Nara Chandrababu Naidu's Visionary Policies For Andhra Pradesh's Development
Transportationrx
1. the
transportation
prescription
BOLD NEW IDEAS FOR HEALTHY, EQUITABLE
TRANSPORTATION REFORM IN AMERICA
2. PolicyLink
PolicyLink is a national research and action
institute advancing economic and social
equity by Lifting Up What Works.®
Prevention Institute
Putting prevention and equitable health
outcomes at the center of community
well-being.
This report was commissioned by the
Convergence Partnership which includes
the following institutions:
The California Endowment
Kaiser Permanente
The Kresge Foundation
Nemours
Robert Wood Johnson Foundation
W.K. Kellogg Foundation
Centers for Disease Control and Prevention
as technical advisers
Design by Chen Design Associates
Leslie Yang for PolicyLink
3. the
transportation
prescription
BOLD NEW IDEAS FOR HEALTHY, EQUITABLE
TRANSPORTATION REFORM IN AMERICA
BY
Judith Bell
President
PolicyLink
Larr y Cohen
Founder a nd Executive Director
Prevention Institute
EDITED BY
Shireen Ma lekafza li
Senior A ssociate
PolicyLink
4. A NOTE ABOUT THIS R EPORT
The Transportation Prescription: Bold New Ideas for Healthy, Equitable Transportation Reform in America
builds on the research and analysis of a number of experts who are working at the intersection of
transportation, equity, and public health. The ideas that collectively form the heart of this paper are explored
in depth in the book, Healthy, Equitable Transportation Policy: Recommendations and Research. Chapters
are written or co-written by the authors listed below. Each chapter and the entire book can be found online
at www.convergencepartnership.org/HealthyEquitableTransport.
Larry Cohen, co-author, “Traffic Injury Prevention: A 21st-Century Approach,” founder and executive director,
Prevention Institute, Oakland
Susan Handy, “Walking, Bicycling, and Health,” professor of Environmental Science and Policy and director of
the Sustainable Transportation Center, University of California, Davis
Todd Litman, “Public Transportation and Health,” founder and executive director of the Victoria Transport
Policy Institute, British Columbia
Leslie Mikkelsen, co-author, “Traffic Injury Prevention: A 21st-Century Approach,” managing director,
Prevention Institute, Oakland
Kami Pothukuchi, co-author, “Sustainable Food Systems: Perspectives on Transportation Policy,” associate
professor of Urban Planning, Wayne State University, Detroit
Catherine L. Ross, “Roadways and Health: Making the Case for Collaboration,” director, Georgia Tech Center
for Quality Growth and Regional Development and the Harry West Chair for Quality Growth and Regional
Development, Atlanta
Janani Srikantharajah, co-author, “Traffic Injury Prevention: A 21st-Century Approach,” program coordinator,
Prevention Institute, Oakland
Todd Swanstrom, “Breaking Down Silos: Transportation, Economic Development, and Health,” E. Desmond Lee
Professor of Community Collaboration and Public Policy Administration at the University of Missouri, St. Louis
Richard Wallace, co-author, “Sustainable Food Systems: Perspectives on Transportation Policy,” senior project
manager, Center for Automotive Research, Ann Arbor
We owe a sincere debt of gratitude to these progressive individuals who recognize the value of working across
fields to identify effective and long-term solutions to multiple problems.
5. Contents
5 Foreword
Congressman James Oberstar, Chairman of the House Transportation and Infrastructure Committee
6 Preface
Angela Glover Blackwell, Founder and CEO, PolicyLink
9 Introduction
10
Transportation in America: A New Vision
13 How Transportation Policies and Plans Influence Health
13
Direct Health Effects
Pollution
Climate Change
Contents
Physical Activity
Mental Health
Safety
16
Indirect Health Effects
Transportation, Income, and Health
Older Adults and People with Disabilities
<<
18 What Does Healthy, Equitable Transportation Policy Look Like?
3
21
The Federal Transportation Legacy and Challenges Ahead
pg.
23 A Foundation for 21st-Century Transportation Policy
24 Policy and Program Priorities to Improve Health and Equity
Healthy, Equitable Transportation Policy
26 Conclusion
27 Author Biographies
28 Acknowledgments
29 Notes
6.
7. Foreword Congressman James Oberstar
Discussions of public health and wellness often and helping Americans incorporate exercise
are limited to the health and medical fields. It and fresh air into their daily travel routines. We
is my hope that soon, the transportation sector must also continue our pursuit to reduce the
will be part of the discussion and play a role in number—and rate—of traffic fatalities and
providing solutions to improving the nation’s injuries that occur each year.
overall health, well-being, and quality of life.
Our most recent surface transportation
One of my goals as Chairman of the Committee legislation, enacted in 2005, took important
on Transportation and Infrastructure is to create steps toward building a healthier infrastructure
a new model for surface transportation, one by investing billions of dollars in safety, public
that invests in alternative modes and promotes transit, walking, and bicycling. This legislation is
active, healthy lifestyles. Public health and helping to construct safer infrastructure, enable
transportation policy choices are inextricably workforce development, build new transit
linked. The transportation sector is responsible lines, repair existing systems, and establish
for one-third of the greenhouse gas emissions non-motorized transportation networks.
Foreword
in the United States. Our infrastructure and land We also enacted the Safe Routes to School
use choices often dictate our daily travel, and program, which allows states to invest in safety
whether or not we have access to clean, healthy improvements and education campaigns
transportation options. And in any given year, to get kids walking and biking to
approximately 40,000 Americans are killed on school again. This program has shown
our roadways. The policy decisions we make great early success and has the ability
regarding transportation have repercussions on to change the habits of an entire
public health throughout our society. generation.
