Integrating Health and Physical Activity Goals Into
Transportation Planning:

Building the Capacity of Planners and Practitioners
Proceedings of the Portland Roundtable

January 22, 2004

Table of Contents

Overview

Roundtable Participants and Presenters

Introduction and Topic Overview

Panel 1: A Focus on Transportation Planning

Overview and Context

Incorporating Non-Motorized Travel in Transportation Planning

Regional or MPO-Scale Transportation Planning Experiences

Planning in State Departments of Transportation

Public Transit Planning

Panel 2: A Focus on Public Health and Physical Activity

Overview and Context

County Health Agencies

Regional Health Agencies

Health Impact Assessments

Lessons Learned

Obstacles

Promising Methods

Next Steps

Appendix A - Participants in Roundtable

Appendix B - Roundtable Agenda

Overview

The roundtable was organized by the Federal Highway Administration (FHWA) and the Federal Transit Administration (FTA) of the U.S. Department of Transportation (USDOT) to bring together transportation and public health professionals to discuss opportunities and strategies to include health and activity goals within the transportation planning process. The premise is that health impacts are typically not considered within transportation planning despite increasing recognition that investment decisions and strategies resulting from this process can have major health impacts. The roundtable considered why this is the case and exchanged ideas about strategies to encourage better integration of health and physical activity goals within transportation planning.

The goals of the roundtable were to: 1) discuss ways to enable transportation planners to incorporate health and activity goals into the transportation planning process; and 2) enable public health practitioners to become more involved in the transportation planning process. Transportation planning and public health experts with experience in integrating public health and activity goals within transportation planning exchanged perspectives and discussed how to expand opportunities to work together. The presentations and discussions during the roundtable were intended to provide participants both from public health agencies and transportation planning and operating agencies with ideas and information to incorporate within their programs and organizations. USDOT will distribute information and insights from the roundtable to a national audience of transportation planners and others interested in transportation through the FHWA and FTA Transportation Planning Capacity Building program. Participants left with a better understanding of how each field operates, areas of mutual interest, and opportunities for future collaboration.

Roundtable Participants and Presenters

Participants represented different fields and perspectives within transportation planning and public health and provided overviews on research and practice. Since transportation planning is typically undertaken by State Departments of Transportation (DOTs), federally designated metropolitan planning organizations (MPOs), city and county transportation agencies, and transportation providers, representatives from each of these entities participated in the roundtable. Similar to state and local agencies with energy, environment, economic development, and land use responsibilities, public health agencies can also consider transportation trends, issues, and strategies in their planning. Members from city, county, and state departments of health and academic and national public health programs participated to provide the public health perspective on how to improve integration.

The roundtable was by invitation to allow a broad and structured discussion within the space and time allotted (Figures 1 and 2).

The 29 participants represented transportation, public health, and academia from all over the country (Table 1). Additional information on all participants is provided in Appendix A. Each panel began with an overview followed by presentations with examples of applications and experiences for each topic.

Table 1: List of Participants by Type of Organization
 

Transportation			Public Health
Organization Association of Metropolitan Planning Organizations (AMPO) American Planning Association (APA) Federal FHWA Office of the Secretary, US DOT FTA Regional Administrator, WA* Oregon Division Administrator, FHWA* State Oregon DOT Washington State DOT† New Jersey DOT Regional/MPO/Local Planning Director, Berkeley-Charleston-Dorchester Council of Governments, SC† Thomas Jefferson Planning District Commission and Charlottesville-Albemarle MPO, VA Portland Metro Transit New Jersey Transit† Tri-Met, OR Research/Academia University of California at Davis* Georgia Institute of Technology† Texas Transportation Institute			Organization Association of State and Territorial Health Officials (ASTHO) Prevention Institute National Association of County and City Health Officials (NACCHO) Federal Centers for Disease Control and Prevention (CDC)* State Oregon Department of Human Services Office of Public Health Systems, OR Regional/Local Ingham County Health Department, MI† Tri-County Health Department, CO† Research/Academia Leadership for Active Living, San Diego State University Georgia Institute of Technology† * Denotes speaker † Denotes panelist

Following an introduction and topic overview, the roundtable was divided into two consecutive panels: the first focused on transportation planning; the second focused on health and activity. The agenda is attached as Appendix B. Speakers provided an overview and context for each panel and panelists described their experiences and perspectives on identified sub-topics (Figure 3). Discussions followed the conclusion of each part and a general discussion took place at the end of the roundtable to summarize main points.

Introduction and Topic Overview

The roundtable began with opening remarks by Richard F. Krochalis, FTA Regional Administrator, Region 10, and Dave Cox, FHWA Division Administrator, Oregon. Next, Sherry Ways of the FHWA provided an overview of the topic and of the roundtable, its sponsorship under the FHWA and FTA Transportation Planning Capacity Building program, and the types of support the FHWA and FTA can provide on this topic. This support includes:

• Providing a nexus for collaboration with new partners;
• Providing technical assistance and capacity building to transportation agencies interested in integrating planning with physical activity goals;
• Educating the public health and physical activity community on the transportation planning and decision-making process;
• Continuing to promote benefits of multi-modal transportation planning to State DOTs, MPOs, and Transit Operators;
• Continuing to encourage multi-modal alternatives including non-motorized options (biking and walking); and
• Exchanging information and ideas with public health stakeholders and exploring opportunities to work together.

William Lyons of the USDOT/Volpe Center discussed the format, themes, and goals of the roundtable. The main themes for discussion included:

• What are key obstacles to integration?
• What are some promising methods - technical and institutional?
• What specific steps will encourage integration?

Because of the complexity of the topics of transportation and public health, the roundtable began with two critical focuses (Figure 4). These focuses were intended to guide discussion and assist in improving the understanding of potential linkages between the fields of transportation planning and public health:

1. Physical activity from daily activities in contrast to more general research and programs that look at broad aspects of public health, including respiratory and other diseases related to air or water pollution, and safety. Physical activity from daily activities, also known as "utilitarian" physical activity, is one specific focus among many under the broad heading of public health.

