Wednesday, May 23, 2018

Dear Smart (and Sexy) Traffic Engineer

Dear Smart (and Sexy) Traffic Engineer

Hey there, good lookin’. Do you come here often? Did you hear the bad news? I’m supposed to kill you. No, no, I’m not dropping names and he definitely does not have the twitter handle @JeffSpeckAICP. But here’s a better idea. How about I buy you a drink in hopes that I get lucky (lucky enough to have safe and appealing streets where people enjoy life).

And here’s the thing, smartypants: I know you’re not to blame. Not really.

You’ve been given all the wrong parameters and the phony metrics and the appearance of doing “objective math” on how to move the cars. Everyone else is doing it. What are you supposed to do?

I get it. I’m here for you, I see you here drowning in your sorrows as you try to find a way to deal with the inhumane practices you’ve been told to deploy on poor, unsuspecting cities across the world. There’s a way out, and I can help you (and nobody, and I mean nobody, has to die).

Do you know who can help fix this? Urban Planners.

Tell them they need to give you better parameters to work with. Tell them it all starts with aligning the metrics with broad goals of the city. Tell them they should facilitate REAL conversations with their city’s leadership.
Unless these Planners have, because they’ve probably tried, and they probably wish they were more effective, and they are likely dealing with people who don’t get it -- and maybe nobody from their team has heard of a stroad (the ugly, deadly hybrid of street and road). So help them. Join forces. COL-LAB-OR-ATE! With your powers combined, you could do amazing plan-gineering things. Amazing things like (re)design streets that are loved by local residents and business owners alike. Streets with character and destinations for lively, not deadly, places people love. Sure, you'll still have the naysayers. Those troublesome folks probably say, “My city isn’t Paris” and “here, people are different.” But, if you take a close look at those bipedal humanoids in the City of Not-Paris, I guarantee they have similar walking and biking abilities to those “Paris weirdos.” The difference, undoubtedly, is largely due to whether or not urban design has been applied along a city’s streets to make them appealing, comfortable, and connected. What are you doing for people who deserve appealing streets? Don’t tell me, you have meandering sidewalks that accommodate the drunk pedestrian as they stumble their way to nowhere. I’m not in the mood to be depressed; it makes me homicidal. So, let me ask again: What are you doing now? You, the person who can kick ass and take names with the best of them. The smart (and sexy) Traffic Engineer that you are can be a force for good. A mighty force. Someone who is trained to solve problems with math and physics. Not that fake math crap that the traffic engineering standards would have you believe are a measure of anything worthwhile. You need design parameters that align with the city's goals.

A wise man once said: Pick your winners.

Winners are streets (or redesigned stroads) with the opportunity for Sprawl Repair. Find as many as you can. Recruit help. Build a sense of community while you build your physical community. Acknowledge that solving for free flowing, quick, convenient car travel works cross-purposes for the community life along these streets. Pick your winners, and design streets to beautiful places to hang out, be safe, be comfortable, and be a places that inspire people to love their city. There’s a broad community of doers here who can help.

P.S. I’d hate for some driver to run you over and nobody be held accountable. ¯\_(ツ)_/¯

Image courtesy of NACTO 

Tuesday, February 13, 2018

The Rich "Capture" Transit - a ponzi scheme in the making #Trump #Infrasture #Proposal

If you don't follow the Twitters, you may have missed the trending topic of #infrastructure as of yesterday when posted some guidelines and a legislative framework to make America's infrastructure great again. I went to the source, and at every turn of the Trump Administration's "Building a Stronger America" initiative, there is a common combination of proposals:

  1. Eliminate Regulations (lower expectations)
  2. Reduce Federal proportion of cost-share (states and cities, your allowance is slashed)
  3. Solicit Private Investors (cash-strapped state and local governments will have little choice)
  4. Promote Profiteering (exploit of all resources)
All types of infrastructure share in the agressive shift of goals from serving the public interest to returns on investments. The topics range from water infrastructure, to access roads to public lands for resource extraction, to transportation (among others). Every type of infrastructure on the list, based on my review, all elements achieve the magic combination above.

Trump's proposal may not pass, but there are enough scary concepts that should be blocked before they become enacted by legislation. The bad ideas, taken one at a time, can be misleadingly tame in their quantity of terribility. Taken together, they're terribly terrible. The compounding terribility is akin to the compounding of the words: (1)Trump, (2) talking, (3) with women, (4) grabbing, and (5) grabbing by... nevermind. This demonstrates the wrong combination of things make the terrible, terrifying.

