Understanding the Links between Transportation and Health Case Studies

Webinar Transcript

May 23, 2016

Event ID: 2887713
Event Started: 5/23/2016 12:49:55 PM ET Please stand by for real-time captions.

[ music ]

Please stand by we are about to begin. Thank you for standing by. Welcome to the Understanding the Links between Transportation and Health Case Studies. At this time all participants are in a listen only mode. Later we will conduct a question and answer session and instructions will be given out at that time. I would now like to turn the conference over to Rae Keasler. Please go ahead.

Good morning and good afternoon everyone. Thank you for joining us today. I just wanted to present a few logistics before we begin. Thank you for listening. If you have any questions or comments that you would like to share, feel free to add that in the chat box. That is on the left-hand side of the screen. We will address any comments or questions that come in live as they are happening. We will hold a question and answer session at approximately 2:10 Eastern time.

I wanted to note that all of the presentations are available for download. That is in a box at the bottom of the left-hand screen called file share. Feel free to download any presentation there. This box will disappear when we actually start going into the presentation and then it will reappear during the question and answer session.

If you have any questions feel free to enter them into the chat box. Without further ado let me turn this over to James Garland.

Thank you, Rae. Good morning and good afternoon everyone. I am James Garland. We are really happy that you are able to join us for our discussion today. We think this is a very timely webinar to talk about the links between transportation and health and understand some case studies from the field. .FHWA in partnership with FTA and the American Planning Association and also the PHA and CDC have been doing work on the topic of health and transportation. A couple of really high level updates from the office of planning. For those who are interested we have an update . We are anticipating the release of that very same. Please keep your eyes out for the final rule on planning. We know this has been a long time coming so most of you will definitely appreciate the final rule being release. We cannot give a specific date but keep your eyes out for it very soon.

Another thing that I wanted to mention is that today's webinar again will focus on the links between transportation and health. You will hear from a host of very good speakers that are lined up to talk about specific cases, also the transportation and health tool, and a number of initiatives that we have been working on within U.S. Department of Transportation and specifically with the FHWA. We want to acknowledge AMPO. They helped us push out the notice for this webinar so we appreciate that they have helped get the word out.

One other thing is that you as to if you are available on June 1, we will have another external webinar that is free for internal FHWA participants as well as for external participants. That will be on the Rapid Policy Assessment Tool. That is one of the products coming out of the second Strategic Highway Research Program. If that sounds remotely interesting to you, feel free to dial in. That webinar will take place on Wednesday, June 1 from 1:00 until 2:30 p.m. Eastern time.
We will continue these external webinars once the final rule on planning has been released. We will also have a date for when we will share information on that. Again, this is to keep your eyes out for notices regarding that webinar as well and for the release of the final rule on planning.
We really appreciate everyone dialing in for today's webinar. You can always check for updates at planning.dot.gov. From there I would like to turn it over to Tonya.

Thank you, James. Good morning and good afternoon. I am working in concert with FHWA for the transportation capacity building program in which this webinar is part of. I wanted to give just a few highlights of what is happening at FTA. In April, FTA announced the availability of 20.5 million dollars of competitive grant funding for the transit oriented development pilot program. In essence, the program supports local comprehensive planning efforts associated with transit, capital projects, seeking funding with FTA's investment grant program. Another exciting program that was announced in early April was the passenger ferry grant program. That program announced the award and distribution of about $58.9 million dollars for passenger ferry projects and ferry operators through our administrator’s passenger ferry grant program. The fund supports 18 projects in roughly 10 states of the nation's waterways to help repair and modernize ferryboats and terminals and related facilities which of course will help thousands of residents in these communities.

Also in FTA, we have rulemaking under our safety program and the first is the public transportation safety program rule that was published February 5 of this year. The second safety rule making that was published is entitled the national public transportation plan. That also was published February 5. Finally, we have the Rides to Wellness NOFO–Notice of Funding Opportunities. The mobility grant was issued in March and I believe it closes in May. We are honored to have Marianne Stock from FTA today to give a presentation. That is exciting.
Without delaying any further, I will turn it over to Fred Bowers.

Thank you, Tonya. Before we get started I think we're going to put up poll question number three.

We're going to do that before your presentation.

Once again, we have a poll question if you could kindly take a second and look through that.

The question is: have you used the transportation and health tool before today?

We are going to broadcast the results of the question and as we thought -- a lot of you have not. A couple of you have so that is good.

Moving on -- I will be talking about the transportation and health tool. It was developed by the US Department of Transportation and the designer for content at disease control to provide easy data to examine the health impact of transportation systems.

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In the beginning to increase awareness of health in transportation, FHWA published two publications on transportation and health.

The 2012 major Metropolitan area report examined integrated and flexible approach and their partners can consider held during the transportation planning process.

This report includes for case studies, like Puget Sound, Sacramento, Nashville and San Diego.

In 2014, we followed up with a companion web publication. It looked at how states can improve and incorporate health into the transportation planning process. We found that DOT's have an important role as state health agencies support the consideration of help in transportation planning.

In this report there are additional studies including California, Iowa DOT, Massachusetts, Minnesota DOT and North Carolina DOT.

In the Metropolitan report we define health and transportation by four main topic areas. These include active transportation providing a wider range of transportation options. Safety by incorporating a number of measures that transportation agencies can reduce motor vehicle crashes. Later by improving transportation -- cleaner vehicles can begin to reduce the impact on our environment.

Connectivity providing a multimodal transportation network that increases people's ability to access destinations such as jobs. And other essential services.

