New Search »
Improving Health Through Transportation and Land-Use Policies
Policy Date: 11/10/2009
Policy Number: 20099
Transportation and land-use policies are significant factors in the built environment that affect (a) rates of injury and death caused by traffic crashes, (b) ease and safety of physical activity, (c) air quality, (d) greenhouse gas emissions, and (e) access to key community resources such as health care and healthy food. Land-use policies pertain not only to the movement of people but also to the movement of freight and goods from ships through ports and on trucks and trains, which affects communities and workers across the country. In the United States, transportation and land-use patterns have historically favored automobile travel, spawned sprawling development, and taken an unnecessary toll on human life.1 Traffic injuries and fatalities are an enormous public health and health care problem in the United States, accounting for more than 41,000 deaths annually,2 2.5 million nonfatal injuries,3 and more than $200 billion in annual expenditures.4 In 2007, there were 4,654 pedestrian and 698 bicyclist fatalities in the United States and more than 100,000 combined injuries from nonmotorized travel.5 The health costs associated with motor vehicle emissions were estimated to be $40 to $65 billion in 2000,6 and climate change is estimated to be responsible for more than 150,000 deaths per year along with devastating effects on global climate patterns.7,8 Although transportation and land-use policies affect all people, the cumulative health impacts are disproportionately borne by low-income communities and some communities of color.
National health care expenditures in the United States surpassed $2 trillion annually in 2006 [approximately 16% gross domestic product (GDP)] and are projected to constitute 17% of GDP by 2011.9 Effective transportation and land-use strategies can not only improve the health and well-being of Americans but also decrease demand on an already overextended health care system. This resolution explores 4 major health impacts of transportation and land-use policies that take some of the largest tolls on health, equity, and the economy: traffic injuries and fatalities, physical activity and nonmotorized transportation, air quality, and health equity and the disparate impact on vulnerable populations. This policy is in accordance with action steps 1 through 6, previously adopted by the American Public Health Association in American Public Health Association (APHA) policy 2004-04, Creating Policies on Land-Use and Transportation Systems that Promote Public Health.10
Traffic Injuries and Fatalities
Traffic crashes are the leading cause of death in the United States for people younger than 34.11 By 2030, traffic-related deaths will be the fifth leading cause of death worldwide.12 Native Americans are 1.5 times more likely to die from traffic crashes than other Americans 13 African Americans make up approximately 12% of the population, but they account for 20% of pedestrian deaths.14 However, traffic injuries and fatalities can be prevented through effective traffic safety policies and practices.15 Strong evidence indicates that traffic safety legislation has been effective and largely responsible for increasing people’s use of passenger and occupant safety features.16,17 Enforcement of stricter laws and public education has contributed to personal choices that favor safety (e.g., avoiding impaired driving, reducing speed, wearing helmets, and using child safety seats and safety belts).18 An estimated 301,000 lives were saved between 1970 and 2006 because of legislation associated with occupant protection, motorcycle helmets, and drinking age.19 Diversifying transportation options to accommodate safe walking, bicycling, and public transportation use can result in fewer traffic injuries compared with communities built to accommodate motor vehicles alone.20 Contrary to the widespread belief that increased bicycle and foot traffic will lead to more cyclist and pedestrian injuries, increasing the numbers of nonmotorized travelers may actually make walking and bicycling safer.21 Residents of transit-oriented communities also tend to have lower per capita traffic fatality rates.22
Physical Activity and Nonmotorized Transportation
