Online TDM Encyclopedia - Health and Fitness

Health and Fitness

Strategies That Improve Public Health Through Physical Activity

~~~~~~~~~~~~~~

Victoria Transport Policy Institute

~~~~~~~~~~~~~~~~~~~~

Updated 25 January 2010

This chapter discusses ways to improve public fitness and health by more active transportation, including walking, cycling, running and skating. Inadequate physical activity is a major contributor to many diseases. Transportation and land use policies that result in even modest increases in aerobic exercise could provide significant health benefits, equal or greater than the benefits of traffic safety programs. Many TDM strategies increase active transportation by improving nonmotorized travel conditions, creating land use patterns that are more suitable for nonmotorized travel, and by encouraging shifts from driving to nonmotorized travel.

Introduction

Transportation facilities and activities can affect health in many ways, including crash risk, physical activity, air and noise pollution impacts, transport related stress, mental health and community cohesion (Litman 2005; Frank, Kavage and Litman 2006). Health objectives (including new ones, such as encouraging physical activity) are becoming more important in transport planning (Davis 2005), although there is still limited integration in transportation analysis and planning, resulting in policies that often conflict. For example, many transportation policies and planning practices, such as generous minimum parking requirements and funding dedicated to roadway improvements that cannot be used for other modes, continue to favor automobile dependency, although that contradicts many health objectives. Transportation Demand Management strategies tend to help achieve health objectives, as well as other planning objectives. This chapter discusses specific transportation-related health objectives and supportive TDM strategies.

Physical Activity and Health

Physical Activity refers to physical exercise. Inadequate physical activity is a major contributor to cardiovascular disease, diabetes, hypertension, obesity, osteoporosis and some cancers (Killingsworth and Lamming 2001). Research by Franco, et al (2005) indicates that moderate physical exercise increases average longevity by 1.3 and 3.7 years in typical middle-age Americans. A sedentary lifestyle ranks second only to smoking as a lifestyle risk for disease and premature death, contributing to more than 10% of all deaths in the United States, representing direct economic costs of $150 billion annually (Surgeon General 1999).

Diseases Associated With Inadequate Physical Activity

· Heart disease

· Hypertension

· Stroke

· Diabetes

· Obesity

· Osteoporosis

· Depression

· Some types of cancer

Even modest increases in physical activity tend to reduce mortality rates for both older and younger adults (Sallis, et al. 2004). Health experts recommend at least 150 minutes of moderate exercise a week in intervals of ten-minutes or more, and additional exercise up to 60 minutes per day of vigorous physical activity appears to provide additional health benefits (Cavill 2001; www.cdc.gov). ICLEI (2003) provides a method for valuing the health benefits of more active transportation. Ball, et al. 2009) describe how Health Impact Assessment (HIA) can be applied to transportation and land use planning.

Center for Disease Control Physical Activity Recommendations (www.cdc.gov/nccdphp/dnpa/physical/recommendations/index.htm)

Adults should:

· Engage in moderate-intensity physical activities for 30-60 minutes on 5 or more days of the week. (Moderate-intensity means that a person feels some exertion but can carry on a conversation comfortably during the activity. Examples include walking briskly, dancing, easy swimming or bicycling on level terrain.)

· Engage in vigorous-intensity physical activity 3 or more days per week for 20 or more minutes per occasion. (Vigorous-intensity physical activity results in a significant increase in heart and breathing rate. Examples include jogging, chopping wood, participating in high-impact aerobic dancing, swimming continuous laps or bicycling uphill.)

Adolescents should:

· Be physically active daily, or nearly every day, as part of play, games, sports, work, transportation, recreation, physical education, or planned exercise.

· Adolescents should engage in three or more sessions per week of activities that last 20 minutes or more at a time and that require moderate to vigorous levels of exertion.

Elementary school-aged children should:

· Accumulate at least 30-60 minutes of age-appropriate and developmentally appropriate physical activity from a variety of activities on all, or most, days of the week.

· An accumulation of more than 60 minutes, and up to several hours per day, of age-appropriate and developmentally appropriate activity is encouraged.

· Some of the child’s activity each day should be in periods lasting 10 to 15 minutes or more and include moderate to vigorous activity. This activity will typically be intermittent in nature, involving alternating moderate to vigorous activity with brief periods of rest and recovery.

· Children should not have extended periods of inactivity.

The total health costs of inadequate physical activity are greater than those resulting from traffic crashes, although traffic crashes tend to injure and disable people at a younger age than most sedentary lifestyle illnesses and so crash health costs rank relatively high when measured in terms of Potential Years of Life Lost (PYLL) (“Crash Costs,” Litman, 2005). According to a major study by the Harvard University School of Public Health, cardiovascular diseases are the leading causes of premature death and disability in developed countries, causing ten times as many lost years of productive life as road crashes (Murray 1996, Table 2). Even modest reductions in these illnesses could provide even greater overall health benefits than large reductions in traffic crashes.

There are many ways to be physically active. Some people play sports or exercise regularly in a gym, but these cost money and require special time and effort, so most people will not participate in such activities regularly over their full lifetime (Sevick, et al. 2000). Walking is the most popular form of physical activity, and many experts believe that more Nonmotorized Transportation (Walking and Bicycling, and their variants such as Wheelchairs and Small Wheeled Modes, also called Active Modes and Human Powered Transport) is the most practical and effective way to improve public fitness. One major study concluded, “Regular walking and cycling are the only realistic way that the population as a whole can get the daily half hour of moderate exercise which is the minimum level needed to keep reasonably fit” (Physical Activity Task Force 1995). Health experts recommend that people walk 10,000 steps or about 5 miles per day for basic physical fitness.

Active transportation is declining in most industrialized countries. Table 1 indicates changes in walking and cycling recorded by the U.S. National Personal Transportation Surveys between 1977 and 1995. Although cycling increased slightly, walking, which is much more common, declined by more than 40%. Similar patterns have occurred in most other countries.

Table 1 Personal Trips By Active Modes (NPTS)

	1977	1983	1990	1995
Walk	9.3%	8.5%	7.2%	5.5%
Bicycle	0.6%	0.8%	0.7%	0.9%
Total	9.9%	9.3%	7.9%	6.4%

Inadequate physical activity is often viewed as an individual problem (“fat people are lazy”), but public policies and design factors can also have significant effects on the amount of physical activity that occurs in a community (Sallis, et al., 2004). Current transportation and land use patterns tend to create barriers to walking and cycling (Evaluating Nonmotorized Transportation). Research summarized by Jackson and Kochtitzky (2001) and Killingsworth (2003) indicate that Automobile Dependency and urban sprawl can be considered a health risk, while more balanced transportation systems and TDM programs can contribute to improved public health.

Communities with suitable conditions have much higher levels of walking and cycling (Land Use Impacts on Transportation). Ewing, et al., (2003) found an association between sprawl and health risks including less physical activity, increased obesity and increased hypertension. Frank, Andersen and Schmid (2004) found that each quartile increase in land-use mix (number of non-residential destinations within one kilometer of each house) is associated with a 12.2% reduction in the likelihood of obesity. Each additional hour spent in a car per day was associated with a 6% increase in the likelihood of obesity. Conversely, each additional kilometer walked per day was associated with a 4.8% reduction in the likelihood of obesity.

A study by Sung, Park and Kim (2009) found that commuters who switching from automobile to walking or cycling for eight weeks experienced significantly reduced lower blood pressure, improved lung capacity, and improved cholesterol counts. It estimated that commuters who use active modes achieve annual health and fitness benefits worth an average of 2.2 million Korean Won (about $2,000). They found that incorporating these values into transportation policy and project evaluation significantly affected outcomes, resulting in higher values for policies and projects that increase active transportation among people who otherwise achieve less than 150 weekly minutes of physical activity.

Some researchers argue that there is little empirical evidence that automobile-dependent land use patterns are unhealthy, pointing out that in the U.S., residents of suburbs tend to be fitter than urban residents (Schwartz 2002; Utt 2003), but such aggregate analysis indicates little about potential fitness and health benefits that could occur if urban and suburban residents were more physically active. In an international comparison of travel patterns and health impacts, Pucher and Dijkstra (2003) found that cyclists in the Netherlands and Germany have lower per mile and per trip crash injury rates, and that residents of countries with higher rates of walking and cycling have much lower rates of obesity, diabetes and hypertension than in the U.S. For example, residents of the Netherlands, Denmark and Sweden have obesity rates only a third of those in the U.S., and Germany’s is only half as high; residents of these four European countries live an average of 2.5 to 4.4 years longer while spending half as much on health care as in the U.S.

Research by Sturm (2005) found that, accounting for demographic factors such as age, race/ethnicity, educational achievement and income, the frequency of self-reported chronic medical conditions such as asthma, diabetes, hypertension and cancer increased with sprawl. On average there are 1,260 reported chronic medical conditions per 1,000 population. A 50-point change from more to less sprawling cities is associated with 96 fewer conditions. Shifting from a very sprawled region such as San Bernardino, California to a less sprawled region such as Boston, Massachusetts would result in a reduction of 200 chronic medical conditions per 1,000 population, a 16% reduction. This effect appears to be particularly strong for the elderly and lower-income people. Increased street connectivity is significantly associated with reductions in hypertension and heart disease, apparently reflecting the increased walking that results.

Besser and Dannenberg (2005) used the 2001 National Household Travel Survey to analyze the amount of walking associated with public transit trips, and factors that affect this activity. They found that Americans who use public transit on a particular day spend a median of 19 daily minutes walking to and from transit, and that 29% achieve the recommended 30 minutes of physical activity a day solely by walking to and from transit. In multivariate analysis, rail transit, lower-income, age, minority status, being female, being a nondrivers or zero-vehicle household, and population density were all positively associated with the amount of time spent walking to transit.

The Travel Smart TDM program in Perth, Australia has reduced automobile use by 14% and increased active transportation by 20% (www.dpi.wa.gov.au/travelsmart). A major study found that people who regularly commute by bicycle have a 40% reduction in mortality compared with people who do not cycle to work, which suggests that the incremental risks of bicycle transportation are far outweighed by health benefits, at least for experienced adult cyclists riding in a bicycle-friendly community (Andersen, et al, 2000). Another study concludes that heart disease would decline 5-10% if one-third of short trips shifted from driving to bicycling or walking (BAC 1995).

The health benefits of Nonmotorized Facilities such as paths and sidewalks extend to all sectors of society including the elderly and the disabled, not just people who run or cycle for exercise. Recreational walking and cycling are among the most common forms of physical exercise. Most cycling and walking takes place on public roads. This suggests that there are justifications to fund Pedestrian and Cycling improvements through both transportation and recreation budgets.

Although traffic safety is widely recognized as an important objective in conventional transportation planning, increased physical activity is not. Most planners consider it desirable to accommodate walking and cycling where there is demand, but not at the expense of motorized modes. Recognizing increased physical activity as a transportation planning goal would give greater emphasis to projects that improve nonmotorized travel conditions, and policies that encourage shifting from automobile travel to walking, cycling and transit, since most transit trips include nonmotorized links.

World Health Organization Charter on Transport, Environment and Health

www.who.dk/London99/transport02e.htm

Physical Activity

Lack of physical activity is one of the major risk factors for coronary heart disease, which is the leading cause of mortality in Europe. On the other hand, walking and cycling as daily activities can promote health by providing physical activity, decreasing noise, and air pollution.

The health benefits of regular physical activity can be summarized as:

50% reduction in the risk of developing coronary heart diseases (i.e. a similar effect to not smoking).

