Transportation & Health 101 Toolkit

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A vision of healthy communities cannot disregard or devalue transportation. A healthy community is one in which people have access to healthy foods, feel safe, have opportunities for physical activity, breathe clean air, have access to gainful employment and feel connected to opportunity. Transportation is access, thus, transportation is opportunity.

Transportation significantly effects health through traffic crashes, air pollution exposure, access to healthy food, access to physical activity, and economic opportunity, which are only a few of the implications. 

Effective transportation policies are key to improving the health of communities and their residents. Transportation planning and projects that connect low-income communities to opportunity and basic goods and services, while always prioritizing public transit and non-motorized transportation holds enormous potential for addressing many of our nation’s most pressing societal problems. Transportation solutions for public health are shared solutions which can create social and economic equity, benefit the environment, and improve the economy. These benefits are long-term and must be prioritized for this nation to remain economically competitive, have a healthy population who is able to participate and produce, and have a sustainable environment for generations to come.

Health advocates are beginning to recognize the importance of getting involved in transportation planning and policy to ensure the health implications of such work are considered.

Transportation advocates are also interested in better understanding the intersection of health and transportation. Data regarding health and equity outcomes is compelling, and can help inform policy proposals and transportation decision-making. Additionally, working across disciplines presents an opportunity for a new cadre of advocates to join and provide support for healthier transportation solutions.

This toolkit will help health advocates better understand transportation issues and their related health connections, and help inform transportation advocates on the importance of health in their work.

Inside the Toolkit

Crafted by researchers and national experts, this toolkit presents an overview of transportation policy and planning, the connections between transportation and health as well as policy opportunities to create healthy transportation options. Much of this content was originally prepared for the Centers for Disease Control and Prevention meeting, Linking Transportation Policy and Public Health, in November 2008. For more information on the conference, including the goals and the agenda, click here. (create link to page 8 –see below)    

The focus of many of these documents is on federal transportation policy. The Federal Transportation Reauthorization Act, a large bill that passes through Congress every six to seven years, sets federal transportation policies and provides funding for state and local projects. A new bill will be developed within two years making this time critical to ensure health is considered in the decision-making process.

Table of Contents

»Overview of Transportation and Health

»Impacts of Transportation on Health

  • Public Transit
  • Roadways
  • Walking and Biking
  • Economic Development and Transportation
  • Food Systems and Transportation
  • Injury Prevention
  • Air Quality
  • Physical Activity

»Advocacy Opportunities

»Case Studies

»Glossary of Terms

»Additional

 

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Overview of Transportation and Health

Transportation effects health both directly and indirectly. Directly, transportation impacts health through traffic crashes, air pollution, limited physical activity, mental health, and inaccessible medical care and healthy foods. Indirectly, transportation impacts health by creating access, or lack of, to economic opportunity. Income is the number one determinant of health. The more income a person makes the healthier they are. Transportation provides access to jobs and employment centers, creating or hindering economic development and impacting household budgets. For example, the larger the percent of income spent on transportation, the less families have on important household expenses such as healthy foods, medical and child care.

  • Transportation and Public Health (LINK TO PDF)

Presentation by Dr. Howard Frumkin at the CDC

This presentation explains the impacts transportation has on health, including issues of injury, physical activity, global warming, mental health and social capital.

  • Overview of Transportation Issues (LINK TO PDF)

Presentation by Dr. Stephanie Pollack at Northeastern University

This presentation provides an overview of transportation issues. It discusses everything from what transportation is, how transportation policy is made and provides insights into traditional and newer, innovative ways of looking at tranportation policyto create healthier communities.

  • Overview of the Federal Transportation Reauthorization (LINK TO PDF)

Document by the America Public Health Association

This four-page document provides an overview of the federal transportation reauthorization and focuses on the parts of the bill most relevant to public health and safety. For a more detailed description of the impacts of relationships between the federal transportation bill and public health, see APHA’s more comprehensive brief, At the Intersection of Public Health and Transportation: Promoting Healthy Transportation Policy. (link italicized title to a PDF in the following location: F:\Programs\Health Disparities\Convergence Project\Ad hoc committees\built environment\APHA policy resolution).