Equity was added later and it intersects all of the topics.

From the research we identified several key points in the transportation planning process for incorporating health. On the right is a graphic of the federal planning process and on the left shows points where health can be included in the planning process. For example, motivation such as reducing the impact of traffic can be a good starting point. Building partnerships at state and local organizations. Next we’ll look at leveraging federal funds with other agencies and fostering support with both MPO and communities is important and demonstrates leadership at the state and MPO level. Using an incremental approach to integrating health in transportation planning activities can help with difficult decision-making.

As a starting point for the tool development, we convened an expert panel that met in Washington, DC in 2013 and that group came up with an initial list of indicators. From this the core team generated a potential list of indicators. Thirty-four indicators were screened to see if they were evidence-based in their applications for the needs. Fourteen indicators were selected based on geographic scale and availability of data.

Through an extensive review of health and transportation literature, the final 14 indicators prove to have the strongest evidence based of linking health transportation. These were generally broken into three primary categories of health, transportation base, and policy related. You can see the 14 on the screen there.

Back to the screen, getting started on the main page. If you want the whole spreadsheet, it is downloadable.

Next, select the geographic scale like urbanized area.

Select a location you are interested in. I selected Boston, Massachusetts. That is where I grew up.

Here are the indicators for the Boston MSA. For all of the indicators, the longer the blue bar appears the better the score is. As you can see Boston is doing very well in a number of categories. For instance, they score a 100 for transit. Boston MBTA remains the nation's fifth- largest mass transit. It serves a proximally five million people with an average weekly ridership of approximately 1.3 million passenger trips.

To make results easier to interpret, the scores were created by first assigning standardized scores to each state MSA. As many of you know, the scores measure the difference between given state MSA or the national averages standards in deviation.

Looking at the indicators again, Boston might want to look at their traffic fatalities per 100,000 for both bike and pedestrian . You see the red arrows there.

What would they do next? They would look at some of the strategies in the area. To encourage and promote safe biking and walking.

The link takes you to a page with useful information. You see that page -- for this strategy there is information on encouraging and promoting safe bicycling.

To learn more, the tool provides a series of case studies that support the strategies. For example one of the cases were promoting safe biking and walking is a New York City pedestrian accident
-- action plan. Is a very well thought out plan that many locations will find useful and may want to develop their own versions.

Another strategy for improving biking and walking may include traffic calming. Look on the red arrow and it takes you to the traffic calming page. You can find information on the road diets, increasing traffic lanes, and actions that communities can take to provide safety for pedestrians.

For example, in 2012 road safety action in Seattle set a goal of zero traffic fatalities by 2030 and identified speed reduction is one of the six priority areas to help achieve that goal. These strategies combined with priorities outlined in their master plan for bicycling and walking they did groundwork to improve safety in walking and biking and transit use in Seattle. That is how the THD was designed to work. You'll find a lot of useful information on the site. We encourage you to fully explore the tool. If you have any questions or suggestions, please let us know.

This is a screenshot of the FHWA website. And you will find a link to the THT by the red arrow. It has a lot of additional information related to help in transportation.

I thank you. That is my contact information and now we will move to the next speaker.

Kate Robb at the American Public Health Association will talk about THT in upcoming workshops.

Yes, I am here. Thank you, Fred.

Before Kate starts, we have one more poll question. Will you use the transportation and health tool as a part of your long-range planning question mark?

The vast majority of people said they will. That is great news.

Okay, Kate. Back to you.

That is wonderful news. Thanks so much Fred, and thank you for having me here today. I look forward to hearing the other speakers. And Fred, I enjoyed your presentation as well.

As Fred mentioned I work at the American Public Health Association on our healthy community design initiative. APHA has been involved with the transportation health tool or THT creation and we are now working with the THT team to encourage the use of the transportation health tool among the nation.

When we created the transportation in health tool before the launch, we worked on that with folks to beta test the THT. The stakeholders we asked to test included representatives from state DOT, MPO, local health departments and nonprofit active transportation professionals. We did this to ensure that the THT works smoothly and was user-friendly and how to find out how people plan on using it. Before we launched the THT, we took the feedback to improve the THT. Some examples include providing a background of the THT creation display of the THT data and an explanation of this growing methodology.

We are currently in the process of prioritizing future updates to create an even more accessible and user-friendly tool.

Something we are very excited about are the THT implementation workshops. We would like the THT to be incorporated in practice. We have promoted the THT at various webinars and other communication channels such as social media and press release. We are releasing this tool to help people use it in their work. One way that we are doing that is by providing the THT implementation workshops. In early summer, we will provide two THT implementation workshops and I listed here online at the MPO level but it could be state as well. The implementation workshops will explore the THT at length. The workshops will have professionals from both the health and transportation sector to learn about the THT and how to

incorporate the THT in practice and facilitate collaboration between the transportation and health sectors.

We will use these workshops or host these workshops in communities that have active planning processes underway so we can show how to incorporate the THT in real life.

We are currently interviewing potential candidates for the THT implementation workshops and we will determine locations within the next two weeks or so.

We are also going to do some case studies. As Fred mentioned in his presentation earlier, there are case studies on the THT.  That is really how to integrate the strategies suggested into practice. The case studies we're talking about here are featuring communities that are using the THT in their work and how they are using it in their work. We are generating the case studies to inform practitioners and policymakers not only about the THT but also highlight the various ways the THT can be used in practice. The case studies will be shared with our networks and posted to the THT website and a little plug, if you are already using the THT and you would like to share your story with us, please let us know. We would love to highlight you. You can email me at environment at APHA atenvironment@APHA.org.