How does this relate to the much talked about #Infrastructure plan?

So let me explain how the wrong combination of proposals, bad city fiscal statuses, and desperation of cities can result in local governments being robbed by the wealthy investor class and savvy developer (legally, of course).

Potentially good ideas by themselves: 
  1. Cities using value capture to sustain the revenues necessary to operate and maintain a first-class transit service
  2. Cities made to focus on generating a return on investments; not offer miserable transit that's federally subsidized
  3. Public-Private Partnerships (PPPs)
The Federal cost-share allocated to the cities in years prior have not always been used effectively. I point to the good work at Strong Towns to illustrate the arguments that liabilities of our over-built, under-utilized, poorly maintained roads, highways, interstates, bridges, and tunnels add up to a bunch of places that have a frightening fiscal future ahead of them as a lot of bills are coming due. Many at the same time.

What cities have been able to do effectively with a Federal project funds is to use it as leverage in bringing needed resources to the negotiations of PPPs. Transit stations could be (and have been) designed with space that offers leased space (maybe managed by and profitable to private firms operating within) that offered a return to the city. This is an example of value capture. Value capture studies record these returns at 6.5% to 7%, even in American cities where value capture is rare and not pursued aggressively (as it is in Hong Kong or Tokyo).

My expectation is, without those Federal project funds, cities will have far less leverage in the negotiations of PPPs. Instead, cash-strapped cities will compete over a limited supply of capable investors (compounded by the preserved lending power left over from quantitative easing policies). In the mismatched supply and demand, cities with desperate needs will be forced to take desperate measures with little guidance for best practices in how to navigate the new terrain of private funding and managing the new federally mandated value capture aspect to the project.

And with the private sector stepping in and financing the major share of these infrastructure projects, would they not be best suited to be first in line for the value captured from these brand new projects? As a mortgage holder, I know that my payments are meant to slowly benefit the principal owed. Would the financiers not treat cities similarly? Would the value capture rate not first benefit the investors? Will the private parties defer maintenance so that by the time the city starts to get a cut on the value capture that those returns will be eaten up on additional costs associated with older equipment and infrastructure? With a profit motive, is there not opportunity to see value capture models get aggressive?

Some of these ideas (i.e. value capture) work well on their own, but in conjunction with the rest of the conditions, I have serious concerns that the trillions of dollars worth of work that is needed across the country will be inequitable, insufficient, and parasitic results due to the ideological (not empirical) motivations to punish all forms of government, who supposedly does not contribute to wealth (according to the right-wing libertarian basic talking points), and continue the long played game of privatizing the profits and socializing the liabilities.

I hope I am wrong.

I also hope that if I am right that we move beyond the question of how much to spend, and talk about how it is spent.

Thursday, October 6, 2016

Even the President is Paying Attention

The Whitehouse put out a report (Sept. 2016) that identifies a number of leverage points where local governments could take a good hard look at their regulations. Here's the list:

  • Establishing by-right development  
  • Taxing vacant land or donate it to non-profit developers  
  • Streamlining or shortening permitting processes and timelines  
  • Eliminate off-street parking requirements  
  • Allowing accessory dwelling units 
  • Establishing density bonuses  
  • Enacting high-density and multifamily zoning  
  • Employing inclusionary zoning  
  • Establishing development tax or value capture incentives  
  • Using property tax abatements
The list is pretty good. Although, it should come with a caveat: The message is targeting urban areas with at least one transit corridor and a healthy land value to match. These healthy land values tend to inspire strategic investments by the developers to capture the value that already exists and has a momentum of growth and social allure (think the most sought after parts of Seattle, Portland, San Fran, NYC, Washington DC, or San Diego). The difference in suburbia there is still the need to evolve (at least in identified opportunity areas), and therefore the suburbs need to partner with developers who are trying to build equity in the long run, being strategic with the roll-out of the investment, carefully staging the phasing of a development to adapt with the evolving landscape.

I'll break down the urban vs. suburban context and how these strategies need to take careful consideration of the context prior to implementing the toolkit. This will also serve as the start of the barriers to sustainable development, as there is a lot of overlap between that and the toolkit here. But, importantly, there are also important differences as I see them.

