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Federal program that helps tackle health disparities threatened in ’18 budget

Congress is threatening to eliminate a small yet significant federal program housed within the Centers for Disease Control and Prevention (CDC) that helps local communities take concrete steps to prevent someone’s zip code from being the most powerful determinant in their long-term health.

Walking, biking, and access to transit are part of a suite of healthy choices promoted by T4America and our colleagues at the National Complete Streets Coalition. People who walk or bicycle more for transportation are shown to have lower rates of heart disease, diabetes and other conditions that can complicate or shorten lives. And the demand for more opportunities to safely walk and bicycle is at an all-time high, in both heartland towns and urban centers alike.

Scores of communities are eager to find ways to improve the health of their most vulnerable residents — the people most likely to suffer from poor health outcomes — and those less likely to have access to safe streets for walking or biking. They want to know how to steer more of their transportation dollars into projects that will bring significant health benefits and reduce these disparities.

The Racial and Ethnic Approaches to Community Health program (REACH), a small program within the CDC, has helped these communities meet the demand for more active transportation projects, address the wide disparities in health from zip code to zip code, increase access to opportunities, and create a foundation of shared and sustainable prosperity.

REACH is an evidence-based program that directly tackles these health disparities and is the only community health program currently funded at the CDC.

Both the House and Senate Appropriations bills for next year (FY 2018) eliminate funding for this critical program. Please take a moment to send a message to your representatives and urge them to keep it going. 

A group of more than 200 diverse organizations — including The National Complete Streets Coalition and Transportation for America — signed a letter urging Congress to provide the program with another $50 million round of funding.

These funds are helping a plethora of communities make healthy living a reality. (We produced a series of case studies that includes some of these communities here.) It equips them to tackle the risk factors for some of the most expensive and burdensome health conditions impacting racial and ethnic groups. Without these funds communities across the country will have an even harder path to reduce disparities like these cited by the CDC:

  • Non-Hispanic blacks have the highest rate of obesity (44 percent), followed by Mexican Americans (39 percent).
  • The rate of diagnosed diabetes is 18 percent higher among Asian Americans, 66 percent higher among Hispanic/Latinos, and 77 percent higher among non-Hispanic blacks compared to non-Hispanic whites.
  • American Indians and Alaskan Natives are 60 percent more likely to be obese than non-Hispanic whites and have the highest prevalence of diabetes, with a rate more than double that of non-Hispanic whites
  • The incidence rate of cervical cancer is 41% higher among non-Hispanic black women and 44% higher among Hispanic/Latino women compared to non-Hispanic white women.

And as shown by the National Complete Streets Coalition in their last Dangerous by Design report, people of color are significantly overrepresented in pedestrian deaths.

Solving these kinds of pernicious issues doesn’t happen overnight.

But the REACH program is investing directly in local community coalitions with multiple years of awards, providing the time and resources necessary to address the many root causes of racial and ethnic disparities and reverse the upward trend of chronic disease.

Help protect REACH. Congress must continue to fund REACH in FY18 at the same level of investment ($50.95 million) as was provided in FY 2017.

A few of the groups leading the effort have set up an easy page for sending a message here.

Take Action

How are metro areas prioritizing health and building more biking and walking projects?

Though there’s booming demand all across the country to build more projects that can help residents get out and bike or walk — whether for exercise or just for getting around safely from A to B — it can be an uphill battle to do so. How are metro areas upending the conventional wisdom and building more projects that help improve their residents’ health?

How we get around each day shapes our quality of life, especially our health. People who walk or bicycle more for transportation are shown to have lower rates of heart disease, diabetes and other conditions that can complicate or shorten lives. And the demand for more opportunities to safely walk and bicycle is at an all-time high in cities and towns of all sizes across the country.

Communities are responding by planning, funding, and fast-tracking projects to make bicycling, walking, and riding transit safer, more convenient, and more realistic as travel options.

But getting these projects planned, designed and built can be a challenge. How can regions bring more of these projects to fruition?

This new paper, produced with the American Public Health Association, outlines four policy levers MPOs have at their disposal to help increase and improve active transportation projects to meet the demand, decrease health disparities, increase access to opportunities, and strengthen local economies — with specific short real-life stories to go with each.

For the launch of the paper, we had an online discussion with a number of the metropolitan planning organizations (MPOs) featured in this paper to hear how they’re successfully prioritizing bicycling and walking projects.

We spent some time exploring the specific policies these MPOs have adopted, and how they’ve implemented them. Catch up with the recording below.

New national survey examines how metro areas use performance measures to evaluate their spending

Thanks to action taken by Congress, metro areas will be required to use a data-driven process to measure the performance of their transportation spending. But some metro areas already go far beyond the modest new federal requirements. T4America’s new national survey of over 100 metro planning agencies examines the current state of the practice — and where it’s headed.

The federal transportation law enacted in 2012, MAP-21, ushered in a new era by requiring metropolitan planning organizations (MPOs) to start evaluating the performance of their transportation investments against a handful of federally required measures. (We’ve written about this just a bit over the last few years.)

Some metro areas have been doing this for years, going far beyond the federal government’s modest new requirements (such as safety or condition of roads & bridges) to assess their transportation investments in terms of more ambitious goals like return on investment, public health and access to jobs. With the new suite of measures finalized by USDOT in early 2017, it’s no longer an option for MPOs now — it’s a requirement.

To find the answers to some of these key questions and establish a state of the practice, T4America conducted a national survey of 104 MPOs from 42 states in 2016. Our survey tried to assess:

  • How many MPOs are already using performance measures in some form?
  • How many are interested in going beyond the new modest federal measures?
  • What’s keeping them from doing more?
  • What other key goals and metrics are they interested in measuring?

Among a range of interesting findings, we discovered that the majority of the MPOs surveyed (75 percent) are already using performance measures in some fashion. However, there is significant room for improvement in how they use them — only 30 percent of all MPOs utilize performance measures to evaluate specific projects for inclusion in the fiscally constrained five-year plans that govern all short-term spending.

While most MPOs are focused on meeting the new federal requirements, two-thirds of all agencies surveyed also want to become national leaders in using performance measures — including many MPOs currently doing only the minimum or just getting started. When it comes to additional measures outside of MAP-21’s modest new requirements, nearly half of MPOs surveyed chose equity and/or health as one of the five additional goals they are interested in measuring and assessing.