I think that covers it for me. Thank you again so much for having me.

Great. Thank you, Kate. We will be taking questions at the end of the presentations or if you have something to would like to put in the chat pod feel free to do so.

Now we're going to move to Marianne Stock.

Thank you, Fred. This is really an honor to be a part of this webinar. I want to tell you a little bit about the enactment of the affordable care act and how health care has become more -- public transportation can be an important enabler with for access to preventive care by ensuring that the population can get to the doctor and for affordable care act screenings. That is what our rights to wellness program is all about.

We are going to decide what Rides to Wellness is going to do and how we are promoting in terms of planning, testing solutions, finally building the business case for investment.

The opportunity return investment strategy shows not how only people's health improves but strong public transportation network that everyone can get to the doctor or to rehabilitation following their hospital stays. What we realized was that if access to transportation provided even to state 1% difference in access to care, then -- and reducing health disparities -- there could potentially be a significant positive health impact for millions of people and that leads to reduced healthcare -- reduced healthcare cost.

We thought that we were in a unique position to leverage our great-grandson partner with the Department of Health and Human Services and the healthcare industry to leverage resources and stipulate investments. That's how we came up with our vision for Rides to Wellness.

There are a couple of statistics that defined the compelling need for better access to health care. Eight-four percent of healthcare spending in 2006 with only 50% of the population who have one or more chronic conditions. A 2000 study of the total cost of healthcare came up with a total cost of 2.5 trillion and 2.1 trillion of that was for managing chronic conditions.

There was also a recent report from the AARP that noticed 3.6 Americans missed at least one medical trip because of the lack of transportation. We know that patients and customers need to access their postoperative rehabilitation services and they need to be able to get back and forth to the doctor. Now that public transit is available it can ensure transportation.

How are we going to accomplish this?

We came up with a three-pronged strategy for help. The first was to build a coalition of major national stakeholders for transportation, and health awareness. We started in March 2016, we are continuing through forums that we are holding at the national and regional levels. We want to drive change in we do that through our technical assistance centers which create and submit materials on best practices and solutions. And finally we stimulate investments. We have already release 400,000 solutions and finally we stimulate investments. We have already released $400,000 in grants to 16 local communities and states that have creative partnerships with health care in transportation and just recently on March 29, 2016 we announced the phase 2 of these grants which is the demonstration of innovative and quartered access and mobility opportunity with implementation in 2016 and 2017.

As I mentioned our technical assistance Center, the National Center for Mobility Management provides information. And what they are doing is posting two types of information gathering for Ladders and connectivity, peer exchanges, regional planning, transportation, and other stakeholders are coming together to explore how to better understand and adjust the ability to access key destinations. To develop more deeply -- delve more deeply. Also hosting its Rides to Wellness and its best practices are strategy. Those are happening around the country and some have already happened. Some are still coming up in the next year and a half.

These are some of the events. These included we started back in March 2015 and we held a number of events just recently. One was held in Charlotte, North Carolina and we are still continuing around the country.

What has been learned from this? We have had a number of key things that have come out of these discussions. I will just mention a few of them. There continues to be a clear consensus regarding the importance of coordinated planning. We know that partnerships are really important. We are looking to further explore and determine investment value of these partnerships and let me just move on and I will tell you a little more detail about some of these.

As I mentioned, we have been testing solutions with our healthcare access design challenge grants. Sixteen communities received these grants and they tested their assumptions about the proposed concepts and adapted solutions.

These are a few of the things that came out of this. While scheduling their appointments in Waukesha, Wisconsin, they did a one call, 1-Click transportation. In Wood County, Ohio, they were implementing a volunteer driver program for dialysis patients and would charge a nominal fee to providers.

There are 16 of these examples that can be accessed through our website. If you want more details.

What we're doing now as I mentioned, we have out there 5.3 million dollars Ride to Wellness demonstration program. There is still time if you are interested in applying. It closes on May 31. The focus of this opportunity is to select access solutions the other communities can't replicate. We are looking for projects that demonstrate impact related to the goals of the Rides to Wellness as we have been describing here.

In addition to those grants, there are still a couple of projects that are aimed around research and data. Our communities project is targeted to address the question specifically and doing a survey to ask the questions “how does the lack of transportation impact healthcare costs?”. What percentage of direct cost are associated with those? And the Transportation Research Board and the help the medicine division workshop is going to also explore the issues of healthcare and transportation from a research perspective. We will be looking at models, discussing data sources, and exploring opportunities to measure the value of transportation services. That is on June 6 and June 7 and should be webcast.

There is my contact information and that is all I have for now.

Great. Thank you, Marianne. You will be available for questions later?

Yes.

The next poll question as I introduce our next speaker is “how are you incorporating help into the transportation planning process?”

I'll introduce our next speaker. Melissa Taylor is the Director of Strategic Long-Range Planning at Chattanooga TPO. She will be talking about the transportation planning process.

Hello. And thank you, Fred. There was great background information from our national partners and I hope that all of you joining us today will see links from what was mentioned from those partners in our work.

First, before I get started, I wanted to give a special shout out and thanks to Kevin with Gresham Smith and partners. His team conducted much of the analysis we used.

My presentation will focus on project selection but to just give you a little bit of background here as we start the presentation, the Chattanooga TPO area is rather spread out, covering over 2000 lane miles, 19 jurisdictions, and an annualized rate of population growth at a little less than 2%

per year with job growth at about 1% per year. The area has very different types of communities across the rural to urban spectrum and as you can imagine an array of transportation needs.