Tuesday, October 4, 2016

Reset Button

Many new products that come to market can be purchased, tried, and then the purchaser can decide whether to keep it or put it on Craigslist. An entire newly designed and built community does not quite work like that. Once you build it, there's no listing it on Craigslist for another city to come and take it out of your city. You can redesign it, but that is no small task. There's no good RESET BUTTON for the massive abundance of suburbia U.S. cities have built over the years. But if there were a RESET BUTTON, apparently a growing majority of Americans would push it and give up their big suburban home IF they could live in a walkable urban neighborhood. I've seen statistics as high as 81% of Americans would do this!

I do not know if I believe 81%, but it is perfectly reasonable to believe that this applies to a majority. And demand for walkable neighborhoods is on the rise!

In a short series of blogs, I want to outline some of the obstacles to walkable urban development and the alternatives that promote great, wonderful, opportunity-rich neighborhoods, communities and cities.

Wednesday, September 14, 2016

1980 - 2010, Low-Density Continues to Dominate the American Landscape

If you're like me...

you see that suburban America comes with a giant pile of problems we haven't even begun to really quantify, fully understand, or even remotely pay the cost of yet. And it is frustrating we really haven't shifted the growth model much in response to this growing call to action (well, at least those in the industry hear the call, I don't know about the general house hunter).

Suburban problems...What am I talking about? Here's a short list:

  • Air + water pollution from additional reliance on single-occupancy automotive transportation and the massive amounts of carbon fuel used to power the 1.2 billion cars (and growing) on the road
  • Expensive infrastructure that hasn't paid for its own growth + maintenance in the long-run
  • Suburbia is a tax burden to the urban economic engines of the country
  • Uses more energy, water, resources that, unless technology can save us, is not consumed at rates of sustainable yield
  • Suburban poverty is more difficult to manage and connect people to the social services they desperately need
  • Health impacts adding inches to our waists and numerous other disease-associated factors
  • Social isolation
  • Loss of natural habitats and ecosystem services
  • Loss of fertile farmland

A better alternative?

Urban environments are not without their own challenges of negative inflictions on our personal and ecological health, but they are measurably more sustainable from either a financial, environmental, and /or social perspective. Should they be forced upon everyone? No (and do yourself a favor and not listen to crazy talk that the Government is going to make you in accordance to the UN's Agenda 21).

And then there are those who do low-density responsibly. There are those who have a low-impact lifestyle in the countryside who garden, live locally, and make the most of their land in an ecologically responsible way. Bravo to them.

Most of us need a reality check. 

We at least owe it to the future generation to have a healthy, collaborative, sustainable lifestyle alternative to the human environment we seem to keep mass-producing for decades. The attached image demonstrates just how large of a tide we're up against. Even if you don't want to give up this suburban lifestyle (which is likely the only lifestyle you've ever really known), you owe it to your city to become a supporter of your downtown to grow into a densified, attractive, car-optional, pedestrian-oriented, bike-embracing, sufficient-minded, creative, compact, healthy, connected, energy- and water-efficient, tax-surplus oasis with a promising future.

Entry inspired by: Richard Florida's article in CityLab (9/14/16)...
The Difficulties of Density

Thursday, April 18, 2013

Designed to Fail the Small Scale

Suburbia has an image to uphold.  The sales pitch offers things like ownership, pride, space, safety, quiet, clean, and friendly neighbors.  With that space, people preserving their own space, and preserving a feeling of openness comes a great dependence on a machine to travel those distances at fast speeds and modern comforts required of a seat you'll spend many years of your life in.  Unfortunately, that machine we've chosen (the car/truck/SUV) is big, inefficient, takes up that open space, pollutes, makes noise, creates a danger to kids walking to school (so notice the suburban sales pitch falls a little short of all the hype) and completely disrupts efficiencies in spatial economics so that retail or other business can work at the human scale.  The car takes up space all the time and requires a driveway, garage, parking lots, road lanes, highway lanes, and maybe even off-road lanes.  It's not impossible, but given the choices and preference shifts that come with this space-hungry environment, pedestrians and those competing for a chance at providing something at a smaller scale have immense challenges.

The latest victim of the suburban (sub)economy: Fresh & Easy Neighborhood Markets who are being abandoned by their English owners, Tesco.  Tesco Express (of the U.K.) and Fresh & Easy (of the U.S.) are both small convenience-oriented grocers that offered ready-to-go lunches and prioritized freshness and healthy selections -- the difference being that Tesco Express's are profitable and Fresh & Easy's aren't... $1.8 billion (₤1 billion) loss reported for the U.S. chain.  All the details in reports about the closing of Tesco's American experiment have focused on the same boring simplified line of "not understanding American culture."  The listed mismanagements claim that Tesco didn't understand American preferences along the lines of flavors, selection, pricing, coupons, etc.  I challenge this narrative as being far too limited (and bogus, mostly).

