Health and Fitness

Strategies That Improve Public Health Through Physical Activity


TDM Encyclopedia

Victoria Transport Policy Institute


Updated 21 March 2019

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.




Transportation facilities and activities can affect public health in many ways, including crash risk, physical activity, noise and air pollution exposure, affordability, transport related stress, mental health and access to healthcare services (APHA 2010; Frank, Kavage and Litman 2006; Tranter 2010; PfP 2011; Litman 2017). Health objectives (including new ones, such as encouraging physical activity) are becoming more important in transport planning, 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.


Transportation Health Impacts



Transport Impacts

Transport Policies for Health

Crash Risks

Risk of traffic accidents, particularly for vulnerable modes (walking, bicycling and motorcycles).

Increased vehicle travel and higher traffic speeds tend to increase per capita crash risks.

Targeted traffic safety strategies (e.g., safer vehicle and road design), vehicle travel reduction programs and Smart Growth development policies.

Physical Activity

People’s physical activity (target is at least 22 daily minutes of moderate activity).

Active transport (walking and bicycling) is one of the most practical ways to exercise.

Improving and encouraging walking, bicycling and public transit (since most transit trips include active links). Smart Growth development policies.

Pollution Exposure

Amount of noise and air pollution people are exposed to.

Motor vehicles are major sources of noise and air pollutants.

Vehicle noise and air pollution reduction policies. Vehicle travel reductions.


Portion of household budgets that must be spent on transport.

Motor vehicle travel is costly and often unaffordable to lower-income households.

Improve affordable travel modes (walking, bicycling, ridesharing and public transit) and increase affordable housing options in accessible locations.

Mental health

Security, physical activity, community connections and affordability tend to reduce mental stress and increase happiness.

Transportation can affect mental health in many ways.

Create communities where residents are safer, walk more (for exercise and community cohesion), and have more affordable transport options.

Healthcare Access

Ability to access healthcare services.

Inadequate transport can be a barrier to healthcare, particularly for physically and economically disadvantaged people.

Improve affordable travel options. Smart Growth development policies. Identify and address special mobility to healthcare needs.

Transportation policies and planning decisions affect public health in several ways.




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 (DHHS 2008; Blair 2009).


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). According to experts, such as the U.S. Center of Disease Control, adults should average at least 150 minutes a week (about 22 minutes a day) of moderate-intensity, or 75 minutes a week (about 11 minutes a day) of vigorous-intensity aerobic physical activity, and children should average at least one hour a day of physical activity (CDC 2008). Additional exercise up to 60 minutes per day of vigorous physical activity appears to provide additional health benefits.


The Aerobics Center Longitudinal Study (a study of 80,000 adults in which researchers periodically measure the participants' body composition and body mass index) found that sedentary living accounts for about 16% of all deaths in both women and men, which is substantially higher than the risks associated with smoking, obesity, hypertension, high cholesterol and diabetes (Blair 2009). The analysis suggests that a physically active (i.e., walks 30 daily minutes), obese smoker is likely to live longer than a sedentary, thin, non-smoker. 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.


How Much Physical Activity Do You Need?

Center for Disease Control Physical Activity Recommendations (


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.



A major study of 429,334 UK residents found that, accounting for other demographic factors, incremental increases in neighborhood walkability are associated with significantly reduced blood pressure and hypertension risk, indicating large public health benefits (Sarkar, Webster and Gallacher 2018).


In a study of 299 U.S. older adults (mean age 78 years) Erickson, et al. (2010) found significantly higher rates of grey matter volume and cognitive ability in those who, in previous years had walked more than 72 blocks a week. Hoehner, et al. (2012), analyzed data from 4,297 adults who had comprehensive medical examinations between 2000 and 2007 in 12 Texas metropolitan counties. It adjusted for sociodemographic characteristics, smoking, alcohol intake, family history of diabetes and high cholesterol, body mass index (BMI) and weekly minutes of physical activity. The study found that commuting distance was negatively associated with physical activity and cardiorespiratory fıtness (CRF), and positively associated with BMI, waist circumference, systolic and diastolic blood pressure, and continuous metabolic score.


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.


It's Better To Be Chubby And Fit Than Skinny And Stagnant

Exercise Benefits People Of All Weights, Studies Find

Jill Barker, Vancouver Sun, 27 December 2010 (


The struggle to lose weight is a see-saw between success and failure. Lose a couple of pounds, and you can almost see yourself fitting into your favourite jeans again. Gain a couple, and you wonder if you'll ever reach your goal weight.


The constant yo-yoing of weight loss and gain is not only frustrating, it makes you question whether all that hard work in the gym is worth it. Before you pack up your workout gear for good, however, rest assured that gym workouts are well worth the time and effort -- even if those extra pounds stubbornly refuse to disappear.


Exercise has a lot more to offer than just a means to lose weight. Its most important role is the impact it has on health -- especially among those who carry extra pounds. Most people already know that exercise improves cardiovascular health and reduces the risks of some forms of cancer. What's less well known is that exercise also reduces the health risks associated with carrying extra weight. In fact, several studies suggest that chubby exercisers are healthier than skinny couch potatoes.


The first to speculate that it's possible to be fit and fat was Steven Blair, who in 1999 reported on a study of 22,000 men, all of whom were put through treadmill tests and body-composition assessments at the start of the study. During the eight years of followup the results were surprising. Lean men who scored poorly on the treadmill test were twice as likely to have died when compared with men who were overweight but fit. Similar results were found among women. In another study by Blair, published in 2003, moderately fit women of all weights had a 48% lower risk of dying prematurely (from all causes) when compared with unfit women -- even the skinny ones. The conclusion, said Blair, is that it's entirely possible to be fit and fat.


These results in no way suggest that it's okay to pack on extra weight. High blood pressure, heart disease, Type 2 diabetes, gallbladder disease, osteoarthritis, sleep apnea and breast, colon and endometrial cancer are all more prevalent in the overweight population. But for those who struggle to reach their goal weight, it's worth noting that exercise can ameliorate a lot of the risk factors associated with obesity. Bones get stronger, blood glucose is better regulated, blood pressure goes down, and psychological well-being improves.


Most researchers gathered their data by reviewing the benefits of exercise across all weight classes, including individuals in the lean (BMI 25), overweight (BMI between 25 and 30) and obese (BMI 30-plus) categories. And although it wasn't surprising to find that the fittest had the lowest risk for poor health outcomes and the least fit the most risk, they were buoyed to see that this held true through all weight classes. That being said, there's a point when carrying too much weight makes exercise impossible, which is tragic for those unable to make even this small effort to improve their health.