 
2. Transportation planning and decision-making in contrast to a broader focus on transportation decisions and their health impacts. Rather than considering the physical activity implications of specific investments (e.g., a new road project, bus route, or bikeway), multi-modal systems (e.g., a coordinated network of roads, park-and-ride lots, bus routes, sidewalks, etc.), or strategies (e.g., congestion pricing or coordinated management of parking), the focus is on the transportation planning process that leads to these decisions. State DOTs, MPOs, counties, cities, and transportation providers conduct this planning process at the statewide, metropolitan area, or local level. This process corresponds to the framework for statewide and metropolitan transportation planning defined in the federal legislation under the Intermodal Surface Transportation Efficiency Act (ISTEA) in 1991, continued in 1996 under the Transportation Equity Act for the 21st Century (TEA-21), and planned for reauthorization in 2005.

Figure 4: The focuses of the roundtable (areas in dashed lines).

Panel 1: A Focus on Transportation Planning

Each panelist provided a perspective on one of the following topics: incorporating non-motorized travel in transportation planning, regional or MPO-scale transportation planning experiences, planning in state departments of transportation, or public transportation planning. These perspectives were important to share with the participants since many participants from the field of public health had limited knowledge of these topics.

The panelists used the following questions to guide their presentations:

• What do health and activity practitioners need to know about transportation planning and decision-making?
• How are you introducing health and activity goals to transportation planning?

What did you need to learn?

What was the most difficult?

What institutional or technical barriers have you encountered and overcome?

What advice do you have for other transportation planners on health/activity?

The answers to these questions were intended to provide participants both from public health and transportation planning and operating organizations with ideas and information to incorporate within their own programs and organizations.

Overview and Context

Dr. Susan Handy, Associate Professor, Department of Environmental Science and the Institute of Transportation Studies, University of California, Davis, provided an overview of the transportation planning process. Transportation planning is both top-down, with policies and directions from the federal government and state agencies, and bottom-up, with key plans and decisions implemented at local levels. There are key agencies at different levels of government with a range of responsibilities in the planning process (Table 2). Public health and active living goals must be integrated into the planning process at each of these levels.

Research on the link between the built environment and physical activity for utilitarian purposes suggests that residents walk and bike more in communities that provide proximity to destinations, direct connections to destinations, and attractive and safe places. Much of the burden for meeting these goals falls on local governments and on land use planning (Table 3). Thus, efforts to integrate physical activity goals not just into transportation planning but also into local land use planning processes are needed.

Dr. Handy concluded her presentation by comparing traditional approaches to key elements of the planning process to emerging approaches that may provide opportunities for incorporating health concerns into transportation planning (Table 4).

Incorporating Non-Motorized Travel in Transportation Planning

Dr. Michael Meyer, Professor of Civil and Environmental Engineering, Georgia Institute of Technology, described how aspects of transportation planning and modeling processes significantly limit the serious consideration of non-motorized transportation options in regional and local decision making. After describing how a typical transportation planning process operates, Dr. Meyer made a series of observations:

1. Although most metropolitan area vision statements encourage support for community development that would be conducive to walkable communities and non-motorized transportation, few local governments have adopted plans or zoning ordinances that are consistent with such a vision.

 
2. Most of the system performance measures used in transportation planning processes today have as their lineage concepts defined by traffic engineers decades ago as being the critical elements of transportation performance. Very few examples exist of performance measures that relate to walkable communities and non-motorized transportation.

 
3. Many aspects of the current state-of-the-practice of transportation analysis, such as how transportation networks and urban areas are represented in models, the underlying assumptions of travel motivation, and the use of average system performance measurements, ignore or limit the consideration of walkable communities and non-motorized transportation within the broader planning process. There is very little analysis capability for addressing these issues in the typical metropolitan transportation planning process.

 
4. Transportation analysis is driven by data. The quality of the analysis is only as good as the quality of the data that serves as input. For decades, especially during the formative years of developing the current modeling framework, non-motorized trips were not counted, and urban design considerations were not incorporated into descriptions of land use. To a large extent, this remains true today. In addition, there is some evidence to suggest that one of the major sources of data for transportation analysis, the U.S. Census, undercounts the segments of the population that would have the highest transit ridership and would walk the most.

Some metropolitan areas have taken positive steps to rectify the deficiencies described above and effectively capture non-motorized trips in the transportation planning process. These steps include:

• Activity-based modeling;
• Accounting for trip tours;
• Total trip-based data collection; and
• Overall greater awareness of non-motorized transportation activity.

Regional or MPO-Scale Transportation Planning Experiences

Dan Hatley, Planning Director of the Berkeley-Charleston-Dorchester Council of Governments (BCDCOG) in South Carolina, discussed the transportation planning process and experiences from the MPO and regional levels. The Berkeley-Charleston-Dorchester metropolitan area includes three counties, 14 municipalities, an air force base, and a state port and has a population of just over a half a million with 460,000 people in the metro region. The region has an ideal model for a compact mixed-use development pattern in the historic peninsula city of Charleston. While the development patterns of the 1970s and 1980s for the region were mostly low density sprawl, there are now are several high-profile new urbanist/neo-traditional developments as well as a large inner-city/former navy base revitalization/infill compact mixed-use development under way in North Charleston.

ISTEA and TEA-21 changed transportation planning by requiring multimodal transportation planning and by giving MPOs a more significant role in the transportation planning process and a higher amount of funding. These changes in part led to a policy change in the Charleston MPO that required new highway projects or improvements to include bicycle and pedestrian facilities (Figure 5).

