HDR
SarahPresenters:Larsen, MetroPlan Orlando
Nick Lepp, AICP, CTP, Pathways to Orlando’s Health Strategic Plan
Jeffrey Arms, AICP, PMP,
Community Health: MetroPlan
PE,
HDR
Team: Adam Yeeles, PhD, ENV SP,
HDR
Florida Planning Conference
HDR Transportation
Jeri Brittin, PhD,
Megan Ferguson, PE, AICP,
September 7, 2022
HDR
About MetroPlan Orlando A Health Strategic Plan: Why and What? Developing a Framework for Understanding Transportation-Health Connections From Framework to Strategic Planning Overview of the Health Strategic Plan Applying the Plan 01 02 03 04 05 Transportation Pathways to Community Health: MetroPlan Orlando’s Health Strategic Plan 06
• Set priorities and determine how federal and state transportation dollars are spent in the region
MetroPlan Orlando leads transportation planning efforts in Orange, Osceola, and Seminole counties.
01
About MetroPlan
Orlando
• Works with elected officials, industry experts, and the community to shape a future system that offers a variety of travel options
MetroPlan Orlando’s Integration of Health into Transportation Planning
Plans (CHIPs) development has been part of this process.
Participation
2040 Long Range Transportation Plan Adopted SR 50 AssessmentImpactHealth
?
Federal
if and
grants to develop healthrelated White Papers Transportation Think In Framing the Future Health and Public Transportation Transportation Think-in Created Dedicated Health PositionPlanner 2015 2016 2017 2019 Health PlanningTransportationinAudit
Examined how
plans included a reference to health concerns 2045 Metropolitan Transportation Plan Adopted 2018 2020 2021
in Community Health Improvement
MetroPlan Orlando’s Health Strategic Plan is a set of Objectives, Strategies, & Actions to guide the organization’s effort to plan a regional transportation system that benefits community health. The plan should: Be evidence-based most effective actions for the region Take into consideration organizational capabilities
•
• Identify
Why?
•
Need for comprehensive guidance on how to identify, prioritize and act in the transportation system to influence community health outcomes.
A Health Strategic Plan:Why and What?
02 What?
The Health Strategic Planning Process Define Success Goals, Objectives, Strategies, and ActionsDevelop Framework PATHS for(PlanningFrameworkandAnalysisTransportationandHealthStrategies)
The Project Team met with a group of key Community Health representatives to ideate and craft a vision statement to guide the development of the Health Strategic Plan. is the current state of community health? does a healthy central Florida look like? does transportation mean for different people does that fit in the vision of health?
and where
▪ What
Developing a Context-Sensitive Vision
▪ What
▪ What
Supporting a diversity of trips and modes of travel that aid in the achievement of diverse community health goals.
Vision for the Health Strategic Plan
Developing a Framework TransportationUnderstandingforHealth Connections Collaborative Ideation & VisioningMPOPublic Health Depts. Document Synthesis Research Scoping Review Framework Development and Refinement 03
Orange Osceola Seminole
Health Equity Equitable Access to Care Behavioral Health (including mental health and substance abuse) Healthy Weight, Nutrition & Physical Activity Social Determinants of Health (housing and food, employment, transportation)
Considering Regional Public Health Assessments and Plans
CHIP Priority Areas
• Strong evidence of positive associations between walkability, access to destinations and services, personal safety from crime, and total physical activity
Integrating Evidence
• Walking is the only type of physical activity related to residential density
Relevant Findings:
Key Conception of Transportation: Transportation as Infrastructure
Example: Activity Research Literature
• Positive association between the presence of sidewalks, controlled crossings, and children's physical activity (not confirmed as causal)
Key People Differentiator: Age, especially Children and Older Adults
• Pedestrian-friendly infrastructure matters. Street lighting, greenery, and aesthetically pleasing scenery are positively associated with physical activity
• Destinations such as shops, public transport, parks and public open space, and recreational facilities support physical activity
• No evidence that physical environmental variables correlate with physical activity in children between 0 and 6 years of age
Physical
Conceptualizing Transportation-Health Connections PATHS(PlanningFrameworkandAnalysis for Transportation and Strategies)Health Review of MetroPlan Orlando’s current health transportation work Turning conventional thinking around … • What is the public health community working to achieve? • What Determinants of Health? • What Transportation System interventions DeterminantsimpactofHealth based on evidence? Transportation System Health Outcomes Health Outcomes Determinants of Health TransportationSystem
EQ 3 Exposure to extreme weather
Examples:
S2 - Pedestrian/cycling injuries
F = Access
Food S = Safety
What are the determinantspriority of health for healthcommunityimprovingoutcomes
What are the primary health outcomes desired by community?the
PA 2 Leisure/recreational physical activity
EQ =
EQ 1 - Exposure to air pollution/air quality
OutcomesHealth DeterminantsTransportation-RelatedofHealth
What are the relatedtransportation-infrastructureattributesinthecommunitythat
HC 1 Access to primary care/wellness/screening services
F1 - Access to nutritious food
Who are the key groups of people for whom a transportation infrastructure or action change would be most effective?
impact this health determinant?
PATHS Framework
S1 - Motor-vehicle crashes
Infrastructure Action
EQ 2 - Exposure to noise pollution
S3 - Crime
life expectancy, chronicmentaloccurrence,diseasehealthstatus
PA
PA 1 Travel related physical activity
People
HC 2 - Access to mental & behavioral health services
Planning and Analysis of Transportation and Health Strategies
What are policies,(e.g.,relatedtransportationthe-actionsprograms,services)inthecommunity that impact this determinanthealth?
