5 Arup Health+Mobility

Health +
Mobility
A DESIGN PROTOCOL FOR MOBILISING HEALTHY LIVING
2
Health + Mobility
A design protocol for mobilising healthy living
This report is a product of a research collaboration between Arup, BRE, University College
London and AREA as part of Arup’s Global Research Challenge 2015.
RESEARCH TEAM
Arup
Laurens Tait, Project Director
Ikumi Nakanishi, Project Manager
Paul Grover, Associate Director
Thomas Paul, Planner
Kim Cooper, Planner
BRE
Helen Pineo, Associate Director for Cities
University College London

Professor Nick Tyler, Chadwick Chair of Civil Engineering
Dr Xenia Karekla, Research Associate at Centre of Transport Studies
AREA Research / Perkins + Will

David Green, Principal
Lydia Collis, Architect/Urban Designer
Ingrid Stromberg, Knowledge Manager
Acknowledgments
The authors acknowledge the following people for providing valuable input:
Amanda Sacker, Institute of Epidemiology & Health, UCL

Jenny Mindell, Institute of Epidemiology & Health, UCL
Marcella Ucci, The Bartlett School of Environment, Energy & Resources, UCL
Jemima Stockton, Institute of Epidemiology & Health, UCL
Adriana Ortegon, Department of Civil, Environment & Geomatic Engineering, UCL
Catherine Garnell, Assistant Chief Executive, Liverpool City Council
Martin Thompson, Policy Officer, Liverpool City Council
Ian Williams, Research Officer, Liverpool City Council
Basak Alkan, Urban Designer for the Baton Rouge Project, Perkins + Will
Health + Mobility 3
Health + Mobility
A design protocol for mobilising healthy living
4
Arup is a global firm of designers, engineers, BRE is an independent and impartial, research-based
planners and business consultants providing a consultancy, testing and training organisation,
diverse range of professional services to clients offering expertise in every aspect of the built
around the world. Arup is renowned for its specialist environment and associated industries. We help
expertise in multiple disciplines encompassing all clients create better, safer and more sustainable
aspects of the built environment. products, buildings, communities and businesses -
and we support the innovation needed to achieve
Arup is dedicated to an interdisciplinary approach this. The BRE Trust funded a three-year research
that brings its full complement of skills and project to explore the links between urban
knowledge to each project. Since its inception in environments and health and develop indicators to
1946, it has been the creative force behind many of support policy and decision-makers.
the world’s most innovative and sustainable designs.
www.arup.com www.bre.co.uk
University College London is one of the world’s AREA Research is an independent, non-profit
top ten universities. The Department of Civil, organisation operating parallel to Perkins + Will.
Environmental and Geomatic Engineering (CEGE) AREA is a platform that connects the design
leads research programmes that seek to optimise professions, academia, and research institutions,
built environments for health such as: the Pedestrian supporting innovative research to improve the
Accessibility and Movement Environment Laboratory built environment, and by extension, the lives of its
(PAMELA) programme and the Healthy Infrastructure inhabitants. AREA and Perkins + Will together bring
Research Group. By working with UCL’s partnership a depth of knowledge across practices including
of 25 hospitals, these groups combine cutting edge healthcare, higher education, science + technology,
research in both health and infrastructure to create a city planning and transportation.
healthier environment.
www.ucl.ac.uk www.arearesearch.org
Health + Mobility 5
Contents
Executive Summary 7
Introduction 8
Urban Mobility Impact on Health 10
Health + Mobility Framework 18
Design protocol 26
Applying the Design Protocol 30
Knowledge Quarter, Liverpool UK 34
Baton Rouge, Louisiana US 50
Way forward 70
Glossary 75
Appendix 76
A. Existing tools and methodologies 77
B. Data sources 78
C. References 79
Biographies 87
6
Health + Mobility 7
Executive
Urban living requires significant being designed, city leaders and
transport and mobility infrastructure design teams should consider health
Summary
to enable people to travel for school, at the earliest stages. Cost-benefit
work or leisure activities. Transport analyses of different options must
affects health and wellbeing through take into account the full range of
many pathways, resulting in a myriad benefits that active transport and high
of positive and negative impacts. quality public transport systems have
Transport offers Transport infrastructure contributes been shown to achieve.
to greenhouse gas emissions and
one of the greatest influences the environment in a Planners, engineers and design
number of ways. It can be the source professionals are increasingly
opportunities for of both solutions and problems around aware of the relationship between
some of society’s biggest challenges transport and health. Yet there
improving public including climate change, increasing are still challenges to overcome
rate of chronic diseases and rising in implementing high quality
health. healthcare expenditure. transportation infrastructure as
cities and service providers require
Transport is a major contributor to a convincing business case to invest.
3.7 million deaths globally from Transport and design professionals
ambient air pollution1, and has an need to work with public health
annual count of 1.3 million deaths specialists and local communities to
from road accidents and 78.2 million gather data about priorities and jointly
non-fatal injuries requiring medical develop solutions.
care2. The transport sector is also a
major contributor to climate change, There are many successful examples
responsible for 23% of global carbon of strategic integrated planning
emissions3. It is possible to design for transport and mobility that
a low carbon transport network achieve wider social, economic and
powered by sustainable energy with environmental objectives. These
benefits for health and wellbeing, projects should be used as the
for people, the economy and the evidence-base to inform economic
environment. However, the legacy of appraisals that go beyond traditional
carbon based technologies and car- methods. Cost savings may occur
centred infrastructure will be with us across multiple city agencies or
for decades to come and continues to national departments. A more
be included in the design of new cities joined-up approach with strong
and communities. leadership will be required to capture
opportunities to improve urban
A city’s transport network and infrastructure to address complex
mobility infrastructure includes challenges like health.
everything from trains and buses to
street lighting and benches. Studies This design protocol offers one
have demonstrated that a mixture of approach for using city data to
traffic reduction measures, coupled understand local health and
with supportive infrastructure for transport issues and opportunities.
pedestrians, cyclists and public This evidence can inform designs,
transport, can result in benefits to specifications and supplier briefs
local economies, social networks, for better transport and mobility
health and the environment4, 5, 6. An infrastructure that will support people,
upfront cost to improving existing the economy and the environment.
infrastructure is significantly
compensated through savings from
reduced injuries and decreased rate
of health deterioration. Where new
transport systems and streets are
8
Introduction
The body of knowledge that describes The research assessed current
the effects of integrated transport studies and literature, best practice
planning on citizens, the economy case studies and current tools and
and the environment has grown to methodologies in an attempt to
a substantial size. Research shows comprehend the links, application
Researching health that multiple physical and mental and assessment methods of mobility
health aspects are affected by the infrastructure and health. The
impacts and urban accessibility and availability of active outcome was a framework which
and non-active transport modes in structures the relationship between
mobility door-to-door journeys. A recent report mobility infrastructure and health
combining evidence from over 500 outcomes alongside a design protocol
academic papers shows that 9% of which utilises the framework through
premature deaths worldwide are data.
attributed to physical activity7 and
cities designed for activity benefit Both the design protocol and
from increased employment, safety, framework have been developed to
private investment and health be applicable to any planning, urban
outcomes8. design or transport project interested
in improving the health and wellbeing
Yet despite the growing body of of the community. They are flexible
knowledge on the interdependence enough to use existing and available
between health and transport, datasets along with data from sensors
governments and planning bodies and other connected devices to
do not seem to be aware of (or able provide evidence for decision making
to exploit) the opportunities their on healthy mobility infrastructure.
projects offer for the improvement of
health outcomes and reduce health The flexibility and application of the
inequalities. design protocol and framework was
tested on two project case studies
This research aims to help decision- in Liverpool, UK and Baton Rouge,
makers to deliver better mobility Louisiana, USA during the research.
infrastructure in their city by While both project case studies are
understanding its relation and impact in areas with a strong interest in
on health and wellbeing. improving the health of the local
community, the design protocol and
AIM framework revealed different issues
Help decision-makers to deliver better and opportunities.
mobility infrastructure in their cities by
understanding its impacts on health,
well-being and other factors.
This research is the outcome of a
collaboration between Arup, BRE,
HOW UCL and AREA as part of Arup’s
Develop a clear framework that Global Research Challenge 2015. The
structures the relationship between Global Research Challenge is part of
mobility infrastructure and health Arup’s annual research investment
outcomes.
and aims to nurture open innovation
Develop workflow and process that around prioritised topics through
uses data to guide transport collaborations between academia,
decision-making for the best health
outcomes.
industry partners and Arup’s
employees.
OUTCOME
The result is a design protocol and
supporting framework which use data to
help design mobility infrastructure for
health outcomes through
evidence-based decision-making.
Health + Mobility 9
This report provides an overview of the research with particular focus on the
health and mobility framework, design protocol and its application on project For this project, the following key
case studies. The report contains the following chapters and appendices: definitions have been used:
MOBILITY
URBAN MOBILITY IMPACT ON HEALTH Mobility describes the ability of
Why health and mobility? people to move between places
and the ease with which they reach
HEALTH + MOBILITY FRAMEWORK activities, such as accessing essential
How can we make sense of the complex relationship between health and facilities, communities and other
mobility? destinations that are required to
support a decent quality of life and
DESIGN PROTOCOL a resilient economy. Mobility is
How can we design for health through mobility infrastructure? affected by transport infrastructure
and the services that facilitate these
APPLYING THE DESIGN PROTOCOL movements9, 10.
What does the design protocol look like when applied on real case
studies? MOBILITY INFRASTRUCTURE
The physical environment built by
WAY FORWARD humans, that includes bridges, roads,
How can the health and mobility agenda be taken forward? railways and transit hubs, together
with the natural environment, compile
APPENDIX mobility infrastructure9.
What are the existing tools/methodologies?
What are currently available data sources? HEALTH
References Health is described by the World
Health Organization as:
“Health is a state of complete physical,
mental and social well-being and
Increasing transportation investments not merely the absence of disease or
infirmity.”11
for projects that are focused on poor, This project focuses on human health
in OECD countries.
elderly, people with disabilities and other
vulnerable populations, is critical for
health at a national level as it can reduce
risk of obesity, cancer, mental health
disorders, asthma and heart disease12.
10
Urban Mobility
Impact on
Health
Health + Mobility 11
What are the key

relationships between
health and mobility?
12
Urban Mobility
TRENDS AND DRIVERS and diabetes16. Among other factors,
Transport and mobility are significant the risk factors for these diseases
Impact on
determinants of health and wellbeing include physical inactivity and being
in urban areas. The way that we move overweight or obese16. In 2012,
Health
about cities on a daily basis can impact noncommunicable diseases were
our health in many ways, both positive responsible for 68% of global deaths
and negative. Even when we are not and more than 40% of these were
travelling, the impacts of transport premature17. The impacts of these
Transport plays a key infrastructure such as air and noise diseases have social, economic and
pollution can affect our health. human costs.
role in global health
The global epidemics of obesity and The shift toward people living longer
challenges diabetes have achieved significant with chronic conditions is resulting in
media coverage with emphasis on growing costs for health care services
sedentary lifestyles amongst other (see Fig 3). In the United States,
causal factors. In the UK, 62% of 86% of all health care spending in
adults are overweight or obese13, 2010 was used for the treatment of
and nearly 4 million adults suffer people with chronic conditions19.
from diabetes14. The cost of treating The World Health Organization
diabetes-related conditions rose to recognises the complexity of
£10 billion in 2011-2012 in the UK15. these challenges and the need
Obesity and diabetes are not the only to involve multiple stakeholders
concerning health conditions brought across government agencies and the
on by our modern lifestyle. development industry to produce
urban environments that contribute
Noncommunicable diseases, also to preventing disease20. The answers
known as chronic or lifestyle diseases, will not come from healthcare
are rising globally (see Fig 1 and Fig practitioners alone; a whole-of-society
2). The four main chronic diseases are: approach is needed.
cardiovascular diseases (such as heart
attacks and stroke), cancers, chronic A cross-sector effort to produce
respiratory diseases (like asthma) healthy environments is required
60% 100%
Non-communicable diseases
90%
50% High income countries

80%
Upper middle income countries

Percentage of total DALYs
Percentage of total deaths
70%
40%
Communicable diseases, 60%

maternal, neonatal and World
nutrition disorders
30% 50%
Lower middle income countries
40%
20%
30%
Low income countries
Injuries
20%
10% Projections
Baseline scenario
10%
0 0
1990 1995 2000 2005 2010 2000 2005 2010 2015 2020 2025 2030
Fig 1: Global burden of diseases shown Fig 2: The increasing development of

through causes of loss of healthy life years18. noncommunicable diseases shown through
resulting deaths18.
because many factors influence our

health and wellbeing. Healthcare 10%
services and genetics are only part of a
bigger picture of complex interactions
between our lifestyle, environment
9%
and individual characteristics that
determine health22. These wider OECD average expenditure on health care
Percentage of GDP
factors are known as the ‘social
determinants of health’. Transport and 8%
mobility infrastructure fall into this
category as do education, housing,
employment and many other aspects
of our lives. Studies have tried to 7%
estimate the extent to which these
environmental domains influence our
health and wellbeing, resulting in the
6%
values ranging from 45% to 60%22. 2001 2003 2005 2007 2009 2011 2013
Year
Inequalities also strongly influence
health. There is a social gradient in Fig 3: OECD total health expenditure as a percentage of GDP21.
health with the poorest people dying
earlier and suffering longer from
disability than wealthier people23.
This is starkly evident in cities where
the life expectancy gap in different
neighbourhoods can range widely,
for example from 8 years in New York
City24 to 15 years in Glasgow25. In
cities, deprived neighbourhoods may
suffer from multiple inequalities, such
as poor quality housing, transport, and
schools. These challenges can be self-
reinforcing and are associated with
poor health.
It is clear that the social determinants

