Transportation, public health go hand-in-hand: Advocates gear up for renewal of federal transportation bill
===========================================================================================================

* Kim Krisberg

For many in public health and transportation, Amanda Thompson is a breath of fresh air. She just gets it.

The planning director for the city of Decatur, Ga., Thompson sounds more like a tried-and-true public health worker than the typical city planner, especially when she describes the need for better public health and transportation collaboration as “do or die time.” Indeed, Thompson represents what many public health advocates hope is America’s transportation future: a system that actively supports more than simply cars, led by decision-makers who understand that transportation policy is also public health policy. In Decatur, that philosophy is coming to life as Thompson, her colleagues and the community at-large slowly transform the city of 18,000 into a place where biking and walking aren’t merely forms of exercise, but primary modes for daily commuting.

“There’s the people that want to promote vehicles first and they’re lobbying to maintain that way of life,” Thompson told *The Nation’s Health.* “But it’s time for planning and public health officials to say ‘hey, we need to better help people, so it’s time we balance out our transportation system.’”

![Figure1](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/39/4/1.1/F1.medium.gif)

[Figure1](http://www.thenationshealth.org/content/39/4/1.1/F1)

Kristine Bruce walks with her son, David, in Arlington, Va., in 2007. Walkability is a health priority in transportation planning.

Photo by Jacquelyn Martin, courtesy AP Images

Public health advocates have been echoing Thompson’s sentiments for some time, and the chorus is getting even louder with the coming renewal of the nation’s largest federal surface transportation bill, known as the Safe, Accountable, Flexible, Efficient, Transportation Equity: A Legacy for Users bill — or more simply, SAFETEA-LU. Originally signed into law in 2005, the $244 billion, five-year law supports maintenance and development of the U.S. transportation system, including funds for highway, interstate and bridge infrastructure as well as safety and public transit efforts. Unfortunately, out of the entire law, only a little more than 5 percent of funds went toward the bill’s core health and safety programs that address air quality and traffic safety. But with the law’s reauthorization expected to come before Congress this summer, public health advocates, such as APHA, are working to spread the message that smart transportation policy can positively impact health.

Such policies include supporting programs such as Safe Routes to Schools, which encourages children to walk and bike to school, and making health a regular piece of the transportation puzzle. That piece will come into better view, advocates say, when the use of health impact assessments becomes a standard part of policy-making decisions. Defined by the Centers for Disease Control and Prevention as a procedure by which a “policy, program or project may be judged as to its potential effects on the health of a population, and the distribution of those effects within the population,” health impact assessments are considered a way to integrate public health needs into transportation plans.

Andrew Dannenberg, MD, MPH, a medical officer within CDC’s National Center for Environmental Health, said he knows of about 50 such assessments conducted across the United States, noting that in places where the assessments have caught on, it is often because leaders have “put health high on the list of what they care about.” Such was the case in Decatur in 2007, when a health impact assessment was done as part of the city’s community transportation plan. City planning director Thompson said the long-term goal of the plan, officially known as “Decatur Gets Around,” is to create safe and efficient transportation systems that promote the health and mobility of residents. In fact, the second sentence of Decatur’s transportation plan reads: “How we live and travel effects not only our physical well-being but our mental, emotional and spiritual state as well.”

Decatur’s transportation goals include ensuring “complete” streets that can be safely used by every mode of travel, whether that be walking, biking, public transit or driving, and promoting connectivity between destinations. The long-term plan also promotes a mixture of land uses, Thompson said, so that residents can not only bike safely, but bike to necessary destinations such as the grocery store or to school. And by expanding residents’ daily travel choices, the city is also promoting healthy behaviors, particularly addressing the sedentary behaviors tied to today’s growing chronic disease rate, she said.

Decatur’s plans are also influenced by broad community input gathered from pedestrian and bicycle workshops, kids’ events and telephone surveys, Thompson reported. While it “took a second for everyone to wrap their head around the idea” that transportation and public health go hand-in-hand, the inclusive, public health-based approach garnered wide appeal, she said.

“If public health doesn’t get involved, we’re not going to see changes in what’s happening with obesity and we certainly won’t see changes in the environmental impacts on society,” Thompson said.

