County Health Rankings & Roadmaps, A Healthier Nation, County by County

The County Health Rankings models and measures

Our Approach

The County Health Rankings model of population health

What can I do?

Action Center

Explore guides and tools for improving health.

What Works for Health

Explore programs and policies that work!

What can I learn from others?


Key findings from the last four years of County Health Rankings and other national reports.

County-by-County Blog

Project updates, commentaries, events and news about health across the nation from the County Health Rankings & Roadmaps team.

Complete Streets & streetscape design initiatives

Evidence Rating

Scientifically Supported

Streetscape design improvements enable pedestrians, bicyclists, transit riders, and motorists to share and use the street, accommodating the needs of all users. Improvements to streetscape design can include increased street lighting, enhanced street landscaping and street furniture, increased sidewalk coverage and connectivity of pedestrian walkways, bicycling infrastructure, street crossing safety features, and traffic calming measures. Streetscape design improvement projects typically include elements from more than one of these categories; these projects can be implemented incrementally or comprehensively, and are often part of community-level Complete Streets policies (SGA-Complete streets).

Expected Beneficial Outcomes (Rated)

  • Increased physical activity

  • Increased pedestrian and cyclist safety

Other Potential Beneficial Outcomes

  • Increased active transportation

  • Reduced obesity rates

  • Improved sense of community

  • Improved neighborhood safety

  • Reduced stress

  • Reduced vehicle miles traveled

Evidence of Effectiveness

There is strong evidence that streetscape design improvements, often implemented via Complete Streets initiatives, increase physical activity, particularly as part of a multi-component land use approach (CG-Physical activity, , CETRT). Street crossing safety features and traffic calming measures, often components of streetscape design improvements, have also been shown to reduce traffic speed and increase pedestrian and cyclist safety (CG-Physical activity, , , Rothman 2015, , , Retting 2003, MN DOT-Stine 2014). 

Street-scale urban design projects can provide safer, more inviting environments for outdoor physical activities (CG-Physical activity). Features such as street furniture, street-facing windows, and active street frontages are also associated with increased pedestrian street use (Ewing 2016), and traffic calming features can increase walking and bicycling (Winters 2010, Morrison 2004). Living in neighborhoods with greater street connectivity, more streetlights and bike paths, and related environmental characteristics is associated with higher levels of walking, increased physical activity, and lower rates of overweight and obesity (, Reynolds 2010, Lee 2012b). Environmental improvements that make neighborhoods more walkable are also associated with lower body mass indexes (BMIs) among children (Duncan 2014).

Connected sidewalks, street crossing safety features, and bicycle lanes can reduce injury risk for pedestrians and cyclists (Reynolds 2010). Narrower streetscapes may encourage slower driving than large, open streetscapes, improving both livability and safety (). Streetscape design improvements may also improve green space, increase sense of community, and reduce crime and stress (CG-Physical activity). A New York City-based study, for example, suggests that streetscape design elements, especially tree canopy coverage, increase perceptions of safety ().

Complete Streets with light rail public transit can increase physical activity for new riders (). Efforts to connect different forms of transit and enhance pedestrian and bicycle commuting infrastructure may encourage transit use and help riders easily travel the last mile to a destination (Zellner 2016).

Replacing automotive trips with biking and walking can reduce vehicle miles traveled (VMT) and greenhouse gas emissions that contribute to climate change (EPA-Kramer 2013, ). Activity friendly environments such as streetscapes with greater street connectivity and access, more greenery and trees, proximity to parks, and mixed land use can also increase environmental sustainability and enhance economic activity (Sallis 2015, Perk 2015), and may increase employment and nearby property values ().

Research suggests that clear initiative definition, efforts to educate the public, advocates, and decision-makers, and strong and diverse networks of supporters can help further adoption of local Complete Streets policies (Dodson 2014).

Costs for infrastructure improvements vary significantly both by locale and type of improvement, for example the median cost is $340 for a striped crosswalk, $16 per linear foot for an asphalt sidewalk, and $89,470 per mile for a bike lane (UNC-Bushell 2013). Streetscape design improvements typically have a lower cost per mile than the cost per mile for an average new arterial street project ().