According to the US Surgeon General, 60% of US adults do not meet recommended levels of physical activity, and 25% are completely sedentary.23 The causal link between physical activity and health is well established, with sedentary lifestyles estimated to contribute to as many as 255,000 preventable deaths per year and physical inactivity being a major contributor to the rising rates of chronic illnesses such as type II diabetes and heart disease.24 An emerging body of evidence shows that particular transportation and land-use patterns can influence people’s decision to engage in physical activity, making transportation and land-use decisions an opportunity to increase levels of physical activity.25–28 These land-use characteristics include high-density and mixed use development, good public transportation, and proximity to destinations.29,30 Characteristics such as bicycle and pedestrian facilities, good street connectivity, presence of parks and open space, and residents’ perceived safety have also been shown to enhance physical activity in some communities.31–34 Particularly in low-income communities where only 73.5% of low-income households own cars compared with 91.7% of all U.S. households, nonmotorized transportation is a good opportunity to meet daily recommended levels of physical activity.30 However, the quality of nonmotorized infrastructure is often lower in low-income and minority communities, contributing to higher pedestrian fatality rates.35 Forty percent of the lowest income transit users meet the recommended levels of physical activity solely from walking to and from transit, making public transportation an important strategy to improve activity rates among vulnerable populations.30 Because walking and bicycling remain more dangerous than motorized travel, per trip and per mile,36 improving the safety of bicyclists and pedestrians must have a high priority. Ensuring that public fears regarding violence and overall safety are fully addressed may also increase levels of physical activity.37,38
According to the US Environmental Protection Agency (USEPA), 35 million people in the United States are exposed to air toxins emitted from road traffic.39 Particulate matter and other pollution are often present at high concentrations along traffic-heavy roads,40 especially when a large fraction of this traffic uses diesel fuel.41 Low-income communities and some communities of color are at risk for higher levels of pollutant exposure, because their homes are more likely to be located near busy roadways.42 Several studies have documented that children going to school near major roadways have higher rates of respiratory symptoms,43 asthma diagnoses, and allergic sensitization,44,45 and children living near major roadways are more likely to suffer from asthma.48–52 Adults living or working near roadways are also more likely to suffer from asthma53–55 and other respiratory diseases,56–60 as well as atherosclerosis and other cardiovascular problems.61,62 Other health effects associated with exposure to poor air quality near roadways include cancer,63–67 adverse reproductive outcomes,68 and impaired neurocognitive performance in children.69
The transportation sector is a significant source of harmful air pollutants, including greenhouse gases. Mobile sources emit more than half of the nation’s benzene, toluene, and acetaldehyde, the air toxics of greatest public health concern, as well as approximately 91 additional air toxics that are known carcinogens or have toxicity reference concentrations in the USEPA’s main risk assessment database, the Integrated Risk Information System.70 The US transportation sector emits approximately 10% of all energy-related greenhouse gas emissions worldwide and more than one third of all transportation emissions worldwide. Over the next 50 years, greenhouse gas emission from the US transportation sector is poised to grow another 80% beyond current levels.71
Health Equity and Disparate Impact on Vulnerable Populations
In addition to disparities in the incidence of traffic injuries and deaths, limited access to opportunities for physical activity, and exposure to poor air quality, barriers to necessary community resources have disproportionately contributed to poor health among particular populations in the United States, including low-income communities, communities of color, people with disabilities, children, and older adults.72 Nearly one third of the US population—including children, older adults, people with disabilities, low-income people, women, and rural residents—are transportation disadvantaged (e.g., they are unable to transport themselves or purchase transportation).73 Low-income households can spend up to 40% of their income on transportation expenses, further perpetuating the gap in economic disparities and isolation from essential opportunities and resources.74–78 Executive Order 12898, Federal Actions to Address Environmental Justice in Minority Populations and Low-Income Populations, brought federal attention to the environmental conditions that have had disproportionately adverse health effects on low-income and minority communities,79 yet there have been no equivalent efforts to address inequities perpetuated by the built environment.
