Originally published in the September 2023 edition (v. 42) of Streetsmart News

Municipal transportation plans can play a vital role in shaping the health and well-being of the public. By incorporating health indicators into these plans, municipalities can promote active transportation, reduce air pollution, and improve access to healthy food options. But are these indicators used and do they influence municipal transportation decision-making? Through a case study of five cities my dissertation, The Use and Influence of Health Indicators in Municipal Transportation Plans, explored which factors contributed to use and influence. By indicators, I mean constructs measuring a condition; in the transportation world these are typically called performance measures.

Let's start with the instrumental use of indicators and their usefulness. The instrumental use of indicators is likely the way most people conceptualize their use: technical information as an input to a decision. In the transportation plans I examined, there were two primary instrumental use cases. The first was systems monitoring, in which municipalities constructed baseline conditions using indicators with the intention to monitor them over time, ostensibly to assess progress and course correct. All the plans examined had this use case. The second use case was prioritization. Indicators were either used to prioritize projects within the plan itself or they were developed to be used as evaluation criteria at a later date--primarily within capital improvement programming.

I explored both indicator usability factors and organizational factors to determine how indicators were used in administrative decision-making. I'll focus on the indicator usability factors in this newsletter. By indicator usability, I'm referring to indicator credibility (e.g., accuracy, reliability), salience (e.g., policy-relevance, timeliness), and legitimacy (i.e., are they trusted by users and stakeholders?). Overall, the legitimacy of indicators was not a concern of any of the people I interviewed. This may be because they were developed in the context of community engagement processes (more on that in another newsletter).

In the prioritization use case, the primary concern was in the geographic spatial scale of the indicators; this was especially true for health outcome data, which tends to be aggregated into large geographies. The systems monitoring use case, on the other hand, faced additional challenges. The geographic scale of the data was sometimes a concern, but concerns about data availability, measurability, accuracy, timeliness, and ease of communication (i.e., interpretable) were more often raised. For those who wanted indicators to serve as an accountability mechanism, measurability was important. Timeliness was essential to make adjustments in programs and projects:

“There's a real understandable lean towards using data that's going to be available anyway . . . Census-type data . . . but it's very slow, it's very delayed, it's very infrequent . . . . If there's a course correction needed, will you know it before it's too late?” (Informant 25)

Another key aspect of indicators is whether indicators were output or outcome focused; both have their own advantages and shortcomings. Output indicators measure an activity (e.g., miles of bike lanes) and outcome indicators measure the desired result or condition (e.g., bicycle mode shift). Outcome indicators faced timeliness and attribution challenges because the desired condition may taken many years to achieve and several different factors may contribute to that outcome:

"You're not actually going to see change on obesity . . . over one year, three years, or maybe even five years . . . let alone attribute any change to the ped[estrian] plan . . . . It's fine, but . . . what is it really telling us and does it really matter?" (Informant 35)

Output indicators, on the other hand, run the risk of measuring an activity that may not ultimately contribute to the desired outcome:

“[The city's accountability structure] is very focused on: ‘Are you doing the things you promised?' which are about outputs, not outcomes. Not, ‘Are you doing the most important things?'” (Informant 56)

tl;dr: Know which indicator usability characteristics are important for your use case and use a mix of output and outcome measures.

Note that a great set of indicators only gets you so far: The key factors responsible for use and influence were organizational. More on organizational factors in the next newsletter. In subsequent newsletters, we'll discuss why it's important to develop indicators collaboratively and how that relates to policy change.

Originally published in the June 2023  edition (v. 41) of Streetsmart News
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A diverse group of built environment practitioners ame together after the emergence of COVID-19 and the death of George Floyd to develop principles for centering health equity into built environment work. The result was the PHEAL principles. PHEAL has inspired the two initiatives below:

Originally published in the February 2022 edition of Streetsmart News (v. 40)
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As discussed in the APHA policy statement, the effects of segregation have had lasting effects on people of color. This includes reduced economic opportunity and more severe impacts on health from the urban heat island effect (discussed in a previous newsletter). The results from a joint project by FiveThirtyEight and ABC news, The Lasting Legacy Of Redlining, show that historically redlined areas are still primarily populated by people of color: "In total, we analyzed the demographics of 138 metropolitan areas where HOLC (Home Owners’ Loan Corporation) drew maps, using data provided by the University of Richmond’s Mapping Inequality project and by the 2020 census. And we found that nearly all formerly redlined zones in the country are still disproportionately Black, Latino or Asian compared with their surrounding metropolitan area, while two-thirds of greenlined zones — neighborhoods that HOLC deemed 'best' for mortgage lending — are still overwhelmingly white." However, it should be noted that a different problem is happening in some cities, where gentrification has pushed people of color out of historically redlined areas and white people have moved in.

