The Environmental and Energy Study Institute, in conjunction with the Senate Smart Growth Task Force, held a Congressional briefing to explore the relationship between public health, transportation and land-use. New studies indicate that improvements in land use and community design could help moderate many of the chronic diseases of the 21st century -- high blood pressure, obesity, and asthma -- by providing transportation options that increase physical activity and reduce air pollution. The panel discussed the need to adequately address health considerations in transportation and land-use decisions, and the specific policy measures that could move us toward healthier land-use patterns and healthier communities. The Senate Smart Growth Task Force founded by Senators Carl Levin (D-MI) and Jim Jeffords (I-VT) co-sponsored this briefing. In her opening remarks, Kris Sarri, legislative assistant to Senator Jack Reed (D-RI), a member of the Task Force, invited Senate offices to join the task force. Established in 1999, the Task Force provides Senators with a forum for education and coordination of efforts concerning sustainable growth patterns. The overall goal of the Task Force is to determine and promote ways the federal government can help states and localities to address their own growth management issues. On the date of the briefing 20 Senators or 1/5th of the Senate were listed as members of the Task Force

Naomi Friedman

Ray Minjares

English

IssueLab

 Page 1 The Environmental and Energy Study Institute, in conjunction with the Senate Smart Growth Task Force, held a Congres-sional briefing to explore the relationship between public health, transportation and land-use.  New studies indicate that improvements in land use and community design could help moderate many of the chronic diseases of the 21st century – high blood pressure, obesity, and asthma – by providing trans-portation options that increase physical activity and reduce air pollution. The panel discussed the need to adequately address health considerations in transportation and land-use decisions, and the specific policy measures that could move us toward healthier land-use patterns and healthier communities.  The Senate Smart Growth Task Force founded by Senators Carl Levin (D-MI) and Jim Jeffords (I-VT) co-sponsored this briefing. In her opening remarks, Kris Sarri, legislative assis-tant to Senator Jack Reed (D-RI), a member of the Task Force, invited Senate offices to join the task force. Established in 1999, the Task Force provides Senators with a forum for education and coordination of efforts concerning sustainable growth patterns. The overall goal of the Task Force is to determine and promote ways the federal government can help states and localities to address their own growth manage-ment issues. On the date of the briefing 20 Senators or 1/5th of the Senate were listed as members of the Task Force. The Built Environment and Our Health The built environment – human built or modified buildings, spaces, and products -- influences health in many ways, began Dr. Allen Dearry, Associate Director for the National Institute for Environmental Health Sciences (NIEHS). Some of the most critical health problems of our day, including acute respira-tory illnesses and diseases associated with obesity, are caused or exacerbated by the way we design our communities.  Dr. Dearry cited studies that demonstrate the link between motor vehicle pollution and asthma, slowed lung growth, and other respiratory diseases. Urban design patterns have contributed to an increase in vehicle miles traveled and a decrease in trips made by walking and biking. The average American now drives 73 minutes per day and uses the automobile for almost 90 percent of trips regardless of distance. Children between the ages of five and fifteen, described Dr. Dearry, walked and biked 40 percent less in 1995 than in 1977.  For school trips one mile or less, only 30 percent are made by walking.  This is in sharp contrast to walking rates in other counties. While Americans walk or bike to complete 6 percent of all trips, Italians and Swedes use walking and biking to complete 54 percent and 40 percent of all trips, respectively.  As Americans drive more, they put on pounds.  From 1976 to 2000, the rate of  The Public Health Effects of Sprawl A Compelling Case for Addressing Public Health in Transportation and Land Use Policy 	 									 !"#$%&' !"#$#()))**'+	+			,&$-./		PANELISTS   	    	  		 	 	     ! "  #     			$ #  % & 		" '( ( 		  " ! 	 ( # % ) 	( 	# 	"   	 * ) 	" & ) " +,      	 	 	     	- .  	    "  		 		"  	 *  	    *  	"  (  	 ( 	 )   	  									 	!"#	$	%		$	&'		($%$&)*+,	-			'."/									..	*			0					1	2 	23  	 33 	334 		43 	.$%$&	,,5647(-55)$%$&	,,,56776 (-5  47)$%$&	5666(-5  4)$%$&	,,,5666(- 553)					Obese BMI 30.0Overweight or obeseBMI >25.0Overweight BMI 25.0-29.9 Page 2  Americans that are overweight or obese climbed from 47 to 65 percent, with 31 percent of Americans classified today as obese (defined by a body mass index greater than 30 kg/m3). Lack of physical activity is cited by the NIEHS as a critical factor in this increase. Few incentives exist to design communities that are walk-able, and current building designs work against the use of stairs.  