BCDCOG recently analyzed growth trends in the region from the 1970s to 2000 using satellite imagery from NASA Mission to Planet Earth. They found that while population increased by 52% from 1973 to 2000, the developed area or urbanization increased by 318%. From analysis of these growth trends, staff realized that most of the MPO projects slated for the 1990s were necessary largely due to poor land use decisions. Accordingly, BCDCOG attempted to link land use and transportation planning through a regional "Growth Options" initiative that was made possible partially with funding from the first year of the FHWA Transportation and Community and System Preservation Pilot (TCSP) Program. Growth Options analyzes various development and growth patterns as well as the costs, both to the environment and to serve with infrastructure. Funding from the National Oceanic and Atmospheric Administration (NOAA) has provided for analysis of alternate development patterns and costs on a site basis. Staff and program partners hope to promote infill and compact mixed-use development with a goal to reduce future infrastructure needs.

Through TEA-21-related enhancement programs, the MPO staff discovered new partners for bicycle and pedestrian planning in the Charleston Area Bicycle Advocacy Group, some of whom come at the issue from the recreational and health perspectives. Through the "Growth Options" program and other urban design initiatives, MPO staff became involved in the Medical University of South Carolina's yearly Urban Design for Healthy and Prosperous Cities Conferences and Community Leaders Environmental Education Conferences. Staff and partners began to investigate South Carolina health statistics and realized that a case could be made for the need to consider health in transportation planning. South Carolina has the highest stroke death rate in the nation and has the third highest rate of diabetes. Seventy-nine percent of the population is considered at risk for health problems related to limited exercise. This led to a partnership of BCDCOG, Charleston Metropolitan Planning Organization (MPO), the Charleston Bicycle Advisory Group, and the Medical University of South Carolina (along with other interested groups of citizens) to submit a proposal to the Robert Wood Johnson Foundation - Active Living By Design Program in 2003. The proposal was funded and will help the transportation planning process in the region evolve yet again in the upcoming years.

Planning in State Departments of Transportation

Julie Mercer Matlick, Community Partnership Program Manager in the Highways and Local Programs Division of the Washington State Department of Transportation (WSDOT), discussed transportation and health-related planning by State DOTs. WSDOT began to educate people of the health benefits of active environmental design in 1995. Through community workshops on urban design that discussed walkable and bikeable communities, trails, downtown revitalization, and bicycling, the public has placed a higher value on bicycling, walking, safe school routes, and safe accessible transit. In addition, training programs within WSDOT, such as design and planning workshops, have strengthened staff understanding of the health benefits of active environmental design. To further strengthen this understanding, WSDOT involved other agencies in the planning of a number of their projects. These agencies included the FTA; FHWA; the Department of Health's nutrition and physical activity advisory team, which developed the state's data-based Health Plan; and the state land use agency, which reviews comprehensive land use plans. Ms. Mercer Matlick advised that it is important to keep these projects non-partisan and to have good data to support decisions.

Developing strong partnerships is key to incorporating health goals into the transportation planning process. Toward this end, WSDOT has worked with the:

• Washington Traffic Safety Commission;
• Washington State Department of Health;
• Washington Coalition for Promoting Physical Activity;
• Leadership for Active Living Initiative with the National Governor's Association; and
• Active Community Environments.

This last program was a grassroots initiative with Washington State MPOs and Regional Transportation Planning Organizations (RTPOs) that receives multi-year funding through a partnership with the Department of Health. Under this program, MPOs and RTPOs prioritize transportation projects for funding.

WSDOT is also involved in policy development. Some of the policies that take into account health benefits on which WSDOT has worked or adopted include a:

• Livable Communities policy;
• Context Sensitive Solutions/Design Executive Order, which has a community-based project development process that directs staff to support a context-driven approach; and
• Memorandum of Understanding with land use and health agencies.

Additionally, a WSDOT task force is developing an active living policy for their transportation plan update. Having the political support of the Washington State Secretary of Transportation has been key for WSDOT as it develops these programs, partnerships, and policies.

Public Transit Planning

• Provide easy, convenient parking at train stations;
• Minimize walk time to the train or bus;
• Provide the rider with comfortable stations and places to sit;
• Give the rider a seat on-board to let you rest as you travel;
• Minimize the effort it takes to transfer between public transit services; and
• Provide escalators and elevators in stations to make the trip as effortless as possible.

Transit operators take this approach, which seems contrary to fostering utilitarian physical activity, because of the expectations that fast and easy connections are critical to attract new transit riders and compete with other modes, primarily single occupant vehicles.

However, at the same time, transit agencies are interested in increasing ridership through expanding station access and modal integration and the building of sidewalks and bicycle paths, providing bicycle racks and lockers, and putting bicycle racks on buses and allowing bicycles on board. In turn, these actions can promote health. Coupled with scarce and expensive parking, living within walking distance of stations has become popular, especially with stores locating near transit stations. For transit users who walk or bike to transit stations and no longer have to drive in traffic, transit has made people's lives less stressful.

Five communities participated in NJ Transit's Station Renewal Program during the 1990s. A key to the success of this program is that before NJ Transit presented a plan, it spoke with people in the community to see what they wanted changed. This minimized local opposition because those in a position to object became involved in the design process, and local and state political leaders became vocal about their support for the projects, which helped raise necessary project funds. The projects that resulted from this program produced benefits beyond simply upgrading a transit facility; they also became integral to communities because they were used for non-transit purposes (for example, farmer's markets, art shows, community meetings, etc.) and, coupled with less stressful commutes, they helped set the stage for the resurgence of downtowns as viable places to live and commute from. ISTEA and TEA-21 helped similar programs in other states come to fruition.

What occurred during the early years of the ISTEA funding program is instructional when considering current interest in the integration of health and transportation goals: if federal transportation program funding criteria are changed to include health goals, then what is built will change accordingly, and the projects that are funded early on will set the tone for the types of projects that will get funded in the future. For instance, representatives of NJDOT, the State Office of Smart Growth, NJ Transit, the Robert Wood Johnson Foundation, Projects for Public Spaces, and Rutgers University, among others, have met on several occasions to discuss how to better collaborate to dovetail their missions to better achieve the objectives of the Governor's Smart Growth Initiative.