Impact on Disparities

No impact on disparities likely

Implementation Examples

As of 2016, over 1,100 Complete Streets policies have been adopted at the local, regional, and state level (SGA-Complete streets). Urbanized states are more likely to have adopted Complete Streets policies (); such policies are less prevalent in smaller communities with lower median education levels and communities in the South (). The National Complete Streets Coalition and Smart Growth America highlight 10 best Complete Streets policies of 2012 in a 2013 report (NCSC-Seskin 2013). Active Living By Design and Active Living Research also highlight many communities implementing Complete Streets policies and individual streetscape design improvements (ALBD, ALR-Complete streets).

Walk Friendly Communities is a national recognition program that supports and encourages efforts to enhance safer walking environments, which include streetscape design improvements. Walk Friendly Communities have been recognized in 28 states. Seattle and New York City are the only platinum level communities; 15 communities are recognized as gold, 17 as silver, 31 as bronze, and 20 as honorable mentions (WFC-State map).  

London, Kentucky is an example of a city working to improve streetscape design with additional bicycling infrastructure and connecting walking routes that incorporate streetscape beautification, parks, urban greening efforts, as well as local public art displays (Gilboy 2016).

Implementation Resources

LHC-Toolkit 2009 - Leadership for Healthy Communities (LHC). Action strategies toolkit: A guide for local and state leaders working to create healthy communities and prevent childhood obesity. Princeton: Robert Wood Johnson Foundation (RWJF); 2009.

WHO-Edwards 2008 - Edwards P, Tsouros AD. A healthy city is an active city: A physical activity planning guide. Copenhagen, DK: World Health Organization Europe (WHO-E); 2008.

SGA-Complete streets - Smart Growth America (SGA). National Complete Streets Coalition resources.

Gilpin 2012 - Gilpin J, Costakis C. Montana complete streets toolkit: for cities, small towns and tribal communities. Bozeman: Alta Planning + Design, Montana Nutrition and Physical Activity Program (NAPA), Montana Department of Public Health and Human Services (DPHHS); 2012.

NCSC-Seskin 2013 - Seskin S, Gordon-Koven L. The best Complete Streets policies of 2012. Washington, DC: National Complete Streets Coalition (NCSC), Smart Growth America (SGA); 2013.

UNC-Bushell 2013 - Bushell MA, Poole BW, Zegeer CV, Rodriguez DA. Costs for pedestrian and bicyclist infrastructure improvements: A resource for researchers, engineers, planners, and the general public. Chapel Hill: University of North Carolina, Chapel Hill, Highway Safety Research Center; 2013.

ChangeLab-Zimmerman 2013 - Zimmerman S, Kramer K. Getting the wheels rolling: A guide to using policy to create bicycle friendly communities. Oakland: ChangeLab Solutions; 2013.

AHA-VFHK toolkits - American Heart Association (AHA), Robert Wood Johnson Foundation (RWJF). Voices for healthy kids (VFHK): Toolkits to make the healthy choice the easy choice in the places where children live, learn and play.

CDC-DNPAO data - Centers for Disease Control and Prevention (CDC), Division of Nutrition Physical Activity and Obesity (DNPAO). Nutrition, physical activity and obesity: Data, trends and maps online tool.

LHC-Rockeymoore 2014 - Rockeymoore M, Moscetti C, Fountain A. Rural Childhood Obesity Prevention Toolkit. Leadership for Healthy Communities (LHC). 2014.

US DOT-PBIC Sidewalks - US Department of Transportation (US DOT), Federal Highway Administration (FHWA). Pedestrian and Bicycle Information Center (PBIC). Sidewalks and walkways.

ChangeLab-CS - ChangeLab Solutions. What are Complete Streets (CS)?

Schlossberg 2013 - Schlossberg M, Rowell J. Making streets into Complete Streets: An evidence-based design manual. Portland, OR: National Institute for Transportation and Communities (NITC); 2013.

