New report highlights the importance of transportation policies to civil rights
The Road to Health Care Parity: Transportation Policy and Access to Health Care, a report released by The Leadership Conference Education Fund, demonstrates the connections between transportation policy, community health, and civil rights. It points to the tendency of transportation policies to exacerbate preexisting disparities in access to health care and exposure to environments that often diminish public health. Communities of color and in rural areas, the elderly, children, low-income families and individuals with disabilities are more likely to be unable to drive, and are thus underserved by policies that ignore transportation options outside of the automobile. Automobile dependence often renders health care, nutritious food and exercise opportunities physically and economically inaccessible to many people. Traffic fatalities, of which pedestrians make up a notable proportion, are another direct consequence of automobile dependence that disproportionately affects children, seniors and communities of color.
Furthermore, automobile use contributes to obesity and obesity-related illnesses and to air pollution, which has been linked to asthma, leukemia and heart disease. Asthma, in particular, is more prevalent among minority children. The report concludes with the recommendation that decision-makers focus policies and funding towards expanding the infrastructure of public and active transportation, which might reduce pollution and pedestrian fatalities and improve mobility, thereby reconnecting many underserved Americans with health care.
U.K. study explains how and why to encourage walking
Living Streets, a U.K.-based organization dedicated to “putting people first” in the construction of streets, has recently released a report entitled Making the Case for Investment in the Walking Environment, commissioned from the University of the West of England. This report reviews evidence in studies conducted by advocacy organizations, independent organizations and academic institutions that focus on the costs and benefits of investments in the walking environment. The reported benefits of walking and environments that support walking were extremely diverse; however, improvements to health due to increased physical activity provided the most significant financial benefit.
Overall, it was reported that walking-friendly environments in urban areas are correlated with 24%-100% greater probabilities of walking. Walking has been shown to have significant mental and physical health benefits, including reductions in the risk of obesity, high blood pressure, diabetes, overall mortality, anxiety and depression. The development of environments that are supportive of walking has indirect benefits as well—by promoting walking above other modes of transportation, these environments can induce a shift from automobile dependence, thereby improving air quality.
The report also examined the specific projects and investments that have the greatest impact in the development of environments conducive to walking. These interventions include speed limits, safe routes to school, traffic calming and shared use paths. They have been shown to increase pedestrian activity and physical activity in general, improve safety and reduce noise.
Safe Routes to School National Partnership releases new local policy guide
The Safe Routes to School Local Policy Guide represents an additional effort to bring public health considerations into the development of transportation policies and practices. The guide advocates for a “Health in All Policies” approach, through which it emphasizes the role of schools and local communities in the development of policies and practices that can improve the health of their children by promoting and enabling engagement in safe and active transportation. By supporting policies and tools such as Complete Streets and the use of health impact assessments—as well as those targeted more specifically at schools, such as crossing guards and school bonds, for example—SRTSNP explains how community members can ensure that their neighborhoods are active and healthy environments through which their children can walk, bike and play. The guide represents a truly comprehensive and collaborative effort: over one dozen community leaders throughout the country provided evidence supporting more than twenty specific policy changes.
Transportation Equity Network unveils primer for advocates, public officials
The Transportation Equity Network released a new brochure entitled “What is Transportation Equity?” in April, at the TEN 2011 Conference, One Nation, Indivisible. The brochure is intended as a primer for transportation advocates and public officials. It concisely provides readers with background information on transportation equity principles, civil rights and the connections between the two. It also clarifies and explains the position of the Transportation Equity Network on a number of issues.
National Prevention Strategy points to the importance of HIAs
The National Prevention Strategy, released June 16, highlighted the importance of health impact assessments in ensuring that municipal planning, land use and transportation policies and projects are developed in such a way as to maximize their potential health benefits, and minimize their costs. The report also explicitly mentions the importance of recognizing and seeking to alleviate health inequalities, and the usefulness of HIAs in this endeavor. HIAs can educate policymakers as to the needs of specific communities, and point to the consequences that certain policies may have for health and health disparities. The report praises HIAs’ ability to “inform initiatives to improve the health, longevity, and quality of life among populations experiencing health disparities by bridging the gap between knowledge and practice.” Moreover, the report demonstrates an awareness of the potential benefits of integrating health considerations into planning and transportation decision-making processes. It points to a need to design communities in such a way as to promote physical activity, good air quality, pedestrian safety and the importance of considering vulnerable populations.