of health are very important, yet
they are governed by many different
policy areas outside of health. The
diagram shown in Fig 4 translates
this concept for urban planners
by demonstrating how the built
and natural environments interact
with social and economic factors to
influence health. The diagram shows
how transport and mobility are linked
to each section of this rainbow, with
the potential to positively impact our
health and wellbeing every day. Fig 4: The Health Map: Health determinants relating to the built environment26.
14
PHYSICAL ACTIVITY environmental and safety benefits8. increasing a city’s resilience to climate
One significant way to improve change impacts to improving its
population health is to increase Experts estimate that a strategic, long- competitiveness. Accessibility and
opportunities for physical activity term approach towards increasing availability of active and non-active
in everyday activities such as physical activity may be more cost- transport modes can promote exercise,
commuting. In addition to reducing effective than other initiatives that reduce inequalities and increase
the risk of chronic diseases, physical promote exercise, sport and active connectivity. This also has a positive
activity helps to: leisure pursuits in a short term32. impact on social cohesion, education
• Prevent excess weight gain27 City leaders and decision-makers and employability.
• Improve mental health28 may focus on the short-term costs
• Improve quality of life29 incurred in building health promoting IMPROVING HEALTH THROUGH
• Reduce the risk of premature environments. The long-term costs are TRANSPORT
death4. far higher and will affect individuals, The global trend of rising rates
employers and society at large. In of chronic diseases coupled with
Although the health and wellbeing addition to the health costs, cities with low levels of physical activity
benefits of regular physical activity low levels of physical activity have demonstrates the size and complexity
are clear, half of the British population lower productivity – losing on average of the challenges facing healthcare
does not meet recommended levels one week per working citizen per providers. Public health practitioners
of physical activity30. In the United year33. will not be able to change behaviours
States one in four adults report that through healthy eating and exercise
they do not engage in any physical There are many different approaches programmes alone. A fundamental
activity outside of their job31. Recent in transport policy and urban design shift in the way we design cities and
research has demonstrated that cities to encourage physical activity transport infrastructure is required
that promote physical activity through through public transport use and to tackle these problems. Transport
transport and mobility infrastructure active transport (usually walking agencies, planners and infrastructure
and dedicated programmes enjoy and cycling). These can also have providers can create walkable
significant economic, social, health, multiple co-benefits ranging from neighbourhoods by reducing distances
City-wide transport
infrastructure improvement
-Bogotà, Columbia
Decentralisation of urban planning The transport system improvements

powers in the mid-1980s led to a have increased physical activity34
radical transformation of transport and have positively impacted income
infrastructure in Bogotà, one of levels for those living near stations,
the densest cities in the world. A particularly lower and middle-
city-wide Bus Rapid Transit (BRT) income groups6. People living near
system, TransMilenio, with dedicated TransMilenio stations were more
lanes was constructed alongside an physically active35, 36, walking around
extensive cycle route, Ciclorutas, in 30 minutes or more per day37. The
2000. These interventions aimed to cycling system, in combination with
reduce air pollution, traffic congestion street design, route connectivity
and private car dependence. In and proximity to a ciclovia path, also
addition, the city upgraded pedestrian encouraged physical activity and
infrastructure and banned parking on resulted in people walking on average
sidewalks. 150 minutes per week or more37.
Prioritising cycling and walking

-Paris, France
In 2002 Paris introduced Quartier Paris’s bicycle-sharing system, Vélib,

Verts (Green Neighbourhoods) to was introduced in 2007, aiming to
improve active transport which reduce traffic congestion, air and
included: widening sidewalks, noise pollution, and to revitalise the
reducing the speed limit to 30km/h, city’s public spaces. City leaders paid
and eliminating through-routes to attention to lessons learned from
slow traffic. Other measures across the other bicycle sharing schemes and
city included banning free parking, used a combination of measures to
giving priority to pedestrians on ensure Paris’s system would be a
a network of shared streets, and success, such as: a large and dense
converting roadways and parking network (400 Km), ease of use, and
spaces into pedestrian/cycle paths. security deposits. There are estimated
These improvements led to a 20% to be 70,000 – 145,000 trips per day
reduction in private vehicle use; a 9% on Vélib bicycles40.
reduction in carbon emissions and
a 25% reduction in road injuries72.
Safer intersections for cyclists

in Denmark
-Copenhagen, Denmark
In an effort to reduce cyclist and Evaluations show that the intervention

moped accidents, the Municipality of acts as an effective ‘warning signal’
Copenhagen transformed signalised and affects road safety if there is one
crossings by applying blue cycle lanes. painted lane. Single lane crossings
These blue painted lines highlight showed a 32% reduction in road
the area of conflict between motor accidents and a 34% reduction in
vehicles and cyclists and provide a injuries. However, intersections where
dedicated lane for cyclists through the two to four blue cycle crossings were
intersection. marked, have shown an increase in
road accidents of approximately 30%.
The first blue crossing was created in (45) This indicates that consideration
1981, growing to 65 by 2003. They is required when identifying the
are now used throughout Denmark, appropriate arrangement for
as well as in other countries such as intersection design. Researchers
Sweden and in the US. The number note that safety is increased with a
of blue lanes varies between one and combination of appropriate lanes,
four lanes. signs and signals.
16
between destinations and improving litter, graffiti and dog mess were 50% zones, road causalities fell by 42%
cycling and pedestrian facilities. This less likely to be physically active, and from 1986 to 2006 with children and
will encourage physical activity and 50% more likely to be overweight or cyclists being the main beneficiaries
reinforce social support networks that obese41. City managers need to pay of reduced causalities4. This policy has
are important for health38. attention to environmental cues of risk significant financial benefits as well. In
and insecurity such as abandoned or Hull, England the city estimated that
The details count when it comes to run-down buildings. Adequate street 200 serious and 1000 minor injuries
creating infrastructure that supports lighting and passive surveillance can were prevented during an 8 year
walking and cycling. Pedestrians help people feel more secure. Parents’ period after introducing 20 mph zones
feel safer and are more likely to perceptions of safety (from crime or on residential roads. The cost savings
walk when there are sidewalks, traffic) are associated with the extent exceeded more than 10 times the
frequent crosswalks on busy roads, of children’s participation in physical initial £4 million set-up cost4.
good wayfinding signage and street activity42. Transport planners need to
lighting39. For cyclists, cycle lanes or take all of these needs into account Public transport networks can be
shared-use paths feel safer39. Women and encourage local communities, categorised as a form of active
are twice as likely as men to fear for including minorities and under-served transportation because people usually
their safety when cycling and they are populations, to participate in all walk to or from stops and stations.
more likely to cycle on off-road paths stages of planning to ensure transport Improving public transport services,
than busy roads40. Cyclists also need infrastructure will benefit everyone12, especially in low-income and minority
secure places to store bicycles at the 43
. communities, can improve wellbeing
end of journeys. through greater access to social
One intervention that is widely shown networks and employment. Locating
People’s perceptions of safety and to improve safety for all street users major commercial and institutional
crime within a neighbourhood is the 20 mph zone. According to the activity centres in highly accessible
influence the amount of time spent World Health Organization, this is the areas, increasing frequency of
outdoors walking or cycling. Results recommended speed limit for built-up services, and reducing travel times
from a European cross-sectional areas with shopping streets, schools can all help improve public transport
survey found that respondents from and residential streets44. In areas use and the associated social and
residential areas with high levels of of London that introduced 20 mph economic benefits. Infrastructure
Reducing traffic emissions

-London, England
In 2003, the central London Transport for London (TfL) estimates

Congestion Charge was introduced to that the following reductions were
improve congestion, car journey time achieved in the first few years of
reliability, goods and services delivery, the scheme: 8% reduction in road
and bus services64. The current daily traffic emissions of nitrogen oxides
charge of £11.50 per vehicle (between (NOx); 7% reduction in emissions
07:00 and 18:00 on weekdays) was of fine particulate matter (PM10);
applied within specified areas of and 16% reduction in emissions of
central London and has resulted in carbon dioxide (CO2)65. TfL also credit
fewer cars, safer streets and cleaner the Congestion Charge with a 27%
air. reduction in vehicles (80,000 fewer
cars per day) and a 66% increase in
The Congestion Charging Zone has cycling in the charging area since the
been credited with a 50% increase in scheme was introduced66.
bus usage (2002 to 2003)65.
such as shelters at bus/tram stops Creating an environment where people

and convenient ticket payment also
improve service uptake. actively choose to walk and cycle as part of
NEGATIVE HEALTH IMPACTS OF everyday life can have a significant impact
TRANSPORT
Car ownership is increasing globally on public health and may reduce inequalities
year by year, with new vehicle
registrations rising by almost 6% in health. It is an essential component of a
in the EU and 9% in the UK (2013
to 2014)46, and nearly 3% in the strategic approach to increasing physical
USA (2012 to 2013)47. Private cars
and other motorised vehicles affect activity and may be more cost-effective than
health through air pollution, noise and
traffic injuries with additional indirect other initiatives that promote exercise, sport
impacts resulting from car-centred
development patterns. and active leisure pursuits32.
Road injuries are the eighth-leading of city streets and transit waiting Young and older residents of streets
cause of death globally and they are areas52. with light traffic reported twice as
the biggest cause of death for people many acquaintances and friends on
aged 15 to 252. Poor traffic policies Transport systems are a great their street than residents of streets
and infrastructure, such as unsafe contributor to air pollution through with heavy traffic60, 61. In addition,
pedestrian crossings can lead to vehicle emissions. Ambient air heavy traffic results in a feeling of
accidents. Human behaviours, such pollution was linked to 3.7 million ‘reduced ownership’ of streets, which
as excessive speeding and alcohol premature deaths globally in 201253 can be prevented by better street
consumption, are responsible for 90% and 40,000 deaths annually in the design, promoting socialising among
of road fatalities48. Pedestrians are UK54. Vehicle emissions contribute residents38. A meta-analysis on the
the most likely road users to be killed substantially to air pollution through links between social relationship
in road accidents38 and chances for nitrogen oxides (NOx), particulate and mortality found that the quality
their survival decrease with increasing matter (from road dust, brake linings and quantity of social relationships
vehicle speed. Roads with speed limits and tire wear) and volatile organic influences mortality to the extent
of 20 mph are the safest, with only compounds55, 56. Air pollution, amongst comparable with well-established
5% of pedestrians likely to die from tobacco smoking, allergens and risk factors such as smoking and
collision with a vehicle at this speed. occupational risks, is considered alcohol consumption62. Different
In collisions at 30mph, about half of a primary risk factor for chronic transport modes can also aid the
pedestrians die, with fatalities rising respiratory conditions and is closely social interactions and cohesion
to 95% at 40mph49. associated with increased incidences through direct contact alongside the
of cancer57, 58. possibilities of people meeting and
Areas where residents tend to drive socializing.
less and rely on alternative modes People living near major roads with
have lower traffic fatality rates heavy traffic experience constant Research has suggested correlations
than more automobile dependent traffic noise and can suffer from sleep between travel mode and stress levels
communities50. Research shows that deprivation and annoyance as well with several studies indicating that
presence of more pedestrians and as stress and depression59. Traffic commuting by automobile generally
cyclists on the street is associated noise can be reduced through quieter appears to be more stressful than
with a reduced risk of motor vehicle road surfaces such as porous asphalt travelling by other modes. This
collision, suggesting that motorists which is considered to reduce noise stress appears to be attributable to
drive more cautiously due to by 4–8 dB, roughly the same effect as factors outside the driver’s control
increased awareness of high levels reducing traffic volume by half. including traffic delays, unpredictable
of pedestrian/cycling activities51. behaviours of other drivers, anxiety
Increased walking, cycling and public Heavy traffic is also linked to and time pressures56, 63.
transport appears to increase overall community severance, reduced
security of places and reduce crime social interaction and inability to
rates by providing passive surveillance access social services and support.
18
Health +
Mobility
Framework
How can we make

sense of the complex
relationship between
health and mobility?
20
Health and
The health and mobility framework regular journeys. The built
was set up as part of this work to help environment is focused on mobility
Mobility
structure the complex relationship infrastructure (i.e. hard infrastructure)
between the built environment in particular. It is acknowledged,
Framework
(focusing on mobility infrastructure) however, that softer measures
and health. The framework aims to including policy and education
review all transportation modes and to programmes also have an important
capture their numerous relationships role in how the built environment can
Defining and with health. This was done to affect health.
understand the broad and overall
organising the relationship rather than concentrating The area of affordability is not
exclusively on active transport, on directly included in the framework
relationship between which much recent research has at this stage but it is recognised that
focused, or the impacts of safety or transportation can create or reduce
health and mobility emissions which have often been financial burdens, particularly for
the only health related outcomes lower-income households where
considered in planning decision transportation expenditures comprises
making. a large percentage of household
budgets. A reduction of financial
The framework was designed and burden can allow money to be better
populated through a literature review. spent on purchasing healthy food and
This provided references of the medical care55.
individual steps or connections, and
revealed the overall relationships STRUCTURE
of mobility infrastructure to health. The health and mobility framework
This approach was undertaken as is based on the determinants of
the determinants of health exist in health: environmental and lifestyle
a complex system, which can make and behaviour factors. The third
direct causality of specific built determinant, personal factors, (i.e.
environment elements especially hard genetics) was not considered as part
to determine. of this framework.
For this project, mobility for transport From the determinants of health,
(as opposed to recreation) has been health impacts were identified which
the key interest as it provides a huge then lead to a health outcome. An
opportunity for improving public overview of the structure can be seen
health through the population’s in Fig 5.
Fig 5: High level structure of the health and mobility framework based on health determinants
MOBILITY INFRASTRUCTURE AND Environmental factors refer to the Personal factors refer to the users’
MODAL CHOICE conditions created which can be actual characteristics including gender,
The relationship of the determinants and/or perceived. This differentiation age and socio-economic status as
of ‘environment’ and ‘lifestyle and is made as studies have found that mentioned above. The cultural factors
behaviour’ to health can be broadly an individual’s perception of the refer to the societal characteristics,
categorised in two ways: environment influences modal choice attitudes and values which affect
• Environment impacting health even though there may be little the individual’s behaviours. This
directly (i.e. air pollution) association between perception and includes broader values to the specific
• Environment impacting health reality (objective environment)67. attitudes around transport modes
through influencing lifestyle and which can differ between countries.
behaviours (i.e. modal choice). These environmental conditions fall
under the following interrelated main All three of these factors influence
In the health context, the substantial themes listed below: each other.
research on the relationship • Safety
between automobile oriented urban • Comfort It is important to note that the
development and inactivity has • Attractiveness individual’s decisions that influence
created a strong interest in modal • Directness mobility choice are quite complex
choice. Alternatives such as public • Access and have been simplified for the
transport or active transportation • Coherence framework. An international literature
(walking and cycling) contribute review of over 300 studies, policies,
to physical activity as they require These environmental factors are models and reports on encouraging
physical exertion to get from one of particular interest as they relate walking and cycling modes concluded
place to another. Accordingly, directly to the design of mobility that our understanding of how users
a number of studies have been infrastructure. While each of these respond to various interventions
undertaken to ascertain how to create themes is relevant to each of the is limited. While there is a large
this modal shift and what motivates transport modes, the hierarchy of body of research available, complex
the public to walk, cycle or take public relevance, or priority, is dependent psychological, social and economic
transport. on the characteristics of the factors make it difficult to pinpoint
transportation mode as well as the the impact of various interventions.
The framework currently identifies users. An example of this can be seen Improved study designs and
three key factors which influence the where safety becomes a large aspect datasets are required to isolate the
link between mobility infrastructure of a parent’s decision whether to confounding factors67.
and modal choice: allow their children to walk or cycle68.
• Environmental Conversely for the elderly, coherence
• Personal (i.e. wayfinding) can play a bigger role
• Cultural. in deciding to walk69.
22
Framework structure
For clarity, the framework begins with