50% reduction in the risk of developing adult diabetes.

50% reduction in the risk of becoming obese.

30% reduction in the risk of developing hypertension. 10/8 mm Hg decline in blood pressure in hypertensive subjects (i.e. a similar effect to that obtained from antihypertensive drugs).

Other effects include reduced osteoporosis, relief of symptoms of depression and anxiety, and the prevention of falls in the elderly.

A total of 30 minutes’ brisk walking or cycling on most days of the week, even if carried out in 10–15 minute episodes, is effective in providing these health benefits.

The average trip by walking in Europe is about 1.5 km and the average cycling trip is about 3.5 km, each taking about 15 minutes to make: two such trips each day would be enough to provide the recommended “daily dose” of physical activity.

Psychosocial Effects

Certain patterns of transport have a broad range of effects on mental health, including risk-taking and aggressive behaviors, depression, and post-traumatic psychological effects of crashes.

High levels of traffic can cause social isolation and limit interpersonal networks of support, factors which have been found to be associated with higher mortality and morbidity in the elderly.

Children who have the opportunity of playing unhindered by street traffic and without the presence of adults have been found to have twice as many social contacts with playmates in the immediate neighbourhood as those who could not leave their residence unaccompanied by adults due to heavy traffic.

The fear of collisions is reported by parents as being the main reason for taking children to school by car. This hinders the development of children’s independence and reduces their opportunities for social contact. It also has an influence on children’s attitudes towards car use and personal mobility in adulthood.

The lack of physical activity, including walking and cycling, is associated with mental ill health, including depression.

Traffic Risk

In many situations, nonmotorized travel has a higher per mile crash rate than motorized travel (Traffic Safety). In the United States, pedestrian fatalities are 36 times higher, and bicycling fatalities are 11 times higher, than car occupant fatalities per km traveled. This additional risk can be minimized, however, as shown by much lower fatality rates in The Netherlands and Germany (Pucher and Dijkstra, 2000). Pedestrian fatalities per billion km walked are less than a tenth as high, and bicyclist fatalities are only a quarter as high, das in the United States.

Changes in individual pedestrian and bicyclist behavior can also reduce current crash risk. A combination of improved cycling skills, increased helmet use, improved night lighting, and reduced drunk cycling and driving could reduce bicyclist fatality rate per mile by half or more. Traffic Calming and appropriate Nonmotorized Planning can reduce risk further.

Bicycle Fatality Reduction Strategies

Based on American Society of Civil Engineers’ Human Powered Transport Subcommittee analysis of bicyclist behavior and additional sources. Risk factors overlap and are therefore not cumulative.

Potential Fatality Reduction

1. Teaching riders to avoid common mistakes. 50% or more.

2. Helmet use. 40% to 50%

3. Eliminating intoxicated bicyclists. 16% or more

4. Eliminate intoxicated automobile drivers. 16%

5. Enforcing nighttime lighting requirements. 10% or more

6. Teaching motorists to share the road with bicyclists. 5% or more

7. Infrastructure improvements. Significant

Based on this analysis, a responsible bicyclist who follows traffic rules is estimated to have a per trip crash fatality rate approximately equal to that of non-interstate automobile occupants, and poses a minimal accident risk to other road users, resulting in a reduction in overall fatalities compared with motor vehicle driving. Walking can have even lower risks. There is no evidence that shifting travel from driving to non-motorized travel is a public health risk, especially if safety education and facility improvements are provided.

Demand for Active Transportation

There appears to be significant latent demand for nonmotorized travel. That is, people would walk and bicycle more frequently if they had suitable facilities and resources. A U.S. survey found that 17% of adults claim they would sometimes bicycle commute if secure storage and changing facilities were available, 18% would if employers offered financial incentives, and 20% would if they had safer cycling facilities (Bicycling Magazine, 1991). Table 2 summarizes a recent Canadian public survey indicating high levels of interest in cycling and walking.

Table 2 Active Transportation Survey Findings (Environics, 1998)

	Cycle	Walk
Currently use this mode for leisure and recreation.	48%	85%
Currently use this mode for transportation.	24%	58%
Would like to use this mode more frequently.	66%	80%
Would cycle to work if there “were a dedicated bike lane which would take me to my workplace in less than 30 minutes at a comfortable pace.”	70%
Support for additional government spending on bicycling facilities.	82%

Appropriate facilities and roadway improvements for walking and cycling (sidewalks, crosswalks, multi-use paths, bike lanes, traffic calming) can increase nonmotorized travel. One study found a significant increase in walking activity and willingness to allow children to exercise outdoors after a Traffic Calming program was implemented in an urban neighborhood (Morrison, Hilary Thomson and Mark Petticrew, 2004). Residents of communities that have suitable walking and cycling conditions use nonmotorized modes more for both recreation and transportation than communities that do not (Land Use Impacts on Transportation). One study found that each mile of bikeway per 100,000 residents increases bicycle commuting 0.075 percent, all else being equal (Nelson and Allen, 1997). This indicates that such facilities provide consumer benefits.

Strategies that Encourage Physical Activity

A variety of urban design features and programs can encourage use of active transportation.

Nonmotorized Transportation Improvements

Nonmotorized Transportation Planning, Pedestrian Improvements and Bicycle Improvements help create facilities and travel conditions that are more suitable for active transportation. Public trail development can be particularly important for encouraging nonmotorized transportation and recreation (Rail-to-Trails Conservancy).

Nonmotorized Encouragement

Nonmotorized Transportation Encouragement programs include a variety of activities to support and encourage use of active transportation, and increase the number of people using these modes. These can be supported by TDM Marketing programs.

Traffic Calming

Traffic Calming includes a variety of roadway design features that reduce vehicle traffic speeds and volumes. This tends to create roadway conditions that are safer and more comfortable for walking and cycling.

Car-Free Planning and Vehicle Restrictions

Comprehensive Car-free Planning and Vehicle Restrictions can improve nonmotorized accessibility and encourage active transportation. Campus Transportation Management can be a way to create and improve Car-Free areas in campus areas.

Land Use Management Strategies

Land use management strategies such as New Urbanism and Smart Growth are the basis for creating more Accessibility communities with attractive, walkable neighborhoods. These land use patterns can increase walking and cycling (Land Use Impacts on Transportation).

Street Reclaiming

Street Reclaiming is a process for increasing the social, cultural, recreational and economic activity in neighborhood streets. It involves reducing vehicle traffic volumes and speeds, and creating more attractive street environments, to encourage interaction and increase residents’ involvement in their community.

Universal Design

Universal Design refers to pedestrian facility designs that accommodate the widest range of potential users, including people with disabilities and other special needs. Universal Design supports accessibility, and encourages active transportation, particularly by people with physical disabilities who often have difficulty obtaining exercise. Improved accessibility can provide significant health and emotional benefits to people with physical disabilities (Jackson and Kochtitzky, 2001).

School Transport Management

School Transport Management encourages parents, students and staff to reduce automobile trips and use alternative modes for travel to and from schools. This improves walking and cycling conditions and encourages active transportation.

Address Security Concerns

Efforts to Address Security Concerns faced by pedestrians and cyclists can help increase active transportation.

Transit Improvements

Transit and nonmotorized transportation are complementary transportation modes: most transit trips involve walking or cycling links, and pedestrians and cyclists often rely on public transit to travel longer distances. Travel surveys indicate that the average walking distance involved in a transit trip is five to ten times longer than the average walking distance of an automobile trip. Transit Oriented Development can be a catalyst for more pedestrian-oriented land use patterns.

Designing Buildings To Favor Walking

Some new buildings are specifically designed to encourage walking, specifically use of stairs rather than elevators (Naik, 2005).

New Buildings Help People Fight Flab

Gautam Naik, The Wall Street Journal, November 16, 2005

In July 2007, when students of Virginia Commonwealth University attend classes in a redesigned business-school building, they'll face a new hurdle: a staircase. Most of the 3,000 students now at the Richmond, Va., business school take elevators to reach classrooms. But in the new structure, the elevators will be especially slow-moving. They will also be tucked away at the rear, while the atrium will feature a prominent set of stairs – 28 to get to the second floor, and a total of 76 to get all the way up to the fourth floor.

A key reason for the new design: keeping faculty and students fit.

“Clients are making a conscious decision to promote physical activity” in the workplace, says Philip Dordai, an architect at Hillier Architecture of Princeton, N.J., which is designing the new VCU business-school building and has also been involved in other, similar projects.

Buildings have long been designed so people can get from one place to another with minimum physical effort. Now, in a bid to fight a rising tide of obesity, companies, universities and other institutions are embracing the opposite idea: buildings that force employees to move around a lot more.

At the California Department of Transportation's new district headquarters in Los Angeles, elevators stop on every third floor -- an inducement for those who can to use the stairs. (There's a separate elevator for the disabled.) Phone giant Sprint Nextel Corp.'s corporate campus in Overland Park, Kan., has pathways and a covered arcade, to encourage employees to walk even in inclement weather.

Health-related design has growing appeal for some of the biggest users of real estate -- companies that rent office space. When architects were designing a lab for Swiss pharmaceutical giant Novartis AG in San Diego, they had the option to build an enclosed corridor linking the five buildings. Instead, they constructed an outdoor, shaded walkway. Not only has this provided more indoor space for the labs, but the idea of a walk outside on a nice day (almost every day in San Diego) encourages employees to meet and spontaneously interact -- an outcome that scientific-research firms and universities are keen to promote.

To see if he could persuade people to use stairs instead of elevators, Luuk Engbers, a human-movement scientist at the VU University Medical Center in Amsterdam, last year began a 12-month experiment in a seven-story office building in The Hague. At the entrance, he printed footprints on the floor that led toward the staircase. Stickers on the elevator cheekily asked would-be passengers how long they had been waiting -- and exhorted them to walk up and lose some calories instead. The staircase itself was lined with health-related posters and special mirrors that made people look slim. “We wanted to make them look better than they do in an elevator mirror,” explains Mr. Engbers.

Employees at a similar building nearby were studied as a control group. The result: People in the first building took the stairs twice as much, and covered more floors with each use, than those in the control building.

Even small steps can yield a worthwhile benefit. James Sallis, a professor of psychology at San Diego State University, estimates that climbing up stairs for just two minutes a day lets a person burn an extra 5,800 calories, or 1.6 pounds, a year. In theory, that should wipe out the average weight gain of one pound per year for Americans, based on data collected for the years 1990-2000, by the U.S. Centers for Disease Control and Prevention in Atlanta.

Walking up the stairs to their office may be all the exercise many employees ever get. Leisure-time physical activity in the U.S. increased in the late 1990s but then remained at the same level before dropping in 2004. The percentage of American adults who engaged in regular leisure-time physical activity fell to 30.2% in 2004 from 32.8% the previous year, according to the CDC survey.

Barbara Hansen, a 51-year-old technical writer working at Sprint Nextel's Overland Park corporate campus, weighed 256 pounds in March 2004. Her job requires her to sit for hours at a time in front of a computer. But today, Ms. Hansen weighs 196 pounds – 60 pounds lighter. Her blood pressure has returned to a normal level, and she no longer takes Crestor, a cholesterol-reducing drug.

Ms. Hansen attributes her weight reduction to healthier eating, regular visits to a fitness center and plenty of walking -- thanks to the design of Sprint's large campus. Employees are encouraged to bike or jog during their lunch hour; the stairwells are brightly lit and hung with paintings; the elevators are a little slower than usual. Ms. Hansen says she now climbs the stairs everyday to her office, five floors up.

