Albany County Department of Health
Municipalities on the Move: Complete Streets Collaboration
Albany County is located in eastern New York State, 136 miles north of New York City. The total County population is 305,279, including 245,557 adults. The County population is predominantly white (78.2%), and the largest minority groups include Black or African American (12.8%), Hispanic/Latino (5.2%) and Asian (5.1%) persons. The percentage of minorities in Albany County is substantially below the estimated percentages for New York State; however, minority populations are concentrated primarily in the urban areas. While the City of Albany is home to approximately 32% of the County population, 77% of the African American population and more than 53% of the Hispanic population reside within the City of Albany.Â¹
The latest Behavioral Risk Factor Surveillance System (BRFSS) survey conducted in Albany County estimates that 21.7% of adults do not participate in leisure time physical activity, 10% of adults do not have adequate access to locations for physical activity, and an estimated 62.8% of adults are overweight or obese, a significant increase from the 2003 estimate of 54%. Approximately 8.8% of adult Albany County residents have physician-diagnosed diabetes. In addition, approximately 4.9% of adults have physician-diagnosed prediabetes.Â²
Chronic disease, such as diabetes, cardiovascular disease (CVD), and obesity are costly and often preventable. Heart disease, stroke and diabetes were responsible for 31.4% of deaths (2015) and 14.2% of hospitalizations (2014) in Albany County, NY. Risk factors underlying CVD and diabetes are poor nutrition, physical inactivity, and hypertension (HTN). There is a significant disparity in the distribution of CVD and obesity-related disease within Albany County. The urban cities of Albany, Cohoes, and Watervliet and town/village of Green Island have higher rates for diabetes and circulatory conditions compared to suburban and rural areas in Albany County.Â³ These cities also have higher poverty rates than the County average4 and are confronted by aging transportation infrastructure, impaired American with Disabilities Act (ADA) accessibility, pedestrian safety concerns and economic development demands. Studies demonstrate that individuals living in walkable communities participate in 35-45 more minutes of moderate physical activity per week and are less likely to be overweight or obese when compared with less-walkable communities.5
The Albany County Department of Health (ACDOH)'s (www.AlbanyCounty.com/Government/Departments/DepartmentofHealth.aspx) goal is to increase physical activity by helping communities build environments that make it easier for people to walk, bike and/or access physical activity opportunities. Accordingly, a specific ACDOH's intervention is to assist priority communities (i.e. those communities experiencing a high prevalence of obesity, diabetes and HTN as well as social-economic determinants of health) with adopting and implementing Complete Streets policies. Complete Streets create communities that support active living with improved connectivity, promote safer streets, contribute to environmental protection, and encourage economic development.
To date, ACDOH has worked with four (4) of the nineteen (19) municipalities within Albany County to adopt and or implement Complete Streets resolutions or policies. By collaborating with municipality decision makers and planners, the regional metropolitan planning organization (MPO), and community-based organizations, ACDOH guides efforts to increase awareness about the health and economic benefits of complete streets; coordinates pop-up demonstrations to show potential street designs and solicit community input; and provides technical assistance for leveraging funding opportunities. As a result, each of the engaged municipalities measurably advance Complete Streets implementation.
The Complete Street policies adopted require each municipality to consider the walkability and bike-ability of all street improvement work proposed for a 76.6 square mile area and improve access to physical activity opportunities for the 160,438 residents living in these municipalities. While the process for developing and adopting a Complete Streets policy can be time consuming, it allows for a sustainable approach to increasing the physical activity level of a community. Municipalities that create streetscapes that promote walking and biking, create a definitive benefit for public health, communities, and economic development.
1. United States Census Bureau: State & County Quickfacts. Albany County: http://quickfacts.census.gov/gfd/states/36/36001.html.
2. New York State Expanded Behavioral Risk Factor Surveillance System, 2013-2014.
3. New York State Department of Health Prevention Quality Indicators. Accessed July 14, 2015.
4. American Community Survey 5-Year Estimates, 2009-2013. Accessed July 14, 2015.
5. Sallis, James F, et al. (2009). Neighborhood built environment and income: Examining multiple health outcomes.â€ Social Science and Medicine 68: 1285-1293.