the built environment on the left and
DETERMINANTS OF HEALTH
health outcomes on the right. The
steps in between are categorised
according to the way the built
environment affects health, directly
or through lifestyle and behaviours
ENVIRONMENT
(i.e. travel behaviour or mobility
choice) and the health ‘impact areas’.
Factors which influence certain
relationships are introduced including MOBILITY INFRASTRUCTURE
the ‘conditions’ created or provided
by mobility infrastructure and its
performance.
CONDITIONS
PERCIEVED | ACTUAL
Mobility infrastructure covers three
components of:
SAFETY
• Links - segments of a route
MODES
• Intersections - crossing of links and COMFORT
modes DIRECTNESS
• Routes - comprised of links and WALKING
ACCESS
crossings to form a journey from
origin to destination. COHERENCE
These components are applicable for CYCLING
each transportation mode.
PUBLIC TRANSPORT
The framework currently identifies the
following areas in which transport is PERFORMANCE
considered to impact health directly PRIVATE MOTORISED VEHICLE

and indirectly: NETWORK RELIABILITY
• Exposure to noise NETWORK EFFICIENCY
• Exposure to air pollution
VEHICLE EFFICIENCY
• Physical activity
• Accidents and injuries
• Social contact
• Stress/frustration
The framework only represents one

way of structuring the complex and
multi-directional relationship between
the built environment and health.
HEALTH IMPACT HEALTH OUTCOME
LIFESTYLE & BEHAVIOUR
MOBILITY CHOICE
WALKING FOR TRANSPORT EXPOSURE TO NOISE ILLNESS & CONDITIONS
CYCLING FOR TRANSPORT EXPOSURE TO AIR POLLUTION FUNCTION & QUALITY OF LIFE
PUBLIC TRANSPORT USE PHYSICAL ACTIVITY MORTALITY
CAR FOR TRANSPORT USE ACCIDENTS & INJURIES
SOCIAL CONTACT
FRUSTRATION
24
Measures,
The health and mobility framework WALKING
can be used via indicators to allow • Percentage of land used for
Indicators and
planners, designers and decision commercial purposes by
makers to determine, assess and neighbourhood
Data
monitor how mobility infrastructure • Percentage of roadways with
is affecting health-related behaviours sidewalks
and outcomes. Further detail on the • Percentage of sidewalks with shade
process of using the framework and tree coverage
Evidence-based indicators to aid evidence-based • Number of pedestrian prioritised
decisions in designing for health crossings
design through the outcomes through mobility can be • Average crossing time
found in Chapter 3: Design protocol. • Average volume of daily
framework pedestrians at counting stations
Indicators have been included as • Distance covered by 15minute walk
part of this project to help assess and • Number of pedestrian and vehicle
understand the complexity of the incidents
transport and health system, with
the aim of improving evidence-based CYCLING
decision-making and allowing ongoing • Number of bicycle share locations
review and improvement. Indicators • Number of bicycle parking at
are a simple measure necessary to destination locations
help understand information in a • Percentage of streets with cycling
complex system, but should not be specific facilities
seen as a comprehensive source of • Percentage of cycling network with
information. lighting
• Length of continuous cycling path
The framework areas which can • Number of cyclists per day against
be measured through a number of cycling facility types
indicators are as follows: • Number of cyclist and vehicle
• Mobility Infrastructure incidents
• Conditions
• Performance PUBLIC TRANSPORT
• Lifestyle and Behaviours (including • Percentage of population living
factors which influence lifestyle and within 500m of a public transport
behaviour such as demographics stop
and culture) • Frequency of public transport per
• Health impact areas hour
• Health outcomes. • Percentage of residential area
serviced by public transport
Each of these areas can be measured network
through a number of indicators to • Number of public transport stops
allow for flexibility depending on per km of road
data availability. Based on a review • Number of public transport services
of research, tools and metrics, the • Number of public transport patrons
following examples of indicators are daily
provided: • Frequency of public transport per
hour
MOTORISED VEHICLE SCALES AND DATA ISSUES

• Number of traffic counts The majority of the data which feeds There are a number of consideration
• Number of vehicular incidences into the indicators are spatially when gathering data for the indicators.
• Percentage of modal splits attributable (i.e. the data can These include the following:
• Average number of cars per be related to a spatially defined • Data availability and coverage is
household boundary). This is important to not consistent across different
• Method of journey to work provide a structure for comparing and countries, cities or locations.
• Average vehicle miles travelled contrasting different neighbourhoods Depending on the data, information
daily or regions within the appropriate area may be biased to certain framework
• Average commute time unit. areas (i.e. built environment data
• Roadway level of service (LOS) is abundant while there is limited
When acquiring data, finer grained health data) which can result in an
data is generally preferred. It can unbalanced assessment.
DEMOGRAPHICS help identify the level of influence • Different datasets are often
• Age profile of population of design on a local scale for aggregated differently including
• Sex profile of population health impacts. It can also be easily different spatial boundaries which
• Social economic status aggregated to a higher scale while do not correspond to each other.
aggregating city level data to a local This can make it hard to compare
level may not provide the appropriate different datasets.
HEALTH IMPACT information. • Much of the data required to input
• dB level from roadways near into the indicators, particularly
residences The ‘grain’ or scale of data needs health related indicators, are
• Percentage of Nitrogen Oxides in air to be considered with the different typically aggregated to a higher
• PPM levels transportation modes since each mode scale (i.e. council level) to
• Percentage of population has a different reach and impact. For anonymise and protect the privacy
undertaking sufficient physical example, walking tends to have a of individuals. This makes it difficult
activity greater impact on the local scale while to assess health impacts on a local
• Number of traffic related incidences public transport/automobile generally level.
• Number of street crime incidences has a city scale or regional impact. • The data can range in age and
quality.
With this in mind, it is important to
HEALTH OUTCOME consider the data required beyond These issues can cause difficulty
• Life expectancy at Birth the project boundary as the issues in acquiring appropriate data for
• Population’s self-reported health and opportunities held by the project indicators and caution should be taken
level distribution may lie elsewhere, depending on the when applying data and indicators to
• Prevalence of obesity, BMI of 30+ transportation mode involved and the aid evidence-based decision making.
(percentage of population) type of network.
• Type 2 diabetes prevalence A list of open data sources for several
(percentage of population) countries is provided in ‘Appendix B.
• Respiratory problems prevalence Data sources’ as a starting point.
(percentage of population)
• Asthma prevalence (percentage of
population)
• Cancer prevalence (percentage of
population)
• Coronary heart disease prevalence
(percentage of population)
26
Design
protocol
How can we design for

health through mobility
infrastructure?
28
Design protocol
Planning and design

should contribute BENCHMARKING
positively to creating IDENTIFYING SYMPTOMS
How is the area currently performing?
an environment that What vital signs could be improved?
DIAGNOSIS
promotes health.
The mobility + health design protocol SYMPTOMS
is a guidance procedure to help design AND
and assess mobility infrastructure in ASSESSMENT
relation to health outcomes.
OPPORTUNITIES &
The design protocol is based on
Health Impact Assessments (HIA)
CONSTRAINTS
processes (see appendix A. Existing SYMPTOMS ASSESSMENT
tools and methodologies) and Why is the area performing like this?
the framework (Chapter 2) which What are the opportunities and
describes the relationships between constraints?
the built environment (mobility
infrastructure) and health outcomes.
The protocol helps to highlight:
• Which particular health areas can
be influenced by mobility; and
• What mobility infrastructure design
measures could influence health
outcomes.
It is intended to be a supplement to
SCENARIO TESTING
current planning and design processes INTERVENTIONS AND PRESCRIPTION
such as visioning, masterplanning What are the design options?
or strategy development to ensure What should be prioritised?
that opportunities to create an TREATMENT
environment which promotes health
through mobility infrastructure are
considered alongside other key PRESCRIPTION
outcomes. AND
CHECK UP
The guidance procedure is based
on the following steps which are
interrelated and can be taken
FOLLOW UP
sequentially or standalone: CHECK UP
How is the area performing after
implementation?
Are there further areas to improve?
Diagnosis For the benchmarking process to have Treatment

value, measures and indicators from
BENCHMARKING at least two of the framework areas SCENARIO TESTING
Benchmarking helps identify how should be evaluated such as mobility Design scenarios can be based on the
something measures up against the infrastructure and health impact outcomes of the Opportunities and
average or a standard. Accordingly, areas. This can then give an indication Constraints assessment. The scenarios
for each indicator or measure that is of which relationships need to be that are developed can either be:
used in the benchmarking process, further investigated and which built • A series of design options
a relevant and appropriate standard environment areas could help improve which respond to the various
is required to allow comparison and the outcomes. opportunities and constraints
assessment. simultaneously; or
The benchmarking process is intended • A series of design options which
Different geographic scales need to to help identify potential issues or address only a single goal issue or
be considered in the benchmarking ‘symptoms’ in a ‘mobility – health’ opportunity (i.e. scenario where
process. This is because different context that should be taken to the the only goal is to create better air
transport modes influences different next stage of the protocol. quality).
scales (i.e. walking on a local scale)
resulting to health impacts being OPPORTUNITIES AND CONSTRAINTS The scenarios can then be qualitatively
seen in different scales. The different This stage assesses the issues/ assessed against a number of health
geographic scales should consider symptoms identified in the outcomes relationships which can be
the type of project and mobility benchmarking process to understand influenced through the framework
infrastructure which is being designed. the related opportunities and by understanding the wider and
Suggested scales include: constraints and potential solutions. interrelated relationships.
• Street (micro)
Comparison with best practice Using the framework, the FOLLOW UP
• Precinct (study area) improvement areas identified After the chosen design has been
Comparison to best practice or through the benchmarking process implemented, the outcomes should
surrounding neighbourhood can highlight the relationships be monitored periodically to check
averages which need to be further examined. whether they meet the expectations.
• City (metropolitan area) Once these relationships have been The outcomes can be monitored in
Comparison to similar or best identified, small focus studies can be relation to lifestyle/behaviour, health
practice cities undertaken. These studies can involve impacts or health outcomes.
• Region (macro) further focused data collecting and
Comparison with national average. benchmarking to drill down to the key This step helps to close the gap
issues to identify key opportunities between knowledge/design intention
The areas to be benchmarked are and challenges. and actual outcomes. The results from
derived from the four areas of the the follow up should be fed back into
framework: The outcome of the assessment the Health and Mobility framework,
• Mobility infrastructure provides input for a design brief of contributing in this way to further
Availability/type/condition and improving or transforming the areas develop the health and mobility body
performance that require attention according to the of knowledge.
• Lifestyle and Behaviours (including identified symptoms.
demographics) The Health and Mobility framework
• Health impact areas is a continually evolving piece
• Health outcomes of research and does not aim to
definitively state relationships but
A list of potential measures and provides potential links as defined
indicators can be found in ‘Chapter through the literature review. As
2: Health + Mobility Framework’ the relationships are complex and
alongside discussion around of issues still being actively researched,
related to data. it’s expected that the framework
also evolve as new information is
uncovered.
30
Applying
the Design
Protocol
What does the design

protocol look like when
applied on real case
studies?
32
KNOWLEDGE QUARTER, LIVERPOOL UK
BATON ROUGE, LOUISIANA USA

Testing the
assets including the Philharmonic In the creation of the Baton Rouge
Hall, theatres, a number of leading Health District, planners worked with a
design protocol
universities, the Royal Liverpool coalition of health care providers and
University Hospital and other related community entities to identify best
international medical institutions. practices in design of healthy places
While the area contributes as well as the organisational structure
significantly to the city’s economy, required to support such change.
Identifying the environmental and social context
has suffered from piecemeal and The Baton Rouge Treatment Plan takes
opportunities, uncoordinated urban and transport a “medical approach” to diagnosing
planning and inconsistent public realm problems and prescribing solutions,
constraints and in a context of severe deprivation. identifying key health indicators,
For an area that contains some of the benchmarks in similar contexts, and
interventions for two key health institution which operates metrics for success with regard to
on an international level, the urban health and healthy behaviours. The
real case studies. realm can be significantly improved to Treatment Plan also calls for regular
support healthy living. check-ins, to measure progress
Two case studies were selected to be and understand where changes in
assessed against the design protocol Liverpool City Council recognises approach are needed.
and framework. The Knowledge the area as a key regeneration
Quarter in Liverpool, UK and the Baton opportunity which can capitalise on While it does not lay out one
Rouge Health District in Louisiana, recent and future investment from specific physical design solution,
USA were chosen based on both the the universities, hospitals, and private the Plan identifies specific physical
need and desire to improve the health sector investment as well as a growing characteristics and priority design
of their community. While the two student population. elements based on the Design
studies share similar traits, they are Protocol. Scenario testing of these
set in different contexts and different BATON ROUGE, LOUISIANA, USA elements in combination led to the
stages of the regeneration process. The city of Baton Rouge in Louisiana, creation of a potential full-build
United States, is a microcosm of scenario as illustrated in the following
KNOWLEDGE QUARTER, LIVERPOOL the health and healthcare issues pages. The identification of success
UK communities across the nation are metrics is critical to ensuring that any
The City of Liverpool, United Kingdom facing, from high rates of diabetes future final designs meet the goals
sits in North West England and and obesity to a lack of alternatives laid out in the plan.
displays significantly poorer health to private vehicles. However, the
rates when compared to other parts concentration of health care providers
of the country with large variations within the Baton Rouge Health District
across the city. The city has been listed provides an opportunity as well as
as one of England’s most deprived incentive to improve health condition
local authority in the past few years, of people living and working in and
with the city region ranking amongst around the District.
the most deprived on the income,
employment and health and disability As hospitals and healthcare systems
domains of the Index of Multiple expand their focus to population
Deprivation 201573. Programmes such health, planning at the district level
as “Healthy Liverpool”, led by the NHS enables them to influence health
are soft initiatives and respond to beyond the walls of their facilities
Liverpool’s health problems. They are and the boundaries of their campuses.
promoting healthy lifestyles, whilst Across North America, competitive
offering a fresh approach to care and healthcare institutions are tackling
health services. Liverpool City Council these issues as collaborative, place-
recognises that the built environment based “health districts.” Both through
is a key determinant of health. their structure and mechanisms of
The Knowledge Quarter occupies the functioning, health districts support a
east edge of the city centre and hosts culture of health.
a combination of learning and cultural
34
i Knowledge Quarter, Liverpool UK

