Getting Everyone Involved – Post 14

Getting people involved in the policy process is not an easy thing to do. You have to pique people’s interest to the point that they are willing to act.  Essentially we are marketing or advertising for the policy process and the policy process is not always the most interesting subject out there.  I have thought of three ways to try to get people involved.

1. Humor – This is my favorite way.  I don’t have HBO but I watch John Oliver almost every week on youtube.  John Oliver is the host of a show called Last Week Tonight that is on HBO. I’ve never seen an entire episode because they do not post the whole show on youtube they only post these 20 minute long rants that John does every week.  John takes some subject, that often times needs to be addressed with policy change, and points out the problems with the subject in a funny way.  He can take something as uninteresting as “infrastructure” and present it in way that fascinates and motivates people to want change.  The segment usually ends with John inviting viewers to actually do something about the problem even if it is something as small as tweeting about it.  By the end of watching him tell me about infrastructure I am ready to support real policy change.

I’ve tried to do this to a more limited and less funny extent with physical activity.  You can see some of our videos here.

2. Important – The second method is to help people see that a policy is important.  That is what many policy entrepreneurs are trying to do (Kingdon, 2011).  They want attention focused on their policy or their problem.  Getting people to see a problem in a new light or recognize a problem is of importance is actually a big accomplishment (Kingdon, 2011).  A pediatrician named Abe Bergman, showed Senator Warren Magnuson the problem of children’s clothes being flammable by taking the Senator to a burn ward (Kingdon, 2011).

3. This affects You! – I recently attended lobby day with the Arizona Nurse’s Association for APRNs.  I attended out of interest and also because I knew that it would count for clinical hours.  In the brief meeting to begin the day my interest grew because the presenters were able to make me see that policy regarding APRNs in Arizona affects me.  I suddenly became self interested and was probably better able to present my case with the lawmakers that we met with later.  If a policy seems to actually affect me I am suddenly interested in it.

So how do I do this with physical activity and complete streets?

1. Humor – I’ll see if John Oliver will do one on physical activity.

2. Important –  I’m not sure how to show its important but I’ll try this.  Less than half (48%) of American adults meet physical activity recommendations of 150 minutes per week of moderate aerobic exercise such as a brisk walk (Center for Disease Control and Prevention [CDC], 2014). This is a problem because physical activity improves health, can lower risks for heart disease, stroke, diabetes, depression, cancer and helps control weight (CDC, 2014). The problem is worse for those in lower socioeconomic classes. Adults with less education are less likely to meet physical activity guidelines then their more educated peers (CDC, 2014).The problem is accentuated in the urban environment.  People that live in the urban environment are more overweight and less physically active than the rest of the United States (Lopez & Hynes, 2006). Essentially if you live in an urban environment you are going to be less physically active than those who do not and that results in poor health outcomes (Lopez & Hynes, 2006).  You probably need complete streets.

3. This affects you – The design of your community does affect you.  Do you want to live in a place where you can safely walk, bike, ride public transportation or drive?  Do you want to be in a community where everyone has better opportunity to be active?  Do you want to live in a country where 68% of the population is overweight or obese (CDC, 2014)?  I know I’m more likely to be physically active when I live in an area that is conducive to it.  When I lived in Arlington, Virginia I would go on epically long runs because there were bike paths and pleasant places to run to.  Now I just go on short runs because I’m in bad shape and not as interested in the area I live.  I need complete streets.  So do you.

Center for Disease Control and Prevention (2014).  Physical activity facts.  Retrieved from

Kingdon. (2010). Agendas, Alternatives, and Public Policies, Update Edition (2nd ed.). London: Longman Publishing Group.

Lopez, R. P., & Hynes, H. P. (2006). Obesity, physical activity, and the urban environment: public health research needs. Environmental Health, 5, 25. doi:10.1186/1476-069X-5-25



Sustaining Innovation like a Duck – Post 13


I’m not sure how many people are familiar with the modern literary classic Duck on a Bike by David Shannon.  The duck that rides the bike is, of course, awesome.  He is what would be called a leader of innovation.  Duck’s face of innovation would be the Experimenter (Kelley, 2014).  He just one day gets the idea to ride a bike that a boy left sitting around at the farm.  At first the duck is a little wobbly but he quickly gets the hang of it.  Some of the other farm animals think that duck is being ridiculous and even unsafe.  But eventually Duck gets the hang of it and at least a few of the farm animals think that riding a bike might be cool.  Then suddenly a large group of kids arrive at the farm with a bunch of bikes.  The kids all run inside and of course something magical happens…


Yes, all the animals ride the bikes.  Duck has completely innovated the way the animals travel around the farm.  But most tellingly Duck doesn’t just rest on his laurels.  On the last page he is shown considering the tractor.  So how would Duck suggest that we sustain innovation?  He would tell us to never stop innovating, keep looking forward.

