Complete Streets & streetscape design initiatives

Evidence Rating  
Evidence rating: Scientifically Supported

Strategies with this rating are most likely to make a difference. These strategies have been tested in many robust studies with consistently positive results.

Disparity Rating  
Disparity rating: Potential to decrease disparities

Strategies with this rating have the potential to decrease or eliminate disparities between subgroups. Rating is suggested by evidence, expert opinion or strategy design.

Health Factors  
Date last updated
Community in Action

Houghton MI implements Complete Streets

To increase physical activity in a rural region with high rates of unemployment and poverty, and lots of snow, Michigan’s Western Upper Peninsula Health...

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. Projects can be implemented incrementally or comprehensively and are often part of community-level Complete Streets policies1.

What could this strategy improve?

Expected Benefits

Our evidence rating is based on the likelihood of achieving these outcomes:

  • Increased physical activity

  • Increased pedestrian and cyclist safety

Potential Benefits

Our evidence rating is not based on these outcomes, but these benefits may also be possible:

  • Increased active transportation

  • Reduced obesity rates

  • Improved sense of community

  • Improved neighborhood safety

  • Reduced stress

  • Reduced vehicle miles traveled

What does the research say about 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 approach2, 3, 4, 5. 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 safety2, 3, 6, 7, 8, 9, 10, 11, 12, 13.

Street-scale urban design projects can provide safer, more inviting environments for outdoor physical activities2. Features such as street furniture, street-facing windows, and active street frontages are also associated with increased pedestrian street use14, and traffic calming features can increase walking and bicycling15, 16, 17. Complete Streets initiatives can increase bicycling and bicycle commuting3. 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 activity4, and lower rates of overweight and obesity18, 19, 20. Environmental improvements that make neighborhoods more walkable are also associated with lower body mass indexes (BMIs) among children21.

Statewide implementation of Complete Streets policies is associated with decreases in pedestrian fatalities, and the impact can last for several decades8. Complete Streets initiatives can also improve safety for cyclists and decrease bicyclist fatalities3. Connected sidewalks, street crossing safety features, and bicycle lanes can reduce injury risk for pedestrians and cyclists3, 19. Narrower streetscapes may encourage slower driving than large, open streetscapes, improving both livability and safety22. Streetscape design improvements may also increase green space, improve sense of community, and reduce crime and stress2. A New York City-based study, for example, suggests that streetscape design elements, especially tree canopy coverage, increase perceptions of safety23.

Complete Streets with light rail public transit can increase physical activity for new riders24. 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 destination25.

Replacing automotive trips with biking and walking can reduce vehicle miles traveled (VMT) and greenhouse gas emissions that contribute to climate change26, 27, 28, 29. 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 activity30, 31. In some circumstances, Complete Streets can improve the economic resilience of local housing markets and increase nearby property values32, 33; however, effects on housing prices are not consistent34.

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 policies35. Including active living design standards and requirements in planning documents may also increase implementation of Complete Streets policies36.

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 lane37. Streetscape design improvements typically have a lower cost per mile than the cost per mile for an average new arterial street project33.

How could this strategy advance health equity? This strategy is rated potential to decrease disparities: suggested by expert opinion.

Streetscape design and Complete Streets initiatives have the potential to decrease disparities in active travel, walking and bicycling for transportation, and the associated positive health benefits between people with different socio-economic backgrounds, race and ethnicity, and gender49. Initiatives can be strategically designed to increase opportunities for communities with fewer resources to increase physical activity. Available evidence suggests that Complete Streets initiatives have supported an increase in active transportation for women, especially women with low incomes50, and reduced road traffic injuries that disproportionately effect people of color and those with low incomes51. Complete Streets initiatives can embrace principles of environmental justice such as equal distribution and access to resources and systemic changes to planning processes to include communities of color and those with low incomes in improving community conditions52. Examples of these efforts include adopting policies to address equity and inclusion, increasing community involvement in decision-making for policy and built environment change, and addressing community safety concerns53.

Designing and implementing equitable Complete Streets policies is critical to reducing health disparities experienced by communities with low incomes, minority populations, and by gender. An analysis of all available Complete Street policies in 2015 showed fewer than 7% of the policies had explicit language mentioning such populations, likely decreasing the potential of these policies to be implemented equitably49. In New York City, neighborhood slow zones were implemented with community feedback, paying close attention to responses from residents with low incomes and residents of color, to reduce road traffic injuries and prioritize areas with higher traffic casualties. This Complete Streets initiative created safer neighborhoods by incorporating feedback and addressing the concerns of local residents51.

What is the relevant historical background?

Communities of color, people with low incomes, and people across the gender spectrum continue to experience health disparities, and evidence shows that the built environment is a significant contributor to these inequities50, 53. These communities are more likely to live in areas with fewer parks, health care facilities, and developed infrastructure53. Many factors shape the built environment and influence its role in physical activity and health.

