Incorporating Health into Long-Range Transportation Planning

The North Central Texas Council of Governments (NCTCOG), the metropolitan planning organization for the Dallas-Fort Worth region, has integrated health into its transportation planning process, including its most recent long-range transportation plan. By considering health in the transportation planning process, NCTCOG recognized the health benefits of initiatives it was already pursuing, such as those related to safety and air quality. NCTCOG is also using data on health-related indicators to assess the health of counties today and to measure changes in the future.

FHWA-HEP-17-076 Also available as Adobe PDF (266 KB)

Considering existing health efforts

In the summer of 2013, NCTCOG began to think through how many of its transportation initiatives and policies related to health. NCTCOG had completed an update of its long-range transportation plan, Mobility 2035, in June 2013, and wrote an internal white paper on the elements of the plan that impact health. The white paper framed transportation initiatives related to health as programs that would support sustainability, quality of life, and livable communities. Health-related programs in the plan included:

• Air quality. Through working with partners to adopt energy-efficient and low-emitting fleets, advancing clean technologies, and encouraging changes to daily behaviors, NCTCOG aimed to reduce emissions and improve air quality.
• Active transportation. The plan aimed to increase physical activity through developing bicycle and pedestrian facilities, including improving infrastructure near schools through the Safe Routes to Schools Program, and developing a regional “Veloweb” network of off-street shared-use paths.
• Sustainable development. The plan incorporates economic development, environmental protection, and social equity considerations into planning and programming. This includes a Sustainable Development Funding Program that allocates transportation funds to land-use projects that promote alternative transportation modes or reduced automobile use.

Health indicators and strategies

When it came time to develop its next long-range transportation plan, Mobility 2040, NCTCOG put a strong effort into incorporating health into its process. NCTCOG used resources developed by the Centers for Disease Control and Prevention (CDC) to evaluate how counties in the region compared to peer counties in terms of specific health indicators, and to identify strategies that NCTCOG was already pursuing that improve health outcomes.

NCTCOG collected data from the CDC’s Community Health Status Indicators dataset, which allowed them to move beyond the limited set of public health indicators they had used previously, such as those related to air quality, to a broader set of measures. Out of over 40 indicators included in the dataset, NCTCOG selected eight that it thought could be affected by transportation programs:

• Unhealthy ozone days;
• Unhealthy fine particulate matter (PM2.5) days;
• Motor vehicle deaths;
• Unintentional injury (including motor vehicle injuries);
• Unemployment;
• Living near highways;
• Access to parks; and
• Adult obesity.

Then, NCTCOG used the CDC data to compare how the 12 counties within the region were performing on these indicators as compared to peer counties.¹ This analysis showed that, in general, many of the counties within the Dallas-Fort Worth region are performing the same or better than peer counties on the selected public health indicators. However, some of the counties scored worse than their peers on particular indicators, highlighting potential areas for improvement (see Figure 1).

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NCTCOG also incorporated into Mobility 2040 six transportation strategies to improve health outcomes based on the CDC’s Transportation Health Impact Assessment Toolkit, which identifies transportation design and infrastructure strategies that promote positive health outcomes and/or reduce negative health outcomes. The strategies are:

• Reduce vehicle miles traveled (VMT);
• Expand public transportation;
• Promote active transportation;
• Incorporate healthy community design features;
• Improve safety for all users; and
• Ensure equitable access to transportation networks.

NCTCOG identified how the policies, programs, and initiatives included in Mobility 2040 support these six strategies, and summarized the findings in an appendix. For example, for the strategy of reducing VMT, Mobility 2040 includes policies and programs related to implementing travel demand management, such as an employer trip reduction program, a regional vanpool program, and park-and-ride facilities (see Figure 2). Related to active transportation, Mobility 2040 includes a goal of supporting the planning and design of a multimodal transportation network that promotes walking and bicycling as equals with other transportation modes. It also includes programs and activities that promote pedestrian and bicycle safety.

By applying the CDC indicators and strategies to its long-range transportation plan, NCTCOG was able to consider how many of the policies and programs throughout its plan support improved health outcomes, even if they do not explicitly focus on health.

Next steps

By using data and resources developed by the CDC, NCTCOG was able to apply a health lens to its long-range transportation plan and identify how many of the transportation strategies it was already pursuing improve the health of the region. NCTCOG will continue to include health indicators and strategies in its next long-range transportation plan. It is also interested in coordinating with public health professionals on shared research goals and to ensure that transportation planners and public health professionals are speaking a common language. Eventually, NCTCOG is considering developing public health performance measures to incorporate into its planning process.