Animals riding bikes leads into discussing what this blog has been addressing, the complete streets movement with more people riding bikes (rather than animals).  So how do we sustain innovation in the complete streets movement?  The complete streets movement really takes its cue from European cities that place different modes of transportation at a higher priority than motor vehicles.  The Take a look at this picture of Copenhagen…


So lets explore what some of these European cities are doing to sustain complete streets and physical activity there.

Copenhagen – In Copenhagen somewhere near half of all commuter trips are done on bikes (McCann, 2010).  Part of this is accomplished by having large blue bike lanes painted on almost every street and by maintaining low speed limits for cars.  (McCann, 2010).  But in Denmark there are also spaces for pedestrians, buses, trains and cars (McCann, 2010).  Maintaining the innovation has been easier because there is a consensus in Denmark that having multiple modes of travel is important and reduces traffic  (McCann, 2010).  One thing is for certain the increased bicycle usage leads to higher rates of physical activity.

London – There is currently plans in London to build cycling highways that are exclusively for cyclists (Walker, 2015).  These plans are receiving overwhelming support and construction should soon begin (Walker, 2015).

Amsterdam – Amsterdam is the busiest cycling city in Europe (Neild, 2015).  The city has over 4000 KM of cycling trails and residents there can be pretty aggressive on bikes (Neild, 2015).  Bikes take a priority here.

If we want to establish streets that encourage physical activity like these European cities and maintain the innovation we need to do work on a few things.

1.  Work to establish a consensus.  These cities are able to make the streets a safe place to be physically active because there is agreement that that is a priority.

2.  Highlight the benefits of the innovation.  Duck did this by showing the other animals how cool biking can be.

3. Keep working and pushing the innovation.  London is working to continue to support physical activity by adding cycling highways to the city.  Moving forward is a priorty for London just like it was for Duck.  I think if you are not moving forward you are probably moving backward.



Kelley, T. (2005). The ten faces of innovation. New York, NY: Doubleday

McCann, B. (2010).  Complete streets lessons from Copenhagen.  Smart growth America.  Retrieved from

Neild, B (2015, February 16). Cycling  in Amsterdam: How to pedal like a local.  Retrieved from

Walker, P. (2015, February 4).  Segregated cycle superhighways set for go-ahead in London. The guardian.  Retrieved from

Healthcare Financing and Obesity – Post 12

Obesity is now estimated to add $190 million to annual healthcare costs in the U.S. (Ungar, 2012).  Obese men cost an extra $1,152 a year and obese women cost an extra $3,613 a year (Ungar, 2012).  These are significant costs.  So how do we pay for this?

As I wrote about earlier on this blog one way to pay is to make the obese patients pay for it.  The affordable care act enables employers to charge more for healthcare if employeess do not participate in wellness screening (Ungar, 2015).  This is a way employers are trying to pass rising costs onto patients that are not living healthy lifestyles.

Another major way the nation is trying to fight these costs is by providing more preventative treatment and more treatment directly for obesity.  The Affordable Care Act (ACA) is stepping in to support obesity treatment.  The ACA is doing this in several ways…

1.  The federal government will match funds for states that are covering U.S. Preventive Services Task Force grade A and B recommendations for preventive services (Centers for Medicare & Medicaid Services, 2014).  Obesity screening and counseling is recommended for all age ranges (Centers for Medicare & Medicaid Services, 2014).

2. The ACA calls for states to educate the public regarding obesity-related services (Centers for Medicare & Medicaid Services, 2014).

3.  The ACA is funding research to combat childhood obesity (Centers for Medicare & Medicaid Services, 2014).

Arizona also has a program known as the Nutrition, Physical Activity and Obesity Program (Arizona Department of Health Services [ADHS], 2014). This program is working to make Arizonans healthier. The primary goals of the program are

  1. To promote and enable the citizens of Arizona to eat smart and have access to healthy and nutritious foods (ADHS, 2014).
  2. To promote and enable active lifestyles and communities for Arizona residents (ADHS, 2014).

But where exactly is the money coming from to fund these kind of programs?  Well in Arizona the Nutrition, Physical Activity and Obesity Program is run by the Arizona Department of Health Services (ADHS, 2014).  ADHS gets its funding primarily through the state budget.  The ACA is a federally funded program with funds coming from the American taxpayers.

It is somewhat surprising when you actually look at the numbers to see how much the United States is spending on healthcare.  The federal government spent $3.5 trillion in 2014 (Center on Budget and Policy Priorities [CBPP], 2015).  Of that about 24% was spent on healthcare (CBPP, 2015).  This includes: Medicare, Medicaid, the Children’s Health Insurance Program (CHIP) and the ACA marketplace subsidies (CBPP, 2015).  The bill comes to $836 billion with most of that amount, about $511 billion, going to Medicare (CBPP, 2015).

The numbers are staggering.  The federal government is getting this money primarily through income tax.  This year I got a pretty good return because of the number of children in my house but basically it is us that are footing the bill for all of this.  I just learned today that to be considered middle class in Arizona you need to make between $32,000 and $97,000 a year (Kane, L. & Kiersz, A., 2015).  $32,000 does not seem like much of an income to be considered middle class but I guess somebody has to pay for all this.



