Marissa Sheldon, MPH, a Public Health Prevention Service Fellow at the Centers for Disease Control and Prevention who is temporarily working at the Manatee County Health Department in Bradenton, Fla., spoke at a session today during the APHA annual meeting on working with non-traditional partners to improve community health. Sheldon heads the county’s APHA Power of Policy Complete Streets Work Group. The health department is developing guidelines for a complete streets policy with implementation planned for 2013. Such a policy ensures that transportation planners and engineers consistently design and operate the entire roadway with all users in mind – including bicyclists, public transportation vehicles and riders, and pedestrians of all ages and abilities.

>>View a related infographic on the connection between transportation and health.

NewPublicHealth spoke with Marissa Sheldon just before the meeting.

NewPublicHealth: Who were the partners on the complete streets project?

Marissa Sheldon: There are so many different benefits to the project that it is important to include multiple people with multiple interests. From the health department perspective we are interested in obesity prevention, getting people out walking and biking, and injury prevention. Then you have people from the planning department or public works who are more interested in making sure that the traffic flow is going well and there isn’t a lot of congestion and that there aren’t a lot of accidents. The school board is concerned about kids who are walking to school. We have people who are bicyclists and pedestrians themselves who just want to make sure that they are safe when they are out on the roads and we also have been in contact with fire and rescue and the sheriff’s department who are the people who are responding to accidents on the roadways. So, it’s really a big effort of several different groups of people who are all interested in the same project, but for different reasons. 

NPH: How close are you to completion? 

The August Centers for Disease Control and Prevention Vital Signs monthly report on health indicators focuses on adult walking and finds that 62 percent of U.S. adults get their physical activity by walking at least once for ten minutes or more per week, up from 56 percent n the 2005. However, close to 50 percent of adults don’t get enough physical activity to improve their health, the report finds. The 2008 Physical Activity Guidelines for Americans recommend at least 2.5 hours of moderate intensity aerobic activity per week, such as brisk walking.

“Having more places for people to walk in our communities will help us continue to see increases in walking, the most popular form of physical activity among American adults,” says CDC Director Thomas Frieden, MD, MPH.

“People need more safe and convenient places to walk,” adds Joan M. Dorn, PhD, branch chief of the Physical Activity and Health Branch in CDC’s Division of Nutrition, Physical Activity and Obesity. “People walk more where they feel protected from traffic and safe from crime.  Communities can be designed or improved to make it easier for people to walk to the places they need and want to go.”

The Vital Signs report offers suggestions to provide better spaces and more places for walking:

• State and local governments can consider joint use agreements to let community residents use local school tracks or gyms after classes have finished.
• Employers can create walking paths around or near the work place and promote them with signs and route maps.
• Residents can participate in local planning efforts that identify best sites for walking paths and priorities for new sidewalks.

>>Read more on smart growth for more walkable cities.

Got five minutes? Spend it viewing a recent video on walkability from Dan Burden, a reigning expert, who took NewPublic Health on a walkability audit of San Diego during the recent New Partners for Smart Growth Conference. Burden is executive director of the Walkable and Livable Communities Institute.

The video is a veritable travelogue for walking as the best possible way to get around locally. Burden discusses metrics, safety features and fixes to current streets while video scenes, including happy walkers of all shapes and sizes, flash on screen. Burden makes some pivotal points about walkability, including creating destinations for walkers, adding landscaping to enhance the enjoyment of the walk, and making changes to traffic technology such as replacing some lights with traffic circles to improve safety for drivers, walkers and bikers.

Walkable 101: The Basics from Martin County CRA on Vimeo.

How walkable is your community? Try this checklist from the Pedestrian and Bicycle Information Center, a national clearinghouse.

Sixteen years ago, Deb Hubsmith was on her daily drive after work and another vehicle violently smashed into the passenger side of her car. Her car was totaled. As the crash took place, Hubsmith vowed to herself that if she survived, she'd give up owning a car for good. Hubsmith, who told her story here, went on to found and direct the Safe Routes to School National Partnership and spearhead a national movement to create healthier, more walkable communities where children can walk or bike to school every day.