Therefore APHA urges public health and social justice practitioners, advocates, researchers, and philanthropists to advocate and support advancing transportation and land-use legislation that will ensure the following goals—
1. Federal transportation policy must prioritize health, equity, and safety for all travelers. Roadways should be safe and accessible for all travelers rather than being designed exclusively for motorized travelers.
a. A greater share of federal, state, and local transportation dollars should be invested in safe infrastructure for walking, bicycling, and public transportation (including transit operating funds).
b. All new construction and redevelopment of roadways should apply the Complete Streets model to make roadways safe for all users. Complete streets ensures that roadways are designed and operated with all users in mind, including bicyclists, public transportation vehicles and riders, and pedestrians of all ages and abilities.80
c. Federal, state, and local policy should create incentives for investing in underserved communities, particularly those with existing infrastructure to support nonmotorized travel- and transit-oriented development.
d. Roadways should be designed to have good visibility, have traffic-calming features, and create greater distances and barriers between moving traffic and nonmotorized travelers (i.e., pedestrians and bicyclists).
e. Community residents, public health, labor unions, transportation system employees, social justice, and other diverse stakeholders should be engaged in transportation policy development and planning.
2. Transportation policy and subsequent implementation must prioritize using cleaner energy sources and reducing harmful emissions, including greenhouse gases.
a. Reducing the transportation sector’s contributions to global climate change should be prioritized at the federal, state, and local level.
b. Environmental justice goals to reduce the disparate exposure to harmful emissions from mobile sources should be honored and advanced in transportation and land-use activities.
c. Reducing adverse health impacts of goods movement and freight transport on low-income, minority communities and workers should be a priority in transportation and land-use policymaking.
3. Community development and redevelopment activities should preserve historic, environmental, agricultural, and aesthetic resources.
4. State departments of transportation and local agencies should partner with community groups to conduct Health Impact Assessments for major transportation and land-use activities.
a. All agencies that make decisions that affect health should be held accountable and be responsible for these health outcomes.
b. Public health should work with transportation and city planners to identify the health indicators and performance measures by which to evaluate such activities.
5. State and local transportation and land-use decisions should promote equity by—
a. Improving transportation linkages and options between housing, employment hubs, health care facilities, healthy food retailers, and schools, particularly in low-income communities and communities of color.
b. Encouraging high-density, mixed-use, and transit-oriented development with affordable housing and transit options in these developments.
c. Building roadways to accommodate safe nonmotorized travel of people with disabilities and older adults.
d. Prioritizing local and regional food transportation networks and infrastructure over long-distance ones.
. Frumkin H, Frank L, Jackson R. Urban Sprawl and Public Health: Designing, Planning and Building for Healthy Communities. Washington, DC: Island Press, 2004.
2. Fatality Analysis Reporting System. National Statistics: Table updated with 2006 final data and 2007 annual data. Available at: www-fars.nhtsa.dot.gov/Main/index.aspx. Accessed October 22, 2008.
3. US Department of Transportation. National Highway Traffic Safety Administration. 2007 Traffic Safety Annual Assessment—Highlights. DOT HS 811 017. Traffic Safety Research Facts: Crash•Stats. Washington, DC: NHTSA; 2008. Available at: www-nrd.nhtsa.dot.gov/Pubs/811017.PDF. Accessed October 22, 2008.
4. Blincoe LJ, Seay AG, Zaloshnja E, et al. The Economic Impact of Motor Vehicle Crashes, 2000. DOT HS 809 446. Washington, DC: National Highway Traffic Safety Administration; 2002. Available at: www.nhtsa.dot.gov/staticfiles/DOT/NHTSA/Communication%20&%20Consumer%20Information/Articles/Associated%20Files/EconomicImpact2000.pdf. Accessed November 17, 2008.
5. National Highway Traffic Safety Administration. Traffic Safety Facts 2007 Data: Pedestrians; 2008. Available at: www.nhtsa.dot.gov/portal/nhtsa_static_file_downloader.jsp?file=/staticfiles/DOT/NHTSA/NCSA/Content/TSF/2007/810994.pdf. Accessed November 23, 2009.
6. US Department of Transportation. Federal Highway Administration. Addendum to the 1997 Federal Highway Cost Allocation Study. 2000. Available at: http://www.fhwa.dot.gov/policy/hcas/addendum.htm. Accessed December 14, 2009.