Ranahan 2014 - Ranahan ME, Lenker JA, Maisel JL. Evaluating the impact of Complete Streets initiatives. Center for Inclusive Design and Environmental Access (IDEA). University at Buffalo, the State University of New York. 2014.

Citations - Evidence

* Journal subscription may be required for access.

Brownson 2006* - Brownson RC, Haire-Joshu D, Luke DA. Shaping the context of health: A review of environmental and policy approaches in the prevention of chronic diseases. Annual Review of Public Health. 2006;27:341–70.

Morrison 2003* - Morrison DS, Petticrew M, Thomson H. What are the most effective ways of improving population health through transport interventions? Evidence from systematic reviews. Journal of Epidemiology and Community Health. 2003;57(5):327-33.

Retting 2003 - Retting RA, Ferguson SA, McCartt AT. A review of evidence-based traffic engineering measures designed to reduce pedestrian-motor vehicle crashes. American Journal of Public Health. 2003;93(9):1456-63.

CG-Physical activity - The Guide to Community Preventive Services (The Community Guide). Physical activity.

CETRT - Center of Excellence for Training and Research Translation (CETRT). Find interventions. UNC Center for Health Promotion and Disease Prevention (HPDP).

Reynolds 2010 - Reynolds CCO, Winters M, Ries FJ, Gouge B. Active transportation in urban areas: Exploring health benefits and risks. Vancouver: National Collaborating Centre for Environmental Health (NCCEH); 2010.

Wilson 2011a* - Wilson LA, Giles-Corti B, Burton NW, et al. The association between objectively measured neighborhood features and walking in middle-aged adults. American Journal of Health Promotion. 2011;25(4):e12-21

Cochrane-Bunn 2003* - Bunn F, Collier T, Frost C, et al. Area-wide traffic calming for preventing traffic related injuries. Cochrane Database of Systematic Reviews. 2003;(1):CD003110.

Cochrane-Beyer 2009* - Beyer FR, Ker K. Street lighting for preventing road traffic injuries. Cochrane Database of Systematic Reviews. 2009;(1):CD004728.

Cochrane-Aeron-Thomas 2005* - Aeron-Thomas A, Hess S. Red-light cameras for the prevention of road traffic crashes. Cochrane Database of Systematic Reviews. 2005;(2):CD003862.

Morrison 2004 - Morrison DS, Thomson H, Petticrew M. Evaluation of the health effects of a neighbourhood traffic calming scheme. Journal of Epidemiology and Community Health. 2004;58(10):837-40.

Winters 2010 - Winters M, Brauer M, Setton EM, Teschke K. Built environment influences on healthy transportation choices: Bicycling versus driving. Journal of Urban Health. 2010;87(6):969–93.

Lee 2012b - Lee RE, Mama SK, Medina A V, Ho A, Adamus HJ. Neighborhood factors influence physical activity among African American and Hispanic or Latina women. Health & Place. 2012;18(1):63–70.

EPA-Kramer 2013 - Kramer MG. Our built and natural environments: A technical review of the interactions among land use, transportation, and environmental quality. Washington, DC: US Environmental Protection Agency (EPA); 2013.

UNC-Bushell 2013 - Bushell MA, Poole BW, Zegeer CV, Rodriguez DA. Costs for pedestrian and bicyclist infrastructure improvements: A resource for researchers, engineers, planners, and the general public. Chapel Hill: University of North Carolina, Chapel Hill, Highway Safety Research Center; 2013.

Salon 2012* - Salon D, Boarnet MG, Handy S, Spears S, Tal G. How do local actions affect VMT? A critical review of the empirical evidence. Transportation Research Part D: Transport and Environment. 2012;17(7):495–508.

Sallis 2015 - Sallis JF, Spoon C, Cavill N, et al. Co-benefits of designing communities for active living: An exploration of literature. International Journal of Behavioral Nutrition and Physical Activity, 2015;12(1):1–10.

