Tool Improves Transportation and Health Policies

Web Site Provides Stats and Strategies to Help Decision Makers

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Katherine Robb, MSPH, is a policy analyst with the American Public Health Association.

Ann Steedly, PE, is COO of Planning Communities, a private consulting firm in Raleigh, N.C.

Posted: Wednesday, August 31, 2016 2:30 am

It isn't likely that a controversial highway like the Cross Bronx Expressway could be built in America in 2016.

The expressway, created by New York City planner Robert Moses in 1948 and open since 1955, is likely the shining example of how NOT to design a major transportation artery. Moses continues to be blamed for destroying the South Bronx neighborhood by putting the automobile first and ignoring vital social and public health concerns.

Robert A. Caro’s 1974 Pulitzer Prize-winning biography, “The Power Broker: Robert Moses and the Fall of New York,” details how it happened.

And, coincidentally, in 2010, President Barack Obama, after awarding Caro a National Humanities Medal, said "I think about Robert Caro and reading The Power Broker back when I was 22 years old and just being mesmerized, and I'm sure it helped to shape how I think about politics."

That thinking, shared by others, no doubt influenced the Transportation Research Board about the same time to form a transportation and health committee, considered the “eureka moment” for finally recognizing that policy decisions like the Cross Bronx Expressway can seriously impact public health.

In April 2013, the Department of Transportation (DOT), Centers for Disease Control and Prevention (CDC) and the American Public Health Association (APHA) began collaborating on ways to strengthen resources for making better transportation and health policy.

The result? The Transportation Health Tool, or THT, an information-packed DOT website.

While everyone benefits from using roads, sidewalks, trails, and public transportation, the web site notes, "transportation systems can also have harmful effects. These range from decreased air quality to a lack of safe places to walk, bike and engage in physical activity without unnecessary risk.

“For a long time, transportation policy, program and funding decisions gave little attention to public health effects and benefits. That has begun to change. Many state officials, metropolitan planning organizations (MPOs), and partners now include public health goals and health criteria in transportation planning and policies and transportation project selection. The public health community has also begun to partner with transportation planning agencies to integrate health considerations into transportation work.”

Architects of the THT describe it as a set of transportation and public health indicators to help show how different areas compare on several transportation and health metrics; a resource to help understand the links between transportation and health; and a set of strategies to improve public health through transportation programs and policies.

Katherine Robb, a policy analyst with APHA, said the THT website was launched last October and the three agencies have been promoting it at various conferences, workshops and webinars.

“Our goals are to raise awareness about the links between transportation and health in both sectors; encourage health-supportive federal, state and regional transportation policy and project decisions, and support more effective and efficient collaboration between the transportation and public health sectors,” Robb explained.

She added that emphasis has especially been placed on transportation inequities for low-income areas and communities of color.

“They have higher transportation costs and longer commutes, are more likely to live near a highway or major roadway and have inadequate infrastructure promoting active transportation (walking or cycling),” Robb said.

The THT is designed to encourage partnerships, for example, between DOT and CDC, state health and transportation departments and MPOs and health agencies.

Equally important is expanding cross-sector collaboration between transportation and health across the board, said Ann Steedly of the private consulting firm Planning Communities in Raleigh, N.C., which was hired by the APHA for the project. “We also want to see health incorporated into transportation decisions and policies and to address inequities through a ‘health-in-all-policies’ approach,” she said.

Steedly said that from the start the team developing the THT put a lot of thought into what data to share. “We were not looking to create a plug-and-play tool, but one that starts a dialogue, a conversation between health and transportation officials who normally work in completely different arenas," Steedly said.

Ed Christopher, a veteran transportation planning consultant based in Chicago, who helped design the THT, said the tool offers transportation related metrics that tie directly to health outcomes statewide, in urban or large metropolitan areas.

THT indicators were narrowed down to 14 from 190 potential choices, refined through research evaluation criteria, subject matter expert consultation, and expert panel workshop and agency reviews.

These were chosen:      

• Commute mode share.

• Person miles traveled by mode.

• Public transportation.

• Vehicle miles traveled per capita.

• Housing and transportation affordability.

• Land use mix.

• Proximity to major roadways.

• Alcohol-impaired fatalities.

• Road traffic fatalities by mode.