According to Dr. Dearry, current obesity rates are threatening to diminish some of the public health gains of the past century.  Obesity is a massive health problem on the magnitude of tobacco smoking. In fact, a study published early this year by the Centers for Dis-ease Control and Prevention shows that deaths due to poor diet and physical inac-tivity rose by 33 percent over the past decade and may soon overtake tobacco as the leading preventable cause of death. Obesity increases diabetes, heart disease and stroke, arthritis, and certain types of cancer. The health care costs associated with obesity exceed $100 billion per year, even higher than the costs of health care associated with smoking.   Public policy interventions to combat obesity must be employed with a similar fervor to the initiatives employed to reduce tobacco smoking. Yet, there are few public policy programs that address obesity issues. To combat this current health crisis, Dr. Dearry called for:  • Additional research on the connections between the built environment and health outcomes • An examination of the positive health impacts of sustainable and well-planned communities • Improved communication and partnerships between policy makers, planners and health experts. Study Demonstrates Connection Between Urban Design and Public Health The first national study to show a clear relationship between urban form, physical activity and obesity in the United States was de-scribed by lead author Dr. Reid Ewing of the National Center for Smart Growth. Published in the September/October 2003 issue of the American Journal of Health Promotion, the study analyzed health data compiled by the Centers for Disease Control and Preven-tion for more than 200,000 Americans in relation to a County Sprawl Index for 448 metropolitan counties to see how the built envi-ronment may be affecting health. Controlling for other factors, the study found that people living in sprawling counties: Briefing Summary: The Public Health Effects of Sprawl A Compelling Case for Addressing Public Health in Land Use and Transportation Policy   Page 3  1. Walk less in leisure time 2. Weigh more 3. Are more likely to be obese; and 4. Are more likely to have high blood pressure  These factors are true when compared with people living in more compact communities. In fact, researchers found that every 50 point increase in the degree of sprawl was linked to an increase in body mass index (BMI) of 0.17, equal to a gain of one pound for the average person. According to the study, those living in the most sprawling areas are likely to weigh six pounds more than those living in the least sprawling areas.  The study also found that people in more sprawling areas were more likely to be overweight, whether or not they exercised regularly.  These results indicate that what is missing from many people’s lives in these areas is the ability to engage in active living -- to get routine physical activity in the course of walking to work or to a store, or bicycling to a park or friend’s home.  Dr. Ewing highlighted several ways we can reduce sprawling land-use patterns and give people more opportunities to get activity in daily life through:  1. Increasing community densities 2. Connecting streets and shortening blocks 3. Mixing land-uses (i.e., residential, commercial, institutional) 4. Strengthening city centers, and 5.Building complete streets that provide safe and convenient travel for people on foot and bicycle.  What Does This Mean on the Local Level? Dr. Pat Lenihan, Deputy Commissioner, Chicago Health Department, urged attendees to take a broader view of public health con-cerns to include land-use factors, which are as significant a threat to public health as bio-terrorism or other exotic risks receiving significantly more attention. Problems caused by the built environment, “are largely preventable,” pointed out Dr. Lenihan.  Dr. Lenihan described the value of bringing local health officials to the table and forging partnerships with planning and transportation officials.  Public health officials can share their skills in data collection and in public health education and help to promote local reso-lutions that link health with land-use and transportation planning.  Public health agencies can be very effective at persuading decision makers that community development and good health go hand-in-hand. The National Association of County and City Health Offi-cials (NACCHO) has been working with local health departments to urge more effective integration of public health practices into local land-use planning and decision making.  Policy Implications The increasing body of research linking health problems to the way we design our communities has many implications for policy-making, according to Jeff Soule, Policy Director of the American Planning Association (APA).  