Health by Design

Hea lt h by

Design

A REGIONAL PLAN FOR ACTIVE LIVING INFRASTRUCTURE

FOR NORTHWEST NORTH CAROLINA

Northwest Partnership for Public Health Region 3 - A Regional Collaboration of Local Public Health Departments Alleghany

Ashe

Davidson

Davie

For syth

Stokes

Sur r y

Watauga

Wilkes

Yadkin

Prepared For: Northwest Partnership for Public Health & Community Transformation Grant Project

Prepared By:

Acknowledgements Community Transformation Grant Region 3 Staff and Core Team Suzanne Wright, Lead Health Director Beth Fornadley, Lead Coordinator Tyler Jenkins, Urban Coordinator Melissa Bracey, Communications Lead Rachel Miller, Healthy Eating/ Active Living Lead Cindy Douglas, Fiscal Lead Donna Parks Hill, Tobacco-Free Living Lead Debbie Mason, Health Policy Unit Director, Forsyth Co. Dept. of Public Health Jennifer Greene, Director of Allied Health Services

Region 3 Health Directors and Staff Appalachian District Health Department (Alleghany, Ashe, and Watauga Counties) Beth Lovette, Health Director Jennifer Greene, Director of Allied Health Services Davidson County Health Department Monecia Thomas, Health Director Jen Hames, Health Education Supervisor Davie County Health Department Suzanne Wright, Health Director Brandi Patti, Health Educator Forsyth County Department of Public Health Marlon Hunter, Health Director Lynne Mitchell, Preventive Health Services Director Debbie Mason, Health Policy Unit Director

Stokes County Health Department and Family Health Center Scott Lenhart, Health Director Chelsea Bullins, Health Educator Surry County Health and Nutrition Center Samantha Ange, Health Director Jeanna Read, Assistant Health Director Maggie Simmons, Public Health Education Specialist Wilkes County Health Department Ann Absher, Health Director Amanda Stamper, Health Promotion Coordinator Jared Belk, Health Educator Yadkin County Department of Human Services Kim Harrell, Director Jessica Wall, Assistant to the Director

Local Government and Community Leaders The following local government and community leaders were interviewed throughout the development of this plan and are listed below in alphabetical order.

Alleghany County Alleghany Wellness Center Staff and Board of Directors Don Adams, Manager, Alleghany County Kevin Dowell, Planner, Town of Sparta Bryan Edwards, Manager, Town of Sparta Jane Wyatt, Project Manager, Town of Sparta Ashe County Hannah Abee, Project Champion, Beaver Creek Wellness Matthew Levi, Planner, West Jefferson Pat Mitchell, County Manager/ Economic Developer, Ashe County Ann Rose, Project Manager, Greater Lansing Area Development Scott Turnmyre, Recreation Director, Ashe County Davidson County Alan Carson, City Manager, City of Lexington Guy Cornman, Planning Director, Davidson County Kelly Craver, City Manager, City of Thomasville Robert Hyatt, Manager, Davidson County Jeanne Johnston, Business and Community Development Coordinator, City of Lexington Scott Leonard, Senior Planner, Davidson County Vickie McKiver, Recreation Director, City of Thomasville Charles Parnell, Recreation Director, Davidson County Davie County Beth Dirks, County Manager, Davie County

Forsyth County Matthew Burczyk, Bicycle and Pedestrian Coordinator, City of Winston-Salem Marylin Moniquette-John, Project Planner, City of Winston-Salem Paul Norby, Planning Director, City of Winston-Salem Stokes County David Suddreth, Planning Director, Stokes County Alan Wood, Director of Economic Development, Stokes County Surry County Catrina Alexander, Director of Parks and Recreation, Mount Airy Bill Blackley, Chair, Elkin Valley Trails Association Denise Lyon, Elkin Valley Trails Association Adam McComb, Recreation Director, Town of Elkin Josh Smith, Town Manager, Town of Dobson Daniel White, Recreation Director, Surry County Watauga County Joe Furman, Planning and Economic Director, Watauga County Deron Geouque, County Manager, Watauga County Eric Gustaveson, Maintenance Supervisor, Town of Boone John Lanman, High Country Pathways, Inc. Stephen Poulos, Recreation Director, Watauga County Wilkes County Eddie Barnes, Planning Director, Wilkes County Andrew Carlton, Director of Planning and Community Development, Town of Wilkesboro Jodi Frichner, Director, Wilkesboro Tourism Development Authority Joshua Harrold, Planning Director, Town of North Wilkesboro Yadkin County Aaron Church, County Manger, Yadkin County Paul Lowe, Director of Economic Development, Town of Yadkinville Christopher Ong, Town Manager, Town of Yadkinville Jason Walker, Recreation Director Yadkin County

5

Table of Contents INTRODUCTION

Planning Purpose & Goals 2

Organization of The Plan 3 Planning Process 4 CHAPTER 1: CHRONIC DISEASE AND THE NEED FOR ACTIVE LIVING INFRASTRUCTURE

The Situation and Its Consequences 8

The Need for Active Living Infrastructure 10 A Call for Collaboration 11

CHAPTER 3. PRIORITY INITIATIVES FOR AN ACTIVE LIVING ENVIRONMENT

Priority Initiatives Overview & Matrix

Category I Priority Initiatives

Category II Priority Initiatives

39 42-57 58-73

CHAPTER 4. ACTIVE LIVING DESIGN GUIDELINES Downtowns 77 Parks & Playgrounds 80

Suburban Workplace Campuses 82

Active Transportation in Rural Areas 83 Rural Roads 84

CHAPTER 2. DISCOVERY: STUDY AREA PROFILE

Political Jurisdictions and Assets 15 CHAPTER 5. STRATEGIC DIRECTION Natural Resources 15

Strategies & Action Steps 88 River Basins 17 Regional Trails 17 REFERENCES 93

A Regional Perspective of Public Health 19

A Relative Assessment of the Region 19

Social Determinants of Health 19 Community Risk Factors 20 Health Risk Outcomes 21

The Total Health Model Map 22

Health Overview by County 24-34

7

H E A LT H B Y D E S I G N : R E G I O N 3 P L A N F A C T S H E E T A Community Transformation Grant Project

Background Hea lt h

Local health department regions throughout North Carolina have been awarded multi-year Community Transformation Grant Project (CTG Project) funding through the NC Division of Public Health. Priority areas for this project include active living, healthy eating, and tobacco-free living. The Health by Design planning initiative addresses the “active living� element of the CTG Project.

Consultant

by

Design

To complete this planning initiative, CTG Project has retained Destination

by Design, an economic development, planning and promotions firm that assists communities working to enhance quality of life as a means of creating greater economic opportunity and healthier living.

The Plan

Health by Design is a 15-year master plan identifying key projects, or Priority Initiatives, that both improve the built-environment and positively impact public health. This plan will guide regional health professionals, during the life of CTG Project and for many years to come, as they assist their communities to develop infrastructure that supports active living. CTG Project funds are available to provide specific planning or engineering assistance for these efforts within the next three years.

Dest

Dest

The immediate goal of Health by Design will be to provide focus for NW region health leaders working to determine how best to allocate remaining CTG Project grant funds for 2014 - 16.

Discovery

Because partnerships and momentum are critical for implementing built-environment projects, this plan will highlight initiatives that are underway, planned for, or supported by not only regional public health leaders, but also other local leaders, such as municipal/county managers, planners, economic development professionals, and recreation directors. A significant part of this planning process will involve interviewing these leaders to determine Priority Initiatives.