• Road traffic fatalities exposure rate by mode.

• Physical activity from transportation.

• Seat belt use.

• Complete streets policies.

• Use of federal funds for bicycle and pedestrian efforts.

Christopher said THT provides a standardized score for each of the 14 indicators for each state. “It is comparable to a high school standard test score. If you were judging your state’s alcohol-impaired fatalities against a neighboring state, a score of 100 would be the best, a 0 the worst...

“For me, the THT is a catalyst, a way to really start the dialogue. It is not an instant pulse, but rather it gives you the bigger context. It provides the evidence and fuel to bring it up to the board. One of the beauties of the site, besides numbers and data, is that it gives you strategies... and it gives you a lot of reasons why a strategy affects health outcomes,” Christopher said.

How does THT work?

Robb said the easy-to-use website follows five primary pathways — active transportation, safety, cleaner air, connectivity and equity. One can click on any of these links on the home page to find its relationship to public health and find research studies and other resources related to the topic.

“Studies show that almost one in four adults in the U.S. report they do not engage in any physical activity outside of their jobs," Robb said. "Sedentary lifestyles are an important reason why two of every three adults in the U.S. are overweight or obese. Thus, if you were trying to encourage people in your community to bicycle to work, you could get a lot of help by going to the THT Active Transportation link,” she said.

Christopher said visitors to the web site can drill down to a lot more detail to learn, for example,  what the alcohol-impaired indicator encompasses, related strategies to combat it, its transportation and health connection, and other data.

Steedly said the THT team spent a lot of time developing the 25 strategies recommended on the website. The strategies had to be effective at positively impacting transportation and health outcomes, and had to support both short- and long-term goals.

“We reviewed 150 potential strategies, interventions and/or policies,” Steedly recalled, “and consolidated highly similar concepts. One of the most important is recommending the expansion of bicycle and pedestrian infrastructure.

“Our inspiration was the New York City Pedestrian Safety Report and Action Plan by the city’s Department of Transportation, which evaluated records of more than 7,000 pedestrian accidents with injuries or fatalities. As a result, NYCDOT installed pedestrian countdown signals at 1,500 intersections, retrofitted 60 miles of streets to improve pedestrian safety and revised 20 intersections for pedestrian safety on major two-way streets.”

Robb said the THT tool has drawn a lot of attention. “People attending our conferences and workshops are interested in using it, not only for the data, but also for ways to improve their communities. I find it exciting and I am learning a lot about transportation. I am meeting people who want to collaborate and I believe that five or 10 years down the road we’ll see improved healthcare.”

Said Steedly, “For me, THT is one of the tools we have been involved with that has actually turned into something we can all use. We are getting calls every week now from federal highway agencies, the CDC and APHA. We are seeing more cross-agency coordination. There is a positive, strong and ongoing agency involvement and commitment for THT,” she said.

“The Transportation and Health Tool provides a useful resource for transportation practitioners by bringing together data to help them understand how the transportation system in their state or metropolitan area is performing from a health perspective, said Jason Broehm, transportation analyst in the Office of the Assistant Secretary for Transportation at the U.S. DOT. “It also provides useful resources to help them identify strategies for improvement."

A staunch supporter of the tool is Clackamas County, Ore., perhaps the only county in the U.S. with a locally adopted Transportation Safety Action Plan.

Joseph Marek, director of Clackamas Safe Communities, said, “At some point we need transportation and health professionals talking to each other. Our action plan adopted in 2012 focuses on safety, takes a broad approach and brings culture change.”

According to the plan, “Building on the foundation of our existing assets, we envision a well-maintained and designed transportation system that provides safety, flexibility, mobility, accessibility and connectivity for people, goods and services; is tailored to our diverse geographies and supports future needs and land use plans.”

Marek said the THT tool offers advantages to engineers and public health professionals working together toward solutions. “In our case it’s encouragement and access to transit, a good tree canopy for air purification, planning and zoning options and sidewalks as places to exercise.”

While American cities have come a long way since the ribbon for the Cross Bronx Expressway was cut, they apparently have some distance yet to go. The National Safety Council just reported that traffic fatalities are up nine percent for the first six months of 2016 compared to the same period last year. The THT gives communities another tool in the struggle to reverse that trend.

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