View the full survey results here.

Apply for technical assistance from T4America

In addition to the survey, T4America is today announcing a new technical assistance program specifically designed to help MPOs successfully respond to federal, state and local requirements. Find out more about applying, including info on an upcoming webinar to explain more about the application process.

Learn more & apply

Measuring what we value: Prioritizing public health to build prosperous regions

A new package of case studies released today by T4America, in partnership with the American Public Health Association, showcases a range of strategies that metro area planning agencies can use to strengthen the local economy, improve public health outcomes for all of their residents, promote social equity and better protect the environment.

CDC APHA health case studies

Today, we’re launching Measuring what we value: Prioritizing public health to build prosperous regions, four short case studies that extend our previous work on data-driven decision-making for choosing transportation projects.

Download the four case studies below.

A growing number of the metro leaders, elected officials and citizens we talk to are asking questions like: can the people in neighborhoods more likely to be unhealthy easily get out for a walk or bike ride without having to traverse dangerous streets? Do our regional planners effectively consider the impacts on regional air quality as we choose which projects to build? Is the area putting forward the most competitive possible projects to win limited state or federal funding for walking and biking?

A handful of metro areas have found smart, data-driven ways to better conceive, select and build the transportation projects that can help address these looming questions. We’re happy to share with you four of those stories from metro areas big and small: Sacramento, CA; Broward County, FL; Nashville, TN and Greensboro, NC.

Download each one below.

SACRAMENTO, CA
Promoting health and economic prosperity through data-driven decision-making

Citrus Heights community center groundbreakingUsing a lens of improved economic performance by improving public health, the Sacramento Area Council of Governments (SACOG) adopted several health- and social equity-related performance measures into a rigorous, data-driven process for choosing transportation projects, resulting in more projects that make it safer and more convenient to walk or bicycle.

Download the Sacramento case study. (pdf)

BROWARD COUNTY, FL
Healthy, safe & prosperous by design: Building complete streets

Prompted by a need for safer streets, the Broward Metropolitan Planning Organization (MPO) spearheaded an effort to build regional consensus and political support for planning, designing and building more complete streets projects. As a result, 16 of the MPO’s 31 jurisdictions have adopted Complete Streets resolutions or guidelines, and the MPO increased funding for active transportation projects, with 90 individual bicycle and pedestrian projects totaling $120 million awarded funding since 2012.

Download the Broward case study. (pdf)

NASHVILLE, TN
Prioritizing public health benefits through better project evaluation

Nashville missing sidewalksBacked by data from comprehensive health studies and growing public demand to make biking and walking safer and more convenient throughout the region, the Nashville Area Metropolitan Planning Organization (MPO) designed a new scoring and selection process to prioritize transportation projects that can bring health benefits. The MPO’s new approach substantially increased the amount of funding in the their long-term transportation budget dedicated to making it safer and more attractive to walk or ride a bicycle, making strides toward improving the health of the region’s residents.

Download the Nashville case study. (pdf)

GREENSBORO, NC
Healthy competition: Using data and modeling tools to win funding for active transportation projects

Greensboro sidewalks Guilford CollegeTo make walking and biking safer, more equitable and more convenient in Greensboro, North Carolina, the Greensboro Metropolitan Planning Organization (MPO) developed a rigorous evaluation and data-driven selection process to analyze and select the best possible bicycle and pedestrian projects for the metro area’s available funds, and to help the region better compete for the limited, competitive funding controlled by the state.

Download the Greensboro case study. (pdf)

The development of these case studies was made possible through a contract between the American Public Health Association and Transportation for America funded through cooperative agreement 5U38OT000131-03 between the Centers for Disease Control and Prevention and the American Public Health Association.  The contents of this document are solely the responsibility of the authors and do not necessarily represent the official views of the American Public Health Association or the Centers for Disease Control and Prevention.

Metropolitan planning for healthier, safer, more prosperous regions

How can metro area planning agencies strengthen the local economy, improve public health outcomes for all of their residents, promote social equity and better protect the environment? Join us to hear the stories of how a handful of metro areas have found smart, data-driven ways to better conceive, select and build the transportation projects that will help meet those regional goals.

Flickr photo by the Broward MPO. /photos/speakupbroward/24986492294

Flickr photo of an event by the Broward MPO. /photos/speakupbroward/24986492294

Metropolitan planning organizations (MPOs) not only have responsibility to create regional plans that govern federal spending within their borders, but those in larger regions also control a limited amount of transportation funds directly. How they manage these responsibilities has a huge impact on the health of their residents and their access to jobs and other opportunities.

Can the people in neighborhoods more likely to be unhealthy easily get out for a walk or bike ride without having to traverse dangerous streets? Does an MPO effectively consider the impacts on regional air quality as they choose which projects to build? Is the area putting forward the most competitive possible walking and biking projects to win limited state or federal funding?

We’re excited to bring you the stories of a handful of MPOs that have good answers to all of these questions next week via a new series of short case studies and an accompanying webinar on Thursday, September 22 at 1 p.m. EDT. Register for the webinar with the link below.

REGISTER NOW

 

Register for the webinar and you’ll be the first to receive a copy of these new case studies. If you work for an MPO, advocacy group or health organization and want to learn about ways to increase or improve the quantity and quality of active transportation projects in your region, this one is for you.

The MPOs we’re featuring have found ways to better use data and modeling tools to win funding for active transportation projects, standardize the process for building safer, more complete streets, or promote health and economic prosperity through transparent, data-driven decision-making. And we’re excited to share their stories with you.

On the webinar, we’ll have a short conversation with staff from four MPOs featured in the case studies. They’ll share details on their policies and programs, the transportation projects that resulted and the partnerships they had to forge to taste that success.

Join our team and experts on September 22nd at 1pm EDT. Register today!

Development of the case studies featured in this webinar was made possible through a contract between the American Public Health Association and Transportation for America funded through cooperative agreement 5U38OT000131-03 between the Centers for Disease Control and Prevention and the American Public Health Association.  The contents of this document are solely the responsibility of the authors and do not necessarily represent the official views of the American Public Health Association or the Centers for Disease Control and Prevention.