<<
5
For too long now, our transportation decision- Environmental sustainability, access,
pg.
making has failed to address the impacts and our collective well-being
that our infrastructure network has on public must combine with mobility and
health and equity. The asphalt poured and lane safety as the cornerstones of our
miles constructed enhanced our mobility and transportation investments. The following report
The Transportation Prescription
strengthened our economic growth; but too represents an important contribution to our
often, this auto-centric mindset took hold and emerging understanding of the connections
crowded out opportunities to invest in a truly between transportation and public health
sustainable intermodal transportation system, and is an invaluable resource for policymakers
in particular a system that meets the needs of and all those interested in building healthy
underserved communities. communities. With a greater recognition of
the strong linkage between public health and
The failure to link transportation and land use transportation, I believe we can build a network
decision making, and to consider the public that supports our mobility and creates access
health effects of these choices, has led to and economic strength while promoting equity,
a tilted playing field that has made driving sustaining our good health and quality of life.
the easiest—and often the only—option
available in many parts of the country. Our
transportation policies and investments must
do more to provide access for all through
various modes. Transit, walking, and bicycling Congressman James Oberstar
all have a significant role to play in lowering
Chairman of the House Transportation
our dependence on foreign oil, reducing our
and Infrastructure Committee
greenhouse gas emissions and air pollutants,
8. Preface Angela Glover Blackwell
Transportation policy has enormous these neighborhoods have low levels of physical
potential to catalyze the development of activity and high rates of chronic diseases.
healthy communities of opportunity. The Creating a more equitable transportation
upcoming authorization of the federal surface system must lie at the core of any analysis of
transportation bill represents the single biggest transportation or health, and it must guide all
federal opportunity to influence how our reform.
communities, cities, and regions are shaped.
The Convergence Partnership, the collaborative
Transportation impacts health directly: it affects of funders that commissioned this project,
air quality, injury risk, physical activity levels, embraces the imperative that health and equity
and access to necessities such as grocery stores. be central to transportation policy debates.
Transportation is also one of the largest drivers Further, the Convergence Partnership recognizes
of land use patterns; it thus determines whether how transportation policy is connected to
communities have sidewalks and areas to play the Partnership’s broader efforts to support
and be physically active as well as whether environmental and policy changes that will
Preface
communities are connected to or isolated from create healthy people and healthy places. The
economic and social opportunities. Partnership’s steering committee includes: The
California Endowment, Kaiser Permanente, the
Research shows that low-income communities Kresge Foundation, Nemours, the Robert Wood
and communities of color often do not have Johnson Foundation, and the W. K. Kellogg
access to the benefits our transportation system Foundation. The Centers for Disease Control and
can provide, yet they bear the burdens of Prevention serves as technical advisor.
that system. For example, many low-income
>>
neighborhoods have little or no efficient, In this project, leading academic researchers
6
reliable public transportation to get them to and advocates working at the intersection of
pg.
jobs and essential goods and services. But these transportation policy, equity, and public health
communities are often situated near bus depots, identify opportunities for creating transportation
highways, and truck routes, where pollution systems that promote health and equity. This
levels are high—and not coincidentally, asthma report synthesizes their insights and offers
The Transportation Prescription
rates are high as well. In addition, many of these concrete recommendations for change.
same communities live without safe, complete
sidewalks or bike paths, making walking and Reform is long overdue. Climate change,
biking difficult and often dangerous. As a result, shameful health disparities, growing rates of
9. chronic diseases—transportation policy has
contributed to these problems, and now it must
address them. Increasing rates of poverty and a
severe economic downturn add to the urgency
for reform.
This report intentionally uses the term
authorization and not the more common word,
reauthorization, in reference to the surface
transportation bill. We want to make clear that
new thinking and innovative approaches are
necessary to meet the needs of a changing and
diverse America.
Many advocates are already working hard to
Preface
push for fundamental reform. This report was
written for community leaders, policymakers,
funders, practitioners, and advocates interested
in an overarching strategy to promote active
living and to build healthy communities of
opportunity. PolicyLink, Prevention Institute,
and the Convergence Partnership believe
that building healthy communities requires a
<<
collaboration of stakeholders from diverse fields
7
and sectors. Together, we can identify and
pg.
support shared solutions.
The project recognizes that effective strategies
to improve health, particularly in vulnerable
The Transportation Prescription
communities, often fall outside the conventional
domain of health policy, yet deserve equal
attention. Federal transportation policy is a
critical opportunity at our fingertips. Leveraging
the strength of collaboration and networking can
yield powerful results. Let’s seize the moment.
Angela Glover Blackwell
Founder and CEO
PolicyLink
10.
11. Introduction
In St. Louis, MO, major cuts in bus service this spring left workers, students, people with
disabilities, and older residents stranded and feeling bereft. Stuart and Dianne Falk, who
are both in wheelchairs, told CNN they no longer would be able to get to the gym or the
downtown theater company where they volunteer. “To be saddled, to be imprisoned, that is
what it is going to feeling like,” Stuart Falk said.1
In West Oakland, CA, families have no escape from the diesel exhaust belching from trucks at
the nearby port: The air inside some homes is five times more toxic than in other parts of the
city. “I’m constantly doing this dance about cleaning diesel soot from my blinds and window
sills,” 57-year-old Margaret Gordon told the San Francisco Chronicle. 2
Introduction
In Seattle, WA, Maggieh Rathbun, a 55-year-old diabetic who has no car, takes an hour-long
bus ride to buy fresh fruits and vegetables. She cannot haul more than a few small bags at a
time so she shops frequently—if she feels well enough. “It depends on what kind of day I’m
having with my diabetes to decide whether I’m going to make do with a bowl of cereal or try
to go get something better,” she told the Seattle Post-Intelligencer.3
Our transportation system has an enormous communities of color especially. Forward-
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impact on our way of life, on the air we thinking transportation policies must promote
9
breathe, and on the vitality of our communities. healthy, green, safe, accessible, and affordable
pg.
Transportation choices influence personal ways of getting where we need to go. They
decisions about where to live, shop, attend also must go hand in hand with equitable,
school, work, and enjoy leisure. They affect sustainable land use planning and community
stress levels, family budgets, and the time we economic development.
The Transportation Prescription
spend with our children. Although most people
don’t think of it as a determinant of health, Streets and roads are the largest chunks of
our transportation system has far-reaching property owned by most cities and states. We
implications for our risk of disease and injury. have choices to make about how to use, and
Transportation policies and accompanying land share, that real estate. Who decides? Who
use patterns contribute to the glaring health benefits? Who pays? Transportation policy at
disparities between the affluent and the poor all levels of government can be a vehicle to
and between white people and people of color. promote public health, sustainability, equitable
opportunity, and the economic strength of
This report demonstrates that transportation neighborhoods, cities, and regions. But that
policy is, in effect, health policy—and will happen only if advocates, experts, and
environmental policy, food policy, employment organizers steeped in all these issues bring their
policy, and metropolitan development policy, knowledge and passion to critical transportation
each of which bears on health independently decisions. The upcoming authorization of
and in concert with the others. Longstanding the most important transportation legislation
transportation and land use policies are at in the United States, the federal surface
odds with serious health, environmental, and transportation bill, makes this a pivotal moment
economic needs of the country, and they to bring a broad vision for health and equity to
have harmed low-income communities and transportation policy.
