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Active transportation has been considered as one method to address the American obesity epidemic. To address obesity prevention through built-environment change, the local public health department in Columbus, Ohio, established the Columbus Healthy Places (CHP) program to formally promote active transportation in numerous aspects of community design for the city.
In this article, we present a case study of the CHP program and discuss the review of city development rezoning applications as a successful strategy to link public health to urban planning. Prior to the CHP review, 7% of development applications in Columbus included active transportation components; in 2009, 64% of development applications adopted active transportation components specifically recommended by the CHP review. Active transportation recommendations generally included adding bike racks, widening or adding sidewalks, and providing sidewalk connectivity. Recommendations and lessons learned from CHP are provided.
American adults and children have decreased walking and biking activities by a third since the late 1970s,1 a factor that has been linked to the rise of obesity. Obesity is the second-leading cause of preventable death in the United States.2 Regular daily physical activity has been shown to reduce or prevent obesity as well as many of the leading causes of morbidity and mortality.3 There is growing evidence that promotion of active transportation benefits obesity prevention efforts.4 Specific community design features associated with increased walking and biking include sidewalks, parks and open space, distance to destinations, aesthetically pleasing places, multi-use paths, and bike racks.4,5 The ability of community design to foster active transportation is emerging as a tool in the fight against the American obesity epidemic.
Compact community design can promote active transportation; conversely, sprawling community design can make active transportation less safe and convenient. Sprawl is characterized by streets that do not connect to one another, cul-de-sacs, long block lengths, and distant destination places. Sprawl has been shown to have a direct relationship to obesity and body mass index (BMI) and an indirect relationship to physical activity. Individuals living in communities rated higher on a sprawl index were less likely to walk, weighed more, and had a greater prevalence of hypertension compared with those living in communities rated lower on a sprawl index.6 Specifically, residents of the least sprawling communities walked 79 minutes more and weighed 6.3 pounds less than those living in the most sprawling county. Compact neighborhoods are those in which you can walk or bike to destinations and do not need a car. Compact community design is characterized by grid-pattern streets, short block lengths, and close destination places.6 Local zoning codes govern whether walking-friendly elements can be allowed in a given community and play an important role in creating a more physically active community.7
Currently the nation is facing a physical inactivity epidemic, particularly for physical activity in the daily American life. Only 15% of children walk to school,8 and adults walk only one of every 10 trips within one mile—an easily walkable distance.4 Consequently, nationwide, obesity and overweight have been increasing in both adults and children.2
The city of Columbus, Ohio, has identified similar, unhealthy trends in both physical activity and obesity: 59% of the adult population is obese or overweight, and 38% of third-graders are overweight.9,10 These alarming data are compounded by the fact that only about 50% of the adult population meets the physical activity guidelines11 of 150 minutes per week of moderate-intensity aerobic activity,3 which includes sessions as short as 10 minutes in length. The Alliance for Biking & Walking's 2010 Benchmarking Report showed the majority of Columbus residents did not walk and bike to work or for overall trips.12 For most of the indicators presented in this report, Columbus' rates were lower than the average. For instance, in the 50 metropolitan areas surveyed, 4.8% of people walked to work, compared with only 2.7% for Columbus residents.12 When including all trips, the 50 metropolitan areas' average was 11.0% for walking trips and 0.9% for biking trips; Columbus fell below this average, with 8.2% of residents walking and 0.3% biking for all trips. Active transportation activities, such as walking to and from public transportation, have been shown to help physically inactive populations achieve recommended levels of physical activity.13
Community design is varied in Columbus. Shopping centers, schools, and houses in older neighborhoods were built with compact community design. In these neighborhoods, walking and biking are easier and safer. In 1950, the city began to annex land around the city. The land became part of the city, and the city grew from 42 square miles in 1950 to 227 square miles in 2009 (Personal communication, Kevin Wheeler, Columbus Department of Development Planning Division, May 2010). Farm fields still exist within the city limits. Like many other American cities that grew significantly after 1950, community design in Columbus changed to sprawling. As personal cars became a more dominant part of life, many streets did not have sidewalks; likewise, there are no sidewalk connections or bike racks in these neighborhoods.