My best I apologize there. I tried numerous times to keep from cutting off the graph at the bottom, I think you can still see why I am attempting to show here.

One aspect related to transportation was consistent across the board. That was our alarming health statistics. At the time of our 2040 plan, data and reports are clear that Tennessee and our local area lead the state in obesity for both adults and children with much of that cause being attributed to inactivity. Essentially a lack of daily activity -- exercise. It was important for us to engage with our health base partners to help identify how our transportation planning efforts could influence projects and outcomes of the plan in the future.

Our 2040 plan established a set of goals and objectives inflows to extensive public outreach conducted in the summer of 2012. Health-based partners comprised our leadership team and state core groups and helped to identify major components of the community-oriented perspective making it critical and focusing on the advancement of livability, quality of life principles, and multimodal travel options for a broad set of users.

However, the TPO had to develop a project selection that would strike a right balance in terms of addressing those needing such health-based issues and more regionally such as congestion and freight goods movement. Presented here as a community to region which is intended to help illustrate the transition and perspectives related to transportation needs as you may for the community scale to the regional scale. This community to region approach became the foundation for the plan and was used to guide development of specific goals and objectives.

There are three main performance measures in the community to region framework in which health-based considerations were taken into account. Relative to the weight of the highlighted measures and more specific measures used in addressing the actual project level evaluation. The remainder of the presentation we will dive into the information we used to get to this point.

Our team did not have time for more rigorous traditional health impact assessment and opted for a heavily GIS-based format. Only using readily available data and data that would yield the most relevant results.

The information we prepared in the analysis derived inform the entire process which was purposeful by the establishment of the community to region framework.

Health-related information was considered in the objectives of the project identification process, the actual logic evaluation, and the overall plan evaluation.

Health was addressed and targeted multimodal investments on complete streets, and strategies to reduce DMT. In addition, more focused effort was undertaken to address needs including health and disadvantaged areas and investment allocations by mode.

For those specifics, proximity became the critical key. The plan evaluation needed to address projects that were related to what people would be willing to do if facilities were in place for them to do so. Therefore we had to identify destinations relative to distance.

A three-pronged approach, which seems to be common these days, was developed to address proximity to the active transportation facilities and to health-related destinations. The third prong being active transportation facilities that then serve the health destinations.

To carry out the approach we needed to understand some of the data for the active transportation portion. We examined the presence of sidewalks, transit accessibility, level of service for biking and other areas such as parks, open space, and trails.

A map of active transportation facilities is shown here.

Several data inconsistencies or lack thereof presented difficulty in determining opportunities to evaluate the pedestrian routes; we utilized intersection density as a proxy for sidewalks. Either existing or the potential for new. Intersection density is an element of connectivity which by definition and travel demand is very first to the directness of links and the density of connections in path to road networks.

A well-connected road or passive network has many short links to numerous intersections and minimal dead ends. A connection to the increases travel distances decreased in route options increase allowing more direct travel between destinations in creating more accessible systems.

Perfect consideration for the health destinations we looked at predominate health care, grocery, farmer market, and public and private schools.

This led to the creation of our health-related destinations map. Much of this work was adapted from outcomes of our health departments and Foundation healthy communities grant.

However, even though we had a map of these destinations, we needed to determine our definition of accessibility for reaching health-related destinations. We decided on a quarter of a mile as walk accessible. This quarter of a mile is half of the distance of SBA's area for walking but given the areas level of interactivity incentive more reasonable expectation as well as bike access established at the 1 mile. It also felt appropriate during educational efforts to associate these words from Thomas Jefferson.

From this point, we created a series of accessibility maps to painting the destinations at the quarter, half, and greater than 1 mile distances. The darkest orange is the quarter mile walk access and bike access which is shown in the slightly lighter orange. This map is for the access parks and open spaces. Chattanooga values protection of the environment both natural and man- made is evident here. As the one for the healthcare facilities, grocery stores and supermarkets, and lastly access to transit stops to ensure we captured first and last miles for the transit rider.

We then put it all together using this model which is compatible with art map to create what is termed as a composite active transportation score; this led to two final composite score maps shown here is the access to active transportation and here, the access to health-related destinations.

We learned during this analysis that the average home in the Chattanooga region is 1.6 miles from the nearest trail, bike route or a bus stop. But the average distance from home to the nearest transit stop is through .05 miles.

At 36% of all health-related destinations are within a quarter mile from a transit stop.

We also learned some other very interesting facts from the data received from our health department. 60,000 people in the four neighborhoods listed here have access to grocery stores, there are 64 corner stores and gas stations and 23 fast food chain restaurants. These four neighborhoods were part of our efforts to further some of our analysis in the disadvantaged communities in the area.

After consideration of that information and the analysis generated that generated the two scores for the accessibility to active transportation and health-related destinations, additional analysis was conducted to identify gaps in the system. For the highest demand or potential exists. This first one shows pedestrian infrastructure gap.

A second for bicycle accommodations and the third for transit. These gaps were used in the final project evaluation in ranking process which helped to yield a range of projects from high-scoring bike, ped modal investments to road projects.

Overall outcomes resulted in doubling of funding for pedestrian improvements which includes complete streets for roadway projects an increase in transit expansion and funding set aside desk offering which address health-related issues. I noted that was a lot of information to cover in one presentation but I would be happy to share more about the work that we did including details of the mapping a portion. If you would like to reach me here at this email address or telephone number. Thank you so much.

