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Creating Policies on Land Use and Transportation Systems that Promote Public Health

Policy Date: 11/9/2004
Policy Number: 2004-04

THE AMERICAN PUBLIC HEALTH ASSOCIATION,
Noting that nations around the world, including ours, are experiencing epidemics of overweight, obesity,1-2 and type II diabetes2 that are associated with decreased physical activity.3,4 Decreased physical activity is directly associated with other risk factors and diseases, such as colon cancer,5,6 cardiovascular risks,7,8 and depression.9,10
Acknowledging that our nation is also experiencing an epidemic of asthma: since the 1970s, asthma prevalence rates have increased nationwide by 75 percent, with children under 4 experiencing a sharper increase of 160 percent.11 The burden of asthma is not distributed equally among ethnic and social groups, with children in some inner city communities experiencing asthma prevalence rates above 25 percent.12
Noting that the "built environment" has a profound influence on human health and productivity, as well as environmental quality. The built environment can be defined as those aspects of our environment that are modified by humans and includes urban and suburban spaces, housing, schools, workplaces, roads, sidewalks and public transportation infrastructure. Public health determinants associated with the built environment include air quality, opportunities for and safety of physical activity, access to healthful foods, water quality, and psychosocial stressors.13 This policy focuses on land use and transportation and their influence on public health.
Being aware that changes in land use over the last half century, involving low density, single-use, geographically dispersed development, affect the above-mentioned determinants of public health,14 and that land use characteristics have been associated with physical activity.15
Being aware that changes in transportation patterns, principally growing dependence on automobile travel and a decline in non-motorized travel (walking and bicycling), also affect these determinants of public health,12 and that proximity to roadways has been associated with worsened asthma.16,17
Being aware that these land use and transportation trends also threaten public health through other means, including risks of automobile crashes, pedestrian injuries and fatalities,18 and threats to social capital.12
Noting that The Institute of Medicine has recognized linkages between the built environment and health as evidenced by reports of the Roundtable on Environmental Health Sciences, Research and Medicine19 and creation of the Committee on Physical Activity, Health, Transportation and Land Use.20
Noting that the land use and transportation patterns and their consequent public health impacts are determined by policy and funding practices at the federal, state, and local levels and by local and regional planning and decision-making practices.
Acknowledging that the mission of local, state and federal public health agencies is directly impacted by transportation and land-use policies and practices.
Noting that improvements in transportation and land-use policies and practices that minimize environmental impacts, maximize public health benefits, and promote sustainable communities are expected ultimately to help decrease obesity, cardiovascular disease, and asthma while improving mental health and social capital.
Therefore, the APHA:
1) Calls for efforts to train public health students and professionals, including local, state, and federal public health officials, on the linkages between transportation and land use systems and policies and public health; similarly, a public health component should be added to urban planning, architecture and transportation design curricula.
2) Supports national, state, and local organizations, and local public health officials in their efforts to engage in local and regional transportation and land use planning and policy-making processes.
3) Supports transportation and land use legislative and regulatory initiatives that promote public health, and oppose those that potentially threaten public health.
4) Calls for improving public and public health participation in transportation and land-use decisions, establishing transparent and appropriately timed evaluation processes of transportation and land use plans and policies, and establishing a process to assess the health impacts of proposed transportation and land-use plans, policies, and projects.
5) Supports research initiatives to evaluate the determinants within the built environment of adverse as well as beneficial public health impacts.
6) Calls for better data collection by transportation agencies on the availability, use and users of nonmotorized transportation.
References
1. Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and Trends in Obesity Among US Adults, 1999-2000. JAMA 2002;288:1723-1727.
2. Mokdad AH, Bowman BA, Ford ES, Vinicor F, Marks JS, Koplan JP. The continuing epidemics of obesity and diabetes in the US. JAMA 2001;286:1195-1200.
3. Hill JO, Melanson EL. Overview of the determinants of overweight and obesity: current evidence and research issues. Med Sci Sports Exerc 1999;31(11):S515-S521
4. Hu FB, Sigal RJ, Rich-Edwards JW, Colditz GA, Solomon CG, Willett WC, Speizer FE, Manson JE. Walking compared with vigorous physical activity and risk of type 2 diabetes in women: a prospective study. JAMA. 1999;282(15):1433-39.
5. Colditz GA, Cannuscio CC, Frazier AL. Physical activity and reduced risk of colon cancer: implications for prevention. Cancer Causes Control 1997;8(4):649-67.
6. Cronin KA, Krebs-Smith SM, Feuer EJ, Troiano RP, Ballard-Barbash R. Evaluating the impact of population changes in diet, physical activity, and weight status on population risk for colon cancer (United States). Cancer Causes Control 2001;12(4):305-16.
7. Blair SN, Goodyear NN, Gibbons LW, Cooper KH. Physical fitness and incidence of hypertension in healthy normotensive men and women. JAMA 1984;252(4):487-90.
8. Wei M, Kampert JB, Barlow CE, Nichaman MZ, Gibbons LW, Paffenbarger RS Jr, Blair SN. Relationship between low cardiorespiratory fitness and mortality in normal-weight, overweight, and obese men. JAMA 1999;282(16):1547-53.
9. Mokdad AH, Marks JS, Stroup DF, Gerberding JL Actual causes of death in the United States, 2000. JAMA 2004 Mar 10;291(10):1238-45.
10. Colditz GA. Economic costs of obesity and inactivity. Med Sci Sports Exerc 1999 Nov;31(11 Suppl):S663-7
11. U.S. Department of Health and Human Services, National Institutes of Health, National Heart, Lung and Blood Institute; Data Fact Sheet: Asthma Statistics; January 1999.
12. Findley S, Lawler K, Bindra M, Maggio L, Penachio MM, Maylahn C. Elevated asthma and indoor environmental exposures among Puerto Rican children of East Harlem. J Asthma 2003;40(5):557-69
13. Srinivasan S, O’Fallon LR, Dearry A. Creating Healthy Communities, Healthy Homes, Healthy People: Initiating a Research Agenda on the Built Environment and Public Health. Am J Public Health 2003; 93(9):1446-1450.
14. Frumkin H. Urban Sprawl and Public Health. Public Health Reports May-June 2002;7:201-217.
15. Ewing R, Schmid T, Killingsworth R, Zlot A, Raudenbush S Relationship between urban sprawl and physical activity, obesity, and morbidity. Am J Health Promot 2003 Sep-Oct;18(1):47-57.
16. Venn AJ, Lewis SA, Cooper M, Hubbard R, Britton J. Living near a main road and the risk of wheezing illness in children. Am J Respir Crit Care Med 2001;164(12):2177-80.
17. Brauer M, Hoek G, Van Vliet P, Meliefste K, Fischer PH, Wijga A, Koopman LP, Neijens HJ, Gerritsen J, Kerkhof M, Heinrich J, Bellander T, Brunekreef B. Air pollution from traffic and the development of respiratory infections and asthmatic and allergic symptoms in children. Am J Respir Crit Care Med 2002;166(8):1092-98.
18. Ewing R, Schieber RA, Zegeer CV. Urban sprawl as a risk factor in motor vehicle occupant and pedestrian fatalities. Am J Public Health 2003 Sep;93(9):1541-5.
19. Roundtable on Environmental Health Sciences, Research, and Medicine. Available at: http://www.iom.edu/project.asp?id=4897.
20. Institute of Medicine of the National Academy of Sciences. Physical Activity, Health, Transportation, and Land Use (joint with TRB). Available at: http://www.iom.edu/project.asp?id=15724.