The program can also fund safety improvements for transit and pedestrian and bicycle access to transit.
New Starts

The FTA New Starts and Small Starts program is the primary federal funding mechanism for major capital investments in transit. When evaluating New Starts projects, FTA uses a variety of documented criteria, including economic development, environmental benefits, mobility improvements, and land use conditions (such as pedestrian facilities). Capital transit improvements through New Starts may thus improve bicycle and pedestrian integration into the metropolitan transportation network and provide more facilities and destinations for active transportation.

Elderly and Persons with Disabilities Program

The FTA Elderly and Persons with Disabilities (5310) program funds capital expenses for transportation services for the elderly and persons with disabilities when existing transportation options are insufficient or inappropriate. Funds are allocated to States based on population share for these groups. The States then allocate funds to local applicants and oversee coordination between funded activities and other Federally-funded projects.

A photo of bike commuters in the Puget Sound area

The Puget Sound Regional Council worked with Public Health – Seattle and King County, which received a Communities Putting Prevention to Work grant from the CDC, to develop a bicycle and pedestrian toolkit for local jurisdictions and to integrate health into the LRTP prioritization proposal. Source: Puget Sound Regional Council.

Federal resources can help formalize local partnerships and interest in health, leading to long-term relationships and actions that otherwise would not have occurred.

MPOs can plan to use 5310 funds to improve accessibility for the elderly and persons with disabilities, who likely have greater challenges in reaching healthy destinations such as medical centers. Funds can support transportation components of local housing projects to improve access to allow "aging in place."

USDOT Partnerships

The USDOT is involved in a number of interagency initiatives that focus on health or related topics. Three of the more relevant ones are listed below, in chronological order.

National Prevention Council

The National Prevention, Health Promotion, and Public Health Council (National Prevention Council), is an interagency Federal council that includes all executive agencies, including USDOT. The Council was called for under the Affordable Care Act and coordinates federal activities that foster a national focus on wellness and prevention.

In June 2011 the Council developed a National Prevention and Health Promotion Strategy. The strategy promotes a shift from a focus on sickness and disease to one based on wellness and prevention. It presents a vision, goals, recommendations, and action items that individuals and public, private, and nonprofit organizations can use to reduce preventable death, disease, and disability in the United States. The National Prevention and Health Promotion Strategy was preceded by the National Strategy for Quality Improvement in Health Care (March 2011). The National Quality Strategy presented three national aims for improving the quality of health care in the U.S.: Better Care, Healthy People and Communities, and Affordable Care.

HUD-DOT-EPA Partnership for Sustainable Communities

The Partnership for Sustainable Communities is intended to help communities nationwide improve access to affordable housing, increase transportation options, and lower transportation costs while protecting the environment. To guide coordination of Federal funding programs and policies, the partnership developed six Livability Principles, three of which explicitly reference the intersections between transportation and public health. The principles aim to provide more transportation choices in part to improve air quality and promote public health, improve economic competitiveness of neighborhoods by giving people reliable access to basic needs, including healthcare services, and to enhance the unique characteristics of all communities by investing in healthy, safe and walkable neighborhoods. The Federal Partnership agencies (USDOT, EPA, and HUD) are collaborating on a broad range of initiatives at national, regional, and local levels with their different regional and local planning partners. Many of these planning initiatives either include or could include a health focus.

USDOT, EPA, and HUD each provide separate grant programs, some of which allow for a health and transportation component, as discussed in the previous section for USDOT. For example, the Sustainable Communities Grant Program, administered by HUD, supports planning efforts that integrate several components of healthy communities, and places a priority on investing in partnerships, including public health, that promote integration of Federal Livability Principles into long-term and regional strategies. One example grant is the $2.6 million grant to Shelby County in Tennessee for developing a Mid-South Regional Greenprint and Sustainability Plan to initiate long-term comprehensive land use planning. One anticipated benefit is an increase in affordable housing located near walking and biking trails and improved health outcomes from creating more walkable neighborhoods.

Other Federal Initiatives and Funding

In addition to the USDOT partnerships, there are several other Federal agencies and initiatives that have public health initiatives with a connection to transportation.

