CONTEXT: The number of children who bicycle or walk to school has steadily declined in the U.S. and other high-income countries. In response, several countries responded in recent years by funding infrastructure and noninfrastructure programs that improve the safety, convenience, and attractiveness of active travel to school. The objective of this study is to synthesize the economic evidence for the cost and benefit of these programs. EVIDENCE ACQUISITION: Literature from the inception of databases to July 2018 were searched, yielding 9 economic evaluation studies. All analyses were done in September 2018-May 2019. EVIDENCE SYNTHESIS: All the studies reported cost, 6 studies reported cost benefit, and 2 studies reported cost effectiveness. The cost-effectiveness estimates were excluded on the basis of quality assessment. Cost of interventions ranged widely, with higher cost reported for the infrastructure-heavy projects from the U.S. ($91,000-$179,000 per school) and United Kingdom ($227,000-$665,000 per project). Estimates of benefits differed in the inclusion of improved safety for bicyclists and pedestrians, improved health from increased physical activity, and reduced environmental impacts due to less automobile use. The evaluations in the U.S. focused primarily on safety. The overall median benefit‒cost ratio was 4.4:1.0 (IQR=2.2:1-6.0:1, 6 studies). The 2-year benefit-cost ratios for U.S. projects in California and New York City were 1.46:1 and 1.79:1, respectively. CONCLUSIONS: The evidence indicates that interventions that improve infrastructure and enhance the safety and ease of active travel to schools generate societal economic benefits that exceed the societal cost.

Physical activity is higher in communities that include supportive features for walking and bicycling. In 2016, the Community Preventive Services Task Force released a systematic review of built environment approaches to increase physical activity. The results of the review recommended approaches that combine interventions to improve pedestrian and bicycle transportation systems with land use and environmental design strategies. Because the recommendation was multifaceted, the Centers for Disease Control and Prevention determined that communities could benefit from an assessment tool to address the breadth of the Task Force recommendations. The purpose of this article is to describe the systematic approach used to develop the Active Communities Tool. First, we created and refined a logic model and community theory of change for tool development. Second, we reviewed existing community-based tools and abstracted key elements (item domains, advantages, disadvantages, updates, costs, permissions to use, and psychometrics) from 42 tools. The review indicated that no tool encompassed the breadth of the Community Guide recommendations for communities. Third, we developed a new tool and pilot tested its use with 9 diverse teams with public health and planning expertise. Final revisions followed from pilot team and expert input. The Active Communities Tool comprises 6 modules addressing all 8 interventions recommended by the Task Force. The tool is designed to help cross-sector teams create an action plan for improving community built environments that promote physical activity and may help to monitor progress toward achieving community conditions known to promote physical activity.

CONTEXT: Municipal bodies such as planning or zoning commissions and active transportation advisory committees can influence decisions made by local governments that support physical activity through active transportation. Public health professionals are encouraged to participate in and inform these processes. However, the extent of such collaboration among US municipalities is currently unknown. OBJECTIVE: To estimate the prevalence of active transportation bodies among US municipalities and the proportion with a designated public health representative. DESIGN: A cross-sectional survey administered from May through September 2014. SETTING: Nationally representative sample of US municipalities with populations of 1000 or more people. PARTICIPANTS: Respondents were the city or town manager, planner, or person with similar responsibilities (N = 2018). MAIN OUTCOME MEASURES: The prevalence of planning or zoning commissions and active transportation advisory committees among municipalities and whether there was a designated public health representative on them. RESULTS: Approximately 90.9% of US municipalities have a planning or zoning commission, whereas only 6.5% of these commissions have a designated public health representative. In contrast, while 16.5% of US municipalities have an active transportation advisory committee, 22.4% of them have a designated public health representative. These active transportation bodies are less common among municipalities that are smaller, rural, located in the South, and where population educational attainment is lower. Overall, few US municipalities have a planning or zoning commission (5.9%) or an active transportation advisory committee (3.7%) that also has a designated public health representative. CONCLUSIONS: Approximately 9 in 10 US municipalities have a planning or zoning commission, whereas only 1 in 6 has an active transportation advisory committee. Public health representation on active transportation bodies across US municipalities is low. Increasing the adoption of active transportation advisory committees and ensuring a designated public health representative on active transportation bodies may help promote the development of activity-friendly communities across the United States.