7. Pandian S., Gokhale S, Ghoshal AK. Evaluating effects of traffic and vehicle characteristics on vehicular emissions near traffic intersections. Transportation Research Part D: Transport and Environment. 2009;14(3):180–196.
8. Lin J, Ge YE. Impacts of traffic heterogeneity on roadside air pollution concentration. Transportation Research Part D: Transport and Environment. 2006;11(2):166–170.
9. Poisal JA, Truffer C, Smith S, et al. Health spending projections through 2016: modest changes obscure Part D’s impact. Health Aff (Millwood). 2007;26:w242–w253.
10. American Public Health Association. APHA policy statement 2004-04: Creating Policies on Land-Use and Transportation Systems that Promote Public Health; 2004. Available at: www.apha.org/advocacy/policy/policysearch/default.htm?id=1282. Accessed November 30, 2009.
11. Centers for Disease Control and Prevention. National Center for Health Statistics, National Vital Statistics System, produced by: Office of Statistics and Programming, National Center for Injury Prevention and Control. Ten Leading Causes of Death and Injury (Charts). 2006. Available at: www.cdc.gov/injury/wisqars/LeadingCauses.html. Accessed December 14, 2009.
12. World Health Organization. Global Status Report on Road Safety, Time for Action. Geneva, Switzerland: The World Health Organization, 2009.
13. Centers for Disease Control and Prevention (CDC). Web-Based Injury Statistics Query and Reporting System (WISQARS). WISQARS Injury Mortality Reports, 1999 – 2006. Available at: http://webappa.cdc.gov/sasweb/ncipc/mortrate10_sy.html. Accessed December 14, 2009.
14. Pucher J, Renne JL. Socioeconomics of urban travel: evidence from the 2001 NHTS. Transport Quarterly. 2003;57:49–77.
15. World Health Organization. World Report on Road Traffic Injury Prevention. Geneva, Switzerland: World Health Organization; 2004. Available at: www.traffic.bilkent.edu.tr/who/wt_summary.pdf. Accessed October 22, 2008.
16. Task Force on Community Preventive Services. Motor-vehicle occupant injury: strategies for increasing use of child safety seats, increasing use of safety belts, and reducing alcohol-impaired driving. MMWR Recomm Rep. 2001;50(RR07):1–13.
17. Task Force on Community Preventive Services. The guide to community prevention services. Reducing injuries to motor vehicle occupants. Systematic reviews of evidence, recommendations from the Task Force on Community Prevention Services, and expert commentary. Am J Prev Med. 2001;21:1–90.
18. Dellinger A, Sleet DA, Jones BH. Drivers, wheels, and roads: motor vehicle safety in the twentieth century. In: Ward J, Warren C, eds. Silent Victories: The History and Practice of Public Health in Twentieth-Century America. New York, NY: Oxford University Press; 2007:343–362.
19. US Department of Transportation, National Highway Traffic Safety Administration, Traffic Safety Facts 2006. Washington, DC: US Department of Transportation; 2007. Available at: www-nrd.nhtsa.dot.gov/Pubs/TSF2006FE.PDF. Accessed March 26, 2008.
20. Ewing R, Schmid T, Killingsworth R, Zlot A, Raudenbush S. Relationship between urban sprawl and physical activity, obesity, and morbidity. Am J Health Promot. 18;2003:47–57.
21. Jacobsen PL. Safety in numbers: more walkers and bicyclists, safer walking and bicycling. Inj Prev. 9;2003:205–209.
22. Litman T. Safe Travels: Evaluating Mobility Management Traffic Safety Benefits. Victoria, BC, Canada: Victoria Transport Policy Institute, 2006. Available at: www.vtpi.org/safetrav.pdf. Accessed November 23, 2009.
23. Office of the Surgeon General. The Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity. Rockville, Md: U.S. Department of Health and Human Services, Public Health Service, Office of the Surgeon General; 2001.