As noted previously, such community design elements may be a barrier to daily physical activity, which may be associated with rising obesity rates. The poor compliance with physical activity recommendations and adult obesity rates in the city motivated Columbus Public Health to invest in broad-based strategies to address these problems in the local community. While physical activity recommendations11 can be reached by using leisure-time physical activity or active transportation, the focus of this research is on the use of active transportation to increase daily minutes of physical activity. This article describes the partnership between urban planning and public health in the development of the Columbus Healthy Places (CHP) program to promote active transportation.
Several key events occurred over time that set the stage for Columbus Public Health and the Columbus community to be ready for a program addressing community design. A local Mobilizing for Action through Planning and Partnerships (MAPP) process had been underway for some time, involving key stakeholders and agencies.14 MAPP is a community-driven strategy planning process for improving community health. Columbus Public Health initiated the MAPP process, as it supported the need for regular tracking and reporting of health indicators, including obesity and physical activity. In 2004, Columbus Public Health began reporting on a concise set of indicators, including the percentage of adults who are obese and overweight, percentage of adults meeting the Surgeon General's physical activity recommendations, and percentage of third-graders categorized as overweight. These indicators were selected because they covered broad audiences and could provide valid data, and because Columbus Public Health believed it would have the ability to effect some change on them.
Around the same time, Columbus Public Health recognized the link between public health and the built environment. Smart Growth principles, such as selecting a location close to a residential neighborhood with sidewalks and public transportation access, were used in decision making for the new health department building in 2001. Smart Growth refers to a national movement that restores community and focuses on walkable neighborhoods with open space and compact community design.15 In 2005, the Columbus health commissioner attended a National Association of County and City Health Officials/American Planning Association seminar that solidified the idea for a program that could focus on healthier community design.
The CHP program was created to address active transportation in the community design processes for Columbus. A retired urban planner for the city worked part-time to research the program objectives and create the program work plan. The CHP program was officially launched in the fall of 2006 when Columbus Public Health staffed the program with a full-time urban planner as its coordinator.
The mission of CHP is to (1) establish development policies and practices to reduce negative health impacts and (2) create places that foster physical activity as part of everyday life in the city of Columbus. CHP aims to teach city employees and the community to voluntarily use community design that incorporates active transportation infrastructure and to change the built environment. It permanently alters the community design to make walking and biking safer, thus increasing opportunities for physical activity.
To achieve the mission, the CHP coordinator first needed to learn the current level of interest within city divisions and the community for improved walking and biking infrastructure. Recent neighborhood and area plans were used as a tool to gauge community interest in walking and biking infrastructure. Neighborhood and area plans are documents that direct development for the next 10 to 20 years in small neighborhoods and larger sections of the city, respectively. All plans from 2004 to 2006 called for improved walking and biking infrastructure, which provided evidence of community support for built-environment changes.
Another strategy to provide evidence for community neighborhood support for active transportation elements came from the input obtained from community members during neighborhood walk audits. CHP conducted 10 walk audits during the first year of the program. Residents walked the neighborhood and gave input on preferred locations to walk or bike, and whether they felt safe doing so, as well as locations perceived as unsafe or not preferable to walk or bike. This community input helped to inform the walking and biking infrastructure to be included in community design decisions.
In addition to community input, neighborhood walk audits also result in neighborhood walking maps. Maps encourage active transportation by highlighting safe routes and neighborhood destinations places, as illustrated in Figure 1. Maps are distributed to community agencies and members at no cost. Further, maps have been created in conjunction with the Division of Mobility Options, the City of Columbus Department of Public Service division responsible for walking and cycling infrastructure, for the purpose of assessing mobility barriers encountered during the walk audit as a part of their community mobility plans.