 

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Impacts of Transportation on Health

Leading experts and researchers at the crossroads of health and transportation have written papers and presentations to find connections between the two issues. They have compiled the latest and most compelling research providing insight and analysis as they relate to health, and identifying solutions to create healthier transportation policies.

  • Public Transit
  • Roadways
  • Walking and Biking
  • Economic Development and Transportation
  • Food Systems and Transportation
  • Injury Prevention
  • Air Quality
  • Physical Activity  

 

Public Transit

By Dr. Todd Litman

Executive Director

Victoria Transport Policy Institute

The benefits of public transportation helps achieve several public health objectives; directly it improves traffic safety, reduces air pollution, and increases physical activity and fitness. It also increases community cohesion, improves access to medical services, and increases transport affordability which reduces mental stress. These services are particularly beneficial to physically, economically and socially disadvantaged people.

The indirect impacts of high quality public transit affects land use development patterns and per capita vehicle ownership. These indirect impacts are often larger, so comprehensive evaluation is needed to understand the full potential health impacts of planning decisions that affect its quality and use.

  • Presentation on Public Transportation and Health (link to PDF)
  • One-page Summary (link to PDF)

 

Roadways

By Dr. Catherine Ross

Director and Harry West Chair for Quality Growth and Regional Development

Center for Quality Growth & Regional Development
College
of Architecture
Georgia Institute of Technology


Roadways are a major cause of health concern. Highways including roads, streets and parkways are the site of vehicular emissions, crashes, traffic risks and traffic congestion and commuting that exacerbates emotional well-being.

Negative public health results include; over 3 million vehicular injuries every year and approximately 43,000 deaths annually; increased incidence of asthma, lung disease, and cardio vascular disease; higher  levels of greenhouse gases that cause climate instability and result in natural disasters, food scarcity, unhealthy ecological and weather patterns and premature deaths; degraded social and mental health; limited connectivity forces use of busy roadways exposing travelers to greater risk; road surface erosion causing higher levels of local and regional air pollution and limited access for vulnerable populations. The dependence on cars also leads to physical inactivity and reductions in bicycling and walking trips.

There are also a number of equity concerns surrounding highway infrastructure. The higher cost of car ownership excludes accessibility for many minority and low-income populations. In addition, those with disabilities suffer limited mobility if they are restricted to motor vehicle travel. The transportation system exposes lower income populations to more personal hazards and the air pollution burden is higher among lower income households, minority households and children. In addition, the burden of traffic related injuries and deaths are higher for disadvantaged populations. 

  • Presentation on Roadways and Health (link to PDF)
  • One-page Summary (link to PDF)

 

Walking and Biking Transportation

By Dr. Susan Handy

Director, Sustainable Transportation Center and

Professor, Department of Environmental Science and Policy

University of California at Davis

 

Walking and bicycling are important forms of physical activity and transportation. A fifteen minute non-motorized commute twice a day meets the CDC’s recommendations for adult physical activity The health benefits are numerous: prevention of weight gain, improved cardiorespiratory and muscular fitness, and lower risk of Type 2 diabetes, heart disease, stroke, and other conditions. 

Non-motorized transportation can improve equity of access to needed activities including jobs, healthcare, and shopping. Non-motorized modes also enhance access to transit, which in turn enhances access to needed activities. Health disparities are also influenced by walking and bicycling, which provide an important source of physical activity for lower income and minority populations.

Increased non-motorized travel also produces numerous economic benefits: reduced spending on transportation, improved access to jobs, and stimulation of local economic development. A shift from motorized to non-motorized modes produces an abundance of environmental benefits as well, including less air and water pollution, less noise, and lower greenhouse gas emissions. There are few downsides to non-motorized transportation, as long as safety is ensured. 