For smart growth and related policies to become more widespread, "an overarching vision" needs to be created that ties together disparate smart growth initiatives in a way that is compelling and makes sense to people. To do this, there is a critical need for basic data, on both a macro and personal level, that spell out facts about the downside of current development patterns on children and routine daily life, including health.

Panel 2: A Focus on Public Health and Physical Activity

In their presentations, each panelist talked about county health agencies, regional health agencies, or Health Impact Assessments. These perspectives were important to share with the participants since most participants from the field of transportation planning had limited knowledge of these topics.

The panelists used the following questions to guide their presentations:

• What do transportation planners need to know about the health and activity impacts of transportation decisions?
• What are institutional, technical, or other barriers to participation by health practitioners in transportation planning?
• What skills, tools, or knowledge do transportation planners need to work with public health practitioners?
• What advice do you have for health practitioners seeking to participate in transportation planning?

The answers to these questions helped the participants identify experiences, discuss trends, and make observations that they may be able to use in their programs and organizations.

Overview and Context

Dr. Andrew Dannenberg, Associate Director for Science in the Division of Emergency and Environmental Health Services, National Center for Environmental Health at the Centers for Disease Control and Prevention, provided the overview and context for the health and activity portion of the roundtable. The design of communities, such as the connectivity of the street network, affects transportation choices and therefore affects health. The World Health Organization defines health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." Accordingly, health includes physical health, mental health, well-being, and livability. Sprawl can affect health in a number of ways (Table 5).

In the last 10 years, obesity rates in the United States have increased by more than 60% among adults (Figure 6); approximately 59 million adults are obese. Physical inactivity is a major risk factor for obesity.

Fifty-five percent of American adults do not participate in the recommended level of regular physical activity needed to achieve health benefits, such as reduced risk of cardiovascular disease, diabetes, and other adverse health outcomes. A sedentary lifestyle increases the risk of overall mortality 2- to 3-fold, cardiovascular disease 3- to 5-fold, and some types of cancer, including colon and breast cancer, and the effect of low physical fitness is comparable to that of hypertension, high cholesterol, diabetes, and even smoking. Increasing weight is associated with an overall increase in risk of:

• Overall mortality up to 2.5-fold in the 30-44 age group, less at older ages;
• Cardiovascular mortality up to 4-fold in the 30-44 age group, less at older ages;
• Diabetes up to 5-fold;
• Hypertension; and
• Gall bladder disease.

Because transportation systems affect options available for physical activity, transportation planners can have a substantial impact on the health of their communities. A community designed with sidewalks and bicycle trails that connect people's homes to their neighbors and to schools, stores, offices, parks, and other destinations encourages higher physical activity levels than one where most daily destinations can only be reached by automobile. Well-designed roads, sidewalks, and trails also reduce the risk of injuries to pedestrians. A community with a substantial bus, light rail, and/or heavy rail network is likely to have less motor-vehicle generated air pollution and associated respiratory diseases than a similar community without such a network. In addition, persons who walk to and from transit stops may be able to incorporate physical activity into their daily routines more easily than if they drive to most daily destinations. Increased numbers of roads and parking lots also lead to increased non-point source water pollution and contamination of water supplies that can also impact human health, and increased erosion and stream siltation causes environmental damage and may affect how water treatment plants run. The mental health of individuals and a community's social capital also may be influenced by the design of a community and the transportation options available to its residents.

Dr. Dannenberg discussed the possibility that a formal process for assessing the potential effects of a transportation project on the health of a population might lead to healthier community design choices. This process could be in the form of a health impact assessment, which has similarities to an environmental impact assessment, but with a local health officer performing the assessment and considering health as opposed to environmental aspects. Regardless of whether a formal approach such as an HIA is applied, transportation planners should consider the health impacts on the affected population when planning for roads, transit systems, and walking and bicycling routes. Health should be an important consideration in transportation decisions.

County Health Agencies

Bruce Bragg, Director of Ingham County Health Department, talked about county health agencies. Ingham County Health Department (ICHD) became involved in land use planning when the Tri-County Planning Regional Planning Commission (TCPRPC) invited them to do so. TCPRPC serves the three county area around Lansing, Michigan, and is the federally designated metropolitan planning organization for transportation.

Community engagement in envisioning regional growth can be useful. TCPRPC's Regional Growth Project, which involved hundreds of citizens, helped develop land use scenarios to accommodate the region's projected growth. This planning technique made transportation and growth interesting to the general public. Through public education, people have become interested in the impacts of land use on health.

Public education and cooperation with other agencies in the region are important. Public health practitioners need to coordinate with planners and others to describe transportation planning and health impacts and to disseminate information to the public to influence change. Data sources need to be identified to help educate the public; geographic information systems (GIS) are key tools in this process because they help demonstrate to citizens that their efforts make a difference. An indicator of land use change over time (such as loss of open space) can be informative and energizing. Valid indicators to measure value and monitor change over time should also be developed to help educate the public.

Transportation and land use plans need to be synchronized and the land use vision needs to reflect community values, such as continuing investment in urban/village centers, preserving open space, and avoiding strip development and sprawl. To implement the vision, there needs to be a mechanism, such as a Health Impact Assessment, that could provide clear and understandable information. Currently, transportation and other projects are being developed with little consideration of health impacts. Health Impact Assessments could help decision makers evaluate the health impact of projects.