U.S. Department of Health and Human Services: Centers for Disease Control and Prevention

The mission of the U.S. Department of Health and Human Services (DHHS) is to provide the "building blocks" for Americans to live healthy and successful lives. The Centers for Disease Control and Prevention is a component of the Department of Health and Human Services, and seeks to create tools and disseminate information to help the population protect their health.

These Centers have a number of programs and initiatives with a focus on the transportation implications of public health. These programs are cited as important resources in the case studies that follow.

U.S. Department of the Interior

The National Park Service (NPS) has an Office of Public Health that is primarily staffed with commissioned officers from the United States Public Health Service under a memorandum of agreement between DHHS and the Department of the Interior. The Office has four focus areas: Environmental Health, Disease Detection and Response, Public Health Protection and Promotion, Emergency Preparedness and Response. The Public Health Protection and Promotion area has recently expanded in scope, in part in response to the international Healthy Parks Healthy People initiative, which promotes the important interdependency between the health of parks and health of people. The U.S. Healthy Parks Healthy People Strategic Action Plan outlines future NPS activities on public health, including increasing park access and greater cross-agency collaboration.

The NPS Director has also established a Health and Wellness Executive Steering Committee and tasked it with exploring the role of NPS in improving the nation's health while continuing to uphold the core mission and values of NPS. The initiative so far has consisted of an invitation-only workshop in April 2011 of representatives from Federal agencies, health care companies, and nonprofits; an inventory of physical activity and public health programs at parks from 2005-2010; and promotion of programs such as the Park Prescriptions Initiative, which Indiana Dunes National Lakeshore implemented, where doctors prescribe walking regimes and recommend specific locations, such as nearby parks.

U.S. Department of Agriculture National Institute of Food and Agriculture

The USDA National Institute of Food and Agriculture (NIFA) Grants have broad eligibility for programs in rural areas. These grants can be used for infrastructure, planning, or other projects that promote human health through improved access to food. Previously funded applications include community gardens, food access and security assessments, and community kitchens. NIFA grants can thus increase local access to food resources, and may also create data and plans that serve as health inputs into the metropolitan area transportation planning process.

U. S. Environmental Protection Agency

Along with participating in the Partnership for Sustainable Communities, EPA also offers an Environmental Justice Small Grants Program for funding for environmental and public health issues.

EPA's Smart Growth Program supports local communities that are seeking to establish development and planning practices that are sensitive to the built and natural environments. In addition to providing informational resources and technical assistance to local partners, EPA also funds smart growth grants that may be useful for governments and organizations developing health-related assessments and data as part of planning efforts.

President's Council on Fitness, Sports, and Nutrition

The Council's mission is to "engage, educate and empower all Americans across the lifespan to adopt a healthy lifestyle that includes regular physical activity and good nutrition." The Council plays a role in developing the administration's priorities, outreach and awareness efforts to help improve the health and quality of life for all Americans. The Council incorporates messaging and promotes efforts with the National Physical Activity Plan, which has recommendations centered around eight areas, including transportation, land use and community design.

America's Great Outdoors

The America's Great Outdoors initiative was launched by President Obama to develop a conservation and recreation agenda. The initiative, which includes USDOT, has a number of public health goals that involve connecting people with nature and sites for outdoor activities.

For example, one objective is to provide safer and more accessible and affordable transportation options to better connect youth to exercise venues such as outdoor parks.

Let's Move

Let's Move is an initiative launched by First Lady Michelle Obama with the goal of solving childhood obesity within a generation. The program, which coordinates with the America's Great Outdoors, is focused on helping children and their parents access opportunities for healthy eating and physical activity. The five pillars of the initiatives are: creating a healthy start for children, empowering their parents and caregivers, providing healthy food in schools, improving access to healthy and affordable foods, and increasing physical activity.

At the launch of Let's Move, President Obama signed a Presidential Memorandum creating the Task Force on Childhood Obesity. This was established to develop and implement an interagency plan that "details coordinated strategy, identifies key benchmarks, and outlines an action plan to solve the problem of childhood obesity within a generation." The action plan makes about 70 recommendations to achieve this goal.