Recognizing that built-environment decisions are made in various departments, CHP has created successful partnerships with several agencies inside city government and in the private sector. A description of the agencies and partner activities are provided in Figure 2. Relationships were cultivated through meetings with each agency. Directors were the first point of contact. Along with an explanation of CHP, a request was made for the most appropriate agency contact. All agencies were very receptive to the CHP collaboration. The agencies welcomed the additional support for walking and biking infrastructure from the health perspective and hoped it would help to advance their work.
The collaboration is unique for each agency and based on the agency procedures. For example, the Department of Development Planning Division has a specific process for collecting information and writing neighborhood and area plans. CHP is able to review the first draft of the plan and hear public comment at the third public meeting. The CHP coordinator then works directly with the planner to incorporate any active transportation recommendations into the plans. A similar process occurs with the aforementioned Division of Mobility Options for the community mobility plans. For both of these agencies, CHP has officially supported policy changes that improve walking and biking infrastructure through letters of support.
As an example of how CHP has successfully partnered with other city departments, CHP's work with the city's Department of Development Building Services Division is thoroughly examined in the next section. We present a case study—the review of development applications during rezoning reviews—as a successful strategy to link public health to urban planning.
Whenever new development in the city is proposed, either in farm fields or in redeveloping an older part of the city that currently does not have active transportation infrastructure, it creates an opportunity to increase walking and biking through infrastructure. The CHP program wanted to review development applications and request walking and biking infrastructure, such as bike racks, sidewalk connections, and wider sidewalks. After consultation with the city's Building Services Division, the division responsible for building permits and new development, CHP was given permission to comment on any application during monthly rezoning reviews. A precedent was set for Columbus Public Health to review applications when an industrial or chemical development was proposed. While CHP had permission to make recommendations to any rezoning application, the recommended changes would not be mandatory. A developer is required to go through the rezoning process when the current land use does not permit the proposed development. For example, if the current land use is residential and the proposed development is a shopping center, a rezoning is required.
A uniform review process was created for every type of development application. Separate review is conducted for residential and non-residential applications, and recommendations for each type are shown in Figures 3 and and4,4, respectively. Residential applications are subdivided into single-family and multifamily developments. Non-residential applications include commercial, office, industrial, and manufacturing uses.
For all residential areas (Figure 3), walking and biking features are recommended, including 5-foot-wide sidewalks, connection to the existing sidewalk system, and connection to any adjacent developments and bus stops, where no property line conflicts are present. Bike racks are requested for multifamily developments and at parks included in single-family developments. Because Columbus has a Parkland Dedication Ordinance, which requires parkland be set aside for residential developments, CHP does not include parkland as a recommendation.
Non-residential land uses are evaluated by using trip generators, as shown in Figure 4. Trip generators are defined for this purpose as developments within half a mile that would attract pedestrians or cyclists, including shopping centers, employment centers, bus stops, schools, parks, libraries, neighborhoods, and grocery stores. When recommending trip generators, it is also important to consider that some employees or customers may have limited choices for travel and, therefore, must walk and bike out of necessity rather than choice.
If no trip generators are present or only a bus stop is within half a mile of the development, 5-foot sidewalks and bike racks are recommended. More recommendations are made as the number of trip generators increases or if the development is closer to an existing environment conducive to walking and biking. In addition to the recommendations previously listed for residential housing, additional recommendations for non-residential development may include adding signage at the entrance and exit of the parking lot to alert drivers to pedestrians, adding bike racks, and expanding sidewalk areas to bridge the public sidewalk to the front door of the business.
Concerns outside of Columbus Public Health's purview were addressed prior to CHP officially commenting on rezoning applications. Two major issues had to be considered: the development community and the right-of-way. First, the development community is the economic development engine of the city, and the group expressed concern with extra processes, regulations, and costs. Many of the recommended walking and biking infrastructure changes are low-cost, such as adding a bike rack for $200. However, other recommendations, such as wider or longer sidewalks, can be substantially more costly for a developer. Initial apprehension was voiced in one meeting with city staff and the development community about CHP comments; however, the Building Services Division staff reiterated to the development community that all city -departments are able to comment on rezoning proposals. Since the implementation of the CHP rezoning review, no concerns or issues have been voiced.
