Rationale:

As cities consider expanding transportation options, bicycling presents a convenient way for residents to be physically active while traveling to work, school, shops, and many other common destinations. Numerous studies have shown that “active transportation” –travel by bicycle, walking, or similar means—supports improved health.^1,2

Local elected officials can encourage bicycling by ensuring that travel by bicycle is perceived as safe, comfortable, convenient, and viewed as a worthwhile activity. Steps that city and county governments can take to encourage bicycling include improving bicycle safety and conditions by increasing the miles of bicycle lanes, creating cycle-tracks or bicycle boulevards, or adding additional protections to existing bicycle infrastructure. Municipal and county governments can also increase the convenience of bicycling by establishing ordinances around bicycle parking, or by making it easier to bring bikes aboard public transit.

To improve bikeability, many communities use an overarching policy document, referred to as a bicycle master plan, which allows for community engagement, a process for identifying policies, and a strategy for the implementation and evaluation of those policies.

Recommended Actions:

• Develop and implement a comprehensive bicycle master plan.
• Form a diverse and representative bicycle advisory group.
• Increase the mileage of striped or buffered bicycle lanes, protected bike paths, cycle-tracks, parallel off-street paths, or bicycle boulevards in order to transform major streets and create a connected bike network.
• Establish or support a community-wide public bicycle sharing program.
• Outfit city buses with bike storage racks and/or permit bikes on public transportation.
• Create or enforce a safe passing distance ordinance of at least three feet.
• Reach the next level “Bicycle Friendly Community” through the League of American Bicyclists.
• Create and implement a bicycle parking ordinance to ensure plentiful bicycle parking, such as by requiring bicycle parking in new commercial and multi-family developments or in licensed parking facilities, or by providing secure bicycle parking at large public events.
• Develop new parks and recreation bicycle-safety educational programming for youth, using police as partners.

References:
1. Pucher J, Buehler R, Bassett DR, and Dannenberg AL. “Walking and Cycling to Health: A Comparative Analysis of City, State, and International Data” American Journal of Public Health. 2010 October; 100(10): 1986-1992.
2. Does the Built Environment Influence Physical Activity? Examining Evidence (Special Report 282). Washington: Transportation Research Board/Institute of Medicine, Committee on Physical Activity, Health, Transportation and Land Use, 2005.

Rationale:

Evidence is growing that the design of the built environment affects an individual’s physical activity levels. People tend to spend more time outside being active, whether for recreation or active transportation, when a city’s streets, sidewalks, parks, plazas, and open spaces are interesting, pleasing and safe.³ City design that promotes health can also promote sustainability and economic development.⁴ Design improvements, like new sidewalks, benches, trees, and street lighting, can attract new businesses to a neighborhood and increase economic activity.

The development and implementation of healthy city design guidelines can be a blueprint for improved design of neighborhoods, streets, and outdoor spaces to promote physical activity. Additionally, by integrating healthy design standards into existing processes, cities and counties may be able to more effectively time and ensure cost efficiency of future design elements or changes. Design elements to consider include:

• Transit and parking design (e.g., furnishing transit stops with pedestrian conveniences, including covered benches, adequate lighting, and wayfinding resources).
• Parks, open spaces, and recreational facilities (e.g., creating walking/biking/running paths, and drinking fountains, children’s and adult recreation amenities, and public plaza design and location).
• Street connectivity (e.g., maintaining dedicated pedestrian and bicycle paths, even on dead-end streets or where cars cannot pass).
• Pathway and sidewalk design (e.g., wider sidewalks with permeable surfaces, tree shading, benches, water fountains, and exterior lighting).
• Streetscape aesthetics (e.g., continuous facades and consistent signage).
• Stairwell design (e.g., placement of point-of-decision prompts in or near stairwells, and glass in stairway doors to encourage visibility, safety, and increases in stair use).

Urban planners, architects, engineers, developers, and public health professionals can all be key partners in both the development of healthy city design guidelines and the subsequent implementation of strategies, which could result in changes to zoning regulations, building codes, and builder’s practices. These design guidelines could be a stand-alone document or incorporated as part of a comprehensive or general plan.

Recommended Actions:

• Develop and implement healthy city or county design guidelines to encourage physical activity. Design elements to consider including: stairwell design, transit and parking design, street connectivity, pathway and sidewalk design, and the design of parks, open spaces and recreational facilities.
  • OR If design guidelines currently exist, revise accordingly.
  • OR Incorporate language and objectives around healthy city design into the city or county’s comprehensive, general, or master plan
• Work with builders and real estate developers to include health-focused design components into the design and building of public buildings and/or affordable housing.

