Health and the Humble Pavement

Nestled in the Rockies, where five valleys converge, the city of Missoula, in the U.S. state of Montana, was founded as a trading hub. With a population of 74,000 residents, the city has slowly transformed from an economy based on lumber to labour, stemming largely from the university, hospital and tourism.

Like many cities, Missoula is focused on addressing poverty, poor health and a lack of investment.

In 2016 Missoula received a planning grant from the national Invest Health programme, an initiative of the Robert Wood Johnson Foundation and Reinvestment Fund. Invest Health helps transform how city leaders work together to help low-income communities thrive. Special attention is paid to community features that drive better health - such as access to safe and affordable housing, places to play and exercise and quality jobs.

The development and implementation of strategies to improve citizen health, as part of Invest Health, drove an investigation of three neighbourhoods that were amongst the lowest in income and had high incidence of obesity, asthma and mental illness.

The key project principle was to give voice to the residents of the three targeted neighbourhoods. The Missoula Invest Health team undertook both quantitative and qualitative community data collection and analysis, but more needed to be done. Added to the study methodology were neighbourhood walkabouts (or walking focus groups), the collection of qualitative visual materials including photographs taken by participants and an extensive resident survey.

The results indicated that, to varying degrees, residents’ physical and mental health in these neighbourhoods was impacted by a range of factors including limited access to healthy food options, a lack of parks and recreational facilities and scarcity of affordable housing.

There was nothing particularly revealing about these findings. In fact, they were generally consistent with low income communities where there has been low levels of investment. What was significant however, was that the common factor impacting all resident’s lives was the quality and quantity of the pavements.

All three neighbourhoods saw that a lack of ‘sidewalks’ isolated them, limited opportunities to get around, was a hindrance to safe routes to schools and created a barrier to being active.

In response, the City totally reviewed their approach to sidewalks. Repair and maintenance of pavements was no longer prioritised based on the engineer’s recommendation as to what may be technically easier or more cost effective.

Similarly, no longer were funds allocated to pavements in higher income areas because these were the ones that attracted developer contributions. Instead, the City developed a complete sidewalk strategy that filled missing sidewalks based on need, that allocated funding based on health outcomes and that recognised that pavements serve a significant public good.

The lesson from Missoula is that you can't take for granted those metres of humble pavement that connect people from home to school, that create smooth passage from street to shop and connect home to home.

Every step taken along a safe and secure path is a step towards social and physical activity, every block of concrete can lead to better health for those who need it most.

This article is one of a series from the 2018 Walk Bike Place Conference, New Orleans, USA.


Katherine O’Regan, Executive Director

Cities Leadership Institute

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