Arizona Department of Health Services (2014).  Nutrition, Physical Activity and Obesity Program. Retrieved from

Center on Budget and Policy Priorities. (2015). Policy Basics: Where Do Our Federal Tax Dollars Go? Retrieved from

Kane, L. & Kiersz, A. (2015, April 2). How much you have to earn to be considered middle class in every US state. Business insider. Retrieved from

Ungar, R. (2012).  Obesity Now Costs Americans More In HealthCare Spending Than Smoking. Forbes.  Retrieved from

Centers for Medicare & Medicaid Services. (2014).  Reducing obesity.  Retrieved from

Innovators and Agents of Change – Post 11

My wife and I sometimes play a card game called Innovation.  I’ll admit that it is a pretty nerdy game.  The idea is that you are moving forward through time.  The first cards that you get involve using stone tools and by the end of the game you’re using futuristic space age technology.  To win the game you have to be willing to adapt by discarding old technologies but also by finding new ways to use the old technologies.  Usually it is the person that is willing to make the most changes during the game that wins.  That’s probably true for real innovation as well.

I want to share a story that probably many people are familiar with.  Dr. Ignaz Semmelweis was a physician that worked in a hospital in Vienna in 1846 (Davis, 2015).  He developed an interest frequent deaths that occurred in child birth due to a disease that was termed child birth fever (Davis, 2015).  He studied the rates of death in the two wards in the hospital where women gave birth, the death rate was 5 times higher in the ward where medical doctors and students practiced in comparison to the midwives (Davis, 2015).  Semmelweis wanted to work out why this was occurring.  Eventually Semmelweis was able to deduce the difference between the two wards was possibly due to the fact that the doctors were performing autopsies and the midwives were not (Davis, 2015).  He began an experiment where he had doctors wash their hands with chlorine prior to seeing pregnant patients.  The results of the experiment were very convincing but the hand hygiene did not continue. Doctors did not like the implication that they were spreading infection and Semmelweis was not tactful in his advocacy of handwashing (Davis, 2015).  Eventually the handwashing stopped and Semmelweis was committed to an insane asylum.

The physicians were just not ready for the innovation and did not want to make a behavior change.  The physicians did not like to be accused of hurting their patients especially by a guy like Semmelweise.  Now hand hygiene is common practice but can still be an issue in some hospitals.  A recent episode of Freakonomics addressed this hygiene issue.  A hospital got physicians to increase compliance with hand hygiene after culturing physician hands and posting pictures of the cultures.  The hospital also started reading out names of providers that were not doing hand hygiene.  They had to shame some of these doctors into changing..

Innovation is not easy.  If it was easy it would already be done.  An innovator needs to be willing to accept failure as much as success. James Dyson built 5127 vacuum prototypes until he had the design that would be successful (Kelley, 2005).  After you overcome failure there still will be resistance to innovation (people that won’t wash).  For success the innovator has to have a “never surrender” attitude (Kelley, 2005).  And of course innovation based on real evidence is more likely to succeed (Porter-O’Grady & Malloch, 2011).

So how does this apply to the complete streets movement?  The movement has evidence supporting making change but it needs to continue to fight failure and to overcook resistance.  The National Complete Streets Coalition is working on it.  Agents of change need to not only have good evidence for change but a plan to make the change actually happen.



Davis, R. (2015).  The Doctor who championed hand-washing and briefly saved lives.  Retrieved from

Kelley, T. (2005). The ten faces of innovation. New York, NY: Doubleday

Porter-O’Grady, T., & Malloch, K. (2015). Quantum leadership: Building better partnerships for sustainable health (4th ed.). Sudbury, MA: Jones & Bartlett.

Changes: Turn and Face the Strange – Post 10

David Bowie’s classic on changes insists that you, “turn and face the strange.”  That’s what changes in policy force us to do.  Face a new and strange future.  Something we won’t immediately recognize and may be uncomfortable with.  Opponents of complete streets do not want to, “face the strange” of bike lanes, public transportation and increased pedestrian crossings/walking areas.  The opponents cry out against cost and changes that seem to limit the use of cars.  So how do we help these people “turn and face the strange?”

One way can be to use, Kotter’s Change Management Model (Campbell, 2008).  Kotter intended the model to be used in a smaller organizational setting but it can be helpful to apply to a change as wide as enacting complete streets policy to help increase physical activity (Campbell, 2008).  Kotter suggests a nonlinear 8 step approach.