Regional Health Agencies

Carol Maclennan, Environmental Health Policy Coordinator for the Tri-County Health Department in Denver, talked about insights she developed while working at a regional health agency. As part of her work, Ms. Maclennan reviews county land use plans and makes recommendations to the counties on how their plans can foster public health. With respect to the health and activity impacts of transportation decisions that transportation planners need to know about, Maclennan mentioned six points:

• It is well established that regular physical activity has multiple health benefits.² It reduces risks of serious chronic physical and mental illnesses, from heart disease and diabetes to depression and anxiety, and it enhances overall health: bone and muscle strength, agility, balance, and the physical functioning of the ill and disabled.
• There is a growing body of research that shows that transportation planning is an important environmental determinant for promoting or discouraging physical activity and utilitarian travel. A walkable community has dense, interconnected streets; availability of convenient, safe sidewalks/bicycle paths; and open spaces. People living in sprawling counties with poor street accessibility are slightly significantly more likely to walk less, weigh more, and have more hypertension than those living in compact counties.³
• The U.S. spends a larger share of its GDP on health care costs than any other major industrial nation and it is one of the fastest growing components of the federal budget: nearly 14% of the GDP, up from 5% in 1960.
• Physical inactivity is one of the most common and preventable patterns of unhealthy behavior.⁴ Excess weight and physical inactivity cause 300,000 excess deaths a year, which is second only to tobacco-related deaths.
• Enhancing the pedestrian, bicycling, and transit (transit riders are pedestrians at some point) elements of our transportation infrastructure could encourage physical activity and improve health. There is room for improvement here: the 1995 National Personal Transportation Survey found that 86% of person trips were by motor vehicle and less than 5% were walking.
• In addition to the health benefits of transportation decision-making that would be more health-conscious, avoided costs of health care would theoretically be available for other funding priorities, including transportation.

There are a number of barriers to participation by health practitioners in transportation planning. The general perception of both planning and health agencies is that health practitioners do not have a legitimate role in transportation planning. Health practitioners are often unfamiliar with the transportation planning process and do not know how or where to intervene effectively. MPOs and state and local transportation planning agencies do not invite health practitioners to participate in the process. Where health agencies do see a role for themselves, statutory and funding limitations may exist. Statutes do not specifically mandate or address participation in broad land use or transportation planning activities. Current budget realities limit health agency resources and agencies are often challenged to meet minimum programs mandated by statute. Additionally, there is a lack of quantitative data to more fully describe the relationship between transportation planning and public health outcomes. These data are needed to support health-related criteria for transportation policies or project funding for strengthened pedestrian or bicycle elements of transportation programs and projects.

Ms. Maclennan concluded by providing advice for health practitioners seeking to participate in transportation planning. First, stay abreast of research linking transportation decisions and health and educate key policy makers on Boards of Health, in local governments, and in transportation planning agencies to secure support for public health's role in the transportation planning process. Second, educate or hire staff with a working understanding of the transportation planning process. This knowledge is critical for credibility and effective intervention. Third, build relationships with, and request participation in, local and regional transportation planning activities as appropriate. These activities take place within MPOs and city and county master/transportation planning processes.

Health Impact Assessments

Dr. Catherine Ross, Director of the Center for Quality Growth and Regional Development at the Georgia Institute of Technology, discussed Health Impact Assessments (HIA) and the status of their development. Much as health professionals seek to promote health and know little about transportation, transportation professionals seek to promote transportation and know little about health. Additionally, transportation planners typically seek to promote economic growth. Speed and convenience may be priorities ahead of promoting health, which is the purpose of an HIA. HIA is designed to bring health effects into wider discussions and to assist in balancing transportation and economic objectives with health objectives.

HIA makes use of both existing quantitative and qualitative knowledge. It provides a structured approach and is rigorous, but it does not generate absolute answers. The method used for HIA should be simple, rapid and structured, include all relevant elements, and be presented in a logical, consistent manner. The health impacts of transportation plans can be gauged for aspects of public health other than physical activity. These aspects include crashes/accidents, air and water pollution, noise, community disruption, and access to community services. The procedure for conducting an HIA can be as follows:

HIA efforts outside the United States are receiving increasing worldwide attention. These efforts are usually focused at the local project level and are almost always linked to community participation. The macro level policy environment in Europe is moving in the direction of taking health effects into consideration in all policy-making. Key challenges to HIAs include:

• Uncertainties surrounding data, models, and policies;
• Timeliness;
• Sectoral boundaries; and
• Relevance to legislators.

To address these shortcomings, an international conference in 1999 called for countries to adopt HIA procedures to appraise transport plans, programs, and strategies; develop methods, tools, and capacity to conduct HIA and estimate the economic costs of transport-related health effects; and improve the evidence base for HIA. The European experience shows that:

• HIA is a useful framework for increasing awareness and advocating the inclusion of health in the transportation agenda;
• HIA fulfills the need for simple procedures to be systematically applied at national, regional, and local levels; and
• The assessment of health impacts in transportation systems is early in the development stage.

In the United States, lessons for HIA practice can be learned from experiences with Environmental Impact Assessments (EIA). While EIA has provided an avenue for public participation, it also results in large complex documents, is time-consuming and expensive, frequently involves litigious processes, tends to focus on projects and not policies, and does not fully (if at all) consider health outcomes. Even if HIA is not applied as a complete and stand-alone methodology, health concerns can be considered in many areas of the planning process by means of:

• Goals and objectives;
• An expanded focus on safety, security, accessibility, pedestrian, and non-motorized modal planning;
• Flexible design of transportation infrastructure;
• The development of measures of regional health impact to determine what planning alternatives are the most supportive;
• Expanding health impact assessment in environmental assessment, EIS, etc.;
• Developing procedures for Comparative Risk Assessment to integrate health impacts into a single framework to measure mortality and morbidity;
• Improving demand estimation techniques for non-motorized modes; and
• Changing units of analysis as appropriate.

Lessons Learned

The goals of the roundtable were to discuss methods and approaches that transportation planners could use to incorporate health and activity goals into the transportation planning process and that public health practitioners could use to more actively and successfully participate in the transportation planning process. Consistent with the themes for the roundtable, participants used presentations and discussions to identify obstacles, promising methods, and steps necessary to reach these goals.