The Centers for Disease Control and Prevention monitors community health status indicators that are important in understanding the health of communities. Results for each indicator are available at the county level and allow communities to compare their county to peer counties in the US that have similar demographic, population density, and household income characteristics.1 The following graphs illustrate how counties within the Dallas-Fort Worth Metropolitan Planning Area (MPA) score compared with their peer counties for several community health status indicators. If no bar is shown for a county, the county received a 0 for that indicator. Green bars indicate that the county performs better than peer counties across the nation for that particular indicator, orange bars represent moderate performance compared with peer counties, red bars represent worse performance compared with peer counties, and blue bars represent the US median. Unhealthy Ozone Days: When ozone occurs at ground level, it acts as an air pollutant that threatens health. This indicator measures the number of days that the maximum average ozone concentration, measured over eight hours, exceeds national standards. Though the MPA is in nonattainment for ozone, only five counties have more days above the NAAQS than peer counties. Unhealthy PM2.5 Days: When particulate matter (PM) occurs at ground level, it acts as an air pollutant that threatens health. This indicator measures the number of days with PM2.5 levels above the NAAQS. Though the MPA is in attainment for PM2.5, one county (Ellis) has more days above the NAAQS than peer counties. 1 Centers for Disease Control and Prevention’s Community Health Status Indicators Website, http://wwwn.cdc.gov/CommunityHealth/home

Motor Vehicle Deaths: Motor vehicle deaths are the leading cause of death for people aged 5 to 34 years and are more common in rural areas. This indicator measures the number of motor vehicle related deaths per 100,000 residents. Seven counties within the MPA perform at the same level as their peer counties

Death Caused by Unintentional Injury (including motor vehicle): Unintentional injuries were the fifth leading cause of death in the US in 2010. Unintentional injuries are the leading cause of death for Americans aged 1 to 44, as well as a leading cause of disability for all ages, regardless of sex, race/ethnicity, or socioeconomic status. This indicator measures the number of unintentional deaths per 100,000 residents. Most counties within the MPA perform at the same level as their peer counties in this indicator. Unemployment: The association between unemployment and poor physical and mental health is well established. Unemployed people tend to have higher annual illness rates, lack health insurance and access to health care, and have an increased risk for death. This indicator is based on the percent of the civilian labor force, age 16 and older, that is unemployed but seeking work in 2013. Three counties within the MPA perform better than peer counties, while eight counties perform at the same level as their peers. One county (Rockwall) performed worse for this indicator. 0 5 10 15 20 25 30 35 Number of deaths per 100,000 people County Motor Vehicle Deaths 0 10 20 30 40 50 60 70 Number of Deaths County Deaths Caused by Unintentional Injury (Including Motor Vehicle) 0.0% 1.0% 2.0% 3.0% 4.0% 5.0% 6.0% 7.0% 8.0% % Unemployed County Unemployment Appendix C: Environmental Considerations C3 Mobility 2040 Living near Highways : Several studies have documented that concentrations of traffic -related pollutants are highest close to roads . A recent review determined that there is sufficient evidence to show a causal association between exposure to traffic -related air pollution and asthma exacerbation; the review also found suggestive evidence of a causal association for onset of childhood asthma, non – asthma respiratory symptoms, impaired lung function, all -cause mortality, cardiovascular mortality, and cardiovascular morbidity. This indicator measures the percent of the population living within 150 meters of a highway. One county (Hood) performed better than its peer counties. Five counties performed at the same level as peer counties, and six performed worse.

Access to Parks: Parks, trails, and gardens provide safe and affordable places where residents can engage in physical activity. This indicator measures the percentage of the population that lives within one -half mile of one of these areas. Three counties (Ellis, Hunt, and Johnson) within the MPA perform better than peer counties while seven counties are comparable to peer counties . Adult Obesity : Obese people face health problems that can generate medical costs that are more than $1,000 greater per year than medical costs of people who are not obese. This indicator measures the percent of adults age 20 and over who report that their body mass index is 30 or higher. Five counties (Dallas, Denton, Hood, Kaufman, and Parker) within the MPA perform worse than their peer counties. Two counties (Rockwall and Wise) perform better.

1 The CDC developed a method and variables for peer county groupings based on an iterative process guided by subject matter experts. For more information on this methodology, see https://wwwn.cdc.gov/CommunityHealth/info/HowtoUseReport/TX/Bosque/#PeerComparison.