Shifting Road Space From Automobile to Nonmotorized Modes

Converting vehicle traffic lanes to cycling lanes and wider sidewalks can improve nonmotorized travel conditions and shift travel from motorized to nonmotorized modes.

Neural Aging Walks Tall: Aerobic Activity Fuels Elderly Brains, Minds

Science News Online (www.sciencenews.org/20040221/fob1.asp), 21 Feb. 2004, by Bruce Bower.

Seniors interested in pumping up their brains and maintaining an attentive edge might consider taking this inexpensive prescription: Go for a walk every 2 or 3 days. Don’t sweat it, but make an effort. Limit each walk to between 10 and 45 minutes.

That’s the conclusion, at any rate, of two new studies that demonstrate for the first time in people that physical fitness, whether achieved on one’s own or through a brief aerobic-training course, induces brain changes associated with improved performance on an attention-taxing task.

“Even moderate cardiovascular activity of the sort that is within reach of most healthy older adults results in improved neural functioning and may help to extend or enhance independent living,” says neuroscientist Arthur F. Kramer of the University of Illinois at Urbana-Champaign. Kramer directed the new studies with his colleague Stanley J. Colcombe.

Prior research showed that mice score higher on tests of learning, memory, and attention after regularly exercising on a running wheel for several weeks. In the animals, this training boosts the brain’s blood supply, increases connections between neurons, and promotes the development of new brain cells.

Moderate exercise works similarly in people, Kramer and Colcombe’s team reports in an upcoming Proceedings of the National Academy of Sciences. The scientists first assessed physical fitness in 41 older adults, ages 58 to 77, after each walked 1 mile. Participants then performed an attention task in which they viewed arrays of five left-or-right-pointing arrows and used computer keys to indicate whether the central arrow pointed left or right.

During testing, a functional magnetic resonance imaging (fMRI) scanner measured the rate of blood flow in specific regions of each volunteer’s brain.

Adults identified as particularly fit made judgments about the arrows faster and with equal accuracy compared with their less-fit peers. Moreover, the fMRI data show that highly fit seniors exhibited intense blood flow in frontal-brain areas implicated in allocating attention and minimal neural activity in a frontal region that usually perks up in situations of indecision.

In a second study, 15 elderly volunteers accomplished attention tasks markedly faster after completing a 6-month aerobic-training course than they had before the course started. Participants gradually built up to walking for 45 minutes at a moderate pace three times each week. By the end of the study, these volunteers’ brain activity resembled that of highly fit seniors in the first study.

In contrast, 14 seniors who completed a 6-month course of stretching and toning exercises, but not aerobic exercise, showed little improvement on the attention task. Their brain activity was similar to that of less-fit seniors in the first study.

Colcombe and Kramer’s studies are “an impressive achievement,” remarks psychologist Timothy Salthouse of the University of Virginia in Charlottesville. Further research should examine whether aerobic training enhances seniors’ performance on other psychological tasks and whether such improvements confer any advantages in daily life, Salthouse says. Kramer and his colleagues are now testing whether aerobic training might improve seniors’ driving skills.

Healthy Community Design

The table below summarizes a list of indicators that can be used to evaluate the degree that transportation and land use planning decisions help achieve various health objectives.

Table 3 Transport and Land Use Health Indicators (Lawrence Frank & Company 2008)

	Physical Activity	Air Pollution	Physical Activity	Mental Health	Water Pollution	Noise
Residential Density: Works at many scales; easy to calculate. A net density (dwelling units or population per acres of residential land) measure is the most accurate measure.	X	X			X	X
Employment Density: Requires employment data to calculate. Again, a net measure of employment density will create a more accurate picture.	X	X
Land Use Mix: Can be complex to calculate, but a number of valid measures have been used in the literature	X	X
Retail Availability: Simple measure to calculate (number of retail parcels within 1 km), but fewer research results connecting this measure to the outcomes.	X	X
Retail F.A.R.: Standard land use code measure; can be complex to calculate from parcel land use data.	X	X
Street Connectivity: Requires street network analysis in GIS – can be calculated as a measure of intersection density (# of intersections per acre)	X	X
Access to parks/recreational facilities: Percent of population within 1 km walking (network) distance of park / recreational facility	X			X
Access to healthy food: May be difficult to operationalize; depends on land use data available.	X
Access to transit: Percent of population within 1 km walking (network) distance of transit.	X	X		X		X
Transit Level of Service: Specific measure used depends on available data; measuring transit travel time to major centers in comparison with drive time is one of the most robust ways to operationalize this concept. Transit LOS has not been connected to health outcomes in the literature, but it is connected to transit use.
Intermodal Connectivity: Measures the ease of transfer between modes; this measure has not been connected to health and wellness outcomes, but logic dictates that it could encourage transit and active transport modes.
Provision of sidewalks/bikepaths: Data availability sometimes limited.	X		X
Pedestrian crash risk: Crash risk should be measured as a ratio of number of pedestrian crashes to traffic volume. It requires accident location data to calculate.	X		X
Proximity to high-traffic roads or freeways: Avoid sensitive uses within 500 ft (about 150 m).		X				X
Proximity to gas stations: Avoid sensitive uses within 300 feet (about 90 m) for a large facility; 50 feet (15 m) for a standard one		X				X
Proximity to rail yards: Avoid sensitive uses within 1,000 feet (about 300 m); mitigate up to a mile (1600 m)		X				X
Proximity to Gravel Extraction Plant: Avoid sensitive uses less than 800 meters away.		X		X	X
Proximity to Landfills: Avoid sensitive uses within 450 metres of working face of the landfill, or within 300 metres of the disposal area of an operating or non-operating landfill.		X
Aesthetics: May include elements such as building design, landscaping and availability of amenities such as benches and lighting. May be difficult to operationalize, data availability typically limited.	X			X
Crime activity: If data is available, can measure location and/or severity of crimes; may be used as a quality of life measure.	X			X
EMT response times: With changes in urban form, it will be necessary to maintain EMT response times. Response times can also be used as an overall quality of life measure – although they are not connected to any of the outcomes discussed in this report, EMT response time has an obvious and direct connection to mortality.

This table summarizes indicators that can be used to evaluate how various transport and land use planning factors affect specific health objectives.

Below is a list of specific planning practices that help create healthier communities:

· Strategic planning. Is there a comprehensive community vision which individual land use and transportation decisions should support?

· Self-contained community. Are common services such as shops, medical services, transit service, schools and recreation facilities located within convenient walking distance of houses and each other? Is there a good jobs/housing ratio within a 2-mile radius?

· Walkability. Do streets have sidewalks? Are sidewalks well designed, maintained and connected, and suitable for people using wheelchairs and pushing strollers and carts? Are streets easy to cross, even by people with disabilities?

· Cycling. Are there adequate bike paths, lanes and routes? Are there cycling skills training and law enforcement programs? Are there bike racks and changing facilities at worksites?

· School access. Are most children able to walk or bicycle to school? Are walking and cycling condition around the school adequate. Are there programs to improve walking and cycling, and encourage use of alternative modes for travel to school?

· Mixed income communities. Are there a mix of housing types and prices, allowing lower income and disabled people to live in the community? Are there programs to insure affordable housing is located in accessible, multi-modal areas where residents can easily walk to public services such as stores, medical clinics and transit stops?

· Sense of place. Does the community have a strong sense of identity and pride? Does the neighborhood have a name?

· Transit service quality. Does the neighborhood have high quality public transit, with more than 20 buses or trains a day (less than half-hour headways) and little crowding during peak periods?

· Parking management. Are parking requirements flexible, so developers and building managers can reduce their parking supply in exchange for implementing a parking management program?

· Roadway and walkway connectivity. Are streets and paths well-connected, with short blocks and minimal cul-de-sacs. Are streets as narrow as possible, particularly in residential areas and commercial centers. Are traffic management and traffic calming to control vehicle impacts.

· Complete streets. Are streets designed to accommodate walking, cycling and public transit, and comfortable and convenient for activities such as strolling, playing, shopping, sightseeing, eating and special events?

· Site design and building orientation. Are buildings to be oriented toward city streets, rather than set back behind large parking lots?

· Transportation demand management. Are TDM strategies and programs implemented to the degree that they are cost effective? Do employers have incentives to implement commute trip reduction programs? Is there a local transportation management association?

· Greenspace. Are there efforts to preserve greenspace, particularly wild areas such as streams, shorelines and forests?

To help consumers, real estate professionals and planning practitioners apply these concepts the Healthy Location Index below indicates the degree to which a particular site or neighborhood reflects healthy community planning principles.

Table 4 Healthy Community Index Calculations

Feature	How to Calculate	Points
Sidewalks on block	No (0 points) Yes (10 points)
Portion of local streets with sidewalks.	Range from 0 points for no street within ½ kilometer have sidewalks up to 10 points for all streets have sidewalks.
Portion of local streets and paths that accommodate wheelchairs.	Range from 0 points for no street within ½ kilometer with sidewalks that accommodate wheelchairs, up to 10 points for all streets with sidewalks that accommodate wheelchairs.
School walkability	10 minus number of minutes required for a child to walk safety to school. 0 if walking to school is not feasible for a typical child.
Cycling conditions	Portion of streets within 1 kilometer that safely accommodate bicycles, rated from 0 to 10.
Neighborhood service destinations	One point for each of the following located within ½ kilometer convenient walking distance, up to 10 maximum: grocery store, restaurant, video rental shop, public park, recreation center, library.
Public transit service quantity	Number of peak period buses per hour within ½ kilometer, up to 10 maximum.
Public transit service quality	Portion of peak-period transit vehicles that are clean and comfortable from 0 (all vehicles are dirty or crowded) up to 10 (all vehicles are clean and have seats available).
Local traffic speeds	Portion of vehicle traffic within 1-kilometer that have speeds under 40 kilometers per hour, from 10 (100%) to 0 (virtually none).
Air Pollution	10 minus one for each exceedance of air quality standards.
	Total

This table summarizes the calculation of the Healthy Community Index, which can range from 0 (unhealthy location) to 100 (healthy location). It reflects various neighborhood design factors that affect residents’ health.

Case Studies

The Active Living by Design website (www.activelivingbydesign.org), and Edwards and Tsouros (2008) provide numerous case studies of local programs that encourage healthier and more active transportation.

The Road to Obesity or the Path to Prevention: Motorized Transportation and Obesity in China, Obesity Research (www.obesityresearch.org), Vol. 10, 2002, pp. 277-283.

By A. Colin Bell, Keyou Ge and Barry M. Popkin

Abstract: Dependence on motorized forms of transportation may contribute to the worldwide obesity epidemic. Shifts in transportation patterns occurring in China provide an ideal opportunity to study the association between vehicle ownership and obesity. Our objective was to determine whether motorized forms of transportation promote obesity.

A multistage random-cluster sampling process was used to select households from eight provinces in China. Data were included on household vehicle ownership and individual anthropometric and sociodemographic status. Cross-sectional data (1997) from 4741 Chinese adults aged 20 to 55 years were used to explore the association between vehicle ownership and obesity. Cohort data (1989 to 1997) from 2485 adults aged 20 to 45 years in 1989 (59% follow-up) were used to measure the impact of vehicle acquisition on the odds of becoming obese.