  1. Increase urgency – This means to make the change seem more important to those that the change affects (Campbell, 2008).  For complete streets it could include discussing the increased safety and physical activity that comes from implementing complete streets in a community (Center for Disease Control, 2014).
  2. Build Guiding teams – Guiding teams help implement the change in the direction it needs to go.  The biggest guiding team right now for the complete streets movement would be the National Complete Streets Coalition (2014).
  3. Get the vision right – The policy needs to actually be making a worthwhile change.  Redesigning a street is pointless if the change does not actually improve safety and walkability in an area.
  4. Communicate for buy in – The idea of complete streets needs to be communicated to stakeholders so that all those involved can actually know the benefits of making changes.
  5. Enable Action – For policy making this means actually giving stakeholders a policy they can approve.  The City of Mesa did this with the Mesa 2020 plan as discussed in earlier posts.
  6. Create short-term wins – Short-term wins show that a policy or a change is making an immediate difference.  This can be seen in Mesa on Mesa Drive as discussed in an earlier post.
  7. Don’t let up – The 1969 Cubs had a 9 game lead on the Mets with about a month and a half to go but the team let up (Campbell, 2008).  The Mets ended up winning the division by 9 games and went on to win the world series (Campbell, 2008).  Short-term wins don’t turn into long term ones unless the policy change is supported moving forward.
  8. Make it stick – To make a change stick you have to show that it is making a real difference.  Many social programs do not actually focus on results and have few studies to show that the policy is making a difference (Liebman, 2013).  Complete streets can change this by doing follow-up studies to continue to show the increased physical activity and increased traffic safety so that the policy sticks.

Change is difficult to accomplish and even more difficult to maintain.  Everyone has made a goal at some point to be more physically active or eat better only fail.  I’m not sure how to always maintain change on a personal level and making change stick at a larger county, state or national level is sure to be tough.  There are plenty of times I have not wanted to turn and face the strange.


Campbell, R.J. (2008). Change management in health care. The Health care manager. 27(1) pp. 23-39

Center for Disease Control and Prevention (2014).  Physical activity facts.  Retrieved from

Liebman, J.B. (2013).  Building on recent advances in evidence-based policy making. The Hamilton Project and Results for America.

National Complete Streets Coalition (2014). Fundamentals. Retrieved from

Privacy and the Biometric Screening – Post 9


Complete streets policies to help increase physical activity are not really the kind of policy that lends itself to a lot of concern related to data and privacy  but issues related to obesity certainly do.  I recently overheard a conversation at work regarding the company’s biometric screening.  Several of my coworkers were discussing their dissatisfaction with BMI as a measurement of health and were upset that they were included in the overweight or obese area of BMI.  I did not join in the conversation because I did not want to be the small, skinny man defending the BMI measurement.  Besides the BMI measurement was not the real issue here it was what the company is using the BMI measurement for.

The real question that needs to be discusses is, “Can a company penalize overweight people by raising the costs of their healthcare?”  The Equal Employment Opportunity Commission [EEOC]does not think so (Thornton, 2014).  The EEOC recently filed a suit against Honeywell claiming that Honeywell is requiring screenings or their employees will suffer higher insurance costs of up to $4000 (Thornton, 2014).  The EEOC is basing this lawsuit off of the Americans with Disabilities Act [ADA] and the Genetic Information Nondiscrimination Act [GINA] (Thornton, 2014).  So the EEOC is filing suit over the use of biometric screenings as a way to determine health care costs but currently it is legal to increase costs due to failure to comply with a biometric screening.

Currently companies that do biometric screenings use a third party to gather the information and the information is not shared with the company (McGregor, 2013).  But if clearly the company has to have some understanding of the information because the company is still the entity in charge of giving the rewards for participation in the screening or administering the penalties for not participating.  So regardless of whether the company knows the employee’s exact weight they know who got the bonus and who did not.

These biometric screenings are of course well intentioned and really should be commended.  But companies are not doing these screenings out of altruism.  The company hopes to save money on healthcare.

Maricopa county currently encourages its employees to participate in biometric screening.  By participating in the screening employees can save up to $480 dollars a year on insurance premiums (Maricopa County, 2014).  Here are a couple of the frequently asked questions regarding the County’s biometric screening program.

Will my supervisor or anyone in Maricopa County see the results of my Biometric Screening or Health Assessment?

A. Absolutely not! Your confidential individual health data is protected by State and Federal Regulations including the Health Insurance Portability and Accountability Act (HIPAA). Maricopa County personnel will never see your confidential “protected” individual health results. Maricopa County will receive an executive summary report showing aggregate health data that will reveal the prevalence of certain conditions within Maricopa County, such as percent of employees with high blood pressure. This data will be used to improve our employee worksite wellness programs and overall employee health status.

Q. Will the insurance rates increase for Maricopa County employees if the aggregate health profile based on the anonymous (de-identified) biometric screening shows that Maricopa County employees have high prevalence of blood pressure, weight management issues, etc.?

A.  No, the results of the biometric screening are not used to determine the insurance rates for Maricopa County employees. The aggregate health profile, based on the anonymous (de-identified) biometric screening results, will be used to continuously improve the employee worksite wellness program.


So I personally think that biometric screenings are great and can help patients know what areas of their health they need to work on.  The issue comes when it is employers mandating the screenings.  Your health information is private information and is protected information.   It is a slippery slope when your employer gets involved.