The Liverpool Knowledge Quarter, located east of Liverpool City Centre, is an
area of higher education, science, medical expertise, knowledge and wealth
creating potential. It hosts a cluster of world class biomedical institutions
including the Royal Liverpool University Teaching Hospital, the Liverpool
School of Tropical Medicine, Merseybio Incubator and a number of bio-medical
research institutions. The educational institutions of the University of Liverpool,
Liverpool John Moores University, Liverpool Hope University, Liverpool
Community College and Liverpool Institute for Performing Arts are situated here.
Although dominated by science and educational institutions, the Knowledge

Quarter assets are supported by an increasingly high quality cultural and leisure
offer, focused around Hope Street. The area also contains clusters of residential
properties which are occupied by both students and local residents.
Together the Knowledge Quarter institutions generate in excess of £1billion for

Liverpool each year, more than 15% of the city’s total GVA. These institutions
support over 14,000 full-time jobs, equating to approximately 7% of the total
jobs in Liverpool74.
The area is considered to be crucial in the wider regeneration of Liverpool. In

this case study opportunities for interventions in the mobility infrastructure
are identified, that will contribute to improving the health and wellbeing of
Liverpool.
The area is at an early stage of the regeneration process. The design protocol
has been used to provide a high level assessment of the transport in relation
to health outcomes. The evaluation obtained is context-specific and aims to
facilitate creation of vision and strategy leading to it.
City centre
Key routes
Liverpool John
Moores University
Moorfields
Station
Cultural The Royal Liverpool
Quarter University Hospital
Lime Street
station
Central Retail
Area
Three Graces James Street
Station University of
Liverpool
Central
Station
Liverpool John
Moores University
Albert Dock
Liverpool
Women’s Hospital
Echo Arena
Exhibition Centre
Liverpool
36
City of Liverpool
LIVERPOOL IS A MARITIME CITY
ON THE EASTERN SIDE OF THE
MERSEY ESTUARY. ALTHOUGH THE
CITY DATES BACK TO AROUND
1200, MAJOR URBANISATION
AND EXPANSION OF THE CITY
TOOK PLACE DURING THE
INDUSTRIAL REVOLUTION LEADING
TO LIVERPOOL PLAYING AN
IMPORTANT ROLE IN THE GROWTH
OF THE BRITISH EMPIRE. SUCH WAS
LIVERPOOL’S ROLE IN WORLD TRADE
THAT IT WAS GRANTED WORLD 7.5 km
HERITAGE STATUS IN 2004 AS A
30 min
PROTECTED MARITIME MERCANTILE
CITY.
LIVERPOOL CITY
Size 111.8 km2
POPULATION
City 473,100 (2014)
Rank 9th (England)
City region 1.517.500
The Knowledge Quarter occupies the Liverpool has an extensive road

east of the City Centre and is within network. Multiple roads classified as
a 7.5km radius from the wider city “Class A - Principal road in Urban area”
boundary. run through the city, often carrying
large volumes of traffic. However,
In Liverpool there is a close correlation these roads do not cater for users
between social deprivation and poor other than cars and buses and often
health. The life expectancy as well function as barriers to pedestrian
as the number of premature deaths movement. Despite this extensive
are significantly worse than the road network, congestion is often
England average. 76% of all deaths in reported as a problem in Liverpool.
Liverpool are premature, due to cancer,
cardiovascular disease and respiratory The number of local buses serving the
disease75. whole of the city and its surrounding
areas is notable. These services run
Liverpool’s transport infrastructure is from two centrally located terminals
very much centred around road and (Queen Square and Liverpool ONE Bus
rail networks. The local urban rail Stations). Additionally, a coach station
network serves the whole of Liverpool offers long distance coach services.
city region. The national mainline
network provides Liverpool with Most of Liverpool, not taking
connections to major towns and cities topography into account, is within
across England. Both networks are bicycle range. Yet, the modal share for
accessible from Liverpool Lime Street cycling is low. A bicycle hire scheme
station, at the fringe of the Knowledge has recently been installed, however
Quarter area. cycling infrastructure is limited.
HEALTH ISSUES
Mortality from cardiovascular diseases and

cancers is up to 1.3 times higher than the
England average. Within England, hospital
admissions due to asthma and respiratory
Liverpool’s road
problems are highest in the North West and,
traffic causes
within the North West, they are highest in
congestion, poor air
Liverpool75.
quality and has a
negative impact on INACTIVITY ACTIVE MOBILITY INFRASTRUCTURE
the ability to cycle

and walk.
52.4% of all 28.5km
adults in Liverpool are dedicated cycle lanes
physically inactive76. in Liverpool78.
Copenhagen
TRANSPORT RELATED EMISSIONS
(Population: 580,184)
57% of the NO 2
has a total of 454 km
(main cause of poor cycle lanes79.
air quality across the
MODAL CHOICE
UK) from local roads in
Liverpool is accounted 44-69%
for by buses75. of all trips to work are
within cycling range80.
37 hrs wasted 49% of all trips

in traffic annually
to work are by car81
per driver in 2015 in
while only 2% are by
Liverpool (UK is 6th in
bicycle81.
Europe with 30 hrs) . 77
38
Surrounding neighbourhoods
APART FROM THE CITY CENTRE Surrounding Neighborhoods
AND THE RIVERSIDE, THE AREA
Knowledge Quarter Core Area
SURROUNDING THE KNOWLEDGE
QUARTER IS CHARACTERISED BY Liverpool wards
ONE OF THE HIGHEST DEPRIVATION Kirkdale
RATES IN ENGLAND
Everton
In terms of demographics, these areas
display high levels of 18-24 year olds
(37.2%), when compared to the rest of
Liverpool82. This is due to the presence
of the universities and student Kensington & Fairfield
accommodation.
Central
Almost 39% of residents from the
neighbourhoods surrounding the
Knowledge Quarter travel less than
Pincton
2km for work: either within their
own neighbourhood, the Knowledge
Quarter or Liverpool City Centre80.
The percentage of people who Princes Park

walk to work is comparable and car
Riverside
ownership is relatively low in these
neighbourhoods81.
Based on the all above, one can

conclude that the areas surrounding
the Knowledge Quarter are largely
pedestrian used areas. However, major infrastructure unintentionally promoting short
elements such as railways, inner distance travel by motorised transport,
With its central location the ring roads and the subsequent urban due in part by the areas topography.
Knowledge Quarter plays an important clearance lead to a poor pedestrian
role by physically connecting the and cycling environment with a low
deprived neighbourhoods with the social security level. This is likely Liverpool
opportunities available in the city to be discouraging the residents
Surrounding neighbourhoods
centre. from walking or cycling while
Knowledge Quarter
Modal choice for travel to work Distance travelled to work

60% 45%
40%
50%
35%
40% 30%
25%
30%
20%
20%
15%
10% 10%
5%
0%
Rail Bus Taxi Car or van Passenger in a Cycling Walking Other or work 0%
car or van from home < 2km 2km - 5km 5km - 10km > 10km
Fig 6: Modal choice for travel to work and distance travelled for the City of Liverpool, the Knowlege Quarter and its surrounding neighbourhoods.
DEPRIVATION
Everton, Kirkdale and Princes Park Wards have

the largest population within the 1% most
deprived in England83.
The neighbourhoods
surrounding the All of the LSOAs1 within Kensington & Fairfield,
Liverpool Knowledge are within the 10% most deprived in England83.
Quarter are mainly
CAR OWNERSHIP MODAL CHOICE
pedestrian used
areas. 66% of 55-68%
households in of all trips to work are
the surrounding within cycling range80.
neighbourhoods do
not have a car84. 2% of all trips are
by bicycle81.
39% of all trips

to work are made by
walking81.
1 A Lower Layer Super Output Area (LSOA) is a geographic area, used for
reporting of small area statistics in England and Wales.
40
Knowledge Quarter - Precinct

THE KNOWLEDGE QUARTER OFFERS HIGH QUALITY ASSETS WHICH ARE LOCATED IN A GENERALLY POOR,
FRAGMENTED AND DISCONNECTED URBAN ENVIRONMENT
70/h
Lime Street
Train Station
30/h
20/h 100/h
100/h
120/h
1.2 km
Queen Square
Bus Station 15 min 25/h
40/h
Liverpool One 10/h 10/h

50/h
Bus & Coach Station
12/h
30/h
20h
Bicycle lane (in the direction of the end marker)
Roads which are part of bus network
Major road link north of the Knowledge Quarter
Fig 7: Indication of the number of buses per hour in one direction on different segments in the area85, 86, 87.
It takes 15 minutes to walk across the The overall quality of pedestrian Demographics, car ownership, modal
Knowledge Quarter. Pedestrians enjoy routes is suboptimal with poorly choice and distance travelled to work
a number of architecturally attractive maintained footpaths, limited seem to suggest that residents of
landmarks which aid in legibility in access to green space and cluttered the Knowledge Quarter travel the
the area. In contrast, the environment street furniture. Furthermore, cycle neighbourhood by walking. They use
outside the core area is fragmented infrastructure is very limited within public transport or car on trips outside
and, in places, disconnected. the Knowledge Quarter. None of the the area.
scarce bicycle paths running towards
Generally the road infrastructure is the area continues through the
car-dominated with multiple high Knowledge Quarter.
capacity urban roads running through
the area. Access to bus services can be
considered outstanding. Multiple high
frequency bus services are within
walking distance. On the downside,
a number of roads along the edges
and even through the area cater
for over a 100 buses per hour. This
creates challenges with noise and air
pollution, as well as congestion.
MAJOR ROAD INFRASTRUCTURE CAR OWNERSHIP
20-37k 73% of
cars drive along the households without
major road links on car (46% in
Roads in the area are an average day of the Liverpool)84.
dominated by cars year (one direction)88.
and buses, causing a
BUS SERVICES POPULATION BY AGE
negative impact on
the environmental 55 bus stops 68% of people
quality.
28 bus routes in the Knowledge
Quarter are aged
within walking range
18-24 compared to
in the core area86.
14.2% in Liverpool
Local Authority82.
Car-dominated
streets
Many roads in Liverpool display a
combination of factors which have a
negative impact on the quality of the
urban environment.
Wide roads, cars parked on sidewalks
and clumsy placing of signs make
for a poor pedestrian environment
and discourage the development of a
street life.
Absence of dedicated bicycle lanes
and poorly maintained roads make
cycling unnecessarily dangerous and
uncomfortable.
42
Air quality and active travel

BELOW IS AN APPLICATION OF THE FRAMEWORK IN THE DETERMINATION OF SOME OF THE DETERMINANTS THAT
COULD LEAD TO A HEALTHIER TRANSPORT INFRASTRUCTURE FOR THE KNOWLEDGE QUARTER
DETERMINANTS OF HEALTH
ENVIRONMENT
DESIGN CONDITIONS
MOBILITY INFRASTRUCTURE
EXAMPLES PERCIEVED | ACTUAL
SAFETY
DOES THE USER FEEL SAFE AND IS THE ENVIRONMENT SAFE?
REDUCED CONFLICT BETWEEN USERS AND MODES
LIGHTING PROVIDED (WELL LIT)
VISIBILITY
SIDEWALKS PERCEPTION OF BEING SAFE
PASSIVE SUVELLIANCE (ACTIVE FACADES)
CROSSINGS
COMFORT
SIDEWALK ON BOTH SIDES OF STREET DOES THE USER FEEL COMFORTABLE START / END / DURING THEIR
BRIDGES JOURNEY?
WALKING PROTECTION FROM NOISE, POLLUTION, SPRAY AND GLARE
SIGNALISED CROSSING
TUNNELS PROTECTION FROM CLIMATE / WEATHER (RAIN, WIND, HEAT)
FACILITIES AVAILABLE (BEGINNING / DURING / END OF JOURNEY)
PRIORITY PEDESTRIAN CROSSING (ZEBRA)
PASSAGES SUITABLE SURFACES
RELATABLE SCALE
STREET FURNITURE ...
CYCLEPATHS DIRECTNESS
IS THE USER ABLE TO ACCESS THEIR DESTINATION DIRECTLY AND
BICYCLE PARKING EFFICIENTLY?
...
CYCLING BICYCLE HIRE STATIONS

ACCESS
IS THE USER ABLE TO ACCESS THEIR DESTINATION AND MOVE EASILY?
SIGNAGE
...
E-BIKE CHARGING STATIONS

COHERENCE
ROADS ARE USERS ABLE TO NAVIGATE AND SPACES EASILY UNDERSTOOD?
...
INTERSECTIONS
SIGNAGE
PERFORMANCE
CAR PARKING
ITS (INTELLIGENT TRANSPORT SYSTEM)
NETWORK EFFICIENCY / RELIABILITY
TUNNELS
PATRONAGE
STREET WIDTH INCREASE
VIADUCTS TRAFFIC VOLUME
ROAD CAPACITY
TRAFFIC SIGNALS
BRIDGES CONGESTION
TRAVEL SPEED
STREET PATTERN / DESIGN PREDICTABILITY OF JOURNEY TIME
BUS LANES
SERVICE DISRUPTIONS
INTERSECTIONS BUS STOP / INTERCHANGE DESIGN
TERMINALS SPEED LIMITS