12. Transportation in America: A New Vision
Underlying this report is a vision of it stood as a symbol of American freedom,
transportation as more than a means to move ingenuity, and manufacturing prowess.
people and goods, but also as a way to build
healthy, opportunity-rich communities. Health is While some have few or no transportation
often viewed from an individual perspective. Yet, choices due to limited transportation
Transportation in America: A New Vision
each resident in a region is both an individual infrastructure and resources in their
and part of a larger community. Therefore, our communities, many Americans do have the
vision for healthy, equitable communities is one opportunity to make choices about how to
that extends beyond individual outcomes and travel and where to go. For these people, the
creates conditions that allow all to reach their car provided the means to flee the city, buy a
full potential. It does not force us to balance quarter-acre patch of suburbia, and drive to their
one individual against another. It provides the hearts’ content without giving much thought to
opportunity for everyone to participate in their the disinvested neighborhoods left behind, or
community, be healthy, and prosper. the farmland lost to development, or the fossil
fuels and other natural resources their lifestyles
Transportation systems are essential to the consumed. Community environments, however,
competitiveness of the nation and the viability of affect the choices individuals make, and public
regions. Building America’s Future, a bipartisan policy molds those environments. As the nation
coalition of elected officials, views increased confronts severe economic, environmental, and
transportation investment as a key to the health challenges as well as the widening gulf
economic growth and job creation needed between rich and poor, it is becoming clear that
to strengthen cities and rural communities.4 we must make different choices as individuals
>>
The American Recovery and Reinvestment Act and as a society.
(ARRA), the nearly $1 trillion stimulus package
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passed by Congress and signed by President A new framework for transportation policy and
pg.
Obama in early 2009, emphasizes transportation planning is emerging. Rather than focus almost
investments to revive the ailing economy and exclusively on mobility (and its corollaries, speed
rebuild regions.5 The act galvanized advocates and distance), this framework also emphasizes
to push government agencies to spend the transportation accessibility. In other words,
The Transportation Prescription
money in ways that promote health, protect instead of designing transportation systems
the environment, and benefit everyone. Now primarily to move cars and goods, the new
momentum is building to bring a focus on approach calls for systems designed to serve
health and equity to the next version of the people—all people—efficiently, affordably, and
federal surface transportation bill.6 safely. This approach prioritizes investments
in: (1) public transportation, walking, and
Over the past half-century, federal bicycling—transportation modes that can
transportation policy has changed the American promote health, opportunity, environmental
landscape, physically, socially, and culturally. quality, and indeed mobility for people who do
Beginning with the Federal-Aid Highway Act not have access to cars; and (2) communities
of 1956 authorizing the Interstate Highway with the greatest need for affordable, safe,
System, the leading transportation priority by reliable transportation linkages to jobs, and
far has been what planners call mobility and essential goods and services—chiefly, low-
which became synonymous with the movement income communities and communities of color.
of more and more cars and goods farther and
faster. Mobility advanced the nation’s growth The goal is to improve transportation for
and prosperity, and it formed our sense of everyone while delivering other important
identity as well as our image abroad. The car payoffs, including better respiratory and
was more than a machine to get us around; cardiovascular health; improved physical fitness;
13. less emotional stress; cleaner air; quieter streets; But the push to reform transportation (along
fewer traffic injuries and deaths; and greater with its cousin, land use planning) has gained
access to jobs, nutritious foods, pharmacies, urgency in the face of three massive challenges
clinics, and other essentials for healthy, that are upending the status quo of every field
productive living. and that go to the heart of our love affair with
Transportation in America: A New Vision
the car: (1) climate change, with its threat of
This new vision is at the core of a burgeoning global ecological upheaval; (2) U.S. dependence
movement to shape transportation policy on foreign oil, which carries grave risks for our
to support work in a number of critical economy and security; (3) a healthcare system
areas, such as climate change, sustainable crumbling under the demands of skyrocketing
agriculture, the prevention of chronic diseases, rates of diabetes and other chronic diseases
workforce development, and neighborhood associated with sedentary lifestyles, and
revitalization. Advocates and experts in public astronomical costs. Transporting goods, services,
health, environmental justice, labor, community and people accounts for about one-third of
economic development, food policy, and other greenhouse gas emissions and two-thirds of
fields and disciplines have important roles to petroleum consumption in the United States.7
play in transportation debates. A broad range As the National Surface Transportation Policy
of interests, working in partnership, can craft and Revenue Study Commission noted in its
innovative, environmentally sound solutions that landmark report, Transportation for Tomorrow,
benefit everyone, rather than plans that reflect the environmental gains we achieve through
the motor vehicle orientation of road engineers incremental fixes such as higher fuel-efficiency
and builders. Government transportation standards, though important, will be trumped
<<
agencies and developers—the architects of our by increases in driving and traffic if we continue
transportation systems for decades—must be on our current policy course.
11
held accountable for how their investments affect
pg.