Thornton, J.D. (2014, November 20).  Are employee biometric screenings legal?  Total Wellness.  Retrieved

Maricopa County (2014).  Frequently asked questions: General biometric screening and health assessment. Retrieved

McGregor, J. (2013, March 21).  The CVS health screening debate.  The Washing Post.  Retrieved




The Private Sector and City Planning for Physical Activity – Post 8

I interviewed my friend Spencer Gardner regarding the private sector and city planning.  He is a AICP, which is the professional certification for urban planners.  Spencer has worked mostly with pedestrian and bicycle planning for the past few years.  He rides his bike to work everyday and has a very handsome beard.  He currently lives and works in Madison, Wisconsin.

My questions are in black and his answers are in blue.

What do you do?

I am an urban planner. Specifically, I prepare bicycle and pedestrian plans for various levels of government. 
To what extent are you involved with local government?
It really depends on the project. In some cases, we are hired directly by a city – they are our client and we do everything in consultation with them. In other cases we are working on a statewide project and may interface with local governments tangentially as part of the planning process. 
Positive/negative experiences with local government?
 In general, local governments are good to work with. They tend to have the closest relationship with their citizens (as opposed to state or federal agencies) so they are highly motivated to get things done and do it right. There are many challenges too. Municipalities are rarely able to fund projects on their own – they are often partnering with a state or federal agency who provides money. This can complicate the process and introduce hurdles that, for good or bad, wouldn’t otherwise be an issue.
My other thought is that it depends so much on the municipality in question. I’ve worked with some great local governments. I’ve also worked with some that had little interest in the project and were simply wanting to “check a box” to satisfy some state or federal requirement. It’s frustrating to work in these circumstances because you’re often left without guidance or input and it’s clear that whatever plan you write is just going to sit on a shelf.
Does your company do studies to see the impact of new trails or walking paths on the physical activity of the area?
We have done some of that, although I haven’t been directly involved. I was just working on a project a few months ago on behalf of a federal agency where we interviewed various state departments of transportation. Our purpose was to ascertain to what level these organizations actually track the impact of their bicycle and pedestrian projects. Unfortunately, the answer from most was that they don’t really do anything like that now.
Some cities have wised up to the need for this kind of data and are starting to take it more seriously. Last year, the City of Madison, for example, installed a new bicycle counter on one of the main paths leading into downtown. I pass it every day on my way to work. It’s kinda fun to see how much usage the path is getting. In winter it’s down near 300 people per day, but when the weather is nice it’s well above 1,000.
What kind of studies does your company do before a new project?
Typically, a government would start the process with some kind of plan. It might be a comprehensive plan, which encompasses more than just transportation – things like housing, education, employment, storm sewers, etc. This answers questions like, “what kind of city do we want to be?”, and, “what do we need to do to get there?”. From there a more specific plan directly related to the project would generally follow. This would establish answers to questions like, “where should this path start and where should it end?” or, “what’s the best way to ensure that neighborhoods surrounding this path can access it?”
From there, you might move into preliminary engineering, where you actually start dealing with the physical reality of building the path. You would survey the ground and draw up designs for the trail based on the existing conditions.
This would lead into final engineering, where you get into details like how deep to pour the asphalt or how much material is needed to backfill in a low spot.
Finally, you’d construct the path.
My firm tends to focus on the plans and preliminary engineering phases. We don’t do as much detailed engineering and we definitely don’t do construction.
Does your company try to influence governmental policy?
Sorta. I’m not aware of any direct lobbying that my firm has done on a piece of legislation. We’re pretty small and insignificant as far as planning/engineering firms go. But we are members of professional organizations, such as the Association of Pedestrian and Bicycle Professionals (APBP), and the American Planning Association (APA). These organizations definitely lobby on behalf of policies that they see as beneficial.
More generally, we as a company are committed to the idea that all people should be able to get around their cities safely and easily without the necessity of driving a car. We believe cars and non-motorized travelers can and should coexist, and that too much of our landscape is out of balance in favor of moving automobiles rather than moving people. In that respect, we engage in the civic arena to advance our cause, whether it’s through our Twitter account, participation in conferences and professional activities, or simply doing the work that we’ve been hired to do.
This leads me to my last point. In many cases, we are hired explicitly for the purpose of providing advice on government policy. As an example, I’ve been working on a project here in Madison where the City has hired us to take a look at bike parking in the downtown area and offer suggestions for improving it. We are making recommendations such as changing parts of the zoning code to boost requirements for providing bike parking. We are also identifying specific locations where the city can install more bike racks. We don’t set the policy – the City is free to ignore our advice – but they have paid us to do the research and provide an expert perspective on the issue.
What goals do you/your company have for Madison?
Hmm. I don’t know that we have any explicit goals for Madison. As I stated above, we are committed to ensuring that everyone feels safe and comfortable getting around without a car. Madison does a pretty good job of that compared to many places in the US, but there are still problems to solve. 
In fact, my co-workers and I have often talked about how Madison seems to be resting on its laurels a little bit. We have an excellent system of bikeways (both paths and bike lanes), but there hasn’t really been anything meaningful done in the last decade. In the meantime, other cities have been innovating like crazy. For instance, while we I lived in Chicago the city built an awesome new bike lane with special traffic signals for bikes. The lane is separated from moving traffic by parked cars so that you feel more protected. It got a lot of press and has really reshaped biking in the downtown area. That project was actually one of the things that got me thinking about changing to work at my current firm. Madison hasn’t really done anything like that in recent years.
What lessons have you learned that you think could be helpful in other towns?
One key lesson is that it really takes leadership within the city administration to get these things done. As consultants, we’re really limited by the vision and direction of the city we work for. If someone like a mayor or powerful city council person gets behind a project and is willing to fight for it, the end result is always so much better. There’s a lesson here for citizens, too. Elected leaders tend to respond when their constituents ask for things. If city leaders sense that no one really wants bike or pedestrian infrastructure, or that they’re not willing to repurpose roadway space to do it, they’re not going to fight for it. If, on the other hand, they hear people asking for better bike lanes or more paths or more sidewalks, they will respond accordingly.
The other lesson I would offer is that we are experiencing a significant shift in the perception of bicycle and pedestrian transportation. It used to be that we provided paths, sidewalks, and bike lanes purely as a recreational amenity. The result was that we built facilities that lead to the middle of nowhere – nice if you’re out for a jog, but not very helpful if you need to get to the grocery store. 
Now, cities are starting to realize that biking and walking should be considered forms of everyday transportation. We’re reaching a breaking point in the US where we can’t build enough roads to solve our traffic problems. We have to look for other ways to get people where they want to go. There’s a saying in the industry that building more roads to alleviate traffic congestion is like trying to treat obesity by loosening your belt. Building more and bigger roads doesn’t solve a traffic problem. It just provides temporary relief and ultimately encourages the problem to get worse! Instead, we should be ensuring that everyone has alternatives to choose from when they need to get around.
Instead of widening a road, we should be looking at how to more effectively use the space we have. Here’s a cool image that illustrates this point. We dedicate vast amounts of space to moving cars that carry only a single person on average. Biking and walking, by contrast, require very little space, are less expensive to build infrastructure for, and encourage a more healthy way of getting around. Consider this: the city of Portland, OR, one of the premier biking cities in the US, has spent about the same amount on their biking infrastructure in the last decade as it costs to build a single mile of freeway.