Originally published in the February 2022 edition of Streetsmart News (V. 40)
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ITE's Health and Transportation Committee has been busy this past year producing webinars and "Quick Bites" (something like a cross between a white paper and fact sheet) to help transportation professionals better integrate health into transportation. If you are looking for a quick, easy, and accessible way to learn about and communicate transportation and health, take a look at the these three Quick Bites finished in December 2021: Transportation as a Determinant of Health, Health and Co-Benefits of Active Transportation, and Transportation for Mental Health and Happiness.

The American Public Health Association Policy Statement has updated its policy statement, Improving Health through Transportation and Land Use Policies, to better address equity. The new policy statement, Ensuring Equity in Transportation and Land Use Decisions to Promote Health and Well-Being in Metropolitan Areas, using a social determinants of health framework to identify the pathways by which land use and transportation decisions impact health equity. Key issues include authentic community engagement, the legacy of redlining on economic opportunity and health, and transportation investments that have severed communities. Strategies and policies at federal, state, and local levels are recommended to address these inequities and improve health outcomes.

Vehicle electrification often gets promoted as the best strategy for reducing greenhouse gas emissions (GHG) in the transportation sector. However, new research shows that active travel can not only better reduce GHG but also reduce traffic-related deaths as well as improve other health outcomes. In the journal article Health Benefits of Strategies for Carbon Mitigation in US Transportation, 2017-2050 (paywall), the health benefits of active transportation are compared to the electrification of cars as ways to decarbonize the transportation sector. Results showed that the active travel scenario avoided 167,000 deaths and gained 2.5 million disability-adjusted life years by 2050, monetized at $1.6 trillion using the value of a statistical life. Carbon emissions were reduced by 24% from baseline. Electric cars avoided 1,400 deaths and gained 16,400 disability-adjusted life years, monetized at $13 billion. These take-aways can be used to improve public health and urgently reduce carbon emissions in transportation by centering active travel in public policy.

with Huijun Tan
For some time, researchers and professionals have advocated for a paradigm shift in transportation that focuses on access rather than mobility, as expressed here by Todd Litman or explained in this video by Dr. Susan Handy. This recognizes that the purpose of transportation is to provide access; it is not just travel for travel’s sake. In technical jargon, transportation is a derived demand, which is a term that emphasizes that transportation responds to household and land use characteristics.
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The benefit of this approach is that it de-centers the mobility strategies that have not produced healthy or sustainable outcomes—or even effectively solved mobility goals (looking at you, induced demand). Prioritizing mobility and speed, for example, has serious safety consequences. In a recent analysis of pedestrian traffic fatality hotspots, nearly all fatalities occurred on multi-lane arterials (which are designed for automobility), with 70% requiring pedestrians to cross five or more lanes.

After decades of conceptualizing and measuring accessibility*(aka access to destinations) in academia, there is growing acceptance of the idea in practice. Some version of this concept has been described as creating complete neighborhoods or as 20-minute neighborhoods. However, Paris Mayor Anne Hidalgo’s plan for the 15-minute city (also called a city of proximities) has captured international attention and generated conversation about accessibility.

Part of this conversation also includes some skepticism about the feasibility and fairness of this model, particularly for American cities with land use and transportation patterns that make it difficult to get to any destinations by walking or bicycling. Another critique is that the 15-minute city excludes people with disabilities owing in part to the economic inaccessibility of existing complete neighborhoods. Edward Glaeser argues that a 15-minute city does not provide enough economic opportunity for residents; residents need access to the entire metropolis within an hour's time.