To be clear, 150 minutes of exercise a week isn't going to result in substantial weight loss. It will, however, do as heralded and result in substantial health benefits, which, according to most public-health officials, is more important than a washboard set of abs.



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 transport declined in most industrialized countries during the Twentieth Century, although it has started to increase in recent years (Bassett, et al. 2011). 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)























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., (2014) 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.


Frederick, Riggs and Gilderbloom (2017), analyzed the relationships between commute mode diversity (CMD, the portion of commuters who do not drive an automobile, which ranges from 11% to 36%) as an indicator of a multimodal community, and twelve indicators of measure health, leisure and quality of life outcomes for various mid-size U.S. cities and counties.  The results show a strong statistical relationship between more modal diversity and positive public health outcomes including more healthy behaviors reported in the Gallup/Healthway’s Well-Being Index, leisure quality reported by Sperling’s Cities Ranked and Rated, a higher percentage of “Poor Physical Health Days” reported in the Behavioral Risk Factor Surveillance System, improved access to exercise reported by the Environmental Systems Research Institute, significantly lower rates of sedentary living and obesity reported in the Center for Disease Control’s Diabetes Interactive Atlas, significantly fewer Years of Potential Life Lost (an indicator of longevity and overall health) and lower birth weights (an indicator of infant health) reported by the National Center for Health Statistics. These relationships are stronger than many other sociological, geographical, and economic concerns, including race, density, latitude, education, and income.


The 2010 Bicycling and Walking Benchmark Report (ABW 2014) shows a negative relationship between walking and cycling activity in a region and rates of obesity and related illnesses such as diabetes and high blood pressure. Lopez-Zetina, Lee and Friis (2006) found statistically significant associations between per capita vehicle travel and obesity rates for California counties. 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. Cavill, Cope and Kennedy (2009) estimated that an integrated program to encourage walking in British towns provided a benefit/cost ratio of 2.59 (each £ spent on the program provided £2.59 worth of benefits) from reduced mortality. Benefit/cost ratios of this magnitude are classed as ‘high.’ Including other benefits (such as morbidity; absenteeism; congestion; pollution) would be likely to increase this value. The Department for Transport found even higher economic returns (DfT 2010).


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 (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 reduced automobile use by 14% and increased active transportation by 20% ( 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).


Tranter (2010) argues that the emphasis in urban areas on increasing vehicle traffic speed and volume contributes to ill-health through its impacts on local air pollution, greenhouse gas production, inactivity, obesity and social isolation. In addition to these impacts, a heavy reliance on cars as a supposedly ‘fast’ mode of transport consumes more time and money than a reliance on supposedly slower modes of transport (walking, cycling and public transport). Using the concept of ‘effective speed’, this paper demonstrates that any attempt to ‘save time’ through increasing the speed of motorists is ultimately futile. If planners wish to provide urban residents with more time for healthy behaviours (such as exercise and preparing healthy food), then, support for the ‘slower’ active modes of transport should be encouraged.


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


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: people would walk and bicycle more frequently if they had suitable facilities and resources (ABW 2014). Appropriate facilities and roadway improvements for walking and cycling (sidewalks, crosswalks, multi-use paths, bike lanes, traffic calming) can increase nonmotorized travel. Traffic Calming in an urban neighborhood significantly increased walking activity and parents’ willingness to allow their children to play outdoors (Morrison, Thomson and 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.


A New York City Department of Health (NYCDH 2011) study evaluated the health benefits of active transportation. The analysis indicates that people who commute by walking, cycling or public transit achieve about twice the total (transportation and recreational) exercise as automobile commuters, and so are much more likely to achieve public health targets of thirty or more daily minutes of moderate physical activity. This study can be a model for use in other communities interested in tracking physical fitness and health.



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 (, 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 2            Transport and Land Use Health Indicators (Lawrence Frank & Company 2008)


Physical Activity

Air Pollution

Crash Risk

Mental Health

Water Pollution


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.







Employment Density: Requires employment data to calculate. Again, a net measure of employment density will create a more accurate picture.







Land Use Mix: Can be complex to calculate, but a number of valid measures have been used in the literature







Retail Availability: Simple measure to calculate (number of retail parcels within 1 km), but fewer research results connecting this measure to the outcomes.







Retail F.A.R.: Standard land use code measure; can be complex to calculate from parcel land use data.







Street Connectivity: Requires street network analysis in GIS – can be calculated as a measure of intersection density (# of intersections per acre)







Access to parks/recreational facilities: Percent of population within 1 km walking (network) distance of park / recreational facility







Access to healthy food: May be difficult to operationalize; depends on land use data available.







Access to transit: Percent of population within 1 km walking (network) distance of transit.







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.







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.







Proximity to high-traffic roads or freeways: Avoid sensitive uses within 500 ft (about 150 m).







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







Proximity to rail yards: Avoid sensitive uses within 1,000 feet (about 300 m); mitigate up to a mile (1600 m)







Proximity to Gravel Extraction Plant: Avoid sensitive uses less than 800 meters away.







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.







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.







Crime activity: If data is available, can measure location and/or severity of crimes; may be used as a quality of life measure.







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 3            Healthy Community Index Calculations


How to Calculate


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.





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.




Healthy Exercise From Driving?

By U. S. Senator Royal S. Copeland, former Health Commissioner of New York City, cited in Motor, July 1922.


Of course motoring bestows its greatest benefits on the person who drives the car. Not only does the driver get the full benefit of open road and fresh air, but he gets actual physical exercise in a form best calculated to repair the damages wrought by our modern existence. The slight physical effort needed in moving the steering wheel reacts on the muscles of the arms and abdomen. Most of us get enough exercise in the walking necessary, even to the most confined life, to keep the leg muscles fairly fit. It is from the waist upward that flabbiness usually sets in. The slight, but purposeful effort demanded in swinging the steering wheel, reacts exactly where we need it most. Frankly I believe that steering a motor car is actually better exercise than walking, because it does react on the parts of the body least used in the ordinary man's routine existence.


They could never imagine just how sedentary one could be. This sounds like an argument that mousing and typing is sufficient daily exercise as is getting up from the sofa to get a beer from the refrigerator.