Two years later, the Partnership for Sustainable Communities is still moving forward, one community at a time
The Partnership for Sustainable Communities was formed in June 2009 to develop communities with interconnected and affordable public transportation, services, housing and jobs, and in which environmental health was included. The Partnership quickly discovered that a revitalization of transportation options was integral to meeting community demands for a revitalization of neighborhoods, and that such efforts have the potential to aid these neighborhoods in economic development and recovery. Two community projects have recently been highlighted by Secretary of Transportation Ray LaHood as especially representative of the Partnership’s work. A key component of Ranson, VA has been the implementation of a Complete Streets policy, which will allow pedestrians, cyclists and users of other modes safe access to the downtown area. In Boston, efforts focused on improving public transit access to the Fairmont Corridor were highlighted; this project aims to greatly improve mobility and quality of life in surrounding low-income neighborhoods.
Kentucky includes road safety audits in “Healthy Communities” initiative
Kentucky’s “Healthy Communities” Initiative was created in response to the state’s growing epidemics of obesity and smoking, and plummeting physical activity levels. It was developed at Kentucky’s 2010 Healthy Communities Conference, and focuses on the idea that a healthy lifestyle depends not only on the decisions of individuals, but on the choices presented to those individuals by the built environment as well. The Kentucky Transportation Cabinet (KYTC) and the FHWA-Kentucky Division partnered with the Cabinet for Family and Children’s Services to include Road Safety Audits (RSAs) in the initiative. Training workshops on RSAs and pedestrian safety were provided to over 80 participants, including employees of local health departments and representatives from local area development and highway district offices. The focus on pedestrian safety has led many communities to use the RSA method to conduct walkability surveys in their neighborhoods. RSAs have already been conducted in a number of towns in Kentucky, and will be submitted to government officials once their results have been analyzed.
Tri-State region is the most dangerous for older pedestrians
Older Pedestrians at Risk, a report recently released by the Tri-State Transportation Campaign, which includes New York, New Jersey and Connecticut, has called attention to the startlingly high pedestrian fatality rates among individuals over 60 years of age in that tri-state area. According to the report, both the age disparities in pedestrian fatality rates and senior pedestrian fatality rates are much higher in those three states than in the rest of the country: individuals over 60 made up only 18.1% of the tri-state population in 2010, but over 35% of pedestrian fatalities. This risk is greatest on wide arterial roads, where seniors often do not have enough time to cross. County-level data collected for this project demonstrates the extent of the age disparity in pedestrian safety: in each of the ten most dangerous counties, the fatality rates for seniors were much higher than those for younger pedestrians, and counties with low pedestrian fatality rates did not necessarily have low senior pedestrian fatality rates.
In response to these findings, the Tri-State Transportation Campaign and AARP have initiated movements to support pedestrian safety in the tri-state area. In New York, these groups have partnered with Transportation Alternatives in support of current Complete Streets legislation. In New Jersey, the focus has been on the implementation of performance measures and the prioritization of repair projects. In Connecticut, Tri-State and AARP have been emphasizing the importance of funding Safe Routes to Transit and Safe Routes for Seniors programs. Each of these programs has the potential to reduce senior pedestrian fatalities, reduce the age disparity in fatality rates, and make roads safer for pedestrians of all ages and abilities. For more information regarding the transportation issues currently facing senior citizens, and programs that may alleviate these problems, see Transportation for America’s new report “Aging in Place, Stuck without Options.”
Park prescription programs
Park prescription programs have become increasingly popular as awareness of the relationship between the built environment and public health has increased. These programs seek to encourage patients to engage in regular physical activity. Managers of these programs typically attack the problem of inactivity on two levels: by making outdoor exercise more accessible to patients, and by using prescriptions to emphasize the medical importance of physical activity. These programs are supported and actively encouraged by Exercise is Medicine, a program run by the American College of Sports Medicine.