Here's the rest of the story: 

In one simple graphic I've collected views of Tesco's stores in the U.K. (left column) versus views of the Fresh & Easy stores of California, Nevada, and Arizona (right column).

These images were all captured by using Google Map's street view (one of planner's favorite tools for quickly exploring urban geography - Google Earth helps too with topography).  While I did my best to select from a variety of cities throughout England, the scenes all looked very similar (except for the maybe last one from Rugby).  In the collection of American views, I always tried to select stores located near the urban core of respected locations, if available (from top to bottom: San Francisco, CA; Los Angeles, CA; Sacramento, CA; Sunrise Manor, NV; Phoenix, AZ).

Here are some themes that contrast the U.S. from our neighbors across the pond:

The following are the physical (built environment) conditions that shops like Fresh & Easy and Tesco Express often depend upon just to have the potential to thrive.

1. Mixed Use

In EVERY case from the U.K. the store is part of a building that serves as more than a store.  With offices or housing above the store, every store is sure to have potential customers mere feet (or, since this is the U.K., meters) away.  In EVERY pictured F&E in America, this is NOT the case.  Instead, they have nice elegant architecture, but are part of retail-only shopping centers or stand-alone buildings. Engineering our built environment comes with a responsibility of monitoring how it PERFORMS (not just its aesthetics).

2. Storefront to the public (and doors at the sidewalk)

While there is very little architectural interest in these U.K. storefronts (simple awnings, glass sheet windows) they FUNCTION for the benefit of attracting customers.  There are whole blocks of buildings and destinations that align to this same standard.  The multiple destinations, complemented with street parking, shade trees, narrow roads and wide sidewalks prioritize the needs of the pedestrian.  People have a perfectly good rationale for choosing to ditch a car and take a trip by foot instead.  And even if U.K. customers do drive, the destination will likely be closer since they will pass a series of properties WITHOUT wasted space along the drive.

You might expect maybe you could find this pedestrian-friendliness in the most urban settings Fresh & Easy can be found in, so I offer in the top-right corner a store in San Francisco. While there are electric cables for transit above the road and street parking (unlike the other U.S. scenes), remaining are barriers to the pedestrian to reach the doors of the store.  Notice the knee wall at the outer edge of the parking lot in front of the store.  This knee wall makes sense, because headlights should be shielded from the road when these cars are only parking.  HOWEVER, it's symbolic of how the prioritizing of the car once again disrupts the experience of the pedestrian in a series of ways.

This is something that is SLOWLY changing in the U.S.

Yet, for the most part, buildings being built across the U.S. are required to be "setback" from property lines in American cities.  Typically, the only time municipalities will allow a new building to be built to the property line that shares the public space is where a special zoning code is applied called Form-Based Codes.  I warn you however, in a majority of our (sub)urban space, these codes are thought FAR too progressive by local council members.  Many residents remain low-intensity advocates making a fuss over the need for generous setbacks, two-story building height limits and require ample parking lots.

3. Complete Streets, not Urban Highways

When a street exceeds 5 lanes (2 in either direction with a shared turn lane), it starts to take on a feel that it is engineered to move people through, rather than explore, shop, or be a part of your life.  The destinations go unappreciated as cars zoom by at 45 MPH.  That is not a street that a range of activity can feel comfortable on.  The faster people move through it, the less FUNCTIONAL it becomes for achieving what cities were meant to achieve in the first place (hint: it's not to serve as a highway).

It's also more than about the number of lanes and the speed of traffic.  Those only deter a variety of users.  The next step is to move beyond that and find assets for cyclists and pedestrians, such as convenient, safe crosswalks, street trees, benches, flowers, shade, wide sidewalks, variety of destinations within the same mile walk, protected bike lanes, bike racks, street parking, and proper lighting for the nightlife.

And these are just the top three physical planning attributes that go unappreciated by the mainstream analysis in the discussion of why Fresh & Easy failed.  Until we recognize the ways our urban design depresses the spatial elements of our economy, we'll never be asking the right questions or pursuing the right solutions.  If you agree, you have a responsibility to voice this concern to your local council member.  Tell them briefly that you support (1) mixed use development, (2) form-based codes, and (3) complete streets.

