Intersection of Transportation and Health: Q&A With Andrew Dannenberg

Jan 14, 2013, 12:50 PM


The Transportation Research Board, a division of the National Research Council, is holding its annual meeting this week including a critical session later today that will bring together several subcommittees to talk about the intersection of transportation and health.

>>Read our coverage from last year’s Transportation Research Board meeting.

Ed Christopher, who is with the Federal Highway Administration Resource Center Planning Team and co-chair of the health subcommittee, says that over the last ten years people in the transportation sector have become more aware of the connections between health and transportation including physical activity, safety, air quality, equity, and access, but that collaboration is still in its early stages. “Health and transportation professionals often come from different scientific backgrounds and have separate institutional structures,” says Christopher. Today’s session bring together the health subcommittee along with several others including committees on policy, legal resources, safety and public transportation.

Christopher says the session will help “demystify” the connections between health and transportation, and identify promising opportunities for research and collaboration.

The keynote speaker at today’s session is Andrew Dannenberg, MD, MPH, an Affiliate Professor at the University of Washington’s School of Public Health Department of Environmental and Occupational Health Sciences and the Department of Urban Design and Planning in the College of Built Environments.

Dr. Dannenberg is also a consultant to and former team lead of the Healthy Community Design Initiative at the Center for Disease Control and Prevention, where he works on activities related to the health aspects of community design including land use, transportation, urban planning, and the built environment. In advance of today’s meeting, NewPublicHealth spoke with Dr. Dannenberg about synergies between transportation and health.

NewPublicHealth: What is the intersection of health and transportation and why does it matter?

Andrew Dannenberg Andrew Dannenberg, University of Washington School of Public Health

Dr. Dannenberg: That really is the key question. I see three major intersections. One that has had our attention for a long time is air pollution.

The second one that’s been around for a while is injury prevention and safety, and certainly the transportation world has been very aware of how they can make a safer road and a safer car and reduce injuries. But they don’t always use health terminology, so they’ll talk about safety and not so much injury or they’ll talk about air pollution, but not necessarily the health outcome from air pollution.

The third issue, which is relatively newer, is the physical activity and obesity component of transportation and that is what I highlight every time I talk about this. How do you encourage the healthy parts of transportation—biking, walking and use of public transit? I mention public transit particularly because using transit generally means walking to or from transit. We should have cars; they have a very central role in a lot of transportation. But the big message is how do you get a more balanced transportation system that puts sufficient resources into the walking and biking and transit infrastructure? From the health point of view we’d like to see a better balance.

The research we have from many European countries is that they have a much higher proportion of all trips taken by a walking, biking and transit and a lower proportion by motor vehicles, and a big part of that has to do with how they’ve chosen to invest in their infrastructure. In the U.S. that varies by where you are. Take a place like Portland, Oregon—more people are walking and biking and using transit because they put the infrastructure investment there. Or you take a city like Atlanta where they’ve put very little investment in walking, biking and transit. So we can see that how those investments really impact peoples’ behaviors.

NPH: How significant are the benefits?

Dr. Dannenberg: We use the term co-benefit—if you do it right you get multiple benefits. The co-benefits of building infrastructure and encouraging the use of active transportation really cross over all of the health issues so that you get less air pollution because fewer people are driving. You get fewer injuries if you design active transportation so that it is safe to walk and bike. You can get less obesity if people are being physically active. You can do a whole number of things to help with climate change if you’re improving the infrastructure.

NPH: What are the next steps in using transportation to create healthier places to live?

Dr. Dannenberg: In my ideal world, every transportation and planning student would have at least a lecture on, if not a course on, the health aspects of what they do, and for that matter, every public health student should have a lecture or a course on the planning and transportation world. We should start having people with joint degrees, and have them starting to be hired by the transportation departments and by the public health department so there’s someone right on the spot who can start to give some public health perspective on decisions being made.

Some of those steps are very discrete policies, such as Complete Streets. That’s a policy that says if you’re building something, design it so it takes care of bikers and walkers. So to the extent that a Complete Streets policy is adopted in more and more places, you gradually start to change things. Safe Routes to School has been a major policy shift because as you start to do the infrastructure around schools, you both help the kids walk and bike to school more but you also then help the community because everyone else who lives near a school has benefits from the changes to the infrastructure.  

And I put the Safe Routes to School fairly high on the list because it has multiple benefits beyond what I just said. One is that if kids start walking and biking as kids, then they’re thinking about it. You’re teaching them early this is a viable mode to transportation.

NPH:  What else do you hope the field focuses on?

Dr. Dannenberg: Health impact assessments (HIAs) look at the health consequences of proposed policies and plans. I think I think transportation is one of the major areas where it can and should be used. HIA looks at any decision that’s being made and asks where the financial and environmental impacts are being considered, and asks you to look at the health impact as well.

Environmental impact statements, as they currently exist, could include more health. The wording of the law that governs them actually talks about health and the National Research Council report on HIA that said there ought to be more health in the existing processes.

Most of the HIAs that have been done to date have been voluntary. The value of that is that they’re easier to do, but they may or may not have as much influence. So if you have a more progressive community that wants to hear the information and decision makers who want to hear it, a voluntary HIA gives them the information and then they can decide how to use it. But it has the drawback that they’re also free to ignore it.

NPH: How do you get around personally?  

Dr. Dannenberg: I don’t have a car here in Seattle. I walk and bike and use transit for everything. So I’m in that fringe of society that’s decided not to have a car. I use Zipcar or rent a car on the occasions where I have to have one. And I’ve been a cyclist all my life. I’ve almost never driven on a daily basis, and that’s part of where I’m coming from in thinking the world could be better [with more transportation options].

NPH: How do you want the public to engage on the issue?

Dr. Dannenberg: I think there’s a big role for advocacy groups and if you have a place that has an active biking group and a walking group and a public transit group and get enough people engaged, they can start to be visible. Here in Seattle, the biking group has 10 or 15,000 members. I was talking to some transportation folks here in Seattle one time and asking about a project that could benefits bikers and walkers, and they said because of the size of the advocacy groups, we wouldn’t even consider moving forward without getting input from those advocacy groups. So I think there really is a role in getting that critical mass of cyclists and walkers and transit users who then become more visible, start to have a political voice and start to influence how the decisions are made.

>>Bonus Links:

  • Read a new report from the Department of Transportation on metropolitan area transportation planning for healthy communities.
  • Read a NewPublicHealth National Prevention Strategy interview with U.S. Department of Transportation Secretary Ray LaHood.

This commentary originally appeared on the RWJF New Public Health blog.