Local Health Leaders make a plan during the Health by Design planning workshop.

The Health by Design Plan Fact Sheet was developed to introduce the project to local planners, elected officials and other community members.

TRAILS

SIDEWALKS

GREENWAYS

Priority Initiatives

Priority Initiatives include, but are not limited to, trails, sidewalks, greenways, downtown improvements, public parks, mixed-use developments, or other specific planning projects. Each county within Region 3 will be provided design schematics that conceptually illustrate particular Priority Initiatives identified within their county.

Consultant Contact Local Contact Eric Woolridge, AICP eric@dbdplanning.com Destination byDesign 828.719.1109 Destination byDesign

DOWNTOWNS

PUBLIC PARKS

MIXED USE

Prioritization

In addition to projects that impact public health, CTG Project leaders and regional public health professionals are particularly interested in projects that are outlined within other plans and demonstrate momentum for implementation. CTG Project leaders are also interested in whether communities exhibit the financial and human resource capacity necessary for implementation.

Vicinity Map: Health

by Design Study Area Vicinity Map: Health

by Design Study Area

[Insert county contact] A project of the Northwest Partnership for Public Health

Introduction In 2010 the US Centers for Disease Control and Prevention (CDC) awarded North Carolina a Community Transformation Grant (CTG) through the Affordable Care Act’s Prevention and Public Health Fund. The focus of the CTG Project is to “create healthier communities by making healthy living easier and more affordable where people work, live, learn, and play” (Centers for Disease Control and Prevention, 2009).

The five year, $7,446,092 grant is being administered by the North Carolina Division of Public Health, which divided grant funds among the ten regions of the NC Association of Local Health Directors. Each region, including their respective Health Directors, is responsible for determining priorities and allocating resources to address the four CTG Project priority focus areas: 1) tobacco-free living, 2) healthy eating, 3) clinical and preventative services, and 4) active living.

This plan - Health by Design - was developed by Region 3 Health Directors to address the CTG Project strategy for active living.

Region 3 includes North Carolina’s northwest counties of Alleghany, Ashe, Davidson, Davie, Forsyth, Stokes, Surry, Watauga, Wilkes and Yadkin. These 10 counties represent the Health by Design planning study area.

of Regions: Association of of Local MapMap of Regions: NCNCAssociation LocalHealth HealthDirectors Directors

The Health by Design plan study area includes North Carolina’s 10 northwestern counties, referred to as Region 3 by the NC Association of Local Health Directors.

1

Planning Purpose & Goals

Because partnerships and momentum are critical for implementing built-environment projects, this plan aims to highlight initiatives that are underway, planned for, or supported by not only regional public health leaders, but also other local leaders, such as municipal/county managers, planners, economic development professionals, and recreation directors.

1.

Provide health professionals from Region 3 with a greater understanding of processes and techniques for creating built-environment change.

2.

Strengthen relationships among local health professionals and other local government leaders working to create active living opportunities by improving the built environment.

3.

Identify specific built environment projects throughout Region 3 that can both increase active living opportunities and maintain a high likelihood for implementation.

4.

Develop general evidence-based guidelines and recommendations for how communities can increase active living opportunities.

5.

6.

7.

Hea lt h

Goals:

2

Health by Design is a 15-year master plan identifying key projects, or Priority Initiatives, that both improve the built-environment and positively impact public health. This plan will guide regional health professionals, during the life of the Community Transformation Grant Project and for years to come, as they assist their communities to develop infrastructure that supports active living.

by

Create a resource for non-health professionals (ie. planners, managers, recreation professionals, etc.) to understand the current state of health throughout the country, state, and region.

Design

Create a tool to enable regional leaders to communicate funding needs to private and public grant-making authorities.

Create a document that can be easily modified and updated as new priorities and projects are identified.

Organization of The Plan 1. The Need for Active Living Infrastructure 2. Discovery: A profile of REgion 3 3. Regional Priority Initiatives 4. Active Living Design Guidelines 5. Strategic Direction

This plan is organized according to five (5) subsequent chapters: 1) Chronic Disease and the Need for Active Living Infrastructure, 2) Study Area Profile, 3) Regional Priority Initiatives, 4) Active Living Guidelines, and 5) Strategic Direction.

Chapter 1. Chronic Disease and the Need for Active Living Infrastructure This chapter establishes the foundation and need for the overall Community Transformation Grant Project initiative and the Health by Design Plan. This section explores the public health and financial impact of chronic disease, obesity, and sedentary life. Communities must become more proactive in creating safe and accessible opportunities for the general public to incorporate active living within daily life.

Chapter 2. Discovery: Study Area Profile This chapter explores the physical geography and status of human health throughout the 10-county region.

The region’s geography, including its political jurisdictions, public lands, rivers, and regional trails systems serve as a backbone for understanding the key ingredients for improving the built environment. With an in-depth look at the region’s health condition, local health leaders can prioritize their efforts to make the greatest impact in areas with the most dire health challenges. This chapter provides a foundation for understanding the impact of Priority Initiatives identified in the subsequent chapter.

Chapter 3. Priority Initiatives for an Active Living Environment This chapter is the mainstay of the Health by Design Plan, providing an overview of specific projects, or Priority Initiatives, that can create new active living opportunities throughout the region. Consensus was developed for these initiatives between both public health and community leaders. These specific initiatives provide a roadmap for Region 3 Health Directors as they work to improve the built environment in coming years.

Chapter 4. Active Living Design Guidelines Whereas the previous chapter outlined specific initiatives, this chapter serves as a general guide for local government, community, and public health leaders working to create new active living opportunities. If employed, these best practices and proven methods can help get the citizens of Region 3 moving in new ways.

Chapter 5. Strategic Direction This chapter outlines goals and strategies for advancing the Priority Initiatives, Active Living Guidelines, and other recommendations identified within this plan.

3

Planning Process The Health by Design planning process is comprised of the seven following major tasks.

4

Project Kick-off. The Consultant and CTG Project Core Team finalized planning goals, developed target dates for planning milestones and developed the plan fact sheet and brand. The Health by Design planning process and scope was presented in Wilkesboro, NC at a public meeting where many regional leaders were in attendance.

Health by Design: The Workshop. The Consultant provided an intensive, day-long workshop to educate regional health leaders about plan development and implementation techniques, particularly as they relate to the built-environment and active living.

Research and Asset Inventory. The Consultant developed a literature review focusing on the connections between planning, public health, and active living. A GIS database was created including demographic, health, political boundaries, and regional asset data. The Consultant obtained existing local government plans pertaining to active living and the built environment.

Making the Connection: Local Government Interviews. The Consultant team and local health professionals interviewed local government managers, planners, recreation professionals, and community leaders to discuss current and planned efforts to create new active living opportunities within their community. The goal of each interview was to determine Priority Initiatives to be considered for possible CTG Project funding support.

Determine and Assess Active Living Priority Initiatives. Local government and community leaders submitted their Priority Initiatives via an online form, making said project eligible for funding support. The Consultant Team and local health leaders followed up with a site visit to assess the Priority Initiatives submitted.

Plan Development. The Consultant team analyzed the Priority Initiatives within the regional context and worked with local health leaders to develop a matrix for prioritizing projects. A presentation is made to Region 3 Health Directors and core staff on June 7, 2013, providing an overview of the Health by Design plan and recommendations. A preliminary report was also provided.

Final Plan and Adoption. The Consultant team and regional health leaders released the draft Health by Design plan and provided a public presentation of the plan and its findings on June 28, 2013. The 10-county Health Directors adopted the plan in July 2013.