Thank you, Melissa. That was great. It was a very high level of analysis. We're going to put up the next poll questions and the question is what issues or obstacles do you face incorporating health into transportation?

While you are filling out that poll question, I will introduce our next speaker. Michelle Lacewell is deputy director and communications officer for the Nashville Area Metropolitan Planning Organization. She will be talking about some of the guiding policies they have been used in Nashville.

Hello.

Are we ready to take that down question mark?

We do have a response in the chat box.

Lack of data in the city and chronic disease.

Will come back to that question at the end of the presentation.

Michelle, if you are ready.

Okay. Thank you, everyone. I'm going to share with you a little bit about how the Nashville area MPO has evolved to our project for long-range transportation parent and also allocated resources and funds the impact health outcomes in the middle Tennessee region.

On this first slide, just to give you some context for where our world is in middle Tennessee, what you see on the screen is our planning area pulled out in the seven counties we represent. This larger image of the counties that are darkened, show the level of population growth we expect over the next 25 years. Just to briefly give you an overview of understanding, we are a very dense part of the state and we are expecting our population to increase in 2020. Because of that we have had challenges for our sprawling region and limited transportation options. Most of our jurisdictions have taken strides locally to improve safety and access for people walking and biking by collectively and culturally thriving places are demanding this even more. Rapidly increasing traffic congestion and limited transportation options, traffic and affordability of becoming more pressing as we look at the population growth that we expect.

To help address some of these issues, the Nashville Area MPO has sought to more actively direct active transportation investments to where the greatest impact could be made.

In 2010, we adopted our 2035 long-range plan and this was the first time that the Nashville Area MPO had called out this report for active transportation. I'm going to walk you through the policies that were enacted in the funding we dedicated in 2010 which led to great improvements in our walking and bicycling infrastructure throughout the region. I will also share about our health and transportation work that is that we did in 2012 they gave us more robust data and then led to the development of our most recent plan. What you see on the screen right now are the goals that were established for our last plan adopted in 2010. These established not only a bold new vision for mass transit, but also called out the support for active transportation and walkable communities and then really focused on the preservation and enhancement of strategic roadways.

What we did, we received about 450 projects, and to prioritize them, the staff developed an evaluation process for each project. For the first time we included elements of health and safety into consideration. So what you see on the screen, right there, are the project scoring criteria that we used in 2010 that allowed us to provide weight and value to the projects that actually had facilities that improved mobility through active transportation.

75% of the projects that were submitted had a bike pedestrian element and weighted projects also became part of the network. On this next slide you will see that based on the information in funding resources available we dedicated 75% of our funding from our surface transportation program to roadway projects that improved health outcomes and safety. In addition, the following bullets make up the other 30% of the investments from our funds. One of the challenges we had at the time was that we did not have a lot of data to really focus on the outcomes. So, since this initial plan was developed and we created an investment strategy around active transportation, we have been, the last few years, developing a process to move forward for this plan that was just adopted.

I will show you a few more things -- 70% of the projects included sidewalks, bicycle lanes are shared use lanes. This is an increase of 2% from the 2030 plan.

This is what we have titled our 2040 long-range transportation plan. In the next 25 years we were able to include a little over 200 projects. The regional goals you will see a shift from the three kind of succinct bold statements that we had in 2035 to the maintaining reliable transportation systems for people and goods and helping local communities grow in a healthy and sustainable way. Enhancing economic competitiveness and also spending public funds wisely for a return on investment.

What we did in this plan that was an improvement over the previous one is that we have increased how we evaluated health outcomes -- health components in active transportation in this plan.

As a set, one of the things we were challenged with in 2010 was not having enough data so we created a baseline of information and data to prioritize the placement of bike/ped facilities with a higher rate of health disparities, chronic disease. We collected our own data on the region through our middle Tennessee transportation help study which identified a series of factors that really helped inform the funding and policymaking for the 2040 plan. Additionally we had the behavioral data for the regional travel demand modeling.

One of the things to go back not only anecdotally saying that this is becoming a demand in our region that we are starting to see it not only come up from the conversations with our elected, but also from our research. We did our survey at the end of 2014 and you will see on the screen the most important problems to solve were lack of transit options, lack of sidewalks, and poorly maintained roadways. These were the top three issues that came up across the region. This really helped us know that we were going the right way with how we were attempting to develop the evaluation process for our plan.

On the next screen is a snapshot of a complete detailed presentation. The integrated transport health and impact model, we developed this in partnership with the CDC. The health impact modeling discussed the benefits of increased physical demands or I'm sorry increased physical activity for accounting for changes in bike/ped. This takes into consideration additionally the effects of reduced air pollution on respiratory diseases as well. What you are seeing here is just a brief snapshot of the baseline of how many minutes per week and how many miles per week people are walking in our region. Then, as it goes up, the investment level showed the outcome. If we had a conservative investment in active transportation facilities you would see a bump up to 40 minutes per week on the walking. I am on the maroon colored line right now. If we saw a moderate investment in facilities and even greater increase and then an aggressive investment in facilities and even greater increase. This kind of information provided a framework to show us that if we put the dollars into this infrastructure, there would be a return on investment.

Additionally one of the things that we created was we developed a methodology that allowed us to determine the demographic and characteristics that were most highly concentrated with chronic disease related to physical inactivity and that is what you see on the screen. In the region, three out of four individuals are affected by poverty, unemployment, or they are over the age of 65.

This allowed us to award more points to projects that came from these areas that included walking and biking facilities so that we could have a greater impact on the impact -- mobility of these individuals in these areas.