Across the country in California, the San Francisco Department of Public Health has been working on transportation and land-use issues, as well as employing health impact assessments, for some time. The work emerged around the turn of the millennium as local community groups became more aware that transportation decisions were affecting residents’ health, said Rajiv Bhatia, MD, MPH, the department’s director of occupational and environmental health. While San Francisco has good ambient air quality, it is a dense city with a lot of high-volume roadways, Bhatia said, and as the city increased its density, housing was built near some of the busiest roads. Such areas became home to high rates of pedestrian-vehicle collisions, Bhatia said. Figuring out how to work with city transportation and planning officials to prevent such injuries was the origin of the department’s experience with health impact assessments and the resulting integration of public health into transportation policy, Bhatia said.

![Figure2](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/39/4/1.1/F2.medium.gif)

[Figure2](http://www.thenationshealth.org/content/39/4/1.1/F2)

Photo courtesy Tony Tremblay, iStockphoto

“What we realized was that in order to make defensible judgments about what the (health) impacts were, we needed stronger tools,” he told *The Nation’s Health.* “We couldn’t simply rely on the public health literature saying pollution or noise was bad or that walking was good for health — we needed specific tools to document these problems.”

In fact, it was a comprehensive health impact assessment of San Francisco’s land-use planning that identified the need for tools that measure effects on noise, air quality and pedestrian hazards. With such tools in hand, public health workers were able to demonstrate the need for taking public health into account and new policies soon followed, Bhatia said. In 2008, city officials passed a new law requiring housing developers to assess pollution from nearby traffic sources and, if needed, install proper ventilation systems. Bhatia noted that new regulations aren’t necessarily needed to support health impact assessments — such work can easily be integrated into the environmental impact assessments that the law already requires.

“The main measurements (in transportation policy) have usually been speed and mobility, but from a public health perspective, what we need is access,” he said. “If we can make access a main performance measure — How far is the grocery store? The school? Is this a safe place to walk? — we will be improving public health.”

Health impact assessment work has brought Seattle’s public health and transportation officials closer as well. In 2007, Washington state legislators directed Public Health Seattle & King County and the Puget Sound Clean Air Agency to assess the health impacts of rebuilding a major bridge and roadway going through Seattle and its suburbs. The assessment took about eight months and was the public health department’s first formal project with state transportation officials, according to Barbara Wright, the department’s director of environmental health.

Examining issues such as green space, physical activity, noise, mental well-being and safety, the assessment’s recommendations included two overriding principles: to ensure health elements are integral to the overall plan and that all the recommendations should be supported — even in difficult budget times — to achieve optimal health benefits. Earlier this year, the Seattle City Council passed a resolution calling for the health recommendations to be integrated into the transportation plans. As the project moves forward, Wright said a next big step is educating community members on the links between public health and how people travel, so that they too can advocate for a healthier transportation system.

“We believe that if we can build communities where we can be physically active and feel connected and safe, we’ll all be healthier,” she said.

For more information on public health and transportation, download a free APHA brief at [www.apha.org/advocacy/reports/reports](http://www.apha.org/advocacy/reports/reports) or visit Transportation for America at [www.t4america.org](http://www.t4america.org).

## Advocates call for new national transportation plan

A newgroup of advocates has come together to change the way Americans get from place to place, and public health is working to help lead the way.

Officially launched in February, Transportation for America is calling on national policymakers to modernize the national transportation system via a federal spending bill. The organization’s platform, released at a Washington, D.C., news conference, outlines how an investment in clean, smart and efficient transportation can put an end to America’s oil dependency and allow American businesses to compete and thrive in the 21st century. As a campaign partner, APHA is supporting the platform’s objective of encouraging healthier communities and behaviors.

The platform highlights public health and safety as an area that can benefit from an investment in public transportation. A reliance on automobiles has created an upswing in injuries and exacerbated chronic conditions such as obesity, cardiovascular disease, diabetes and asthma, according to Transportation for America. Areas of heavy traffic discourage active living, with a lack of quality sidewalks tied to increased injuries among bicyclists and pedestrians. Additionally, an increase in vehicular traffic leads to higher levels of pollution, which can have especially serious implications on people with respiratory problems. People with asthma who reside near areas of heavy traffic are almost three times as likely to go to the emergency room or be hospitalized than people in areas with less traffic, the group platform said.

The American public is supportive of transportation change as well. According to a new survey released by Transportation for America and the National Association of Realtors, while 75 percent of people consider building and improving commuter rail systems to be the best way to accommodate the travel needs of a growing population, only 7 percent think that their community is doing an excellent job providing practical and convenient public transportation.

For more information or to download the platform, visit [www.t4america.org](http://www.t4america.org).

— Catharine Harris

*   Copyright The Nation’s Health, American Public Health Association