Join us for the release of Planning for a Healthier Future

2016_0504 Kresge Calthrope PM ReportThanks to 2012’s MAP-21 legislation, all metro areas and states will soon be using a limited array of performance measures. While the in-progress federal requirements will cover a limited range of measures, T4America is releasing a new resource next week to help metro areas find ways to use performance measures to improve public health, address social equity concerns, and advance environmental quality.

Join us next week on Wednesday, June 22 at 4:00 p.m. EDT for a special online discussion about the new report, including firsthand experience from some of the metro regions that participated in a related two-year collaborative — more about that below. Sign up and be the first to get a copy of the Planning for a Healthier Future report in your inbox next Wednesday.

REGISTER NOW

 

While the federal performance measures currently being developed will cover limited metrics like safety, condition of roads and bridges, or how to measure congestion, this report lays out additional measures that enable MPOs and regions to understand the health impacts of transportation and land use decisions within three other dimensions: physical activity, traffic safety, and exposure to air pollution.

This report is the result of our two-year Planning for a Healthier Future collaborative with teams from the regions of Seattle, WA, Portland, OR, San Diego, CA and Nashville, TN. These four regions are actively working to improve health, increase access to opportunity for vulnerable populations, protect the environment and promote economic competitiveness by developing and implementing transportation performance measures for their respective metropolitan planning organizations (MPOs)

Performance measures and health?

urban design for health transportation impacts health

Cities and regions around the country face important choices about how and where they want to grow, how to connect people to economic prosperity and how to use limited resources to promote healthy communities and provide a great quality of life for all of their residents.

Performance-based planning allows stakeholders and decision-makers to understand how a given investment, policy, or decision “performs” across certain measures over time — providing more clarity and transparency on exactly what state or regional transportation dollars are accomplishing. As a result of the transportation projects that get built, is the air cleaner? Do more people have access to opportunity? Is environmental quality made better or worse? Are the impacts on people’s health — especially vulnerable populations — positive or negative?

This detailed report summarizes current best practices in the development of health, equity and environmental measures that can be used to evaluate the performance of transportation investments at a regional scale. It aims to explore and test a variety of different data-driven measures that can evaluate packages of transportation investments — such as those frequently bundled together by MPOs in transportation plans.

Join us next week to learn more and get your copy!

REGISTER NOW

Kresge Calthorpe report logos

Surgeon General: building walkable communities is essential to our health

Yesterday the Surgeon General issued a powerful call-to-action that focuses on improving public health by encouraging walking and the creation of more walkable places. 

It was an inspiring moment to see the nation’s top doctor get in front of a crowd in Washington, DC (with thousands of others watching online) and urge Americans not just to get more exercise, but also to rethink how we build and grow our communities in ways that can encourage more walking by making it an attractive and convenient option.

Americans do not get enough physical exercise, he said. Chronic diseases — including diabetes, heart disease, cancer and obesity — are responsible for seven in 10 deaths per year, and cost us trillions of dollars. We can reduce the risk of those diseases to our health, however, with one simple action: walking. An average of 22 minutes of walking per day — about two and a half hours per week — can significantly reduce risk.

But for too many Americans, walking is not safe, convenient or easy.Communities (especially lower-income neighborhoods) may suffer from a lack of sidewalks, crosswalks, and the basic building blocks of what makes a walk possible. As many as 30 percent of Americans report that their communities have no sidewalks.

For decades, we built scores of communities without walking in mind, designing out the most common form of transportation from our daily lives and assuming that we’d be better off having to make the bulk of our daily trips with a car, which our federal transportation policy supported (through the creation of the interstate system and numerous other policies.)

Manchester Av students Upper Providence Twp Delaware Co PA October 5 2007Metro ATL Pedestrians06

But enough ink has been spilled looking backward at the numerous decisions that got us here. Instead, how can we move forward? How can we make it easier for more people to walk each day and stay healthier?

“We can change that,” U.S. Surgeon General Dr. Vivek Murthy says. “We can change it by city planners, transportation professionals and local government leaders working together to improve the safety and walkability of neighborhoods for people with all abilities.”

The solution can be found in part by recapturing the wisdom of how we once designed neighborhoods and towns of all sizes with walking as a central feature. The Surgeon General called on local governments and city planners to design their towns so that walkers have safe, easy places to walk to their destinations. As we covered yesterday in a preview of the call to action, we know that there is huge demand for, and economic returns to be had by, building places where walking is a central part of the design:

Since Indianapolis’s Cultural Trail, a high-quality biking and walking trail, opened in 2008 the value of properties within a block have increased an astonishing 148 percent. Last week, the Atlanta-Journal Constitution published a special packageabout the amazing demand for homes near the still-in-progress Beltline project that will eventually encircle the city with trails and transit. Nashville’s metropolitan planning organization recently began considering health criteria as they select transportation projects in the hopes of helping improve the health of residents over the next few decades as they grow. Washington State adopted a Vision Zero plan to reduce pedestrian deaths to zero. Making their vision a reality includes not just educating drivers about pedestrian and bike safety but also re-designing streets and roads to slow traffic and give folks walking and biking safe and attractive facilities to use.

“Today we have the opportunity to reclaim the culture of physical activity that we once had,” the Surgeon General said. “Today we are here to make that commitment that in America everyone deserves a safe place to walk and to wheelchair roll.”

Designing cities and towns to encourage walking involves smart planning of public transit and cycling infrastructure because both amenities extend the range that the average citizen can walk. Smarter transportation planning puts the majority of a person’s needs within walking distance, from errands to school, work and everything else. And the more we walk, the better our mood, the safer our streets and the healthier we become.

Tyler Norris, vice president of Total Health Partnerships at Kaiser Permanente, one of the many guests on hand to extol the benefits of the Surgeon General’s call-to-action, closed the day with some inspiring words about the numerous benefits of walking. Walking, he said, is good not only for individuals, but for communities:

“We were born to walk. Our bodies are designed to walk. There is nothing we can do that is simpler or more cost effective for our health and well-being than walking. Nothing is a better contributor to creating a healthy community than to make the public and private investments that are essential for the infrastructure for walking and rolling [in wheelchairs] throughout our communities. Every mayor and economic development leader will tell you that a walkable community is also a more economically vibrant and prosperous community.”