Recent studies demonstrate how historic zoning patterns have shaped communities today. Zoning has significantly contributed to current inequities, including racial residential segregation, regional inequality, disparities in public resources and services, and unaffordable housing54. Zoning is used to maintain strict distinctions between residential neighborhoods zoned for single-family houses with high values and areas for commercial and industrial uses55.

Urban areas in the U.S. experienced unrestrained industrialization, often without environmental regulations and land use controls. Early U.S. environmental movements focused on conservation and nature preservation and did not consider environmental urban inequities or public health56. In the 1950-1960s, the urban renewal movement emphasized urban cleanup, redevelopment, and revitalization projects and was planned and designed by city developers, excluding the voices of residents, mostly people of color. Urban renewal destroyed homes and community institutions such as churches, schools, recreational facilities, and ethnic organizations57. As select neighborhoods were gentrified, households of color with low incomes were displaced and relocated together in under-resourced urban areas frequently suffering from multiple environmental injustices56.

Automobile-centric design motivated many zoning patterns and urban movements, creating even more community inequalities with reduced access to equitable transportation options, increased residential segregation, and further entrenched health disparities50. Altogether, these patterns have decreased the physical health of communities and their safety. People of color, those with low incomes, and those who are uninsured are more likely to suffer pedestrian injuries and fatalities because they are all more likely to live in low income communities that are the least safe for walking58. The Complete Streets movement was started to counter the increasing prevalence of automobile-centric design, to support more physical activity in communities, and to increase community safety, which are all interrelated58.

Equity Considerations
  • How do local planners implement Complete Streets initiatives in your community? What data and community feedback are collected to ensure equitable implementation?
  • How can you work with local planners to support the implementation of Complete Streets initiatives to meet the needs of your community? How can local community advocates support engagement between local planners and the community?
  • Can Complete Streets be used to support efforts to increase active transit (i.e., walking, biking, public transit) and reduce dependence on cars in your community? How does this fit with existing land uses, pedestrian-oriented features, and strong job markets?
  • Who are the local stakeholders that can help identify opportunities for Complete Street initiatives in your community?
  • How have historic zoning patterns and uses, traffic design, and other built environment factors contributed to local challenges, such as safety?
Implementation Examples

As of 2016, over 1,400 Complete Streets policies have been adopted at the local, regional, and state level38. As of 2018, 21 states and Washington, D.C. have adopted state Complete Streets legislative statues, with three quarters of them adopted since 200739. However, only a few states require specific actions for implementation of Complete Streets initiatives to qualify as such40. Urbanized states are more likely to have adopted Complete Streets policies41; such policies are less prevalent in smaller communities with lower median education levels and communities in the South42. The National Complete Streets Coalition and Smart Growth America highlight 10 best Complete Streets policies of 2012 in a 2013 report43. Active Living By Design and Active Living Research also highlight many communities implementing Complete Streets policies and individual streetscape design improvements44, 45.

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 at various levels in 29 states. Seattle and New York City have been recognized at the platinum level; 15 communities have been recognized as gold, 18 as silver, 31 as bronze, and 22 as honorable mentions46.

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 displays47. In 8 years, Memphis Tennessee went from being one of the worst cities for bicycling, to one of the best in the U.S. This was done by reframing the issue of increased opportunities for physical activity from being recreational, to being about health, connectivity, and mobility38. Richfield, Minnesota implemented Complete Streets to develop more usable roads for their residents by redesigning roads and reconstruction with extensive community engagement that focused on livability, economic vitality, transportation and community health48.

Implementation Resources

Resources with a focus on equity.

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.

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.

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

Sansone 2019 - Sansone C, Sadowski J, Chriqui JF. Public health engagement in Complete Streets initiatives: Examples and lessons learned. Chicago: Institute for Health Research and Policy, University of Illinois at Chicago. 2019.

WHO-E-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.

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.

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

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

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.

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

Schlossberg 2013 - Schlossberg M, Rowell J. Rethinking streets: An evidence based design manual on making streets into Complete Streets. 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.

LHC-Rockeymoore 2014 - Rockeymoore M, Moscetti C, Fountain A. Rural childhood obesity prevention toolkit. Leadership for Healthy Communities (LHC), Center for Global Policy Solutions, Robert Wood Johnson Foundation; 2014.

AHA-VFHK toolkits - American Heart Association (AHA). Voices for healthy kids (VFHK): Resources and toolkits.

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.

PAS-Zoning 2016 - Planning Advisory Service (PAS). Planning & zoning for health in the built environment. American Planning Association (APA); 2016.

SRTSNP-Safe routes to healthy foods - Safe Routes to School National Partnership (SRTSNP). Healthy communities: Safe routes to healthy foods.


* Journal subscription may be required for access.

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

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

3 Mooney 2018 - Mooney SJ, Magee C, Dang K, et al. “Complete Streets” and adult bicyclist fatalities: Applying G-Computation to evaluate an intervention that affects the size of a population at risk. American Journal of Epidemiology. 2018;187(9):2038-2045.