Still not convinced?  Let's explore how the lack of these elements within our productive community cores can affect behavior.

1a. Lack of Mixed Use

This has to do with pooling enough discretionary income and variety of culture to develop a market of consumers, producers, and influencers.  I'm talking about more than the simple expendable commodities that make it to the landfill like your phone in a year.  With urban cores that support a creative class comes music, performance, culinary experiences, groceries, social and political movements, books, drinks, dance floors, sports, etc.  These happen best when we're not all competing to buy more space to spread ourselves out and remain in our walled off back yards.  This requires collaborative space and social mingling in common areas of our lives (and gridlock on your expressway doesn't count -- we're not collaborating then, we're competing to get away from each other).  

What does this have to do with Fresh & Easy (or any small business whose business model requires frequent small transactions with customers)?  When we make a trip in our car (which is something few of us look forward to doing), we have a tendency to want to "stock up" and we also need a place to store such stocked items (in transport and in our home).  This behavioral motive helps people determine the need for an SUV or large trunk and then a super-size pantry.  These concepts counter the business model of most small businesses that cannot afford a store with a mega footprint to offer customers everything in the world at bulk rates.  And, by the way, not EVERYONE has to live in these mixed use buildings, but the mixed use environment needs to be offered in pockets of our city centers at the least to achieve urban economies that FUNCTION.

2a. Lack of Proper Urban Form (Form-Based Codes)

Space is formed with interior rooms and exterior rooms. Space between a building and street trees, building and curb, awning and sidewalk... these are all exterior spaces that create outdoor rooms.  We've done alright with interior rooms in America.  We have far less of a portfolio with exterior spaces that rival the plazas of Italy, for example.

Here's an analogy:  Without a proper meeting space, a company lacks a place for round table discussions and decisions.  Without proper spaces in the public, quasi-public, quasi-private, and private realms, there are many functions of our social and economic lives that lack the appropriate space to function well.

England has inherited an urban form that functions in a way that serves the human scale.  It wasn't built with codes and compliance measures that offered priority to people's personal automobile.  The western states Fresh & Easy ventured into didn't have that pedestrian history.  Urban design has transferred much of its residents' proximity concerns to minimum parking space requirements, large landscape tracts between the parking and the street, and the aggregation of a lot of personal space (big suburban lots) that stands in the way between resident and destination.  With the average stride length of 2.6 feet and only walking 2.8 - 3.5 MPH, distance from door to door means a lot more in effort and time to the pedestrian than the motorist (and even motorists are pedestrians when they get out of their car!).

3a. Lack of Complete Streets

As a species, we've only been getting around by car for a handful of decades.  For thousands of years, cities functioned without large, ultrafast motorized traffic.  Since the invention and the general acquisition of the automobile, cities have spread across more land, cutting more trees, requiring more fossil fuels, more pavement, more stone, more lumber, more water, and it has added up quickly to produce a collective conundrum.  

Our individual preferences (or compromised preferences based on a balance of options and needs) have not prioritized/optimized our spatial outcomes as a society.  This means that in order to manage space, we've offered more lanes of traffic on expressways, which have only encouraged people to move farther from their jobs and acquire more personal space in newer suburbs.  The whole transportation system requires incentives to encourage different behavior from commuters, shoppers, students, wanderers, tourists, ect.  Complete Streets offer an alternative that returns balance to the priorities in our multimodal era of travel.  Without countering the automotive dominance (and dependence), we'll constantly be undermining the Main Street developments that have always served as the home for small, local business(wo)men who could depend on a consistent and well developed market of local residents.  It is home to the hot dog stand, the specialized hardware store, and the small convenience store all with CEOs who lived in your neighborhood and shared in the successes or failures of your community.

Implementing Complete Streets challenges the Big Box stores and the way they function/retain market share.  Big Box retailers have successfully altered the buying habits of the suburban American to buying in bulk with over-sized carts, transferred to over-sized trunks, to over-sized pantries, with overly-processed foods and even leading to oversized meals and caloric intakes (to some extent).  Complete Streets offers the alternative of buying in smaller quantities, as you need, and you carry home what you can... allowing you to buy fresh ingredients.  This will require time used to watch TV, time to perhaps interact with your fellow community members more, and steps that burn those extra calories your Big Box gym has convinced you only they can solve.