The Affordable Care Act – Post 7

So this week I’m taking a brief turn a little bit away from my main topic to focus more on the Affordable Care Act.  Obviously having appropriate health care can support anyone in achieving more physical activity and the basic idea behind the act is to put patient more in charge of their health (U.S. Department of Health and Human Services [HHS], 2015).  For a patient to really become physically active the patient has to take responsibility for their health.  All the walking paths and bike lanes in the world will not create healthy people.  People have to choose to use the paths and lanes.

So first the basics of what the law is supposed to do for us (from HHS website about the law).


  • Ends Pre-Existing Condition Exclusions for Children
  • Keeps Young Adults Covered
  • Ends Arbitrary Withdrawals of Insurance Coverage
  • Guarantees Your Right to Appeal


  • Ends Lifetime Limits on Coverage
  • Reviews Premium Increases
  • Helps You Get the Most from Your Premium Dollars


  • Covers Preventive Care at No Cost to You
  • Protects Your Choice of Doctors
  • Removes Insurance Company Barriers to Emergency Services

My family and I are currently covered by a plan that we got through the Affordable Care Act, or Obamacare.  I’m quite satisfied with it at this point.  We enrolled through on the open marketplace and found a plan that was appropriate for us at this time. The coverage is better than our previous plan and the cost is less.  For me the lack of cost for well checks and preventative care is awesome.  Previously taking my daughters to a well child check would cost a copay of $25 for each girl ($75 for just a well child check).  Now the well child checks are actually free.  I am satisfied with the care we’re getting.

I have not addressed the most controversial part of the plan referred to as minimum essential coverage (Centers for Medicare and Medicaid Services [CMS], 2015).  This is the part of the law that requires coverage for particular individuals or fines have to be paid (CMS, 2015).  The outcry against this is mostly about freedom being taken away and losses that small businesses might have because of the requirement.  I can understand both sides of the argument.  In a perfect world everyone would have health insurance and not be required to buy insurance.  This is not a perfect world.

The Affordable Care Act was signed into law in 2010 and has been slowly rolled out with the open enrollment in the Health Insurance Marketplace beginning in October 2013 (HHS, 2015).  But how did we get here. The implementation of the Affordable Care Act can be instructive for the implementation of any new law or policy.

The idea for the Affordable Care Act was actually taken from a similar reform done in Massachusetts.  David Simas, a whitehouse staff member, stated, “The state’s progressive vision of universal coverage and the conservative idea of market competition are what formed the blueprint for Obamacare: that everyone should have access to quality, affordable health care, and no one should ever go broke just because they get sick” (2013).  President Obama first began to address this kind of reform in the 2008 campaign.  He presented a plan very similar to the system in Massachusetts (The Commonwealth Fund, 2008).  With Obama’s election and democrats taking the majority in both the House and Senate the democrats could work on passing health care reform.  Both parties acknowledged that reform was necessary but of course disagreed on how it should take place.