There is a significant disparity in the distribution of obesity related disease within Albany County. In general, hospitalization rates for diabetes in the County are higher in urban areas (specifically Albany, Watervliet, Green Island, and Cohoes), than in areas considered suburban and rural. These urban areas also tend to have higher poverty rates than the County as a whole. The percent of persons living below the poverty level in the City of Albany is almost double the percent living below the poverty level in Albany County (25.2% vs. 13% respectively). There is no comparable summary of behavioral risk factors (i.e. nutrition, physical activity, and tobacco use) at these smaller geographic levels; however it is likely that these disparate disease rates are accompanied by a disparity in behavioral risk as well.
Chronic diseases and related risk factors are the leading causes of death and disability in the United States. The Albany County priority population, which includes adult residents in the cities of Albany, Green Island, Watervliet, and Cohoes, has disproportionate risk for chronic conditions. The percentage of residents below the poverty level in the priority neighborhoods of the City of Albany are 28.2% in Arbor Hill, 38.9% in the West End and 31.3% in the South End. In Green Island, 15.9% of residents are below the poverty level; 15.4% of Watervliet residents are below the poverty level; and 14.3% of Cohoes residents are below the poverty level. The poverty rates in these target areas are all above the 13.6% average poverty rate for the County of Albany and 13.5% for the nation. Prevention Quality Indicator (PQI) data are used to describe the health disparities in certain neighborhoods of the target population. The West End, South End and West Hill neighborhoods all have observed rates for PQI Diabetes data that are three times as high as the Albany County rate. The anticipated total population (adults and children) reach for the identified target area is approximately 125,114, or 41%, of Albany County residents.
Top Tier Neighborhoods are defined as those with residents who are super-utilizers (persons who are emergency room super-utilizers and/or had a 30 day readmission history), as well as those who have multiple chronic physical conditions include Arbor Hill, South End, West End, and West Hill. Neighborhoods like the South End in Albany have high proportions and numbers of these super-utilizers, as well as poverty rates that are almost double the regional average and a more diverse racial mix. Cohoes, Watervliet, and Green Island were also identified as Top Tier Neighborhoods.
The Albany County 2016-2018 Community Health Improvement Plan (CHIP) has a focus on obesity/diabetes prevention. Local resources available to the target population include a diabetes resource guide and scheduled National Diabetes Prevention Programs (NDPP). NDPP is available through the Center for Excellence in Aging and Community Wellness, Capital Region YMCA and the St. Peters Diabetes & Endocrinology Center. The Center for Excellence in Aging and Community Wellness also provides other self-management classes to the community including the Chronic Disease Self-Management Program, the Diabetes Self-Management Program, as well as programs to increase physical activity.
There are a number of primary care providers that are located within the target population communities. Whitney M. Young Jr. Health Center is a federally qualified health center located in the Arbor Hill neighborhood in the City of Albany and in Watervliet. Other primary care providers include St. Peter's Family Health Center and Koinonia Primary Care located in the South End and West Hill neighborhoods in Albany. St. Peter's Health Partners has a family practice in Cohoes and Watervliet. Healthy Capital District Initiative indicates that neighborhoods such as Arbor Hill, Cohoes, and Watervliet have fewer primary care physicians per capita than the Upstate New York average.
There are a number of existing resources and services to prevent chronic disease in the priority population. Access to free physical activity opportunities in the City of Albany include the Healthy Living Center located in the Hannaford Supermarket and free fitness classes, including Zumba and yoga, offered by the City of Albany Department of Recreation. The cities of Albany, Watervliet and Cohoes have public pools open to residents in the summer months. Each municipality also has community gyms, parks and trails. Ongoing work is being completed at both the county and city level to improve access to safe walking areas. This work includes developing and implementing transportation and community plans that promote walking and biking.