Saturday, March 9, 2013

Planning "solutions" to Bitter Pill by Steven Brill

If you haven't read Steven Brill's Time cover story that made all sorts of news these past weeks, you should check it out for yourself.  If you don't have 2-3 hours to devote to reading all 24,000+ words that will make your blood boil, let's see if I can quickly summarize it for you:
Brill brilliantly asks the question, not who should pay for medical bills, but instead, why are health care costs so high?  He takes a mix of experiences had by people who all have encountered bills that break the bank.  Two starkly different scenarios are a guy with cancer and another person who is rushed to the ER after falling.  The common thread is the unsubstantiated price of service trapping the unwilling buyer now stuck with a bill that offers little transparency or accountability.  This is a pricing luxury not shared by many sectors of the economy where most industries have sacrificed and are doing more with less.  It's as if the medical industry exists in another economy.  Hospitals across the country, whether not-for-profit or for-profit, are recording huge surpluses of cash off the backs of small insurance providers/customers and those without insurance -- only Medicare, the largest buyer of health care, seems to pay prices based off of what the care actually costs to provide.  Brill mentions CEOs of not-for-profit hospitals who make over a million dollars a year.  This compensation, Brill mentions, can easily be rationalized for running complex hospitals that save untold numbers of lives.  But he scoffs at the fact that any hospital can charge $77 for a gauze pad (one of many exorbitant prices for simple medical supplies) or thousands of dollars for one treatment of a cancer super drug that sells in other countries (with the use of price controls on these monopolized/patented drugs) for less than half the cost paid by his example of the cancer patient.  Even in countries with price controls on these monopolized life-saving drugs, companies are still happy to operate profitably.  In other articles I've read about drug price controls, it's understood that the patent protecting new drugs is a monopoly power that ought to be checked by regulators. If these prices aren't checked, who else is left to keep the prices from reaching the point where greed costs lives?
In a nut shell, Brill highlights the unique power that Medicare has with negotiating realistic prices and thinks highly of its powers to save us in the real economy from being abused by the monopolistic powers found in all parts of the health care industry (ambulance, hospitals, drug companies, machinery, ect.).  He argues that more could be done if Medicare wasn't "handcuffed" by Congress from negotiating on tests and other things.  And thanks to the test loophole, tests maybe ran more frequently than necessary (but why leave expensive machinery sitting around unused when it could be utilized and pay for itself?).
Other fine responses to Brill's work (but none from a planning perspective): here here here here and here

After reading Bitter Pill, and reading responses by various authors, and hearing Brill's interviews -  I was convinced that the solution to affordable health care is going to be a multifaceted one.  So the question for planners is, what can planning/zoning/urban design contribute?  What can land use do to help relieve this monopoly power that regional hospitals have?  Here I raise more questions than answers (but I try to interpret what some planning concepts will mean for our health care costs).

Part of the problem, as Brill points out, is that health care consumers are coerced customers that are buying before they know the price by simply taking their doctors advice.  Many times, in an emergency situation, the hurt are at the mercy of responsive care and are then bound to pay the bills at the end.  The lack of transparency and choice makes for a natural monopoly.

Here's an untested idea: what if planning policy encouraged regional hospitals to be less concentrated and more geographically dispersed?  This would allow the physical breaking up the monopolies (competitors who wouldn't have to share the same space) to be more practical and/or give greater accessibility to health care facilities to everyone (from a proximity perspective).  There may be drawbacks to this concept, such as a loss of efficiency with breaking up the regional hospital or the monopoly power - perhaps price controls are a better option and leave monopolies alone (maybe).

What solutions are there in EMS routing and making travel more responsive, safer, and faster?  I know they use traffic signal overrides currently, but maybe there's more that can be done.

Are there impacts from our other land uses?  Is suburban sprawl (or density) increasing the cost per capita for health care?  Would more mixed use offer any benefit, cause complications, or have no effect?  What are the effects of road diets?

Perhaps active transport and space for active recreation need to be prioritized according to health impact assessments.  I know there is a lot of recent research in this area, what are the payoffs?  What specific health care services will likely increase/decrease if active communities become standard?

What can local produce and urban gardening do for people's nutritional health?  How might that influence the demand for certain health care services?

How many ER cases are the result of car accidents?  What advancements in transportation will effect the costs to people from ER bills?  It is suspected that computer driven cars will be safer.  How much money will such car technology save us in lives and in ER bills?