Streetsmart News. Vol. 42, 2023
Evidence and Insight for Healthy Transportation
Useful Health Indicators for Municipal Transportation Plans
Municipal transportation plans can play a vital role in shaping the health and well-being of the public. By incorporating health indicators into these plans, municipalities can promote active transportation, reduce air pollution, and improve access to healthy food options. But are these indicators used and do they influence municipal transportation decision-making? Through a case study of five cities, my dissertation, The Use and Influence of Health Indicators in Municipal Transportation Plans, explored which factors contributed to use and influence. By indicators, I mean constructs measuring a condition; in the transportation world these are typically called performance measures.

Let's start with the instrumental use of indicators and their usefulness. The instrumental use of indicators is likely the way most people conceptualize their use: technical information as an input to a decision. In the transportation plans I examined, there were two primary instrumental use cases. The first was systems monitoring, in which municipalities constructed baseline conditions using indicators with the intention to monitor them over time, ostensibly to assess progress and course correct. All the plans examined had this use case. The second use case was prioritization. Indicators were either used to prioritize projects within the plan itself or they were developed to be used as evaluation criteria at a later date--primarily within capital improvement programming.

I explored both indicator usability factors and organizational factors to determine how indicators were used in administrative decision-making. I'll focus on the indicator usability factors in this newsletter. By indicator usability, I'm referring to indicator credibility (e.g.., accuracy, reliability), salience (e.g., policy-relevance, timeliness), and legitimacy (i.e., are they trusted by users and stakeholders?). Overall, the legitimacy of indicators was not a concern of any of the people I interviewed. This may be because they were developed in the context of community engagement processes (more on that in another newsletter).

In the prioritization use case, the primary concern was in the geographic spatial scale of the indicators; this was especially true for health outcome data, which tends to be aggregated into large geographies. The systems monitoring use case, on the other hand, faced additional challenges. The geographic scale of the data was sometimes a concern, but concerns about data availability, measurability, accuracy, timeliness, and ease of communication (i.e., interpretable) were more often raised. For those who wanted indicators to serve as an accountability mechanism, measurability was important. Timeliness was essential to make adjustments in programs and projects:

“There's a real understandable lean towards using data that's going to be available anyway . . . Census-type data . . . but it's very slow, it's very delayed, it's very infrequent . . . . If there's a course correction needed, will you know it before it's too late?” (Informant 25)

Another key aspect of indicators is whether indicators were output or outcome focused; both have their own advantages and shortcomings. Output indicators measure an activity (e.g., miles of bike lanes) and outcome indicators measure the desired result or condition (e.g., bicycle mode shift). Outcome indicators faced timeliness and attribution challenges because the desired condition may taken many years to achieve and several different factors may contribute to that outcome:

"You're not actually going to see change on obesity . . . over one year, three years, or maybe even five years . . . let alone attribute any change to the ped[estrian] plan . . . . It's fine, but . . . what is it really telling us and does it really matter?" (Informant 35)

Output indicators, on the other hand, run the risk of measuring an activity that may not ultimately contribute to the desired outcome:

“[The city's accountability structure] is very focused on: ‘Are you doing the things you promised?' which are about outputs, not outcomes. Not, ‘Are you doing the most important things?'” (Informant 56)

tl;dr: Know which indicator usability characteristics are important for your use case and use a mix of output and outcome measures.

Note that a great set of indicators only gets you so far: The key factors responsible for use and influence were organizational. More on organizational factors in the next newsletter. In subsequent newsletters, we'll discuss why it's important to develop indicators collaboratively and how that relates to policy change.
Implementing Equitable Transportation and Land Use Policies

The Prevention Institute has released a new guide, Toward Equitable Transportation and Land Use Policies: Strategies for Advancing Implementation, for use by government staff, elected officials, or non-profit organizations. This guide addresses internal resistance from implementing agencies, insufficient funding, or processes that lack transparency. A key strategy to advance implementation is building community power.

h/t to Rachel Bennett for drawing attention to this resource.
Why Streetsmart?
At Streetsmart Planning, we know that transportation connects people to the places that are essential for their well being. 

Yet, for many people, destinations are too far from home, transit is not reliable, walking and bicycling are impractical, or the streets are not safe. Rather than connecting people to opportunity, lack of adequate transportation is a barrier to reaching employment, schools, health care services, and social networks. Vehicular emissions expose communities to air pollution, increasing their risk of asthma and heart disease. Transportation is also the largest contributor to greenhouse gas emissions in the US, driving climate changes that will disproportionately affect children, older adults, and many communities of color.   

We believe that transportation systems can create and support healthy, just, and climate-resilient communities. Streetsmart Planning offers planning services in transportation and city planning, strategic planning, performance management, and research, including research reports, research synthesis, and research translation. Streetsmart's flagship product, the research synthesis and resource clearinghouse, is freely available here.​
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