The Health by Design planning process serves as a unique approach for addressing the Community Transformation Grant Project’s Active Living Strategy; the region’s local health directors sought to develop a unified plan.

A Community Transformation Grant Project

Background Hea lt h

Consultant

by

Design

To complete this planning initiative, CTG has retained Destination by Design, an economic development, planning and promotions firm that assists communities working to enhance quality of life as a means of creating greater economic opportunity and healthier living.

The Plan

Health by Design is a 15-year master plan identifying key projects, or Priority Initiatives, that both improve the built-environment and positively impact public health. This plan will guide regional health professionals, during the life of CTG and for many years to come, as they assist their communities to develop infrastructure that supports active living. CTG funds are available to provide specific planning or engineering assistance for these efforts within the next three years.

Destination byDesign Destination byDesign

The immediate goal of Health by Design will be to provide focus for NW region health leaders working to determine how best to allocate remainging CTG grant funds for 2014 - 16.

Discovery

Because partnerships and momentum are critical for implementing built-environment projects, this plan will highlight initiatives that are underway, planned for, or supported by not only regional public health leaders, but also other local leaders, such as municipal/county managers, planners, economic development professionals, and recreation directors. A significant part of this planning process will involve interviewing these leaders to determine Priority Initiatives.

TRAILS

SIDEWALKS

GREENWAYS

Priority Initiatives

Priority Initiatives include, but are not limited to, trails, sidewalks, greenways, downtown improvements, public parks, mixed-use developments, or other specific planning projects. Each county within Region 3 will be provided design schematics that conceptually illustrate particular Priority Initiatives identified within their county.

Consultant Contact Eric Woolridge, AICP eric@dbdplanning.com Destination byDesign 828.719.1109 Destination byDesign

Local Contact

DOWNTOWNS

PUBLIC PARKS

MIXED USE

Prioritization

Rachel Miller, MSPH Appalachian District Health rachel.miller@apphealth.com 828.264.4995

In addition to projects that impact public health, CTG and regional public health professionals are particularly interested in projects that are outlined within other plans and demonstrate momentum for implementation. CTG is also interested in whether communities exhibit the financial and human resource capacity necessary for implementation.

Vicinity Map: Health

by Design Study Area Vicinity Map: Health

by Design Study Area

A project of the Northwest Partnership for Public Health

- Consultant team and local health staff meet with local government planners, managers and recreation professionals in each county

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Local Health Department regions throughout North Carolina have been awarded a multi-year Community Transformation Grant (CTG) through the NC Division of Public Health. Priority areas for this project include active living, healthy eating, and tobacco-free living. The Health by Design planning initiative addresses the “active living” element of the CTG project.

April-

A RoAdmAp foR

HealtHier General Plans G

etting healthy policies into a community’s general plan can seem daunting. Planning is often a timeconsuming and occasionally complicated process. But health-promoting policies go a long way toward creating more livable neighborhoods – increasing opportunities for residents to buy fresh foods, ensuring they can walk and bike to meet daily needs, reducing crime and pollution, encouraging social connections, and more.

May

June

- Local officials submit their CTG Project Priority Initiatives online - Consultant team and local health officials follow up with site visits to each location

- Rank Priority Initiatives - Develop Schematics - Synthesize data into Overall Plan - Presentation to Region 3 Health Directors & Community Presentation

PLAN dEVELOPMENT

Kick-Off H E A LT H B Y D E S I G N : R E G I O N 3 P L A N F A C T S H E E T

- Review of Existing Plans - Literature Review

HbD Interactive Workshop

- Interactive workshop on Planning Fundamentals to Health Professionals

- Public Presentation Fact Sheet Development - Identify Key Interviews

Feb.-March

aSSESS Priority Initiatives

Jan. ‘13

P R O C E S S

Local Gov’T. Interviews

Dec. ‘12

P L A N N I N G

Inventory & Research

T H E

City planners, health department staff, communitybased advocates, experts and consultants, philanthropic organizations, and elected officials all have roles to play to ensure the general plan reflects both healthy community goals and best practices. In fact, the involvement of these stakeholders is critical throughout the process – from educating residents and decisionmakers alike about the impact of planning decisions on public health to actively participating in drafting policy language that creates more sustainable communities.

Visions and values may differ from one community to the next, but much of the structure and process for updating a general plan is common throughout California (indeed, land use planning processes usually follow the same general path nationwide).

This roadmap, which draws from lessons learned and best practices from real-life planning process, highlights roles and strategies for key players to consider along the way.

This roadmap draws from research

by Heather Kuiper, DrPH, using three California cities as case studies: Santa Clara, Mountain View, and San Jose.

Project # County/ Project Alleghany A.1 Alleghany Wellness Center Design A.2 Alleghany Co. Recreation Master Plan A.3 Crouse Park Site Master Plan A.4 Sparta Greenway Phase I Engineering A.5 Downtown Sparta Streetscape Phase II Engineering and Design Ashe B.1 Beaver Creek Wellness B.2 West Jefferson Trail Implementation B.3 Ashe County Outdoor Recreation Plan Davidson C.1 Lake Thom-A-Lex Environmental Education Trail Construction Documents C.2 Thomasville Parks and Recreation Master Plan C.3 Thomasville Bike Plan Implementation C.4 Wilcox Bridge Plan C.5 Hughes Park Planning C.6 Abbotts Creek Greenway Phase II Davie D.1 Davie Co. Greenway Master Plan D.2 Old High School Re-Purposing Engineering and Design Forsyth E.1 Stratford Road Rail-Trail Feasibility E.2 Winston-Salem Downtown Pedestrian Environment Study E.3 Winton-Salem Sidewalk Missing Link Study E.4 Winston-Salem Development Ordinance Review and Overhaul E.5 Wake Forest Innovation Quarter Trail North Planning Stokes F.1 Sokes Co. Comprehensive Land Use Master Plan Surry G.1 Stone Mtn. State Park to Pilot Mtn. State Park Trail Master Plan G.2 Mount Airy Wayfinding Signage Plan G.3 Mount Airy Greenway Feasibility Analysis G.4 Mount Airy Pedestrian Plan Implementation G.5 Surry County Regional Recreation Master Plan G.6 Mountains-to-Sea Trail Foot Bridge Design G.7 Trail Master Plan: Elkin Municipal Park to Crater Park to Chatham Park Watauga H.1 New River Headwaters Trail – Middle Fork Greenway Phase II Design H.2 Historic Valle Crucis Village Trail Engineering Wilkes I.1 Stone Mtn. State Park to Pilot Mtn. State Park Trail Master Plan I.2 North Wilkesboro Parks and Recreation Master Plan I.3 North Wilkesboro Downtown Engineering Yadkin J .1 Yadkinville Community Park Phase II Engineering and Design J .2 Jonesville Greenway Extension J .3 Yadkin County Park Design and Engineering J .4 5-D Engineering J .5 Rockford River Access

Total Health Model and Priority Initiatives ALLEGHANY

ASHE

A.3 Sparta A.1 A.4 A.5 B.3

G.2 G.3 A.2

G.4

Jefferson

G.5

B.2

Danbury

Dobson

B.1

F.1

SURRY

I.1

WATAUGA

WILKES

G.6 J.5

G.7

H.2

Boone I.3

I.2

Wilkesboro

FORSYTH

YADKIN

J.2

H.1

STOKES

G.1

J.4

J.1

Yadkinville E.3 E.2 E.5 E.4 E.1

J.3

Winston-Salem

®

Total Health Model Percentage* Based on natural breaks within the data distribution, three tiers have been established to provide a relative understanding of health determinants throughout the region.