Our main outcome measure was current obesity status and the odds of becoming obese over an 8-year period. In 1997, 84% of adults did not own motorized transportation. However, the odds of being obese were 80% higher (p < 0.05) for men and women in households who owned a motorized vehicle compared with those who did not own a vehicle. Fourteen percent of households acquired a motorized vehicle between 1989 and 1997. Compared with those whose vehicle ownership did not change, men who acquired a vehicle experienced a 1.8-kg greater weight gain (p < 0.05) and had 2 to 1 odds of becoming obese.

Encouraging active forms of transportation may be one way to protect against obesity.

Evaluating Cascadia Health (Sightline, 2006)

The report Sprawl & Health In The Northwest (www.sightline.org/research/cascadia_scorecard/res_pubs/cs2006), evaluates the effects of land use and transportation patterns in Washington, Oregon, Idaho and British Columbia. The analysis indicates that:

· Cities are safer than suburbs when it comes to car collisions, which are the leading cause of death for northwesterners under the age of 50. Residents of sprawling communities drive more and are at a higher risk of being in a fatal accident than those who live in denser neighborhoods.

· Residents of compact, walkable communities are less likely to be obese and suffer from related diseases and chronic illnesses. One in five residents of the Northwest states is obese.

· Simple steps to make walking and physical activity a part of daily life and to reduce driving can help save the region billions of dollars in medical costs, lost productivity and wages from car fatalities, obesity, and related illnesses.

Healthy Community Evaluation (www.euro.who.int/document/E91883.pdf)

The report, A Healthy City Is An Active City: A Physical Activity Planning Guide (Edwards and Tsouros, 2008) includes various checklists that can be used to evaluate how well a particular community accommodates and encourages active transportation (walking and cycling) and other healthy community features.

Regional Differences in Obesity (Stats Canada, 2006)

The report Regional Differences in Obesity is based on actual measurements of height and weight from the 2004 Canadian Community Health Survey. The study examines obesity and overweight individuals inside and outside census metropolitan areas (CMAs). Overall, 20% of CMA residents aged 18 or older were obese in 2004, compared with 29% of those who lived outside a CMA. The national average for obesity was 23%.

Furthermore, as the size of the city increased, the likelihood of being obese fell. In CMAs with a population of at least 2 million (Toronto, Montréal and Vancouver) only 17% of adults were obese. The comparable figure for CMAs with a population of 100,000 to 2 million was 24%. In urban centres with populations of 10,000 to 100,000, 30% of adults were obese.

The report examined whether low obesity rates in the largest cities could be explained by the tendency of immigrants to settle in these areas, given that immigrants are less likely than people born in Canada to be obese. However, the relatively low prevalence of obesity in large cities persisted, even when immigrant status and the number of years since immigrating were both taken into account.

Tired, Headachy and Cranky? Blame the Commute

Long Hours On The Road Are Taking A Toll On More Than Our Cars. Women Are Especially Hard-Hit.

By Eric M. Weiss, Washington Post, April 16, 2007

For seven years, Gail Ennis has been spending as many as three hours a day behind the wheel of her Subaru, commuting between her law office in Washington and her home on Gibson Island, Md. What she's gotten out of the 100-mile daily round trip is sciatica — a shooting pain down one leg — and a lack of time for exercise. “It’s just too much and getting worse every year,” Ennis said.

Besides taking time away from family, a long commute can be harmful to your health. Researchers have found that hours spent behind the wheel raise blood pressure and cause workers to get sick and stay home more often. Commuters have lower thresholds for frustration at work, suffer more headaches and chest pains, and more often display negative moods at home in the evenings. Carpool passengers deal with what they call "Mustang neck" or "Beetle neck" — from the contortions they make to wedge themselves into the back seats of certain cars.

In cities where grueling commutes are a way of life, drives can be as much as an hour each way on a good day — and there aren't many good days. As a consequence, more drivers will probably suffer the health effects of a commuter lifestyle, researchers and doctors said.

"You tell someone they need to exercise or go to physical therapy, but how can they? They leave at 5 a.m. and get home at 7 or 8 p.m. at night," said Robert Squillante, an orthopedic surgeon in Fredericksburg, Va., who has treated patients for back pain and other commuting related problems.

Constant road vibrations and sitting in the same position for a long time is bad for the neck and spine, he said, and puts special pressure on the bottom disc in the lower back, the one most likely to deteriorate over the years.

Raymond Novaco, a professor at UC Irvine's Institute of Transportation Studies who has researched commuting for three decades, found a correlation between traffic congestion and negative health effects such as higher blood pressure and stress. Novaco's research team measures the blood pressure and heart rate of commuters shortly after they arrive at work and again two hours later. Commuters also fill out detailed questionnaires on their home and work lives. "The longer the commute, the more illness" and more illness-related work absences occur, he said.

"If you're driving an hour-and-a-half each way twice a day for 30 years, the consequences don't catch up with you at 32, they catch up in your 50s," said Jerry Deffenbacher, a professor of psychology at Colorado State University , who uses a computerized driving simulator to test the connection between traffic congestion and anger. "Like smoking, it wouldn't be immediately obvious."

Drivers with multiple route changes are at greater risk, Novaco found after plotting the commutes of his study subjects. "It's a physical strain as well as psychological one," he said. His research showed that long solo commutes are especially tough on women, who generally "had more responsibility for getting family up and running and were significantly more likely to report being rushed to get to work," Novaco said.

Squillante said some of his surgery patients have said the best thing about a back operation was the forced hiatus from their daily commute during recovery. Patients are desperate for solutions and swear by certain types of car-seat pillows or jury-rigged lumbar supports, Squillante said. "There are people who feel they've discovered the miracle pillow," he said, though he knows of no sure-fire solution.

Neighborhood Walkability Contributes to Mental Health (Berke, et al, 2007)

“Neighborhoods may impact male depression: Men who live in walkable areas have fewer symptoms, study says”

Microsoft News, 3 May 2007

Living in a pedestrian-friendly neighborhood may help shield older men from depression, a new study suggests. Researchers found that among 740 older adults living in the Seattle area, men who lived in more walkable neighborhoods tended to show fewer depression symptoms than men from less walker-friendly areas.

The findings, published in the Journal of American Geriatrics Society, are in line with research suggesting that moderate exercise can help battle depression. However, the link between neighborhood "walkability" and lower depression risk was not fully explained by higher exercise levels.

“That tells us that there's something else about the neighborhood itself,” said lead study author Dr. Ethan M. Berke, of the Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire.

One possibility is that these neighborhoods allow older adults to feel more connected to their communities and less socially isolated, Berke told Reuters Health. Walkable neighborhoods have sidewalks, streets with safe intersections, and stores, restaurants and other destinations within a short distance. In their study, Berke and his colleagues found that men who lived in such areas had lower scores on a standard measure of depression -- even with other factors, like overall health, income and exercise habits, taken into account.

The same was not true of women, but the reason for this is not clear. Men are less likely than women to seek care for depression symptoms, which may leave them more vulnerable to environmental factors that worsen depression. Women may also have other forms of social support that buffer them from the effects of living in a less-walkable neighborhood.

The study findings do not prove that a person's neighborhood changes his depression risk, Berke pointed out. But if pedestrian-friendly neighborhoods do offer depression protection, that would be important for older adults who are deciding where to live after they retire, he said. It could also mean that more senior centers and assisted living facilities should be built in walkable neighborhoods.

Suburban sprawl is often seen as an environmental issue, Berke noted, but recent studies are pointing to possible effects on people's health as well. Some research has linked suburban living, with its reliance on cars and, often, lack of sidewalks, to a higher risk of obesity. “Hopefully,” Berke said, “we'll start looking at neighborhood design as a public health issue.”

Walk For Your Life (Demers, 2006)

Marie Demers’s book Walk For Your Life! Restoring Neighborhood Walkways To Enhance Community Life, Improve Street Safety and Reduce Obesity, provides an excellent introduction to issues related to why and how to increase nonmotorized transportation. It can help planners and policy makers understand the importance of increased walking and cycling, help health professionals understand how this can be done, and encourage individuals to take more steps each day. The writing is interesting and personal, with numerous quotes and facts (did you know that obesity is spreading to pets: she claims that the portion of pets that are overweight increased from 15% a decade ago to 40%, resulting in diabetes, hypertension and cardiac problems), and includes detailed references and an extensive list of information resources.

The book discusses various reasons that individuals and communities should improve walking conditions and encourage walking activity, and describes various ways of doing this. It emphasizes public health (particularly reduced obesity and increased physical fitness), community livability (including community cohesion) and personal enjoyment benefits, as well environmental and equity benefits. It describes various policy and planning reforms to help create more walkable communities, particularly new urbanism. It is not as technically detailed as some recent academic books, such as Howard Frumkin, Lawrence Frank and Richard Jackson, Urban Sprawl and Public Health: Designing, Planning, and Building For Healthier Communities (2004), but it is more accessible to a general audience.

Transportation Prescription (www.convergencepartnership.org/transportationhealthandequity)

A study by PolicyLink and the Prevention Institute Convergence Partnership evaluates ways that transportation policies affect public health and identifies specific policy reforms that can improve public health and transportation options, particularly in underserved communities.

Walkability and Health

Ray Tomalty and Murtaza Haider (2009) evaluated how community design factors (land use density and mix, street connectivity, sidewalk supply, street widths, block lengths, etc.) and a subjective walkability index rating (based on residents' evaluation of various factors) affect walking and biking activity, and health outcomes (hypertension and diabetes) in 16 diverse British Columbia neighborhoods. The analysis reveals a statistically significant association between improved walkability and more walking and cycling activity, lower body mass index (BMI), and lower hypertension. Regression analysis indicates that people living in more walkable neighbourhoods are more likely to walk for at least 10 daily minutes and are less likely to be obese than those living in less walkable areas, regardless of age, income or gender. The study also includes case studies which identified policy changes likely to improve health in specific communities.

Healthy By Design

by Steve Berg, Star Tribune, Minneapolis/St. Paul

(www.startribune.com/dynamic/story.php?template=print_a&story=5533882),

Published July 31, 2005

Any busy downtown sidewalk will reveal the mystery of why Vancouverites are an uncommonly vigorous and healthy bunch and why their city is so widely admired.

Stand on Robson Street for five minutes on a weekday afternoon. Count the people walking past: 346. Note the number who are obviously overweight: 2. Estimate the number wearing backpacks: 100. Now take another five minutes to count the cars moving steadily and easily past: 74 (plus two trucks and three buses). Reach for your calculator: 4.5 pedestrians for every car.

There you have it. Not exactly scientific proof, but an insight into Vancouver's formula for healthy residents and urban vitality: more walking, less driving.

More than any North American city, Vancouver has intentionally merged public health with city planning. The goal is not just to promote recreation (there are plenty of bike trails and tennis courts), but to design physical activity into the daily routine, to build a city so compelling that people will leave their cars at home, strap on a backpack and take up walking as their primary mode of travel.

The result is a cityscape that's breathtaking in its beauty and impressive in its retail vitality. Thick layers of trees and flowers have invaded the downtown district. Strips of freshly trimmed green grass line many downtown sidewalks. Hundreds of small shops and restaurants have sprouted among the ever-expanding supply of townhouses and high-rise condos. You can take a beautiful and pleasant walk to fetch almost anything you need, so why drive?

Indeed, driving has become the backup mode of downtown travel. Growth in auto traffic has lagged far behind growth in resident population, which has doubled to 80,000 in the last 15 years. Auto traffic actually declined by 13 percent between 1994 and 1999, according to a city government study, while pedestrian traffic rose 55 percent. Last year, vehicle registrations declined for the first time in memory as new residents began eschewing second cars. Transit ridership, meanwhile, rose 20 percent over three years. Air quality improved. And the Vancouver region led Canada in many health categories, including life expectancy.