BUS VEHICLE EFFICIENCY
BUS STOPS ... EMISSIONS
SPEED
INTERCHANGES
ENERGY CONSUMPTION
...
HEALTH IMPACT HEALTH OUTCOME
LIFESTYLE & BEHAVIOUR
REDUCE CAR USE
EXPOSURE TO NOISE RESPIRATORY PROBLEMS
INCREASE CYCLING FOR TRANSPORT
REDUCE VEHICLE EMISSIONS EXPOSURE TO AIR POLLUTION ASTHMA
INCREASE WALKING FOR TRANSPORT
PHYSICAL ACTIVITY CANCER
INCREASE PUBLIC TRANSPORT USE
ACCIDENTS & INJURIES PREMATURE DEATH
SOCIAL CONTACT STRESS

REDUCE NUMBER OF VEHICLES
FRUSTRATION OBESITY
CARDIOVASCULAR DISEASE
REDUCE BUS USE FOR SHORT TRIPS
DIABETES
INCREASE CYCLING FOR TRANSPORT
INCREASE WALKING FOR TRANSPORT

44
Exposure to This, next to causing air pollution, Based on the detailed version of
air pollution
impacts negatively on the quality of the framework, the main challenges
the urban environment, especially identified for Liverpool focus
and physical
when considered from the perspective around reducing emissions from
of pedestrians and cyclists. transport and promotion of active
inactivity
modes of transportation. The latter
For cyclists we see that modal share will contribute to both reducing
is quite low, even though most of the emissions as well as increasing
In Liverpool, the impacts of poor city could be cycled across within 30 physical activity levels. In the context
air quality, due in part to the cities minutes if infrastructure would allow of neighbourhood deprivation it is
maritime location and prevailing cyclists to move around efficiently. important to increase the connectivity
wind direction, and lack of physical Despite the high capacity of the of the neighbourhoods surrounding
activity on health condition are existing road network, continuous the Knowledge Quarter with the
apparent. Mortality rates originating in increase in road traffic causes severe Knowledge Quarter and the city
cardiovascular diseases and cancers, congestion, which leads to frustration centre, by removing physical barriers
as well as number of admissions and even more harmful emissions. as well as improving walking and
to hospital due to asthma or other cycling conditions. This will positively
respiratory conditions are higher than Another observation from the impact the ability of their inhabitants
in the other cities in the UK. benchmark study is that a high to access facilities and opportunities.
number of bus lines, combined with
Although walking seems a popular high frequency of operating, is the The following pages outline the key
mode of transportation in the central main contributor to the NO2 levels aspects of these challenges as defined
areas of the city, the city wide in Liverpool exceeding the imposed through the detailed framework.
mobility infrastructure is very much limits.
car oriented. As a result roads are
dominated by motorised traffic.
Reducing
INCREASING EFFICIENCY AND Additionally, a number of traffic
RELIABILITY OF THE NETWORK management improvements can be
vehicle
Increased efficiency and reliability of considered, including:
both bus and road network is expected • Traffic reporting and variable
emissions
to contribute to a modal shift to public message signs installed along the
transport and indirectly - to reduction roadway, to advise road users
of vehicle emissions. • Linking navigation systems up to
Reducing vehicle emissions can be automatic traffic reporting
achieved through a number of ways, The efficiency and reliability of the bus • Providing real-time traffic counts
the most obvious one being the network in Liverpool could potentially • Parking guidance and information
reduction of the number of emitters, in be improved by optimising the systems.
this case - motorised vehicles. This can network configuration and frequency
be done by promoting a modal shift of the services. For example, lines
to active transport for shorter trips can be cross-linked, number of buses
and public transport for trips longer adjusted in order to increase the
than 7.5km. Secondly, improving the patronage, while simultaneously
throughput and quality of the road decreasing the journey times and bus
network, as well as the efficiency idling times. In doing so, it should be
of the bus network, could reduce ensured that the average distance
emissions. Lastly vehicle emissions between bus stops and the percentage
can be reduced by improving the of area covered remain acceptable.
efficiency of the vehicles or switching Other possible measures include bus
to different types of vehicles, for priority systems and protected bus
example electric or hydrogen fuel-cell lanes.
vehicles. This is especially relevant for
the buses in Liverpool which have low Given the number of bus lines
environmental standards. operating currently in Liverpool, an
alternative public transport system
MODAL SHIFT TO PUBLIC like a tram or new metro lines could
TRANSPORT be considered. However, in the long
There are different incentives and run the impact of the intervention will
disincentives that can be used in order outweigh its cost.
to promote the use of public transport
rather than the use of a car: A potential opportunity would be to
• Improve park and ride facilities reduce road capacity in places through
• Provide more circular routes calming, shared space and allocation
• Decrease parking facilities to active modes to slow traffic down
• Increase the reliability of public and improve the flow. It has been
transport service observed that many streets in the
• Increase the predictability of Knowledge Quarter consist of 2x2
journey time lanes which means they should be
• Decrease journey time. able to handle approximately 3,000
cars/hour. It is unlikely this capacity
is required in all of these streets,
however this assumption should be
checked against traffic counts and
projections.
46
Promoting
wide, ending on the sidewalks or of potential users and through
being cut off by major roads. engagement with businesses through
active mobility
corporate travel plans and planning
Examples of measures to improve the conditions on new developments.
cycling network are:
Although the use of public transport • Dedicated and protected cycle Although the demography and scale
should be promoted for longer trips, lanes of the Knowledge Quarter suggest
replacing short trips by active modes • Cycle routes with priority that the mode share of cycling could
has a positive impact on both air • Dedicated cycling traffic controls be a lot bigger, it is important to keep
quality as well as physical activity. • Absence of clutter in signage in mind that the topography of the
• Improved parking facilities at area will be a limiting factor. The land
To achieve this both the pedestrian destinations rises steeply upwards from the River
and cycling network need to be • Creation of clear level crossings Mersey. Pedestrian and cycle access
improved at many levels, including or grade separated crossings by from the core commercial centre and
additional mobility infrastructure removing barriers. public transport hubs requires a climb
and the conditions of the existing up fairly steep streets, which will be a
infrastructure. A strategy for implementing these counteracting factor for the use of the
measures should be based on an systems.
WALKING INFRASTRUCTURE understanding of the current flows
The walking infrastructure of the
Knowledge Quarter can be improved
in different ways:
• Establishing clear walking routes
with signage indicating destinations
and their distance
• Removing obstructions in the
network
• Removing clutter from the
sidewalks
• Giving priority to the pedestrian in
the design of the public realm
• Minimise waiting times at
intersections
• Connecting walking routes to
(existing) green infrastructure
• Enhancing connections with
surrounding neighbourhoods by
creating additional crossings with
major roads currently disconnecting
these areas
• Providing consistency in the quality
of the public realm.
CYCLING INFRASTRUCTURE
Even though Liverpool has the
ambition to become a cyclist-friendly
city, a safe, comfortable, well-
connected, accessible and coherent
network is still missing.
Over the past years just 2 kilometres

of cycle lane has been installed,
however these lanes do not form a
network and contain design errors
such as lanes not being sufficiently
In addition to increased physical

activity and reduced exposure to air
pollution, these measures have some
additional health benefits:
• Fewer motorised vehicles to reduce
Other measures
noise pollution arising from traffic
• Less motorised traffic and
and benefits
congestion for increased road
safety
• Less congestion and traffic intensity
Apart from the physical interventions for decreased stress and frustration
described on previous pages, there • Less congestion for better
are additional measures to decrease movement of emergency vehicles.
the exposure to air pollution and to
promote active mobility:
• Pricing strategies for public
transport modes
• Reducing the need for travel
• Promotion of more flexible work
place practices
• Telecommuting encouraged through
legislation and subsidies
• Increasing vegetation to filter air
• Parking and bus lane enforcement
• Wider availability of city bicycles.
48
Design Protocol
A PROGRAMME FOR HEALTHY INFRASTRUCTURE
Although the Knowledge Quarter has the potential to
Summary
spark a wider regeneration process, a city wide programme
is required to move towards a healthier mobility
infrastructure for Liverpool. This would include the
development of consistent and legible networks for active
Knowledge Quarter modes as well as a more efficient public transport system.
BENCHMARKING OPPORTUNITIES &

CONSTRAINTS
SYMPTOMS REDUCING VEHICLE EMISSIONS
• High mortality rates from cardiovascular diseases • Modal shift to public transport
and cancers as well as admissions to hospital with • Increasing throughput and quality of road network
asthma and respiratory problems • Increasing efficiency and reliability of the bus
• High percentage of inactive adults network.
• NO2 levels exceed the annual average objectives
• High number of short trips taken by car or bus. PROMOTING ACTIVE MOBILITY
By adding mobility infrastructure as well as improving
CAUSES conditions of the existing infrastructure.
• A car oriented, yet congested, urban environment • Pedestrian network
• The network for active mobility fails to meet all • Cycling network.
basic criteria
• Major road infrastructure disconnecting surrounding
neighbourhoods
• An inefficient bus system.
SCENARIO TESTING
POSSIBLE SOLUTIONS TO INVESTIGATE
• An alternative public transport system such as a tram or extended metro system
• Allocation of road space to modes other than the car
• Integral design for a Liverpool cycling network including standardised solutions for crossing roads
and parking
• Implementing pedestrian crossings where the balance between safety and directness is restored.
FOLLOW UP
MEASURING SUCCESS
• Modal split • Emission levels for transport pollutants
• Public transport patronage • Premature mortality
• Number of vehicles circulating in the city • Respiratory hospital admissions.
• Baseline person journey time per mode
50
i Baton Rouge, Louisiana US

THE CAPITAL OF THE US STATE OF LOUISIANA IS FACING THE COMMON ISSUE BATON ROUGE METRO AREA
OF HIGH RATES OF OBESITY AND DIABETES.
Centrally located in the US state of Louisiana, Baton Rouge is the second largest
city (after New Orleans) and the capital of the state. Since 1947 the City of
Baton Rouge and the more rural East Baton Rouge Parish have operated as a
consolidated city-county government.
One of the largest challenges faced by both the state of Louisiana and the City
of Baton Rouge is the rising rate of noncommunicable disease, particularly
obesity and diabetes. The Centers for Disease Control and Prevention (CDC)
includes East Baton Rouge Parish in the so-called “Diabetes Belt,” comprising
644 counties that stretch from Louisiana to the East Coast of the United States89.
The Baton Rouge Health District, located in South Baton Rouge, is home to much EAST BATON ROUGE PARISH
of the City’s healthcare economy, including 3 large healthcare anchors and a
number of other providers. It also includes a broad mix of other uses - from
education, to residential. As it currently exists, however, the District suffers BATON ROUGE CITY PARISH
from a lack of coherent and cohesive planning and little mobility infrastructure Size: 250 km2
not tailored to private vehicle use. Even though this is a place for wellness
and healing, much more could be done to create a place that supports and POPULATION
encourages healthy behaviour for those who live and work in the district. City: 229,493 (2010)
Metro Area: 820,159
A guiding Health District plan (the Baton Rouge Health District Treatment Plan)
proposes solutions to common issues, looking at the District at 5 scales, and DISEASE PREVALENCE IN LOUISIANA
through multiple functional lenses: Healthy Place, Health Education, Health Care Diabetes: 11.6% (2013)90
Delivery, and Disaster Preparedness. Obesity: 33.1%91
Using the metaphor of medical treatment, the Plan diagnoses key issues
(symptoms and vital signs), as well as benchmarks, and recommends a series of
interventions to improve the physical and organisational health of the district.
As the Treatment Plan addresses both the existing District as well as a future
build-out scenario, it engages the portions of the Protocol dealing with
improving physical conditions (walking conditions, public transport, and roads)
as well as those that consider future systems (walkability, cycle-ability, access to
public transport).
1. 2. 3. 4. 5.
THE THE THE THE THE
DISTRICT DISTRICT BATON ROUGE SOUTHEAST STATE OF
CORE NETWORK METRO AREA SUPER-REGION LOUISIANA
Fig 8: The 5 Scalar Lenses of the Baton Rouge Health District Treatment Plan
WA ME
MT ND VT
MN NH
OR NY MA
SD WI
ID CT RI
MI
WY
IA PA NJ
NE
OH
IL IN DE
NV
UT WV MD
CO VA
KS MO DC
CA KY
NC
TN
OK SC
AZ NM AR
GA
MS AL
TX LA
over 10%
9.0% - 9.9% FL
8.0% - 8.9%
AK
7.0% - 7.9%
6.0% - 6.9%
Fig 10: Prevalence of Diagnosed Diabetes Among Adults, by State, 201392
HI Water Bodies / Streams

Open Space / Parks
Buildings
Surface Parking / Driveways
Roads
Rail
Sidewalk
OUR LADY OF THE LAKE

REGIONAL MEDICAL CENTER MARY BIRD PERKINS
CANCER CENTER
PENNINGTON BIOMEDI-
CAL RESEARCH CAMPUS
LSU MEDICAL EDUCATION &
INNOVATION CENTER
BATON ROUGE CLINIC
BATON ROUGE GENERAL

REGIONAL MEDICAL CENTER
OCHSNER MEDI-
CAL CENTER
0 500 1000 2000 ft
Fig 9: The Baton Rouge Health District Today

52
The Baton Rouge Metro Area

PRIORITY: THE NEED TO IMPROVE THE HEALTH OF THE COMMUNITY.
AREAS WITH HIGHEST SOCIO-

ECONOMIC BARRIERS TO
HEALTH
Community Need Index (CNI)
measures economic and structural
barriers to overall health by zip
code, with a score of 0 indicating
the lowest need, and 5 indicating
the highest. A high CNI score
indicates severe socio-economic
barriers and has also been
correlated with high hospital and BATON ROUGE HEALTH
emergency room use94. DISTRICT
CNI: 4-5 CNI: 3-4
CNI: 2-3 CNI: 1.6-2
Residents in the Baton Rouge Metro MEDICARE BENEFICIARIES WITH POTENTIALLY PREVENTABLE
Area and East Baton Rouge Parish DIABETES MORTALITY
suffer from high rates of preventable
diseases and have unequal access to
healthcare. Healthcare institutions are
critical partners for a change, as next
29% of 154 out of
to healthcare they also provide health Medicare patients 100,000 deaths
education and employment.
in Baton Rouge have in Baton Rouge
diabetes95 (compared are potentially
to 24% in Austin, preventable with
Texas, a comparable timely and effective
city and 16% being care (compared to 72
the lowest rate of in the top 10% best
diabetes seen among performing regions)96.
states).
The District Core