With Congress back in session now, it begs the question: Will policymakers in the Capitol heed the call from the nation’s top doctor and begin to align more of our country’s transportation policies with the need to get active? Will the House’s draft multi-year transportation bill — expected to be released this month — help or hurt state and local efforts to meet this demand for more walkable places?

This call to action could be the start of a transformation of how Americans think about the impact that the design of their towns and cities have on their health, but Congress will have to play a part.

What if we labeled unwalkable neighborhoods like we do cigarettes?

The Surgeon General of the United States will unveil a bold new initiative today, aiming to help Americans lead healthier lives — by making walking and physical activity built-in features of more of our neighborhoods.

Cross-posted with Smart Growth America. -Ed.

At a press conference at 10 a.m. this morning the U.S. Surgeon General will kick off a new national Call to Action, urging cities and towns to consider how the design of our roads and public spaces can encourage more walking by making it easier, safer and more convenient. (Tune into the live webcast of the event at 10 a.m. EDT.) To show how significant an issue this is to the Surgeon General, today’s announcement is only the sixth such Call to Action in the last 10 years.

surgeon general warning

According to the Surgeon General’s office, only half of American adults get enough physical activity to reduce the risk of chronic disease, and 10 percent of the preventable deaths in the United States are related to lack of physical activity. Communities that lack safe places to walk are a part of this problem.

What if we labeled unwalkable neighborhoods like we do cigarettes? A similar call from the Surgeon General in 1964 was the watershed event that kicked off a decades-long decline in cigarette use. Could today’s Call to Action do the same for communities without safe places to walk?

What if we put states, cities and towns on notice that streets and roads that are dangerous by design for people on foot or bike are a prime contributor to the obesity epidemic (as well as a contributing factor in an alarming number of fatalities)? What if we prioritized sidewalks and crosswalks the same way we do sunscreen, “no smoking” signs, and preventing underage drinking?

Help us celebrate this important step forward: share today’s announcement with friends and colleagues:

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The Surgeon General’s position makes it clear that America needs more than a simple call to “get out and exercise.” We need to build communities where walking is a safe and convenient option — so getting where you need to go can help you stay physically active and healthy.

The good news is that the tide is turning in communities of all types and sizes all over the country. Small towns, rural, suburban and urban areas are reinvesting in their downtown cores and creating vibrant walkable neighborhoods like never before and reaping the benefits of better walking and biking infrastructure. We still need to do more to encourage walking, but there’s clearly huge pent-up demand for walkable neighborhoods and high-quality facilities that anyone can use.

People want to walk, and they increasingly want to live and work in places where it’s a convenient option.

Since Indianapolis’s Cultural Trail, a high-quality biking and walking trail, opened in 2008 the value of properties within a block have increased an astonishing 148 percent. Last week, the Atlanta-Journal Constitution published a special package about the amazing demand for homes near the still-in-progress Beltline project that will eventually encircle the city with trails and transit. Nashville’s metropolitan planning organization recently began considering health criteria as they select transportation projects in the hopes of helping improve the health of residents over the next few decades as they grow. Washington State adopted a Vision Zero plan to reduce pedestrian deaths to zero. Making their vision a reality includes not just educating drivers about pedestrian and bike safety but also re-designing streets and roads to slow traffic and give folks walking and biking safe and attractive facilities to use.

There’s far more to do, though. While these stories are encouraging, the lowest-income neighborhoods across the country are the ones more likely to lack sidewalks, crosswalks or other facilities to keep residents safe.

Help celebrate this important call to action. Share this post and image with your friends and family and colleagues.

U.S. Surgeon General issuing a rare call-to-action to make walking safer & more convenient

The Surgeon General will issue a new call-to-action next Wednesday that focuses on encouraging cities and towns to design and build their roads and public places to make walking easier, safer and more pleasant.

From an email this morning:

The Call to Action will highlight the significant health burden that exists in the U.S. today due to physical inactivity – contributing to more than 10 percent of the preventable mortality in America today. More specifically, it will make recommendations to a number of key sectors about critical actions they can take to improve community walkability and increase walking throughout the U.S..

family-cultural-trailIt’s an incredibly noteworthy moment to see the Surgeon General identify this issue as a major public health problem. Issuing an official call is a significant event for the Surgeon General, and rare — only six others have been issued within the last ten years.

According to the Surgeon General’s office, only half of American adults get enough physical activity to reduce the risk of chronic disease, which is the leading cause of death in the United States. To address this grim statistic, the Surgeon General and HHS will release a set of recommendations on how to encourage walking and better shape our communities to encourage people to get out and walk or bike more to get around each day.

Communities around the country are seeing the benefits of better walking and biking infrastructure. Nashville’s metropolitan organization recently began considering health criteria as they selects transportation projects. Washington State was the first state to adopt a Vision Zero plan to reduce pedestrian deaths to zero. Making their vision a reality includes not just educating drivers about pedestrian and bike safety but also re-designing streets and roads to slow traffic and give folks walking and biking safe and attractive facilities to use.

We can’t just ask folks to get out and walk more — we need to give them safe and convenient opportunities to do so.

The Surgeon General and the U.S. Department of Health and Human Services will be launching this report and call-to-action next Wednesday, September 9, at Kaiser Permanente’s offices in Washington, DC., and we’ll be there to cover it.

If you’d like to watch next week, the event will be webcast on the Surgeon General’s website. On September 9th, go to http://www.surgeongeneral.gov/library/calls/walking-and-walkable-communities/event-webcast.html

Improving Health and Opportunities: Programs Designed to Save Lives

Community health and transportation are inextricably linked. Residents in vulnerable communities face a number of threats posed by poor street design, CO2 emissions, and inadequate pedestrian infrastructure. Investments in curbing threats posed to low income communities in particular are a matter of life and death for residents that call these communities home. In Arizona and Washington State, two new transportation programs intended to improve community health are seeing positive results for the most vulnerable populations. 