Here is also a physician describing the difference between working with a car as compared with the horse and buggy days. It is quite interesting to note that the modern communication and transportation technologies of the car and telephone made people travel less, not more. What I have found has always seemed to suggest the opposite but it would be interesting to do more detailed studies.


There were two doctors when I came here [rural Connecticut- my home area!]. At times there have been three. But now that I have an automobile I can readily cover the region. But the strange part of it is that I have fewer calls to make on the same people. The fact is that the automobile and the telephone have set people's minds at rest. They don't send for me in the middle ofthe night the way they used to. If it is only a slight matter they wait until morning. If a little more serious, they telephone. Only in emergencies do they ask me to come to the house at night.  In the past they wanted me to come anyway, in case there might be critical developments; but now they know I can get there in no time if needed, and they do not worry.


John C. Long (1924), “The Automobile: Its Province and Its Problems,” Annals of the American Academy of Political and Social Science, Vol. 116, November, pp. 18-21



Case Studies

The Active Living by Design website (, 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 (Bell, Ge and Popkin 2002)


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 (, 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 (

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.



Smart Growth Urban Development and Health

Frank, et al. (2010) and  found that “smart growth” urban form factors (transit accessibility, residential density, and street connectivity) tend to increase per capita walking activity and reduce per capita motor vehicle fuel consumption, providing both health and environmental benefits. Guo and Gandavarapu (2010) identify various geographic, demographic and urban design factors that tend to increase walking and cycling, and reduce automobile travel. They use a simple model to evaluate the cost effectiveness of neighborhood sidewalk construction based on health and air pollution reduction benefits.



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 (

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.



Neighborhood Walkability and Health (Creatore, et al. 2016)

Researchers at the Knowledge Institute of St. Michael's Hospital, Toronto examined whether urban neighborhoods that are more walkable are associated with a slower increase in overweight, obesity, and diabetes than less walkable neighborhoods. The researchers used annual provincial health care (n = 3 million per year) and biennial Canadian Community Health Survey (n = 5,500 per cycle) data for adults (30-64 years) living in Southern Ontario cities. Neighborhood walkability was derived from a validated index, which included 4 equally weighted components: population density, residential density, walkable destinations (number of retail stores, services [e.g., libraries, banks, community centers], and schools within a 10-minute walk), and street connectivity. Neighborhoods were ranked and classified into quintiles from lowest (quintile 1) to highest (quintile 5) walkability.


8,777 neighborhoods were included in the study. In 2001, the adjusted prevalence of overweight and obesity was lower in quintile 5 vs quintile 1 (43 percent vs 54 percent). Between 2001 and 2012, the prevalence increased in less walkable neighborhoods, while the prevalence did not significantly change in areas of higher walkability. In 2001, the adjusted diabetes incidence was lower in quintile 5 than other quintiles and declined by 2012. In contrast, diabetes incidence did not change significantly in less walkable areas.


Rates of walking or cycling and public transit use were significantly higher, and that of car use lower in quintile 5 vs quintile 1 at each time point, although daily walking and cycling frequencies increased only modestly from 2001 to 2011 in highly walkable areas. Leisure-time physical activity, diet, and smoking patterns did not vary by walkability and were relatively stable over time.



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


31 July 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.”



New York City Active Design Guidelines (

This attractive publication by the New York City Department of Design + Construction provides detailed information for planners and designers about opportunities to increase daily physical activity. Implemented over a broad range of urban and architectural projects these measures can contribute significantly toward bringing about healthier lifestyles in our communities. A number of the strategies in these guidelines can also reduce energy use in buildings and transportation, thereby benefiting the environment. Key recommendations include:



HEAT Model (

The Health Economic Assessment Tool (HEAT) for cycling is a science-based computer model that calculates the human health benefits that result from increased cycling activity (Kahlmeier, et al. 2010). It allows user to model the impact of different levels of cycling, and attach a value to the estimated level of cycling when the new infrastructure is in place. This can be compared to the costs to produce a benefit/cost ratio, or as an input into a more comprehensive cost benefit analysis. It can be applied to a specific project that increases cycling on a facility or corridor, or to a set of policies and projects that increase cycling activity in an area. For instance, to estimate the mortality benefits from achieving national targets to increase cycling or to illustrate potential cost consequences to be expected in case of a decline of the current levels of cycling.



Health Benefits of Non-motorized Transport

Meta-analysis by de Hartog, et al. (2010) indicates that people who shift from car to bicycling enjoy substantially larger health benefits (3 – 14 months gained) than the potential mortality effect of increased inhaled air pollution doses (0.8 – 40 days lost) and the increase in traffic accidents (5 – 9 days lost). Societal benefits are even larger due to reductions in air pollution and accident risk to other road users. The researchers conclude that the estimated health benefits of cycling were substantially larger than the risks relative to car driving for individuals shifting mode of transport.



Building Healthy Places Toolkit

The Urban Development Institute’s Building Healthy Places Toolkit identifies opportunities to enhance health through changes in approaches to buildings and projects. It outlines 21 evidence-based recommendations for promoting health at the building or project scale. These 21 “gold star” recommendations are organized according to three categories: physical activity, healthy food and drinking water, and healthy environment and social well-being. At the heart of the report lies a rigorous review of existing health literature. The 21 recommendations all have strong supporting evidence. A list of practical implementation strategies and best practices, grouped according to their available evidence base, supports each of the 21 overarching recommendations.


The American Planning Association’s Metrics for Planning Healthy Communities (Ricklin and Shah 2017) provides specific guidance on ways to measure these impacts. Developers, owners, property managers, designers, investors, and others involved in real estate decision making can use the strategies described in this report to create places that contribute to healthier people and communities and that enhance and preserve value by meeting the growing desire for health-promoting places.



Traffic Control Health Benefits (

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.



Public Transit and Health (Litman 2010)

Public transit improvements and more transit oriented development can provide large health benefits. People who live or work in communities with high quality public transportation tend to drive significantly less and rely more on alternative modes (walking, cycling and public transit) than they would in more automobile-oriented areas. This reduces traffic crashes and pollution emissions, increases physical fitness and mental health, and provides access to medical care and healthy food.


Lachapelle and Frank (2009) found that the likelihood that Atlanta, Georgia residents would meet federal targets for physical activity by walking for transportation (at least 1.5 miles or 30 minutes a day of walking) were much higher (odds ratio 3.87) if they used transit that day, controlling for demographics, neighborhood density, presence of services near workplaces, distance from home to transit, and car availability. Lachapelle (2010) fund that transit users have higher frequencies of utilitarian walking to destinations near the home and workplace independent of neighborhood walkability, car availability, and enjoyment of moderate physical activity.