Tier 1 areas, or those with higher percentages, are most vulnerable. Note that some Priority Initiatives are county-wide efforts that will impact the entire county or a sub-region.

Tier Tier 33

11 - 20%

Tier Tier 22

20.1- 27 %

Tier Tier 11

27.1 - 36 %

0

5

10

DAVIE

Mocksville

C.2

C.1 D.1

D.2

20 Miles

C.5

C.3

Lexington C.6 C.4

DAVIDSON

*This analysis combines data associated with Social Determinants of Health (poverty, education, and minority populations), Community Risk Factors (number of health care workers and access to grocery stores), and Health Risk Behavior/Outcomes (heart disease, stroke, and cancer).

Data Sources: NC State Center for Health Statistics, NC Center for Geographic Information and Analysis, US Census

5

New Yorkers stroll through Central Park in the late 19th century.

Chapter One CHRONIC DISEASE AND THE NEED FOR ACTIVE LIVING INFRASTRUCTURE

Chronic Disease and the Need for Active Living Infrastructure The Situation and Its Consequences

8

Chronic Disease is the result of Modifiable health risk behaviors.

The Community Transformation Grant Project was launched by the United States Centers for Disease Control and Prevention to help communities address the leading causes of death in the United States: Chronic Disease.

Chronic disease is a long-lasting condition that can be controlled but not cured. And while they’re among the most common and costly health problems, they are also among the most preventable.

The common causes of chronic disease are associated with four primary and modifiable health risk behaviors, including 1) lack of physical activity, 2) poor nutrition, 3) tobacco use, and 4) excessive alcohol consumption.

Consider the following:

More than half of American adults possess at least one chronic disease (www.healthcare.gov, 2013).

7 out of 10 deaths among Americans each year are from chronic diseases. Heart disease, cancer and stroke account for more than 50% of all deaths each year (Kung HC, 2005).

133 million Americans – almost 1 out of every 2 adults – have at least one chronic illness (Wu Sy, Green A, 2000).

1 in 3 adults is obese, and more than 33 percent of children and adolescents, approximately 25 million kids, are overweight or obese, (Ogden CL, Caroll MD, McDowell MA, Flegal KM, 2007).

Physically inactive children and those without active parents are twice as likely to be obese as adults.

While local health leaders must look to address all four modifiable risk behaviors, this plan provides strategic direction for creating new active living opportunities. As a country, state, and region, we must create a built environment conducive to physical activity.

Children are most critical for overcoming these trends. Physically inactive children and those without active parents are twice as likely to be obese as adults. Children that are physically inactive are prone to lower test scores, higher health care costs, and premature death.

Source: Designed to Move www.designedtomove.org

US has experienced a 32% reduction in physical activity. By 2030, it is expected that there will be an additional 14% reduction in physical activity.

Minority populations are at particular risk, especially minority children. In rural America, 44.1% of African-American children are at risk of being overweight. African-American and Hispanic-Latino children are prone to Type-2 diabetes.

North Carolina ranks #5 of states with highest rate of obese children from age 10 – 17. In 2008, 19.3% of this population was considered obese.

The cost of chronic disease and obesity is tremendous, yet entirely preventable. Inactive children are likely to cost $2,741 more dollars per year on health care costs as adults.

While direct costs of chronic disease are high, the indirect costs of chronic conditions may be several times higher than the direct medical costs. These diseases lead to lost productivity, such as missed days of work or school, disability, reduced work output, reduced quality of life, and premature death. The obesity epidemic costs the US $75 billion in direct costs, and $139 billion when considering indirect costs and loss of work.

From 1965 to 2009, the US experienced a 32% reduction in physical activity. By 2030, it is expected that there will be an additional 14% reduction in physical activity.

-- Designed to Move

From 1965 to 2009, the

As a nation, 75% of our Health Care Dollars are spent treating Chronic Disease.

-Centers for Disease Control and Prevention

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The Need for Active Living Infrastructure

Physical Activity is not just a matter of personal choice, but also a function of the built environment (Ferdinand, 2012). According to the CDC, creating, improving and promoting places to be physically active can result in a 25 percent increase in residents who exercise at least three times per week (Kerr, 2008). As a country, state, and region, we must become more proactive in creating an environment and culture where physical activity is part of daily life.

10

An analysis of data collected from planning directors in 67 North Carolina counties and surveys of 6,694 residents, which was conducted in 2007, found higher levels of physical activity among residents of counties with more sidewalks, bike lanes and trails, more walkable mixed land use development, and strong planning policies.

By creating new active living opportunities and infrastructure, we create communities where physical activity is part of daily life, which is especially critical for influencing children. Active parents result in active children.

Lifetime Benefits of Physical Activity.

A community trail can be part of a relatively low- cost intervention to facilitate physical activity by reducing barriers such as cost, inconvenience, and inaccessibility (Eyler et al., 2008).

Childhood physical activity results in better test scores, health savings, and a 15% increase in the likelihood to attend college.

Source: Designed to Move www.designedtomove.org

Although Chronic Diseases are among the most common and costly health problems, they are also among the most preventable.

- Center for Managing Chronic Disease.

A Call for Collaboration Among Planners & Health Professionals Effective infrastructure design can play a significant role in improving public health and decreasing mortality rates. Perhaps the most compelling example of how infrastructure can positively affect public health is the historical successes of the urban reformers in New York City in the 19th and early 20th centuries. These reformers were able to defeat infectious diseases like cholera and tuberculosis by improving buildings, streets, parks, and water and sewer infrastructure (Peterson J., 1979).

In the 19th and early 20th centuries, urban reformers realized that Place Matters for Health.

By improving buildings, streets, water systems and parks, they defeated infectious disease.

Place Still Matters for health.

Planners and public health professionals must work together to change the built environment to increase active living and combat chronic disease.

It has become increasingly well-documented that “place� plays a large role in determining health outcomes for individuals over the course of their lives. The strategic designing of communities where people have the access to resources necessary to promote the leading of happy, healthy, and productive lives has therefore become important for both government and health service planning. Moving forward, it is vital that health professionals understand and are able to communicate the value that their assets and relationships bring to the overall health of a community: economic, social, and personal.

Public Health and Planning were born from a shared problem: finding solutions to infectious diseases that arose as cities grew. Pioneers of both professions understood that place matters for health, and today, these professions must once again work collaboratively to effectively combat chronic illness.

With the integration of public health and planning policy, new community growth and revitalization can more effectively incorporate active living infrastructure.

11

photo by www.bikepedimages.org Laura Sandt

Chapter Two DISCOVERY: STUDY AREA PROFILE

Discovery: Study Area Profile This chapter explores the 10-county region’s physical geography and its status of human health. The region’s geography, including its political jurisdictions, public lands, rivers, and regional trail systems, serve as a backbone for understanding the key ingredients for improving the built environment and creating new active living opportunities.

14

With an in-depth look at the region’s health condition, local health leaders can prioritize their efforts to make the greatest impact in areas with the most dire health challenges. This chapter provides a foundation for understanding the impact of Priority Initiatives identified in the subsequent chapter.

This chapter is comprised of four sections: 1) Political Jurisdictions and Population, 2) Natural Resources and Assets, 3) A Regional Perspective of Public Health, and 4) County Health Overview.