Another factor to consider is perceived accessibility. Measuring access to destinations through objective means has been computationally difficult until relatively recently. Today, practitioners have a number of tools at their disposal. These tools typically define access as the destinations closest to residents, but do people travel to the closest grocery store, as a gravity model would suggest? Or do they choose the store with lower prices or the store with more options? What if the route to the closest destination feels unsafe because of traffic or personal security concerns?

The conceptual issue, which some of the 15-minute city critiques approach, is that measures of accessibility represent potential access to destinations. They don’t represent actual travel behavior or whether resident needs have been met. For example, planners could use typical approaches to measuring accessibility to determine whether there are any food deserts in the city. However, objectively measured accessibility doesn’t capture whether stores are affordable to residents or sell culturally relevant foods. Perhaps the problem is not a food desert, but a food mirage.

Here are some recommendations for analyzing complete neighborhoods:

• Understand the actual travel needs and barriers of residents, particularly historically excluded populations whose travel patterns are not reflected in travel surveys, through a meaningful community engagement process
• Ground-truth accessibility analysis results with residents to understand whether it reflects their sense of accessibility—or whether you actually have an access mirage
• If you have the technical wherewithal, explore models (e.g., multinomial logit) that can account for destination preferences

The climate and health benefits of complete neighborhoods are clear—they increase opportunities for physical activity as part of daily life and reduce the need for driving, which is likely to reduce greenhouse gas emissions and air pollutants. There’s also a good chance that they will create more attractive and safer neighborhoods. Many low-income communities and communities of color have reduced access to resources owing to inequitable planning and policy decisions. Improving access to destinations should be prioritized for these communities. Planners must ensure that these existing residents benefit from improvements. Methods for analyzing the risk of displacement and case studies for preventing displacement can be found on Streetsmart’s Equity and Inclusion page.

We mustn't treat the 15-minute neighborhood (local accessibility) and access to the larger metropolis (regional accessibility) as mutually exclusive paths—we need both for climate, health, and equity.

* Unfortunately, the transportation field uses the term accessibility in two different ways: one is access to destinations, the subject here, and the other is accessibility for people with disabilities. Any efforts to improve local access to destinations should ensure that it meets the needs of people with disabilities.

Climate Change, Health, and Structural Racism
Recent record-breaking heat waves have drawn attention to the impacts of climate change on health and well being. These heat waves have proven especially dangerous in parts of the country that have not historically relied on air conditioning, resulting in emergency actions that ranged from the creation of temporary cooling shelters to school cancellations. Heat is already the leading cause of weather-related deaths and climate change is increasing the severity of the urban heat island (UHI) effect.

These heat waves also elevated the scholarship that illustrates how racist land use practices, such as redlining, have created differential health effects (see also this EPA Environmental Justice webinar on Redlining and Climate Crisis). Historically redlined neighborhoods, deemed unsafe for investment by banks because they were inhabited by people of color, have been found to have significantly higher temperatures than non-redlined neighborhoods. The higher temperatures are a function of high amounts of impervious surfaces, fewer street trees, and inadequate park access. Park-deficient neighborhoods do not benefit from the cooling effects that park vegetation brings. It also means there are fewer places to retreat from the heat, which is particularly poignant when residents do not have air conditioning. Greenspace access is also important for healthy birth outcomes. Less tree canopy coverage has been found to be associated with preterm births among Black women.

While the UHI has recently captured the public’s attention, the particular hazards resulting from the interaction of climate change and racist planning policy may differ depending on the region of the country and the location of formerly redlined neighborhoods (explore the climate change hazards of your region here and here). For example, Sacramento’s formerly redlined (“hazard”) and yellowlined (“declining”) neighborhoods face high flood risk.
 
Air quality is another area with differential exposure and health effects. We now know that fossil fuel air pollution is more deadly than previously realized. The Fourth National Climate Assessment outlines the climate-induced risks of increased ground-level ozone and particulate matter, with respiratory and cardiovascular effects including premature deaths, hospital and emergency room visits, aggravated asthma, and shortness of breath.