These impacts are significant in magnitude compared with other planning objectives, but are often overlooked or undervalued in conventional transport planning. Various methods can be used to quantify and monetize (measure in monetary units) these health impacts. This analysis indicates that improving public transit can be one of the most cost effective ways to achieve public health objectives, and public health improvements are among the largest benefits provided by high quality public transit and transit-oriented development.



LRT (MacDonald, et al. 2010)

Researchers from the University of Pennsylvania, Drexel University and the RAND Corporation found that construction of a light-rail system (LRT) resulted in increased physical activity (walking) and subsequent weight loss by area residents. These findings suggest that improving neighborhood environments and increasing the public's use of LRT systems could improve health outcomes and potentially impact millions of individuals.


Using two surveys, one collecting data prior to the completion of an LRT in Charlotte, North Carolina, the second after completion, investigators found that using light rail for commuting was associated with reductions in body mass index (BMI) over time. Specifically, LRT reduced BMI by an average of 1.18 kg/m2 compared to non-LRT users in the same area over a 12-18 month follow-up period. This is equivalent to a relative weight loss of 6.45 lbs for a person who is 5'5. LRT users were also 81% less likely to become obese over time.


Survey questions assessed level of physical activity, BMI, perception of the neighborhood environment, public transit use before and after LRT construction, any plans to use LRT when available, and actual LRT usage.


Lead investigator John M. MacDonald, PhD, University of Pennsylvania, concluded, “The built environment can constrain or facilitate physical activity. Understanding ways to encourage greater use of local environments for physical activity offers some hope for reducing the growth in the prevalence of obesity. Given that perceptions of neighborhood environments are independently associated with improved health outcomes, and that individuals who choose to use LRT obtain some relative weight reduction, it would be prudent to encourage public policies that improve the safety and attractiveness of pedestrian environments that link home, work and transit stops to increase use of public transit for commuting to work. Public policy investments in transit should consider potential increases in physical activity as part of the broader set of cost-benefit calculations of transit systems. Land- use planning and travel choice have a clear impact on health outcomes. Public transit systems can generate positive health impacts by encouraging greater numbers of users to walk to station stops and maintain more physically active lives. An added benefit of public policy investments in LRT, on top of the general transportation benefits accrued, is the potential reductions in obesity in the population."



Evaluating Land Use Health Impacts (Frank, et al. 2010)

The study project, Neighbourhood Design, Travel, and Health, describes various factors that affect walkability, methods for measuring those factors to create a walkability index, and the impacts of neighborhood walkability on per capita automobile travel, physical activity and fitness in the Vancouver, BC metropolitan region. The results indicate that:

·         Adults living in the top 25% most walkable neighbourhoods walk, bike and take transit 2-3 times more, and drive ap­proximately 58% less than those in more auto-oriented (less walkable) areas.

·         Residents living in the most walkable areas, with good street connectivity and land use mix, were half as likely to be overweight than those in the least walkable neighborhoods.

·         Living in a neighbourhood with at least one grocery store was associ­ated with a nearly 1.5 times likeli­hood of getting sufficient physical activity, as compared to living in an area with no grocery store, and each additional grocery store within a 1-kilometer distance from an individual’s residence was associated with an 11% reduction in the likelihood of being overweight.

·         The most walkable neighbourhoods have the least ozone pollution, but the most pollution from nitric oxide. Neighbourhoods with relatively high walkability and low pollution levels exist across the region.




MetaStudy (Woodcock, et al. 2010)

A meta-analysis of 22 cohort studies in adult populations with a sample size of more than 10,000 participants estimated the effect of light or moderate physical activity on all-cause mortality. The results indicate that, compared with no reported physical activity, 2.5 h/week (equivalent to 30 min daily of moderate intensity activity on 5 days a week) was associated with a 19% reduction in all cause mortality, while 7 h/week of moderate activity was associated with a 24% reduction in mortality. A smaller effect was found in studies that looked at walking alone. The authors conclude that being physically active reduces the risk of all-cause mortality. The largest benefit was found from moving from no activity to low levels of activity, but even at high levels of activity benefits accrue from additional activity.


The study, carried out with researchers at Cambridge University and the Karolinska Institute in Sweden, showed the largest health benefits were in people who did hardly any physical activity. According to the study’s main author, James Woodcock, “Our research confirms that it is not just exercising hard that is good for you. Even moderate, everyday activities like walking and cycling can have major health benefits. Just walking to the shops or walking the children to school can lengthen your life - as well as bringing other benefits for well-being and the environment. It is a very important message to get across, that small amounts of light to moderate activity on a regular basis will have quite large benefits. Large benefits were found in people going from being a couch potato to doing some activity.”



The Community Guide

The Community Guide (, produced by the U.S. Centers for Disease Control and Prevention (CDC), uses scientific research to identify specific ways to create healthier and safer communities. Their report, Physical Activity: Built Environment Approaches Combining Transportation System Interventions with Land Use and Environmental Design recommends various strategies to increase physical fitness and health. These include increased:

·         Street connectivity

·         Sidewalk and trail infrastructure

·         Bicycle infrastructure

·         Public transit infrastructure and access

·         Mixed land use environments that increase the diversity and proximity of local destinations where people live, work, and spend their recreation and leisure time

·         Access to parks and other public or private recreational facilities

·         Additional activities to promote physical activity (e.g., Safe Routes to School).



Smart Growth Health Impacts (Ewing and Hamidi 2014)

A major study by the University of Utah’s Metropolitan Research Center developed a sprawl index that incorporates four factors: density (people and jobs per square mile), mix (whether neighborhoods had a mix of homes, jobs and services), centricity (the strength of activity centers and downtowns) and roadway connectivity (the density of connections in the roadway network); a higher rating indicates more compact, smart growth development (Ewing and Hamidi 2014). This index was used to evaluate how these land use factors affects various travel, economic and health outcomes. It indicates that:

·         Smart growth community residents tend to live longer. For every doubling in an index score, life expectancy increases by about 4%. For the average American with a life expectancy of 78 years, this translates into a three-year difference in life expectancy between people in a less compact versus a more compact county. This probably reflects the combined effects of increased physical activity and significantly lower rates of traffic fatalities, obesity, high blood pressure and diabetes, although these are somewhat offset by slightly higher air pollution exposure and murder risk.