ACDOH advances a Health in All Policiesâ€ approach. Through the ACDOH's implementation of Local IMPACT (one of four subawardees for the New York State Department of Health / Centers for Disease Control and Preventionâ€“funded State and Local Public Health Action 1422 Program), ACDOH collaborates with municipal leaders, the regional metropolitan planning organization (MPO), and community-based organizations promote access to public areas for residents to engage in safe physical activity. Complete Street implementation meets individuals where they live, work and play. Studies demonstrate that individuals living in walkable communities participate in 35-45 more minutes of moderate physical activity per week and are less likely to be overweight or obese when compared with less-walkable communities.Â¹ The Community Guide for Preventive Services cites evidence that infrastructure (i.e. urban and street-scapes) that supports walking and biking increases physical activity.
Complete Streets are roadways designed for safe access by all users (i.e. pedestrians, bicyclists and motorists) and promote walking and biking in communities. In September 2016, ACDOH sponsored a Complete Street Symposium, with the regional MPO, for Albany County municipalities to learn about Complete Streets (CS) and the multi-faceted effort it entails; to gain an understanding of the wide-ranging health, transportation and economic development benefits of CS; and to convene multi-disciplinary stakeholders to establish collaboration on health and transportation issues. As a result, three of the four priority municipalities continue to work with ACDOH and its strategic partners to implement evidence-based CS strategies. These activities include community engagement to build support for CS implementation; coordination of pop-up demonstrations that display CS proposed work; promotion of public sites for physical activity (i.e walking, biking, etc) ; and installation of supports such as bike lanes, sidewalks, and wayfinding signage. These efforts impact 160,438 residents (adult and children) of which 125,114 live in the priority neighborhoods.
Through this collaborative effort, ACDOH builds and sustains strategic and synergistic partnerships that support the municipalities in adopting and implementing CS policies and plans. ACDOH, community-based organizations and the regional MPO provide ongoing education to the community and municipal decision makers. This builds a foundation of support that is driven by the community with the guidance of experts in the field of public health and urban planning. Pop-up demonstrations show realistic options for making changes that improve the safety of pedestrians, bicyclists, and motorists and facilitate discussion between affected residents and city planners. Pop-up demonstrations are short-term commitments that bring to life changes being considered for the community. They provide the means for communities to experience proposed changes with no risk and to consider any concerns or challenges before a more permanent implementation of the change is completed. Community decision makers and residents experience how the changes can benefit their community safety and health.
Three pop-up demonstrations were completed between October 2016 and September 2017 and four more are scheduled for priority communities in 2018. The standard reach for these events is a 3 mile radius: South End Run, Ride, Walk held on October 15, 2016 reached 90,628 residents; Cohoes on the Move held on May 21, 2017 reached 52, 054 residents; South End Run, Ride, Walk held on September 29, 2017 reached the same 90,628 residents as in the previous year. The estimated total reach of the events held in the priority communities is 142,682 residents. Each event promotes walking and biking through the installation of temporary bike lanes and involve community organizations and businesses that support walking, biking, and wellness.
ACDOH also uses this innovative and collaborative platform to communicate opportunities for sustaining the CS work through the leveraging of funding resources and community support. Evidence-based strategies that promote physical activity are then prioritized and implemented by the municipalities with the support and technical assistance of partners. Consequently, four municipalities within Albany County have adopted CS resolutions or policies (reach = 160,438 adults and children). Each is in different stages of installing Complete Street projects that include road diets (reducing traffic lanes), bike lane installation, sidewalk improvement to comply with ADA standards, and/or wayfinding signage installation for area parks and trails. These changes have a near permanent impact on the walkability and bike-ability of the communities.
This strategic approach of bringing together local health departments, regional MPOs, community-based organizations, municipal leaders, urban planners and interested community groups is an innovative way to address the incidence of obesity, diabetes and hypertension. It facilitates unlikely partnerships that create sustainable, active communities that increase physical activity; reduce the incidence of obesity, diabetes and hypertension; and encourage economic development.
1. Sallis, James F, et al. (2009). Neighborhood built environment and income: Examining multiple health outcomes.â€ Social Science and Medicine 68: 1285-1293.