NewPublicHealth caught up with Deb Hubsmith to talk about why safe routes to school are critical for the nation’s health.

NewPublicHealth: Why are safe routes to school important for the nation's health and quality of life?

Deb Hubsmith: The trip to school is a trip every child in America makes. Safe Routes to School is the only federal funding that is dedicated to infrastructure and programs that help kids be able to walk and bike to school in their daily life. By building sidewalks and pathways and safer street crossings, and focusing on safe routes to school, we can change the built environment and also change the culture. This creates opportunities for safe and healthy physical activity for children across the country.

NPH: How did you come to found the Safe Routes to School National Partnership?

Deb Hubsmith: I’ve always cared a lot about the environment and public health. After I got into a car accident 16 years ago, I decided to try living life without a car. It was very difficult to do this. So, I became an advocate for transportation choices. I started off by working with parents and teachers and advocates at the local school in my community. We worked on ways to get kids to school safely by walking and biking, and by carpooling and busing. I became interested in how this could be done on a larger scale, so I started working within the county. When I heard that Congressman Oberstar was looking for ways to improve safe routes to school and walking and biking in America, I had the great fortune of meeting him and having the opportunity to run a national pilot program for safe routes to school in Marin County, Calif. In that program, in one year we increased the number of kids walking and biking to school by 57 percent. This made national news.

The childhood obesity epidemic was rising at that time, and Mr. Oberstar wanted to do something to help all of America, so I worked with his staff on crafting federal legislation, and the Safe Routes to School program was included in the transportation bill in 2005. I launched the Safe Routes to School National Partnership at the same time because I knew we needed a grassroots organization to truly build a movement. This movement needed to be diverse, with partners from health, education, equity, environmental and transportation organizations. Now, our national partnership includes about 600 organizations.

NPH: You've said the concept of safe routes to school has reached the point where it's become a true movement. How did this shift come about?

While at the New Partners for Smart Growth Conference, we took the chance to talk to some of the meeting attendees and get their thoughts on the conference and the intersection between public health and building better communities.

Avtar Nijjer-Sidhu

Senior Health Educator

Public Health Services Department, County of Kern

What brought you to the conference?

I love the intersect between health and planning. For me [this conference is] about peer learning to see what many of my colleagues are doing across the country and how we can take some of the best practice models and apply them to where we are. I’m also such a staunch advocate for health that I think that merging the two worlds of land use and public planning along with public health seems like a nice fit.

Who are your critical partners for smart growth?

Multitudes. On the ground, grassroots, the community residents who live in those areas, and their children and young teens who are taking a real interest now. I work with several government agencies who are realizing that the way we do business doesn’t work anymore. We’re having to look at different approaches to sustain the work we do. I also work with local city planners.

What is some of the work that you’re doing in the health community?

I look at how to improve health, especially for those in low-income communities, in areas that might be considered food deserts or food swamps. Through the public health department when I worked there, we looked at organizing farmers' markets in low-income areas, bringing access to good quality, locally-grown produce. In order to establish the farmers’ market, I had to understand what were the ordinances or the zonings to allow this to happen in a residential area. I also work with city planners to look at health language in their general plans. I work at organizing workshops in which we bring all the county agencies together so that people on the ground can understand what we need from them and what they need from us. I also look at worksite wellness and the policies we develop around lactation and vending machines, creating healthier places and making sure all those policies are infused county-wide, so all the county agencies are on the same page when it comes to promoting a healthy workplace. One of the projects I want to take on is healthy corner store conversions, and that was a really good model presented here.

What I like about this conference is that each year it grows to be more diverse. I like to see public health here. It’s really important. The conference is fairly young, but it’s growing fast and gaining the attention and momentum it should. There are so many of us now making the fight for the connection between health and the environment.

Ashlee Halbritter

Public Health Prevention Service Fellow

Richmond City Health District

What brought you to the conference?

I’m trying to kick off a strategic planning process for a built environment program at the Richmond City Health District.

Who are your critical partners for smart growth?

Our city planning department, economic and community development, the department of transportation, our local transportation system (the Greater Richmond Transit Center), private partners and some of the local non-profits.

How does your work impact the health of your community?

