Transportation is a crucial contributor to health: It directly shapes the social and physical environments in myriad ways and determines the types of places where people can live, learn, work, and play in their everyday lives.
So how can Minnesota better incorporate health considerations into transportation planning practices? That’s exactly what the Minnesota Department of Transportation (MnDOT) wanted to know when the agency reached out to the University.
Over the last year, Yingling Fan, a professor of regional planning and policy at the U of M’s Humphrey School of Public Affairs, has been working with Nissa Tupper, a transportation and public health planner with MnDOT, to answer this question.
Fan and Tupper began with a literature review that underscored how transportation agencies typically use the social determinants of health (SDoH) framework when making transportation-health connections. Defined as non-medical factors that influence health equity and outcomes, SDoH are often classified into five categories—and transportation plays a significant role in each of them:
- Neighborhood and built environment: Safe transportation options that reduce emissions and provide access to clean air, nutritious food, and green space.
- Education: Convenient access to learning and training opportunities for all ages.
- Health care: Reliable, efficient, and convenient access to preventive health services, medical treatment, and emergency care.
- Economic stability: Affordable and reliable transportation options to access employment and build wealth.
- Social and community context: Multimodal transportation that connects with community and relationships to support social, physical, and mental well-being.
“Overall, the emergence of these SDoH-inspired transportation-health frameworks has helped to make a compelling case for collaborative health and transportation planning,” Fan says. “However, [these frameworks] still do not provide a systematic understanding of the transportation-health pathways.”
So Fan extended this framework to include three distinct pathways between transportation and public health: behavioral health, environmental health, and social inclusion.
In the behavioral health pathway, transportation provides opportunities for physical activity, social interaction, healthy eating, and health-care-related activities. In the environmental health pathway, transportation provides safety from crashes, noise, crime, disproportionate enforcement, pollution, and climate change. And in the social inclusion pathway, transportation provides access to places, people, and power. Of the three pathway mechanisms, social inclusion and environmental health are intrinsically linked to social equity and justice issues.
By combining the SDoH framework and the three pathways, Fan ultimately developed one integrated model that MnDOT can use as a framework for collaborative and equitable health and transportation planning (see image at right).
Next, the researchers conducted a comprehensive review of transportation-health initiatives at all 50 state departments of transportation, conducting in-depth interviews with six that are pioneers in this area. Based upon the findings, Fan developed four recommendations for MnDOT to consider when it comes to collaborative transportation and health planning:
- Continue to foster partnerships across all agencies and stakeholders. Although MnDOT already has a good working relationship with the Department of Health, it could develop similar working relationships with other state agencies (such as the Minnesota Pollution Control Agency and Department of Natural Resources on environmental pollution and conservation, and the Department of Agriculture on food systems and accessibility to local, healthy food sources).
- Develop MnDOT’s definition of health and how it relates to transportation. This definition could include physical and mental health, SDoH, social inclusion, behavioral health, environmental health (including actual and perceived safety of transportation users), and health equity (including a focus on vulnerable populations like women and immigrant populations, which are still frequently left out in mainstream transportation/health conversations).
- Develop a scoring and evaluation matrix for project selection and project evaluation. This is one of the most effective ways to center public health in MnDOT’s initiatives. Three of the six state DOTs the researchers interviewed have either adopted or are currently developing a scoring/decision matrix to rank the priorities of projects.
- Ensure MnDOT staff is well-versed and trained in transportation, health, and equity concepts. When it comes to new initiatives, agency-wide awareness and support are key to bridging the gap between planning and implementation.
“Transportation is still shifting from a model that moves cars to one that moves people in a safe, convenient, reliable, affordable system—making sure we’re connecting people to what they need to live a quality life,” Tupper says. “Transportation is about people, and we really can’t forget that. We have a tremendous opportunity to reshape our approaches and partner across fields to make sure that we’re creating infrastructure that helps improve health and equity.”
Fan and Tupper presented their research during a webinar this spring. The recording is available on the CTS website.