4 Brown 2016a - Brown BB, Smith KR, Tharp D, et al. A Complete Street intervention for walking to transit, nontransit walking, and bicycling: A quasi-experimental demonstration of increased use. Journal of Physical Activity and Health. 2016;13(11):1210-1219.

5 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;27:341-370.

6 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.

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

8 Porter 2018 - Porter JM, PhD SL, Bryan SJ, et al. Law accommodating nonmotorized road users and pedestrian fatalities in Florida, 1975 to 2013. American Journal of Public Health. 2018;108(4):525-531.

9 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.

10 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.

11 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):327-333.

12 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):1456-1463.

13 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.

14 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.

15 Landgrave-Serrano 2022 - Landgrave-Serrano M, Stoker P. Increasing physical activity and active transportation in an arid city: Slow Streets and the COVID-19 pandemic. Journal of Urban Design. 2022.

16 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):969-993.

17 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):837-840.

18 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

19 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.

20 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.

21 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.

22 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.

23 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.

24 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.

25 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.

26 Project Drawdown-Walk - Project Drawdown. Climate solutions: Walkable cities.

27 Project Drawdown-Bike - Project Drawdown. Climate solutions: Bicycle infrastructure.

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

29 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.

30 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.

31 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.

32 Yu 2018 - Yu CY, Xu M, Towne SD, Iman S. Assessing the economic benefits and resilience of Complete Streets in Orlando, FL: A natural experimental design approach. Journal of Transport and Health. 2018;8:169-178.

33 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.

34 Vandegrift 2018 - Vandegrift D, Zanoni N. An economic analysis of Complete Streets policies. Landscape and Urban Planning. 2018;171:88-97.

35 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.

36 Peterson 2019 - Peterson EL, Carlson SA, Schmid TL, Brown DR, Galuska DA. Supporting active living through community plans: The association of planning documents with design standards and features. American Journal of Health Promotion. 2019;33(2):191-198.

37 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.

38 Jordan 2021 - Jordan SW, Ivey S. Complete Streets: Promises and proof. Journal of Urban Planning and Development. 2021;147(2):1-10.

39 Porter 2019 - Porter JM, Lee JM, Davis M, et al. Complete Streets state laws & provisions: An analysis of legislative content and the state policy landscape, 1972–2018. Journal of Transport and Land Use. 2019;12(1):619-635.

40 PHLR-Complete Streets - Center for Public Health Law Research (PHLR). New data show few states require specific action for implementation of Complete Streets policies. 2020.

41 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.

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

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

44 HPbD - Healthy Places by Design (HPbD). Advances community-led action and proven, place-based strategies to ensure health and wellbeing for all.

45 ALR-Transportation - Active Living Research (ALR). Promoting activity-friendly communities: Active living resources for transportation.

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

47 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.

48 MN DOT-Phinney 2020 - Phinney R, Fonseca P, Bean N, Zhao J. How do Complete Streets matter for communities? The case of Richfield, Minnesota. St. Paul, MN: Minnesota Department of Transportation (MN DOT), Office of Research and Innovation; 2020.

49 Elliott 2022 - Elliott LD, McLeod K, Bopp M. U.S. Complete Streets initiatives are lacking explicit language surrounding various demographic populations: A call to action. Transport Policy. 2022;123:40-43.

50 McAndrews 2022 - McAndrews C, Schneider RJ, Yang Y, et al. Toward a gender-inclusive Complete Streets movement. Journal of Planning Literature. 2022;38(1):3-18.

51 Hagen 2018 - Hagen JX. Traffic calming and environmental justice: New York City’s neighborhood slow zones. Transportation Research Record. 2018;2672(3):175-184.

52 Slabaugh 2022 - Slabaugh D, Németh J, Rigolon A. Open streets for whom? Journal of the American Planning Association. 2022;88(2):253-261.

53 Prochnow 2022 - Prochnow T, Valdez D, Curran LS, et al. Multifaceted scoping review of Black/African American transportation and land use expert recommendations on activity-friendly routes to everyday destinations. Health Promotion Practice. 2022.

54 Shertzer 2022 - Shertzer A, Twinam T, Walsh RP. Zoning and segregation in urban economic history. Regional Science and Urban Economics. 2022;94:103652.

55 Shertzer 2018 - Shertzer A, Twinam T, Walsh RP. Zoning and the economic geography of cities. Journal of Urban Economics. 2018;105:20-39.

56 NEJAC 2006 - The National Environmental Justice Advisory Council (NEJAC). Unintended impacts of redevelopment and revitalization efforts in five environmental justice communities. 2006.

57 IHH-Urban renewal - The Inclusive Historian’s Handbook (IHH). Urban renewal.

58 Dodds 2017 - Dodds A. For the greater good: A Complete Streets approach can benefit low-income communities. Roads & Bridges. 2017.