24. Transportation Research Board and Institute of Medicine. Does the Built Environment Influence Physical Activity? Examining the Evidence. Special Report 282. Washington, DC: National Academy Press; 2005.
25. Frank L, Engelke P, Schmid T. Health and Community Design: The Impact of the Built Environment on Physical Activity. Washington, DC: Island Press; 2003.
26. Sallis JF, Frank LD, Saelens BE, Kraft MK. Active transportation and physical activity: opportunities for collaboration on transportation and public health research. Transportation Research Part A: Policy and Practice. 2004;38:249–268.
27. Heath GW, Brownson RC, Kruger J, Miles R, Powell KE, Ramsey LT, the Task Force on Community Preventive Services. The effectiveness of urban design and land use and transport policies and practices to increase physical activity: a systematic review. J Phys Act Health. 2006;3:S55–S76.
28. Frank LD, Saelens BE, Powell KE, Chapman JE. Stepping towards causation: do built environments or neighborhood and travel preferences explain physical activity, driving, and obesity? Soc Sci Med. 2007;65:1898–1914.
29. Saelens BE, Sallis JF, Black JB, Chen D. Neighborhood-based differences in physical activity: an environment scale evaluation. Am J Public Health. 2003;93:1552–1558.
30. Besser LM, Dannenberg AL. Walking to public transit: steps to help meet physical activity recommendations. Am J Prev Med. 2005;29:273–280.
31. Frank LD, Schmid TL, Sallis JF, Chapman J, Saelens BE. Linking objectively measured physical activity with objectively measured urban form: findings from SMARTRAQ. Am J Prev Med. 2005;28:117–125.
32. Saelens BE, Sallis JF, Frank LD. Environmental correlates of walking and cycling: findings from the transportation, urban design, and planning literatures. Ann Behav Med. 2003;25:80–91.
33. Saelens BE, Handy SL. Built environment correlates of walking: a review. Med Sci Sports Exerc. 2008;40:S550–S566.
34. Hoehner CM, Brennan Ramirez LK, Elliott MB, Handy SL, Brownson RC. Perceived and objective environmental measures and physical activity among urban adults. Am J Prev Med. 2005;28:105–116.
35. Pucher J, Renne JL. Socioeconomics of urban travel: Evidence from the 2001 NHTS. Transport Q. 2003;57:49–77.
36. Beck LF, Dellinger AM, O’Neil ME. Motor vehicle crash injury rates by mode of travel, United States: using exposure-based methods to quantify differences. Am J Epidemiol. 2007;166:212–218.
37. Foster S, Giles-Corti B. The built environment, neighborhood crime and constrained physical activity: an exploration of inconsistent findings. Prev Med. 2008;47:241–251.
38. Powell KE, Martin LM, Chowdhury PP. Places to walk: convenience and regular physical activity. Am J Public Health. 2003;93:1519–1521.
39. US Environmental Protection Agency. Draft National Ambient Air Monitoring Strategy. Research Triangle Park, NC: Office of Air Quality Planning and Standards; 2005. Available at: http://epa.gov/pm/pdfs/naam_strategy_20051222.pdf. Accessed October 22, 2008.
40. Jerrett M, Burnett T, Ma R, et al. Spatial analysis of air pollution and mortality in Los Angeles. Epidemiology. 2005;16:727–736.
41. US Environmental Protection Agency. The particle pollution report: current understanding of air quality and emissions through 2003. Research Triangle Park, NC: Office of Air Quality Planning and Standards, Emissions, Monitoring, and Analysis Division; 2004. Available at: http://epa.gov/air/airtrends/aqtrnd04/pm.html. Accessed October 22, 2008.
42. Baxter LK, Clougherty JE, Paciorek CJ, Wright RJ, Levy JI. Predicting residential indoor concentrations of nitrogen dioxide, fine particulate matter, and elemental carbon using questionnaire and geographic information system based data. Atmos Environ. 2007;41(31):6561–6571.
