​Useful Health Indicators for Municipal Transportation Plans: Part One

Originally published in the September 2023 issue (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)

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