Additionally, what you see on the screen now is the 100 point process that we used to score projects for our 2040 plan. Backed by data from the two studies that I just briefly touched on, we designed a selection process that prioritized the walking and biking projects to maximize public health outcomes. A substantial portion of the MPO long-range budget is targeted towards improving the active transportation network across the entire region.

You see that 77% of roadway projects include sidewalks, bike lanes are shared use and to give you some context up from 2% in 2030 and that should be up 7% from the 2035 plan. We're seeing a gradual increase in investing in our roadways. The plan we just adopted, we allocated $180 million and the creation of an active transportation program which allows us to offer some competitive opportunities to those in our regions. The active transportation the grant is made up of 10% of the MPO sub allocated funds for advancing projects of walking, biking, and transit facilities.

We ill also coordinate with some of the similar committees that exist around the region.

We also allocated 90 million dollars for transportation alternative funding which is a program that will administer statewide money aimed at improving active transportation facilities.

Just some things that I would like you to be able to take away is that we led with finding out the existing health challenges, and developing regional data and research efforts. We invested in priorities that not only met the goal established in our planning process but also the demands that we're starting to see across our region and we used our own plan in funding opportunities to be able to craft policies and programs that help us continue to actually create the action part for implementing some of the strategies.

I hope that was helpful to you. If you have any questions, I will be answering them at the end.

Great, Michelle. Thank you very much. We'll pull up the next poll question. What tools and resources would you like to see more of to better assist you in this topic area?

I would like to mention a workshop that I was at in New York City last week. The New York City mobility management conference. They are really pushing healthy transportation in New York City. One project in particular caught my attention was people with the sight disability can now work with another person in a tandem bicycle program or a person with a sight disability can ride in the back and do all of the peddling and get the health-related work benefits while the

person upfront does the steering. They even talked about a 24-hour doughnut shop marathon with a ride to all of the different doughnut shops in New York City and stopped at each one along the way. It was quite an interesting project and something that I found very interesting. They are also working on a lot of food system applications as well. New York City is doing a great job.

On the poll question we have a couple of answers -- the data and tools for rural areas is one area you would like to see more of.

For public health professionals or design professionals with public health experience embedded in MPO staff and DOT staffs.

We can move on to our next speaker.

I have a question for you. How are the health benefits negated for the people on the bicycles going to the doughnut shops?

That's a good question. I hope they don't get a doughnut at each stop.

This is Brenda. I'm in the office of human environment and my focus is primarily on environmental justice. As you may know, within the executive order on environmental justice there is a focus on health. Human health impacts. I was wondering if any of the MPO have addressed that after they do their calculation from the health benefits if they actually look at minority and low income populations. To see how they are working on their EJ environments?

This is Michelle from the Nashville area MPO. The map that showed with the red areas across the counties, that is a piece to what is will call it different names for but it is our levels of disadvantaged, and we have eight characteristics that we followed from that standpoint to determine where based on how many of the characteristics a population is exemplifying to what degree they will be the most disadvantaged. Whether it is lack of transportation, education, food, a series of think that is helping us inform our policymaking effort and planning effort. It is helping us from and environmental justice standpoint to have a good lay of the land and understand where our equity disparities are across the region if that is helpful at all.

Thank you.

A few more answers came in on this question.

Would like a complete example of selection process -- that is something to think about.

We have a question. More examples of cities and resources where public health is integrated in MPO. We heard a little bit more about that from Kate earlier.

Victoria with Federal Highways also put the link up to our healthy corridor framework that we just finished. There are a lot of good responses there. With that, we will move to our last speaker.

Ellen Zavisca will be talking about getting your MPO engaged in health related policy work.

Thank you, Fred. And thank you, everybody, for joining us. I'm glad to be part of the Tennessee trifecta on this webinar today. So far Melissa and Michelle have shared some really terrific information about how they have made policy changes that have increased funding for transportation projects that promote healthy transportation. I will take a little bit different focus and take a different role. I will just lay the context but starting with the 3P's. This is overrated. People have thought about how we can help people to have more access to physical activities. The first P would be a program, which would just encourage people to be physically active. The second P would be a project, and we of heard a lot of projects that have been funded -- something that just creates a safe place for people to walk or bicycle. The third P is the direct policy involvement, which for example, will be requiring workability as part of a development or redevelopment. That last P policy is where I'm going to focus today.

I will start of the story about how these three 3P's sometimes all fit together. Here is an example from Knox County, Tennessee, the street is near an elementary school and also leads to a pedestrian bridge that connects to a nearby middle school. As you can see here, -- it also connects to a park, and a library, and a community grocery store.

As you can see, this was not very pedestrian friendly. It was not an environment where anyone would let their child walk to school. A couple of years later, this photo is showing the sidewalk as county funded. It is also showing a program that was created called the "walking school bus." The "walking school bus" was created at the school in response to some data that we collected where we saw that the sidewalk was being used a lot in the evenings and on weekends but it wasn't being used at all as far as we could tell, for children walking to school. Despite the fact that there are a lot of neighborhoods along the sidewalk.

The health department had done a walking school bus at other schools and created this program where they found staff from the school who walked the children home. They started with one afternoon a week because the principal was not thrilled with the idea and they had to call it a program.

It became very popular and you can imagine the parents who sitting in traffic to see the walking school buses go past, quickly start wondering how to get their child involved.

