Transportation is so much more than mobility. Transportation systems drive economic investment, facilitate active living, provide access to opportunity (or present a barrier to it), and are a key contributor to environmental and human health. Yet our transportation planning and design paradigm does not reflect the myriad ways that transportation affects people’s lives.

However, transportation’s role in health is being increasingly recognized and addressed. The 2015 Step It Up! The Surgeon General’s Call to Action to Promote Walking and Walkable Communities underscored the critical relationship between health and transportation. In 2017, several organizations that represent built environment professionals issued a Promote Healthy Communities Joint Call to Action. In January 2019, the Transportation Association of Canada will release a report titled Strategic Opportunities for Integrating Health and Transportation and deliver webinars to discuss their findings.

Streetsmart is a nonprofit research synthesis, resource clearinghouse, and communication platform for transportation currently in prototype form. Streetsmart illustrates the relationship between strategies (e.g., complete streets) and outcomes (e.g., physical activity) so users can evaluate and prioritize projects and make the case for certain kinds of investments. We are currently working with Institute of Transportation Engineers to develop a beta version of Streetsmart that will contain 15 transportation strategies and five outcome areas—walking, bicycling, physical activity, vehicle miles traveled, and greenhouse gas emissions. Integrating health into transportation decision-making is central to our mission.

Over the past year, Streetsmart convened several focus groups in planning, engineering, and public health to find out more about the challenges in integrating health into transportation. Here is what the 35 focus group participants, drawn in part from the Institute of Transportation Engineers, the American Public Health Association, and the National Association of Regional Councils, had to say:

1. Learn a new language

Planners, engineers, and public health professionals all speak different languages. They may even use different terms to express similar ideas: for example, a planner may recommend tactical urbanism to improve neighborhood walkability, whereas an engineer may ascribe experimental countermeasure terminology to the same scenario, and a public health professional may view the solution in terms of an intervention. And community members may find all these terms unintelligible.

In our focus groups, we heard that practitioners need to “get people on the same page” because of the differences we carry in our heads about transportation concepts. Beyond definitions (which are also helpful! Check out the Built Environment and Public Health Clearinghouse Glossary), people want to see success stories, before-and-after pictures, and stories from people where transportation has made a difference in their personal health. In so doing, we can get better alignment on the definitions, outcomes, and impacts of transportation plans and projects on health.

2. Conceptualizing health

Health is a good example of a concept that everyone understands differently. Engineers have long been charged with protecting the health, safety, and welfare of the public. However, many engineers tend to see health as injury prevention, and as such, focus their efforts on traffic safety. But transportation can impact human health in many different ways—such as its contribution to air pollution and increasing the risk of asthma or creating opportunities for people to travel actively, thereby reducing their risk of chronic diseases. Transportation professionals need a definition of health that includes not only health protection but also health promotion.

Updating this definition of health requires our professions do a better job connecting-the-dots between transportation projects (or interventions, if you will) and their health effects and impacts on the community. Public health professionals are generally very good at this, so ask them for help. Transportation professions are not the only ones that need to learn to build these connections—it is essential to communicate these relationships to policy-makers and elected officials to get plans approved and projects funded.

3. Collaborate

It may be clear by now that collaboration is essential to achieving the tasks above. Indeed, inviting public health professionals to join the transportation conversation may be the single most important thing for integrating health into transportation. I’ll repeat that: inviting a public health professional into the transportation process may be the single most important thing a planner or engineer can do.

Public health professionals are vital to transportation plans and projects–they know the health-related data sources, metrics, evidence-based best practices, and perhaps most critically, ask the right questions to help advance health. It works in the other direction as well. Community members have been successful inviting transportation professionals to participate in plans and ideas for improving the health of the community. Build a relationship with transportation professionals by inviting them early into the process.

4. Institutionalize the right questions

Inviting public health professionals into the conversation is an excellent way to integrate health; however, public health professionals have limited time and may not be able to attend every meeting. How can we institutionalize the knowledge and approach of public health in the transportation field?