·         Counties with less sprawl have more but less severe vehicle crashes. For every 10% increase in an index score, fatal crashes decrease by almost 15%. People in smarter growth communities also have significantly lower blood pressure and rates of diabetes.

·         People in smart growth areas own fewer cars and spend less time driving. For every 10% increase in index score, vehicle ownership rates decline 0.6% and drive time declines 0.5%.

·         For every 10% increase in an index score, the walk mode share increases by 3.9%.

·         The portion of household income spent on housing is greater but the portion of income spent on transportation is lower, in smart growth communities. Each 10% increase in an index score was associated with a 1.1% increase in housing costs and a 3.5% decrease in transportation costs relative to income. Since transportation costs decline faster than housing costs rise, this results in a net decline in combined housing and transportation costs.

·         For every 10% increase in an index score, there is a 4.1% increase in the probability that a child born to a family in the bottom quintile of the national income distribution reaches the top quintile of the national income distribution by age 30.


Table 18 summarizes these results.


Table 18          Summary of Sprawl Outcomes (SGA 2014/ Ewing and Hamidi 2014)




Relationship to Sprawl

Housing affordability

Location Affordability Index (LAI)


positive and significant

Transportation affordability



negative and significant

Combined housing and transportation affordability



negative and significant

Upward mobility (probability a child born in a low-income household will live in a higher-income household by age 30)

Equality of Opportunity databases


negative and significant

Average household vehicle ownership

American Community Survey (ACS)

MSA, county, UZA

positive and significant

Percentage of commuters walking to work


MSA, county, UZA

negative and significant

Percentage of commuters using public transportation (excluding taxi)


MSA, county, UZA

negative and significant

Average journey-to-work drive time in minutes


MSA, county, UZA

positive and significant

Traffic crash rate per 100,000 population



negative and significant

Injury crash rate per 100,000 population



negative and significant

Fatal crash rate per 100,000 population



Positive and significant

Body mass index

Behavioral Risk Factor Surveillance System (BRFSS)


Positive and significant




Positive and significant

Any physical activity



Positive and significant

Diagnosed high blood pressure



Positive and significant

Diagnosed heart disease



Not significant

Diagnosed diabetes



Positive and significant

Average life expectancy

Institute for Health Metrics and Evaluation


negative and significant

This table summarizes various transport, economic and health impacts associated with sprawl.



Tools for Transportation Health Impact Analysis

The following tools are designed to evaluate health impact for transportation and land use planning.


America’s Health Rankings ( provides state by state data on national indicators of health, environmental and socioeconomic characteristics aimed at establishing national health benchmarks and state rankings.


Building Healthy Places Toolkit ( by the Urban Development Institute, identifies opportunities to enhance health through changes in approaches to buildings and projects. It outlines 21 “Gold Star” evidence-based recommendations for promoting health at the building or project scale. These  recommendations are organized according to three categories: physical activity, healthy food and drinking water, and healthy environment and social well-being. A list of practical implementation strategies and best practices, grouped according to their available evidence base, supports each of the 21 overarching recommendations.


Built Environment and Public Health Clearinghouse ( This is a resource for training and relevant news about the intersection of health and place. It was developed by APA, APHA, Georgia Tech, and the National Network of Public Health Institutes.


California Health Assessment Models ( is a comprehensive activity-based public health model that uses detailed inputs (land use, socio-demographic, transportation) and outcome (physical activity and health conditions) data to evaluate how transportation and land use factors affect health outcomes.


County Health Rankings ( Measures the health of nearly all counties in the nation and ranks them within states using a variety of national and state data sources.


EPA Smart Locations Database ( The SLDB is a nationwide geographic data resource for measuring location efficiency. It summarizes characteristics such as housing density, diversity of land use, neighborhood design, destination accessibility, transit service, employment, and demographics. It is coupled with a second data system that allows users to examine the accessibility of a region to jobs by transit and automobiles as well walkability scores.


Healthy Community Design Checklist Toolkit ( The Toolkit was developed to help planners, public health professionals, and the general public consider health in community planning.


Health Economic Assessment Tool (HEAT) for cycling and walking ( calculates the economic value of the health benefits from increased walking and bicycling.


Health Transportation Shortage Index  ( helps identify areas and communities where transportation shortages create barriers to health care access. The HTSI uses a scoring protocol to identify the most important factors associated with transportation barriers to child health care access.


Integrated Transport and Health Impact Modeling Tool ( ITHIM provides integrated health impact assessment of transport through changes in physical activity, road traffic injury risk, and urban air pollution. ITHIM can either be used as a stand-alone model, or linked to other transport and health models. It can be used for development of scenarios, for estimation of changes in exposures, and for modelling health outcomes.


Metrics for Planning Healthy Communities ( by Ricklin and Shah (2017) provides specific guidance on ways to measure these impacts. Developers, owners, property managers, designers, investors, and others involved in real estate decision making can use the strategies described in this report to create places that contribute to healthier people and communities and that enhance and preserve value by meeting the growing desire for health-promoting places.


National Public Health Assessment Model ( is a public health and activity plug-in module that empowers communities to evaluate relative health impacts of contrasting land use and transportation scenarios. It is the first health assessment tool that can connect to multiple existing scenario planning platforms utilizing nationally available data and can be consistently applied nationally. It leverages nationally available built environment data from the EPA Smart Location Database and the Robert Wood Johnson Foundation National Environment Database. It can empower communities to choose investments that have the greatest potential to improve public health and quality of life, reduce health care costs, and address environmental justice related disparities.  


National Environmental Database ( establishes a nationally consistent, standardized, and centrally located set of individual and composite metrics that characterize the built, natural and social environment. It contains over 200 variables which have been demonstrated to best predict health outcomes. It provides planners, public health officials, and researchers with a single source of high quality, high resolution, environmental variables with uniform, nationwide coverage. It is updated periodically to include a robust set of environmental variables known to predict health outcomes and is designed to help researchers, health officials and others assess how neighborhood context can support or hinder public health.


Sleep, Leisure, Occupation, Transportation, and Home-based activities (SLOTH) model ( This model provides guidance regarding interventions that might increase physical activity in each of four non-sleep domains (economic efficiency, equity, effectiveness, and feasibility).  


Transportation and Health Toolkit ( Provides information on the links between health, equity, and transportation and APHA’s efforts to ensure that transportation policy helps public health. Available at.


Transportation Health Tool ( This online tool developed by the USDOT and USEPA allows users to understand how specific communities or states compare in terms of key transportation and health indicators. 