Getting all of the siloed sectors talking to each other about how they can impact the community in a bigger way—not just with health, but with equity, more resources, and a healthier and more vibrant community in general.

Robbyn Lewis, MPH

Public Health Researcher

Baltimore, MD

What brought you to the conference?

I came for a couple of reasons. Firstly, the reason that I’m even able to be here is because I was awarded a diversity scholarship. The second reason is that I am a public health professional. I work mostly with infectious disease research, but I am very interested in sustainability and the environment, and working as a volunteer to change, transform and improve my neighborhood. I knew that I could learn a lot at this conference. I wanted to be here partly for professional development, but also for education – to learn strategies and ideas that I can take back to my home and apply to my community in Baltimore. I want to continue that volunteer work that I’m doing, but do it in a better way.

The third reason is networking. As a public health professional and researcher who is interested in the built environment, I love the field so much that I’ve been looking for ways to redirect my profession in ways that allow me to be paid for my work in the environmental and sustainability. I’m looking to broaden my network and make contacts.

Alexander Frane

Environmental and Emergency Management Specialist

SRA International

What brought you to the conference?

This is the only conference that I know that is devoted specifically to these issues. I am interested to meet the fans and see what they think about it. I want to learn and compare my knowledge with people of different perspectives to see what’s new, what’s going on, and what direction people are looking to.

[Note: All statements here are from the individuals featured and do not necessarily represent the views of the organizations they work for.]

The startling new National Association of Area Agencies on Aging report, "The Maturing of America," concludes that many communities are unprepared for their quickly aging populations, with "nowhere near the level of progress that has to be made to ensure that communities are livable for people of all ages." Last week at the New Partners for Smart Growth Conference, a panel discussed the challenges our nation will face as it ages and how we can better design communities to be healthier and more accessible for all age groups.

Rebecca Hunter, MEd, of the University of North Carolina Institute on Aging and the Centers for Disease Control and Prevention (CDC) Healthy Aging Research Network, said we’re currently facing a "perfect storm" when it comes to aging:

• Baby boomers are starting to reach “older adult” status
• There is a vast increase in the “oldest old,” or age 85 and above
• The economic downturn means we are less and less prepared for the health and social consequences of this trend

We are moving into an era when at least one in five Americans will be age 65 and older, said Hunter. "We need to ensure our communities are livable for all people."

A key group that presented at the New Partners for Smart Growth conference last week, was the Partnership for Sustainable Communities. Created in 2009, the Partnership is a collaborative initiative of the U.S. Department of Housing and Urban Development (HUD), Department of Transportation (DOT), and the Environmental Protection Agency (EPA) with the combined goal of helping communities across the U.S. improve access to affordable housing, increase transportation options, and lower transportation costs while protecting the environment.

The Partnership works to coordinate federal housing, transportation, water, and other infrastructure investments to make neighborhoods more prosperous, allow people to live closer to jobs, save households time and money and reduce pollution.

"Sustainable communities are those that have access to jobs, quality schools, safe streets, environmental benefits—basically, communities that are built in ways that everyone can be included and have a better quality of life," said Shelley Poticha, who serves as HUD’s advisor to the Partnership and as Director for Office of Sustainable Housing and Communities at the Department.

The New Partners for Smart Growth Conference last week had several sessions on creating easier access to transportation alternatives that reduce dependence on motor vehicles. A recent study in the journal Health Place by Jamie F. Chriqui, PhD, senior research scientist at the University of Illinois at Chicago Institute for Health Research and Policy, moves the debate forward with a look at whether laws are a help or hindrance in increasing biking and walking to school by elementary school students.

NewPublicHealth spoke with Jamie Chriqui about the study.

NewPublicHealth: What was the scope of your study?

Jamie Chriqui: This was a nationwide study by the Bridging the Gap program at the University of Illinois in Chicago. We examined the relationship between state laws related to safe routes to school, such as minimum busing distances or requirements for crossing guards, speed zones, sidewalks around schools, and practices and policies at elementary schools related to active travel to school. We conducted the study between 2007 and 2009 and looked at thousands of schools across the country.