  • Presentation on Non-Motorized Transportation and Health (link to PDF)
  • One-page Summary (link to PDF)

 

Economic Development and Transportation

By Dr. Todd Swanstrom

Des Lee Professor of Community Collaboration and Public Policy Administration
University of Missouri - St. Louis


Transportation policy influences what kind of economic development occurs (single use or mixed use), where it occurs (on the suburban fringe or near the center), and who benefits (rich or poor, white or black). Economic development, shaped by transportation policies, has both direct and indirect effects on health. Denser, mixed-use development reduces car use and increases public transit, walking, and bicycling – which improves physical activity and air quality. 

By influencing the location and beneficiaries of economic development, transportation has indirect effects on health. In particular, transportation policies can support economic development that reduces poverty, inequality, and segregation (economic and racial) – which will, in turn, improve health outcomes. Greater transportation equity can be achieved without sacrificing transportation efficiency.

  • Presentation on Economic Development, Transportation and Health (link to PDF)
  • One-page Summary (link to PDF)

 

Food Systems

By Dr. Kami Pothukuchi

Associate Professor of Urban Planning

College of Liberal Arts & Sciences
Wayne State University

and By Richard Wallace

Senior Project Manager

Center for Automotive Research


Research shows there are higher rates of diet-related illnesses among low-income residents (who typically have lower rates of automobility than higher income residents) in neighborhoods associated with “food deserts” (locations with fewer grocery outlets that carry adequate and affordable healthy food choices). Proximity to better grocery stores has shown to be associated with improved dietary health outcomes, particularly for African American residents. This suggests that increased access through proximity is a key approach that needs to be emphasized in transportation policy. These findings also suggest that transportation options are needed for low-income residents to access healthy foods.

Rising transportation costs are a factor in the rising costs of food, which impacts low-income households. Increased food costs may drive some to choose cheap, high calorie, low nutritious foods. The costs of long-distance transportation of foods are likely to rise in the near term. Greenhouse gas emissions and increased air pollution from transportation–within the food sector, by residents to obtain foods, and by municipal services to haul food related wastes to landfills –all threaten the health of residents and the planet.

Ultimately, increasing access through land use solutions and improving the quality of metropolitan transportation and transit networks (including by increasing access and connectivity) is key to improving access to basic needs in general –and particularly important to food access. Transportations’ division by modes and programs, rather than systematic attention to community needs, is a problem communities are experiencing today.

  • Presentation on Food, Transportation and Health (link to pdf)
  • One page summary (link to pdf)

 

Injury Prevention

By Larry Cohen, Executive Director

Leslie Mikkelsen, Managing Director 

Janani Srikantharajah, Program Coordinator 

Prevention Institute

In 2007 traffic crashes accounted for over 41,000 deaths, 2.6 million injuries, and $230.6 billion in total economic costs. More Americans under the age of 34 die from traffic crashes than any other cause of death. And there are clear disparities in traffic-related injuries and fatalities. As a percentage of all deaths, African Americans, Native Americans, Asian and Pacific Islanders, and Latinos die more from traffic crashes than white populations. White bicyclists and pedestrians over the age of 16 have fewer traffic fatalities than people of color. Injury prevention among seniors is becoming an issue of concern as a large segment of the American population enters the over-65 age range. 

The benefits of injury prevention go beyond the reduction of traffic injuries and deaths. Strategies to increase pedestrian/bicyclist safety and disability access to public transportation may also increase the likelihood that people will choose to walk and bike. This in turn promotes physical activity, reduces car travel and thus air pollutants and greenhouse gasses. The partnership between the injury prevention field and other health and environmental disciplines has great promise. In many cases, the same solutions serve all and in other cases, the benefit comes from supporting one another.

Presentations on Injury Prevention and Transportation

  • By Prevention Institute (link to Pdf)
  • By Dr. Ann M. Dellinger from the Motor Vehicle Injury Prevention Team at the Centers for Disease Control (link to pdf)
  • One page summary (link to pdf)

  

Air Quality

Asthma, cardiovascular disease, abnormal lung growth, cancer and low birth-weight have all been attributed to auto and truck emissions. Asthma is the most common chronic disease in children, with nearly one in seven children being affected across the nation. Asthma impacts children of color disproportionately. In Puerto Rico, the asthma prevalence rate in children is 19%, 13% in blacks and 8% in White children. Studies show that children living near busy roadways are more likely than children living near less trafficked roads to have asthma, to have deficits in lung function and to need to visit the doctor for their asthma. Nearly half (46%) of the U.S. population lives in counties that have poor air quality. 