In many cases, the prescription itself serves to connect patients to facilities: those offered by both Recreation Rx in Chula Vista, CA and the Chicago Exercise Prescription Fitness Center Waiver serve as vouchers, offering patients a free membership at a local park for a specific amount of time. Other programs seek to increase the flow of information between patients and recreational facilities: Portland Rx Play provides patient information to local parks and recreation staff, who are then better able to address the needs of that particular patient, and Prescription Trails in Albuquerque, NM offers information (including ratings) of the accessibility of local parks.
Each of these programs is made possible not only by the medical practitioners who supply prescriptions, but also through partnerships with environmental groups, park departments and other organizations. The Medical Mile in Little Rock, Arkansas, represents a unique collaboration among major hospitals, individual practitioners and practices and the Arkansas Department of Health. Heart Clinic Arkansas, the project’s initiator, took action to enhance the built environment of Arkansas in such a way as to promote physical activity. The Medical Mile is a section of the 14-mile Arkansas River Trail that has been developed to support walking, running and biking for individuals of all fitness levels.
Harvard Center for Risk Analysis examines the public health costs of congestion
A Health Risk Assessment conducted by the Harvard Center for Risk Analysis challenges the tendency for analysts and policymakers to focus only on excess fuel consumption and wasted time when evaluating the costs of traffic congestion by providing evidence that public health costs should be considered as well. This study was undertaken to determine the proper place of public health considerations in future assessments, and to improve current estimates of the social costs of congestion in the United States. Congestion is associated with increased tailpipe emissions and thus increased levels of fine particulate matter (PM2.5), nitrogen oxides and sulfur dioxides. This study focuses on the cost of premature mortality due to exposure to these pollutants, which have been demonstrated to have a strong relationship with fatal cardiovascular events.
Researchers studied 83 urban areas in the United States, and developed models used to predict conditions out to 2030. While these models assumed no drastic changes in infrastructure, they did assume an increase in the use and functioning of low-emission vehicles, which would lead to a decrease in total pollutants emitted. The findings of this study demonstrate that the public health costs of congestion are important, and should be considered in the future. In 2005, it was estimated that pollutants emitted during time spent in traffic were associated with approximately 3,000 premature deaths. There are areas, such as San Diego, CA, and Raleigh, NC, in which the public health costs due to congestion are expected to increase, rather than decrease, over the next twenty years. Moreover, this study considered only costs due to mortality not those associated with chronic illnesses that can be exacerbated by traffic emissions, such as asthma and chronic lower respiratory disease. The researchers recommend that public health costs be considered in all future estimates of the social cost of congestion.
Recent research on health and transportation:
- Distance between speed humps and pedestrian crossings: Does it matter? - Johansson C, Rosander P, Leden L. 2011. Accident Analysis & Prevention. 43(5): 1846-51.
- Assessing the impact of road traffic on cycling for leisure and cycling to work. - Foster CE, Panter JR, Wareham NJ. 2011. International Journal of Behavioral Nutrition and Physical Activity . 8(1): 61.
- Use of a new public bicycle share program in Montreal, Canada. - Fuller D, Gauvin L, Kestens Y, Daniel M, Fournier M, Morency P, Drouin L. 2011. American Journal of Preventive Medicine.
- Active ageing. - Hunter D. 2011. Perspectives in Public Health. 131(3): 106-107.
- Physical activity levels of high school students—United States, 2010. – 2011. CDC Morbidity and Mortality Weekly Report. 60(23): 773-777.
- Behavioral intentions of public transit passengers—The roles of service quality, perceived value, satisfaction and involvement. - Lai WT, Chen CF. 2011. Transport Policy. 18(2): 318-325.
- An Applied Ecological Framework for Evaluating Infrastructure to Promote Walking and Cycling: The iConnect Study. Ogilvie D, Bull F, Powell J, Cooper AR, Brand C, Mutrie N, Preston J, Rutter H, and on behalf of the iConnect Consortium. 2011. American Journal of Public Health. 101: 473 - 481.
- Exploring the relative influences of transport disadvantage and social exclusion on well-being - Delbosc A, Currie G. 2011. Transport Policy. 18(4): 555-562.