Nutrition, Physical Activity, and Obesity
An Albany County Department of Health's (ACDOH) Community Health Improvement Plan (CHIP) goal is to create active communities that promote physical activity among all residents and therefore, reduce the incidence of chronic disease related to obesity (i.e. one root cause of diabetes and hypertension). Related CHIP interventions include provision of technical assistance to municipalities to develop and adopt Complete Streets (CS) policies; coordination of pop-up demonstrations in priority neighborhoods; and engagement of community members, leaders (elected officials) and decision makers in the planning and implementation of CS projects.
ACDOH strategically works with community partners to raise awareness about the benefits of CS; identify the effective steps for promoting CS policy adoption and implementation; and to facilitate synergistic partnerships between community based organizations, regional municipal planning organization (MPO), municipalities, and the local health department. ACDOH is an active member of the Capital District Transportation Committee (CDTC) Bicyclist Pedestrian Advisory Committee (BPAC). CDTC is the Capital District's Regional Municipal Planning Organization (MPO). BPAC meets monthly to discuss, strategize, and mobilize CDTC's bicycle and pedestrian planning goals to:
Improve safety; reduce the number of vehicle crashes involving bicyclists and pedestrians;
Increase the number of bicycle and pedestrian trips (especially commuting trips);
Reduce obesity rates, heart disease, and other chronic illnesses;
Increase economic activity related to bicycling and walking;
Increase funding for bicycle and pedestrian projects.
BPAC assists ACDOH with identifying achievable projects that align with CDTC's priorities and leveraging resources and support from other community based organizations and municipalities. ACDOH sponsored, in conjunction with CDTC, a county-wide Complete Streets Symposium in September 2016. The Albany County Executive invited municipal leaders, urban planners and community-based stakeholders. The objective of the Complete Streets Symposium was to aid transportation experts and decision makers identify and overcome barriers to implementing CS. As part of the workshop, CDTC developed CS intersection mock ups for each priority communities identified by the ACDOH. Participants were divided into work groups to strategize CS implementation for these specific site locations. Each of the three priority municipalities left with feasible CS plans; scheduled follow up meetings with ACDOH and Capital Roots( a community-based organization with experience in developing CS policies); and planned CS pop-up demonstrations.
At each of the follow up meetings, the municipalities are represented by CS decision makers and/or city planners. As the lead coordinator, ACDOH facilitates CS discussions between Capital Roots, the municipal attendees. Each municipality shares their status in adopting a CS policy and priorities related to CS implementation (i.e. planned transportation infrastructure projects that provide opportunities to implement complete street plans). ACDOH increases awareness about the incidence of obesity, diabetes and hypertension within their community and how CS can have a positive impact on the community's health and economic development. Capital Roots reinforces this positive messaging and identifies options for promoting CS through various pop-up demonstration models. A series of meetings are held to plan pop-up events and to provide ongoing CS technical assistance.
ACDOH, CDTC, and Capital Roots are instrumental in supporting the municipalities at community outreach and city council meetings that raise awareness and community support for CS. Pop-up events provide the opportunity for elected officials, city planners and community members to experience proposed CS plans and to facilitate discussions between stakeholders about the benefits, challenges and concerns related to the proposed work. This model promotes engagement of community members and often reduces potential opposition associated with the proposed plans. This has been successfully duplicated in each of the four municipalities that are currently engaged in CS work and typically takes about 6 months from the initial meeting to the pop event date.
The pop-up event locations are strategically placed within the priority municipalities. Promotion of the events is achieved with fliers placed throughout the community and through social media (i.e. Facebook, Instagram accounts of partners and community champions).
The South End Run, Ride, Walk event in October 2016 promoted the nearby Albany County Helderberg-Hudson Rail Trail that is within a quarter (Â¼) mile of a public housing unit in the South End of Albany. The planning committee consisted of ACDOH, Capital Roots, City Council members, residents, and other community-based organizations. Wayfinding signage to the trail was installed a few days before the event. Surveys completed before and after the event indicate that many residents in the public housing development were unaware of the trail and after the pop-up event, utilized it primarily for walking. In September 2017, the event was held again with a more active engagement of the City of Albany's planning department and enhanced with the installation of a temporary bike lane. Both events included the participation of community organizations that provide services related to food access, health education and promotion, physical activity, and the arts. It is estimated that 100 residents and local elected officials (200 total) participated at each of the events. This event is scheduled to be held again in 2018. With each year, invested community members take on more leadership responsibilities for the event.