Let's Move has two outgrowth initiatives: Let's Move Outside and Let's Move Cities and Towns. Let's Move Outside is an initiative administered by the Department of the Interior to encourage children and families to take advantage of the outdoors. The initiative recognizes that lack of access and related issues such as busy roads, poor pedestrian infrastructure, and inadequate transit are key barriers to children getting exercise and being outdoors. The initiative also aims to promote outdoor activity, including walking and biking, as the easiest and most affordable option for families to stay healthy. Let's Move Cities and Towns is designed to encourage mayors and elected officials to adopt a plan to fight childhood obesity. The program is currently in the process of updating the "Let's Move Cities and Towns Toolkit," which details strategies and resources for local governments.

NGO Advocacy, Research, and Programs

In addition to government sponsored initiatives, the nonprofit sector plays an important role in advocating for public health outcomes and conducting research that is of use to policy and decision makers. Foundations and non-governmental organizations may also provide funding in areas such as active transportation and trail infrastructure, safety improvements, Environmental Justice, and community design for greater active transportation and transit mode share. There are also funds for programs and projects with public health benefits, many of which may include transportation components. This section describes some of these leading organizations and efforts.

Several of the organizations described below provided recommendations for policies, programs, and specific health-related investments in the new transportation reauthorization bill.[42] Recommendations focused on active transportation, community engagement, mass transit (to improve air quality), and safety. These organizations will continue to be informative sources for emerging policy ideas now that MAP-21 is law.

Transportation Research Board Subcommittee on Health and Transportation

The Transportation Research Board (TRB) Committees on Environmental Justice in Transportation (ADD50), Transportation and Sustainability (ADD40), Travel Behavior and Values (ADB10) and Urban Data and Information Systems (ABJ30) sponsored the creation of the TRB Health and Transportation Subcommittee in March 2011, with co-chairs from the FHWA Resource Center and the American Public Health Association (APHA). The purpose of the subcommittee is "to identify, advance and publish research and information to expand and improve current understanding and evaluation of the health impacts of Federal, State, regional and local transportation policies, procedures and actions." The subcommittee has developed a website that lists a number of resources, a Strategic Plan, and a TRB Calls for Papers.

American Planning Association

The American Planning Association (APA), a nonprofit research and education organization representing the planning profession, has a National Planning and Community Health Research Center. The Center has two ongoing projects: Planning for Food Access, which focuses on food access disparities, and Planning for Public Health, which focuses on how health is being integrated into local comprehensive plans and plan-making processes and has resulted in a survey and report (March 2011). The Center has ongoing interest groups, an online forum, and webinar series, and has developed a Health Impact Assessment Online Course, funded by CDC and in partnership with the National Association of County and City Health Officials (NACCHO), a national nonprofit organization representing local public health agencies.

Previous Center research projects include Planning and Designing the Physically Active Community, which was funded by the Robert Wood Johnson Foundation and resulted in a survey (2003), resource list (2005) and Planning Advisory Service report (2006). The Center also collaborated with NACCHO on an initiative called Healthy Communities through Collaboration, which produced the following activities and reports:

Through these efforts, APA has developed a general approach to the intersection of public health and land use planning that can be expanded to include transportation. Even though some transportation terms appear in the materials developed (e.g., traffic calming and vehicle miles traveled), there is still a need to educate public health stakeholders on transportation planning specifically, both in terms of terminology but also on roles and responsibilities of government entities (e.g., MPOs and DOTs) and the consistent planning framework they follow (described above).

A more recent research project, Planning for Public Health, includes a survey of municipal comprehensive and sustainability plans, but not metropolitan or regional long-range transportation plans. However, several relevant topics were still identified: active transportation (the fourth most cited public health topic in comprehensive plans and first for sustainability plans), active living, physical activity, and environmental health.

National Association of County and City Health Officials

In addition to its collaboration with APA, NACCHO has developed a fact sheet on Public Health in Land Use Planning and Community Design, which specifically mentions traffic safety and air quality, and a development checklist created in partnership with the Tri-County Health Department of Colorado.

