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Integrate Health and Transportation Planning

Recent case studies from across the nation demonstrate that health considerations can be meaningfully integrated into the transportation planning process by fostering improved communications and coordination, building partnerships, and conducting technical analysis at the regional, local, or state organizational levels (FHWA and Volpe Center, 2012; APHA, 2012; FHWA and Volpe Center, 2014). These emerging examples show that local and state public health officials are increasingly and proactively participating in transportation and land use planning decisions. Likewise, local and state planners are folding better informed health considerations into their planning process.

Land use planning that encourages active transportation can provide various benefits, including increased physical activity, decreased air and noise pollution, and increased access to goods and services that support public health. Land use planning for active transportation may include consideration of how land use can promote active transportation through inclusion of walkable or bikeable distances between destinations and transportation corridors for active transportation. It also might consider ways to minimize air pollution exposure or injury risk, and to support access and equity (Goldberg, 2007; Alliance for Biking & Walking, 2014). Incorporating public health considerations – especially those that promote physical activity for people of all ages, abilities, and incomes – into planning and development activities can be accomplished in many ways. Two examples are through adding health-promoting policies in long-range plans or adding health considerations in large-scale development decisions.

Integrating disciplines could include land use management that boosts car-free or car-light approaches, such as restricting car use in urban districts, housing developments, or economic and employment hubs. Limits could be placed on parking availability, including use of parking meters or fees and maximum time allowed for parking. Encouraging bicycle parking at destinations such as parks, employer offices and schools also can help promote active transportation (VTPI, 2014; Alliance for Biking & Walking, 2014). Land use planning that encourages non-automotive access to parks, trails, and recreational areas also supports increased physical activity and increased air quality.

Other activities at the state or local level that can help integrate health into planning are diverse, scalable, and adaptable, and include a range of inter-organizational activities, such as

  • Encouraging the inclusion of public health in long-range planning processes
  • Convening decision-makers in transportation and health organizations concerning the importance of strategic and/or ongoing plans and initiatives
  • Staffing positions at planning organizations to include public health education and expertise, and staffing positions at public health organizations to include transportation planning expertise
  • Using performance measures that include improving the public’s health through increased safety across transportation modes, increased active transportation, decreased fatalities and injuries, improved air quality, etc.

Related Transportation and Heath Tool Indicators

How can this strategy result in health benefits?

  • Address chronic disease (e.g., asthma, diabetes, heart disease)
  • Improve accessibility to healthy food, public transportation, jobs, etc.
  • Improve equity
  • Increase physical activity
  • Improve safety
  • Reduce human exposure to transportation-related emissions
  • Reduce motor vehicle-related injuries and fatalities
  • Reduce transportation's contribution to air pollution

How has this worked in practice?

Iowa’s inter-disciplinary partnerships centered on public health

In 2011, Iowa Governor Terry Branstad launched the Healthiest State Initiative, which aims to make Iowa the healthiest state in the nation by 2016. The initiative supports active living for Iowans in part by supporting increased walking and bicycling for all ages and abilities. It includes various stakeholders, such as the Iowa Trails Council, the Iowa Bicycle Coalition, and the Iowa Department of Public Health (IDPH). Work across the health and transportation disciplines has flourished in recent years. The successes seen in Iowa were profiled in the 2014 FHWA and Volpe Center white paper. The IDPH promoted Complete Streets in its educational materials, and the Iowa Department of Transportation  informed part of the state’s health plan. Public health is a key aspect of the state’s statewide multimodal system. Program managers at the Iowa DOT use a more flexible and decentralized approach, particularly through the Northeast Iowa Safe Routes to School (SRTS) program. This allows strategies to be scaled appropriately to the community. Incorporating physical activity into rural transportation planning was supported through an Iowa DOT grant-funded initiative to coordinate a SRTS liaison to work across the state’s rural planning organizations, local health partners, and local governments to promote children’s health through physical activity. The emphasis is on planning physical activity that children living in rural, remote environments can easily do. As an example, mileage clubs where students win prizes for high daily foot step counts are featured as a strategy.

More People, More Places, More Often, A Plan for Active Transportation and other efforts in Kirkland, WA

Adopted by the Kirkland, Washington, city council in 2009, this active transportation plan was prepared to comply with the call for a non-motorized plan in the city’s comprehensive plan. Kirkland has recognized in recent years that active transportation is a key component to the quality of life of its residents and visitors. It was the first city in Washington to adopt a Complete Streets ordinance. It was also the first city to use pedestrian flags, where a system of orange flags is placed at crosswalks for use by pedestrians. The Kirkland Steppers Walk Program is free and available to adults over the age of 50 years and helps to increase physical activity in older adults. The event has attracted more than 160 participants, and ties back to the city’s Pedestrian Safety Campaign. The active transportation plan, More People, More Places, More Often, A Plan for Active Transportation, is focused around eight goals, each with specific and measurable objectives and strategies tied to it:

  1. Develop the Cross Kirkland Trail
  2. Reduce crash rates
  3. Add facilities for pedestrians
  4. Increase the number of children who use active transportation to travel to and from school
  5. Improve safety for people crossing streets
  6. Remove physical barriers to walking
  7. Improve on-street bicycle facilities
  8. Make bicycling more convenient

Where can I learn more?