Walk Score ( This tool assigns a numerical walkability score to any address in the United States, Canada, and Australia. It also serves up data on travel time, food deserts, apartments, and neighborhoods. 



Walkability Health Impacts (Giles-Corti, et al. 2013)

A ten-year study found that the overall health of residents of new housing developments in Western Australia, improved when their daily walking increased as a result of more access to parks, public transport, shops and services. Lead researcher Professor Billie Giles-Corti, Director of the McCaughey VicHealth Centre for Community Wellbeing at the University of Melbourne said the study provided long-term evidence that residents' walking increased with greater availability and diversity of local transport and recreational destinations. “The study demonstrates the potential of local infrastructure to support health-enhancing behaviours,” she said.


The study examined the impact of urban planning on active living in metropolitan Perth, Western Australia. More than 1,400 participants building homes in new housing developments were surveyed before relocation to new homes and approximately 12 months later. It found that for every local shop, residents' physical activity increased an extra 5-6 minutes of walking per week. For every recreational facility available such as a park or beach, residents' physical activity increased by an extra 21 minutes per week. These findings could inform public health and urban design policy demonstrating that people respond to an environment that is supportive of physical activity.


“Given that being physically active reduces the risk of heart disease and diabetes, which are both huge costs to the health system, these results could have huge implications for government policy such,” Professor Giles-Corti said.



'Walk in to Work Out' Campaign (

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.)

  1. Walk
  2. Cycle
  3. Public transit
  4. Delivery/commercial vehicles
  5. Private car


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


·         Implement Complete Streets Policies which ensure that roadway design and operating practices safely accommodate diverse users and activities including pedestrians, cyclists, motorists, public transport users, people with disabilities, plus adjacent businesses and residents. 


·         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.


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 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


ABW (2014-2016), Bicycling and Walking in the U.S.: Benchmarking Reports, Alliance for Biking & Walking, (; at


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


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


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 (, June 12, pp. 1621-1628.


APHA (2010), The Hidden Health Costs of Transportation: Backgrounder, American Public Health Association (; at


APHA (2011), Transportation Issues from the Public Health Perspective: Website, American Public Health Association (; at


David Bassett, et al. (2011), “Active Transportation and Obesity in Europe, North America, and Australia,” ITE Journal, Vol. 81/8, pp. 24-28; abstract at


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 (


A. Colin Bell, Keyou Ge and Barry M. Popkin (2002), “The Road to Obesity or the Path to Prevention: Motorized Transportation and Obesity in China,” Obesity Research (, Vol. 10, 2002, pp. 277-283.


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 (, 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 (; at


Steven Blair (2009), “Physical Inactivity: The Biggest Public Health Problem of the 21st Century,” British Journal of Sports Medicine, Vol. 43, pp. 1-2; at

Ralph Buehler, Thomas Götschi and Meghan Winters (2016), Moving Toward Active Transportation: How Policies Can Encourage Walking and Bicycling, Active Living Research (; at


Built Environment and Public Health Clearinghouse ( provides training resources at the university and professional levels for improving public health through community design.


Nick Cavill, Andy Cope and Angela Kennedy (2009), Valuing Increased Cycling in the Cycling Demonstration Towns, Cycling England, Department for Transport (; at


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


CDC (2008), Physical Activity Guidelines, Center for Disease Control and Prevention (; at


CDC (2009), Transportation and Health Toolkit, Healthy Eating Active Living Convergence Partnership, Center for Disease Control and Prevention (; at


CDC (2010), CDC Transportation Recommendations, Center for Disease Control and Prevention (; at


CPSTF (2017), Physical Activity: Built Environment Approaches Combining Transportation System Interventions with Land Use and Environmental Design, Community Preventive Services Task Force, The Community Guide (; at


Maria I. Creatore, et al. (2016), “Association of Neighborhood Walkability With Change in Overweight, Obesity, and Diabetes,” JAMA, Vol. 315, No 20, 2211 (DOI:10.1001/jama.2016.5898); at


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) (


Carlos Dora And Jamie Hosking (2012), “Urban Transport and Health: A Review,” Journeys, Nov. 2012, Singapore Land Transportation Authority (; at


Jeroen Johan de Hartog, Hanna Boogaard, Hans Nijland and Gerard Hoek (2010), “Do The Health Benefits Of Cycling Outweigh The Risks?” Environmental Health Perspectives, doi:10.1289/ehp.0901747,


Marie Demers (2006), Walk For Your Life! Restoring Neighborhood Walkways To Enhance Community Life, Improve Street Safety and Reduce Obesity, Vital Health Publishing (


DfT (2010), Cycling Demonstration Towns – Development of Benefit-Cost Ratios by the UK Department for Transport (


DHHS (2008), Physical Activity Guidelines For Americans, Physical Activity Guidelines Advisory Committee Report, Department of Health and Human Services (; at


Peggy Edwards and Agis D. Tsouros (2008), A Healthy City Is An Active City: A Physical Activity Planning Guide, World Health Organization Europe (; at


K.I. Erickson, et al. (2010), “Physical Activity Predicts Gray Matter Volume In Late Adulthood: The Cardiovascular Health Study,” Neurology 75, October, pp. 1415–1422; at


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


Reid Ewing and Shima Hamidi (2014), Measuring Urban Sprawl and Validating Sprawl Measures, Metropolitan Research Center at the University of Utah for the National Cancer Institute, the Brookings Institution and Smart Growth America (; at


Reid Ewing, et al. (2014), “Relationship Between Urban Sprawl And Physical Activity, Obesity, And Morbidity – Update And Refinement,” Health & Place, Vol. 26, March, pp. 118-126; at


Elliot Fishman, Ian Ker, Jan Garrad and Todd Litman (2011), Cost and Health Benefits of Active Transport in Queensland: Research and Review, prepared by CATALYST for Health Promotion Queensland (; summary at


Oscar H. Franco, et al (2005), “Effects of Physical Activity on Life Expectancy With Cardiovascular Disease,” Archives of Internal Medicine, Vol. 165 No. 20 (, Nov. 2005, pp. 2355-2360.