The Obama administration felt that they had to work on healthcare reform quickly and began working in the first year of the administration (Frontline, 2010).  He quickly got major democratic senators and congressmen on board and the Finance Committee formed a bill based around the Massachusetts system already in place (Frontline, 2010).  Throughout the year the President attempted to get bipartisan support for the bill in the Senate and the House (Frontline, 2010).  In the end the bills were passed in both the House and the Senate with no Republican voting for the bill (Frontline, 2010).

So is the act working?  A recent New York Times article basically said yes.  Read the article here.

I’m probably biased on this issue.  I think that everyone should have healthcare.  I get my insurance through the Affordable Care Act and really it is in my interest to have more patients with insurance.  That’s more patients for me to be paid to see.

Passing this reform took a lot.  Pretty much everyone in America had to agree that the current healthcare system was not working well.  Then it was still impossible to get agreement on how to fix it.  In the end Obama said that the Democrats would just pass the bill without the Republicans and that’s what they did (Frontline, 2010).  Hopefully getting people to agree on supporting physical activity won’t be so hard.



Centers for Medicare and Medicaid Services (2015). Health insurance market reforms.  Retrieved from

Frontline (2010).  Obama’s deal: Chronology.  Retrieved from

U.S. Department of Health and Human Services (2015). About the law.  Retrieved from

Simas, D. (30, October 2013).  Why we passed the Affordable Care Act in the first place.  Retrieved from

The Commonwealth Fund (2008).  The 2008 Presidential Candidates’ Health Reform Proposals: Choices for America.  Retrieved from–choices-for-america


Public Sector Influence on Physical Activity Policy – Post 6

The National Physical Activity Plan Alliance (NPAPA) has created a plan to increase physical activity throughout the whole nation (2010).  The primary area of interest to me is the Transportation, Land use and Community Design section of the plan (NPAPA, 2010).  Within that section the plan lists the following strategies…

Increase accountability of project planning and selection to ensure infrastructure supporting active transportation and other forms of physical activity.

Prioritize resources and provide incentives to increase active transportation and other physical activity through community design, infrastructure projects, systems, policies, and initiatives.

Integrate land-use, transportation, community design and economic development planning with public health planning to increase active transportation and other physical activity.

Increase connectivity and accessibility to essential community destinations to increase active transportation and other physical activity.

These strategies can be compared to Mesa 2040 and can found to greatly influence some of the goals of development within the Mesa 2040 plan.  The public sector has helped to develop these plans to increase physical activity through city planning activities.  The question is will these strategies be applied in areas of real need.

Recently the city of Mesa has been doing some work on Mesa Drive near the US 60.  Mesa Drive is not the nicest area of the city and needed some improvements.  The project widened the street, added two pedestrian crossing signals on Mesa Drive,  improved lighting, provided landscaping, bus pullouts and shelters (City of Mesa, 2014).  One of the landscaping projects was taking an old abandoned house on a large lot on Mesa Drive, tearing the house down and turning the remaining lot into a park.  The neighborhood did not have any parks in the area.  The abandoned lot was transformed from a hazard to a place the community can gather.  My wife always comments as we drive past the new park on how nice it is for the kids to have place to run around.  Before the park was created the nearest park was just a little less than a mile away but across major roadways.  The roadwork and all the improvements did end up costing over $25,000,000 (City of Mesa, 2014).  So it was not cheap.  I wonder how much it would have been just to buy the lot, tear down the house and make a little park there.

The Mesa Drive project was expensive but it did do some good in the area.  The area is a low income area and now the road is more inviting to walk down and there’s a nice park where before the lot was just full of hazards.  There are certainly other problem areas in Mesa but this is at least a good start (I could have done without all the crazy neon sign stuff though, that seems like a waste of money).


So there is a national plan out there for development that can encourage physical activity and Mesa is trying to incorporate some of that plan into continued city development.  But this is not just a local issue.  The NPAPA’s plan is a national one.  There are areas all over the country that could use further development like Mesa drive.

A recent study looked at the disparities in parks across Kansas City in relation to income and race (Vaughan, Kaczynski, Wilhelm, Besenyi, Bergstrom, & Heinrich, 2013).  The study found real disparities between the parks and play areas in higher income areas and lower income areas (Vaughan et al., 2013).  Lower income areas contained more parks but the quality of the parks was very questionable, the authors felt that the result could be that , “the children who need exercise the most may be less enticed to get it” (Vaughan et al., 2013).

But fortunately some of these problems are being recognized and the recent Shady Lane Park revitalization in Houston, TX is a good example of another project that is supporting physical activity in a neighborhood.  You can watch a video about the park here.


The Houston Chronicle had an article about the revitalization of the park.  The article addressed some of the needs of the community and how the park was really going to help.