“They built it and they live it,” said Lawrence Frank, a planning professor at the University of British Columbia and a leading expert on the link between urban design and public health.

Both here, and earlier at Georgia Tech, Frank has been at the forefront of research that ties obesity, hypertension, coronary disease, diabetes and other health problems to the sprawling development and auto dependence that dominates most cities. His and other research conti nues to show that substituting even a modest amount of walking for driving as part of the daily routine reduces the likelihood of obesity and related diseases.

The greatest inducement to physical activity is living within walking distance of shops, transit stops and other destinations, studies show. In other words, urban form can induce a healthier lifestyle.

“Vancouver is the clearest example of that,” Frank said. Critics suggest that self-selection may have tilted his results -- that people who choose to live in active cities tend already to be trim, fit and quite literally “walking the talk.” Frank acknowledges the point, but insists that the policy implications remain valid. People will have a better chance at a healthy life if cities build physical activity into the urban form.

Vancouver owes its health-conscious design to a list of advantages that most cities, including Minneapolis, don't have: a moderate climate, a geography hemmed in by water and mountains, the relative racial harmony among Vancouver's white and Asian ethnic groups, tax policies favorable to renters and small business, a huge flow of Chinese investment since the mid-1990s, and a contrarian strain of politics that engulfed the city in the early '70s and continues to pay dividends.

“Those were the hippie-dippy days,” recalls Gordon Price, an urban planning consultant and former city councilor who says Vancouver succeeds mostly because environmentalists kept freeways out of the city's center.

As a result, traditional neighborhoods stayed intact; local streets stayed vibrant and busy; crime was held in check; public schools and small business remained strong. The city swallowed hard and accepted high-density redevelopment as a way to preserve the wider region's lush environment.

It was, in short, an early version of “smart growth” that ran contrary to the trends of the day and to human nature. It would have been easier just to acquiesce to sprawl, big-box stores and the auto lifestyle, Price said. Vancouver isn't without problems. Vagrants and drug addicts occupy downtown's derelict eastern edge. Housing prices in the tonier West End are leaving the middle class behind. Meanwhile, the outer ring is suffering traffic woes common in most suburbs. But what most impresses a visitor is central Vancouver's extraordinary care for public spaces. While drivers tend not to notice, walkers are drawn to beautiful spaces. They see their city close up. They won't tolerate crumbling, weed-infested sidewalks or shabby neighborhood businesses. The more walkers a city has, the more pleasant, safe and vital it becomes. Every great city is a great walking city -- not only through parks or along waterfronts, but along ordinary streets that link homes and destinations.

For Vancouverites, the values of healthy physical activity, public beauty and retail/residential success seem to have converged in a perfect synapse. How? A greenways program invests $1 million a year to build attractive pedestrian and bicycle links between homes and destinations, sometimes along “ordinary” city streets. In addition, the park system maintains 130,000 street trees as part of its impressive $80 million (U.S.) annual budget, and the zoning ordinance requires private developers to devote 1 percent of construction budgets to public art, thus embedding scores of sculptures, fountains and other artistic features into the walking environment.

Moreover, city planners routinely negotiate generous landscaping commitments from private developers. “They are expected to match the high standard that the city has set with its landscape investments,” said Sandra James, the city's chief greenways planner. The central idea in creating a healthy city, she said, is to make sure that natural beauty isn't confined to parks and the waterfront but that it invades every block. Quoting the preamble to Vancouver's greeways policy book, she said: “It's time to stop thinking of our cities as one place and nature as someplace else.”

Energy and Health (Woodcock, et al, 2007)

An article published in the medical journal, The Lancet examines links between fossil-fuel-based transportation, greenhouse-gas emissions, and health. Transport-related carbon emissions are rising and there is increasing consensus that the growth in motorised land vehicles and aviation is incompatible with averting serious climate change. The energy intensity of land transport correlates with its adverse health effects, including climate change, road-traffic injuries, physical inactivity, urban air pollution, energy-related conflict, and environmental degradation. For the world’s poor people, walking is the main mode of transport, but such populations often experience the most from the harms of energy-intensive transport. New energy sources and improvements in vehicle design and in information technology are necessary but not sufficient to reduce transport-related carbon emissions without accompanying behavioural change. By contrast, active transport has the potential to improve health and equity, and reduce emissions. Cities require safe and pleasant environments for active transport with destinations in easy reach and, for longer journeys, public transport that is powered by renewable energy, thus providing high levels of accessibility without car use. Much investment in major road projects does not meet the transport needs of poor people, especially women whose trips are primarily local and off road. Sustainable development is better promoted through improving walking and cycling infrastructures, increasing access to cycles, and investment in transport services for essential needs. Analysis indicates that increased active transport could help achieve substantial reductions in emissions by 2030 while improving population health. There exists the potential for a global contraction and convergence in use of fossil-fuel energy for transport to benefit health and achieve sustainability.

Traffic Control Health Benefits (http://injuryprevention.bmj.com/content/15/6/369.full.html)

Jacobsen, Racioppi and Rutter (2009) examine the impact of vehicle traffic on levels of walking and bicycling based on a comprehensive review of medical, public health, city planning, public administration and traffic engineering technical literature. The analysis indicates that real and perceived danger and discomfort imposed by traffic discourages walking and bicycling. Although it can be difficult to measure these effects, observed behaviour provides good evidence for these effects, with the strongest association being an inverse correlation between volumes and speeds of traffic and levels of walking and cycling. They conclude that interventions to reduce traffic speed and volume are likely to improve public health by increasing walking and bicycling activity.

'Walk in to Work Out' Campaign (www.dtlr.gov.uk)

The UK Government introduced a “Walk in to Work Out” initiative in 2002 to provide information and encouragement for people wanting to walk or cycle to work. Recent research found that of those who said they had switched some short car journeys to other modes:

· 34% had done so to get more exercise.

· 8% to help the environment.

· 2% to help to reduce congestion.

The “Walk in to Work Out” initiative includes an information pack to help public officials and employers help commuters leave their car at home. The pack includes goal setting, journey planning, and safety information. The pack is based on a successful pilot carried out in Scotland by the Greater Glasgow Health Board, the University of Glasgow and the Health Education Board for Scotland. Research found that the pack was effective in doubling rates of walking to work, and in contributing to improvements in physical and mental health.

The Department of Health recommends that adults should be physically active for 30 minutes a day, on five or more days of the week, to benefit health. The pack shows how walking and cycling to work can help people to reach this target. For example, walking one mile in 20 minutes uses as much energy as swimming for 10 minutes, playing football for 12 minutes or doing aerobics for 16 minutes.

The Walk in to Work Out pack comprises a co-ordinator’s guide, a number of booklets for staff, and some posters. Copies of the pack are available free of charge from DTLR Free Literature, PO Box No 236, Wetherby, Leeds LS23 7NB.

'New Urbanism' Movement Seeks to Help Reverse Obesity Trend
Ted Landphair, Voice of America, 11 May 2003

Health experts are raising alarms about an obesity epidemic in the United States, where 65 percent of Americans are estimated to be overweight. Sedentary TV watching, heavy computer use, oversized meal portions, and a fondness for fast food are blamed for our widening girth. Also cited is the fact that the society is literally driven by the automobile, to the exclusion of much walking or bicycling. But a movement called “new urbanism” could help reverse that trend, by helping to make cities and towns more pedestrian-friendly.

It's easy to say Americans are lazy and gluttonous, but the fact is that many U.S. communities simply are not designed for walking.

“Sprawl, as we've measured it, is related to the probability that someone will be obese, and to high blood pressure,” says Reid Ewing, an urban planning professor at Rutgers University in New Jersey, has just completed a study of the impact of urban sprawl on people's health. “What it seems to be worth, living in a compact environment where you walk as part of your daily routine is about six or seven pounds [about half a kilo of weight].”

By building car-friendly subdivisions with few sidewalks, far from stores and schools and workplaces, Professor Ewing says, Americans have literally engineered some of their own health problems. “About a third of American adults are getting absolutely no exercise at all,” he says.

One solution, he says, is to once again build pleasant, interesting villages with active street life, even within existing cities. There, people can walk to work, stroll past shops, and get some exercise as a part of everyday life.

In Portland, Oregon, a walker-friendly city with a long downtown corridor that's off-limits to automobiles, Ellen Vanderslice heads “America Walks,” a coalition of 50 advocacy groups from around the country. Just as other public-health campaigns have successfully targeted tobacco and food companies, she says, highway builders, home developers, and politicians have become ripe targets for public pressure. “We've seen a tremendous renaissance of our inner cities in the United States. People are finding that the city offers so much in terms of things to do, places to go, and a walkable environment in many cases,” she says. “But now we have this sort of inner ring of suburbs that are wearing out. And we have a tremendous opportunity to take, say, an old shopping center, tremendous areas of land that you might say are land banks because they've been surface parking lots, and build housing there. So we can go back into these older areas that are of a very suburban design, and they can be transformed.”

This was the route taken in Boca Raton, a city on the Atlantic Coast of South Florida, where a run-down, 1970s-vintage shopping mall was turned into a pedestrian-friendly complex of shops, restaurants, parks, apartments, a concert amphitheater, and even museums.

Marketing director Jo Ann Root says the twelve-hectare development, called Mizner Park, features 1920s-style architecture that gives the area a comfortable, old-timey feel. “We find that a lot of the residents who live to the east [between Mizner Park and the ocean] come out at night, and they'll stroll through Mizner Park,” she says. “It's kind of a happening place. I'm a walker myself. There isn't a day that goes by that at lunchtime I'm not walking to the bank, getting my nails done or my hair cut. When you live here or you work here, you kind of have a big extended family. It's a nice feeling.”

But the picture is less serene elsewhere in the American “Sun Belt,” where cities mushroomed, almost overnight. The explosive growth of Charlotte, North Carolina, and Atlanta, Georgia, for instance, was so tied to the automobile that fewer people walk to work there than anywhere else in the country. Charlotte, where fewer than half of the streets have sidewalks, made Men's Fitness magazine's list of what it called “America's fattest cities.”

But Danny Pleasant, Charlotte's deputy director of transportation, says things are changing. The city that is the nation's second-largest financial market now boasts not only gleaming skyscrapers but also ten thousand new downtown dwelling units, hundreds of newly planted shade trees, and a more pleasant walking environment.

Pleasant: “In the newer development that's occurring now, we've tightened the regulations over the past few years so that we require sidewalks along every street that's built. And we're starting to require bike paths, that sort of thing, what they call the 'new urbanism,' or traditional neighborhood development. Some folks call them, now, 'lifestyle centers' that look like traditional main streets of towns.”
Landphair: “Have we sort of realized the errors of our ways? Is that what's going on?”
Pleasant: “I believe there's an awakening that says there's a limit to how many roads we can build and how much of our cities and communities we can pave over.”

But two forces are holding back the trend toward walkable, Main Street-style neighborhoods. They are more costly to build than traditional subdivisions out in the cornfields, with widely spaced homes and lots of roads. As a result, the Urban Land Institute, an organization of developers and planners, rates fewer than 15 percent of new developments as “walkable.”

The other barrier to change is that a single-family house of one's own, sometimes with the stereotypical white picket fence, has been the American ideal since the Second World War.

But those who tout the health benefits of compact, old-style neighborhoods point out that so-called “baby boomers” approaching retirement age, with no kids at home and less need for big homes and lawns in the suburbs, are starting to look fondly at the amenities and vibrant ambience of a village lifestyle, even if it means giving up their big homes and lawns, two-car garages, and picket fences.