the economic prospects of regions, the health of The good news is that change can happen,
communities, and the well-being of residents. and inspiring examples abound. In the rural
San Joaquin Valley in California, where public
This shift in thinking about what transportation transportation has been virtually nonexistent,
The Transportation Prescription
policy must achieve and who should drive it a new system of publicly managed vanpools
stems from a long list of factors. Among them: is connecting farm worker families to jobs,
near-crippling congestion in many metropolitan schools, and medical services.8
areas; renewed interest in city living and a
hunger for shorter commutes; demographic In Chicago’s West Garfield Park, an alliance
changes (including the increasing number of of residents, activists, and faith-based
people over 65 and immigrants, two groups organizations not only successfully fought
less likely to drive or own cars); the rise in the closure of the rail line that linked the
obesity; the enduring poverty in inner-city and neighborhood to downtown; they also
rural communities; the growing understanding transformed a transit stop into an anchor
of the connections among health, the built development of shops, community services,
environment, and transportation plans; and and moderately priced housing.9
the increasing frustration among residents and
advocates about the limited accountability and In port cities around the country, many groups
inequitable transportation decision-making are working to reduce pollution from ships,
processes at the state and regional levels which locomotives, and trucks, some of the worst
over represent suburban and white male interests. emitters of soot and greenhouse gases. In
the Los Angeles region—one of a number
of regions where the movement of goods
14. represents a significant part of transportation But the legislation does more than provide
investment and economic activity, and money. It also communicates national policy
where ports and freeways abut low-income priorities. Will we build roads on the farthest
neighborhoods—the Coalition for Clean and edges of regions or fix aging roads and bridges
Safe Ports has formed an effective alliance of in cities and inner-ring suburbs? Will we invest
Transportation in America: A New Vision
residents, truck drivers, public health experts, in healthy, green transportation—bicycle
environmentalists, environmental justice lanes, safe sidewalks for walking, clean
activists, unions, immigrant groups, and public buses, ridesharing, light rails? Will we ensure
officials to push for clean air solutions.10 that all voices are equitably represented in
transportation decision-making processes? And
The authorization of the next federal surface will we include incentives and requirements for
transportation bill presents an immense affordable housing near public transportation
opportunity to broaden such engagement and to ensure broad access to the job opportunities
to forge an equitable policy response to the and services that transit oriented development
unprecedented challenges facing the country. stimulates? Or will we spend most of the money
The bill authorizes federal funding for highways, as we have for decades: on new and bigger
highway safety, public transportation, and highways with little public accountability?
bicycling and pedestrian infrastructure for The bill establishes funding categories
approximately six years.11 It transfers hundreds of and requirements and in some cases gives
billions of dollars from the federal government communities and metropolitan regions flexibility
to states and localities. It also triggers to shape strategies to local needs. The new law
hundreds of billions more in matching state is a chance to design communities for health,
>>
and local spending. The bill marks the largest sustainability, and opportunity—and to give all
transportation expenditure in the United States. Americans physically active, clean, affordable,
12
convenient, reliable, and safe options to get
pg.
where they need to go.
The Transportation Prescription
15. How Transportation Policies and Plans Influence Health
How Transportation Policies and Plans Influence Health
Our current transportation system has many The main culprits are fine particulate matter,
direct health consequences: Pollution-related including: diesel exhaust particles, ground-level
asthma, steep declines in physical activity, ozone, a toxic component of smog formed
and the associated rise in obesity and chronic when tailpipe emissions from cars and trucks
illnesses are just a few examples. Transportation react with sunlight and oxygen, and nitrogen
affects health indirectly by connecting people— oxide (NOx), which contributes to the formation
or by failing to provide connections—to jobs, of ozone and smog. The health risks are
medical care, healthy food outlets, and other exacerbated by transportation patterns that
necessities. The National Surface Transportation often embed heavy traffic and diesel-spewing
Policy and Revenue Study Commission—created facilities in poor and predominantly minority
by Congress in 2005 to examine the condition neighborhoods. The American Lung Association
and future needs of our network of highways, has found that 61.3 percent of African American
ports, freight and passenger railroads, and children, 67.7 percent of Asian American
public transportation systems—reached a children, and 69.2 percent of Latino children
sobering conclusion: “The nation’s surface live in areas that exceed air quality standards
transportation network regrettably exacts a for ozone, compared with 50.8 percent of
terrible toll in lost lives and damaged health.”12 white children.20 Ground-level ozone, a gas, can
Nowhere is the toll higher than among low- chemically burn the lining of the respiratory tract.
income people and people of color.
Air pollution is also “one of the most
There is a deep and evolving knowledge underappreciated” triggers of asthma attacks,
base about the links between transportation according to the Centers for Disease Control
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and health. Research shows that when and Prevention (CDC).21 More than 20 million
properly designed, transportation systems Americans—roughly seven percent of adults
13
can provide exercise opportunities, improve and nearly nine percent of all children—have
pg.
safety, lower emotional stress, link poor asthma. In poor and minority communities, the
people to opportunity, connect isolated older rates are considerably higher. For example, in
adults and people with disabilities to crucial Harlem and Washington Heights in northern
services and social supports, and stimulate Manhattan, home to mostly low-income
The Transportation Prescription
economic development. Conventional mobility- African American and Latino residents, one
focused planning by local, regional, and state in four children suffers from the disease.22
transportation agencies generally overlooks Research shows that air pollution can trigger
or undervalues the impacts of transportation the wheezing, coughing, and gasping for breath
investments on health and equity. that signal an attack in people with asthma. But
a study in 10 Southern California cities raises the
Direct Hea lth Effects troubling possibility that pollution can also lead
to the onset of the disease. The study found
that the closer children live to a freeway, the
Pollution
more likely they are to develop asthma.23
Pollutants from cars, buses, and trucks are
Environmental justice activists have called
associated with impaired lung development and
attention for years to the connections among
function in infants13 and children,14 and with
pollution, illness, and transportation policy—
lung cancer,15 heart disease, respiratory illness,16
and the burden on communities of color.
and premature death.17 Long-term exposure to
For instance, in the mid-1990s, West Harlem
pollution from traffic may be as significant a
Environmental Action (WE ACT) used mapping,
threat for premature death as traffic crashes and
air monitoring, and resident surveys to show
obesity.18 In California alone, pollution is a factor
that the neighborhood’s asthma rates were
in an estimated 8,800 premature deaths a year.19
16. How Transportation Policies and Plans Influence Health
linked to its dubious status as the diesel capital Scientists believe that climate change could
of New York City. When WE ACT began work exacerbate a number of current health
on the issue, Harlem housed six of the city’s problems, including heat-related deaths,
eight bus depots and 650 Port Authority buses. diarrheal diseases, allergies, and asthma.28
The group played an important role in getting Those already at highest risk—the poor,
the city to convert buses to clean fuel.24 minorities, children, and older adults—will be
even more vulnerable. Policy neglect would
Pollution from freight transport is another compound the problems. Hurricane Katrina
big concern around the country. To meet revealed, to a horrified public, the disastrous
America’s insatiable demand for goods, ports results that can occur when nature (the sort
and highways are continually expanding to of extreme storm that experts expect to occur
accommodate more ships, locomotives, and more frequently as the earth’s temperature
trucks. Ports frequently border low-income changes) combines with government disregard
and minority neighborhoods, and highways (in this case, the poorly maintained levees that
often run through them. The upshot: Some failed to protect New Orleans from catastrophic
of the worst emitters of fine particles, soot, flooding) as well as resource inequities (the
and greenhouse gases (GHGs) are a growing lack of transportation, which made evacuation
presence in already vulnerable communities. impossible for thousands of people).