As noted above, the more transportation professionals collaborate with public health professionals, the more they will learn a new language and a new approach to addressing transportation issues. Resources like the Health in Transportation Corridor Planning Framework, which prompts users to ask smart questions at every stage of the transportation planning process, are also helpful. The more we can integrate these kinds of questions as part of transportation guidance, the better.

5. The role of trusted resources

This one speaks especially to engineers and public health professionals. Both disciplines have a commitment to the use of trusted resources as part of their daily practice. Transportation research is used to develop guidance for everything from travel demand modeling to geometric design. Their exposure to risk encourages engineers to hew to professional standards and deliver the lowest cost product; furthermore, the fast-paced work environment also makes it difficult for engineers to take time to explore alternatives. Luckily, design guidance exists to help engineers understand design flexibility, such as ITE’s Designing walkable urban thoroughfares: A context sensitive approach and the FHWA document, Achieving multi-modal networks: Applying design flexibility & reducing conflicts.

Public health professionals often start with the evidence base as well. In public health, evidence-based best practices are often distilled through systematic reviews. Public health professionals may draw from the work created by research-based groups such as the Task Force for Community Preventive Services and County Health Rankings & Roadmaps. However, use of the evidence is connected to the needs and circumstances of the population they are serving. Public health recognizes that behavior and culture plays a huge role in health; therefore, effective and long-lasting solutions must account for these dimensions. Use of generalized best practices comes with a caveat: pay attention to the specific needs of people and their context. Ask not only “what works?” but also “what’s appropriate?”

6. Implementation tools

Which leads us to implementation. I have two words for you: case studies. Case studies are among the most highly valued type of implementation resource for all three professions. Well-organized case studies highlight the results of the plan or project (e.g., change in AADT), the contextual details to evaluate the project’s applicability to a situation (e.g., size of the city), and the lessons learned from the engagement process. Remember the engineers’ exposure to risk? Case studies can help by demonstrating precedent.

Another key implementation tool are performance measures. To align investments with goals for health, transportation professionals need measures to evaluate the performance of plans and project. Measuring and quantifying the potential health benefits of transportation projects also helps decision makers understand project outcomes and impacts—helping them understand the far-reaching consequences of their decisions.

7. Leadership

Leaders in health, either internal or external to the transportation agency, are essential for creating a policy environment that encourages practitioners to examine the health consequences of transportation plans and projects. In the fast-paced world of transportation planning and design, many engineers do not have time to venture beyond the established standards and guidance (and can get criticized for not adhering to them). Furthermore, engineers are responsible for projects being built within the established budget and timeframe. They need justification to slow down and evaluate health impacts. New policy or regulations may force planners and engineers to look beyond standard practice for other solutions. Leadership may take the form of an elected official, a principal planner, or an advocacy group. Support them.

Where do we go from here?

Streetsmart asked transportation and public health professionals what it would take to better integrate health and transportation because we wanted to know what we could do to help. We are taking the insights from these conversations to inform the beta version of Streetsmart. Here are some examples of where we are going, in addition to the inclusion of health-promoting strategies within Streetsmart.

Where can we find evidence-based best practices, implementation resources, and learn each other’s language at the same time?
Streetsmart is designed to synthesize the research, connect practitioners to resources, and provide a space where we can all “get on the same page.”

How do we institutionalize the right questions?
While there are many ways to do this, Streetsmart is designing questions into the interface for each strategy and goal to remind users to think about the health and equity consequences, drawing on good work done by others in this space.

Where and how do our disciplines currently intersect and interact?
Certainly, there are good conferences and research partnerships that are bridging the divide. However, we lack a collaborative space for these professionals to ask questions and get advice on a day-to-day basis. Practitioners have their own community of practice within the field—the question is where to do people go for questions outside their discipline? For this reason, Streetsmart started three related listservs, evidently titled, Ask an Engineer, Ask a Planner, and Ask a Public Health Professional. Here a planner can ask an engineer a question about the basis for a standard, for example, or an engineer can ask a public health professional for documentation of health effects.

We believe that having a place where all three professions can convene and learn from one another is really valuable—where practitioners can learn about the languages, approaches, and constraints within which their colleagues work. After all, we are all partners in building healthier streets and communities—we just have different tools for the job.