American Public Health Association

APHA has a Community Health Planning and Policy Development Section and a Public Health Traffic Safety Institute in partnership with NHTSA, and has identified transportation as a public health issue and priority topic for advocacy. Their advocacy and policy page provides resources, including an online communications toolkit, a series of fact sheets and reports, featured research on transportation and health, a newsletter, a resource page with links to work by national, State, local, and private organizations, public health and equity principles for transportation, a 2011 webinar series and case studies. One APHA report, At the Intersection of Public Health and Transportation, provides a good description of the ways in which the two fields intersect and how the programs under SAFETEA-LU impacted health.

Active Living by Design, Active Living Research, and Health Impact Project

The Robert Wood Johnson Foundation is the largest philanthropic organization devoted exclusively to health and health care in the United States. The foundation concentrates grant-making and research in four areas, including the promotion of healthy communities and lifestyles. Two of its national programs are Active Living by Design (ALBD) and Active Living Research (ALR).

ALBD, part of the North Carolina Institute for Public Health at the University of North Carolina Gillings School of Global Public Health, is intended to create community-led change by working with local and national partners to build a culture of active living and healthy eating. ALBD provides consultation and technical assistance and has supported 25 demonstration communities with grants. They offer services including education and training, coaching, and program development, as well as implementation and evaluation. ALBD funds active living projects in communities across the nation, has an extensive literature review on relevant articles, and has a list of tools for city planning and public health professionals to assist them in making their community more active.

ALR is research oriented and supports work to identify environmental factors and policies that influence physical activity. Its goal is to support and share research on environmental and policy strategies that can promote daily physical activity for children and families across the United States, with a focus on children of color and low-income children who are at the highest risk for obesity. ALR is administered by the University of California, San Diego. It funds research in the field and also has an extensive literature review. Its website has a database of research and other documents that can be searched and sorted by topic including transportation.

The Robert Wood Johnson Foundation is also involved in the Health Impact Project, a collaborative initiative with the Pew Charitable Trusts to promote the use of HIAs in policy making at the local and State levels. The Project offers grants for HIA demonstration projects, supports a training and technical assistance network, and researches laws and policies that might support HIAs, among other activities. Several Health Impact Project grantees have conducted HIAs on transportation plans and projects.

Design for Health

Design for Health is collaboration between the University of Minnesota, Cornell University, and the University of Colorado. Between 2006 and 2007, it assisted 19 cities and counties in Minnesota to integrate public health into comprehensive plans, transportation plans, and other guidelines and ordinances. Current work focuses on two main avenues:

ChangeLab Solutions Healthy Planning

ChangeLab Solutions, formerly the Public Health Law & Policy, is a collaboration between the California Department of Health Services, the California Endowment, and Kaiser Permanente. The goal of ChangeLab Solutions is to foster collaboration between public health officials and local planning officials. It works to engage advocates in the land-use and economic development decision-making process, develops tools, and provides technical assistance to promote land-use that supports healthier communities.

World Health Organization

The World Health Organization (WHO) is based in Geneva and is part of the United Nations system. It is involved in public health and planning worldwide. The Healthy Cities Project of the WHO, a movement to engage local governments in health development, has a webpage devoted to the topic of urban health. Healthy urban planning was one of the themes of the WHO European Healthy Cities Network, whose overall goal is to integrate health considerations into cities' urban planning processes and establish the commitment necessary to achieve the goal. The website contains a publication about the link between health and urban planning, as well as case studies of European cities. WHO Europe also supports countries in helping define and manage policies that are beneficial to public health by developing methods and tools to assess health impacts, and promotes sustainable transportation to help reduce health effects from transportation.

The organization has information on HIAs, including examples and other resources. HIAs and WHO's HIA tool are described in more detail in the Data and Tools section of this report.

Massachusetts Institute of Technology AgeLab

The MIT AgeLab is a research collaboration consisting of representatives from universities, businesses, and advocacy organizations to develop and implement products, services, and policies that can improve the quality of life for older adults and their families. A focus research area for AgeLab is "Safe Driving & Lifelong Transportation," which provides tools and resources for safe driving. The AgeLab works in partnership with private companies, including vehicle manufacturers, governments, and nonprofits such as the American Lung Association and AARP.

