Integrating Health and Transportation in Nashville, Tennessee, USA: From Policy to Projects

The Nashville Area Metropolitan Planning Organization (MPO) is among the first MPOs in the United States to integrate public health (physical activity, air pollution, and traffic crashes) into transportation planning, policy, funding, research, and modeling.

Key Takeaway:

  • The Nashville Area Metropolitan Planning Organization (MPO) is among the first MPOs in the United States to integrate public health (physical activity, air pollution, and traffic crashes) into transportation planning, policy, funding, research, and modeling. Initial evidence suggests that there are increased opportunities for active transportation in the region, but more evaluation over time is needed to determine health impacts.


  • The Nashville MPO had a six-pronged approach to improve transportation and health in the region. Specifically, the MPO:
  1. Conducted a Regional Bicycle and Pedestrian Study in 2009 and 2014. They created an inventory of existing bicycle and pedestrian facilities, which included a new scoring system to identify specific priority areas for expanding bicycle and pedestrian infrastructure. This contributed to a strategic vision to improve walking and bicycling in the greater Nashville area. The scoring system was also incorporated in project proposals for consideration in the 2035 and 2040 Regional Transportation Plans.
  2. Solicited public input and shifted its policy focus in response. It increased support for public transit, walking and bicycling, and existing roadway preservation instead of new road construction.
  3. Created quantifiable metrics for roadway projects that prioritized health and Complete Streets components.
  4. Allocated funding for projects supporting multi-modal and Complete Streets transportation projects that were in demand by the public.
  5. Conducted the Middle Tennessee Transportation and Health Study, one of the first regional studies in the nation about the relationship between transportation and health.
  6. Modeled health and fiscal impacts of shifting from motorized transportation to active transportation by implementing the Integrated Transport and Health Impact Model.
  • The greater Nashville built environment has been improved to better encourage and enable walking, bicycling, and public transit use. The following changes occurred from 2009 to 2014:
    • Miles of sidewalks increased by 57 percent.
    • Miles of bicycle lanes, shared routes, and multi-use paths increased by 19 percent.
    • Miles of greenways in the Nashville area increased by 36 percent.

Forthcoming funded projects in the 2035 and 2040 Regional Transportation Plan show promise of continuing this trend.

  • Since funding the Active Transportation Program in 2012, $13.6 million has been awarded for active transportation infrastructure and education projects. The 2040 regional plan allocates an additional $206 million for the program over the next 25 years. 


  • While each region of the country has its unique political contexts, public engagement practices, challenges, and opportunities, there are applicable lessons from Nashville:
    • Lack of data should not be a barrier. Instead, it should prompt transportation planning agencies to collect and track data in a meaningful way to inform projects, policies, and programs.
    • Highlighting the economic benefits of active transportation can be an effective inroad to engage policymakers and elected officials who have a vested interest in increasing economic development in their areas. A discussion of the economic benefits can springboard into the many other benefits of active transportation (i.e., health and environmental outcomes).
    • Public input is vital for transportation planning processes. Direct public engagement techniques and building coalitions with stakeholder groups are crucial.
    • In the absence of existing partnerships, transportation planning agencies can approach the town’s, city’s, county’s, or state’s public health department to discuss collaborations to strengthen the link between transportation and health.


  • The Nashville MPO’s data collection comprised of:
    • A telephone-based transportation opinion survey among 1100 randomly-selected households in the region following the 2009 Regional Bicycle and Pedestrian Study.
    • A mailed survey to gather transportation data for approximately 5000 households, 11,000 individuals, 9000 vehicles, and 40,000 trips. In addition to transportation data, respondents answered six health questions related to diet, physical activity, sitting time, height and weight, and general health status.
    • To create quantifiable metrics for roadway projects, the Nashville MPO established eight broad-reaching transportation categories, ranked them in order of importance, and devised a numerical scoring system that could be used to assess the extent to which funded projects contained healthy transportation and planning elements.
    • The Nashville MPO relied on the skills of modelers, mappers, and analysts to perform transportation and mathematical modelling.

Meehan, L. and Whitfield, G. (2017). Integrating health and transportation in Nashville, Tennessee, USA: From policy to projects. Journal of Transport & Health, 4.

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