Obstacles

1. Limited Communication, Understanding, and Collaboration - Currently, the involvement of public health professionals in the transportation planning process appears to be limited. This lack of involvement is at both technical and institutional levels. Most involvement is initiated by city and county planning agencies, and less frequently or directly by state DOTs, MPOs, or transit operators. For example, public health agencies are unlikely to participate in technical aspects of the planning process, such as in the formulation of performance measures and data collection. Contacts between transportation planning and health agencies are often indirect (perhaps through a city planning agency) or informal (through a staff technical advisory group or public meetings) rather than formal (through a memorandum of understanding, for example, that might provide for coordination of strategic goals, forecast assumptions, or long range plans). This has led to interdisciplinary language and conceptual barriers.

 
2. Different Missions - Transportation and health agencies may have different missions or pursue different operating principles. For example, public transit operators may design out walking (e.g., in intermodal transfers) to make transit more attractive, easier, and quicker to use, and more competitive with automobiles.

 
3. State DOT Reluctance - Many State DOTs may view considering physical activity as one more requirement to consider alongside numerous other federal or state requirements in transportation planning. Many State DOTs may resist the idea of incorporating physical activity into the planning process and having health practitioners advocating new and different goals.

 
4. Health Impact Assessments (HIA) - HIAs may not be well understood and may often be viewed as potentially laborious or uncertain steps for transportation planners.

 
5. Unreliable Data and Measures - There is a lack of reliable data, performance measures, and agreed-upon metrics for physical activity. These technical tools would be essential for transportation planners to consider physical activity implications, including costs and benefits, relative to other traditional transportation goals such as reducing congestion and improving mobility. Specifically, there is a need for reliable data on travel behavior and how transportation decisions affect utilitarian physical activity. Conceptual approaches do not adequately capture nor clearly communicate the inherent complexity in collecting and validating this type of data.

 
6. Current Built Environment - Limited bicycle and pedestrian facilities and disconnected streets, sidewalks, and multi-use paths make walking or bicycling to work, the store, or school difficult and limit the attractiveness of investments in these areas. The perception is that these modes are time-consuming and unsafe and that adjustments are difficult and costly.

 
7. Lack of Funds - Observers believe that transportation funding categories (primarily federal) are often rigid and limit the ability to shift funds to non-motorized modes.

Promising Methods

1. Data and Technical Methodologies - Focus less on data and more on behavior, common sense, improved awareness, and small "tipping changes" instead of big systemic and procedural changes. To the extent possible, include health aspects in transportation models, data, context-sensitive design, and performance measures.

 
2. Communication - Both transportation planners and public health officials need to improve communications with each other to become involved in mutual planning processes. Some universities have begun dual degree programs in planning and public health. Involving the public in issues related to both transportation and health may also help bridge the gap.

 
3. Land Uses - To provide choices between walking or bicycling and driving, sidewalks and bicycle paths need to be connected, aesthetically pleasing, and easy to use to compete with other modes, including automobiles.

 
4. Health Impact Assessments (HIA) - HIA is a rapidly evolving collection of procedures and tools to evaluate policies, projects, and programs, rather than a single, fixed methodology. There is currently debate within the public health field about whether to make HIAs regulatory or voluntary. The inclination appears to be toward voluntary approaches and to provide useful tools rather than mandates, especially since many techniques are in early development. It may be useful to adapt specific elements within transportation planning to consider health impacts and demonstrate practical results. Local public health officials could work with transportation planners to perform specific HIA elements.

 
5. Areas of Innovation - As demonstrated by the experiences of roundtable participants, there is fertile ground for and interest in incorporating health and activity goals into transportation planning processes. For instance, some MPOs and State DOTs are already doing innovative planning in related areas. For example, the Charlottesville-Albemarle, VA, and Berkeley-Charleston-Dorchester, SC, MPOs are doing innovative work in vision and scenario planning, livable communities, and smart growth that is bringing land use and transportation planning together, and are interested in how physical activity might complement policies and priorities. The Washington State DOT is working with localities to develop partnerships and capacity in livable community, safety, walk to school, bicycle and pedestrian, and Active Living (physical activity) programs and regional and county health agencies in Michigan and Colorado are involved in land use planning processes.

Next Steps

Participants identified the following ideas for next steps to encourage the integration of health and activity goals in transportation planning.

1. Interest in Pursuing Integration - Participating transportation planners and public health representatives agreed that the integration of physical activity goals within transportation planning is a worthwhile topic to pursue. One suggestion was to hold a small workshop of experts to focus on detailed steps that might encourage integration. A number of participants also cited the need for getting the word out to an expanded audience beyond just those who attended the roundtable.

 
2. Usefulness of Safety Conscious Planning as a Model - It is useful to consider the history of how safety became a consideration in the transportation planning process. Safety goals and policy have been pursued as priorities through outreach, partnerships, research, dissemination of case studies and technical tools, training, and other voluntary as opposed to regulatory means. Encouragement of physical activity might follow a similar path.

 
3. Role of Public Education - Public health professionals could educate the public on health and activity issues related to transportation planning decisions. Coupled with improved collaboration between the fields of public health and transportation planning, public health professionals and the public can then become helpful contributors to the transportation planning process. Programs to exchange health and transportation planning staff and cross training would strengthen the understanding and communication between transportation planners and public health professionals both within participating organizations and more broadly, if insights are documented.

 
4. Value of Focusing on Own Organizations - Transportation planners and health practitioners interested in developing strategies to incorporate physical activity within the planning process should first look within their own agencies and communities for new partners (and look at existing funding across transportation, health, and human service programs).

 
5. Incremental Progress - Participants agreed that there is a great potential for progress through beginning modestly in specific areas with easy-to-demonstrate benefits. Early successes and partnerships can then be the basis for other actions. For example, an MPO might work with a city public health agency to introduce physical activity measures or goals as part of a new non-motorized transportation plan or a transit operator might be interested in including measures of physical activity in an assessment of a transit oriented development or a major new urban rail project. Successful results from these experiences could serve as a foundation for other future activities.