Health & Community Design Lab

The Health & Community Design Lab, formerly the Active Transportation Collaboratory, at the University of British Columbia conducts research on active transportation and its benefits to the environment, communities, and individual health. It is led by Dr. Lawrence Frank, a professor at the Schools of Population and Public Health and Community and Regional Planning.

Convergence Partnership

The Convergence Partnership is a partnership of funding organizations that support policy and practices to create environments that foster good nutrition and physical activity. Funders include Kaiser Permanente, the California Endowment, Nemours Foundation, the Robert Wood Johnson Foundation, the W.K. Kellogg Foundation, and the Kresge Foundation. The CDC is a technical advisor to the Partnership. They have developed a "Transportation & Health 101 Toolkit" as well as funder toolkit entitled "Making the Case and Getting Underway: A Funder Toolkit To Support Healthy People in Healthy Places."

Prevention Institute

The Prevention Institute focuses on prevention practices that improve health and quality of life and prevent illness and injury. It funds research, projects, and tools to increase access to healthy foods and create spaces for people to be more physically active. Their activities include the Healthy Places Coalition, which advances public health involvement in transportation planning and land use in California.

Environmental Justice Organizations

Several foundations offer grants to projects that improve environmental health and justice in targeted communities. These include the Nathan Cummings Foundation Health Program, and the Surdna Foundation. A complete list of Environmental Justice funding assistance can be found at the Environmental Justice & Health Union website.

Data and Tools

MPOs play the lead role in conducting the technical component of transportation planning for their designated metropolitan planning areas. This typically involves data collection, evaluation, and assessment for planning the regional multi-modal transportation system. The MPO's technical analysis and related use of tools responds to regional, State, and local priorities and to Federal transportation planning regulations. In some circumstances, the regulations call for the use of specific tools or methods (e.g., models for air quality conformity); in other circumstances, MPOs develop and adapt methods to broader requirements (e.g., for Environmental Justice-related assessments of impacts on disadvantaged neighborhoods). As will be apparent in the case studies that follow, MPOs rely heavily on data collection and technical analysis to successfully and explicitly incorporate health consideration in metropolitan area transportation planning and to guide investments toward improving community health. MPOs that connect transportation to health impacts through data and technical analysis can build stronger causal relationships and gain greater support for investing in transportation projects with health benefits.

Consistent with the purpose of this report to provide a resource for peer MPOs, this section provides an overview of the potential and limitations of available technical tools for use in considering public health in metropolitan area transportation planning. The section provides a summary of these tools in the context of their health applications to provide a menu of options to MPOs; greater details on these and other technical analysis tools are provided in links or are available in other technical assistance reports.

Data Collection

MPOs rely on data to estimate and predict the likely results of transportation plans, policies, strategies, and investments. MPOs also use data to monitor the results of decisions. Data include demographic, employment, and commuting data; information collected directly; and data from external sources such as the U.S. Census Bureau and the National Household Travel Survey. Some MPOs also conduct their own surveys or counts to measure travel behavior independently or in conjunction with their partners at State DOTs, cities or counties, transportation operators, or neighboring MPOs.

The data that MPOs use for travel planning include several important indicators directly or indirectly related to public health. First, demographic data on age and income level demonstrate the presence of populations that may be more vulnerable to health impacts of transportation; these include the elderly, young children, and low income populations with less ability to move away from unsafe or undesirable conditions. Car-ownership and transit-dependency data drawn from the Census can indicate populations with restricted access to grocery stores, active recreation sites, and medical offices. Travel behavior surveys can indicate residents or employees who are more likely to use active transportation modes, perhaps because of proximity to important destinations or to reliable transit. MPOs can use similar data to identify areas where investments will improve physical activity, safety, or health related access for significant numbers of people.