Kate Kraft, senior program officer at the Robert Wood Johnson Foundation, which is donating more than $70 million to find ways to get more Americans walking, says a cooling of the driving passion is helping. “There's concern over the amount of time that people are spending in traffic, in congestion on not only the use of our time, but also on air quality and a whole host of other health connections,” she says. “There's a group of people out there thinking more about having neighborhoods that are walkable, that have other amenities. It may not still be the mainstream. But I think there's a growing demand for that type of lifestyle.”

But “new urbanism's” move back to, if not the city, then a vigorous city-type lifestyle, is a slow process. As Reid Ewing at Rutgers University told VOA, “It took 50 years to create the mess we're in, and it will take decades to build more compact communities where people are active as part of their daily routine.”

Best Practices

Establish physical activity as a transportation planning goal.

Place a high priority on Walking and Cycling Improvements in transportation planning.

Use the following ranking to Prioritize transportation resource allocations (road space, funding, traffic management, etc.)

Walk
Cycle
Public transit
Delivery/commercial vehicles
Private car

Identify and overcome barriers to active transportation, including inadequate facilities and threats to personal security (Evaluating Nonmotorized Transportation).

Create land use patterns that accommodate and encourage active transportation (New Urbanism).

Provide pedestrian and bicycle safety programs to reduce the risks of nonmotorized travel.

Promote Active Transportation as a TDM strategy.

· Highlight the enjoyment and health benefits of active transportation. Convey the message that regular, moderate physical activity will (www.pushplay.org.nz):

1. Make you feel great.

2. Give you energy.

3. Help control weight

4. Build and maintain healthy bones, muscles and joints.

5. Help control asthma.

6. Reduce the risk of heart disease and stroke.

7. Reduce the risk of high blood pressure.

8. Reduce the risk of non-insulin dependent diabetes.

9. Reduce feelings of depression/anxiety.

10. Reduce the risk of colon cancer.

Wit and Humor

This 85 year old couple, having been married almost 60 years, had died in a car crash. They had been in good health the last ten years mainly due to her interest in health food, and exercise.

When they reached the pearly gates, St. Peter took them to their mansion, which was decked out with a beautiful kitchen and master bath suite and Jacuzzi. As they “oohed” and “aahed” the old man asked Peter how much all this was going to cost. “It’s free,” Peter replied, “this is Heaven.”

Next they went out back to survey the championship golf course that the home backed up to. They would have golfing privileges everyday and each week the course changed to a new one representing the great golf courses on earth. The old man asked, “what are the green fees?” Peter's reply, “This is heaven, you play for free.”

Next they went to the clubhouse and saw the lavish buffet lunch with the cuisines of the world laid out. “How much to eat?” asked the old man. “Don’t you understand yet? This is heaven, it is free!” Peter replied with some exasperation. “Well, where are the low fat and low cholesterol tables?” the old man asked timidly. Peter lectured, “That’s the best part...you can eat as much as you like of whatever you like and you never get fat and you never get sick. This is Heaven.”

“With that the old man went into a fit of anger, throwing down his hat and stomping on it, and shrieking wildly. Peter and his wife both tried to calm him down, asking him what was wrong. The old man looked at his wife and said, “This is all your fault. If it weren’t for your bran muffins, I could have been here ten years ago.”

References And Resources For More Information

Action for Healthy Kids (www.actionforhealthykids.org) is a U.S. national initiative dedicated to improving the health and educational performance of children through better nutrition and physical activity in schools.

Active Living by Design (www.activelivingbydesign.org) encourages physical activity and health through community design and public policy strategies.

Active Living Research (www.activelivingresearch.org) provides up-to-date information on research related to environmental factors that influence physical activity.

Active Living Website (www.icma.org) by the International City/County Management Association.

Active Living Storybank (www.activeliving.org) is a searchable database of projects, programs and initiatives that promote health through changes in the built environment, public policy and education.

AJHP (2003), “Special Issue: Health Promoting Community Design,” American Journal of Health Promotion (www.healthpromotionjournal.com), Vol. 18, No. 1, Sept./Oct. 2003,

AJPH (2003), “Built Environment and Health,” American Journal of Public Health (www.ajph.org ), Vol. 93, No. 9, Sept. 2003. Many of these articles are available at the Active Living By Design (www.activelivingbydesign.com) website.

America WALKs (www.webwalking.com/amwalks) is a coalition of walking advocacy groups.

American Academy of Pediatrics (2009), “The Built Environment: Designing Communities to Promote Physical Activity in Children,” Pediatrics Vol. 123 No. 6, June 2009, pp. 1591-1598 (doi:10.1542/peds.2009-0750); at http://aappolicy.aappublications.org/cgi/content/full/pediatrics;123/6/1591.

American Trails (www.outdoorlink.com/amtrails) fosters communication among trail users.

Lars Bo Andersen, et al (2000), “All-Cause Mortality Associated With Physical Activity During Leisure Time, Work, Sports and Cycling to Work,” Archives of Internal Medicine, Vol. 160, No. 11 (http://archinte.ama-assn.org/issues/v160n11/full/ioi90593.html), June 12, 2000, pp. 1621-1628.

APA (2003), Planning and Designing the Physically Active Community: A Resource List, American Planning Association (www.planning.org/physicallyactive/pdf/ReferenceList.pdf).

BAC (1995), Bike For Your Life, Bicycle Association & Cyclists’ Public Affairs Group (London).

J. Ball, M. Ward, L. Thornley and R. Quigley (2009), Applying Health Impact Assessment To Land Transport Planning, Research Report 375, New Zealand Transport Agency (www.ltsa.govt.nz); at www.ltsa.govt.nz/research/reports/375.pdf.

David Bassett, John Pucher, Ralph Buehler, Dixie L. Thompson, and Scott E. Crouter (2008), “Walking, Cycling, and Obesity Rates in Europe, North America, and Australia,” Journal of Physical Activity and Health, Vol. 5 (www.humankinetics.com/jpah/journalAbout.cfm), pp. 795-814; at http://policy.rutgers.edu/faculty/pucher/JPAH08.pdf.

BEAT (2008), BEAT The Path To Health, Built Environment and Active Transportation (BEAT), ActNow BC (www.physicalactivitystrategy.ca); at http://physicalactivitystrategy.ca/pdfs/BEAT_Publication.pdf .

Judith Bell and Larry Cohen (2009), The Transportation Prescription: Bold New Ideas for Healthy, Equitable Transportation Reform in America, PolicyLink and the Prevention Institute Convergence Partnership (www.convergencepartnership.org/transportationhealthandequity).

Beneficial Designs, et al. (1999), Designing Sidewalks and Trails for Access; Review of Existing Guidelines and Practices, Federal Highway Administration, USDOT (www.fhwa.dot.gov/environment.bikeped), Publication No. FHWA-HEP-99-006.

Ethan M. Berke, Laura M. Gottlieb, Anne Vernez Moudon, Eric B. Larson (2007), “Protective Association Between Neighborhood Walkability and Depression in Older Men,” Journal of the American Geriatrics Society (www.blackwell-synergy.com), Vol. 55, No. 4, pp. 526–533.

Lilah M. Besser and Andrew L. Dannenberg (2005), “Walking to Public Transit: Steps to Help Meet Physical Activity Recommendations,” American Journal of Preventive Medicine, Vo. 29, No. 4 (www.acpm.org); at www.cdc.gov/healthyplaces/articles/besser_dannenberg.pdf.

Bicycling Magazine (1991), “A Trend On the Move: Commuting by Bicycle.” Bicycling Magazine, Rodale Press, April 1991.

BMJ (2000), “Cycling and Health Promotion,” British Medical Journal (http://bmj.com/cgi/content/full/320/7239/888), Vol. 320, 1 April 2000, p. 888.

Laura K. Brennan Ramirez, et al. (2006), “Indicators of Activity-Friendly Communities: An Evidence-Based Consensus Process,” American Journal of Preventive Medicine, Vol. 31, No. 6, December.

Shaunna Burbidge (2006), Public Health and Transportation: Planning for Active Modes Along Utah's Wasatch Front, Wasatch Front Regional Council (www.wfrc.org/reports/publichealthandtransportation/publichealthandtransportation.htm).

Nick Cavill (2001), “Walking and Health: Making the Links”, World Transport Policy and Practice, Vol. 7, No. 4 (www.ecoplan.org/wtpp), pp. 33-38.

Nick Cavill (2003), “The Potential of Non-Motorized Transport for Promoting Health,” Sustainable Transport: Planning for Walking and Cycling In Urban Environments (Rodney Tolley Ed.), Woodhead Publishing (www.woodhead-publishing.com), pp. 144-158.

CDC (2005), Designing and Building Healthy Places, U.S. Center for Disease Control (www.cdc.gov/healthyplaces). This website provides information on research programs to help identify design features and programs that create healthier communities.

CDC (2009), Transportation and Health Toolkit, Healthy Eating Active Living Convergence Partnership, Center for Disease Control and Prevention (www.convergencepartnership.org/th101).

CFLRI (annual reports), Physical Activity Monitor, Canadian Fitness and Lifestyle Research Institute (www.cflri.ca). This series of surveys and reports examines Canadian health behavior, including the degree to which they are physically active and want to engage in walking and cycling.

Children on the Move site on children and transport: www.ecoplan.org/children.

CMHC (2006), Your Next Move: Choosing a Neighbourhood with Sustainable Features, Canada Mortgage and Housing Corporation, (www.cmhc-schl.gc.ca); at www.cmhc-schl.gc.ca/odpub/pdf/62180.pdf.

Committee on Physical Activity, Health, Transportation, and Land Use (2005), Does the Built Environment Influence Physical Activity? Examining the Evidence, TRB Special Report 282, Transportation Research Board (www.trb.org); at http://trb.org/publications/sr/sr282.pdf.

CORDIS (1999), Best Practice to Promote Cycling and Walking and How to Substitute Short Car Trips by Cycling and Walking, CORDIS Transport RTD Program, European Union (www.cordis.lu/transport/src/adonisrep.htm).

Adrian Davis (2005), “Transport and Health-What is the Connection? An Exploration of Concepts of Health Held By Highway Committee Chairs in England,” Transport Policy, Vol. 12, No. 4 (www.elsevier.com/locate/transpol), pp. 324-333.

DCE, et al (2006), Understanding The Relationship Between Public Health And The Built Environment: A Report Prepared For The LEED-ND Core Committee, U.S. Green Building Council (USGBC), the Congress for the New Urbanism (CNU) and the Natural Resources Defense Council (NRDC) to assist with the preparation of a rating system for neighborhoods called LEED-ND (Leadership in Energy and Environmental Design for Neighborhood Development) (www.usgbc.org/ShowFile.aspx?DocumentID=1480).

Marie Demers (2006), Walk For Your Life! Restoring Neighborhood Walkways To Enhance Community Life, Improve Street Safety and Reduce Obesity, Vital Health Publishing (www.vitalhealthbooks.com/book/2414947630.html).

Peggy Edwards and Agis D. Tsouros (2008), A Healthy City Is An Active City: A Physical Activity Planning Guide, World Health Organization Europe (www.euro.who.int); at www.euro.who.int/InformationSources/Publications/Catalogue/20081103_1

Dan Emerine and Eric Feldman (2005), Active Living and Social Equity: Creating Healthy Communities for All Residents, International City/County Management Association (http://bookstore.icma.org).