Air quality and pollution in Phoenix, AZ and surrounding Maricopa County persisted as major threats to the community for well over two decades. Under the federal Clean Air Act, the region was dubbed a “non-attainment area” in 1978 and remained noncompliant with pollution. High rates of single-occupancy vehicle driving commutes have contributed to increases in pollution.

phoenix-smog-1024x443

Flickr photo by Devin: https://www.flickr.com/photos/kingdafy/321019324/

The region’s transit agency, Valley Metro, uses their robust trip reduction program  to reduce the rate of single-occupancy vehicles commuting to and from work. This was accomplished by actively engaging employers in the region. Their work was bolstered by a state statute requiring employers to make a good-faith effort to reduce solo driving trips by participating in the regional effort. Click here to learn more about the comprehensive program and how Valley metro is reducing trips: http://bit.ly/1WcYgAB. 

WAgraph

Vulnerable populations disproportionately suffer negative health and safety affects from poorly planned transportation systems. High numbers of pedestrian fatalities is one of those harsh consequences. Communities of color and senior citizens in particular make up a significant portion of these avoidable traffic deaths. In the year 2000, Washington State became the first state in the nation to adopt a policy aimed at eliminating deaths on its roadways, a movement most known as Vision Zero. Since then, the state has made remarkable progress, dropping to the 4th lowest fatality rate in the country.

Similarly, Washington’s Target Zero blueprint relies on four tenants: educating, enforcement, engineering, and emergency medical services. Washington State finds its continued partnership with the governor’s administration, federal, state and local agencies, local organizations, and interested stakeholders remains vital to achieving the goal of zero traffic deaths and fatalities by 2030. Learn more about how your region and community can implement a vision zero plan here: http://bit.ly/1DDcLYy. 

Check out additional regional case studies in our series on Improving Health and Opportunities . Interested in more transportation equity news and trends? Contact Program Manager, Alicia Orosco, for more information at Alicia.Orosco@t4america.org.

Healthy economies need healthy people — Nashville leads the way for other regions

What’s the connection between healthy residents and a healthy bottom line? Why should a local business community care about improving the health of the residents that live there? Representatives from five regions gathered last week in Nashville to learn how providing better transportation infrastructure and building more walkable communities can help improve residents’ health — and boost local economic prosperity and competitiveness.

This post was written by Rochelle Carpenter and Stephen Lee Davis with Transportation for America.

The Nashville Area Metropolitan Planning Organization, responsible for planning and allocating federal transportation dollars in the seven-county Nashville region, has become a nationally recognized leader in prioritizing health when selecting transportation projects.

Getting to that point wasn’t easy, but their hard work to make that shift was kick-started by two related developments: the widespread recognition of a looming health crisis in the least active state in the nation, and the realization that there was pent-up demand among Nashville residents for healthier options to get around —whether safer streets with new sidewalks, trails, transit, or bikeshare.

One economic connection is obvious: employers are often the ones paying a large share of healthcare costs for employees. If those employees are living in a place where it’s challenging to get or stay healthy because of factors inherent to the built environment, that’s a cost that those companies have to bear. If those costs become a known challenge within the business community, it presents a major roadblock when recruiting new employers or trying to retain them.

Whether by continuing to make ambitious plans to bring new bus rapid transit to the city, building new projects that make it easier to walk or bike, or through incorporating health considerations into their process for funding transportation projects, Nashville is trying to stay ahead of their growth challenges, remain competitive for new talent and ensure that their residents can be healthy — all helping to boost the bottom line for the region. It’s a region experiencing some of the fastest job growth in the country, but they know they can’t rest on their laurels.

We’ll be publishing an in-depth profile of how Nashville began to integrate health considerations into their planning efforts sometime in the next few weeks. Watch this space, and sign up for our emails to be notified if you haven’t already. –Ed.

To learn from Nashville’s experiences, T4America and the Nashville MPO — through an ongoing grant from the Kresge Foundation — brought civic leaders and agency staff from Seattle, San Diego, Detroit and Portland, OR, to the Music City last week; sharing best practices and hoping to build on what the others have done.

Kresge Nashville gathering 2

MPO staff and advocates from Nashville, San Diego, Detroit, Portland and Seattle along with Nolensville staff and leadership during last week’s gathering in Nashville.

Meeting in the Bridge Building overlooking downtown Nashville and the Cumberland River, the group of leaders from across the country saw the rapid changes made in the downtown core to improve streetscapes and public spaces to create vibrant, welcoming places for the many families, professionals and visitors.

While Nashville proper is making significant strides, other communities around the MPO’s seven-county region are also eager to expand their options for walking, bicycling and transit.

The delegation visited the rapidly growing town of Nolensville (pop. 8,000) on the south side of the region.

Kresge Nashville gathering 1

Nolensville Mayor Jimmy Alexander led Transportation Choices Coalition Executive Director Rob Johnson, Upstream Public Health Policy Manager Heidi Guenin and Transportation for America Field Organizer Chris Rall along Nolensville Road. The town was recently awarded half a million dollars to construct a greenway parallel to Nolensville Road, providing a new safe and convenient route between popular destinations.

Nolensville Mayor Jimmy Alexander described the town’s ambitious goal that local leaders see as critical for their local economy and competitive advantage. “We want to make it possible for every student in Nolensville to be able to walk to school,” he told us. The town has passionately sought and secured federal, state and local funding for multi-use paths, sidewalks and greenways that will eventually link the community’s most-visited destinations: residential neighborhoods, the historic district and commercial town center, schools, Nolensville Ball Park and the Williamson County Recreation Center.

Nolensville’s early leadership in clamoring for more of the infrastructure that makes it easier to safely get around on foot or bike — and the Nashville MPO’s response in providing technical assistance, policy and funding — will help them reach their goal in just a few years time.

The tour of new, energetic thinking on transportation and community development in the area would not be complete without a visit to Casa Azafrán, a community center and home to several nonprofits that serve the thousands of recent immigrants and refugees that are settling in Nashville and helping shape its future.

Renata Soto, Executive Director of Conexión Américas, led the delegation on a tour of Casa Azafrán, including a day care center, culinary incubator, health clinic and classrooms. But since moving to their new location on busy Nolensville Pike in south Nashville two years ago, Soto has witnessed first hand the challenges of poor transportation infrastructure. She took it upon herself to get the city to install the city’s first bilingual crosswalk to allow clients and visitors to safely cross busy Nolensville Pike while welcoming non-English speakers.