In 2012, the U.S. DOT's Volpe National Transportation Systems Center for the Federal Highway Administration (FHWA) Office of Planning released a white paper on Metropolitan Area Transportation Planning for Healthy Communities. The document presents a framework metropolitan planning organizations (MPOs) can use to successfully consider health throughout the transportation planning process. The report explores how health can effectively be incorporated in metropolitan transportation planning through four case studies: Nashville Area MPO, Puget Sound Regional Council, Sacramento Area Council of Governments, and San Diego Association of Governments. A complementary 2014 white paper, Statewide Transportation Planning for Healthy Communities, by FHWA and the Volpe Center presents a model for state departments of transportation interested in integrating public health considerations into transportation planning. The report also profiles five innovative departments of transportation and their partners. FHWA and the Volpe Center are planning a third phase of research to examine how transportation planning can apply data, performance indicators, and forecast models to consider health.

The National Environmental Public Health Tracking System (Community Design Module) showcases data on various community design indicators, including types of transportation to work, access to parks, and access to schools.

County Health Rankings and Road Maps includes information, data, and metrics on land use planning and related approaches for increased physical activity via active transportation.

Comprehensive Planning for Public Health: Results of the Planning and Community Health Research Center Survey by the American Planning Association highlights the results of a web-based survey used to identify comprehensive and sustainability plans, either in draft or completed, that explicitly address public health.

The Built Environment and Public Health Clearinghouse offers resources and news on community design and health.

The Bicycle & Pedestrian Program of the FHWA Office of Human Environment provides extensive bicycle and pedestrian resources and guidance. The U.S. DOT Office of Planning website offers resources and information on transportation and land use planning.

Promoting Active Living is one of CDC’s Transportation Recommendations. Some suggestions for achieving that include bringing health, transportation, and community planners together to develop safe, convenient, and complete pedestrian and bicycle master plans. Another option is to provide safe and convenient pedestrian and bicycling connections to public park and recreation areas.

Promoting active transportation: an opportunity for public health by APHA and the Safe Routes to School National Partnership provides an introduction and orientation as to why and how health should be considered in transportation planning and decision-making.

Evidence base

Active Living Research (ALR). Do all children have places to be active? Disparities in access to physical activity environments in racial and ethnic minority and lower-income communities. Princeton: Robert Wood Johnson Foundation; 2011.

The Alliance for Biking and Walking. Bicycling and Walking in the United States: 2014 Benchmarking Report; 2014.

American Public Health Association. Promoting Active Transportation: An Opportunity for Public Health; 2012.

Aytur SA, Rodriguez DA, Evenson KR, Catellier DJ, Rosamond WD. Promoting active community environments through land use and transportation planning. American Journal of Health Promotion 2007;21(4):397-407.

Bassett D, Pucher J, Buehler R, Thompson D, Crouter S. Walking, cycling, and obesity rates in Europe, North America and Australia. Journal of Physical Activity and Health 2008;5(6):795-814.

Brownson RC, Housemann RA, Brown DR, Jackson-Thompson J, King AC, Malone BR, Sallis JF. Promoting physical activity in rural communities: Walking trail access, use, and effects. American Journal of Preventive Medicine 2000;18:235-241.

Buehler R, Pucher R, Merom D, Bauman A. Active Travel in Germany and the USA: Contributions of Daily Walking and Cycling to Physical Activity. American Journal of Preventive Medicine 2011;40(9):241-250.

Dumbaugh E, Li W. Designing for the safety of pedestrians, cyclists, and motorists in urban environments. Journal of the American Planning Association 2010;77(1):69-88.

Federal Highway Administration (FHWA) and Volpe Center. Metropolitan transportation planning for healthy communities. Washington, DC: U.S. Department of Transportation; 2012.

Federal Highway Administration (FHWA) and Volpe Center. Statewide Transportation Planning for Healthy Communities; 2014.

Frank LD, Sallis JF, Conway TL, Chapman JE, Saelens BE, Bachman W. Many pathways from land use to health: associations between neighborhood walkability and active transportation, body mass index, and air quality. Journal of the American Planning Association 2006;72(1):75-87.

Frumkin H, Frank LD, Jackson RJ. Making Healthy Places: Designing and Building for Health, Well-Being, and Sustainability; 2011.

Goldberg D, Chapman J, Frank L, Kavage S, McCann B. New Data for a New Era: A Summary of the SMARTRAQ Findings Linking Land Use, Transportation, Air Quality, and Health in the Atlanta Region; 2007.

Guide to Community Preventive Services. Environmental and Policy Approaches to Increase Physical Activity: Community-Scale Urban Design Land Use Policies; 2013.

Jones MG, Ryan S, Donlon J, Ledbetter L, Ragland DR. Seamless Travel: Measuring Bicycle and Pedestrian Activity in San Diego County and Its Relationship to Land Use, Transportation, Safety, and Facility Type; 2010.

Kaczynski AT, Bopp MJ, Wittman P. Association of workplace supports with active commuting. Preventing Chronic Disease 2010;7(6):A127.

National Cooperative Highway Research Program (NCHRP). NCHRP Synthesis 436: Local Policies and Practices that Support Safe Pedestrian Environments: A Synthesis of Highway Practice. Transportation Research Board; 2012.

New York City. Vision Zero website; 2014.

Parker KM, Gustat J, Rice JC. Installation of bicycle lanes and increased ridership in an urban, mixed-income setting in New Orleans, Louisiana. Journal of Physical Activity & Health 2011;8 (Suppl 1):S98-S102.

U.S. Environmental Protection Agency (EPA). Our Built and Natural Environments: A Technical Review of the Interactions Between Land Use, Transportation, and Environmental Quality. 2nd Edition; 2013.

Victoria Transport Policy Institute. Car-Free Planning: Reducing Automobile Travel at Particular Times and Places. TDM Encyclopedia; 2014.