This is an example of a project leading to a program. And then it led us to realize these experiences and others let us to realize that we needed a districtwide policy because we are experiencing different barriers at school sometimes from principles and sometimes in other areas. We needed a policy that is going to address safe rides to school districtwide. It should be accommodated in the same way as busing and parents driving kids to school. That is a policy that we're in the process of creating and we will be taken to the school board.

This scoring illustrates two key lessons. The work, itself, on projects and programs can reveal the need for policies when you encounter barriers again and again. It reveals that there is something going on that we need to look at the big picture. And the work on the programs and projects also creates relationships and trust that facilitate the policy work.

As we have a group of people who have been working on safe rides to school together for years and we have been able to broaden the group a little bit and work on a safe roads to school policy.

I have talked about Safe Routes to School as an area where MPOs can get involved in policy and I will talk about a few others here. Obviously complete streets policy sometimes called routine accommodations which help ensure that transportation projects work for everyone regardless of mode, choice ability, or age. And in addition to creating policies at the MPO level, it creates or improves complete street policies. It is not just street design that can encourage or discourage healthy transportation, local development regulations are important as well.

Subdivision regulations, those are going to determine whether sidewalls and trails are included automatically in neighborhoods or not.

There isn't any regulations that's going to determine whether we have destinations within or near neighborhoods that people can walk or bicycle to. Those factors are showing influence whether people walk or bike on a regular basis. The MPO cannot make the rules but we can influence local governments.

In Knoxville, we are working with a team that are presenting technical assistance from the International Association for Counties. We are putting together educational materials that will support policy change at the local level to enhance walk ability. We also sent a team recently along with the Chattanooga MPO, with the a team to a Walkability Institute put on but a part of the Center for Disease Control and that teams from Knoxville is working on recommendations around zoning that will enhance walkability and some additional educational outreach we will be providing to our local government

Another way for MPOs to get involved is to look around for councils or other groups that are engaged in health policy. Knox County has a Community Health Council and a lot of places have groups like that. If the MPO is not represented on the Council, they can get involved and bring all sorts of information and resources to that health Council and really educate folks about the importance of the environment. I mentioned we have a Community Health Council and the group has recently determined for priority areas they will work on. One of those is increasing access to parks, greenways, and trails. Now we not only have those of us in the planning world advocating for these improvements, but we have folks from hospitals and other health-related industries who are really aware of this and are championing it.

Vision zero and other efforts are nearing in on reducing traffic fatalities.

Two important bits of the policy focus -- it is something that saves time. Once you have a good policy in place, of course getting there takes time. I will give you that. That ideally you want to have a good policy in place. You do not have to fight the same battle over and over.

I will come back to sidewalls. We're still working on getting a policy countywide that says sidewalls are required with the developments. We have to fight that with every development but

once we get that countywide policy in place, then it will happen more automatically and of course you have to make sure it is implemented correctly.

A good policy also means a more level playing field. That applies to developers as well into the communities affected by development. If you get active transportation only in those neighborhoods that have created a ruckus and raised a fuss, and you are really neglecting the neighborhoods that have less social capital and that maybe need those investments more. That gets back to the environmental justice issue.

Here is a local example from a few weeks ago.

A neighborhood that had asked for sidewalk investments and held a walk and got a lot of media attention about it and that is great. I applaud that. But at the same time there are neighborhoods that need the investments that do not have the social capital to do these sorts of events and might be neglected. The investments are only based on who makes the biggest bursts.

It is important and I will not tell you it is easy. This work takes a lot of time and it takes bringing along and keeping informed multiple partners and sometimes multiple coalitions. Once the policy in place, you have to make sure it is being implemented. The change is possible and as I said in Knox County we're talking about sidewalk requirements for new developments. It is getting close to happening in it is to the point of it is not a question of is it going to happen but when and how is it going to happen. That has been a big victory in something that brings to mind this quote from Max Weber that says politics is a strong and slow boring of hard boards.

With that, I'll be happy to respond to any questions.

Thank you, Ellen.

We're going to put up our poll question six again. We realize we took it down rather quickly. The question is what issues or obstacles do you face when incorporating health into transportation question more

We got a response in the chat pod and the question is but are the options for rural communities with no public transportation?

Ellen, I will turn back to you. It seems like you may have a response for this.

Was the question rural communities?

Yes. With no public transportation.

The obstacles that they face -- that is a good question. There might be opportunities -- our MPO covers a range from urban to suburban to rural, and we have some transit providers to do more of a demand response. They get the funding. They are for rural areas so they have a demand- response transportation which is more needs based and it covers medical appointments and things like that. We also have someone from a volunteer-based transportation and we have one of those as well VAT volunteer assisted transportation. They maintain a fleet of cars and volunteers use those cars to pick up people who otherwise cannot get to appointments and shopping and things like that.

This is Marianne, and if I could to speak to the issue also.

One thing you can do is talk to the State Department of Transportation and see if there is a rural transit service usually that is done through the funding that is administered by the State. Talk to them about that. A couple of other resources, the national Center for Mobility Management that I mentioned is one of the FTA technical assistance centers that can help if people are interested in trying to use mobility management concept to advance transportation in the area. You can reach them by just Googling National Center for Mobility Management. National Transit program may be able to help you find resources in the particular state or area where it you try to get the transit system started.

Great. Thank you, both of you.

Melissa, there's a question in the chat pod, Amy would like to know if there is a chance she can get a copy of the GIS files to teach her class?

I don't initially see why not, the only thing that might be an issue could be with respect to the community. It would depend on whether in our final analysis actually exported some of those files directly to GIS or if they are still sitting in our Community Viz module. Sure, we are happy to share whatever we have in whatever format. I think the person and I believe it was Amy would just need to contact me via email and I will see what I can do.