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During a visit to Casa Azafrán, a community center and home to nonprofits serving New Americans, Renata Soto explains the new bilingual crosswalk installed to make it safer to get to work, the bus stop and several restaurants on both sides of busy Nolensville Pike.

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The signs on the new bilingual crosswalk on busy Nolensville Pike.

The promise of a new rapid bus line coming later in the year will help, but challenges remain. “There are so many high school students who could use our facilities,” Soto explained. “But they can’t get here — they’re so close, but so far away.”

This gathering last week in Middle Tennessee offered inspiration, new information and a meeting of the minds to generate new ideas and discuss how to overcome political and technical challenges in our path. Stay tuned as we report more from each of these regions over the coming months.

American Lung Association: smart growth saves lives, improves health

Photo courtesy of Compass Blueprint

There are many reasons smarter growth makes sense. By building more sustainably and closer to where people work and shop and plan, we reduce hours stuck in traffic and make it easier to reach life’s necessities.

But there is something even more important at stake: our health. According to new data from the American Lung Association in California, smart growth policies can prevent 140 premature deaths and 105,500 asthma attacks every year in that state. The figures resulted from looking at a proposed 2035 planning scenario for California that prioritized more compact and sustainable development with better transportation options.

Changing how we build and plan would also relieve our communities of $1.66 billion in public health costs. It would also prevent:

•    260 heart attacks
•    215 acute bronchitis incidents
•    95 cases of chronic bronchitis
•    2,370 asthma attacks
•    101,960 other respiratory symptoms
•    205 respiratory ER trips and hospitalizations
•    16,550 lost work days
•    132,190 tons of criteria pollutants

Chelsea Allinger discussed the link between smart growth and active living over at Smart Growth America:

Like many Americans, I grew up knowing only one type of community design — drivable suburbia. In my community, exercise wasn’t something that happened naturally over the course of the day. It required carving out designated time slots from a crowded schedule.

Frankly, that didn’t happen as often as it should.

Since that time, I’ve learned that cultivating a more active lifestyle doesn’t have to mean finding a 25th hour in the day. Moving to a walkable, mixed-use, smart growth community quite literally changed my life — with, as it turns out, more significant health benefits than I’d initially realized.

Here is Dr. Sonal Patel in Capitol Weekly, discussing why many of her colleagues in health care also see the connection:

Most California cities were designed to make it easy to drive and park cars. Homes were separated from stores, workplaces and other commercial activities. The unwitting result was sprawling cities that maximize the amount of miles we drive and the time we sit idling in traffic and that minimize healthier options like walking, biking or public transit.

In the past decade, California has been on the cutting-edge of efforts to build more sustainably and closer to transit. In 2008, Governor Arnold Schwarzenegger signed SB 375, which required local communities to include greenhouse gas reduction targets in their land-use and transportation planning policies.

Increased traffic is hazardous to our health

Much of the discussion around health and transportation has zeroed in on how a lack of travel options and an unwalkable built environment in our communities reduces physical activity. But when traffic is the leading cause of death among children worldwide and the leading cause of death among Americans between the ages of 1 and 34, something far more urgent is at stake. Shouldn’t we be outraged that tens of thousands die in preventable traffic accidents each year?

The Centers for Disease Control deserves credit for prioritizing increased seat-belt use and reductions in impaired driving as paramount to traffic safety. Where CDC and other agencies fall short, as Greater Greater Washington points out, is the role of traffic itself in health outcomes, rather than simply traffic safety. Ken Archer writes:

The flaw in this exclusive focus on traffic safety is that increased safety only matters when vehicle miles traveled (VMT) are kept static or reduced. Instead, safety improvements that reduce fatalities per VMT have been offset by rising VMT.

Ken is exactly right. Under the status quo, vehicle-miles-traveled will continue to rise, offsetting much of the progress we make on safety-related measures. Until we build roads to safely accomodate all users, whether in cars, on foot, bike or transit, Americans will continue to be at risk. Streetsblog asked why traffic reduction isn’t a top public health concern. That’s a question we hope more will start asking.

Helping kids get active and healthy by “keeping them moving”

Toks Nashville Originally uploaded by Transportation for America
Adetokunbo Omishakin, the Director of Healthy Living Initiatives for the City of Nashville, Tennessee, explained the barriers facing children and parents he met in parts of E. Nashville who want to walk or bike outside — but find their neighborhoods not only lacking sidewalks or bike lanes, but often facing crime that can keep them indoors.

A healthier transportation system for America’s kids requires change in federal policy. But change will remain out of our grasp absent a sense of urgency from the everyday people on the ground.

The need for a meeting point between policymakers in Washington and citizens in their neighborhoods was evident in today’s roundtable on childhood obesity, titled “Keeping Kids Moving,” sponsored by Transportation for America, the Robert Wood Johnson Foundation Center to Prevent Childhood Obesity, The Convergence Partnership and PolicyLink.

We’re facing an epidemic of childhood obesity and poor health, and as a few people pointed out, this could very well be a generation of children who live shorter, less healthy lives than their parents if we don’t act now to change things.

The shape and structure of streets, sidewalks and the ability to safely use them has an enormous impact on whether children become overweight or obese. Kids get more physical activity and lead healthier lives when they can bike and walk to school, play in local parks and reach recreational opportunities with ease. Among American children between the ages of 10 and 17, 32 percent are overweight or obese, and many are at risk for more serious conditions like type 2 diabetes, heart disease and stroke. Obesity rates are disproportionately high among low-income and minority children.

In search of a solution, many routes invariably lead to transportation policy.

During the panel, several federal officials stressed the need for partnerships that cross departments and jurisdictions, with Roy Kienitz, undersecretary for policy at the Department of Transportation quipping, “transportation is too important to be left to transportation professionals.” Kienitz also emphasized the need for Americans to speak up and utilize the democratic process, noting that “the distance between the top [at DOT] and that sidewalk on your street is vast.”

Chip Johnson, mayor of Hernando, Mississippi, knows just how much of a difference one repair can make. As part of a broader push to repair his town’s streets, Johnson oversaw the pouring of concrete for a new sidewalk right outside his office window. On the old, cracked sidewalk, Johnson used to see a handful of pedestrians every morning, but he saw dozens more walking by once the improvements were completed.