Climate Change The urgent need to reduce GHGs has catapulted
transportation policy into the limelight. The
GHGs are not pollutants in the classical sense. United States has only about five percent of
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They cause the atmospheric changes and the world’s population but contributes nearly
resulting climate disruptions that are projected 25 percent of GHGs, mainly because of fossil
14
to alter the natural and built environments on fuel consumption, motor vehicle emissions,
pg.
which society relies.25 The health risks come and industrial agricultural practices (which
largely from those environmental alterations. In themselves are promoted by our transportation
a major shift in federal policy, the Environmental system). Improving vehicle technology, while
Protection Agency in April 2009 adopted the important, is not enough. Americans need to
The Transportation Prescription
position that greenhouse gases pose a danger drive less. That will happen only if walking,
to human health and welfare. A few weeks bicycling, and public transportation become
later, the Climate Change and Health Protection feasible, efficient alternatives to driving in many
and Promotion Act, H.R. 2323, was introduced more communities, and if land use patterns are
in the House of Representatives.26 The bill would changed so people no longer have to jump in
direct the Department of Health and Human the car for every trip.
Services to develop a national strategic action
plan to prepare for and respond to the health Physical Activity
effects of climate change.
Sixty percent of adults in the United States
Researchers are just beginning to assess the do not meet recommended levels of physical
specific health dangers in the United States; activity, and 25 percent are completely
to date, most of the published data come sedentary.29 African Americans and Latinos
from abroad. So far, however, there are more are less likely than whites to get enough daily
questions than answers. How will less rainfall physical activity.30 The links between physical
affect the potential for waterborne diseases? activity and health are well established.
Food supplies? Food prices? How will extreme Sedentary lifestyles are estimated to contribute
weather conditions such as heat waves or to as many as 255,000 deaths each year.31 Many
hurricanes affect mental health? Physical children and teens are already at risk for heart
activity? Population displacement? disease and type 2 diabetes, once considered
17. How Transportation Policies and Plans Influence Health
“adult” ailments. Today’s youth may turn out to Many people find commuting by high-quality
be the first generation in modern history to live public transportation to be less stressful than
shorter lives than their parents.32 commuting by car. As we discuss below, the
financial costs associated with long commutes
Physical inactivity is an important factor in the exacerbate the stress, particularly in low-
rising rates of obesity and chronic disease—and income households.
transportation practices strongly influence
physical activity habits. The more time a person Safety
spends in a car, the more likely he or she is
to be overweight. Conversely, higher rates of Traffic crashes are a leading cause of death and
walking and bicycling are associated with lower injury for Americans in the prime of life.36 In
rates of obesity. A 2004 study found that every 2000, motor vehicle crashes cost $230.6 billion
additional hour spent in a car is associated in medical costs, property damages, lost worker
with a six percent increase in the likelihood of productivity, travel delays, and other expenses.37
obesity, and every additional kilometer walked is That figure equals about half of all spending
associated with a 4.8 percent reduction.33 on public education from kindergarten through
12th grade.
There are many ways to be physically active,
but quite a few require time, skill, and money. Native Americans die in traffic crashes at more
Walking and bicycling not only for recreation than 1.5 times the rate of other racial groups.38
but also for transportation are the most practical African Americans drive less than whites but die
ways to improve fitness. They are often the only at higher rates in car crashes. Walking, too, is
<<
viable option for low-income residents who live also more dangerous in communities of color.
in neighborhoods without parks, who cannot CDC data in the mid-1990s revealed that the
15
afford gym memberships, and who do not have pedestrian death rate for Latino males in the
pg.
the luxury of leisure time. Atlanta metropolitan area was six times greater
than for whites.39 African Americans make up
People who use public transportation tend to 12 percent of the U.S. population but account
walk to and from bus stops and train stations, for 20 percent of pedestrian deaths.40
The Transportation Prescription
increasing their likelihood of meeting physical
activity recommendations.34 Residents of Inequitable transportation policies and
compact neighborhoods walk, bike, and use resources contribute to these disparities. Low-
public transportation more than residents of income people and people of color have fewer
spread-out communities, and they have lower resources to buy products that improve safety,
rates of obesity. such as late-model cars and new child safety
seats. In underinvested neighborhoods, poorly
Mental Health designed streets, neglected road maintenance,
inadequate lighting, limited sidewalks, and
Rush-hour gridlock, long waits for the bus, and minimal traffic enforcement place residents at
arduous commutes are stressful. They take time higher risk of injury.
away from family, friends, and the activities
that provide emotional sustenance: hobbies, Safety is also a huge concern for older
religion, sports, clubs, civic engagement, and adults—the fastest-growing segment of the
volunteer commitments. Every 10 minutes spent population—and for rural residents. Driving
commuting is associated with a 10 percent drop skills decline with age, and frailty makes older
in the time spent traveling for social purposes.35 adults especially vulnerable in a collision.41 They
are more likely to be killed or injured in a crash
18. How Transportation Policies and Plans Influence Health
of a given severity than any other age group.42 Transportation, Income, and Health
Older adults also walk slower and are more
susceptible to pedestrian injuries. As housing and jobs have moved farther apart,
the distance has created employment barriers
Although less than a quarter of all driving in for anyone without unlimited ability to drive.
the United States takes place in rural settings,43 Nineteen percent of African Americans and 13.7
more than half of all motor vehicle crashes percent of Latinos lack access to automobiles,
occur there.44 compared with 4.6 percent of whites. Poverty
complicates the problem: 33 percent of poor
The more we drive, the more likely we are to African Americans and 25 percent of poor
get hurt or die in a crash; there is a strong Latinos lack automobile access, compared with
positive relationship between per capita vehicle 12.1 percent of poor whites.47 Cars owned
miles traveled and traffic casualty rates.45 by low-income people tend to be older, less
Communities with high annual mileage tend to reliable, and less fuel-efficient. This makes
have higher traffic death rates than communities commuting to work unpredictable and more
where people drive less. Passengers on buses, expensive, at best.
light rail, and commuter rail have about one-
tenth the traffic death rate as people in cars. Income is an important determinant of health.48
The association between poverty and poor
Investments in public transportation and health is well documented. Jobs with good
walking and bicycling infrastructure can reduce wages, including those in the transportation
injuries and deaths. Contrary to popular belief sector, are essential to sustaining health.