PRIORITY: THE NEED TO CONNECT INSTITUTIONS IN A HEALTHY ENVIRONMENT.
PENNINGTON BIOMEDICAL BURDEN MUSEUM AND

RESEARCH CENTER CAMPUS GARDENS BATO
234 ACRES OF OPEN SPACE ius 440 ACRES OF OPEN SPACE
rad
1. P
ile
R
1m
2. B
3. O
6 FUTURE CREEK TRAIL
4. L
5 B
PE
1 RK 4 5. O
IN
S
E
M
LAN
RD 3
7
EN
6. M
ESS
7. O
2 S
8. O
9. B
8 —
Partn
9 Wom
Blue
E
T AV
LA D
NNE
Louis
EBO
PERKINS ROAD The N
BLU
COMMUNITY PARK FUTURE PASSENGER RAIL Baton
52.2 ACRES OF OPEN SPACE STATION (LOCATION TBD) Surgi
BATON ROUGE HEALTH DISTRICT The District core is car-oriented and suffers from heavy traffic congestion
1. Pennington Biomedical Research on its main arterials. It lacks sidewalks and pedestrian connections between
Center destinations.
2. Baton Rouge Clinic
3. Our Lady of the Lake College There is limited access to the remarkable open-space amenities located within
4. LSU Health Sciences Center walking distance. The district core has a large concentration of pillar healthcare
Baton Rouge Branch institutions, as well as many private practices, physicians’ groups and other
5. Our Lady of the Lake Regional businesses, both health-related and more general.
Medical Center
6. Mary Bird Perkins Cancer Center INTERSECTION DENSITY AVERAGE DAILY TRAFFIC
7. Ochsner Medical Center -
Summa/Bluebonnet
8. OLOL Children’s Hospital (future)
9. Baton Rouge General Medical
9 intersections 42,690
Center —Bluebonnet Campus are located within cars per day on major
Partners Located outside District Core a square mile in arterials in the area93
• Woman’s Hospital
• Blue Cross Blue Shield of LA the district core (a (compared to 21,800
• LA Department of Health and
Hospitals walkable environment cars on Brookline Ave,
• Louisiana State University
• The Neuromedical Center that supports transit a similar main arterial
• Baton Rouge Orthopaedic Clinic
• Surgical Specialty Center of use typically has 25- serving the medical
Baton Rouge
30 per square mile93). district in Boston, MA).
54
Prevalence
As upsetting as the current situation
is, a potential for significant
of Chronic
improvements have been identified.
The proximity of a number of leading
Disease
health care providers as well as their
commitment to creating a health-
supportive environment will be crucial
In Louisiana, as elsewhere across the in the prevention of chronic disease.
nation, the slow pace of change does The CDC has identified environmental
not reflect the urgency of the health change as one of the 4 key factors in
needs in the broader population. chronic disease prevention99. These
The prevalence of obesity—a root factors are:
cause for many preventable chronic • Epidemiology and surveillance to
diseases—has doubled since 1990 monitor trends and track progress;
in Louisiana and currently stands at • Environmental approaches to
33.1%: one of the highest rates in promote health and support healthy
the nation91. At the current rates of behaviours;
increase, the number of obese adults • Healthcare system interventions to
in Louisiana is expected to double by improve the effective delivery and
203097. use of clinical and other high-value
preventive services; and
The prevalence of diabetes in • Community programmes linked to
Louisiana has also increased steadily clinical services to improve and
from 6.6% in 2000 to 10.3% in sustain management of chronic
2010. Lower socio-economic status conditions.
is correlated with a significant
increase in disease risk: close to
20% of residents in the lowest tier of
income had diabetes as opposed to
6% among the highest tier. In 2013,
11.6% of Louisianans had diabetes,
with only Alabama, Mississippi,
and West Virginia having higher
percentages90. East Baton Rouge is one
of 644 counties located in the CDC-
identified “Diabetes Belt”89, which
extends from Louisiana towards the
East Coast (Fig 12).
Diabetes and obesity in Baton Rouge

amount to $1.5 billion in healthcare
costs annually98. Creating a health-
supportive physical environment is
one of the key practices to prevent
chronic disease as identified by the
CDC99.
WA ME
MT ND VT
MN NH
OR NY MA
SD WI
ID CT RI
MI
WY
IA PA NJ
NE
OH
IL IN DE
NV
UT WV MD
CO VA
KS MO DC
CA KY
NC
TN
OK SC
AZ NM AR
GA
MS AL
TX LA
FL
over 35%
AK
30-35%
25-30%
20-25 %
Fig 11: Prevalence of self-reported obesity among adults, by State, 201391

HI
WA ME
MT ND VT
MN NH
OR NY MA
SD WI
ID CT RI
MI
WY
IA PA NJ
NE
OH
IL IN DE
NV
UT WV MD
CO VA
KS MO DC
CA KY
NC
TN
OK SC
AZ NM AR
GA
MS AL
TX LA
over 10%
FL
9.0% - 9.9%
AK
8.0% - 8.9%
7.0% - 7.9%
6.0% - 6.9%
Fig 12: Prevalence of Diagnosed Diabetes (Type 1 and 2) among

HI adults, by State, 201392
56
Sprawling
communities where walking is not with the objective to make the
only unsafe, but often impossible100. city more walkable. The code, as
Development
The Baton Rouge Unified Development it currently stands, is a significant
Code (UDC), while adopted in 1995, barrier to orderly development that
builds on the legacy of car-centric builds a sense of place and a vibrant,
A large percentage of the 1,000+ acre zoning codes. pedestrian-friendly public realm.
study area for the District is zoned
C2—Heavy Commercial District, which The city-parish has sought to
specifically permits the construction address the need for walkability by
of laboratories, offices, and other adding urban design districts to the
research facilities in addition to a wide zoning code. These include stricter
variety of other uses ranging from development requirements intended
gas stations to townhomes. There is to build a sense of place and a unified
also a number of residentially-zoned public realm.
parcels although the majority of the
District’s residential plots are located One of the primary recommendations
in commercially-zoned areas. of FuturEBR, the comprehensive plan
for East Baton Rouge Parish, was the
Like elsewhere in the US, zoning was revision of the UDC to enable mixed-
established in Baton Rouge to protect use buildings and districts, shared
the health, safety, and welfare of parking facilities (such as surface lots
the community. A growing body of and structures which are managed
research shows that zoning codes and used jointly by multiple private
of this era may have contributed to entities), and to promote pedestrian-
the obesity epidemic in the nation oriented, compact development.
by promoting the development of The City-Parish is taking steps to
use-segregated and car-oriented overhaul the UDC in the near term101,
Parcel Boundary
Zoning District Boundary
General Office Districts

BLUEBONNET
PE Commercial Districts
RK
INS
Residential Districts
Light Industrial Districts
STARING
Planned Unit Developments
Hospitals
Study Area Boundary
Fig 13: Zoning categories currently in use in the Health District

Inefficient
disconnected street network102. Boulevard—which also carry large
volumes of regional traffic (Fig 14).
Transport
As a result, most people drive to work On any given day at rush hour, these
and make additional vehicular trips on two main arterials serving the District
Network
a daily basis for necessities. are clogged with bumper-to-bumper
traffic moving at extremely slow
The sprawling land use pattern speeds.
For much of the low-income and combined with lack of investment
at-risk population in Baton Rouge, in transportation infrastructure has
appropriate care can also be physically created significant traffic challenges,
difficult to access. Traffic issues, lack which are experienced most acutely in
of transportation options, and poor the Health District103.
appointment availability during non-
work hours can become barriers that Insufficient mobility infrastructure
disproportionately impact residents (including roads and other options)
without the access to a car. and a general reliance on the car
contribute to a gridlock situation in
The Baton Rouge metropolitan area the District.
has developed in a way that makes
living without car virtually impossible. The highway, Ward’s Creek and
A 2014 study supported by the Kansas City Southern Railroad, all of
National Institutes of Health (NIH) which run east-west across this area,
and the Ford Foundation found Baton limit access into the core District.
Rouge to be one of the most sprawling With most drivers trying to enter
metro areas in the nation due to or exit the highway, District traffic
its segregation of urban functions, is channelled into two regional
low density of development, and arterials—Essen Lane and Bluebonnet
JEFFERSON
BLUEBONN
ESSEN
ET
Highway
Arterials
KCS RR
Railroad
Creek
Local Streets
Access Points
DAWSON
Hospitals
Points of Congestion*
PERKINS Neighbourhood Cut-throughs (routes on local
STARING
streets to by-pass arterial intersections)*
*reported by public meeting participants
Fig 14: The current road network in the District

58
Lack of
EXISTING DISTRICT STREET NETWORK
Alternative to
the Car
The car-oriented development of
the Health District contributes to
congestion and prevents people from
choosing to walk—sometimes to
destinations as close as 1,000 feet
(four minute walk) - due to a fear of
crossing streets. The focus on the car
also limits the use of buses, which are
often stuck on the same roads and
are unable to deposit pedestrians
at locations where it is safe to walk.
Even if residents were to choose to EXISTING SIDEWALK NETWORK
walk, today only 22% of streets in the
District have sidewalks.
Even though the design of District

streets is poor, it is actually rather
lack of them that makes walking
virtually impossible. Street
connectivity (measured by the
number of intersections) is one of
the key determinants of walkability93.
The District fares poorly from this
perspective: it has, on average,
almost a tenth of the connectivity
of Downtown Baton Rouge. Even in
areas that have a grid of connected
streets, the long block sizes reduce the
potential for through-movement. The
typical block size in the Calais office EXISTING BICYCLE NETWORK
park subdivision is 400 feet by 1,300
feet.
The average Walk Score - a number

between 0 and 100 that measures the
ability to walk to various destinations
from a given location - within the
district is 48.
Bicycle facilities within the District leveraged within the Health District
are also in short supply - there are to make it a viable transportation
no designated cycle lanes, shared means for those without a car and
streets, or multi-use sidewalks. The an alternative to potentially reduce
District’s only bicycle facility is the 0.5 overall vehicular use.
mile trail along Kenilworth Parkway.
The Baton Rouge Health District is By increasing the mobility options
located next to a globally-recognised within and to the District, there is a
outdoor museum, a regional children’s huge opportunity to connect with
destination for adventure sports, and a green and recreation spaces nearby.
creek with historical significance that Aside from the well-known benefits
is gaining new life with active trails. of fresh air, research also shows
Yet, it has surprisingly weak pedestrian significant psychological benefits of
and bicycle connections. Data analysis physical and visual access to natural
by Strava, a website and mobile app environments104. Natural open spaces
used to track athletic activity via GPS, also provide opportunities for active
shows that runners and cyclists in the recreation: doctors around the U.S.
community largely avoid the District are using “park prescriptions” to
with the exception of streets where encourage their patients, especially
sidewalks are present. children, to spend time exercising
outdoors105.
The Capital Area Transit System (CATS)
provides service to the Health District.
This system needs to be better
Fig 15: Snap shot of the district from Strava’s Global Heatmap. Activity levels are indicated by blue to red lines, with red indicating the highest
level of use for routes.
60
Physical Scenarios
The Baton Rouge Health District Because the district is looking at both The primary physical prescriptions
Plan is not meant to be a definite improving existing infrastructure for the District are outlined on the
master plan; rather it sets a series and creating new elements, following pages.
of goals and solutions that can be recommendations consider both
implemented in a number of different aspects of the determinants of health
ways as the district evolves. As part of as laid out in the Design Protocol.
the planning process, the design team These include the quantitative aspects
tested a number of physical scenarios of transport infrastructure, such as
to understand the impacts, positive whether there are sidewalks on both
and negative, of various design sides of the street, linear units of cycle
solutions. lanes and direct access to open spaces
as well as the more qualitative aspects
The outcome of the scenario that may change behaviour, such as
testing process is an illustrative, frequency of transit, perceived safety
demonstration physical framework, of a street and improved intersection
including a new street network, a conditions.
new and enhanced network of parks
and open spaces, and new infill The scenario testing at this stage of
development. While specific locations the process has been focused on the
for infrastructure such as streets availability and design intent of future
and cycle lanes may change, the infrastructure, rather than testing
prescriptions laid out in the document specific final design solutions. To fully
will help the district administrators support the desired health outcomes,
guide future development in order to a similar type of testing should
meet the specific health (and other) happen for the final design of each of
goals identified at the outset of this these elements.
process.
Design Protocol Indicators

WALKING CONDITION CYCLE-ABILITY ROAD
• Positive association/perception • icycle Hire Scheme: Implement
B • Traditional Grid: Build a Street
with the built environment: Adopt bicycle and car share programmes Framework - reconnect/distribute
District Street Design Guidelines • Number of cycle lanes: cycle traffic
• Pedestrian Safety Islands: lanes on priority cycle corridors
Medians - on larger streets • Proximity to cycle paths: build
provide pedestrian refuge the Health Loop Trail; complete
a bicycle trail network; add rail
WALKABILITY crossings
• resence of a Sidewalk - Adopt
P
District Street Design Guidelines PUBLIC TRANSPORT
• Pavement Continuity - Manage • Access to public transport and
Access on Arterials destinations: Build a multi-modal
• Access to Facilities +Amenities: transit center
Coordinated Development;
connect to the Burden Campus PUBLIC TRANSPORT AVAILABILITY
• Connectivity/Land Use Mix: • Increase transit routes: add a
Coordinated Development district funded shuttle route
BURDEN MUSEUM
AND GARDENS
I-10
N
DIJO
OLOL
HENNESSY SUMMA
BRITTANY
O'DONOVAN
ESSEN
DIJON
MANCUSO
MIDWAY
BLUEBONNET
BRG
PICARDY
MALL OF LOUISIANA
TH
PENNINGTON BATON ROUGE