The right-of-way refers to the street plus the land adjacent to the street that is owned by the city; therefore, many walking and biking infrastructure elements fall within the right-of-way. The Department of Public Service is responsible for the right-of-way and has full control over infrastructure because infrastructure in the right-of-way is required to conform to state guidelines. CHP is able to recommend active transportation features above and beyond local zoning codes, but recommendations must be congruent with state guidelines. Further, out of respect for the Department of Public Service, CHP only includes comments that are in agreement with what Public Service permits in the right-of-way. For this reason, several meetings were held with Public Service before CHP began to comment and if there were any questions about a recommendation, the Department of Public Service was contacted.
To address possible concerns of the development community, CHP chose to participate in an existing process, referred to as the rezoning staff review. This is the process by which all city departments have the opportunity to make recommendations for changes, referred to as “comments” on rezoning proposals. The first step of this process begins when the resulting comments are sent to a developer in one concise package. The purpose of the comments is to give a brief explanation as a mechanism to inform developers regarding the active transportation recommendations, the number of trip generators within half a mile, and the relationship between the recommended features and their purpose in increasing physical activity. The developer can choose to call the CHP coordinator to discuss the recommendations. The outcome of the phone call—that is, whether or not active transportation features will be included—is reported to the Building Services staff to ensure the decision is carried out. (CHP does not have authority to approve or disapprove an application; therefore, it is voluntary for a developer to incorporate recommendations into the design.) By choosing to participate in the existing process of rezoning staff review, the CHP program is limited to recommendations after a proposal is submitted and is not involved in the initial design phase.
Once the developer has the opportunity to address the recommendations from the rezoning staff review, the second step of the process is for the Development Commission to review the application. The Development Commission is a citizen advisory body that recommends approval or disapproval of the application to the Columbus City Council. The Development Commission receives CHP's comments and can then choose to ask the developer to include active transportation features per CHP request.
The third and final step of the rezoning application approval process is City Council. To change the zoning of a piece of land, the City Council must pass legislation. Columbus Public Health works closely with its appointed City Council member, the Health and Human Development Committee Chair. Due to her interest in the program, the Chair requested that walking and biking infrastructure comments be included in the City Council legislative packet. Prior to this request, comments were not seen by City Council. If the rezoning application accepted walking and biking infrastructure, the legislation language including this information is read at City Council. If the rezoning application did not accept walking and biking features, that is noted in an attachment to the legislation.
Since its inception, CHP has been involved in the review of 70 rezoning applications. Of these, 64% have adopted CHP recommendations for active transportation features; that is, 45 of 70 applications voluntarily adopted one or more of the active transportation elements not required by the zoning code.
The most commonly accepted recommendations have been bike racks (82%); connections to the existing sidewalk or adjacent property, such as another business or library (26%); and 5-foot sidewalks (18%). (Because multiple recommendations may be accepted, percentages can exceed 100%.) From 2007 to 2008, only one application included active transportation features before CHP recommendations; in 2009, that number increased to four applications. This equates to 7% (n=5) of applications with active transportation elements prior to the CHP review.
One example of the rezoning process supporting policy change is the new parking code passed in May 2010. Under the new code, parking lots must incorporate walking and biking infrastructure features, including sidewalk connections from the street to the front door, trees for shade, and bike racks. Data from CHP provided evidence for the use of these features, demonstrating that sidewalk connections and bike racks were already being voluntarily included in development. Additionally, because of the work of CHP and in partnership with the Planning and Building Services divisions, the Board of Health passed a Resolution of Support for the new parking code because of its permanent effect on community design.