The Cohoes on the Move event in May 2017 utilized the mock-up plan from the Albany County Complete Streets Symposium. This event had about 100 attendees who received health-related information from community organizations and businesses, participated in a bike rodeo and group rides to promote bike safety and connections to nearby bike path and trails. Community input was also obtained regarding frequently used walking routes to school, work and public transportation points. This information is used to guide the ongoing work of the ACDOH, Capital Roots and the City of Cohoes related to improving walkability and bike-ability in the community. The City of Cohoes has committed to another event in May 2018 that will be held at the next prioritized CS location.
The City of Watervliet is planning a pop-up event in May 2018 to demonstrate the mock-up plans created during the Albany County Complete Streets Symposium. ACDOH and Capital Roots continue to provide ongoing support to City of Watervliet planners.
The City of Albany is planning a pop-up event in May 2018 to demonstrate alternative recreational use for an under-utilized space that is intersected by a planned bike lane that is to be installed in 2018-2019 ACDOH and Capital Roots are working with the City of Albany to solicit community input as well as to assist with the coordination of this event.
Funding for the pop-up events was provided through the Local IMPACT grant awarded to the Albany County Department of Health and Co-Exist grants awarded to Capital Roots and municipalities. ACDOH subcontracted with the cities of Albany, Cohoes and Watervilet and drafted deliverable contracts ($5,000 each) that encouraged the adoption of CS policies and completion of activities that increase awareness of CS and promote walking in the community. Additionally, ACDOH provided benches to the cities of Albany, Cohoes and Watervliet to be strategically placed along walking routes to public parks and trails â€“ an evidence-based strategy to promote walking.
The timeframe for each of the municipalities to meet the CS objectives varies related to their CS policy status. Municipalities that do not have a policy and/or support for them require more support and time to meet the CS objectives. Municipalities with adopted policies typically require 6 months to coordinate pop-up demonstrations. ACDOH's ongoing role is to:
Increase awareness about the health and economic benefits of CS;
Link health outcomes with evidence-based strategies (i.e. CS);
Provide support and technical assistance to community champions and decision makers;
Provide seed funding to coordinate and support CS events;
Promote free and low-cost physical activity opportunities.
Through these efforts, four municipalities with 160,438 residents have adopted Complete Streets policies or resolutions. Three of these municipalities (City of Albany, City of Cohoes, and Town of Bethlehem) are implementing CS interventions. This innovative and collaborative partnership has conducted three pop-up demonstrations reaching 142,682 residents over the past year and have another four planned for 2018 with projected reach of 256,903 residents.
The Albany County Department of Health (ACDOH) has legacy of building strategic relationships with community partners and stakeholders to improve public health. An Albany County2016-2018 Community Health Improvement Plans priority is to reduce the percentage of adults and children who are obese. Environmental interventions that support healthy behaviors including improving the quality of nutritional intake and increasing physical activity support this goal. Active communities that promote walking and biking increase the physical activity level of residents and therefore, reduce people's risk for developing obesity related diseases such as diabetes and hypertension.
ACDOH recognizes that each municipality varies in resources and support for adopting and implementing Complete Streets (CS) strategies. The National Complete Streets Coalition of Smart Growth America recognizes a continuum of CS progress that municipalities move along - from laying a foundation for CS work to full implementation of a CS work plan. ACDOH uses this framework to guide its CS activities and to meet municipalities where they are in the process and support their progress towards incrementally and successfully implementing a CS work plan.
ACDOH objectives include:
Provide technical assistance to municipalities to develop and adopt CS policies;
Coordinate pop-up demonstrations in priority neighborhoods;
Engage community members, leaders (elected officials) and decision makers in the planning and implementation of CS projects.