 
6. Value of Peer Experiences - Success stories in integrated planning, such as those identified by participants in the roundtable, might be usefully showcased through case studies. Transportation and health agencies would likely be very interested in peer experiences before they undertake similar planning.

 
7. Importance of Evolving Research - It is important to continue to track emerging research literature and new programs that are addressing some of the topics outlined above. Research and programs underway or anticipated are extensive. The FHWA/FTA annotated bibliography produced as part of the project on transportation planning and physical activity is a useful reference and point of departure for future documentation (http://www.planning.dot.gov/).

 
8. Identify Resources - In terms of identifying resources to work on transportation and health issues, it may be helpful to ask federal or state legislators to consider providing funds for the evaluation of the impacts of new transportation projects (perhaps 1% or even 0.1% of overall costs). Such evaluations could cover both the level of service impacts and the health impacts of projects such as building highways, transit, and trails. Funding such work under the category of "evaluation" might be easier than under the category of "research."

 
9. Joint Training and Education - In addition to having joint degree programs in public health and planning, short courses (perhaps three to five days) could be developed to teach current transportation planners about public health and public health officials about transportation planning. These courses could be developed and funded jointly by federal or state transportation and public health agencies.

 
10. Opportunities for Communication - One useful mean to improve communication would be to write articles about transportation planning in relation to public health to be published in public health journals and about public health in relation to transportation planning to be published in transportation planning journals. These articles could also be used as teaching materials in the suggested short courses (mentioned above) as well as in other settings.

Appendix A - Participants in Roundtable (* Denotes speaker)

1. David Belluck
   Senior Transportation Toxicologist
   Federal Highway Administration
   400 7th Street S.W.
   Washington D.C. 20590
   Email: david.belluck@fhwa.dot.gov

 
2. Stuart P. Berlow
   Senior Analyst, Injury Prevention Policy
   Association of State and Territorial Health Officials
   1275 K Street, NW
   Suite 800
   Washington, DC 20005
   Email: sberlow@astho.org

 
3. Bruce Bragg*
   Director
   Ingham County Health Department
   P.O. Box 30161
   Lansing, MI 48909
   Email: bbragg@ingham.org

 
4. David Cox*
   Division Administrator
   Federal Highway Administration Oregon Division
   The Equitable Center, Suite 100
   530 Center Street, NE.
   Salem, OR 97301-3740
   Email: David.Cox@fhwa.dot.gov

 
5. Andrew Dannenberg*
   Associate Director for Science
   Division of Emergency and Environmental Health Services
   National Center for Environmental Health
   Centers for Disease Control and Prevention
   4770 Buford Highway, Mail Stop F-30
   Atlanta, GA 30341
   Email: acd7@cdc.gov

 
6. Barbara Fraser
   Long Range Planning Manager
   Oregon Department of Transportation
   555 13th NE
   Salem, OR 97301-4178
   Email: barbara.k.fraser@odot.state.or.us

 
7. Susan Handy
   Associate Professor*
   Department of Environmental Science and the Institute of Transportation Studies
   University of California at Davis
   One Shields Avenue
   Davis, CA 95616-8573
   Email: slhandy@ucdavis.edu

 
8. Delania Hardy
   Executive Director
   Association of Metropolitan Planning Organizations
   1730 Rhode Island Avenue, NW, Suite 608
   Washington, DC 20036
   Email: dhardy@ampo.org

 
9. Dan Hatley*
   Planning Director
   Berkeley-Charleston-Dorchester Council of Governments
   5290 Rivers Avenue, Suite 400
   North Charleston, SC 29406
   Email: danh@bcdcog.com

 
10. Grant Higginson
    State Health Officer
    Oregon Department of Human Services
    800 NE Oregon St., Ste. 925
    Portland, OR 97232
    Email: grant.k.higginson@state.or.us

 
11. Marla Hollander
    Director
    Leadership for Active Living
    San Diego State University
    3900 Fifth Avenue, Suite 310
    San Diego, CA 92103
    Email: mhollander@leadershipforactiveliving.org

 
12. Tom Kloster
    Transportation Planning Manager
    Metro Planning Department
    Portland Metro
    600 NE Grand Ave.
    Portland, OR 97232
    Email: klostert@metro.dst.or.us

 
13. Richard F. Krochalis*
    Regional Administrator
    Federal Transit Administration Region 10 Office
    Jackson Federal Building
    915 Second Avenue, Suite 3142
    Seattle, WA 98174-1002
    Email: Rick.Krochalis@fta.dot.gov

 
14. Linda Lawson
    Director
    Safety, Energy and Environment
    Office of the Secretary, USDOT
    400 7th Street SW
    Washington D.C. 20590
    Email: Linda.Lawson@ost.dot.gov

 
15. Carol Maclennan*
    Environmental Health Policy Coordinator
    Tri-County Health Department
    Denver, CO
    Email: cmaclenn@tchd.org

 
16. L. Richard Mariani*
    Chief of Customer Resources
    New Jersey Transit
    One Penn Plaza East
    Email: rmariani@njtransit.com

 
17. Julie Mercer Matlick*
    Community Partnership Program Manager
    Highways and Local Programs Division
    Washington State DOT
    P.O. Box 47390
    Olympia, WA
    Email: matlicj@wsdot.wa.gov

 
18. Michael Meyer*
    Professor of Civil and Environmental Engineering
    Georgia Institute of Technology
    Atlanta, Georgia 30332-0355 USA
    Email: michael.meyer@ce.gatech.edu

 
19. Leslie Mikkelsen
    Managing Director
    The Prevention Institute
    265 29th Street
    Oakland, CA 94611
    Email: leslie@preventioninstitute.org

 
20. Marya Morris
    Senior Research Associate
    American Planning Association
    122 S. Michigan Avenue, Suite 1600
    Chicago, IL 60603
    Email: mmorris@planning.org

 
21. Valerie Rogers
    Senior Analyst
    National Association of County and City Health Officials
    1100 17th Street, Second Floor
    Washington, DC 20036
    Email: vrogers@naccho.org