>>
that more walkers and cyclists lead to more
casualties, greater numbers of walkers and Transportation impacts not only family earnings
16
bicyclists actually decrease the risks.46 but also expenses. The cost of getting around
pg.
takes a significant bite out of household
Indirect Hea lth Effects budgets. The general standard holds that a
family should spend no more than 20 percent
The Transportation Prescription
Transportation is a lifeline. We depend on it of income on transportation, or the costs will
to get to work, school, the doctor’s office, the eat into other necessities, such as nutritious
bank, the supermarket, the gym, or a friend’s foods, and medical care.49 The average
house. People without reliable, efficient, family in the United States spends about 18
affordable ways to get around are cut off from percent of after-tax income on transportation,
jobs, social connections, and essential services. but this varies significantly by income and
Access to transportation, to economic and social geography. For example, low-wage households
opportunity, and to resources for healthy living (earning $20,000 to $35,000) living far from
are inextricably linked. Gaps in all three areas employment centers spend 37 percent of their
feed on one another in complex ways. Policy incomes on transportation.50 In neighborhoods
reforms that put health equity objectives at the well served by public transportation, families
center of transportation planning and funding spend an average of nine percent.51
decisions can reduce these inequities.
19. How Transportation Policies and Plans Influence Health
Older Americans and People with available, older adults take advantage of them.
Disabilities More than half of older adults make walking
a regular activity. More than half of older
More than one in five Americans ages 65 and nondrivers in dense communities use public
older do not drive because of poor health or transportation at least occasionally, compared
eyesight, limited physical or mental abilities, with one in 20 in spread-out communities.54
concerns about safety, or because they have no
car. More than half of nondrivers, or 3.6 million The Americans with Disabilities Act (ADA) of
Americans, stay home on any given day—and 1990 significantly expanded transportation
more than half of that group, or 1.9 million, options for people with disabilities. ADA
have disabilities.52 Isolation is especially acute required public bus and rail operators to provide
in rural communities, sprawling suburbs, and accommodations, such as lifts and ramps, to
black and Latino communities. Compared with enable people in wheelchairs to ride. But street
older drivers, older nondrivers take 15 percent design in most communities makes traveling
fewer trips to the doctor; 59 percent fewer trips to and from bus stops challenging—and often
to shops and restaurants; and 65 percent fewer unsafe—for people with disabilities. Paratransit
trips for family, social, and religious activities.53 systems, which use vans or shared taxis to
transport people door-to-door, are helpful, but
When affordable, high-quality public many systems are stretched thin and require
transportation and safe, walkable streets are appointments well in advance.
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17
pg.
The Transportation Prescription
20. What Does Healthy, Equitable Transportation
Policy Look Like?
What Does Healthy, Equitable Transportation Policy Look Like?
Healthy, equitable, transportation policy of funders. The book describes innovative
supports the development of accessible, transportation and land use policies, strategies,
efficient, affordable, and safe alternatives to and programs built on a foundation of equity
car travel, and especially to driving solo. These and sustainability. It includes six key chapters
alternatives enable everyone to walk more, authored by academics and advocates
travel by bicycle, and use public transportation working at the intersection of transportation,
more—in other words, to get around in health, and equity. The book is available
ways that improve health, expand access to online at www.convergencepartnership.org/
opportunity, and reduce toxic pollutants and HealthyEquitableTransport.
greenhouse gas emissions.
Three chapters in the book address
Healthy, equitable transportation policy is transportation options:
forged and implemented in concert with
sustainable land use planning. Together, they • Todd Litman, M.E.S., founder and executive
encourage and support high-density, mixed- director of the Victoria Transport Policy
use, mixed-income metropolitan development Institute in British Columbia, identifies
and affordable housing with good access to numerous economic, social, and
transportation options. Together, they focus, environmental benefits that can result from
particularly, on underserved and economically public transportation improvements.
isolated communities. Among them: reduced traffic crashes,
improved physical fitness and health, energy
Healthy, equitable transportation policy conservation, reduced pollution emissions,
>>
recognizes that income is important to health, increased community livability, increased
and it encourages hiring low-income residents affordability, consumer savings, economic
18
of color for well-paying jobs in transportation development, and expanded opportunity.
pg.
construction, maintenance, and service. Litman contends that improving public
transportation is one of the most cost-
Healthy, equitable transportation policy effective ways to improve public health, and
understands the importance of ensuring equal better health is one of the most significant
The Transportation Prescription
representation. All community members, potential benefits of public transportation
regardless of race, gender, or geographical improvements. Litman identifies policy and
location should be equitably represented and planning reforms to create a more diverse
involved in making decisions which impact their and efficient transportation system. Litman
communities, their infrastructure, and their recommends developing a strategic vision of
options for travel. high-quality public transportation services,
with supportive land use policies to provide
Because access to healthy foods is integral basic mobility to people who are socially
to good health and because transportation isolated, economically disadvantaged, or
systems are integral to food production and physically disabled, as well as to attract
distribution, healthy, equitable transportation “discretionary” travelers, or people who
policy specifically addresses food access issues, would otherwise drive for a particular trip.
including transportation to grocery stores and
food transport practices. • Susan Handy, Ph.D., director of the
Sustainable Development Center at the
This report draws on the book, Healthy, University of California at Davis, argues that
Equitable Transportation Policies: increasing walking and bicycling while
Recommendations and Research commissioned assuring safety, particularly for low-income
by the Convergence Partnership, a collaborative families, children, and older adults, is an
21. What Does Healthy, Equitable Transportation Policy Look Like?
important goal for federal transportation sprawl. Targeted transportation investment
policy. Walking and bicycling, or “active can promote economic opportunity and
travel,” are low-cost, physically active, and reduce health disparities by (1) improving
environmentally clean alternatives to driving, transportation linkages between housing and
yet they represent fewer than 10 percent of employment hubs and between residential
all trips in the United States. In addition to neighborhoods and clinics, pharmacies, and
expanding specialized programs for active grocery stores; (2) encouraging affordable,
travel, the federal government should assist, high-density, mixed-use transit oriented
enable, encourage, and, in some instances, development;56 and (3) creating workforce
require state, regional, and local governments strategies to ensure that jobs in the large,
to address pedestrian and bicycling needs. growing transportation sector are open to
all, including minority and women workers
• Catherine L. Ross, Ph.D., the Harry West and contractors. Swanstrom also asserts that
Chair and director of the Center for Quality while the goals of equity and environmental
Growth and Regional Development at sustainability are not mutually exclusive,
Georgia Institute of Technology, argues policymakers and advocates must address the
that roadways are more than transport short-term needs of low-income families who
routes; they are also our primary spaces live in places where driving is essential.
for civic, social, and commercial enterprise.