References:
3. Heath GW, Brownson RC, Kruger J, Miles R, Powell KE, Ramsey LT and the Task Force on Community Preventive Services. “The effectiveness of Urban Design and Land Use and Transport Policies and Practices to Increase Physical Activity: A Systematic Review.” Journal of Physical Activity and Health. 2006, 3, Suppl 1, S55-S76.
4. U.S. Environmental Protection Agency. Smart Growth and Economic Success: Benefits for Real Estate Developers, Investors, Businesses and Local Governments. Office of Sustainable Communities, Smart Growth Program, December 2012.

Rationale:

Safe routes to schools, parks, afterschool programs, and recreation centers can encourage children and youth to be active by walking or biking. However, safety may be a concern for parents and caregivers due to high traffic, high speeds of cars, and lack of crosswalks or crossing guards.

To increase physical activity and also promote safety for children and youth walking or biking, cities and counties can take a leading role by making infrastructure improvements and using aggressive traffic calming measures at intersections near schools, recreation centers, and afterschool program locations. Traffic calming can improve the livability of neighborhoods by reducing the negative impacts of traffic and creating a safer and more pleasant experience for walkers and bikers.

Even if a city or county has already instituted traffic calming measures around schools, they may not yet have considered the safety of intersections around other destinations frequently visited by children. The National Recreation and Parks Association reports that people are more likely to walk to parks if their communities are better connected to parks by active transit routes.⁵

To choose where to implement new traffic calming measures, cities and counties can consider conducting surveys/audits to assess where there are significant concerns about safety (e.g., busy intersections and areas without sidewalks or adequate signage). The Safe Routes to School National Partnership has found that most successful programs include a thorough community assessment or audit of the barriers that keep children from walking and biking to and from school before action is taken.⁶

Key infrastructure changes associated with traffic calming include narrowing streets, curb ‘bump-outs’ or extensions, raised crosswalks, speed humps, median islands, and traffic circles. It may be helpful to divide improvements into short-term and long-term improvements. Many short-term improvements may be implemented at relatively low cost through a city’s general fund. Long-term needs may be identified and incorporated in a city’s complete streets policy, Safe Routes to School plan, or general or comprehensive plan. Cities and counties can also take advantage of opportunities arising as a result from emergency road repair or utility improvements.

Recommended Actions:

• Establish or enhance slow zones and employ traffic calming measures near schools, parks, afterschool programs, and recreation centers. Actions could include:
  • Slow zones: reduced speeds on streets near schools, parks, afterschool programs and recreation centers.
  • Increased use of speed humps, street narrowing, curb bump-outs or extensions.
  • Textured curb cuts and raised crosswalks.
  • Additional signage or street painting.

References:
5. National Recreation and Park Association. Safe Routes to Parks: Improving Access to Parks through Walkability. Ashburn, VA: National Recreation and Park Association; 2015.
6. Safe Routes to School National Partnership. “Getting Started Locally—Engineering” http://saferoutespartnership.org/local/getting-started-locally/5es/engineering

Rationale:

A healthy meeting policy can model a city’s or county’s commitment to healthy lifestyles, and can reinforce the message to constituents that health is a priority for city or county officials. A healthy meeting policy also aligns with the goal of creating a healthy work environment, which helps employees and their visitors create and maintain healthy eating habits and active lifestyles.

A healthy meeting policy will often specify nutritional guidelines for the foods and beverages that can be served at city or county meetings or purchased using city or county funds. While specific guidelines may vary, common practices include making water the default beverage, offering fruits and/or vegetables whenever food is served, decreasing portion sizes, and offering low-sodium choices.

These guidelines ensure that staff are able to make healthy food and beverage choices using city/county funds or during city-/county-run meetings, trainings, and events. The guidelines may also recommend activity breaks for longer meetings to help participants maintain interest and focus.

If a city or county wellness committee does not yet exist, it may be helpful to form a committee of representatives from different departments who are interested in healthy workplaces and contributing to the development of a healthy meeting policy. This committee could review potential food and physical activity guidelines to adopt, develop the guidelines, obtain staff input, and create a process for introducing the guidelines.

Recommended Actions:

• Develop and implement a healthy meeting policy for city or county facilities, events, and meetings. Potential ways to structure the policy include:
  • Guidelines apply whenever food or beverages are purchased using city or county funds.
  • Guidelines apply when city or county facilities are used for meetings held by city or county agencies or when nonprofit or private organizations use city or county property.
  • Guidelines include physical activity breaks or components.

Rationale:

Cities and counties can engage the local business community in health and wellness efforts by creating a free and voluntary recognition program for local businesses and publicly recognizing businesses that have met specific wellness criteria for employees, or made changes in how they serve customers to promote health and wellness.