43. Van Vliet P, Knape M, De Hartog J, Janssen N, Harssema H, Brunekreef B. Motor vehicle exhaust and chronic respiratory symptoms in children living near freeways. Environ Res. 1997;74:122–132.
44. Kim JJ, Smorodinsky S, Lipsett M, Singer BC, Hodgson AT, Ostro B. Traffic-related air pollution near busy roads: The East Bay Children’s Respiratory Health Study. Am J Respir Crit Care Med. 2004;170:520–526.
45. Janssen N, Brunekreef B, Van Vliet P, et al. The relationship between air pollution from heavy traffic and allergic sensitization, bronchial hyperresponsiveness, and respiratory symptoms in Dutch schoolchildren. Environ Health Perspect. 2003;111:1512–1518.
46. Venn A, Lewis S, Cooper M, et al. Local road traffic activity and the prevalence, severity, and persistence of wheeze in school children: combined cross sectional and longitudinal study. Occup Environ Med. 2000;57:152–158.
47. Venn AJ, Lewis S, 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;164:2177–2180.
48. McConnell R, Berhane K, Yao L, et al. Traffic, susceptibility, and childhood asthma. Environ Health Perspect. 2006;114:766–772.
49. Gauderman WJ, Vora H, McConnell R, et al. Effect of exposure to traffic on lung development from 10 to 18 years of age: a cohort study. Lancet. 2007;369:571–577.
50. Edwards J, Walters S, Griffiths RK. Hospital admissions for asthma in preschool children: relationship to major roads in Birmingham, United Kingdom. Arch Environ Health. 1994;49:223–227.
51. Duhme H, Weiland SK, Keil U, et al. The association between self-reported symptoms of asthma and allergic rhinitis and self-reported traffic density on street of residence in adolescents. Epidemiology. 1996;7:578–582.
52. Lin S, Munsie JP, Hwang SA, Fitzgerald E, Cayo MR. Childhood asthma hospitalization and residential exposure to state route traffic. Environ Res. 2002;88:73–81.
53. Lwebuga-Mukasa JS, Oyana T, Thenappan A, Ayirookuzhi SJ. Association between traffic volume and health care use for asthma among residents at a US–Canadian border crossing point. J Asthma. 2004;41:289–304.
54. Oyana TJ, Lwebuga-Mukasa JS. Spatial relationships among asthma prevalence, health care utilization, and pollution sources in neighborhoods of Buffalo, New York. J Environ Health. 2004;66:25–37.
55. Oyana TJ, Rogerson P, Lwebuga-Mukasa JS. Geographic clustering of adult asthma hospitalization and residential exposure to pollution at a United States–Canada border crossing. Am J Public Health. 2004;94:1250–1257.
56. Ciccone G, Forastiere F, Agabiti N, et al. Road traffic and adverse respiratory effects in children: SIDRIA Collaborative Group. Occup Environ Med. 1998;55:771–778.
57. Ciccone G; Gruppo collaborativo SIDRIA. Studi Italiani sui Disturbi Respiratori nell’Infanzia e l’Ambiente. [Features of traffic near houses and respiratory damage in children: the results of the SIDRIA (Italian Study on Respiratory Problems in Childhood and the Environment)] Ann 1st Super Sanita. 2000;36:305–309.
58. Kan H, Heiss G, Rose KM, Whitsel EA, Lurmann F, London SJ. Prospective analysis of traffic exposure as a risk factor for incident coronary heart disease: the Atherosclerosis Risk in Communities (ARIC) Study. Environ Health Perspect. 2008;116:1463–1468.
59. Modig L, Järvholm B, Rönnmark E, et al. Vehicle exhaust exposure in an incident case–control study of adult asthma. Eur Respir J. 2006;28:75–81.
60. Schikowski T, Sugiri D, Ranft U, et al. Long-term air pollution exposure and living close to busy roads are associated with COPD in women. Respir Res. 2005;6:152.