Political Jurisdictions & Regional Assets Political Boundaries and Population The Northwest Partnership for Public Health district includes Alleghany, Ashe, Davidson, Davie, Forsyth, Stokes, Surry, Watauga, Wilkes, and Yadkin Counties. Within this ten county region are 38 distinct municipalities, all varying in population, demographic make-up, economic vitality, and health condition.

The 10 county region is primarily rural. Of the 38 municipal jurisdictions, 29 have populations less than 5,000.

Three (3) jurisdictions are between 5,000 and 9,999. Five (5) jurisdictions are between 10,000 and 49,000, four of which are located in Davidson or Forsyth Counties – the region’s only two urban counties. Winston-Salem is the largest municipality with an approximate population of 230,000, and it is the only jurisdiction with more the 50,000 people.

Natural Resources Northwest North Carolina is host to a variety of public lands and natural resources. The majority of public land is located with the western-most counties of Wilkes, Watauga, Ashe, and Alleghany. Federal lands within this region are primarily anchored within the Blue Ridge Parkway, one of the most visited National Parks in the United States.

North Carolina has also purchased significant tracks within the High Country in recent decades. Elk Knob Park, Bear Paw, and, the internationally recognized, Grandfather Mountain State Park are among some of these most recent acquisitions.

The Study Area is comprised of a primarily rural region, with Davidson and Forsyth as the only two urban counties.

21 £

Lansing

Mount Airy

Sparta

ASHE

ALLEGHANY

§ ¦ ¨ 74

STOKES

Jefferson West Jefferson 221 £

dge e Ri Blu

y kwa Par

Dobson

21 £

601 £

SURRY 311 £ 52 £

WATAUGA 321 £

Beech Mtn.

421 £

WILKES

Boone

Elkin Ronda

Boonville

Jonesville

East Bend Seven Devils

321 £

421 £

Blowing Rock

North Wilkesboro

YADKIN

Wilkesboro

Danbury

Pilot Mtn.

Yadkinville

421 £

§ ¦ ¨ 77

Walnut Cove

King

Tobaccoville Rural Hall FORSYTH Bethania Walkertown Winston-Salem

Lewisville

158 £

Kernersville

Clemmons Wallburg

£

Bermuda Run

601

Midway

§ ¦ ¨ 40

Political Boundaries and Population

DAVIE 52 £

Mocksville

Thomasville

64 £

Cooleemee

Population Size

Lexington

®

< 5000 5000 - 9999 10,000 - 49,999

0

5

10

§ ¦ ¨ 85

20 Miles

> 50,000 Data Sources: NC Center for Geographic Information and Analysis, US Census

DAVIDSON

Denton

ASHE th Nor

Jefferson

SURRY New New R. R. State State Park Park Stone Stone Mtn. Mtn. State State Park Park

Dobson

Re dd ies

R.

Danbury Hanging Hanging Rock Rock State State Park Park

. nR Da

WATAUGA W ata ug aR Boone .

STOKES

Pilot Pilot Mtn. Mtn. State State Park Park

R. ng ari Ro

R. New Fork h t Sou

ay arkw ge P Rid Blue

Fish er R .

. ll R che Mit

16

Sparta

R. rat Ara

Mount Mount Jefferson Jefferson State State Park Park

Elk Elk Knob Knob State State Park Park

ALLEGHANY

R. New Fork

Belews Lake

WILKES

Wilkesboro

YADKIN

. in R Yadk

FORSYTH

Yadkinville Winston-Salem

R. in dk Ya DAVIE DAVIDSON Mocksville

Major Natural Resources and Public Lands

Lake Thom-A-Lex

Lexington

Public Land Federal

State

County Seats

速

Local

High Rock Lake

Major Rivers

0

5

10

20 Miles

Data Sources: NC Center for Geographic Information and Analysis, US Census

Region 3 boasts significant natural attractions including Grandfather Mountain in Watauga County, Hanging Rock State Park in Stokes County, Stone Mountain State Park in Alleghany and Elkin Counties and Pilot Mountain in Surry County.

Photos by others

Moratock Park along the Dan River

Toward the east of the region, however, are other significant state parks, including Stone Mountain, Pilot Mountain, and Hanging Rock. These are treasured assets and represent key anchors for establishing the Mountains-to-Sea Trail across North Carolina.

River Basins There are three major watersheds within the region, each with navigable rivers and tributaries. The New River basin includes portions of Watauga, Ashe, and Alleghany Counties. The New River has long served as a major natural resource and asset to the region and helps contribute to its robust tourism economy.

Stokes County is mostly within the Roanoke Basin, but portions of this basin impact Forsyth and Surry Counties.

The Dan River serves as the heart of this basin and is a major asset for the county and its citizens and visitors.

The county has worked in recent years to improve river access and parks along this river corridor to create more economic opportunity.

The Yadkin River Basin engulfs the majority of the region, and its Yadkin River is arguably the region’s most prominent geographic feature. Whereas the region’s political boundaries divide, it is the Yadkin River that truly connects the majority of this unique area of North Carolina. The Yadkin River Heritage Corridor Partnership has been working for nearly a decade to increase the prominence of this asset, improve its recreation infrastructure, and appropriately brand the river and its valley for tourism.

Regional Trails This region serves a significant portion of North Carolina’s existing and planned Mountains-to-Sea Trail (MST).

A major section of the trail currently exists and enters the region via Grandfather Mountain State Park. This completed trail section ends at Stone Mountain State Park, from which there are multiple planned routes leading to the Yadkin River. The Elkin Valley Trails Association is working to connect Stone Mountain State Park to the Town of Elkin. There is also a completed section of the MST between Pilot Mountain and Hanging Rock State Park, but issues exist pertaining to expired land leases.

The Overmountain Victory National Historic Trail is a national trail with its own Superintendent. This trail celebrates the patriot militia and the route they walked before fighting a significant revolutionary battle at Kings Mountain in South Carolina. This trail begins in Elkin and parallels the Yadkin River before exiting the region at the Wilkes County and Caldwell County border.

Photo by Sunny Morgan

Study Area Profile

The New River Headwaters Trail begins in Blowing Rock and connects to the Town of Boone and the community of Todd in Ashe County. This project is well underway with various trail segments complete, including the anchoring 5-mile Boone Greenway. High Country Pathways, Inc. is the nonprofit organization spearheading this initiative and continues to obtain trail easements and raise significant support for trail construction.

17

ALLEGHANY Mount Airy

Sparta

SURRY

New New R. R. State State Park Park

Mount Mount Jefferson Jefferson State State Park Park

Fish er R .

ra i sT

Boone

New

R.

Re dd ies

R. ng ari Ro

R.

rai l ridor T Cor

WILKES

Yadk

n

Pilot Pilot Mtn. Mtn. State State Park Park

Belews Lake

YADKIN

nal atio

FORSYTH

Yadkinville Winston-Salem

R. in dk Ya

ount a i erm

tor y N Vic

Danbury Hanging Hanging Rock Rock State State Park Park

Elkin

ge il erita aters Tra . erHeadw in R toric Tra il er H v i New Riv Yadk Wilkesboro in R His

Ov

W ata ug aR .

ork th F Sou

Dobson

. ll R che Mit

ASHE WATAUGA

STOKES

. nR Da

ay rkw Pa ge d i eR Stone Mtn. Blu State Park

Jefferson

R. rat Ara

l

18

The Mountains-to-Sea trail spans the entire state of North Carolina. Sections of the trail are built and others are proposed or in development.

ea ern P k rth No

Elk Elk Knob Knob State State Park Park

R. New ork F th Nor

DAVIE DAVIDSON

Regional Trail Connections

Mocksville

Trail Status Existing Planned

Lake Thom-A-Lex

Lexington

速

Mountains-to-Sea Trail Preferred Route Alternate Route 0

5

10

Local Trails > 5 Miles

High Rock Lake 20 Miles

Data Sources: NC Center for Geographic Information and Analysis. NC State Trails Program

Region 3 is home to sections of The Mountainsto-Sea Trail and the Overmountain Victory National Historic Trail.