Geographic Information Systems (GIS) are spatial analysis tools that allow users to display and analyze data based on locational attributes. MPOs frequently use GIS tools to show the location of existing and planned transportation infrastructure relative to spatial data in their regions (jurisdictional boundaries, emergency services, environmental resources, air and sea ports, etc.). GIS tools can also be used to analyze high-vehicle crash locations as well as proximity and connectivity based on different demographic or locational attributes, such as low-income neighborhoods, transit routes, medical centers, or grocery stores ("food deserts"). GIS tools help MPOs to meet requirements and initiatives, for example: consultation with land management and resource agencies, scenario comparison of future s.Research on local food deserts. Source: The Food Trust via Nashville Area MPO,A map shows areas around Nashville that have higher food desert scores. These are located near Gallatin, Goodlettsville, east of Lebanon, and just outside of the central city.

Research on local food deserts. Source: The Food Trust via Nashville Area MPO

To consider health in transportation planning, MPOs can adapt existing tools and may also work with partners to incorporate new data and methods.

GIS tools can identify neighborhoods in need of connectivity to healthy destinations, including neighborhoods with higher percentages of elderly, children, or other transit-dependent populations. They can calculate the proximity of active transportation infrastructure, such as bicycle lanes and sidewalks, to parks, schools, and neighborhoods. Most importantly, they can help planners to identify gaps in current transportation infrastructure that would help connect residents to healthy food, parks, and medical offices.


MPOs are required to project transportation demand over a 20-year planning horizon as part of development of Metropolitan Transportation Plans.[43] Most MPOs use modeling tools to complete travel forecasts for the MTPs. TMA MPOs also frequently use modeling tools as part of their Congestion Management Processes to identify and predict the level, extent, location, and time of recurring or periodic congestion. These models use traffic counts, demographic data, growth projections, and other inputs to predict mode share, congestion levels, and geographic distribution of travel patterns in the future. The projections that result from the model can be applied for planning purposes to traditional areas, such as where to build new roads, as well as to innovative topics, such as safety improvements near concentrations of seniors.

Modeling tools can help transportation planners identify communities that may need additional transportation infrastructure or strategies such as travel demand management to improve community health. For example, transportation planners may plan to add bikeways and sidewalks to improve both mobility and physical activity in targeted neighborhoods. They may also help planners provide nonmotorized or transit connections to medical centers or grocery stores. MPO planners can also work with public health staff (or data) to create more complex tools that estimate health implications of future transportation plans or projects. For example, models may predict changes in traffic emissions or safety resulting from projects or modal shifts that increase or decrease traffic volume or speed.

Performance Measures

MPOs are increasingly using performance measures at all key stages of the planning process, including translating broad goals into measurable results, outcomes, or targets; tracking the implementation of plans and results of decisions; and assessing whether expected regional goals and objectives were accomplished. When MPOs set specific, often quantifiable, targets in MTPs, these performance measures allow for the monitoring of results and improve accountability. MPOs can utilize performance measures to ensure that transportation systems maximize public health benefits or minimize negative health-related impacts. The EPA published a report entitled "Sustainable Transportation Performance Measures," which includes the following suggested performance measures that are directly or indirectly related to transportation and public health:

These are examples of the types of measures with varying complexity that MPOs are adapting to consider health. The list can be expanded, for example, to include other measures such as air emissions per capita for general; physical activity per capita; access to healthy food or medical care by walking, bicycling or transit; nonmotorized connections to transit; and crash rates. Specifically, several of the MPOs featured in the case studies use the following performance measures:

Some data and related measures are universally available to MPOs, some require additional analysis to incorporate external data sources or forecast impacts, and others may require new investments in GIS or other tools. MPOs can work with their regional partners to track performance using both transportation and health-related data inputs. For example, SACOG is able to measure access to healthcare employment in their region using data available to the MPO, and are working with partners to measure access to healthcare in the future.

Health Impact Assessments

Health Impact Assessments are a widely-used planning tool that evaluates the public health impacts of policies and projects that traditionally fall outside the health realm.[45]

These have been used to evaluate the impact on health of housing developments, regional comprehensive plans, resource extraction, and transportation projects and plans.[46] HIAs are generally voluntary in the U.S., although a few States have mandated the use of HIAs for specific projects or types of projects (see State Legislation section).