 
22. Michael Ronkin
    Bicycle and Pedestrian Program Manager
    Oregon Department of Transportation
    355 Capitol St NE 5th floor
    Salem, OR 97301
    Email: Michael.P.Ronkin@odot.state.or.us

 
23. Catherine L. Ross*
    Director/Chair
    Center for Quality Growth and Regional Development
    Georgia Institute of Technology
    760 Spring Street, Suite 213
    Atlanta, GA 30332-0790
    Email: catherine.ross@coa.gatech.edu

 
24. Harrison B. Rue
    Executive Director
    Thomas Jefferson Planning District Commission and
    Charlottesville-Albemarle MPO
    300 East Main Street, P.O. Box 1505
    Charlottesville, VA 22902
    Email: hrue@tjpdc.org

 
25. 
    Phil Selinger
    Director of Project Planning
    Capital Projects and Facilities Division
    Tri-Met
    710 NE Holladay St.
    Portland, OR 97232
    Email: selingep@trimet.org

 
26. Gail Shibley
    Administrator of Environmental Health Systems
    Oregon Office of Public Health Systems
    800 NE Oregon St, Ste 640
    Portland OR 97232
    Email: Gail.R.Shibley@state.or.us

 
27. Gary Toth
    Director of Project Planning and Development
    New Jersey Department of Transportation
    1035 Parkway Avenue
    Trenton, NJ 08625
    Email: gary.toth@dot.state.nj.us

 
28. Felicia Young,
    Transportation and Community and System Preservation Pilot Program
    Office of Planning
    Federal Highway Administration
    400 7th Street, SW
    Washington, DC 20590
    Email: felicia.young@fhwa.dot.gov

 
29. Joe Zietsman
    Assistant Research Engineer
    Texas Transportation Institute
    3135 TAMU
    College Station, TX 77843-3135
    Email: zietsman@tamu.edu

 

Organizers

30. Sherry Ways
    Office of Planning
    Federal Highway Administration
    400 7th Street, SW
    Room 3301
    Washington, DC 20590
    Email: Sherry.Ways@fhwa.dot.gov

 
31. William Lyons
    John A. Volpe National Transportation Systems Center
    United States Department of Transportation
    55 Broadway, Kendall Square, DTS-46
    Cambridge, MA 02142
    Email: lyons@volpe.dot.gov

 
32. Ben Rasmussen
    John A. Volpe National Transportation Systems Center
    United States Department of Transportation
    55 Broadway, Kendall Square
    Cambridge, MA 02142
    Email: benjamin.rasmussen@volpe.dot.gov

Appendix B
Pre-Conference Session for 3rd Annual New Partners
For Smart Growth: Building Safe, Healthy and Livable Communities Conference
Portland, Oregon

Background: As part of the Transportation Planning Capacity Building Initiative, the FHWA and the FTA are sponsoring an expert roundtable to discuss opportunities and strategies to include health and activity goals within the transportation planning process conducted by state departments of transportation, metropolitan planning organizations (MPOs), transportation providers, and other transportation agencies. The premise is that health impacts are typically not considered within transportation planning, despite increasing recognition that investment decisions and strategies resulting from this process have major health impacts. This session will consider why this is the case and exchange ideas about strategies for change. Transportation planning and public health experts with experience in integrated planning will exchange perspectives and discuss opportunities to work together.

USDOT will use insights from this roundtable to inform Transportation Planning Capacity Building efforts.

2:00 - 2:25 pm
Welcome:

Richard F. Krochalis Regional Administrator Region 10 USDOT/Federal Transit Administration

Dave Cox Division Administrator Oregon Division USDOT/Federal Highway Administration

Introduction to Roundtable and FHWA/FTA Transportation Planning and Capacity Building Program:
Sherry Ways, USDOT/Federal Highway Administration

Introduction to FHWA/FTA Transportation Planning and Health/Activity Initiative and Context for Roundtable:
Moderator - William Lyons, USDOT/Volpe Center

Introduction of Roundtable Participants

2:25 - 3:40 pm
Part 1: A focus on Transportation Planning.

• What do health and activity practitioners need to know about transportation planning and decision-making?
• How are you introducing health and activity goals to transportation planning?
• What did you need to learn?
• What was the most difficult?
• What institutional or technical barriers have you encountered and overcome?
• What advice do you have for other transportation planners on health/activity?

Speakers:

• Overview and Context
• Susan Handy, University of California/Davis

• Incorporating Non-motorized Travel in Transportation Planning
• Michael Meyer, Georgia Institute of Technology

• Regional or MPO-scale transportation planning experiences
• Dan Hatley, Berkeley-Charleston-Dorchester Council of Governments
  Charleston, SC

• State Department of Transportation
• Julie Mercer Matlick, Washington State DOT

• Public Transportation
• Richard Mariani, New Jersey Transit, Newark, NJ

3:40 - 3:50 pm
Break

3:50 - 5:00 pm
Part 2: A Focus on Health and Activity

• What do transportation planners need to know about the health and activity impacts of transportation decisions?
• What are institutional, technical, or other barriers to participation by health practitioners in transportation planning?
• What skills, tools, or knowledge do transportation planners need to work with public health practitioners?
• What advice do you have for health practitioners seeking to participate in transportation planning?

Speakers:

• Overview and Context
• Andrew Dannenberg, Centers for Disease Control

• County, city, tribal health agencies
• Bruce Bragg, Ingham County Health Department, Lansing, MI
  Carol MacLennan, Tri-County Health Department, Denver, CO

• Health Impact Assessments: A tool for planning and analysis
• Catherine Ross, Georgia Institute of Technology

5:00 - 5:50 pm
Facilitated discussion with all panelists and audience.

• Opportunities to improve integration of health and activity in transportation planning, with a focus on concrete actions.
• Next steps.

5:50 - 6:00 pm Wrap up
Sherry Ways, FHWA
William Lyons, USDOT/Volpe Center