Duncan 2014 - Duncan DT, Sharifi M, Melly SJ, et al. Characteristics of walkable built environments and BMI z-scores in children: Evidence from a large electronic health record database. Environmental Health Perspectives. 2014;122(12):1359-1365.

MN DOT-Stine 2014 - Stine P, Holdhusen B, Noyce D. Safety impacts of implementing Complete Streets. Minnesota Department of Transportation (MN DOT), Research Services & Library, Local Road Research Board (LRRB). Technical Summary:2013-2031TS. 2014.

Rothman 2015 - Rothman L, Macpherson A, Buliung R, et al. Installation of speed humps and pedestrian-motor vehicle collisions in Toronto, Canada: A quasi-experimental study. BMC Public Health. 2015;15(1):774.

Harvey 2015* - Harvey C, Aultman-Hall L, Hurley SE, Troy A. Effects of skeletal streetscape design on perceived safety. Landscape and Urban Planning. 2015;142:18-28.

Harvey 2015a* - Harvey C, Aultman-Hall L. Urban streetscape design and crash severity. Transportation Research Record: Journal of the Transportation Research Board. 2015;2500:1-8.

Ewing 2016 - Ewing R, Hajrasouliha A, Neckerman KM, Purciel-Hill M, Greene W. Streetscape features related to pedestrian activity. Journal of Planning Education and Research. 2016;36(1):5-15.

Anderson 2015* - Anderson G, Searfoss L, Cox A, et al. Safer streets, stronger economies: Complete Streets project outcomes from across the United States. Institute of Transportation Engineers ITE Journal. 2015;85(6):29-36.

Dodson 2014 - Dodson EA, Langston M, Cardick LC, et al. “Everyone should be able to choose how they get around”: How Topeka, Kansas, passed a Complete Streets resolution. Preventing Chronic Disease. 2014;11:130292.

Zellner 2016 - Zellner M, Massey D, Shiftan Y, Levine J, Arquero MJ. Overcoming the last-mile problem with transportation land-use improvements: An agent-based approach. International Journal of Transportation. 2016;4(1):1-26.

Perk 2015 - Perk V, Catalá M, Mantius M, Corcoran K. Capturing the benefits of Complete Streets. Tampa, FL: National Center for Transit Research (NCTR), Center for Urban Transportation Research (CUTR), University of South Florida (USF); 2015.

Brown 2015a* - Brown BB, Werner CM, Tribby CP, Miller HJ, Smith KR. Transit use, physical activity, and body mass index changes: Objective measures associated with complete street light-rail construction. American Journal of Public Health. 2015;105(7):1468-1474.

Citations - Implementation Examples

* Journal subscription may be required for access.

ALBD - Active Living by Design (ALBD). Increasing physical activity and healthy eating through community design.

SGA-Complete streets - Smart Growth America (SGA). National Complete Streets Coalition resources.

NCSC-Seskin 2013 - Seskin S, Gordon-Koven L. The best Complete Streets policies of 2012. Washington, DC: National Complete Streets Coalition (NCSC), Smart Growth America (SGA); 2013.

WFC-State map - Walk Friendly Communities (WFC), Pedestrian and Bicycle Information Center. Walk friendly communities state map.

ALR-Complete streets - Active Living Research (ALR). Promoting activity-friendly communities: Complete streets.

Gilboy 2016 - Gilboy ET, Philen M, Browning L, et al. London, KY: Turning London green: Conceptual designs for the expansion of London’s streetscape and greenspaces. Blacksburg, VA: Community Design Assistance Center (CDAC); 2016.

Carlson 2016* - Carlson SA, Paul P, Kumar G, et al. Prevalence of Complete Streets policies in US municipalities. Journal of Transport & Health. 2016.

Yusuf 2016* - Yusuf JE, O’Connell L, Rawat P, Anuar K. Becoming more complete: The diffusion and evolution of state-level Complete Streets policies. Public Works Management & Policy. 2016;21(3):280-295.

Date Last Updated

Jun 15, 2017