The HIAs, and a related range of tools and analytical approaches, can help address the need to incorporate health concerns systematically and simply into different stages of the transportation planning process. HIAs can be used for new highway and bridge infrastructure, transit projects, corridor plans, and other projects and programs.

HIAs generally consist of the following steps:

  1. Screening to decide whether a HIA is feasible, appropriate, and valuable to a plan/project;
  2. Scoping to identify the priority issues to assess, research questions, evaluation methods, and participant roles;
  3. Assessing the magnitude, direction, and certainty of health impacts;
  4. Reporting results to decision-makers; and
  5. Monitoring and evaluating the impact of the HIA on the decision-making process.[47]

Stakeholder involvement should be present throughout. Public health officials have generally played leadership roles in conducting HIAs, but transportation planners can also take the initiative to conduct an HIA. The HIAs can help planners measure the influence of the built environment on health in areas such as: accessibility, air quality, environmental and housing quality, food, mental health, physical activity, safety, social capital, water quality, climate change, healthcare facility siting, and noise.

HIAs can vary from small-scale to comprehensive. A range of HIA types include:

The MPOs included as case studies in this report have chosen to undertake a broad range of analysis of health implications of their transportation plans and projects with similarities to HIAs, independently of regulations or other requirements. This is similar to the on-going analysis MPOs undertake of impacts related to traditional transportation goals such as congestion or safety, or non-traditional goals such as greenhouse gas emissions or energy consumption.

Several training guides and resources are available through the U.S. Centers for Disease Control and Prevention, World Health Organization, Human Impact Partners, the National Research Council, or in a synthesis on research and practice in the American Journal of Public Health (See the NGO Advocacy, Research, and Programs section).

Health Economic Assessment Tool

The World Health Organization has developed a Health Economic Assessment Tool (HEAT) for assessment of bicycling and is developing an expanded version to include walking. HEAT requires two simple inputs: the number of walking or bicycling trips that a project or program is estimated to generate and the average trip length. The tool then projects an economic value (in dollars) of the project from increased walking and/or biking in a specified community. The dollar value represents the statistical value of life years saved due to health benefits (mortality) or savings from reduced disease (morbidity) of active transportation modes.[49]

The CDC works with the WHO to refine the range of applications of HEAT and to explore its use in the United States. FHWA and the Volpe Center worked with CDC to estimate economic benefits of health impacts from nonmotorized projects in four pilot communities funded under the SAFETEA-LU Nonmotorized Transportation Pilot Program. The estimates of health benefits are included in FHWA's to Report to Congress on the NTPP.

The CDC also sponsored a study to gauge U.S. interest in HEAT, with the following findings:

Although the case study MPOs in this report have not used HEAT, it and similar tools will broaden the technical capacity of MPOs and their partners to conduct the technical analysis that will be essential for consideration of health in metropolitan area transportation planning.

Integrating Transportation Data and Tools into Public Health Applications

MPOs commonly use the data and tools outlined in this section for transportation planning purposes, but MPO staffs generally do not have the public health expertise to apply data to health outcomes. Partnerships with public health agencies and non-governmental organizations allow the data collected and model outputs derived within the MPO planning process to be analyzed for health-related applications. MPO planners do not typically require data that measures actual health outcomes, such as disease rates or other direct health metrics, for making transportation decisions. Transportation planners are most likely to use transportation surrogate measures with health implications, such as mode shift to active transportation, reduced single occupant vehicle miles travelled, or minutes of active transportation. Public health experts can then use these transportation measures to estimate health outcomes. This collaboration allows MPOs and their public health partners to work together to apply their own expertise, as described in Figure 1. The arrows show the general linear application of transportation outcomes to health research.

Figure 1: Transportation Outcomes as Inputs to Health ResearchTitle: Transportation Outcomes as Inputs to Health Research - Description: Shows connections between transportation planning and health research. The MPO transportation planning process contributes to transportation outcomes, including nonmotorized modeshare, amount of physical activity, and particulate emissions on congested roads. Public health agencies or NGOs use these outcomes as the basis for health research that investigates how these factors influence health outcomes such as reduction in cardiovascular disease and incidence of respiratory illness.

Updated: 9/19/2016
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