Historically, public health and plan-ning have been natural allies. Yet, today, city planners, transportation planners, and public health officials, all agents of change, frequently do not work together.  Planning and zoning have been part of the problem, creating barriers to physical activity by separating land uses, creating automobile dependent communities, perpetuating large lot development, overlooking the impor-tance of human scale, and preventing connections between origins and destinations.   In the past, planning was not very participatory, explained Soule, and it is increasingly important to revisit old comprehensive plan-ning and zoning ordinances to increase active living.  Plans need to be more functional and effectively integrate different elements.  For example, a Seattle ordinance requires covered walkways to make walking easier in rainy weather. Localities need tools to help them implement integrated planning, site design and development.   Briefing Summary: The Public Health Effects of Sprawl A Compelling Case for Addressing Public Health in Land Use and Transportation Policy  “...deaths due to poor diet and physical inactivity rose by 33 percent over the past decade and may soon over-take tobacco as the leading preventable cause of death.” -Centers for Disease Control and Prevention, 2004  Page 4  Localities are increasingly interested in pursuing such measures.  The APA determined through a survey that 64 percent of commu-nities found physical activity to be an important issue but more work needs to be done to encourage agencies to work together. Due to funds made available through the federal transportation bill’s Enhancements Program, communities are doing a better job of integrating transportation and land-use.   Federal policy can play a key role in helping communities embark on this fundamental work of promoting public health through community planning and design.  Summary Concern over rising obesity rates, hypertension, and asthma necessitates a new partnership among land-use planners, transportation experts, and public health officials.  By working together, such individuals can create communities that encourage active living, in-cluding walking and biking, and reduce harmful air pollution caused by vehicle emissions.   Federal policy plays an important role in encouraging such collaborations and in supporting community efforts to improve transportation and land-use planning.   Briefing Summary: The Public Health Effects of Sprawl A Compelling Case for Addressing Public Health in Land Use and Transportation Policy  Key Policies to Promote Public Health through  Improved Land-Use and Transportation Planning  1. Installing Bicycle and Pedestrian Facilities 2. Building Safer Routes to Schools 3. Incentivizing Transit-Oriented Development 4. Utilizing Context Sensitive Design 5. Connecting Transportation Investments to Land-Use Planning 6. Building Parks and Recreational Facilities 7. Supporting the Urban Park and Recreation Recovery Program 8. Supporting the Land and Water Conservation Fund 9. Investing in Rural and Small Communities 10. Providing Local Control Over Program Implementation 11. Re-evaluating Federal Housing and Community Development Programs (e.g., considering connectivity and mixed use factors in Hope VI Program) 12. Increasing Federal Support for Research on the Transportation/Land-use  Connection 13. Balancing Security Investments with Livability / 0 	, " 		" ! 	& 1	)  " 0	) 		& 	, 	( 		! 	& 1	1	2    	-   		  	 	 	"   	 ) 3 	( 	  	 ( (  )  Resources • “Obesity on Track as No. 1 Killer”, USA Today, March 9, 2004 • Ali H. Mokdad, PhD; James S. Marks, MD, MPH; Donna F. Stroup, PhD, MSc; Julie L. Gerberding, MD, MPH, “Actual Causes of Death in the United States, 2000,” Journal of American Medical Association, 2004, http://jama.ama-assn.org • Achieving Sustainability through Healthy Community Design, King County Land Use - Transportation - Air Quality - Health Study (LUTAQH), don.ding@metrokc.gov •  “Special Feature:  Built Environment and Health.” Journal of Urban Health, Vol. 8, Issue 4, December 2003 • Built Environment - Healthy Communities, Healthy Homes, Healthy People, Final Report (Conference) , July 15-16, 2002, Research Triangle Park, NC. http://www.niehs.nih.gov/translat/BE-final.pdf • http://www.niehs.nih.gov/drcpt/be/home.htm and http://www.niehs.nih.gov/oc/factsheets/obesity.htm • http://www.naccho.org/project84.cfm  • “Relationship Between Urban Sprawl and Physical Activity, Obesity, and Morbidity,” American Journal of Health Promotion, Sept/Oct 2003, http://www.smartgrowthamerica.org/report/JournalArticle.pdf  and Measuring the Health Effects of Sprawl : A Na-tional Analysis of Physical Activity, Obesity and Chronic Disease, September 2003, http://www.smartgrowthamerica.org/healthreport.html 

The Public Health Effects of Sprawl: A Compelling Case for Addressing Public Health in Transportation and Land Use Policy

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The Public Health Effects of Sprawl: A Compelling Case for Addressing Public Health in Transportation and Land Use Policy

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