[Note: Bridging the Gap is a Robert Wood Johnson Foundation funded nationally recognized research program dedicated to improving the understanding of how policies and environmental factors influence diet, physical activity and obesity among youth, as well as youth tobacco use.]

NPH: And what were the results of the study?

A major theme at last week's New Partners for Smart Growth Conference was "co-benefits." Many sectors and interests were represented at the conference and each took a different tack on the benefits of smart growth, or building communities so that they are walkable, affordable, generate jobs and help people get to where they need to go, including to fresh food markets, to work and play and to green spaces. The co-benefits of this kind of growth include better health, a cleaner and more sustainable environment, and a stronger economy.

The benefits to the economy were the focus of a Friday session at the Smart Growth conference, led by Lee Sobel, Real Estate Development and Finance Analyst at the Office of Sustainable Communities for the U.S. Environmental Protection Agency.

Mitchell Silver, AICP, Planning Director of the City of Raleigh, NC and President of the American Planning Association quoted Chattanooga Mayor Littlefield with an important maxim for smart growth: "If you aren't a city where people want to live, you aren't a city where people want to invest."

Younger generations will demand a different lifestyle, said Silver, and separate office parks will play no part in it. More integrated, mixed land-use areas where people can walk or take public transit to work are becoming more and more attractive to employees—and, importantly, to employers.

While young people used to find a job and then a place to live nearby, more young people today start by finding a city or community they love and then looking for a job where they want to live, said Silver. That means employers want to be where people want to live.

Beyond attracting employers, dense growth means more tax revenue for cities. It would take 150 acres of 600 single-family homes to equal the tax value of Raleigh's Wells Fargo Capitol Center, which sits on 1.2 acre land, said Silver.

A report from Active Living Research, a national program of the Robert Wood Johnson Foundation with direction and technical assistance provided by San Diego State University, found that green spaces have economic pay-offs as well. The existence of a park within 1,500 feet of a home increased its sale price by between $845 and $2,262 (in 2000 dollars). Additionally, as parks increased in size, their impact on property value increased significantly, according to the report.

This builds on parallel research finding that preventive health efforts are sound business decisions:

• The Healthier Americans for a Healthier Economy report showcases several states and cities that have found that better health for their citizens can also improve their bottom line, in collaboration with local businesses. Read more on the report and a Q&A with Tom Mason, President of Alliance for a Healthier Minnesota, on the business perspective on prevention.
• An investment of $10 per person annually in proven, community-based public health programs could save the U.S. more than $16 billion within five years—a $5.60 return for every $1 invested. Read more on the report on the return on investment of prevention.
• Companies that sell "better-for-you" foods perform better financially. Read a Q&A with the report author.

>>Follow our coverage of the New Partners for Smart Growth Conference.

San Bernardino, Calif., the 100th largest city in the U.S., has several other distinctions: compared to the rest of the state, it has the worst food index (ratio of unhealthy to healthy food index), an average life expectancy that is eight years lower, a homicide rate that is 150% higher, the 2nd highest concentration of alcohol outlets and a 400-acre deficit of parks (two-thirds of residents don't live within a mile of parks or green spaces).

The county of San Bernardino doesn’t fare much better. In the 2011 County Health Rankings, a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, San Bernardino ranks 50th out of 56 California counties in health factors and 55th out of 56 in physical environment factors such as access to healthy foods and air pollution days.

San Bernardino is in the midst of a public health crisis.

The Healthy Communities team at the Bernardino County Public Health Department set out to tackle that crisis—on a staff of three. “We knew partnerships would be critical,” said Evelyn Trevino, Program Coordinator for the program. Thus, the Healthy San Bernardino County Healthy Places Coalition was born.

One of the first steps was to conduct an environmental scan, the results of which provided many of the nuggets above, as well as information on parks and recreation space, the food environment, air and water quality and economic opportunities, said Mark Hoffman, Senior Planner for The Planning Center.

Peggi Hazlett, Assistant to the Mayor of the City of San Bernardino, lives and raises two children in the area, and has been committed to making it a healthier, happier place to live for her own family and future generations. It’s a constant struggle, though. The week of the conference, there were three homicides within a 20-block radius, including a stray bullet that slayed a 15-year-old. “Welcome to my world,” said Hazlett.