A Regional Perspective of Public Health This section provides a public health profile for the region and includes two parts: 1) A Relative Assessment of the Region and 2) County Health Profiles. The first section assesses the region as a whole using health data according to census track. The second section provides a brief health preview for each of the ten counties within the region.

A Relative Assessment of the Region The North Carolina State Center for Health Statistics has conducted extensive research to assess public health throughout the state. Much of the information provided in this section is a result of their work. The custom maps produced from this data indicate three “Tiers,” providing a relative evaluation of each census track according to the specified indicators.

The culmination of this section is the “Total Health Model Map.” This map is the result of analysis combining data associated with 1) Social Determinants of Health, 2) Community Risk Factors, and 3) Health Risk Outcomes. The Total Health Model provides a relative understanding of public health risk areas throughout the region.

Social Determinants of Health There are three primary social determinants that correlate to health disparity: poverty, minority status, and education.

The Tier 1 and 2 poverty areas represent areas that have a poverty rate that is equivalent to the United States or greater (see map: Percent Persons Below Poverty). Most counties within the region have a significant portion of their census tracts representing such a poverty level. There are several small pockets of poverty above the 34% level in the counties of Watauga, Forsyth, and Davidson.

The Tier 1 poverty-stricken areas also correlate with areas of where there is a significant minority population, except in Watauga County where there is a major state university.

Study Area Profile

19

Community Risk Factors There are two primary community risk factors that relate to health disparity: access to health care workers and access to grocery stores.

Sparta Jefferson

ALLEGHANY Danbury Dobson

ASHE

20

Populations with less access to health professionals are more prone to health disparity. These professionals include health care practitioners and those with technical occupations associated with health (see map: Ratio of Health Professionals to Working Population).

STOKES

SURRY WATAUGA Boone

WILKES FORSYTH

YADKIN Wilkesboro

Yadkinville Winston-Salem

DAVIE

Percent Persons Below Poverty Tier 3

0 -15%

Based on natural breaks within the data distribution, three tiers have been established to provide a relative understanding of regional poverty.

Tier 2

15.1 - 34%

Tier 1 areas, or those with higher percentages, are most vulnerable.

Tier 1

34.1- 63%

Considering that North Carolina and the United States have a poverty rate of 16% and 15% respectively, it is apparent that much of this region remains relatively poor.

Mocksville

Lexington

Sparta Jefferson

DAVIDSON County County Seats Seats

0

5

10

速 20 Miles

Data Sources: NC State Center for Health Statistics, US Census, 2010

ALLEGHANY Danbury Dobson

ASHE

STOKES

SURRY WATAUGA Boone

WILKES FORSYTH

YADKIN Wilkesboro

Yadkinville Winston-Salem

Ratio of Health Professionals to Working Population

DAVIE Mocksville

Tier 3

1: 0 - 25

Based on natural breaks within the data distribution, three tiers have been established to provide a relative understanding of the ratio of health workers throughout the region.

Tier 2

1: 26 - 54

Tier 1 areas, or those with higher ratio, are most vulnerable.

Tier 1

1: 55 - 94

County County Seats Seats

Lexington

DAVIDSON

速 0

5

10

20 Miles

Data Sources: NC State Center for Health Statistics, US Census, 2010

Considering that North Carolina and the U.S. have a poverty rate of 16% and 15% respectively, it is apparent that much of this region remains relatively poor.

Health Risk Outcomes Areas with greater incidences of heart disease, stroke, and cancer are of particular interest to regional health professionals working to increase access to active living infrastructure. Heart disease rates, stroke rates, and lung cancer rates transcend the entire region, impacting both rural and urban populations. These outcomes are the result of modifiable behaviors and lifestyles.

Creating accessible and convenient active living opportunities is a key ingredient for combating the incidences of these outcomes.

Sparta Jefferson

ALLEGHANY Danbury Dobson

ASHE

STOKES

SURRY WATAUGA

WILKES

Boone

FORSYTH

YADKIN Wilkesboro

Yadkinville Winston-Salem

DAVIE

Stroke Mortality Rate Tier 3

0 - 45

Tier 2

45.1 - 90

Tier 1

90.1- 276

Mocksville

Based on natural breaks within the data distribution, three tiers have been established to provide a relative understanding of stroke mortality rate throughout the region.

Lexington

Tier 1 areas, or those with a higher rate, are most vulnerable.

速

DAVIDSON

County County Seats Seats

Stroke deaths include all resident deaths in which stroke was coded as the primary cause of death. Rates are presented per 100,000 population.

0

5

10

20 Miles

Data Sources: NC State Center for Health Statistics, NC Death Certificates, US Census, 2010

Sparta Jefferson

ALLEGHANY Danbury Dobson

ASHE

STOKES

SURRY WATAUGA

WILKES

Boone

FORSYTH

YADKIN Wilkesboro

Yadkinville Winston-Salem

DAVIE

Heart Disease Mortality Rate Tier 3

19 - 163

Tier 2

163.1 - 288

Mocksville

Based on natural breaks within the data distribution, three tiers have been established to provide a relative understanding of heart disease mortality rate throughout the region.

Lexington

Tier 1 areas, or those with a higher rate, are most vulnerable.

Tier 1

速

288.1- 735

Tier 1 Area, or those shaded darkest, represent the most vulnerable populations with respect to health.

DAVIDSON

County County Seats Seats

Heart disease deaths include all resident deaths in which heart disease was coded as the primary cause of death. Rates are presented per 100,000 population.

Study Area Profile

0

5

10

20 Miles

Data Sources: NC State Center for Health Statistics, NC Death Certificates, US Census, 2010

21

The Total Health Model Map The â&#x20AC;&#x153;Total Health Model Mapâ&#x20AC;? reflects all data associated with the social determinants of health, community risk factors, and health risk outcomes. The Total Health Model provides a relative understanding of public health risk areas in the region. Based on natural breaks within the data distribution, the three tiers provide a relative understanding of health determinants throughout the region.

22

Five (5) counties have Tier 1 areas, which represent the most vulnerable populations. These counties include Alleghany, Davidson, Forsyth, Surry, and Wilkes. The respective Tier 1 towns within these counties include the Town of Sparta, City of Thomasville and City of Lexington, Winston-Salem, Town of Elkin and Town of Mount Airy, and the Town of Wilkesboro and North Wilkesboro.

The Total Health Model map is a critical tool for regional health professionals that must prioritize limited resources. The subsequent chapter identifies key Priority Initiatives for improving active living infrastructure throughout the region. By placing these initiatives on the Total Health Map, decision makers can understand spatially how projects can impact public health throughout the region.

Making the Total Health Model Map

Social Determinants of Health Percent African American Population Percent Hispanic Population Percent Below Poverty Percent High School Graduate or Higher Percent Spending > 30% of Income on Rent Percentage of the Household on Food Stamps

Community Risk Factors Ratio of Health Workers Population with Access to Grocery Stores

Health Risk Behaviors/ Outcomes Heart Disease Mortality Stroke Disease Mortality Lung/Bronchus/Trachea Cancer Incidence

Total Health Model This map was derived from all the maps, using a spatial analysis method called suitability analysis. Analysis provided

by NC Center for Health Statistics.