I was pleased to see Fried et al.1 make the case for a new era of graduate public health curriculum focused on integrated, problem-based learning and the companion article by Begg et al.2 describe the new MPH curriculum at Columbia University as a model for an integrated, problem-based curriculum. Graduate public health training needs to adapt to new models to adequately prepare the next generation of public health leaders to effectively manage the complex public health problems of the present.

How can we encourage ongoing development, refinement, and evaluation of practices to identify and build an evidence base for best practices? On the basis of a review of the literature and expert input, we worked iteratively to create a framework with 2 interrelated components. The first - public health impact - consists of 5 elements: effectiveness, reach, feasibility, sustainability, and transferability. The second - quality of evidence - consists of 4 levels, ranging from weak to rigorous. At the intersection of public health impact and quality of evidence, a continuum of evidence-based practice emerges, representing the ongoing development of knowledge across 4 stages: emerging, promising, leading, and best. This conceptual framework brings together important aspects of impact and quality to provide a common lexicon and criteria for assessing and strengthening public health practice. We hope this work will invite and advance dialogue among public health practitioners and decision makers to build and strengthen a diverse evidence base for public health programs and strategies.

Successful aging takes on an array of attributes, including optimal health and community participation. Research indicates that (1) persons with disabilities, including age-related disabilities, report frequent barriers to community participation, including unsuitable building design (43%), transportation (32%), and sidewalks/curbs (31%), and (2) many seniors report an inability to cross roads safely near their homes. This paper attempts to define mobility-related elements that contribute to optimal health and quality of life, within the context of successful aging. It then examines the impacts of community design on individual mobility, delving into which traditional and nontraditional actors-including architects, urban planners, transportation engineers, occupational therapists, and housing authorities-play critical roles in ensuring that community environments serve as facilitators (rather than barriers) to mobility. As America ages, mobility challenges for seniors will only increase unless both traditional aging specialists and many nontraditional actors make a concerted effort to address the challenges.

Health equity can be defined as the absence of disadvantage to individuals and communities in health outcomes, access to health care, and quality of health care regardless of one’s race, gender, nationality, age, ethnicity, religion, and socioeconomic status. Health equity concerns those disparities in public health that can be traced to unequal, systemic economic, and social conditions. Despite significant improvements in the health of the overall population, health inequities in America persist. Racial and ethnic minorities continue to experience higher rates of morbidity and mortality than non-minorities across a range of health issues. For example, African-American children with asthma have a seven times greater mortality rate than Non-Hispanic white children with the illness. While cancer is the second leading cause of death among all populations in the U.S., ethnic minorities are especially burdened with the disease.

Life expectancy in industrialized countries like the United States increased | 30 or more years in the 20th century, | resulting primarily from public health efforts in areas such as sanitation and immunization. Ensuring availability of clean | water and safe food was a primary contributor to approximately 80% of this impressive improvement in life expectancy | (Koplan & Fleming, 2000). Unfortunately, | the U.S. environmental health (EH) system | and the workforce that is its primary engine may become a victim of its own success—the ratio of public health workers to | population served shrank from an estimated | 220/100,000 in 1980 to 158/100,000 in 2000 | (Merrill, Btoush, Gupta, & Gebbie, 2003); | 10% of these workers are in EH. Given projected resource and demographic trends, this | shrinking per capita public health workforce | is unlikely to be reversed; at best it may only | be stabilized. Because of past successes and | current economic realities, the EH system | may be heading into a perfect storm.