Leah Fisher, a Built and Natural Environment Analyst, for Clackamas County, OR. Leah has been in this shared public health and transportation and land use role at Clackamas County for just over one year. She works collaboratively with the Department of Transportation (DTD) to incorporate health and equity into the County’s long-range plans and projects. Broadly, activities can include supporting the development of scopes of work or sitting on advisory committees to developing health impact assessments or weaving health considerations throughout the entire process or plan.
We are excited to learn from Leah and appreciate her taking time to provide some real world context to collaborative public health and transportation work.
Vision Zero Network: It’s not often that I meet someone who works precisely at the juncture of public health and transportation. How did you find your way into a position like this and what does it entail?
Leah Fisher: While working as an urban planner at a consulting firm, our team strived to incorporate health considerations into long-range plans and would sometimes receive pushback because we lacked the credentials to back up our beliefs that diversifying the ways we move around our community also benefited community health. This planted a seed for me that going back to school to get an advanced degree in public health could enhance my ability to create healthy walkable communities that also reduce all of the negative externalities of single occupancy vehicles.
Due to other life choices, I moved back to the Pacific Northwest at the time the recession was hitting the economy hard and the choice was almost made for me - I returned to school to earn a master’s in Health Management and Policy with the intent of enhancing the connection between the built environment and health into my work as a planner.
It was actually never my intent to work in public health, however, during my studies a different professional world opened up to me and the opportunity to support creating healthy communities on the public health side felt like a way to make a positive impact in Oregon. I took a position in the Oregon Health Authority’s Health Promotion and Chronic Disease Prevention Section conducting policy, systems, and environmental change interventions in counties across Oregon.
Prior to joining Clackamas County, I worked in a technical assistance role supporting Community Based Organizations, groups, and community members to create livable and inclusive communities. The organization focused on capacity building within land use & transportation systems and processes. We placed an emphasis on supporting communities who have been historically underrepresented and often harmed in these processes, plans, and decisions.
Vision Zero Network: In your experience, how do transportation decisions impact public health outcomes and vice versa?
Leah Fisher: Ahh, where do I start? This position [at Clackamas County] was born out of the desire by one of our transportation engineers to reduce injury and fatalities for our most vulnerable road users. And at the foundation, I feel, incorporating health into transportation projects is about creating safe streets that anyone can use from ages 8 to 80 without risk of injury or death. At the County, we are working to incorporate the Safe Systems Approach into everything we do and it’s been really exciting to be part of that and see the passion my colleagues have around keeping people safe on our streets.
Additionally, if we look upstream, a transportation system that promotes health is asked to meet so many more needs which directly tie to the social determinants of health, which are non-medical factors that affect health. We know that conditions such as what neighborhood you live in, your educational access, economic stability, housing, as well as social and community context has a significant impact on people’s quality of life and health outcomes. I don’t think we could work on any social determinants of heath without touching our transportation infrastructure and systems – they are inter-connected in so many ways from safety to access, to comfort, to cost burden, to what environmental exposures different communities encounter.
Lastly, one area that I think is often overlooked is the social connection and self-efficacy that can be fostered or hindered by our transportation networks. We are realizing more and more in public health how harmful social isolation is, particularly when combined with other factors. The ability to get out to walk and meet your neighbors and connect with other people or pets helps improve mental and physical health. Additionally, a safe multi-modal system offers independence and dignity for youth, folks with mobility limitations, older adults, and people who may not have a car.
Leah Fisher with her children & nephew.
Vision Zero Network: Can you describe any specific projects or programs you have worked on or are currently working on that aim to mitigate the impacts highlighted above? And what have been some of the key outcomes of these efforts?
Leah Fisher: Currently, I’m involved in the Sunrise Corridor Community Visioning project [in which] I’ve been able integrate or weave health considerations throughout the planning process in a way it almost can’t be pulled apart or separated.
For context, the Sunrise project was (and still very much is) a major transportation project that has expanded into a Visioning project to intentionally include and address land use, housing, economy, transit, social connections, and environmental and community health – all of which connect to social determinants of health, which are at the core of enhancing health and improving health outcomes for communities. Additionally, the project is focused on incorporating a safe systems approach which looks at how we change factors in our built environment to reduce accidents and fatalities on our roadways.
We are at the midpoint of this project and public health has been at the table since the launch of the project. Specifically, public health has been able to support the scope to integrate health and health equity considerations, incorporate health data and analysis into the existing conditions report, and actively participate in identifying strategies and actions to improve health in the study area. Again, this wouldn’t be possible without the support from leadership in Department of Transportation (DTD) and the resources to participate in the project.
Vision Zero Network: What do you see as the biggest challenges when trying to integrate public health considerations into transportation planning & decisions?
Leah Fisher: Support for connecting these two professions is the first challenge I expect many jurisdictions will face. I have been super lucky we have very supportive leadership in both DTD and Public Health that see this connection so clearly and have advocated for, and carved out funding for, this collaboration.
That said, I think a major challenge can be funding or the capacity for staff to collaborate and sit at the transportation tables. Public Health Departments are funded differently from Planning Departments and rely largely on program grants which often have a specific purpose that likely doesn’t include land use and transportation efforts. In 2019 in Oregon, our state legislature made a major decision to invest more resources in our public health system so all our counties could operate at a base level of service and capabilities. This “modernization” effort has been a game changer for Clackamas County and other very rural health departments across Oregon. My position is in part funded through these modernization funds and also in part because DTD sees the value of having health at the table.
Once your departments have achieved support for the partnership and funding to make it happen, the last challenge I would say is finding how we each fit into each other’s worlds in a way that is sustainable. It’s still a new role and not always clear where I fit into a plan or project, but I’m lucky that I work with amazing folks who welcome learning with me as we navigate how we work together in small and large ways to change how we do transportation plans and projects in a way that places more emphasis on community health and health equity.
Vision Zero Network: What do you see as critical or missed opportunities for better coordination between public health and transportation agencies more generally?
Leah Fisher: I think we (transportation and public health departments) have many of the same values and goals, and we are missing an opportunity to leverage each other’s expertise and resources. For example, public health invests a lot of resources in maintaining a robust data/surveillance system, building that expertise, and integrating equity into data processes and practices in a way I’ve not seen a transportation department do. Public health is also typically more steeped in evidence-based practices and program evaluation.
On the flip side, transportation professionals have a deep knowledge and understanding of how very complex transportation systems and funding streams work, what the rules and regulations are for design, and how to bring in infrastructure dollars to actually make changes for a safer system in communities. This is not a skill set or authority our public health folks have or would have the resources to develop. These two professions also have different insight and understanding of how best to integrate equity into these processes and outcomes.
Therefore, circling back, the missed opportunity is finding a way to integrate each other’s skills sets and knowledge into our work, into our efforts to advance our shared goals and priorities of safer and healthier and more equitable transportation networks for our communities.
Vision Zero Network: What advice would you give to jurisdictions who are looking to foster ongoing communication and collaboration between their transportation and public health agencies? What would you suggest as accessible starting points for this type of interdepartmental collaborative work?
Leah Fisher: I think be open to a change in the way you do your work and be open to the discomfort that a transition in how we do our work brings. Every jurisdiction is different so an effective partnership for your jurisdiction is going to look different and that’s ok. Small steps forward, maintaining connections, and trying out new ways of working together is how your organizations will find out what works for you. As I mentioned above, it’s still a new role for us at Clackamas County and not always clear where I fit into a plan or project, but I’m lucky that I work with amazing folks who welcome learning with me as we navigate how we work together in small and large ways to change how we do transportation plans and projects in a way that places more emphasis on community health and health equity.
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