Urban sprawl has dramatically impacted air quality as residential developments expand farther away from urban economic centers. Dependence on cars and the number of miles traveled have significantly increased as the distance between work, home and goods and services have grown-without attention to public transportation options. This increased dependence on cars is a major factor in air pollution.

In addition, as globalization and the movement of goods has grown, so has truck traffic from ports to distribution centers. Unfortunately, low-income communities and communities of color frequently bear the burden of pollution generated by the increasing goods movement infrastructure –such as heavily trafficked and expanding highways, bridges, railyards, airports and ports.

Improving air quality through transportation not only directly improves health outcomes, it improves the natural environment and slows down global climate change.

  • Presentation: Transportation and Air Quality (link to pdf on F drive)

By Dr. Jean Ospital from the South Coast Air Quality Management District

 

Physical Activity

Transportation options impact the level of physical activity an individual obtains. Active forms of transportation, such as walking and biking, promote health. Transportation infrastructure that supports physical activity includes sidewalks, bike lanes, and design and land use features which create a safe and supportive atmosphere for active transport. 

Public transportation also helps promote a more physically active lifestyle. A study in Atlanta found that for every additional hour spent in a car, the risk of obesity rose 6%. The very opposite is true for public transportation riders. Nearly 30% of transit riders get the recommended daily dose of physical activity (30 minutes of moderate physical activity) by walking to and from transit. Overall transit riders spend an average of 19 minutes of physical activity through their daily routine.

Physical inactivity contributes to obesity, one of the biggest risk factors for type II diabetes –the fifth most common cause of death for Americans. Overweight and obesity are also risk factors in a number of other poor health outcomes, including cardiovascular disease, cancer and arthritis. Black, Latino, and low-income persons are disproportionately impacted by the obesity epidemic.

 

Transportation and Physical Activity

By Dr. Dietz at the Centers for Disease Control and Prevention (link to pdf)

 

 

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Case Studies of Local Action

This section includes a set of case studies demonstrating how communities are working at the intersection of transportation and health.

Health Impact Assessment in San Francisco: A Tool to Build Healthier Communities (LINK to PDF of case study on F drive)

Health Impact Assessment (HIA) is an approach to examining the effects that land use and development decisions have on health in a particular geographic area. The San Francisco Department of Public Health created the Healthy Development Measurement Tool (HDMT)—a guide to conducting HIA in San Francisco. The HDMT provides the health rationales for considering each element, including sustainable transportation, of community conditions and moves through the established standards, key indicators, development targets, and strategic suggestions for policy and design.

Addressing diesel bus pollution and its health consequences in Northern Manhattan, New York: West Harlem Environmental Action, Inc., and the Columbia Center for Children’s Environmental Health (LINK TO PDF of case study)

In 1996, West Harlem Environmental Action (WE ACT), a nonprofit organization that uses community-based action to advance environmental health policy, public health, and quality of life, partnered with the Columbia Center for Children’s Environmental Health (CCCEH) at the Mailman School of Public Health, Columbia University, to explore the possibility of excess pollution exposure in Northern Manhattan and to craft appropriate policy responses to their findings. WE ACT and its partners have been widely credited with playing a major role in securing the conversion of existing city buses to clean diesel, among other critical policy wins.

Looking at Transportation Planning Through a Health Lens (link to pdf of case study)

The Coalition for a Livable Future (CLF) wants transportation planners to look beyond traffic volume and bus ridership when laying out new roads and rail lines. This Portland, Oregon-based group says health should be considered, too. Building systems that fosters walking and biking for short trips, and light rail for longer ones, and you’ll do more than reduce the congestion and commute times, the coalition says. People will be healthier, too.