CHP has invested in the concept that having a walking and biking infrastructure changes community design and the environment in which people live. The program has taken a social-ecological approach to address physical activity by implementing environmental change and working toward systems and policy change. This approach is in line with “The Community Guide—Promoting Physical Activity: Environmental and Policy Approaches,” which recognizes that environmental and policy approaches can increase physical activity.16 With 64% of new developments voluntarily including walking and biking infrastructure, CHP staff believe this moderate rate of adoption demonstrates feasibility for the use of policy to require this infrastructure be included in new development applications.
While tracking changes within development applications due to CHP comments is clearly feasible, it is very difficult to quantify any change in the number of people walking and biking associated with these environmental changes. Ideally, a large-scale evaluation could be conducted to assess these questions; as demonstrated in community-level evaluation of similar programs to promote physical activity, such as the Safe Routes to School program, it is possible to conduct impact evaluation with sufficient resources.17
A key to the success of the program was being able to find an existing process in which to participate. Creating the uniform application review process added transparency and fairness and made the recommendations as objective as possible. The uniform application review process also allowed the Department of Public Service to review the right-of-way recommendations and make changes as necessary. In efforts to succeed within the existing review process, CHP linked with nontraditional partners, such as the Planning and Building Services divisions. Wisconsin's Comprehensive Planning Law of 1999 serves as a useful example for policy battles over land-use changes, but also the potential for broader promotion of active transportation and active living.18
One limiting factor to the use of the existing process is that a portion of new development does not go through the rezoning process. A rezoning is not required when a proposed development is located in the proper zoning classification—for example, if a shopping center is proposed for land already zoned commercial. For these developments, there is no process for staff review and, therefore, walking and biking infrastructure is not being requested. As a next step of the CHP program, strategies need to be developed to incorporate active transportation into this portion of development.
CHP educates the nontraditional urban-planning partners on the linkage between their work and public health. In the same respect, CHP has linked existing public health programs to city departments so that the work of policy and systems change is more widely spread. As a result of this connection, the Creating Healthy Communities program, which addresses the major risk factors of chronic disease, had a 2010 objective to partner with the city's Planning Division to add two active-living features and/or community gardens to a neighborhood plan, both of which were achieved. The recently formed Institute for Active Living has an interdepartmental team with a focus on changing the built environment through collaboration among city departments.
Given the concerns regarding the national obesity epidemic, programs emphasizing community design to promote physical activity are an underused resource in metropolitan areas. Now in its fourth year, CHP is successfully promoting active transportation through change to the built environment. Other metropolitan areas are encouraged to consider the adoption of a program such as CHP as a valuable investment in community-based obesity prevention.
For other communities that may consider the establishment of a program similar to CHP, we offer four recommendations for success. First, establish good relationships with partner agencies; efforts to communicate the value of the program to the agency and community may be needed to convince reluctant individuals and agencies. Second, program maintenance involves staying in regular contact with individuals at each agency to proactively address concerns or issues as they emerge. Communication through e-mail or regular meetings can facilitate discussion to share problems or successes. Third, health agencies will need to be prepared to defend the public health role in development and built-environment decisions, as the adoption of a novel program such as CHP may meet with resistance from individuals and agencies. Fourth, an urban planner is the key liaison between public health and planning, and the appropriate individual must be fluent in both cultures to be successful. With the increasing recognition of the public health/planning connection, more students of urban planning are exposed to the health effects of the built environment. In the case of CHP, the urban planner had a strong background in neighborhood-level work. While the planner had not taken a public health approach, she understood the issues of low-income and minority communities, which she was able to apply to the new public health role.
At Ohio State University, the ties between the College of Public Health and the City and Regional Planning departments continue to strengthen, and collaborative activities are undertaken to promote this type of interdisciplinary training. Continued interdisciplinary communication and cross-fertilization between these two fields may help to prepare students to create the next generation of programs and research in this area.
Community design elements that promote active transportation should be considered as an opportunity to address sedentary lifestyle and increase physical activity. Programs such as CHP that promote positive change in the built environment can contribute to environmental and infrastructure changes to promote public health through active living in our communities.