Roadways—highways in particular—receive • Kami Pothukuchi, Ph.D., associate professor
the largest share of federal transportation of urban planning at Wayne State University,
dollars by far. Federal policy has historically and Richard Wallace, M.S., senior project
<<
emphasized highways designed to move manager at the Center for Automotive
large numbers of cars and freight vehicles Research, argue that federal transportation
19
at high speeds. Ross argues for greater policy should seek to increase access to
pg.
investments in roadways that integrate healthy foods. Today’s transportation
physical activity, enrich social interaction, networks make large quantities of foods
increase safety, and provide transportation from around the nation and the globe
linkages in underserved communities. She readily available for many Americans,
The Transportation Prescription
urges policymakers and others to consider but industrialized agriculture and the
expanded assessments of the effects of concentrated structure of food retail
roadways on health, through the use of have negative health and environmental
methodologies similar to health impact consequences for low-income communities,
assessment (HIA).55 especially people of color, inner-city and
rural residents, and immigrant farm workers.
Three additional chapters offer transportation For example, urban and rural communities
policy perspectives in key areas that have a often have fewer and smaller supermarkets
significant impact on public health and equity: than suburban communities (if they have any
at all) as well as more limited selections of
• Todd Swanstrom, Ph.D., the E. Desmond Lee healthy foods. As a result, residents eat fewer
Professor of community collaboration and fruits and vegetables and have higher rates
public policy administration at the University of diet-related illnesses. In addition, long-
of Missouri – St. Louis, makes the case distance food hauling has a disproportionate
that federal transportation policy can and impact on the air quality and noise levels in
should address economic development, poor and minority communities along freight
particularly in communities left behind routes. Although food access falls outside
by decades of transportation planning the traditional realm of transportation policy,
that favored car travel and encouraged improved public transportation, transit
22. What Does Healthy, Equitable Transportation Policy Look Like?
oriented development, and cleaner methods as the leading cause of death for people
to move freight can increase access to healthy ages one to 34 and contribute to unnecessary
foods in underserved communities, reduce human, social, and economic costs. Resources
air and noise pollution, and foster local, should be directed to communities with the
sustainable agri-food systems. least infrastructure to support safe walking,
bicycling, and public transportation use
• Larry Cohen, M.S.W., Leslie Mikkelsen, R.D., and continue to support effective vehicle
M.P.H., and Janani Srikantharajah, B.A., safety and occupant protection strategies.
of Prevention Institute argue that traffic Traffic safety is an important strategy not
crashes are preventable and that federal only to reduce injuries and death but also to
transportation policy must make safety for encourage physical activity, improve air quality,
all travelers a priority. Traffic crashes rank and increase transportation accessibility.
>>
20
pg.
The Transportation Prescription
23. The Federal Transportation Legacy
and Challenges Ahead
The Federal Transportation Legacy and Challenges Ahead
Transportation in America is a federal system, and dynamic American surface transportation
not a centralized, national system. Federal policy system is becoming a thing of the past.”
plays a critical role, not by dictating practices
but by enabling and encouraging innovation by At 300 million people, the nation’s population
states, regional transportation organizations, has doubled since the creation of the
transit operators, and other agencies. This Interstate Highway System. We will number
happens in several ways. 420 million by 2050. “Congestion was once
just a nuisance. Today gridlock is a way of
First, the federal government sends billions of life,” the commission’s report said. Growing
dollars for transportation to states and localities. transportation demand threatens to dwarf
For example, the American Recovery and regulatory and legislative efforts to mitigate
Reinvestment Act provides nearly $50 billion its health and environmental consequences.
to build and repair roads, bridges, railways, Increases in total vehicular mileage have all but
and ports. The current surface transportation wiped out the gains achieved through hard-won
bill, SAFETEA-LU (Safe, Accountable, Flexible, regulations on fuel efficiency and emissions
Efficient Transportation Equity Act: A Legacy control. Expansion of freeways cannot get us
for Users), set to expire in September 2009, out of these problems; it will only make them
guaranteed $244.1 billion over six years. These worse. The more we have expanded highways,
dollars, in turn, leverage direct infrastructure the more traffic we have created. The United
investments by state governments, local States needs multi-modal systems with public
governments, and private investors. transportation that efficiently serves a large
segment of the population, using existing
<<
Second, the policies and requirements streets and highways.
embedded in federal transportation programs
21
influence state and local land use decisions and The Intermodal Transportation Efficiency
pg.
transportation priorities. Act (ISTEA), the 1991 version of the federal
surface transportation bill, was supposed to
Many observers contend that transportation lead us there. The act incorporated significant
stands as one of the biggest policy successes in policy change. Since then, the stated goal
The Transportation Prescription
United States history. The Federal-Aid Highway of federal transportation policy has been to
Act of 1956 and its progeny promoted mobility, expand access and improve efficiency through
which contributed mightily to American growth an interconnected multi-modal system that
and prosperity. However, many advocates take a supports highways, public transportation,
more nuanced view of the federal legacy. They walking, and biking. This goal has yet to be
point to the health, equity, and environmental achieved. Funding mechanisms and formulas
consequences of an ethic that held the have continued to favor highway construction
faster, the farther, the better, as well as the and car travel. For example, the allocation
consequences of policies focused almost wholly formula for the Surface Transportation Program
on car and truck travel, with little accountability (STP), the largest program within the federal
to goals beyond mobility. bill, rewards states that consume more gas,
have more miles of highway, and have residents
Either way, the current transport system is no who drive a lot.57 Alternatives to driving remain
longer sustainable or fixable by incremental underinvested. Approximately 80 percent
changes such as pilot projects, encouragements, of the surface transportation bill is allocated
and small incentives. As the National Surface for distribution through the Federal Highway
Transportation Policy and Revenue Study Administration for mostly highway programs,
Commission, created by SAFETEA-LU, wrote while less than 20 percent goes to the Federal
in its final report to Congress: “The strong Transit Agency for public transportation. Other
24. The Federal Transportation Legacy and Challenges Ahead
modes of travel constitute a minute amount of U.S. Department of Transportation’s main public
spending in comparison to highways and public transportation programs for transit operating
transportation. costs.59 In the face of budget shortfalls, local and
regional transportation agencies throughout
Case in point: Walking is the only travel the country have cut service, hiked fares, and
mode that has not had significant declines in deferred maintenance—arguably at a time when
casualties in 40 years. Yet only a tiny share of people need affordable, reliable links to jobs
transportation funding goes to infrastructure more than ever.