Neighborhood Assessment Teams: Moms Fighting Pollution in Long Beach (link to pdf of case study)

Long Beach Alliance for Children with Asthma’s (LBACA) community health workers (CHW) educate families about asthma and help them improve their indoor air environment, as well as recruit mothers of children with asthma to advocate for better air quality in their neighborhoods. Long Beach and the surrounding communities are affected by the ports of Long Beach and Los Angeles and the related goods movement activity. These neighborhoods lie within the wind corridor most affected by harbor, industry, freeway, and refinery pollutants, and the 710 freeway runs through the heart of these communities carrying more than 47,000 truck trips each weekday to and from the third largest port complex in the world.

School Buses are Hazardous to Children’s Health: State Legislation to Limit Idling in Connecticut (link to pdf of case study)

Environment and Human Health Inc. (EHHI), a Connecticut research and policy group, knew the dangers of idling buses in exposing children to diesel pollution. EHHI decided to gather data themselves. The results were alarming. The air monitoring equipment worn by students showed that their exposure to diesel on the bus was 5 to 15 times their normal exposure. EHHI published a report summarizing its findings and took it to state lawmakers. The data, coupled with the diverse coalition, made a compelling case–in 2002 the Connecticut legislature passed a law prohibiting school bus idling for more than three minutes.

Keeping Housing Away from Freeways and Toxic Polluters (link to pdf of case study)

In Otay-Mesa, south of San Diego, developers have proposed 5,500 units of new housing in a largely industrial area near a major freeway. When staff at the San Diego Regional Asthma Coalition learned about the proposal, they began working with partners to stop it. They knew that housing built near polluting businesses and highways could lead to higher rates of asthma and other respiratory diseases for residents—in this case, lower-income Hispanics.

 

 

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ADVOCACY

Here is information on how to advocate for change, as well as opportunities to connect with coalitions currently advocating for transportation policy change. (“how to” is linked to the section below, and “opportunities” to the bottom section on opportunities)

How to:

Advocating for Change Toolkit

Advocating for Change provides an in-depth understanding of the advocacy process and offers detailed information about how to use it successfully to create better opportunities for people and the places where they live. Case studies throughout Advocating for Change provide examples of the positive outcomes that effective advocacy can deliver.

For all the challenges that exist, advocates in cities across the nation have achieved great success in securing improved policies and practices and moving their interests forward. Some advocates have been doing this work for years; others have only recently begun. All have relied on one or more of the advocacy strategies discussed in this manual as a vehicle for change.

Access the full toolkit here.

Advocating for Equitable Development Toolkit

The first step in making change is to recognize the need for it. The second is to know how to make it happen. Advocating for Equitable Development describes the process of moving from recognition to resolution. Advocating for equitable development is nothing less than realizing democracy’s promise of full inclusion and participation in a just society. Advocating for Equitable Development demystifies the process for achieving economic and social equity in low-income communities and communities of color throughout the nation.

Using case studies of equitable development advocacy campaigns from around the country, the manual offers support to everyone interested in making change happen. Access the full toolkit here.

Great Communities Toolkit

The Great Communities Toolkit, developed by TransFORM, is a free listing of resources to help those advocating for sound transit station development. The toolkit was developed to help community groups shape Great Communities around transit, by helping them make sure these plans will result in neighborhoods of affordable homes, shops, accessible job centers, and community services. With this toolkit, you will have the tools to influence your city’s plans for neighborhoods near transit. Access the full toolkit here

 

Building the Line for Equity: Six Steps to Achieving Transit Oriented Development in Massachusetts

Action for Regional Equity (Action!), a coalition of the state's leading housing, transportation, and environmental advocates, has developed six steps to guide transit oriented development in the Massachusetts region. These steps can promote broad access to economic opportunities and affordable housing, ease of use for disabled riders, attention to environmental justice issues, improved air quality, increased transit use, and sensitivity to local economic development issues. Action! has a particular interest in finding policy solutions that address concerns of low-income and working class residents who are at risk of displacement because of escalating housing prices. Read the full document here.

 

Opportunities:

Transportation for America Campaign 

Transportation for America has formed a broad coalition of housing, environmental, public health, urban planning, transportation and other organizations. The coalition is seeking to align our national, state, and local transportation policies with an array of issues like economic opportunity, climate change, energy security, health, housing and community development. Issues that will play a key role in strengthening the foundation of our nation and give families and individuals greater options.