WOR
BIOMEDICAL CLINIC
KENIL
RESEARCH
PERKINS RD
STARING
CENTER
COMMUNITY
PE
PARK RK
IN
S
61
Fig 16: A potential future road network for the Baton Rouge Health District District Study Area
Existing Street Proposed Street
Existing Rail Corridor
Proposed Frontage Road
BUILD THE DISTRICT STREET ADOPT STREET DESIGN GUIDELINES Existing Multi-use Trails and Cycleway
Proposed Multi-use Trails and Cycleway
NETWORK The plan lays out non-prescriptive Existing Creek
An important short-term priority for best practice treatments for the Existing Railroad Underpass or Bridge over Creek
Proposed Rail Underpass or Bridge over Creek
the district is to implement an arterial various street types anticipated in Existing Open Space
street network, moving the area from the district, addressing the different Proposed Open Space
reliance on a single arterial road to a elements found in each of the street Existing Water Body
system of multiple arterials that will, types. Included are:

in time, connect to a robust network • Pedestrian Zone
of major local streets. Completion of • On-Street Parking
this network will not only allow (and • Bicycle Lanes
encourage) more infill development • Travel Lanes
in the district, but it will also help • Medians.
improve air quality by dispersing
traffic, and will provide more options IMPLEMENT CAR AND BICYCLE
for pedestrians and cyclists travelling SHARING
through the district. Baton Rouge has already taken
initial steps toward bicycle share
ADD RAIL CROSSINGS implementation. There are good
Key to the success of vehicular, cycling, examples from institutional and
and pedestrian improvements will corporate campuses; when combined
be the addition of rail crossing in key with the trail system, it will provide a
locations (3 are identified in the plan). viable alternative to private vehicles
Reducing time spent waiting for trains and help facilitate behavioural change.
to pass will reduce traffic congestion,
with a positive impact on air quality,
and also make cycling and walking
more attractive by creating more
direct routes.
62
ENHANCE TRANSIT OPTIONS IN THE

DISTRICT
In addition to encouraging and
ESSEN
facilitating modal shift to get more
people walking and biking, a key
aspect of reducing traffic congestion HENNESSY
and encouraging transit use is to

provide more ways to access existing PICARDY
and planned public transit. The plan

recommends that the District funds
a circulator service to allow more
people access to the District through
public transit.
Current CATS Route

Proposed Core Circulator Route
Auxiliary Service
Existing Hospitals
Planned Hospital
Fig 17: Proposed Circulator Shuttle Route
BUILD A MULTI-MODAL TRANSIT

CENTER
Conceptual service proposals for rail in
the region include a stop in the Baton
Rouge Health District, potentially
linking the District directly with
ESSEN
New Orleans. The plan recommends

including this station in all final
build out models, and explores three N O
potential future locations. A more P
direct connection to New Orleans and

other destinations in the region will
help ease reliance on private vehicles
travelling to and within the district,
MIDWAY
BLUEBONN
potentially having a positive effect on

air quality as well as walking and other
alternate modes of transport.
ET
Transit Station Location

N West of Essen Lane
O East of Essen Lane
P East of Midway Blvd
Fig 18: Baton Rouge Health District Multi-modal Passenger Terminal Location Options
JEFFERSON
BUILD A BICYCLE TRAIL NETWORK
A priority project within the proposed
bicycle trail network is the Health
BLUEBONN
ESSEN
Loop Trail, a 7.4 mile (12km) loop
around the District. This trail would be
ET
an extension of an existing trail, and
would provide key infrastructure for
walking and biking as both commuting
and leisure activity. Critical to the
success of this trail is the creation of
a new creek crossing at the Our Lady
of the Lake Regional Medical Center,
reducing to 3 minutes what is now
a 15 minute walk from the hospital
to the trail head and making walking
KCS RR
and cycling a much more attractive
possibility for those who live, work,
and seek treatment in the District.
PERKINS
STARING
Urban Forest Existing Trail
Active/Sports Park Proposed Trail
Agricultural Fields Creek
Botanical Gardens Lake
District Signature Park Proposed Future Street Network
Fig 19: Baton Rouge Health District Landscape Framework Plan: The Network of Existing and
Proposed Open Spaces and Connecting Corridors
64
Fig 20: Potential build-out option for the District.
OUR LADY OF THE LAKE RMC

Regional destination for nature,
farming, and horticulture MARY BIRD PERKINS CANCER CENTER
A calming walk in nature A welcoming, tree-

lined boulevard
An attractive campus
environment
Happy neighbours
PENNINGTON BIOMEDICAL
RESEARCH CENTER
Fun places for

students to live
A nationally-recognised A regional destination BATON ROUGE CLINIC
Diabetes and Obesity Center for active sports
Train to New Orleans

BATON ROUGE GENERAL RMC MALL OF LOUISIANA

FUTURE OUR LADY OF THE
LAKE CHILDREN’S HOSPITAL
Safe residential OCHSNER MEDICAL

neighbourhoods CENTER - SUMMA
Happy neighbours A health and

wellness village
Walkable neighbourhoods
Lots of places to A new linear park and boulevard
cycle or walk to lunch

66
Follow Up
Check-Up
DESIGN CHECK-UP
• Intersection density
Metrics
• Sidewalk coverage
• Transit coverage
• Diversity of land uses
In order to ensure the success of the • Access to public open space.
prescriptions outlined, the Treatment
Plan calls for regular check-ins and BEHAVIOUR AND HEALTH
adjustments to the prescriptions laid BENCHMARKS
out above. • Traffic volume on arterials
• Employee travel behaviour survey
As the District evolves, the leadership • Prevalence of obesity and diabetes
group will work with community for people living and working in the
groups, healthcare providers, and District.
local and regional authorities to • Mortality rates
collect data about how infrastructure • Community needs indices
is being used, how and if behaviour • Transit access to hospitals
is changing, and the personal, district • Pedestrian and bicycle accidents
level, and regional health outcomes in • Average daily traffic
the area. • Parking demand.
The database created for this purpose In order to get the most meaningful
is integral to the Treatment Plan and data, the leadership group along with
will be added to an on-going basis as the consultant group is working with
assessments occur. local healthcare providers and the
State of Louisiana to access a finer
Additionally, follow-up testing of the grain of health data.
recommendations in the Treatment
Plan and the data it collects can be an The District is now established as
invaluable means to detecting other a non-profit organisation and has
issues. If other diagnoses are hired its first executive director. As
confirmed, additional treatment plans part of the on-going mission of the
will be necessary. This Treatment Plan Baton Rouge Health District, the
serves as a template for continuous leadership group will track key metrics
delivery of care for the District. The at a regular interval. Part of the
goal is to not only make the District a recommendations of the Plan include
healthy place, but to make it a place a digital dashboard for access to
that is proactive about and a model of progress metrics at the district scale.
health far into the future.
Current health information is available
only at the census tract scale, which
is useful for regional trends but not
as informative when tracking the
impact of infrastructure and built
form changes at a local level. This
additional information should allow
the leadership group to make more
powerful, meaningful decisions for the
district.
Design Protocol
STRONG OPPORTUNITIES FOR POSITIVE CHANGE
Current conditions make it difficult for people to use
Summary
mobility options other than private vehicles, but the
creation of a strong coalition of partners (including health
care providers) and a health-supportive environment make
positive change in the district very possible.
Baton Rouge
BENCHMARKING OPPORTUNITIES &

CONSTRAINTS
DISTRICT SYMPTOMS CHALLENGES
• Low intersection density (per 1/4 mile): 9 in the • Lack of coordinated planning and focus on individual
district core vs 25-30 in a walkable environment buildings and car throughput (vehicles/hour)
• High volumes of traffic (cars per day): 42, 690 on • Lack of alternatives to the car
Essen Lane vs 21,800 in a similar district in Boston • Minimal street connections.
• High numbers of Medicare beneficiaries with
diabetes (%): 29% in Baton Rogue vs 16% as the OPPORTUNITIES
lowest rate among states • Mortality and disease rates are regional issues
• High rates of potentially preventable mortality. but can be addressed very locally through a few
interventions
KEY VITAL SIGNS FOR SUCCESS • The coalition of health care providers leading the
• Decrease traffic, increase connectivity and Treatment Plan process is committed to positive
walkability health outcomes
• Decrease rates of preventable mortality and • The amount and quality of green space surrounding
diabetes. the District is a strong framework.
SCENARIO TESTING
DESIGN GOALS • Adopt street design Guidelines
• Priority: implement arterial network to • Implement car and bicycle sharing
disperse traffic and increase connectivity • Enhance transit options in the District
• Priority: health loop trail • Build a multi-modal transit centre
• Build the District street network • Build a bicycle trail network
• Add rail crossings • Connect to open space.
FOLLOW UP
DESIGN CHECK UP POST-IMPLEMENTATION CHECK-IN
• Design review check-ins to ensure proposals • Health outcomes - diabetes and preventable
meets goals of plan (check against mortality.
prescriptions and related benchmarks). • Mobility behaviour survey: work with providers
• Connectivity, adherence to guidelines, for more granular level data to examine health
enhanced access to transit. impacts at the District scale.
68
Way forward
How can the health and

mobility agenda be
taken forward?
70
Way forward
USING THE DESIGN PROTOCOL IN The data from the benchmarking
YOUR PROJECT stage can inform a discussion about
Whether you are an urban planner, the causes of health challenges
infrastructure provider or architect, in the community and how these
there are lessons from this design can be improved through transport
Designing for health protocol that you can apply to your and mobility infrastructure. This
work to improve health through introduces the opportunities and
through mobility transport. Some strategic decisions constraints stage and is probably best
about new transport infrastructure will seen as a stakeholder engagement
in your project and impact communities for decades and activity (or several) where inputs can
possibly centuries. Other decisions be gathered from different agencies
further research areas will have a shorter duration but could and the community.
still have a big impact. The important
principles in the design protocol can The design and engineering teams
be applied at any project scale. The can then work with this information to
protocol can be a useful checklist to develop different options. These are
ensure decision-makers consider the taken through the Scenario Testing
opportunities and potential impacts stage through client meetings and
of the project holistically, at the community engagement activities
earliest possible stage. The healthier as appropriate for the scale of the
option does not necessarily have to intervention. It may also be possible
cost more, and it will be cheaper in to model predicted impacts from
the long run. Prevention is cheaper different design options using the data
than cure! There are several examples gathered in the benchmarking stage.
in this publication to support the
business case. When consensus is achieved and a
particular design is taken forward it
The benchmarking stage of the is important to set measures which
protocol identifies how an area is will allow ongoing monitoring and
currently performing and could evaluation. This could be through data
be aided by national or local data from service providers or possibly
sources. In the USA, the Department sensors, surveys or smartphones.
of Transportation and the Centers for The important point is to ensure that
Disease Control and Prevention have the follow up stage is integrated
developed the new Transportation and into project plans and not forgotten.
Health Tool which provides data via There could be very minor changes
indicators about how transport and required which could ensure that
mobility infrastructure affect health88. the infrastructure meets the original
Many cities have started to make objectives.
cross-departmental data available
online in an open access format. At
the benchmarking stage it would be
useful to collect data about transport
and environment (such as traffic
congestion, air quality and mode
share) alongside health data (such
as physical activity levels, obesity
and disease prevalence). In the UK,
this type of health data is available
through Public Health England’s
Health Profiles with interactive
mapping and reporting functions107.
Complete Streets Policy

- New York City, USA
The New York Department of • 90 miles of new bicycle lanes

Transportation and New York City alongside a reduction of parking
Transit adopted a series of policies spaces.
to create streets that accommodate
cyclists, pedestrians and public Since implementing the Complete
transport users, along with motor Streets programme, usage of the bus
vehicles, including: service increased by 9% and speeds
• Bus-only lanes and transit signal improved by 15-18%. Due to the
priorities; Green Light for Midtown project,
• Complete street roadway design in injuries to motorists and passengers
many key locations within the city; decreased by 63% and to pedestrians
• ‘Green Light for Midtown’ plan to by 35%. Finally, cycling has been
reduce traffic congestion and to increased by 35% annually since the
improve safety and public spaces; bicycle lanes were added.
• A public plaza programme to create
new open spaces and a sense of
community; and
FURTHER RESEARCH AREAS Cities and infrastructure providers are makers (see ‘Appendix A. Existing
There is a large body of research increasingly releasing open data as tools and methodologies’ for an
covering the impacts of transport part of the smart cities movement and existing tool for walking and cycling
on health internationally. Beyond the desire to fuel new technological infrastructure). The impact of transport
the references cited throughout solutions to urban challenges. on health is a complex system linked
this report, there are many This data can now be coupled with to wider social and economic context.
additional sources of information for real-time data from sensors or This makes it difficult to predict
practitioners and policy-makers. In smartphones to provide low-cost the influence of a single piece of
the USA, the Active Living Research and accurate information about how infrastructure on specific health
programme helps move research people are moving about a city and outcomes. However, systems thinking
into practice, with a specific set of how this impacts health. Planners and modelling should help multi-
resources on transportation108. In and designers can begin using this to disciplinary research teams develop
Europe, the WHO Regional Office for evaluate new infrastructure options. tools that can aid design teams in
Europe has a number of transport and This is likely to become increasingly creating urban transport environments
health publications, tools and research sophisticated and automatic through that support multiple outcomes for
networks to disseminate research and cloud-based tools that feed real-time multiple users.
best practice109. data from multiple sources and allow
layers to be mapped spatially and
In the literature review for this interrogated for a number of different
report we also identified a range of priorities. This is not currently widely
existing tools and resources which available, but there are a number
can be used in the urban design of tools which are moving in this
process to integrate healthy transport direction.
and mobility options. These are
summarised in ‘Appendix A. Existing More accurate information about
tools and methodologies’ and may the costs and benefits of new
be a useful resource to help readers infrastructure should be integrated
implement the design protocol. into data driven tools to aid decision-
72
Glossary
BMI: NMT: VMT:
Body Mass Index, is a measure of Non-Motorised Travel, including Vehicle Miles Travel, usually to
body fat based on the height and pedestrian and walking travel that is reference the distance for all travel
weight (mass) that applies to adult derived. via motorised means (e.g., auto,
men and women. BMI is a method of motorcycle, or transit).
screening for weight category such NON-COMMUNICABLE DISEASES:
as underweight, normal or healthy Non-communicable diseases (NCD)
weight, overweight and obesity. is a medical condition or disease
that is non-infectious or non-
DESIRE LINES: transmissible. The four main types of
An informal trail or path worn down non-communicable diseases include
by often foot traffic to create a shorter cardiovascular diseases (like heart
distance between two points rather attacks and stroke), cancers, chronic
than taking a formal or set route such respiratory diseases (such as asthma)
as a footpath. and diabetes.
GVA: OBESITY:
Gross value added is a measure of the A medical term for a person who is
contribution to an economy of an area, very overweight with excess body fat.
industry or sector. The BMI is commonly used to help
classify overweight and obesity in
HEALTH: adults.
The state of complete physical, mental
and social well-being and not merely OVERWEIGHT:
the absence of disease or infirmity11. Overweight is having extra body
weight from muscle, bone, fat and/or
LOS: water. The BMI is commonly used to
Level of Service models aim to provide help classify overweight and obesity
a common rating system for facilities in adults.
used by cyclists and/or pedestrians.
PMT:
MOBILITY: Person Miles Travel, used to refer to
The ability of people to move between the distance for all travel, regardless
places and the ease with which they of mode.
reach their destinations.
PPM:
MOBILITY INFRASTRUCTURE: Parts per million is a unit of measure
The physical environment built by for volume and is often used to
humans, that includes bridges, roads, measure particle concentration in air
railways and transit hubs, together pollution.
with the natural environment which
support mobility of people. PRIORITY PEDESTRIAN CROSSING:
A place designated for pedestrians
MODAL SPLITS/SHARE: to cross a road where the pedestrian
The percentage of travelers or has priority over other transportation
number of trips of a particular type of modes.
transportation mode.
74
Appendix
A. Existing tools and methodologies