“People want to exercise,” said Johnson, a Republican first elected mayor in 2005, adding that it’s up to officials like him to provide them the chance to do it.

keepkidsmoving2 Originally uploaded by Transportation for America

While people like Undersecretary Kienitz, Special Assistant to the President Martha Coven and others are moving the levers where they can in Washington, local officials like Johnson are stepping up and refusing to wait, behavior encouraged by the federal officials who were present.

Nashville Mayor Karl Dean didn’t wait for Washington. He made safe and accessible streets for all users a top priority and hired a director of healthy living initiatives — Adetonkunbo Omishakin, also a panel participant — to help make it happen in Nashville. Child wellness advocate Julia Lopez, herself a teenager, didn’t wait either. Along with being an instigator of change on the ground around her home of southern California, she has traveled the country to bring a youth perspective to the obesity challenge, calling on elected officials to step up and help make healthy transportation the norm, not the exception.

It’s clear that these advocates on the ground and policymakers at the top can meet in the middle to make real change, but it will take continued pressure on Congress from both ends to get the job done.

Active transportation, more walking and biking can help us confront obesity

Obesity is on the rise in 28 states and is one of the biggest public health challenges facing America, but taking some concrete steps to boost walking and biking and invest in more active modes of transportation all across America could be a major factor in turning the tide.

That is the conclusion of F as in Fat: How Obesity Threatens America’s Future 2010, a new report sponsored by the Trust for America’s Health and the Robert Wood Johnson Foundation.

Most striking about the report are the persistent demographic and geographic disparities in obesity rates, as well as rising rates among children. One’s zip code or income should never be the greatest determinant of health.

In 40 states and the District of Columbia, adult obesity rates were higher for blacks and Latinos than whites. The South was home to 10 out of the 11 states with highest obesity rates — Mississippi clocked in on top with 33.8 percent of adults considered obese. And, accounting for income, 35.3 percent of adults earning less than $15,000 per year were obese, as opposed to 24.5 percent of adults earning more than $50,000 per year.

Childhood obesity rates were up, but fluctuated by state, from just 10 percent in Wyoming to 21 percent in Kentucky. You can view a complete map with obesity rates in all 50 states and the district here.

The authors write:

Reversing the obesity epidemic will require individuals, families, schools, communities, businesses, government, and every other sector of American society to reduce the barriers to healthy eating and active living. Every American must have the chance to lead a healthy lifestyle.

F is for Fat’s transportation plank calls for a bold and comprehensive reauthorization of the surface transportation law, similar to the draft proposal released by key House chairman Jim Oberstar last year. The report compels Congress to act on Complete Streets legislation to ensure that people who walk, bike and use transit can use roadways safely, and a reauthorization of the Safe Routes to School program, in hopes of reversing the trend of more and more kids getting driven to class each day.

The report also identifies three legislative vehicles for reorienting our transportation policy and increasing travel options.

The Active Communities Transportation Act would give cities and localities added funds for increasing walking and biking rates and making it safer. The National Transportation Objectives Act would attach safety, efficiency and economic competitiveness benchmarks to federal dollars, making our transportation spending much more accountable to the taxpayers. And the CLEAN TEA bill would cap greenhouse gas emissions and target revenue toward clean transportation projects that can get us where we need to go while reducing emissions at the same time.

As the report points out, we are already moving forward on a number of fronts and many policymakers get it.

The Patient Protection and Affordable Care Act of 2010 signed by President Obama earlier this year funds a number of wellness and prevention programs that have the potential to be expanded. A number of states have taken steps toward healthier school lunches, and Congress may act on legislation as well. And First Lady Michelle Obama’s “Let’s Move” campaign is calling attention to how we can ensure children live healthier lives, including through walking, bike and physical activity.

To view the entire report, you can visit the Trust for America’s Health website here.

America’s veterans need more and better transportation options

Disabled American Veterans is a key provider for veterans’ transit.

As we celebrate the birth of our country this Fourth of July, we should also honor the men and women who have served in uniform. Keeping our promise to America’s veterans means giving them the resources they need when they return home, and that includes their transportation needs.

All veterans rely on a diverse network of travel options, but disabled and rural veterans in particular need a transportation policy that increases their mobility to find employment, commute to work and access regular medical care for both chronic and acute conditions.

Access to automobiles and driving are strongly correlated with employment opportunities. Among veterans with spinal cord injuries, only 16 percent of those unable to drive were able to obtain permanent employment, compared with 58 percent of those who could drive themselves to work. These disabled and injured veterans need other options to get to work – and a new transportation bill can help them get there.

Many veterans endure chronic medical conditions or face long recoveries that require specialized medical care. In rural parts of New Hampshire and Vermont, for instance, 29 percent of veterans reported that travel considerations impacted their decision to access routine medical care, while 28 percent of veterans said transportation issues had impacted their access to care for chronic conditions.

The same study found that increased distance from health care treatment facilities was a statistically significant factor in explaining “care-seeking behavior.” Across several key categories, longer travel times from health care locations had a negative impact on a veteran’s ability to receive care. This included older veterans’ outpatient care, outpatient and inpatient care for veterans with spinal cord injuries, outpatient care after myocardial infarction, aftercare for substance abuse treatment and mental health resources.

The absence of other meaningful transportation options was even a factor in health categories such as routine immunizations and dental care. In a study analyzing why older veterans at risk for influenza did not comply with recommended vaccination protocols, 13 percent of respondents reported transportation difficulties as a major factor in their decision not to pursue immunization. With dental care, 55 percent of veterans who could drive independently or had access to public transit had visited the dentist within the last year, whereas 25 percent of homebound vets had not been to the dentist in more than five years.

There are many existing programs to help veterans get to VA hospitals, but it is clear these programs fall far short of the need. More than 37,000 men and women in uniform have been injured in Iraq and Afghanistan. Today more than ever, our veterans need America to invest in flexible, efficient transportation networks to allow access to crucial services.

Our veterans shouldn’t have to choose between driving to the VA or missing the medical care that they need and have unquestionably earned. That’s no choice at all.