Sparta Jefferson

ALLEGHANY Danbury Dobson

ASHE

STOKES

SURRY WATAUGA

WILKES

Boone

FORSYTH YADKIN Wilkesboro

Total Health Model

Yadkinville

速

Winston-Salem

DAVIE

Based on natural breaks within the data distribution, three tiers have been established to provide a relative understanding of health determinants throughout the region.

Mocksville

Tier 1 areas, or those with higher percentages, are most vulnerable.

Tier 3

11 - 20%

Tier 2

20.1- 27 %

Tier 1

27.1 - 36 %

Lexington

DAVIDSON

This analysis combines data associated with Social Determinants of Health (poverty, education, and minority populations), Community Risk Factors (number of health care workers and access to grocery stores), and Health Risk Behavior/Outcomes (heart disease, stroke, and cancer).

0

5

10

20 Miles

Data Sources: NC State Center for Health Statistics, NC Center for Geographic Information and Analysis, US Census

Health Overview by County The following section provides a health snapshot for each county within the region, including:

24

1. A County Profile of statistics from each county’s Community Health Assessment 2. County Health Rankings 3. The Total Health Model Map with the county highlighted

Based on data available for each county, this section explores specific determinants of health and the overall health factors and outcomes relative to other counties in North Carolina. The rankings look at a variety of measures that contribute to certain health outcomes such as mortality rates, obesity and smoking related disease. These rankings are derived from the American Community Survey (ACS) 2011 5-year estimates and County Health Rankings and Roadmaps. These rankings can be used to garner support for local and regional health initiatives.

y Profi t n les u o C

Region 3

Each County Profile Includes the following data derived from the local county’s Community Health Assessment: • Demographics • Socio-Economic Status • Industry • Public Health Priority Areas • Top Three Leading Causes of Death • Youth Statistics where available

nty Profil u e Co

Alleghany County

Sparta Jefferson

ALLEGHANY Danbury Dobson

ASHE

STOKES

SURRY WATAUGA

WILKES

Boone

FORSYTH YADKIN Wilkesboro

Total Health Model

Yadkinville

®

Winston-Salem

Mocksville

Tier 1 areas, or those with higher percentages, are most vulnerable.

11 - 20%

Tier 2

20.1- 27 %

Lexington

DAVIDSON

This analysis combines data associated with Social Determinants of Health (poverty, education, and minority populations), Community Risk Factors (number of health care workers and access to grocery stores), and Health Risk Behavior/Outcomes (heart disease, stroke, and cancer).

Tier 1 27.1 - 36 %

Alleghany

0

Demographics • Estimated Population: 11,155 (2010).

• Ethnicity: 92.2% White, 1.3% Black, 0.2% Native American, and 1.1% Other.

Of the total population 9% self-reported being Hispanic or Latino.

• Alleghany County has a median age of 45 years old. People over the age of 65 make up 20.7% of the Alleghany County population.

DAVIE

Based on natural breaks within the data distribution, three tiers have been established to provide a relative understanding of health determinants throughout the region.

Tier 3

Alleghany

5

10

20 Miles

Data Sources: NC State Center for Health Statistics, NC Center for Geographic Information and Analysis, US Census

Socio-economic Status • Median Income: $38,031.

• Approximately 18.1% of Alleghany County residents live in poverty.

• In 2009, 18.4% of Alleghany County residents under the age of 18 lived in poverty, a proportion 22% lower than the comparable state proportion. In 2011, Alleghany County had an 11.2% unemployment rate.

• In Alleghany County, 76.1% of the residents have completed high school.

Industry Leading industries: education, health services, manufacturing, and public administration.

The top five employers: - Alleghany County Board of Education - Parkdale Mills - Alleghany Memorial Hospital - Alleghany County - Bottomley Evergreens & Farms, Inc Public Health Priority Areas identified in Community Health Assessment 1. Obesity 2. Access and affordability of health care services The top three leading causes of death in the County are: - Heart Disease- 24.4% - Cancer-23.7% - Chronic Lower Respiratory Diseases- 5.3% Youth Statistics 37.9% of high school aged students have smoked cigarettes. According to the Youth Risk Behavioral Survey, 28.8% of high school students were considered overweight or obese.

Students reported being active an average of 4.2 days. Only 11.3% of all student respondents reported riding a bike to school in the past 7 days.

Study Area Profile

25

Co

Sparta Jefferson

ALLEGHANY Danbury Dobson

ASHE

STOKES

SURRY

AShe County

26

WATAUGA

WILKES

Boone

FORSYTH YADKIN Wilkesboro

Total Health Model

Yadkinville

®

Winston-Salem

Mocksville

Tier 1 areas, or those with higher percentages, are most vulnerable.

11 - 20%

Tier 2

20.1- 27 %

Tier 1 27.1 - 36 %

Lexington

DAVIDSON

This analysis combines data associated with Social Determinants of Health (poverty, education, and minority populations), Community Risk Factors (number of health care workers and access to grocery stores), and Health Risk Behavior/Outcomes (heart disease, stroke, and cancer).

0

Ashe

e

Demographics • Estimated Population: 27,281 (2010).

• The majority of Ashe County residents (95.5%) are white, with minorities making up 4.5% of the population.

• People over the age of 65 make up 20.2% of the Ashe County population.

• Children ages 0-4 represent the smallest portion of the population in Ashe County.

DAVIE

Based on natural breaks within the data distribution, three tiers have been established to provide a relative understanding of health determinants throughout the region.

Tier 3

Prof y t n u il

5

10

20 Miles

Data Sources: NC State Center for Health Statistics, NC Center for Geographic Information and Analysis, US Census

Socio-economic Status • Median household income is $34, 056 (2009).

• Approximately 18.1% of Ashe County residents live in poverty.

• In 2009, 26.4% of Ashe County residents under the age of 18 lived in poverty, a proportion 17% higher than the comparable state proportion.

• In 2011, the unemployment rate in Ashe County was 10.7%.

• In Ashe County, 76.6% of the residents have completed high school.

Industry Leading industries: education, health services, manufacturing, and public administration.

The top five employers are: - Ashe County Board of Education - Ashe Memorial Hospital - American Emergency Vehicles - County of Ashe - United Chemi-Con, Inc. Public Health Priority Areas identified in Community Health Assessment 1. Obesity 2. Access and affordability of health care services The top three leading causes of death in the County are: - Disease of the heart - 20.8% - Cancer -19.9% - Chronic Lower Respiratory Disease - 8.8% Youth Statistics In Ashe County, 41% of high school aged students have ever smoked cigarettes. According to the Youth Risk Behavioral Survey, 31.8% of high school students were considered overweight or obese. Students reported being active an average of 4.4 days. Only 7.3% of all student respondents reported riding a bike to school in the past 7 days.

Davidson County

Co

Sparta Jefferson

ALLEGHANY Danbury Dobson

ASHE

STOKES

SURRY WATAUGA

WILKES

Boone

FORSYTH YADKIN Wilkesboro

Total Health Model

Yadkinville

®

Winston-Salem

DAVIE

Based on natural breaks within the data distribution, three tiers have been established to provide a relative understanding of health determinants throughout the region.

Mocksville

Tier 1 areas, or those with higher percentages, are most vulnerable.

Tier 3

11 - 20%

Tier 2

20.1- 27 %

Tier 1

27.1 - 36 %

Lexington

DAVIDSON

This analysis combines data associated with Social Determinants of Health (poverty, education, and minority populations), Community Risk Factors (number of health care workers and access to grocery stores), and Health Risk Behavior/Outcomes (heart disease, stroke, and cancer).