The Albany County Complete Streets Symposium (September 2016) was organized to aid transportation experts and decision makers identify and overcome barriers to implementing CS. Attendance included a mix of 32 planners, engineers, health professionals, highway maintenance staff, advocates and elected officials from local and state governments and community-based organizations. Representatives from eight Albany County municipalities attended the symposium. A survey was administered after the symposium and participants rated the workshop 4 or better on a 1-5 Likert Scale with 1 being poor and 5 being excellent. Attendees responded that they are working on or developing a CS policy in their community. As expected, the technical assistance needed to implement CS varied by municipality. A majority of respondents identified policy development, implementation and coordination as most prevalent assistance required. Three of the County's priority municipalities committed to working with ACDOH to develop and implement CS. Since the symposium, 2 additional municipalities (cities of Cohoes and Watervliet) approved either CS polices or resolutions and three municipalities implemented (cities of Albany and Cohoes, Town of Bethlehem) CS design plans. The CS policies adopted and implemented by these four municipalities increase the physical activity of 160,438 residents of which 125, 114 represent the priority populations.
Three pop-up demonstrations have been coordinated in the priority neighborhoods and four more are planned for Spring 2018. Each pop-up demonstration had at least 100 participants (300 total) inclusive of community members, elected officials, municipal decision makers, and community-based organizations serving priority populations. The temporary installation of bike lanes at these pop-up events are kept in place a week before the event and a week or two after the event; the reach of these installations is 142,683 residents from our priority communities. At the South End Run, Ride, Walk events completed surveys indicated an increased awareness about the Albany County Helderberg-Hudson Rail Trail and increased use of the pathway after the event. The City of Cohoes, Capital Roots and ACDOH used walk assessment maps from the event to identify and prioritize walking routes among residents.
The objective of the CS initiative is to move priority municipalities (at risk for chronic disease) along the continuum of CS implementation. This has been achieved with one priority municipality adopting a CS resolution (City of Watervliet), another adopting a CS policy (City of Cohoes), and three moving into the implementation stage of placing CS designs in their communities (City of Albany, City of Cohoes, Town of Bethlehem). The impact of these policies will positively affect 160,438 residents living in 76.6 square miles of Albany County. The synergistic partnerships between ACDOH, the regional MPO, municipal leaders and decision makers, and community-based organizations has given the municipalities the necessary support and resources to implement Complete Streets.
The Albany County Department of Health (ACDOH) developed this model practice based on the continuum of Complete Streets (CS) stages outlined by the National Complete Streets Coalition of Smart Growth America. This approach builds the capacity for municipalities to implement CS and strengthen the necessary relationships to sustain work. The continuum phases include:
Laying a foundation for CS that includes increasing awareness about the benefits, tools and design options for CS;
Developing a CS policy that meets local needs;
Implementing a CS policy that assesses challenges and opportunities, and explores solutions to successful implementation; and
Considering CS design options that are guided by research and best practices to create an implementation work plan.
Each partner plays a unique role in supporting the ongoing CS work with each municipality. It is important for each strategic partner to understand the specific challenges, opportunities and resources available for each municipality. Municipal stakeholders come with different motivations for implementing CS (i.e. benefit to community health vs. benefit to economic development) and recognizing and addressing their motivation(s) is important. This comprehensive understanding allows for the appropriate leveraging of expertise and funding sources from strategic partners to support the work. Additionally, it is essential to engage community members, municipal leaders, city planners; and invested community-based organizations to build support for and address concerns around CS implementation. This provides the foundation for CS that is necessary to develop and implement an effective CS work plan.
Through this approach, ACDOH employs a sustainable strategy for supporting CS growth that is strengthened by the innovative and strategic partnerships. The diversity and unique perspectives of strategic partners allows for the opportunity to explore CS designs that meet the needs of the municipalities, address the motivations of stakeholders, and identify creative funding sources for implementing CS. Complete Streets is a CDC recognized evidence-based strategy for increasing physical activity (The Community Guide for Preventive Services). The adoption of the policy extends beyond any one administration and creates a sustainable environment that supports walking and biking in the community. The permanent installation of street-scape designs that make streets safer for pedestrians, bicyclists, and motorists benefits the health and economic development of the community.
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