initiatives that would make walking and biking
safer. Walking and bicycling accounted for 8.6 While federal policy plays a significant role in
percent of all trips in 2001 but 12 percent of shaping transportation systems, states and
traffic deaths.58 metropolitan regions are also critical agents
of change. The new surface transportation
Another case in point: Operating costs for bill offers an opportunity to increase support,
public transportation systems present a huge encouragement, and pressure for integrating
challenge for many communities. Yet federal land use and transportation planning
transportation investment is focused on capital to promote balanced regional growth,
projects. For example, cities with 200,000 equitable economic opportunity, and healthy
people or more may not use grants from the communities for all.
>>
22
pg.
The Transportation Prescription
25. A Foundation for 21st-Century
Transportation Policy
Healthy, equitable transportation policy is 3. Emphasize accessibility, instead of
A Foundation for 21st-Century Transportation Policy
grounded in four principles. These may also simply mobility, in transportation
serve as benchmarks to assess the impacts of policies and programs at all levels of
transportation plans on public health, equity, government as well as across sectors
and environmental quality: and policy silos. Transportation systems
should give communities wider access
1. Develop transportation policies and to all the things that are necessary for a
plans that support health, equity, good life, not to move people faster and
and environmental quality. Federal, farther. The definition of access must also
state, and local transportation policies include affordability. If transportation is
should be aligned with the top health and physically accessible, yet unaffordable, it is
environmental goals of federal departments not truly accessible. Accessibility-oriented
and agencies. For example, transportation transportation policies can catalyze and
policies should be aligned with the support balanced regional growth, walkable
Department of Health and Human Services’ communities, the renewal of long-neglected
strategic goals to promote health equity and neighborhoods, and street design that
foster the economic and social well-being makes walking and bicycling safe, popular
of individuals, families, and communities. transportation options.
Transportation policies should also support
the CDC’s commitment to eliminate health 4. Ensure transparency, accountability,
disparities and to promote its “healthy and meaningful participation by
people in healthy places” goals. residents, advocates with diverse
<<
interests, and experts from different
2. Prioritize transportation investments fields. State and regional transportation
23
in distressed regions, low-income officials and private developers must engage
pg.
neighborhoods, and communities new partners in decision-making and
of color. Federal, state, and local provide the data, training, and resources
transportation agencies should emphasize to allow full, informed participation by the
projects that will revitalize the economy people affected most by decisions and
The Transportation Prescription
of struggling communities, lower health investments. Voices and expertise from local
disparities, and will connect vulnerable communities, public health, environmental
populations to jobs, business opportunities, justice, community development, and other
healthy food outlets, medical services, and arenas can help ensure that transportation
other necessities. Government agencies plans respond to local needs and deliver
must ensure that these projects are health, environmental, and economic
financially sustainable by providing adequate benefits broadly.
funding for maintenance and operations.
The jobs associated with transportation
construction, maintenance, and service
should be available to low-income people
and communities of color.
26. Policy and Program Priorities to Improve
Health and Equity
Policy and Program Priorities to Improve Health and Equity
Government at all levels must consider the affordability and accessibility. It also
health and equity impacts of transportation must incorporate affordable housing and
investments at the beginning of decision-making commercial properties that provide jobs,
processes. Public and private transportation services, and essential goods near people’s
investments must be designed to promote homes. Because people of all income
health rather than to erode it. The following levels desire walkable neighborhoods
recommendations can help policymakers and and shorter commutes, displacement of
planners achieve these ends: longtime neighborhood residents can be an
unintended consequence of transit oriented
1. Prioritize investments in public development. Policymakers must ensure
transportation, including regional that the local residents guide planning and
systems that connect housing and jobs development and that equity is a goal from
as well as local services that improve day one.
access to healthy foods, medical care,
and other basic services. Investments 4. Create incentives and accountability
should include capital costs as well as costs measures to ensure that transportation
for maintenance and operations. Because plans account for their impacts on
older diesel buses have high emission rates health, safety, and equity. New projects
and since bus depots and other facilities must be held accountable for better results.
are often concentrated in low-income Government investment should support
and minority neighborhoods, policies the creation of tools that more sensitively
must be in place to ensure that expanded and accurately measure walking and
>>
public transportation does not lead to bicycling practices and improved outcomes.
increased exposure to pollutants in these Health impact assessment is an emerging
24
same communities. methodology to evaluate the effects of
pg.
policies, programs, and plans on the health
2. Prioritize investments in bicycle and of a population and should be considered an
pedestrian infrastructure to make important tool. People should also have the
walking and biking safer and more right to sue under Title VI of the Civil Rights
The Transportation Prescription
convenient. Strategies include complete Act of 1964 if they suffer disparate impacts
streets designed with all users in mind, from federal transportation investments,
not just drivers; traffic-calming measures; and the U.S. Department of Transportation
and safe routes to transit and Safe Routes should have the power to withhold dollars if
to Schools programs, which create investments are not made equitably.60
infrastructure and programming to support
safe walking and bicycling to bus stops, rail 5. Give state, regional, and local
stations, and schools. Targeted infrastructure government agencies and organizations
investments should also support walking more flexibility to move dollars among
and bicycling in rural communities by, for funding categories and to target
example, improving road shoulders and spending to meet local needs. Greater
building trails to town centers. flexibility would give communities more
leeway to fund walking, bicycling, and
3. Encourage equitable transit public transportation programs. It would
oriented development by creating also enable communities to invest in fixing,
incentives for integrated land use maintaining, and operating local bus and
and transportation planning. Transit rail systems. Flexibility should be strongly
oriented development must emphasize tied to new standards for accountability,