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 (, 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 (; at


Lawrence Frank, Andrew Devlin, Shana Johnstone and Josh van Loon (2010), Neighbourhood Design, Travel, and Health in Metro Vancouver: Using a Walkability Index, Active Transportation Collaboratory, UBC (; at


Chad Frederick, William Riggs and John Hans Gilderbloom (2017), “Commute Mode Diversity and Public Health: A Multivariate Analysis of 148 US Cities,” International Journal of Sustainable Transportation (


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


Billie Giles-Corti, Sarah Foster, Trevor Shilton and Ryan Falconer (2010), “The Co-benefits for Health of Investing in Active Transportation,” NSW Public Health Bulletin, Vol. 21, No5–6, pp. 122-127; at


Billie Giles-Corti, et al. (2013), “The Influence Of Urban Design On Neighbourhood Walking Following Residential Relocation: Longitudinal Results from the RESIDE Study,” Journal of Social Science & Medicine, Vol. 77, January, Pages 20–30 (; summary at


Billie Giles-Corti, et al. (2016), “City Planning and Population Health: a Global Challenge,” The Lancet, (ttp://; at


Jessica Y. Guo and Sasanka Gandavarapu (2010), “An Economic Evaluation Of Health-Promotive Built Environment Changes,” Preventive Medicine, Vol. 50, Supplement 1, January 2010, pp. S44-S49; at


Health Impact Assessment website ( provides information on ways to systematically evaluate and communicate potential health impacts in policy and planning analysis.


Health Impact Assessment, Transportation (, by the San Francisco Department of Public Health’s Program on Health, Equity And Sustainability.


Health Economic Assessment Tool (HEAT) for cycling is a science-based computer model developed by the World Health Organization that calculates the human health benefits that result from increased cycling activity (


Health On The Move ( is an association of public health and transport practitioners and researchers committed to understanding and addressing the links between transport policies and health and promoting a healthy transport system.


Healthy Places By Design ( advances community-led action and proven, place-based strategies to ensure health and wellbeing for all.


Building Healthy Places Initiative ( is an Urban Development Institute program to develop tools to create healthier communities.



Christine M. Hoehner, Carolyn E. Barlow, Peg Allen and Mario Schootman (2012), "Commuting Distance, Cardiorespiratory Fitness, and Metabolic Risk," American Journal of Preventive Medicine ( DOI: 10.1016/j.amepre.2012.02.020; at[4]-stamped.pdf


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


ITF (2014), Cycling, Health and Safety, International Transport Forum (DOI:10.1787/9789282105955-en); at


Peter L. Jacobsen (2003), “Safety In Numbers: More Walkers and Bicyclists, Safer Walking and Bicycling.” Injury Prevention (, Vol. 9, 2003, pp. 205-209; at


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;


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


Sonja Kahlmeier, Francesca Racioppi, Nick Cavill, Harry Rutter, and Pekka Oja (2010), “‘Health in All Policies’ in Practice: Guidance and Tools to Quantifying the Health Effects of Cycling and Walking,” Journal of Physical Activity and Health, Vol. 7, Supplement 1, pp. S120-S125; at


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 (, 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 (, June 2003, pp. 28-32.


Soowon Kim, et al. (2010), “Development Of The Community Healthy Living Index: A Tool To Foster Healthy Environments For The Prevention Of Obesity And Chronic Disease,” Preventive Medicine, Vol. 50, Supplement 1, January, pp. S44-S49; at


Lawrence Frank & Company (2008), The Built Environment and Health: A Review, Plan-It Calgary, City of Calgary (; at


Ugo Lachapelle and Lawrence D . Frank (2009), “Transit and Health: Mode of Transport, Employer-Sponsored Public Transit Pass Programs, And Physical Activity,” Journal Of Public Health Policy (, Vol. 30, pp. S73-S94; at


Ugo Lachapelle (2010), Public Transit Use As A Catalyst For An Active Lifestyle: Mechanisms, Predispositions And Hindrances, PhD Dissertation, University of British Columbia (


Ugo Lachapelle, et al. (2011), “Commuting by Public Transit and Physical Activity: Where You Live, Where You Work, and How You Get There,” Journal of Physical Activity and Health (, Vo. 8 No. 1, January; at


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


Todd Litman (2005), Transportation Cost and Benefit Analysis, Victoria Transport Policy Institute (


Todd Litman (2007), Community Cohesion As A Transport Planning Objective, paper 07-0550, Transportation Research Board Annual Meeting (; at


Todd Litman (2008), “Creating Safe and Healthy Communities,” Environments: A Journal of Interdisciplinary Studies; Special Issue: Planning for Health Through the Built Environment, (, 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 (


Todd Litman (2009), “Transportation Policy and Injury Control,” Injury Prevention, Vol. 15, Issue 6 (; at


Todd Litman (2010), Evaluating Public Transportation Health Benefits, American Public Transportation Association (; at


Todd Litman (2011), Pricing For Traffic Safety: How Efficient Transport Pricing Can Reduce Roadway Crash Risk, Victoria Transport Policy Institute (; at


Todd Litman (2013), “Transportation and Public Health,” Annual Review of Public Health, Vol. Vol. 34, pp. 217-233 (; draft version at


Todd Litman (2013), Safer Than You Think! Revising the Transit Safety Narrative, Victoria Transport Policy Institute (; at


Todd Litman (2014), “A New Transit Safety Narrative” Journal of Public Transportation, Vol. 17, No. 4, pp.121-142; at


Todd Litman (2016), The Hidden Traffic Safety Solution: Public Transportation, American Public Transportation Association (; at


Todd Litman (2017), Urban Sanity: Understanding Urban Mental Health Impacts and How to Create Saner, Happier Cities, Victoria Transport Policy Institute (; at


Todd Litman (2017), The New Traffic Safety Paradigm, Victoria Transport Policy Institute (; at


Todd Litman and Steven Fitzroy (2006), Safe Travels: Evaluating Mobility Management Traffic Safety Benefits, Victoria Transport Policy Institute (; at


Ian M. Lockwood (2004), Transportation Prescription For Healthy Cities, Glatting Jackson Transportation Urban Design Studio, for presentation and Common Ground


Javier Lopez-Zetina, Howard Lee and Robert Friis (2006), “The Link Between Obesity And The Built Environment: Evidence From An Ecological Analysis Of Obesity And Vehicle Miles Of Travel In California,” Health & Place, Vol. 12/4, December, pp, 656-664; at


William Lucy (2002), Danger in Exurbia: Outer Suburbs More Dangerous Than Cities, University of Virginia (; summarized in


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, pp. 1564-1569; at


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


Bill Lyons (2004), Annotated Bibliography on Health and Physical Activity in Transportation Planning, Volpe National Transportation Systems Center ( for the Federal Highway Administration and Federal Transit Administration (


James MacMillen, Moshe Givoni And David Banister (2010), “Evaluating Active Travel: Decision-Making for the Sustainable City,” Built Environment, Vol. 36, No. 4, Dec. pp. 519-536; summary at


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 (, pp. 395–405.