In addition to public recognition, benefits for participating businesses may include reduced employee healthcare costs, increased employee productivity, and participation in a peer network of businesses seeking to promote and protect the health of their employees and customers.

When developing a recognition program, consider including:

• Creation of a wellness committee
• Healthy vending options
• Company-wide walking programs
• Cholesterol and biometric screenings
• An office-wide nutrition policy
• Promotion of taking the stairs as an alternative to elevator use
• Creation and implementation of a lactation policy

The structure of a recognition program can vary considerably. Some components of existing city/county wellness recognition programs include: a partner agreement form, an assessment tool that businesses can use to track their progress, a mentoring component, and quarterly or biannual meetings or conferences for participating businesses. To spur initial interest and participation in the program, cities and counties may consider issuing a community-wide challenge, and setting public targets for the number of businesses involved or meeting recognition criteria. The local chamber of commerce could be a key partner in helping to launch and support a recognition program.

The capacity of city and county staff to provide technical support to businesses participating in the program is important to consider before undertaking this work. If city/county staff capacity is limited, additional expertise may be available from local healthcare providers, YMCAs and fitness centers, or higher education institutions.

Recommended Actions:

• Create and implement a local recognition program for area businesses that implement certain wellness policies. Wellness policies and activities could include office-wide nutrition policies, lactation policies, creation of a wellness committee, promotion of taking the stairs instead of the elevator, cholesterol and biometric screenings, and company-wide walking programs.
  • If a local recognition program already exists at the regional or state level, provide technical support to local businesses to help them obtain recognition.

Rationale:

Farmers’ markets support local farmers, create a space for the community to gather, and increase access to fresh fruits and vegetables. City and county government can play an important role by: sponsoring markets, supporting and promoting existing farmers’ markets, expanding land use and zoning polices to protect and encourage farmers’ markets, and working with foundations or nonprofits to create fruit and vegetable buying incentive programs at markets.

Cities and counties may find that certain areas are not zoned to permit farmers’ markets, or farmers’ markets may not be described as a designated use. Land use policy changes related to farmers’ markets can include allowing farmer’s markets on city park property through zoning changes, or adjusting zoning ordinances to allow farmers’ markets in all non-residential and certain single-family residential zones.

A city or county may also designate specific public land for farmers’ markets, or can be a key convener of partners, including local nonprofits, to start a local farmers’ market. Another way cities and counties can support farmers’ markets is by minimizing the need for special permitting fees or requirements. The city or county can play a key role in promoting farmers’ market to residents through the city’s or county’s website, social media, or broadcast media.

If farmers’ markets do not accept benefits from the Supplemental Nutrition Assistance Program (SNAP, formerly known as Food Stamps) or the Women, Infants, and Children (WIC) Farmers’ Market Nutrition Program (FMNP), then low-income residents’ access to the markets is reduced. The U.S. Department of Agriculture (USDA) encourages farmers’ markets to accept SNAP benefits and provides support to help farmers’ markets obtain point-of-sale terminals. In some cases, it is possible for a city or county to require that all farmers’ markets accept federal and state nutrition benefits through the city’s or county’s zoning code. Alternatively, low-income residents’ use of farmers’ markets may be promoted through incentive “double-bucks” programs, which provide subsidies for purchasing food at farmers’ markets. Many communities have used a mix of public and foundation funding to support these incentive programs.

Recommended Actions:

• Make land use policy changes to expand access to farmers’ markets:
  • Expand areas of the city/county where farmers’ markets are permitted and remove regulatory barriers through zoning changes.
  • Protect existing and establishing additional farmers’ markets in your city/county’s comprehensive or general plan.
• City/county program support, such as:
  • Streamlined permitting process.
  • Consider public property (e.g., parks, schools, transit stations, and street closures for farmers’ market sites).
  • Increase support for farmers’ markets by partnering with school districts, neighborhood groups, senior centers, businesses, and agricultural organizations.
• Ensure accessibility to farmers’ markets for low-income populations:
  • Help farmers’ market organizers accept SNAP and WIC benefits.
  • Require farmers’ markets to accept federal, state, and local food assistance programs.
  • Start an incentive program to double or increase the value of SNAP or WIC benefits in city/county farmers’ markets.

Rationale:

Community gardens and urban agriculture can be beneficial to communities in a variety of ways. In areas with limited access to healthy food, community gardens and urban agriculture can provide a needed source of fruits and vegetables, and can strengthen the local food system. Urban agriculture can spur economic development by providing jobs and cultivating agricultural skills among community members, particularly young people. There is also evidence that community gardens can improve safety and increase nearby property values.