The campaign is on the move, marshaling other like-minded groups and resources together to bring about a better vision of America for the 21st century. Visit T4America.org  to learn more about the campaign and to become a partner.

The coalition’s platform includes the following:

  • A 21st CENTURY NETWORK: Invest in a world-leading, sustainable transportation system.
  • NO MORE BLANK CHECKS: Establish national transportation objectives and hold agencies accountable.
  • SAVE LIVES, PROMOTE HEALTH: Support safe walking and biking, reduced exposure to vehicle injuries and dirty air.
  • FIX WHAT’S BROKEN: Establish a special program to restore and maintain our existing highways, bridges and transit and maximize their efficiency.
  • SHARE THE POWER – AND THE RESPONSIBILITY: Provide funding and decision- making authority to local regions.
  • SUPPORT SUSTAINABLE DEVELOPMENT: Give priority to investments with multiple pay-offs.
  • SMART FINANCING: Broaden the capital and operating funding base.

Transportation for America includes a number of partners with networks and coalitions of their own. Some of these include: 

Transportation Equity Network  

Complete Streets Coalition

America 2050 

Safe Routes to Schools 

Rails to Trails Network 

Bus Riders Union

 

 

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Glossary of Terms

Given the intersection of transportation, environment and health related issues, the Centers for Disease Control and Prevention developed two glossaries to define and clarify terms.

 

Glossary of Transportation and Land use Terms (link to pdf)

Glossary of Health and Environmental Terms (link to pdf)

 

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Additional Resources

CDC Division of Environmental Health  

CDC Healthy Places

CDC Division of Unintentional Injury

CDC Division on Nutrition and Physical Activity

PolicyLink 

Prevention Institute 

Trade Health Environment Impact Project 

America 2050 

Active Living by Design

Bus Riders Union

CDC Division of Environmental Health 

CDC Healthy Places

CDC Division of Unintentional Injury

CDC Division on Nutrition and Physical Activity 

Complete Streets Coalition 

Environmental Protection Agency (EPA), Transportation and Air Quality 

Federal Highway Administration, Air Quality

Healthy Development Measurement Tool  Integrating Health and Physical Activity Goals into Transportation Planning

PolicyLink

Prevention Institute

Rails to Trails Network 

Safe Routes to Schools  

South Coast Air Quality Management District 

Trade Health Environment Impact Project 

Transportation Equity Network 

Victoria Transportation Institute 

 

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Linking Transportation Policy and Public Health

November 13-14, 2008

Doubletree Crystal CityArlington, VA

 

The Centers for Disease Control and Prevention (CDC) recognizes the important implications of transportation on health. Three divisions of the CDC –Environmental Health, Unintentional Injury and Nutrition, Physical Activity and Obesity–came together to organize and lead a conference on the links between transportation and health. The meeting was co-sponsored by the Healthy Eating, Active Living Convergence Partnership.

Meeting Overview 

“Linking Transportation Policy and Public Health” is a forum to bring together professionals from the transportation and public health sectors in order to discuss how transportation policies affect public health. The purpose of this meeting is to provide an overview of transportation and health issues, discuss transportation resources, and launch a mutually supportive dialogue on health and transportation. A key feature of the meeting will be the presentation and discussion of six papers commissioned by the Healthy Eating Active Living Convergence Partnership on public transportation, roadways, non-motorized transportation, economic development, injury prevention, and transport of food. These papers will form the basis for the informational exchange and dialogue among public health, transportation, and policy professionals.

 

Meeting Goals

  1. Bridge the information gap between transportation policy and public health
  2. Think strategically about how transportation policies affect public health
  3. Identify priorities for transportation policy and public health
  4. Build momentum to promote transportation policies that support public health

 

Agenda: Click here to access the full agenda for the meeting. (link to PDF of agenda on the F-drive)

Proceeding: The proceedings from the meeting are being developed. Please come back soon to access the proceedings.