John M. MacDonald, Robert J. Stokes, Deborah A. Cohen, Aaron Kofner and Greg K. Ridgeway (2010), “The Effect of Light Rail Transit on Body Mass Index and Physical Activity,” American Journal of Preventive Medicine, Vol. 39, No. 2, pp. 105-112; at


Roger L Mackett and Belinda Brown (2011), Transport, Physical Activity and Health:  Present Knowledge and the Way Ahead, Centre for Transport Studies, University College London (


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 (


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 ( November 16, 2005, page B1.

National Center for Chronic Disease Prevention and Health Promotion ( provides information on public health programs related to nutrition and exercise.


NCBW (2010), Increasing Physical Activity Through Community Design: A Guide for Public Health Practitioners, National Center for Bicycling and Walking (; at


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 (, pp. 79-83.


NYC (2010), Active Design Guidelines: Promoting Physical Activity and Health Through Design, New York City Department of Design + Construction (; at


NYCDH (2011), Health Benefits of Active Transportation in New York City,” NYC Vital Signs Special Report,  New York City Department of Health, Vol. 10, No. 3, May; at


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, (, with funding from The Caltrans Environmental Justice Program; at


Pedestrian and Bicycle Information Center (


PfP (2011), Transportation and Health: Policy Interventions for Safer, Healthier People and Communities, Partnership for Prevention (Safe Transportation Research and Education Center, Booz Allen Hamilton, and the Centers for Disease Control and Prevention) (; at


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 (


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


PPS (2016), The Case for Healthy Places: Improving Health Outcomes Through Placemaking, Project for Public Spaces (; at


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


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 (, 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


John Pucher, Ralph Buehler, David R. Bassett and Andrew L. Dannenberg (2010), “Walking and Cycling to Health: A Comparative Analysis of City, State, and International Data,” American Journal of Public Health, at


John Pucher and Ralph Buehler (2010), “Walking and Cycling for Healthy Cities,” Built Environment, Vol. 36, No. 4 (, December, pp 391-414; at


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


Anna Ricklin and Sagar Shah (2017), Metrics for Planning Healthy Communities, American Planning Association (; at


David Rojas-Rueda, Audrey de Nazelle, Marko Tainio and Mark J Nieuwenhuijsen (2011), “The Health Risks And Benefits Of Cycling In Urban Environments Compared With Car Use: Health Impact Assessment Study,” BMJ, 343:d4521 (; at


Brian Saelens, et al. (2012), “Obesogenic Neighborhood Environments, Child and Parent Obesity: The Neighborhood Impact on Kids Study,” American Journal of Preventive Medicine ( May, Vol. 42, No. 5, at[3]-stamped.pdf


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 (, May 2004, pp. 249-268.


Chinmoy Sarkar, Chris Webster and John Gallacher (2018), “Neighbourhood Walkability And Incidence Of Hypertension: Findings From The Study Of 429,334 UK Biobank Participants,” International Journal of Hygiene and Environmental Health (


Franco Sassi (2010), Fit Not Fat: Obesity and the Economics of Prevention, Organization for Economic Cooperation and Development (; at,3343,en_2649_33929_45999775_1_1_1_1,00.html.


Christian Schweizer, Francesca Racioppi and Leda Nemer (2014), Developing National Action Plans On Transport, Health And Environment. A Step-By-Step Manual For Policy-Makers And Planners, World Health Organization (; at


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, (; at, and


Olga Skachko (2011), “Здароўе і фітнес: Стратэгіі, паляпшэнне здароўя насельніцтва праз фізічную актыўнасць,” TDM энцыклапедыі; at This is a Belorussian translation of this page.


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 (


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 (


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 (, May, pp. 6-8;


Theresa Tam (2017), Designing Healthy Living, Public Health Agency of Canada (; at


TC (2011), Active Transportation in Canada: A Resource and Planning Guide, Transport Canada (; at


Ray Tomalty and Murtaza Haider (2009), Walkability and Health; BC Sprawl Report 2009, Smart Growth BC (; at


Paul Joseph Tranter (2010), “Speed Kills: The Complex Links Between Transport, Lack of Time and Urban Health,” Journal of Urban Health, Vol. 87, No. 2, doi:10.1007/s11524-009-9433-9; at


Catrine Tudor-Locke, et al. (2010), “Accelerometer Profiles Of Physical Activity And Inactivity In Normal Weight, Overweight, And Obese U.S. Men And Women,” International Journal of Behavior, Nutrition and Physical Activity, August, Vol. 3, No. 7, pp. 60; at


Transportation and Health Toolkit ( presents an overview of connections between transportation and health, and policy opportunities to create healthy transportation options.


UDI (2015), Building Healthy Places Toolkit: Strategies for Enhancing Health in the Built Environment, Urban Land Institute (; at


UPH (2011), Transportation Health Equity Principles, Upstream Public Health (; at


Urban Design for Health ( specializes in applied research on the interactions between land use, transportation, air quality, climate change, and public health. It has produced practical tools for incorporating health objectives into community planning, including the National Environmental Database which includes built, natural and social environmental health performance indicators that can be used to evaluate specific communities.


Ronald Utt (2003), Obesity and Life Styles: Is it the Hamburger or your House?, Heritage Foundation (


Walkable Communities ( works with communities to create more people-oriented environments.


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


Jay Walljasper (2013), Walking As A Way Of Life Movement For Health & Happiness, Everybody Walks ( (; at


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 (


WHO (2011), Health Co-Benefits Of Climate Change Mitigation - Transport Sector: Health In The Green Economy, World Health Organization (; at


WHO (2011), Health Economic Assessment Tool for Cycling and Walking, World Health Organization Region Office Europe (; at


James Woodcock, Oscar H Franco, Nicola Orsini and Ian Roberts (2010), “Non-Vigorous Physical Activity And All-Cause Mortality: Systematic Review And Meta-Analysis Of Cohort Studies,” International Journal of Epidemiology, doi:10.1093/ije/dyq104 (


World Bank (2014), Transport For Health: The Global Burden Of Disease From Motorized Road Transport, Global Road Safety Facility, World Bank Group (; at

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.




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