Tools and Solutions
For resources on climate change mitigation and adaption, look at the C40 Cities site for suggestions. Streetsmart’s page on Greenhouse Gas Emissions (GHG) also has transportation-specific resources, including a list of proven strategies for reducing GHG.

Trees are a critical strategy for improving urban health (increased shade, UHI reduction, reduced housing energy costs, air filtration, stormwater absorption, reduced mental stress, etc.) To help identify where trees should be planted to achieve greater heat equity, use the Tree Equity Score tool created by American Forests. A simple but elegant solution for increasing street tree canopy builds on the oft-lauded 10-minute walk to essential destinations (aka 15-minute city):

“All Charlotte households will have access to essential amenities, goods, and services within a comfortable, tree-shaded 10-minute walk, bike, or transit trip by 2040” (Charlotte’s newly adopted comprehensive plan, Streetsmart emphasis).

One possible solution for reducing air pollution and increasing public space is the Barcelona superblock. In addition to journal articles on this model, the Barcelona Institute for Global Health created a mini-graphic novel to tell the fictional story of how the Barcelona Superblock came to be, inserting air pollution’s health effects (“one third of childhood asthma cases are caused by air pollution”) into the story.

The question that is top of mind of many transportation professionals is how to better integrate equity into transportation processes. Equity in transportation can be considered as a matter of process—fair and authentic engagement with community members—and about producing equitable outcomes.

This two-part article is focused on how to create more equitable outcomes, although how engagement connects to outcomes are also discussed below. Suggestions for addressing equity outcomes are loosely organized by the phases of a transportation project process. The first two steps are presented here; the remaining steps will be covered in the next newsletter.

1. Defining the problem
What transportation agencies define as the problem might not be the most important issue to community residents. This is where it is necessary to cultivate relationships with community-based organizations, particularly with those serving marginalized populations, to understand their transportation challenges.

For example, when the Portland Bureau of Transportation began a project on North Williams Avenue to address bicycle safety, members of the historically Black community expressed concern about the goals and process of the project. Planners realized they needed to step back and, in addition to having more people of color on the advisory committee, redefined the project to address safety for all street users, not just bicyclists.

Let’s remember that the purpose of transportation is to provide access—to jobs, grocery stores, health care services, and social opportunities. Think about transportation challenges as access challenges and ask how well the transportation (and land use) system is helping people reach essential destinations.

Because equity is such a strong component of public health, it is also helpful to understand what health problems exist (e.g., heart disease, asthma, access to healthy food), particularly for marginalized populations, and consider how transportation can help alleviate them. For more on integrating health into transportation, see this detailed framework by the Federal Highway Administration.

2. Identify needs
At this stage, transportation professionals are documenting existing transportation, population, and employment conditions. As part of this process, transportation professionals need to define a study area and understand who lives and works within it.

Typically, transportation professionals identify Environmental Justice (EJ) communities that could be affected by the plan or project. Environmental Justice legislation defines, at a minimum, low-income communities and people of color as EJ populations. However, other populations should be considered, such as children, older adults, people with disabilities, and people with limited English proficiency. EJSCREEN is one tool that can be used to help identify EJ populations, as well as examine environmental indicators, such as air quality, that affect human and environmental health.

One of the problems in this phase is that the data often has been aggregated to a unit of analysis, such as a census tract or transportation analysis zone (TAZ), that may obscure some information. Certain census tracts, for example, might clearly show a large population of low-income households, causing it to be designated it as an EJ area. However, pockets of poverty can be hidden in wealthier census tracts because of the aggregation of the data—they get “averaged” out. This is where working with community-based organizations—relationships built in the first phase—can be helpful. These organizations may know where vulnerable groups reside and can add more granular information about the demographics of the area. Furthermore, they can inquire about the transportation needs of those residents.

Why do transportation professionals need any further equity guidance than what is provided by the existing Civil Rights (Title VI of the Civil Right Act) and EJ requirements (Executive Order 129898)? This essential legislation addresses fair community engagement, discrimination, and identifying adverse effects on minority and low-income populations. However, an EJ analysis does not require identification of the real needs of the community, only documentation of the adverse effects of the proposed plan or project and mitigation for those effects. Making transportation systems work for the most vulnerable requires transportation agencies to go beyond what’s required.