Improving Health and Safety through Walkability in US Insular Areas

Walkability, or the experience of walking around a neighborhood, affects everyone, whether or not people are conscious of its effects on their daily routines. Envision navigating your neighborhood on foot. Do you feel safe? Are the sidewalks and crosswalks in good condition (if they exist in the first place)? Are pedestrian areas poorly lit or frequented by stray dogs? Can people with wheelchairs or strollers move comfortably? Are bicycle and public transit options available, and do they meet the needs of the community? From public health to local economies to the environment, the ability for people to safely walk, bike, and take transit to accessible locations can have a significant impact on communities.

In the United States’ insular areas—jurisdictions that are not part of the 50 states or a federal district—the burden of chronic disease associated with insufficient daily physical activity is a large and growing problem. Indeed, the adoption of lifestyles and transportation patterns similar to the mainland US, where jobs are increasingly sedentary and transportation is increasingly by car, is a substantial contributor to chronic disease risk factors.

This is why TEPHINET is partnering with the US Centers for Disease Control and Prevention (CDC) to support efforts in insular areas to make neighborhoods and streets more walkable. Through local collaboration and with the help of subject matter experts, TEPHINET and CDC are providing assessment and planning assistance, as well as funding for demonstration projects, in the US Virgin Islands (USVI), Guam, and the Republic of Palau.

Build an Environment that Creates a Culture Shift

Many places are taking walkability and active transportation (bicycling and transit use) seriously, recognizing its benefits for human and environmental health. Improved physical activity levels help prevent non-communicable diseases (NCDs) by helping adults get the recommended 150 minutes per week of physical activity which reduces the risk of chronic disease and early death. Walking also lowers blood pressure, helps people manage their weight and builds general fitness. In places with more transit options, fewer trips are taken by vehicle which translates into improved air quality and fewer road traffic injuries. Walkable places also outperform non-walkable places economically. Yet as TEPHINET consultant and public health, planning and transportation expert Mark Fenton explains, people around the world have arranged modern urban spaces around cars, not people, and improving walkability requires a cultural change.

“When we talk about changing the culture, I remind people that one of the best ways to do it is to build an environment that is inviting for that cultural shift,” says Fenton. In other words, build places in which people want to walk, bike, or take public transit, and this shift will happen more naturally.

The Approach: Action-Oriented and Team-Based

In order to work towards this cultural shift, efforts center on an action-oriented, team-based approach that provides skill-based learning and action planning around environmental approaches for physical activity. This program launched in the USVI in 2016, in Guam in 2018, and launches this month in Palau.

In each location, the work follows a replicable model already in use across the United States: first, a community walkability assessment, then a Walkability Action Institute followed by team action planning for demonstration projects and policy recommendations. The end goal is to integrate change on a system level to ensure sustainability.

Step one involves walkability assessments led by Haley Cash, an epidemiologist with the Pacific Island Health Officers Association (PIHOA). Haley and local community volunteers collect field data from neighborhoods to generate baseline data that can be used to make the case for an intervention—for example, in the form of installing a crosswalk. According to Cash, in Guam, her teams’ assessments of 210 different streets found that 70 percent of the road segments they surveyed did not have sidewalks, and about a third lacked adequate street lighting.

Following the assessments, step two is the implementation of Walkability Action Institutes, workshops that convene local stakeholders from across multiple sectors to craft and implement action plans for improving walkability in specific areas. Stakeholders represent both the private and public sectors, including departments of health, planning, public works and transportation; legislators, businesses, local walking and active transit coalitions, non-governmental organizations, community foundations, and more. Fenton provides technical assistance by delivering training on how to improve community walkability to these local teams. The training comprises a two-day Walkability Action Institute workshop with pre- and post-workshop webinars.

The Walkability Action Institutes begin with “walk audits” in which Institute participants explore representative neighborhoods and business districts together on foot, noting what makes their streets feel safe and inviting for walking and what needs improvement. Using this experience, the participants learn about components of a successful action plan, including discussion of policy recommendations. Participant teams then engage in a detailed action planning exercise.

During the final step, each team puts forth an action plan for review by Fenton and CDC subject matter experts. The finalized action plan includes proposals for small-scale demonstration projects, which then receive seed funding from TEPHINET to support implementation. The ultimate goal of these demonstration projects is to illustrate to policymakers and other stakeholders that investments in these types of projects are worthwhile. To that end, evaluation data are collected before and after the completion of each project for incorporation in policy-making decisions.

“It’s not just about the workshops but the bigger community outreach and media strategy to bring policymakers and others on board and get people energized about improving walkability,” says TEPHINET project manager Claire Jennings.

The USVI and Guam workshop teams are currently preparing to implement their demonstration projects, conducting data collection, and creating their new walkability-enhancing features (e.g., crosswalks in areas assessed for need). In the USVI, the project was delayed by two major hurricanes in 2017, which has resulted in the integration of walkability efforts into larger recovery efforts. In Palau, where the government’s current strategic action plan for non-communicable disease prevention and control calls for enhancing the walkability of its streets and roads to improve health, the walkability assessment began in March 2019.

“Hopefully, other countries and partners will see the benefits of this work and want to come on board,” says Jennings. “It’s an exciting initiative for building momentum towards creating healthier local communities on multiple levels. This can have a long-term impact on reducing the burden of NCDs.”