The first stage of this project was Assessment (HIA) as ‘a means of and transport infrastructure supports
a rapid review of bibliographic assessing the health impacts of walking, cycling and accessing public
databases and Google Scholar using policies, plans and projects in diverse transport. These tools could be a
search concepts related to health, economic sectors using quantitative, useful input to the design protocol.
transport and benchmarking. The qualitative and participatory
purpose of this review was to ensure techniques.’112 Transport service WALK SCORE, BIKE SCORE AND
that the outputs of the project build providers may be required to produce TRANSIT SCORE
on existing evidence, methods and an HIA when proposing transport In the US, Canada, Australia and New
best practice. infrastructure which requires Zealand residents, policy/decision-
planning permission, or they may makers and planners can make use
The findings from the review showed choose to produce an HIA for their of Walk Score, Transit Score and
that there has been multiple models own purposes. HIAs are undertaken Bike Score to understand how well
developed to test the impact of by consultants and are not currently a city, neighbourhood or particular
potential transport infrastructure automated processes. Design teams location caters for these activities.
projects on health and wellbeing could use HIAs from similar projects Walk Score is used by academic
using modelling and GIS-based tools. or within the same city to mine useful researchers and has received grants
There is not a consistent and widely data or recommendations. The HIA from the Rockefeller Foundation and
accepted approach for all aspects consultant would be a valuable person the Robert Wood Johnson Foundation
of such modelling. Some areas are to include in the design protocol to ensure the method’s algorithms
more accepted than others, such as outlined in the main report. work with the latest research findings.
measuring ‘walkability’. Many projects Walk Score is also used on real estate
have adapted previous models and HEALTH EFFECTS AND RISKS OF listings in the US as research shows
appear to be continually evolving TRANSPORT SYSTEMS (HEARTS) that homebuyers, tenants and certain
methods in this area, especially in HEARTS is a WHO model of the health businesses place a high value on
relation to GIS-based models. Several effects of road traffic. The tool informs walkability71.
well-known and publicly accessible an integrated health risk assessment
tools and methods are summarised that allows users to compare policy PEDESTRIAN AND CYCLING
below. or development options and their ENVIRONMENT REVIEW SYSTEM
associated risks. This includes The UK’s Transport Research
HEALTH ECONOMIC ASSESSMENT ‘exposure to air pollution, noise and Laboratory has developed two
TOOL (HEAT) FOR WALKING AND road accidents and the associated software tools to aid in the
CYCLING health risks in relation to road assessment of pedestrian and cycling
The HEAT tool was developed by WHO traffic.’113 The research team further environments. The parameters used to
to measure the economic value of developed a GIS-based software tool, evaluate the pedestrian environment
health benefits achieved from reduced STEMS, which incorporates a set of include114: surface quality, lighting,
mortality from walking and cycling110. integrated steps and models based conflict with traffic, pedestrian
The tool can be used internationally on extensive review of the evidence facilities, obstructions, cleaning,
and requires some data input from on the health effects of air pollution, drainage, crossing type, deviation from
the user. The assessment allows noise and road accidents. The HEARTS the desired route at crossing, crossing
transport planners and other users system runs at two levels, as described refuge quality, rest points, public
to benchmark the current situation in the report: 1) ‘the city-wide long- spaces, permeability, road safety and
and compare the impact of potential term level using the proportions public transport waiting areas such as
or proposed transport infrastructure. of time spent in different micro- bus stops and taxi ranks, public spaces
There are limitations about who the environments and’ 2) ‘the detailed and interchange spaces.
results apply to within a population level using individualized space–time–
and which data can be used. However, activity patterns.’113 Other walkability and street
the tool is regarded as the best assessment tools include:
estimate available for non-health ACTIVE TRANSPORT ASSESSMENT • Walkonomics
experts, such as transport planners111. TOOLS • Walkability app
The following tools do not measure • RateMyStreet
HEALTH IMPACT ASSESSMENT health impacts but rather they focus
The WHO defines a Health Impact on how well the built environment
76
B. Data sources
The data sources listed here are freely available. This list is not intended to be
comprehensive but a starting point of data available to support analysis.
UK
OFFICE OF NATIONAL STATISTICS DEPARTMENT FOR ENVIRONMENT THE STATE OF OBESITY
ONS is UK’s largest independent FOOD & RURAL AFFAIRS: AIR The State of Obesity provides
producer of official statistics and QUALITY information on the obesity epidemic
its recognised national statistical The DEFRA’s website includes data within the United States. It includes
institute. ONS is responsible for from automatic air quality monitoring state level data on obesity rates
collecting and publishing statistics stations measuring oxides of nitrogen by age, gender and race alongside
related to the economy, population (NOx), sulphur dioxide (SO2), ozone (O3) ranking and trends from 1990.
and society at national, regional and and particles (PM10 and PM2.5). http://stateofobesity.org/
local levels. This includes the Index http://uk-air.defra.gov.uk/interactive-
of Multiple Deprivation. Census is map
collected every 10 years in England Other
and Wales. Data is available on LSOA
level. USA EUROSTAT
www.ons.gov.uk The Eurostat is the statistical office
https://census.ukdataservice.ac.uk/ UNITED STATES CENSUS BUREAU of the European Union and aims to
The Census Bureau provides data provide statistics at a European level
PUBLIC HEALTH ENGLAND: HEALTH and statistics around the economy, to enable comparisons between
PROFILES population and society at national, countries and regions. Data topics is
Health Profiles is a programme to state and local levels. The Census wide ranging including demographics,
improve availability and accessibility Bureau hosts a number of data and industry, transport, environment and
for health and health-related visualisation tools. The census is economics in a format that is easily
information in England. The profiles collected every 10 years. comparable with other countries and
give a snapshot overview of health for http://www.census.gov/ regions in the EU.
each local authority in England. Health http://ec.europa.eu/eurostat/web/
Profiles are produced annually. CENTERS FOR DISEASE CONTROL main/home
www.healthprofiles.info AND PREVENTION (CDC)
The CDC is part of the Department of OPENSTREETMAP
NOMIS: LABOUR MARKET STATISTICS Health and Human Services. The CDC OpenStreetMap is a crowd-sourced
Nomis is a service provided by the provides data and statistcis on various mapping website which is used
ONS dedicated to providing detailed specific health and disease related and supported by amateur and
and up-to-date UK labour market topics including physical activity, life professional mappers to create a high-
statistics from offical sources. Data expectancy and heart disease. resolution dataset of buildings, roads
includes employment, qualifications, http://www.cdc.gov/ and other topographical features. Data
earnings, benefit claims and can be accessed as spatial information
businesses. HEALTH INDICATORS WAREHOUSE using GIS programs.
www.nomisweb.co.uk (HIW) https://www.openstreetmap.org/
The HIW is maintained by the CDC’s
LONDON DATASTORE National Center for Health Statistics
The London DataStore is a free and and provides access to high quality
open data-sharing portal enabling data to understand a community’s
anyone to access data relating to health status and determinants.
the city. Datasets is wide ranging Indicators include chronic disease and
including environment, housing, conditions, demographics, behaviours.
transport, education, planning and Data that is provided is on National,
safety. The datasets range in scale, State, County and hospital referral
scope and format. region level.
http://data.london.gov.uk/ http://www.healthindicators.gov/
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84
Biographies
LYDIA COLLIS XENIA KAREKLA INGRID STROMBERG
ARCHITECT AND URBAN DESIGNER, RESEARCH ASSOCIATE, CIVIL, KNOWLEDGE MANAGER, PERKINS +
PERKINS + WILL ENVIRONMENTAL AND GEOMATICS WILL
Lydia works on a number of large scale ENGINEERING DEPARTMENT, UCL Ingrid works closely with practitioners
urban design and planning projects in Xenia has a transport engineering around the world to keep the Cities
the UK, Europe, and abroad. Focusing background and, since joining UCL, + Sites group on the cutting edge
on complex mixed-use development, has been working on various projects of innovation. A seasoned urban
research and innovation districts, as targeting improvements on the bus designer, Ingrid brings a strong
well as urban infrastructure for public and metro systems of London. Her practical foundation to internal and
and private clients, Lydia works to PhD research studied the level of external research initiatives around
bring together the complex moving accessibility of London double-decker the built environment and health,
pieces of a city to create unique buses. mobility, resiliency, and advancing
vibrant urban environments that [email protected] sustainable communities.
foreground environmental, social, and [email protected]
economic sustainability and resiliency. IKUMI NAKANISHI
[email protected] PROJECT MANAGER, ARUP LAURENS TAIT
Ikumi is a strategic planner and PROJECT DIRECTOR, ARUP
DAVID GREEN urban designer with a key interest Laurens is an Associate Director
PRINCIPAL, PERKINS + WILL in creating better designs and cities responsible for leading Arup’s
David is the Global Practice Leader for through evidence-based decision Planning and Computation team based
Cities + Sites and in this position his making and community engagement. in Amsterdam. Laurens’ expertise is
work and research focus on issues of Ikumi’s recent work with Arup has in transport infrastructure projects
urban development and the creation seen her work across disciplines and the mobility aspects of large
of strategies for sustainable cities. and internationally on large scale developments and has been involved
This includes aspects of public policy, spatial data analysis, data harvesting, in metro, high speed rail, highway,
implementation of development integrated land use and transport airports and port developments in
controls, and strategic infrastructure planning, infrastructure master Europe, Asia and the Middle East. More
implementation, with a particular planning, precinct and site wide recently, Laurens has been involved
focus on research, education and analysis and design, design principles in various studies to determine links
health districts. development, and digital engagement. between human health and transport
[email protected] [email protected] infrastructure.
[email protected]
PAUL GROVER HELEN PINEO, MRTPI
ASSOCIATE DIRECTOR, ARUP ASSOCIATE DIRECTOR FOR CITIES, PROFESSOR NICK TYLER
Paul is a chartered town planner and BRE CHADWICK CHAIR OF CIVIL
certified economist who is the Arup Helen is responsible for leading ENGINEERING, UCL
UK lead for Urban Wellbeing. Paul the development of BRE services Nick’s research is about the future of
draws on his extensive experience to help cities grow while achieving cities as a way to improve the quality
in the management of strategic and the best outcomes for people, place of life and wellbeing, including the
site specific projects to advise both and the planet. She is leading BRE’s health impacts of urban design.
private and public sector bodies on Healthy Cities programme and is a [email protected]
regeneration strategies, strategic PhD candidate at University College
economic studies, integrated London, researching the use of urban
infrastructure plans, spatial plans, health benchmarking systems by
impact assessments and planning policy and decision-makers.
consents. [email protected]
[email protected]

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Health +

University College London

AREA Research / Perkins + Will

Amanda Sacker, Institute of Epidemiology & Health, UCL

Urban Mobility Impact on Health 10

Health + Mobility Framework 18

Applying the Design Protocol 30

Knowledge Quarter, Liverpool UK 34

Baton Rouge, Louisiana US 50

A. Existing tools and methodologies 77

What are the key

50% High income countries

Upper middle income countries

Percentage of total deaths

Communicable diseases, 60%

Fig 1: Global burden of diseases shown Fig 2: The increasing development of

because many factors influence our

It is clear that the social determinants

Decentralisation of urban planning The transport system improvements

Prioritising cycling and walking

In 2002 Paris introduced Quartier Paris’s bicycle-sharing system, Vélib,

Safer intersections for cyclists

In an effort to reduce cyclist and Evaluations show that the intervention

Reducing traffic emissions

In 2003, the central London Transport for London (TfL) estimates

such as shelters at bus/tram stops Creating an environment where people

How can we make

For clarity, the framework begins with

considered to impact health directly PRIVATE MOTORISED VEHICLE

The framework only represents one

HEALTH IMPACT HEALTH OUTCOME

LIFESTYLE & BEHAVIOUR

WALKING FOR TRANSPORT EXPOSURE TO NOISE ILLNESS & CONDITIONS

PUBLIC TRANSPORT USE PHYSICAL ACTIVITY MORTALITY

CAR FOR TRANSPORT USE ACCIDENTS & INJURIES

MOTORISED VEHICLE SCALES AND DATA ISSUES

How can we design for

Planning and design

Diagnosis For the benchmarking process to have Treatment

What does the design

KNOWLEDGE QUARTER, LIVERPOOL UK

BATON ROUGE, LOUISIANA USA

i Knowledge Quarter, Liverpool UK

Although dominated by science and educational institutions, the Knowledge

Together the Knowledge Quarter institutions generate in excess of £1billion for

The area is considered to be crucial in the wider regeneration of Liverpool. In

The Knowledge Quarter occupies the Liverpool has an extensive road

Mortality from cardiovascular diseases and

the ability to cycle

37 hrs wasted 49% of all trips

The percentage of people who Princes Park

Based on the all above, one can

Modal choice for travel to work Distance travelled to work

Everton, Kirkdale and Princes Park Wards have

39% of all trips

Knowledge Quarter - Precinct

Liverpool One 10/h 10/h

Roads which are part of bus network

Major road link north of the Knowledge Quarter

MAJOR ROAD INFRASTRUCTURE CAR OWNERSHIP

Urban Mobility Impact on Health 10

Health + Mobility Framework 18

Applying the Design Protocol 30

Knowledge Quarter, Liverpool UK 34

Baton Rouge, Louisiana US 50

A. Existing tools and methodologies 77