Environics (1998), National Survey on Active Transportation, Go for Green, (www.goforgreen.ca).

European Network For The Promotion Of Health-Enhancing Physical Activity (www.euro.who.int/transport/news/20050908_1) promotes better health through physical activity.

Reid Ewing, et al. (2003), “Relationship Between Urban Sprawl and Physical Activity, Obesity, and Morbidity,” American Journal of Health Promotion, Vol. 18, No. 1 (www.healthpromotionjournal.com), Sept/Oct. 2003, pp. 47-57, at www.smartgrowth.umd.edu/pdf/JournalArticle.pdf.

Oscar H. Franco, et al (2005), “Effects of Physical Activity on Life Expectancy With Cardiovascular Disease,” Archives of Internal Medicine, Vol. 165 No. 20 (http://archinte.ama-assn.org/cgi/content/abstract/165/20/2355), Nov. 2005, pp. 2355-2360.

Lawrence Frank and Peter Engelke (2000), How Land Use and Transportation Systems Impact Public Health, Active Community Environments, Georgia Institute of Technology and Center for Disease Control (www.cdc.gov/nccdphp/dnpa/aces.htm).

Larry Frank (2004), “Obesity Relationships with Community Design, Physical Activity and Time Spent in Cars,” American Journal of Preventive Medicine (www.ajpm-online.net/home), Vol. 27, No. 2, June, 2004, pp. 87-97.

Lawrence Frank, Peter O. Engelke and Thomas L. Schmid (2003), Health and Community Design: The Impact Of The Built Environment On Physical Activity, Island Press (www.islandpress.org).

Lawrence Frank, et al (2006), “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, Vol. 72, No. 1 (www.planning.org), Winter 2006, pp. 75-87.

Lawrence Frank, Sarah Kavage and Todd Litman (2006), Promoting Public Health Through Smart Growth: Building Healthier Communities Through Transportation And Land Use Policies, Smart Growth BC (www.smartgrowth.bc.ca); at www.vtpi.org/sgbc_health.pdf.

FHWA, Pedestrian/Bicyclist Resource Kit, FHWA (www.ota.fhwa.dot.gov/walk).

Howard Frumkin, Lawrence Frank and Richard Jackson (2004), Urban Sprawl and Public Health: Designing, Planning, and Building For Healthier Communities, Island Press (www.islandpress.org).

Richard Gilbert and Catherine O’Brien (2005), Child- And Youth-Friendly Land-Use And Transport Planning Guidelines, Centre for Sustainable Transportation (www.cstctd.org).

Olof Gunnarsson (1995), “Problems and Needs of Pedestrians,” IATSS Research, Vol. 19, No. 2.

HDA (2005), Making The Case: Improving Health Through Transport, Health Development Agency, UK National Health Service (www.publichealth.nice.org.uk).

Health Canada (2004), Canadian Handbook on Health Impact Assessment, Health Canada (www.hc-sc.gc.ca); at www.hc-sc.gc.ca/ewh-semt/pubs/eval/handbook-guide/vol_1/index-eng.php.

Healthy Cities and Urban Governance (www.who.dk/healthy-cities), World Health Organization, Regional Office for Europe. This website discusses research and policy strategies for creating healthier urban conditions.

Health Impact Assessment website (www.ph.ucla.edu/hs/health-impact) provides information on ways to systematically evaluate and communicate potential health impacts in policy and planning analysis.

Paul A.T. Higgins and Millicent Higgins (2005), “A Healthy Reduction in Oil Consumption and Carbon Emissions?” Energy Policy, Vol. 33, Issue 3, February, Pages 425-425; at www.citeulike.org/user/mokgand/article/1029150.

Hillary Commission for Sports, Fitness and Leisure (www.hillarysport.org.nz) is a national organization in New Zealand that promotes physical activity.

ICLEI (2003), Health Benefits Economic Model, Cities for Climate Protection, International Council for Local Environmental Initiatives (www3.iclei.org/ccp-au/tdm/index.html).

ICMA (2005), Active Living and Social Equity: Creating Healthy Communities for All Residents – A Guide for Local Governments, International City/County Management Association (www.icma.org).

ICMA (2005), Creating a Regulatory Blueprint for Healthy Community Design: A Local Government Guide to Reforming Zoning and Land Development Codes, International City/County Management Association (www.icma.org) and Active Living By Design (www.activelivingleadership.org).

International Association for the Study of Obesity (www.iotf.org) performs research and public education related to obesity, its health impacts and strategies to reduce this problem.

International Physical Activity and the Environment Network (www.ipenproject.org) works to increase communication and collaboration between researchers investigating environmental correlates of physical activity.

Peter L. Jacobsen (2003), “Safety In Numbers: More Walkers and Bicyclists, Safer Walking and Bicycling.” Injury Prevention (http://ip.bmjjournals.com), Vol. 9, 2003, pp. 205-209; at www.tsc.berkeley.edu/newsletter/Spring04/JacobsenPaper.pdf.

Peter L. Jacobsen, F. Racioppi and H. Rutter (2009), “Who Owns The Roads? How Motorised Traffic Discourages Walking And Bicycling,” Injury Prevention, Vol. 15, Issue 6, pp. 369-373; http://injuryprevention.bmj.com/content/15/6/369.full.html.

Richard J. Jackson and Chris Kochtitzky (2001), Creating A Healthy Environment: The Impact of the Built Environment on Public Health, Sprawl Watch Clearinghouse (www.sprawlwatch.org/health.pdf).

S.A. Johnson and J. Marko (2007), Designing Healthy Places: Land Use Planning And Public Health, Capital Health, Edmonton Area (www.capitalhealth.ca); at www.capitalhealth.ca/nr/rdonlyres/eh4qelt76mejjmxogexsmbh5qrs32flyyiknqr3z6jn6xcfgyjqbeqpip3xrsztvr27joqqj2bd2pyr7myh74cnflib/designinghealthyplaceslandusepublication.pdf.

Richard E. Killingsworth and Jean Lamming (2001), “Development and Public Health; Could Our Development Patterns be Affecting Our Personal Health?” Urban Land, Urban Land Institute (www.uli.org), July 2001, pp. 12-17.

Richard Killingsworth, Audrey De Nazelle and Richard Bell (2003), “Building A New Paradigm: Improving Public Health Through Transportation,” ITE Journal, Vol. 73, No. 6 (www.ite.org), June 2003, pp. 28-32.

Lawrence Frank & Company (2008), The Built Environment and Health: A Review, Plan-It Calgary, City of Calgary (www.calgary.ca); at www.calgary.ca/docgallery/BU/planning/pdf/plan_it/health_and_wellness_reports.pdf.

Ugo Lachapelle and Lawrence D . Frank (2008), “Mode Of Transport, Employer-Sponsored Public Transit Pass, And Physical Activity,” Journal Of Public Health Policy (www.palgrave-journals.com/jphp).

Todd Litman (2003), Active Transportation Policy Issues: Backgrounder For the Go For Green “National Roundtable on Active Transportation,” Victoria Transport Policy Institute (www.vtpi.org).

Todd Litman (2004), If Health Matters: Integrating Public Health Objectives into Transportation Decision-Making, Victoria Transport Policy Institute (www.vtpi.org); at www.vtpi.org/health.pdf; previously published as, “Integrating Public Health Objectives in Transportation Decision-Making,” American Journal of Health Promotion, Vol. 18, No. 1 (www.healthpromotionjournal.com), Sept./Oct. 2003, pp. 103-108; at www.vtpi.org/AJHP-litman.pdf.

Todd Litman (2005), Transportation Cost and Benefit Analysis, Victoria Transport Policy Institute (www.vtpi.org/tca).

Todd Litman (2007), Community Cohesion As A Transport Planning Objective, VTPI (www.vtpi.org); at www.vtpi.org/cohesion.pdf.

Todd Litman (2008), “Creating Safe and Healthy Communities,” Environments: A Journal of Interdisciplinary Studies; Special Issue: Planning for Health Through the Built Environment, (www.fes.uwaterloo.ca/research/environments/index.html), Vol. 35, No. 3, pp. 21-43.

Todd Litman (2009), “Public Transportation and Health,” in The Transportation Prescription: Bold New Ideas for Healthy, Equitable Transportation Reform in America, (Bell and Cohen eds.) PolicyLink and the Prevention Institute Convergence Partnership (www.convergencepartnership.org/transportationhealthandequity).

Todd Litman and Steven Fitzroy (2006), Safe Travels: Evaluating Mobility Management Traffic Safety Benefits, Victoria Transport Policy Institute (www.vtpi.org); at www.vtpi.org/safetrav.pdf.

Russ Lopez (2004), “Urban Sprawl and Risk for Being Overweight or Obese,” American Journal of Public Health (www.ajph.org), Volume 94, Issue 9, September 1 2004, pp. 1574-1579.

William Lucy (2002), Danger in Exurbia: Outer Suburbs More Dangerous Than Cities, University of Virginia (www.virginia.edu); summarized in www.virginia.edu/topnews/releases2002/lucy-april-30-2002.html.

William H. Lucy (2003), “Mortality Risk Associated With Leaving Home: Recognizing the Relevance of the Built Environment,” American Journal of Public Health, Vol 93, No. 9, September 2003, pp. 1564-1569; at www.ajph.org/cgi/content/full/93/9/1564.

William H. Lucy and Daivd L. Phillips (2006), Tomorrow’s Cities, Tomorrow’s Suburbs, Planners Press (www.planning.org).

Bill Lyons (2004), Integrating Health and Physical Activity Goals Into Transportation Planning, Volpe National Transportation Systems Center (www.volpe.dot.gov) for the Federal Highway Administration and Federal Transit Administration (www.planning.dot.gov/technical.asp).

Bill Lyons (2004), Annotated Bibliography on Health and Physical Activity in Transportation Planning, Volpe National Transportation Systems Center (www.volpe.dot.gov) for the Federal Highway Administration and Federal Transit Administration (www.planning.dot.gov/technical.asp).

Chloe Mason (2000), “Transport, Environment & Health: En Route to a Healthier Australia?,” Medical Journal of Australia, Vol., 172, No. 5, March 2000, pp. 230-232; available at the Institute for Sustainable Futures (www.isf.uts.edu.au).

Murray May, Paul J. Tranter and James R. Warn (2008), “Towards A Holistic Framework For Road Safety In Australia,” Journal of Transport Geography, Vol. 16 (www.elsevier.com/locate/jtrangeo), pp. 395–405.

Barbara A. McCann and Reid Ewing (2003), Measuring the Health Effects of Sprawl: A National Analysis of Physical Activity, Obesity and Chronic Disease, Smart Growth America (www.smartgrowthamerica.org) and the Surface Transportation Policy Project.

D.S. Morrison, Hilary Thomson and Mark Petticrew (2004), “Evaluation Of The Health Effects Of A Neighbourhood Traffic Calming Scheme” Journal of Epidemiol Community Health Vol. 58, pp. 837–840.

Christopher Murray (1996), Global Burden of Disease and Injury, Center for Population and Development Studies, Harvard University School of Public Health (www.hsph.harvard.edu/organizations/bdu).

Gautam Naik (2005), “New Buildings Help People Fight Flab: Designs Encourage Climbing Stairs and a Lot of Walking; Cheeky Signs on the Elevator,” The Wall Street Journal (www.wsj.com) November 16, 2005, page B1.