American Public Health Association outlines hidden health costs of transportation

The Patient Protection and Affordable Care Act signed by President Obama earlier this year was a step toward expanding health coverage while lowering costs. But there’s far more to be done. A truly comprehensive approach to health must account for transportation’s role in our levels of physical activity.

The American Public Health Association tackles that in a new report titled “The Hidden Health Costs of Transportation.”

For decades, Americans have made great use of the interstate highway system, but our transportation system is outdated and in need of retooling. The promise of convenient inter- and intra-city driving came with unseen drawbacks: long commutes and gridlock that keep Americans stuck in their cars and away from their families.

It doesn’t take a doctor to figure out sitting at work for eight hours a day and driving for another 1-2 can’t be all that good for you. Where we live and how we get there matters. The APHA put it well: “transportation investments and the systems that are developed from them shape lives and communities.”

It’s not just a lack of physical activity that ails us. Our current habits expose us to high asthma rates from pollution and unsafe streets for pedestrians and bicyclists, as outlined in our Dangerous by Design report last year.

So what needs to change? One place to start is by expanding transportation options. Driving will always be a necessity, but Americans have shown their desire for public transportation with their votes and feet. Pollsters found that 82 percent of American voters believe the U.S. would benefit from an improved and expanded public transportation system, and 79 percent of rural residents shared that sentiment as well. Build it and they actually will come, it turns out. The APHA writes:

An investment in a “healthier” transportation system is critical. Providing convenient alternatives, encouraging active modes of transport, and a establishing a transportation system that fosters connectivity and social interaction can not only offset health impacts and costs, but generate health benefits.

In addition to increasing access to other transportation options, the APHA also stresses that health impacts should be considered during the planning and decision-making stages of transportation projects to the fullest extent possible.

Growing recognition of the connection between transportation, land development and health has resulted in some studies and examples where health impacts and costs have been considered and assessed. These examples not only demonstrate that health costs should be a significant factor in decision-making, but also show that calculating such costs is indeed possible.

The APHA has laid out the reasons why our long-term health is distinctly linked to how we get around, and the passage of health care reform should serve an impetus to take the right next steps. Will Congress heed APHA’s counsel as the next surface transportation bill advances?

Nationwide reports identify transportation policy as essential to improving health

Two reports out this week highlight growing awareness of the integral link between health and transportation.

The Centers for Disease Control and Prevention’s Transportation Recommendations acknowledge what we at Transportation for America have stressed for months: not only is our nation’s approach to transportation outdated and inefficient, it also takes a toll on our health and quality of life. Being stuck in traffic and living in places with no chance to safely walk or bike is having a negative impact on our health, and the CDC points out that many Americans yearn for greater physical activity and choices for how they get around. The CDC sees this link between health and transportation as both a challenge and an opportunity.

Expanding the availability of, safety for, and access to a variety of transportation options and integrating health-enhancing choices into transportation policy has the potential to save lives by preventing chronic diseases, reducing and preventing motor-vehicle-related injury and deaths, improving environmental health, while stimulating economic development, and ensuring access for all people.

They recommend a series of changes to federal transportation policy, all of which correlate closely with Transportation for America’s goals. These include:

  • Reducing injuries associated with motor vehicle crashes
  • Encouraging healthy community design
  • Promoting safe and convenient opportunities for physical activity by supporting active transportation infrastructure
  • Reducing human exposure to air pollution and adverse health impacts associated with these pollutants
  • Ensuring that all people have access to safe, healthy, convenient, and affordable transportation

The National Physical Activity Plan touches on many of these same subjects with an elegant and straightforward vision: “One day, all Americans will be physically active and they will live, work, and play in environments that facilitate regular physical activity.” According to the Plan’s research, the average American spent 64 minutes per day in a vehicle, and nearly three-quarters feel they have no choice but to drive as much as they do, a figure echoed by Transportation for America’s poll earlier this year.

Improving active transportation “will require many individuals and agencies – transportation engineers, city planners, architects, schools, health professionals, government agencies at all levels, community advocates, citizens, and employers – to rethink the way we plan and develop our communities,” according to the Plan’s text, stressing:

More transportation options can help us achieve our recommended levels of physical activity, while lowering pollution rates and increasing access to essential destinations like grocery stores, schools, jobs and health care services.

For more information on the National Physical Activity Plan, visit their main site here, or the Transportation section – which includes tactics for each of the four strategies here. You can read more about the CDC’s transportation recommendations here.

Michelle Obama’s Let’s Move campaign a positive step, but must emphasize transportation voices

In February, First Lady Michelle Obama announced her exciting “Let’s Move” campaign and the goal of seriously confronting childhood obesity in the United States within a generation. Now, the campaign – more formally known as the Presidential Task Force on Childhood Obesity – is getting to work on an action plan to influence federal policy.

This is a great start, but there’s an omission: the task force has not emphasized the potential role for the U.S. Department of Transportation. The link between physical activity and the built environment is well established – transportation practices strongly influence physical activity and health outcomes for Americans of all ages.

An active living approach to physical activity incorporates walking and bicycling into everyday activities. Forty years ago, more than half of children walked and bicycled to school, contributing to exercise and good health. Today, less than 15 percent of children walk or bike school, with the rest ferried by school buses or car.  Children who have access to safe, convenient and ample walking and bicycling opportunities in their community develop active transportation habits that can last a lifetime.

Michelle Obama has been a positive role model for children and a leader in promoting healthy habits. Let’s make sure the influence of transportation and the built environment are a part of the Let’s Move effort. More walking and biking = healthier kids.

You can see Transportation for America’s comments on the First Lady’s task force here.

T4 America health fly-in participant meets Senator Barbara Boxer

Julia Lopez meets Sen. Boxer Originally uploaded by Transportation for America

Fourteen-year-old Julia Lopez, right, a childhood wellness advocate from Los Angeles, CA, met California Democratic Senator Barbara Boxer in the Capitol yesterday. Lopez is in Washington, D.C. to participate in Transportation for America’s “health fly-in” to speak with Congressional representatives about the link between and health and transportation. Lopez will address her own advocacy against childhood obesity during Congressional meetings and this morning at a briefing in the Capitol Visitors’ Center.

Read more about the health fly-in in this press release.