Thank you. Great.

I need to mention that the share pod is back up and if you could reload your presentations I would appreciate it.

Lack of data seems to be one that keeps popping up. If anyone on the telephone can press *6 or if any of our speakers would like to talk a little about the data that would be great.

I'm sorry, it is*zero.

This is Melissa, again, with Chattanooga.

As far as the data is concerned, for us it may have been slightly easier situation only because we had such alarming statistics in Tennessee and much of the health department here had spent a great deal of time tackling some of the issues already and diving into more specific sub area data sets or working with the CDC and at the Robert Wood Johnson grant I mentioned to try to get a handle on those.

I haven't looked to see what it would be like in other areas but I will say that if you are focusing on priority locations I think it benefits all so if you feel like some of that data is lacking -- there

are lots of other reasons for continuing to focus on a safer and more expanded environment for Especially from the transit aspect. So, getting people to actual transit routes or stops is important as well.

Thank you.

If anyone would like to ask a question, operator could you please open the telephone lines for smart

Ladies and gentlemen, if you would like to ask a question please press star then number one on your telephone. A prompt will indicate when your line has been opened. You can remove yourself from the queue at any time by pressing.

Once again, please press start one at this time --*one at this time.

As a reminder, it is *1 if you would like to ask a question.

Okay, we can turn back to the poll question and if anyone would like to respond, they can press *1. We did get a response that many of the staff did not make the connection between health and transportation. I think this is where the health tool will be very useful to a lot of MPO and states. It bridges the gap between health and transportation and we are hoping that is at least one of the biggest benefits of that.

Any others want to mention anything on that?

Okay. Another question came in or another response, there seems to be a lack of sense of urgency from local politicians -- on transportation and health.

That is a good one. We really haven't tackled that in the health tool. I'm sure some of the MPO have run up against some of that.

This is Michelle from the Nashville Area MPO that the thing I would comment on that is -- you are correct and we are starting to see that elected officials are not as quick to invest in active transportation facilities specifically related to health outcomes. We have found some success with positioning this as not only an economic development -- impact angle but also a quality of life angle for talent retention and attraction. That makes some part of the conversation a little more open for elected officials. The more you offer people ways to be healthy and enjoyed their quality of life, the lower the cost of healthcare which is also a significant issue now and keeping people in the region is critical. A different spin on it other than the health outcomes that's good that has been helpful to us from time to time.

This is Marianne -- that is another thing that we have found is helpful about our rights to wellness initiative. Is opening conversation with the health care providers and hospitals in the area and it really trying to put the focus on cost to the health-care industries and let them be your speakers to how important this is to the elected officials. That may be one angle you would like to try.

Thank you. Any other questions on the phone?

We have no questions at this time.

Back to this poll question again, many in our area think the Northeast Georgia Trails will bring crime. They need data.

Has anyone experienced anything with the trails?

This is Melissa from Chattanooga. I think it is a fairly common reoccurring perception -- I will say that there is a lot of information out in different places around the country including Tennessee-- we even just had a newspaper article over the weekend that is talking about our regional Greenway which is a backbone now of Chattanooga. I think that there is or could be some real evidence depending upon the type of facility or what is happening in a particular piece of a facility, but I think the overarching context of it being something that brings a misconception and there is a lot of information. I will look back and see -- we have put together some resources so if I find that, the person that made the comment -- if you can email me and identify that you are asking for that information I will try to pass along the resources that we had put together at one point.

Great. Thank you.

Thanks. This is Ellen in Knoxville. We have had this concern as well.

I think around here, it is something that trail designers are hearing less and less as people seek trails more in the region. To realize it is still a concern and one way to address it in addition to looking for data and resources like that is focus on designing trails for safety. Focus on the elements that will be a part of the trail that will enhance safety. Making sure that it will be well used and make sure that it will have good clear lines -- where if you are on the trail you can see the nearby neighborhood or commercial neighborhood and people can see you. Include things like markers every 10th of a mile. That way if someone is injured they can call 911 and identify where they are. Partnering with the emergency response folks -- local police agencies often have information or designing for safety around housing or around trails so make use of those resources and you can stress those design elements.

Great. Thank you.

Rae has posted the link to this recording. It will take a couple of weeks to be posted but it will be available online. If there are no other questions on the phone, we will go to one last question in this chat pod and we will wrap up.

Is there anything else on the phone?

There does not appear to be a question on the phone.

Alexandra wanted to know how do you influence both members and politicians on the importance of health and transportation.

This is Melissa in Chattanooga. I would say that one aspect of it that we had not considered before was to add the health-based professionals to our leadership team for developing the transportation plan and also the stakeholder groups that engage periodically with our policy board members. This gives them a chance to talk with into make those personal connections with TPO policy members and to hear the health side of it. They are the strongest and most knowledgeable professionals in that field and it is really important that we create opportunities for them to interact with and give their perspective to policy members one-on-one or to hear from them in that kind of setting.

Okay. The webinar of events is also available at this link -- there is another webinar June 1 on the rapid policy assessment tool. We have the final poll question up their -- please feel free to fill in the final poll question.

Unless there are any final questions on the phone, we will go ahead and wrap up.

We have no questions from the phone.

Would like to think Kate Robb, Marianne Stock, Melissa Taylor with Chattanooga. Michelle with Nashville and Ellen Zavisca .

Thank you all and have a great day. And that concludes our conference for today. You may now disconnect.

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