City and county policies can support community gardens and urban agriculture activities, whether these gardens and agricultural enterprises are run by local government, nonprofit organizations, or faith-based organizations.

As cities and counties begin to plan for new gardens or improve access to existing gardens, stakeholders may want to explore existing policy barriers. For example, are there written limits on the size and scope of community gardens or agricultural enterprises in certain zones of the city or county? Following an assessment of barriers, an inventory may be taken of potential partners, as well as existing gardens and agricultural enterprises. It may also be helpful to map out areas with limited healthy food access as well as vacant or underutilized spaces, and consider them as potential locations for gardens or urban farms.

City and county governments can support community gardens and urban agriculture through the use of:

• Policy approaches (e.g., protective zoning for existing gardens or removal of zoning barriers that make urban agriculture difficult).
• Tax incentives or free or reduced prices on municipal services (e.g., water or waste disposal).
• Land donations (e.g., donation or leasing of vacant land to groups that organize community gardens) or using parts of city parkland for these activities.

Many cities and counties have a number of partners eager to advance the community’s approach to urban agriculture. Partners to consider include food policy councils, local planners, nonprofit organizations, grow-a-row programs*, and university cooperative extension programs.

Recommended Actions:

• Support community gardens and urban agriculture through policy changes, such as:
  • Zoning ordinances specifically for gardens
  • Zoning policies designating agriculture districts
  • Community garden objectives or protections as part of a city’s comprehensive or general plan
• City or county program support, such as:
  • Tax incentives
  • Reduced prices on municipal services
  • Funding in the city or county budget dedicated to supporting community gardens and urban agriculture activities
  • In-kind resources
  • Liability coverage
• Identify and convert vacant or underutilized lots or city parkland:
  • Donating city or county land to be used as garden space or for urban agriculture
  • Creating community gardens in city or county parks

  * Grow-a-row is a campaign or program that encourages gardeners to grow extra and donate produce to local soup kitchens or food banks.

Rationale:

Breastfeeding has life-long impacts on children’s health. Evidence suggests it promotes children’s health and protects against childhood overweight and obesity. Local elected officials can play an active role in supporting mothers who choose to breastfeed by developing and implementing breastfeeding policies for city or county facilities.

Nearly 80 percent of new mothers follow their doctor’s advice to breastfeed immediately after birth.⁷ However, women who plan to return to full-time employment are less likely to initiate breastfeeding.⁸ Further, mothers who return to full-time employment shortly after giving birth are less likely to breastfeed as long as they intended or as long as mothers who return later.^9,10 Flexible work schedules and lactation support in the workplace are important factors in a mother’s decision of whether or how long she is able to breastfeed.

Because breastfed babies tend to have fewer health issues,^11,12 support for breastfeeding mothers can result in reduced employee absenteeism to care for sick children, along with improved employee productivity. While the National Fair Labor Standards Act of 2011 requires that most employers “provide reasonable, unpaid break time and a private, non-bathroom space for an employee to express milk for one year after the child’s birth,” local government-level breastfeeding policies can enhance national or state-level policy, ensuring that the city or county is following national requirements and promoting the city or county’s supportive environment for breastfeeding mothers.

Recommended Actions:

• Develop and implement a breastfeeding policy for city/county facilities and employees in accordance with or going beyond state/federal law. Components of the policy could include:
  • Flexible, reasonable break times for lactation
  • Clean, comfortable space for milk expression
  • Free or subsidized breastfeeding support groups or educational classes
  • Providing on-site or nearby child care
  • Designating lactation rooms in city hall or other public buildings
  • Employee education
  • Private storage areas for expressed milk

References
7. Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention. (July 2014). Breastfeeding Report Card United States 2014.
8. Ryan AS, Zhou W, and Arensberg MB. “The effect of employment status on breastfeeding in the United States.” Womens Health Issues 16, 5 (2006):243-51.
9. Ogbuanu C, Glover S, Probst J, Liu J, and Hussey J. “The effect of maternity leave length and time of return to work on breastfeeding.” Pediatrics. 2011; 127(6): e1414-1427. View article.
10. Mirkovic KR, Perrine CG, Scanlon KS, and Grummer-Strawn LG. “Maternity leave duration and full-time/part-time work status are associated with US mothers’ ability to meet breastfeeding intentions. Journal of Human Lactation. 2014 Nov; 30(4): 416-9.
11. U.S. Department of Health and Human Services. The Business Case for Breastfeeding. Rockville, MD: U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau; 2008.
12. Cohen R, Mrtek MB, and Mrtek RG. “Comparison of maternal absenteeism and infant illness rates among breastfeeding and formula-feeding women in two corporations.” American Journal of Health Promotion. 1995; 10 (2), 148-153.