National Center for Chronic Disease Prevention and Health Promotion (www.cdc.gov/nccdphp/dnpa) provides information on public health programs related to nutrition and exercise. The Built Environment section (www.niehs.nih.gov/drcpt/be/home.htm) provides information on public health and quality-of-life impacts related to community design.

Arthur Nelson and David Allen (1997), “If You Build Them, Commuters Will Use Them; Cross-Sectional Analysis of Commuters and Bicycle Facilities,” Transportation Research Record 1578, TRB (www.trb.org), pp. 79-83.

Robert Noland (2003), “Traffic Fatalities and Injuries: The Effects of Changes in Infrastructure and Other Trends,” Journal of Accident Prevention and Analysis, Vol. 35, pp. 599-611; at www.cts.cv.ic.ac.uk/staff/wp22-noland.pdf.

OCFP (2005), The Health Impacts Of Urban Sprawl Information Series: Volume Four Social & Mental Health, Ontario College of Family Physicians (www.ocfp.on.ca); at www.ocfp.on.ca/local/files/Urban%20Sprawl/UrbanSpraw-Soc-MentalHlth.pdf.

Lynn Parker, Annina Catherine Burns and Eduardo Sanchez (2006), Local Government Actions to Prevent Childhood Obesity, Committee on Childhood Obesity Prevention Actions for Local Governments, National Institute of Medicine, National Research Council (www.nap.edu); at www.nap.edu/catalog.php?record_id=12674#description.

Partnership for a Walkable America (http://nsc.org/walk/wkabout.htm) promotes the benefits of walking and supports efforts to make communities more pedestrian friendly.

PATH (Planning for Active Transportation and Health) (www.nrsrcaa.org/path/Documents.htm), describes practical measures to increase transportation efficiency, equity and health in rural regions, sponsored by the Natural Resources Services of the Redwood Community Action Agency.

PATH (2006), The PATH Guide: Planning Ideas, Tools And Examples To Achieve Transportation Access And Equity In Rural California, Prepared by Natural Resources Services, A Division of Redwood Community Action Agency, Eureka, California, (www.nrsrcaa.org/path), with funding from The Caltrans Environmental Justice Program; at www.nrsrcaa.org/path/pdfs/PATHGuide5_06.pdf.

Pedestrian and Bicycle Information Center (www.walkinginfo.org), 2000.

Theodore Petritsch, et al. (2008), Health Benefits of Bicycle Facilities, Transportation Research Board 87th Annual Meeting (www.trb.org).

Physical Activity Task Force (1999), More People, More Active, More Often, UK Department of Health (London), 1995. Also see Charter on Transport, Environment and Health, World Health Organization (www.who.dk).

Project for Public Spaces (www.pps.org) is a non-profit organization that offers resources and technical support to help create special places that build community life.

John Pucher and Lewis Dijkstra (2000), “Making Walking and Cycling Safer: Lessons from Europe,” Transportation Quarterly, Vol. 54, No. 3, Summer 2000; at www.vtpi.org/puchertq.pdf.

John Pucher and Lewis Dijkstra (2003), “Promoting Safe Walking and Biking to Improve Public Health: Lessons From The Netherlands And Germany,” American Journal of Public Health, Vol. 93, No. 9 (www.ajph.org), Sept. 2003, pp. 1509-1516.

John Pucher (2007), Cycling for Everyone: Key to Public and Political Support, keynote address at the 2007 National Bike Summit, League of American Bicyclists, Washington, DC, March 16, 2007; available at www.policy.rutgers.edu/faculty/pucher/BikeSummit2007COMP_Mar25.pdf.

John Pucher and Ralph Buehler (2007), “At the Frontiers of Cycling: Policy Innovations in the Netherlands, Denmark, and Germany,” World Transport Policy & Practice, Vol. 13, No. 3; at www.eco-logica.co.uk/pdf/wtpp13.3.pdf.

John Pucher and Ralph Buehler (2008), “Making Cycling Irresistible: Lessons from the Netherlands, Denmark, and Germany,” Transport Reviews, Vol. 28, No. 4, July 2008; at www.vtpi.org/irresistible.pdf.

Push Play (www.pushplay.org.nz) is a national program to promote physical activity to New Zealanders of all ages and abilities.

Rails-to-Trails Conservancy (www.railtrails.org) provides information for converting abandoned rail rights-of-way to public trails.

Francesca Racioppi, Lars Eriksson, Claes Tingvall and Andres Villaveces (2004), Preventing Road Traffic Injury: A Public Health Perspective For Europe, World Health Organization, Regional Office for Europe (www.euro.who.int/document/E82659.pdf).

Inas Rashad (2007), Cycling: An Increasingly Untouched Source of Physical and Mental Health, Working Paper No. 12929, National Bureau Of Economic Research (www.nber.org); at www.nber.org/papers/w12929.

Ian Roberts, Harry Owen, Peter Lumb, Colin MacDougall (1996), Pedalling Health—Health Benefits of a Modal Transport Shift, Bicycle Institute of South Australia (www.science.adelaide.edu.au).

RTC (1999), Improving Conditions for Bicycling and Walking; A Best Practices Report, U.S. Federal Highway Administration (www.fhwa.doc.gov) and Rails-to-Trails Conservancy (www.railtrails.org).

RWJF (2003), The Shape We're In, The Robert Wood Johnson Foundation (www.shapenews.com). A five-part series appearing in newspapers across America concerning obesity and poor fitness, including nutrition, physical education in schools, the influence of community design, how the medical community is responding — and highlights innovative solutions.

Brian, E. Saelens, James F. Sallis and Lawrence D. Frank (2003), “Environmental Correlates of Walking And Cycling: Findings From The Transportation, Urban Design, And Planning Literature,” Annals of Behavioral Medicine, Vol. 25, No. 2 (www.sbm.org/pubs/annals.html), pp. 80-91.

James F. Sallis, Adrian Bauman and Michael Pratt (1998), “Environmental and Policy Interventions to Promote Physical Activity,” American Journal of Preventive Medicine, Vol. 15, No. 4, ALPES (http://alpes.ws/content/envpolicyinterventions.pdf), pp. 379-397.

James F. Sallis, Lawrence D. Frank, Brian E. Saelens and M. Katherine Kraft (2004), “Active Transportation and Physical Activity: Opportunities For Collaboration On Transportation and Public Health Research,” Transportation Research A, Vol. 38, Issue 4 (www.elsevier.com/locate/tra), May 2004, pp. 249-268.

Joel Schwartz (2002), CDC Hates the Suburbs, American Council on Science and Health (www.healthfactsandfears.com).

Seattle (1996), Making Streets That Work; Neighborhood Planning Tool, Engineering Dept., City of Seattle (www.ci.seattle.wa.us/npo/tblis.htm).

M.A. Sevick, et al (2000), “Cost-Effectiveness Of Lifestyle And Structured Exercise Interventions In Sedentary Adults: Results Of Project ACTIVE’, American Journal of Preventive Medicine, Vol. 19, No. 1.

Sightline Institute (2006), Cascadia Scorecard 2006: Focus on Sprawl and Public Health, (www.sightline.org); at www.sightline.org/research/cascadia_scorecard/res_pubs/cs2006, and www.sightline.org/research/cascadia_scorecard/res_pubs/cs2006/health-sprawl-resources.

SMARTRAQ (Strategies for Metropolitan Atlanta's Regional Transportation and Air Quality) is a comprehensive study of relationships between land use, transportation, public health and the environment. Results are available at the Active Transport Collaboratory website (www.act-trans.ubc.ca).

Sprawl and Health (http://cascadiascorecard.typepad.com/sprawl_and_health) is an ongoing literature review by researchers at Northwest Environment Watch on the intersection of sprawl and health.

Stats Canada (2006), “Regional Differences in Obesity,” Health Reports, Vol. 17, No. 3 (82-003-XIE), Statistics Canada (www.statcan.ca).

Roland Sturm (2005), Urban Design, Lifestyle, and the Development of Chronic Conditions, presented at the Built Environment and Childhood Obesity, National Institute of
Environmental Health Sciences (www-apps.niehs.nih.gov/conferences/drcpt/oe2005/speakerdocs/strum-doc.pdf).

Hyangun Sung, Jihyung Park and Hyeja Kim (2009), “A Study on the Impact of the Green Transport Mode on Public Health Improvement,” KOTI World-Brief, Vol. 1, No. 1, Korea Transport Institute (www.koti.re.kr), May 2009, pp. 6-8; http://english.koti.re.kr/upload/eng_publication_regular/world-brief01.pdf.

Surgeon General (1999), Physical Activity and Health, Center for Disease Control and Prevention (www.cdc.gov/nccdphp/sgr/sgr.htm). This document establishes recommended levels of physical activity.

Ray Tomalty and Murtaza Haider (2009), Walkability and Health; BC Sprawl Report 2009, Smart Growth BC (www.smartgrowth.bc.ca); at www.smartgrowth.bc.ca/Portals/0/Downloads/sgbc-sprawlreport-2009.pdf.

Transport, Health and Environment Pan-European Programme (THE PEP) website (www.thepep.org/CHWebSite) user-friendly access to policy, legal and scientific information related to transportation and health.

Transportation and Health Toolkit (www.convergencepartnership.org/th101) presents an overview of connections between transportation and health, and policy opportunities to create healthy transportation options.

UN Habitat Archives (www.chs.ubc.ca/archives), at the Centre for Human Settlements (CHS), is an online repository of best practices for building healthy and sustainable cities.

Ronald Utt (2003), Obesity and Life Styles: Is it the Hamburger or your House?, Heritage Foundation (www.heritage.org/Research/SmartGrowth/wm343.cfm).

Walkable Communities (www.walkable.org) works with communities to create more people-oriented environments.

Walkable and Livable Communities Institute (www.walklive.org) provides training in building healthy communities and a range of topics related to integrating urban design and transportation planning to create more livable places.

Washington Coalition for Promoting Physical Activity (www.beactive.org) provides information and resources to encourage physical activity.

WHO (Carlos Dora and Margaret Phillips) (2000), Transport, Environment and Health, World Health Organization Regional Publication, European Series, No. 89 (www.euro.who.int/document/e72015.pdf).

WHO (Adrian Davis Editor) (2003), A Physically Active Life Through Everyday Transport: With A Special Focus On Children And Older People And Examples And Approaches From Europe, World Health Organization, Regional Office for Europe (www.euro.who.int/document/e75662.pdf).

WHO (2004), World Report on Road Traffic Injury Prevention, World Health Organization and World Bank (www.who.int); at www.who.int/entity/world-health-day/2004/infomaterials/world_report.

Sharlene Wolbeck Minke and Marie S. Carlson (2007), Physical Activity in the Community: Literature Review and Environmental Scan, Capital Health, Edmonton Area (www.capitalhealth.ca).

Janes Woodcock, et al. (2007), “Energy and Health 3,” The Lancet (www.thelancet.com), Vol 370, 22 September 2007, pp. 1078-1088.

Yates, Thorn & Associates (2004), Population Health And Urban Form: A Review Of The Literature, Smart Growth BC (www.smartgrowth.bc.ca).

This Encyclopedia is produced by the Victoria Transport Policy Institute to help improve understanding of Transportation Demand Management. It is an ongoing project. Please send us your comments and suggestions for improvement.

VTPI

Homepage

Encyclopedia Homepage

Send Comments

Victoria Transport Policy Institute

www.vtpi.org info@vtpi.org

1250 Rudlin Street, Victoria, BC, V8V 3R7, CANADA

Phone & Fax 250-360-1560

“Efficiency - Equity - Clarity”

#102