Who are the key groups of people for whom this determinant of health should be prioritized?
Transportation System
HC =
?
S4 – Disaster vulnerability = Physical Activity Environmental Quality Access to Health Care to Nutritious
04
Need for additional inputs…
(1) Impact community health outcomes, and
From the PATHS Framework to Health Strategic Planning
We know…
• Not all health determinants have equal potential to be substantially impacted by changes to the transportation system
For input on these differences, we used a multicriterion decision analysis approach to assess regional expert opinions as to which health determinants have the greatest potential to:
• Not all health determinant domains equally contribute to community health outcomes
(2) Most feasibly be impacted by a transportation intervention
To inform strategic planning through a prioritization of understanding of health determinants and the transportation system actions. Criterion 1: Potential impact on community health Criterion 2: Feasibility of an transportationeffectiveintervention PA1 EQ1 EQ2 EQ3 HC1 HC2 F1 S1 S2 S3 S4PA2 PA = Physical Activity EQ = Environmental Quality HC = Access to Health Care F = Access to Nutritious Food S = Safety
Prioritizing Pathways for Planning
• Flexible approach for both qualitative and quantitative decision-making problems
GOAL:
Analytic Hierarchy Process (Saaty, 1994)
AHP allows preferences across pairwise alternatives to be expressed Survey Approach • Public Health Transportationandexperts • Pairwise alternatives weighed to prioritizationinform
•
the AHP Survey The top rankings on both Criterion 1 (health outcomes) and Criterion 2 (transportation impact) were Access to nutritious food (F1) and Exposure to extreme heat (EQ3). Ranking for Criterion 1: Potential impact on community health outcomes Ranking for Criterion 2: Feasibility of an effective transportation intervention F1 - Access to nutritious food F1 - Access to nutritious food EQ3 - Exposure to extreme heat EQ3 - Exposure to extreme heat S3 - Crime MC2 - Access to mental & behavioral health services
Insights
Key from
People are Integral in the PATHS Framework
Age (Youth) for leisure related physical activity, noting that this intersects withsafetypedestrian/cycling
AdvisoryInputTeam
Regional Public HealthReviewPlanning AgecommunitiesLowChildren)(Seniors,incomeRace(Blackcommunity)Language (Spanish speaking community)
userSocio-economic/demographicsegmentation – low income, service workers, families, etc. have different needs
Rural/Urban a people dimension related to physical access more generally
Ability/disability – for travel related physical activity interventions
Who are the key groups of people for whom this health determinant should be prioritized?
Who are the key groups of people for whom a transportation infrastructure or action change would be most effective?People
ResearchReviewLiterature Age Disability/AbilityUrbancommunitiesLowChildren)(Seniors,-incomevs.rural
05
Health Strategic Plan Highlights
MetroPlan Orlando Health Strategic Plan Goals 1 | Supporting Healthy Lifestyles 2 | Implementing Healthy Transportation Infrastructure 3 | Providing a Safe Transportation System 4 | Improving Health Care Access through Transportation 5 | Integrating Health Equity into Transportation Planning
• Seek partnership opportunities with groups working to provide Safe Routes to School.
• Seek partnerships for research to further understand how transportation can contribute to community health in terms of eating behaviors.
Goal 1 | Supporting Healthy Lifestyles
• Facilitate innovative interventions for keeping pedestrian and cycling infrastructure safe for children to engage in safe travel and recreation activities.
1.3: Improve opportunities for people to access nutritious foods.
• Provide planning support for transitoriented development and redevelopment, taking into consideration regional need to support service sector jobs and safe, reliable commutes for low-income residents.
Objectives Strategies Actions
• Pursue additional Complete Streets planning studies and funding for implementation.
• Develop a better understanding of how the food environment and the transportation system interact to improve healthy eating behaviors.
• Support the development of pedestrian infrastructure that links residents and visitors to meaningful destinations.
1.1: Increase availability and attractiveness of active travel.
1.2: Increase opportunities for participation in recreational and leisure activities.
Goal 2 |
Implementing Healthy Transportation Infrastructure
Missed or skipped doctor’s appointment in the last year due to lack of reliable transportation Applying the Plan 06 Ask: What are the present conditions with respect to Health Outcomes and Determinants of Health in the region? 18% 2021 Regional Transportation Survey Example:
Applying the Plan: Considerations
5. What does the policy environment look like regarding current and potential interventions?
7. What indicators can be monitored to assess impact?
6. What partnerships are in place or can be developed to support interventions?
3. What current transportation interventions – ‘infrastructure’ and ‘action’ – are in place that address these key pathways to health?
Applying the Plan: Steps
4. What potential interventions and transportation-related knowledge development may address these pathways?
1. What are present conditions and pathways with respect to Health Outcomes and Determinants of Health in the regions?
2. What are the Health Strategic Plan recommendations for objectives, strategies, and actions to address the conditions?
Thank You Questions Special Thanks to our collaborators at: • Second Harvest Food Bank
American Lung Association
Health Council of East
•
•
Department of Health in Orange County
•
•
University of Central Florida
Florida
American Heart Association
• Central
• Florida
Florida Department of Health in Seminole County • Kissimmee Chamber of Commerce • East Central Florida Regional Planning Council Contact Information Sarah TransportationLarsen Planner at MetroPlan Orlando 250 South Orange Ave, Suite 200 (407) 481 5672 Ext. 312 DirectorJerislarsen@metroplanorlando.orgBrittinofResearchatHDR (208) 387-7021 Jeri.Brittin@hdrinc.com