“One of the most important needs this project addresses is the lack of resources that low-income communities have to engage their citizens in outdoor recreation activities. Shady Lane Park is located in the Eastex-Jensen Super Neighborhood, a densely populated and largely Hispanic area north of downtown Houston. Estimated population of the area is 49,908 with a median income of $26,270. The area has only 75.91 acres of parkland distributed among eight small neighborhood parks, nowhere near the recommended standard of 19 acres per 1,000 people to promote healthy lifestyles and outdoor activities” (Turner, 2013).

The park provides a place for physical activity to occur and gives the kids a safe place to play.  The great thing about the project is that it not only enables physical activity and provides an attractive area in the neighborhood but the park also serves as basin to help prevent flooding in the area (Turner, 2013).  It shows how parks and other policies to increase physical activity can work in synergy to serve other needs of the city.  Plus that playground looks awesome.


Vaughan, K.B., Kaczynski, A.T., Wilhelm, S.A., Besenyi, G.M., Bergstrom, R., & Heinrich, K.M. (2013).  Exploring the distribution of park availability, features and quality across Kansas city, Missouri by income and race/ethnicity: An environmental justice investigation. Annals of Behavioral Medicine. 45(1), p. 28-38.


City of Mesa (2014). Mesa drive and southern avenue improvement projects.  Retrieved from

National Physical Activity Plan Alliance (2010). The plan. Retrieved from

Turner, J. (2013, October 7).  The benefits of public parks. The Houston Chronicle. Retrieved from


Policy making in Mesa for Physical Activity – Post 5

The policy making in Mesa that predominantly deals with city planning and physical activity took place mostly through the development of Mesa 2040.   The basic development of the plan was done through the Planning Advisory Committee (PAC) (Mesa City Council, 2014).   PAC members consisted of citizens from the Planning and Zoning Board, Economic Development Advisory Board, Transportation Advisory Board, Design Review Board, Historic Preservation Board, Housing and Community Development Advisory Board, Human Relations Board, and Parks and Recreation Board (Mesa City Council, 2014).  The PAC reviewed the previous city plan and updated where it was deemed necessary (Mesa City Council, 2014).  The board through working with various governmental departs, especially the planning department developed an outline for the plan.

Then a series of public meetings was held to discuss the plan for the city. The meetings included the PAC reporting to the various boards that made up its membership (Mesa City Council, 2014).  The PAC also set up information booths at various activities, attended civic meetings, and provided a website for citizens to give feedback (Mesa City Council, 2014).  The culmination of the planning was six community workshops where citizens were presented with the plan and offered an opportunity to give feedback on the plan (City of Mesa, 2015).

I’m assuming most of the forums went a little better than the public forums held in Pawnee, Indiana (Pawnee is a fictitious town from the TV show Parks and Recreation.  Its a pretty funny show.)

Following the public forums the plan was put up for a public vote and was approved on the November 4, 2014 balloting (City of Mesa, 2015).  So the policy was developed by a planning committee in a very public way.

The general plan consists of policies that help guide decisions that will be made for Mesa’s future.  Some of the policies that are of particular interest to me include…

  • Public Spaces P1:

    The design and redesign of public buildings and facilities will include consideration of how to provide dynamic public spaces where appropriate.

  • Public Spaces P2:

    Design of neighborhoods, neighborhood village centers, mixed use activity districts, downtown, and transit districts should consider and include the development of a variety of public gathering places appropriate for the scale and location of the development.

  • Neighborhoods S4:

    Establish and maintain an ongoing process for improving connections and walkability in existing neighborhoods by installing sidewalks where needed and improving the amount of shade and other amenities along sidewalks.

  • Neighborhood P3:

    Continue positive working relationship with local schools to provide parks, meeting locations, and support for neighborhoods

  • Transit S2:

    Identify key outcomes from community outreach to guide the development of transit alternatives.

  • Transit P4:

    Develop transit service to match character types.

  • Transit P6:

    Integrate transit into the multi-modal transportation network.

  • Transit P7:

    Create a transit system that is sustainable over the long term.

The plan implements policy not ordinance or statutes.  The general plan guides the city’s development while zoning ordinance are developed to implement the policies of the plan (Mesa City Council, 2014).  The zoning ordinances define the permitted use of lands.  In Mesa zoning code is adopted into the town code by the city council.  Amendments are made by the city council and then forwarded to the City Clerk for insertion into the code.

Basically the city planning in Mesa was done by a group of interested members of citizen boards that participated in the Planning Advisory Committee.  The PAC gave the public plenty of opportunity to comment on the policies of the plan and made changes as necessary.  The plan was then adopted by a city wide vote and now the City Council is in charge of implementing the plan through amendments to the city code.  The planning office is then in charge of enforcing the code although it will accept applications for general plan amendments (City of Mesa, 2015).




City of Mesa (2015). Latest news. Retrieved from

City of Mesa (2015).  Mesa City Code.  Retrieved from

Mesa City Council (2014). Mesa 2040. Retrieved from