61. Hoffmann B, Moebus S, Stang A, et al. Residence close to high traffic and prevalence of coronary hear disease. Eur Heart J. 2006;27:2696–2702.
62. Tonne C, Melly S, Mittleman M, Coull B, Goldberg R, Schwarts J. A case-control analysis of exposure to traffic and acute myocardial infarction. Environ Health Perspect. 2006;115:53–57.
63. Nafstad P, Håheim LL, Oftedal B, et al. Lung cancer and air pollution: a 27 year follow up of 16 209 Norwegian men. Throax. 2003;58;1071–1076.
64. Nyberg F, Gustavsson P, Jarup L, et al. Urban air pollution and lung cancer in Stockholm. Epidemiology. 2000;11:487–495.
65. Feychting M, Svensson D, Ahlbom A. Exposure to motor vehicle exhaust and childhood cancer. Scand J Work Environ Health. 1998;24:8–11.
66. Pearson RL, Wachtel H, Ebi KL. Distance-weighted traffic density in proximity to a home is a risk factor for leukemia and other childhood cancers. J Air Waste Manag Assoc. 2000;50:175–180.
67. Crosignani P, Tittarelli A, Borgini A, et al. Childhood leukemia and road traffic: a population-based case–control study. Int J Cancer. 2004;108:596–599.
68. Wilhelm M, Ritz B. Residential proximity to traffic and adverse birth outcomes in Los Angeles County, California, 1994–1996. Environ Health Perspect. 2003;111:207–216.
69. Suglia SF, Gryparis A, Wright RO, Schwartz J, Wright RJ. Association of black carbon with cognition among children in a prospective birth cohort study. Am J Epidemiol. 2008;167:280–286.
70. US Environmental Protection Agency. Draft National Ambient Air Monitoring Strategy, 2005. 2005. Available at: http://epa.gov/pm/pdfs/naam_strategy_20051222.pdf. Accessed December 14, 2009.
71. Mui S, Alson J, Ellies B, Ganss D. A wedge Analysis of the US Transportation Sector. Washington, DC: US Environmental Protection Agency; 2007. EPA420-R-07-007. Available at: www.epa.gov/OMS/climate/420r07007.pdf. Accessed October 21, 2008.
72. Frumkin H. Health, equity, and the built environment. Environ Health Perspect. 2005;113:A290–A291.
73. Surface Transportation Policy Project. Transportation and Social Equity. Available at: www.transact.org/library/factsheets/equity.asp. Accessed November 23, 2009.
74. Gordon-Larsen P, Nelson MC, Page P, Popkin BM. Inequality in the built environment underlies key health disparities in physical activity. Pediatrics. 2006;117:417–424.
75. Huston SL, Evenson KR, Bors P, Gizlice Z. Neighborhood environment, access to places for activity, and leisure-time physical activity in a diverse North Carolina population. Am J Health Promot. 2003;18(1):58–69.
76. Parks S, Houseman R, Brownson R. Differential correlates of physical activity in urban and rural adults of various socioeconomic backgrounds in the United States. J Epidemiol Community Health. 2003;57:29–35.
77. Taylor WC, Poston WSC, Jones L, Kraft MK. Environmental justice: obesity, physical activity, and healthy eating. J Phys Act Health. 2006; 3(suppl 1):S30–S54.
78. Wilson D, Kirtland KA, Ainsworth BE, Addy CL. Socioeconomic status and perceptions of access and safety for physical activity. Ann Behav Med. 2004;28:20–28.
79. Executive Order 12898. Federal Actions to Address Environmental Justice in Minority Populations and Low Income Populations. February 1994. Available at: www.epa.gov/compliance/resources/policies/ej/exec_order_12898.pdf. Accessed October 21, 2008.
80. National Complete Streets Coalition. Fundamentals. Available at: www.completestreets.org/complete-streets-fundamentals/. Accessed December 14, 2009.
« Back to Top