A Research Roadmap for Transportation and Public Health (2019)

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13 Setting Goals and Performance Measures Agency policies and objectives are assessed according to performance measures, and best practices recommend connecting metrics to specific targets and goals. Agency policies and objectives that consider health outcomes related to transportation plans, projects, and systems require data-centered performance metrics. Transportation-related health metrics can monitor changes in physical activity, equity and affordability of housing and transportation, vehicle miles traveled (VMT), crash rates, air quality, and other indicators of health. For more details, see Section 2.7 of the contractor’s final report. Research Gaps and Needs 1. Gap: Lack of understanding of how agencies are using or incorporating health-related transportation performance measures and whether this strengthens the work that is funded and increases chances of integrating health in other processes. a. Need: Synthesis of practice to identify health-related performance measures actually in use compared to guidance, to identify lessons learned and challenges, and to develop recommendations for future practice. 2. Gap: Lack of scientific methods for measuring agency values, culture, and change. a. Need: Studies to evaluate paradigm shifts in what agencies measure, including how prac- tices may/may not be shifting from auto-oriented measures of performance (such as level of service, or LOS) to measures aligned with health co-benefits (such as reductions in VMT), and what may have prompted shifts. 3. Gap: Lack of commonly accepted tools for measuring access and planning for improved equity in access. a. Need: Studies to develop holistic measures of access (e.g., travel time/network distance to certain destinations using different modes) that can be used in a comparable, standardized way to evaluate projects, plans, and equity outcomes. 4. Gap: Lack of studies that measure how agencies make decisions and change practices; needed to enhance the translation of research to practice. a. Need: Studies that use existing theory—such as network theory and diffusion of innovations—to provide new insights into leverage points, opinion leadership, agency structures, or other models for organizational behavior changes. 5. Gap: Lack of guidance on application of performance measures, new performance measures related to health, and how agencies can measure success in incorporating health into transportation policies. a. Need: Research to develop performance measures and evaluate the effects of such perfor- mance measures on plans, policies, and practices related to health. C H A P T E R 3 Transportation Agency Practices and Research Translation

14 A Research Roadmap for Transportation and Public Health b. Need: Guidance and follow up efforts to standardize health indicators and performance measures to help agencies select, develop, or use the measures that best suit their context. c. Need: Research to develop and integrate new performance measures, including those related to equity as well as emerging issues and modes of travel (such as automated vehicles). Specifically, there is a need for performance measures pertaining to equity that are both easy to operationalize while still being robust enough to capture broader equity outcomes. d. Need: Metrics and models for evaluating how health-oriented policies (such as Complete Streets) change transportation decisions and outcomes. 6. Gap: Lack of basic research on data sources and the role of transportation agencies in measuring community well-being, and how agencies should incorporate community well-being as a performance measurement. a. Need: Research to compare the various methods for measuring community well-being identified to date (e.g., using physical population health measures, economic health measures, psychological health measures such as depression or cognitive decline or social measures such as social engagement and cohesion), the data needs and availability, and current or anticipated usage by transportation practitioners to account for community well-being in performance targets. Interagency Collaborations Interagency collaborations are an essential component in efforts to foster and sustain the uptake of health considerations in the transportation agency processes and practices described elsewhere. Several collaboration examples and tactics emerged in the research process to develop this Research Roadmap, including executive and legislative initiatives, interagency project development and prioritization, grassroots engagement, data sharing and usage agreements, embedded staff, and creative financing and funding. See Section 2.3 of the contractor’s final report for details. Research Gaps and Needs 1. Gap: Lack of model examples of interagency collaboration to advance health in trans- portation processes and practices. a. Need: Synthesis of agency practices to identify diverse sets of examples/case studies of data sharing and usage agreements, memorandums of understanding, executive/legislative initiatives, applications of community health assessments, and other collaborative prac- tices in both rural and urban settings. b. Need: Research to examine the role of executive-level mandates or legislative initiatives in fostering interagency collaboration and how outcomes differ from non-mandated approaches. 2. Gap: Lack of knowledge on practices related to training, organizational structure, and use of “bridge” staff between public health and transportation sectors to increase coordination. a. Need: Synthesis of practice to identify how often “bridge” staff are hired or staff from other departments are integrated/housed at new units and lessons on how this impacted agency capacity to coordinate across sectors. This research could provide the basis for the development of cross-sector collaboration tools/training or other training/capacity building via internship and/or dual degree programs. b. Need: A synthesis of the state of practice in offering public health training opportunities for transportation planners, designers, and engineers; research on work force training gaps; and development of model curriculum or training course learning objectives to improve work force capacity.

Transportation Agency Practices and Research Translation 15 3. Gap: Lack of efficient and clear methods for coordination between state, regional, and local agencies in considering health as part of the decision-making process. a. Need: Development of model process(es) for integrating local, regional, and state-level plans that address health considerations in transportation activities. b. Need: Guidance for facilitating discussions and standing work groups among local, regional, and state officials around health in transportation. c. Need: Case studies and examples of effective working relationships and roles which foster collaboration. 4. Gap: Lack of knowledge on the role of coordination to leverage funding for health- supportive projects and programs. a. Need: Research or case studies demonstrating how agencies—particularly in rural areas— can establish jointly-funded programs (including training) and projects and/or create innovative funding streams to support collaboration, data sharing, and health initiatives. In particular, there is a need for research examining collaborative approaches to leverage innovative funding streams, such as Medicaid travel reimbursements, to improve trans- portation services and access to healthcare or other basic needs. b. Need: Research and/or case studies specifically around challenges, opportunities, and noteworthy practices in leveraging recovery funds after a crisis event to integrate health considerations into new investments. 5. Gap: Lack of tools (or knowledge and usage of existing resources) to support shared language and understanding of different health and transportation processes and terms. a. Need: Synthesis of existing resources, tools, or trainings used to foster interagency collaboration and documentation of the usage of existing tools (such as NCHRP 25-25 Task 105: A Guidebook for Communications between Transportation and Public Health Communities) that can be used to build a shared language and understanding of terminology, processes, and tools from both public health and transportation fields.