0

5

10

20 Miles

Data Sources: NC State Center for Health Statistics, NC Center for Geographic Information and Analysis, US Census

Prof y t n u il

Davidson

e

Demographics • Population: 162,878 (2010).

• Increase of 15,632 (10.6%) people since 2000.

• Ethnicity: White: 84.3%. Other: 15.7%, 6.4% of individuals identified as Hispanic.

Socio-economic Status • In 2010, 10,015 children were living in poverty or 26.3% of all children living in the county, an increase of 6.4% since 2008.

• Annual unemployment rates in Davidson County rose sharply during the period, reaching a peak of 13% in 2009. April 2012, the unemployment rate in the county dipped into single digits (9.8%) for the first time since 2008, and a decrease of 3.2% since 2009.

• In 2010, 17.3% of people in Davidson County were considered to be living in poverty.

Industry Davidson County is in the process of an employment shift from primarily manufacturing to education and health services industries. The decline of the furniture industry in particular has resulted in a significant drop in manufacturing jobs within the county. Davidson County Schools are the largest county employer and are the only employer in the county to employ more than 1,000 workers. Notably, manufacturers such as Thomasville Furniture and Ellison Windows and Doors employed more than 1,000 workers in the middle part of the last decade but no longer are within the top 10 places of employment within the county.

Top five Employers in Davidson County: - Davidson County Board Of Education 1,000+ - County Of Davidson 500–999 - Atrium Companies Inc. 500–999 - Lexington Medical Center 500–999 - Wal–Mart Associates Inc. 500–999 Public Health Priority Areas identified in Community Health Assessment 1. Increasing the number of residents who are physically active and maintain nutritious eating habits; 2. Improving access to care (particularly primary care, mental health, and dental services); 3. Reducing tobacco use The top three leading causes of death in the County are: - Diseases of the Heart - Cancer - Chronic Lower Respiratory Disease.

Study Area Profile

27

Co

Sparta Jefferson

ALLEGHANY

28

Davie County

Danbury Dobson

ASHE

STOKES

SURRY WATAUGA

WILKES

Boone

FORSYTH YADKIN Wilkesboro

Total Health Model

Yadkinville

®

Winston-Salem

Mocksville

Tier 1 areas, or those with higher percentages, are most vulnerable.

11 - 20%

Tier 2

20.1- 27 %

Tier 1

27.1 - 36 %

Lexington

DAVIDSON

This analysis combines data associated with Social Determinants of Health (poverty, education, and minority populations), Community Risk Factors (number of health care workers and access to grocery stores), and Health Risk Behavior/Outcomes (heart disease, stroke, and cancer).

0

Davie

e

Demographics • Population: 42,000. The age with the highest percentage in Davie County is ages 20-24.Males make up the largest percentage between male and females ages 40-44 in Davie County. For Davie County and North Carolina, Caucasians make up the majority of the population. People of Asian descent are the smallest nationality in Davie County.

DAVIE

Based on natural breaks within the data distribution, three tiers have been established to provide a relative understanding of health determinants throughout the region.

Tier 3

Prof y t n u il

5

10

20 Miles

Data Sources: NC State Center for Health Statistics, NC Center for Geographic Information and Analysis, US Census

Socio-economic Status • 33% of residents have a high school diploma.

• The average household income is 50,000-74,999.

• In 2009 Davie County unemployment rate was 11.4% Industry The top employers are: - Davie County Schools - VF Jeanswear - County of Davie Public Health Priority Areas identified in Community Health Assessment 1. Obesity 2. Cancer 3. Crime The top three leading causes of death in the County are: From 2005-2009 the top 3 causes of death in Davie County were: - Cancer - 107.6 % - Diseases of the heart - 170.5% - Chronic Lower Respiratory Disease - 47.0% Youth Statistics In 2010-2011; 46.36% of our 1, 3, 5, 7th grade students had a BMI over 85th or over percentile. The school Body Mass Index rates have been going up since 2009.

Co

Sparta

Forsyth County

Jefferson

ALLEGHANY Danbury Dobson

ASHE

STOKES

SURRY WATAUGA

WILKES

Boone

FORSYTH YADKIN Wilkesboro

Total Health Model

Yadkinville

®

Winston-Salem

DAVIE

Based on natural breaks within the data distribution, three tiers have been established to provide a relative understanding of health determinants throughout the region.

Mocksville

Tier 1 areas, or those with higher percentages, are most vulnerable.

Tier 3

11 - 20%

Tier 2

20.1- 27 %

Tier 1

27.1 - 36 %

Lexington

DAVIDSON

This analysis combines data associated with Social Determinants of Health (poverty, education, and minority populations), Community Risk Factors (number of health care workers and access to grocery stores), and Health Risk Behavior/Outcomes (heart disease, stroke, and cancer).

0

5

10

20 Miles

Data Sources: NC State Center for Health Statistics, NC Center for Geographic Information and Analysis, US Census

Prof y t n u il

Forsyth

e

Demographics Population: 351,798 residents (2010). Forsyth County’s population grew 14.6% since the 2000 US Census when there were 306,067 county residents. 2010 Population by Race/Ethnicity: • White 58.7% • Black/African-American 25.5% • Hispanic 11.9% • Asian 1.8% • American Indian/0.3% • Native Hawaiian/0.04% • Multiracial 1.5% • Other 0.2% Socio-economic Status % Living Below Poverty Level: • Median family household $55,075 • Children (0-17 yr old) 22.8% • Median non-family household $28,023 • Adults (18-64 yr old) 12.9% • Unemployment rate 9.9% • Seniors (≥ 65 yr old) 7.1% Industry Top Employers: - Wake Forest Baptist Medical Center - Novant Health - Winston-Salem/Forsyth Co. School System - City/County Government - Reynolds American, Inc. Public Health Priority Areas identified in Community Health Assessment 1. Physical Activity and Nutrition 2. Chronic Disease Management 3. Maternal and Infant Health 4. Social Determinants of Health The leading causes of death in the County are: - Cancer - Heart Disease - Chronic Lower Respiratory Diseases - Stroke

Study Area Profile

29

Co

Sparta Jefferson

ALLEGHANY

30

Stokes County

Danbury Dobson

ASHE

STOKES

SURRY WATAUGA

WILKES

Boone

FORSYTH YADKIN Wilkesboro

Total Health Model

Yadkinville

®

Winston-Salem

DAVIE

Based on natural breaks within the data distribution, three tiers have been established to provide a relative understanding of health determinants throughout the region.

Mocksville

Tier 1 areas, or those with higher percentages, are most vulnerable.

Tier 3

11 - 20%

Tier 2

20.1- 27 %

Tier 1

27.1 - 36 %

Lexington

DAVIDSON

This analysis combines data associated with Social Determinants of Health (poverty, education, and minority populations), Community Risk Factors (number of health care workers and access to grocery stores), and Health Risk Behavior/Outcomes (heart disease, stroke, and cancer).

0

5

10

20 Miles

Data Sources: NC State Center for Health Statistics, NC Center for Geographic Information and Analysis, US Census

Prof y t n u il

Stokes

e

Demographics • Population: 47,401 (2010) • Ethnicity: 92.9% of the population being Caucasian, while 15.9% of the population is 65 years and older.

• Stokes County is made up of 51% females.

Socio-economic Status • Unemployment in August 2011 was 9.8% in Stokes County vs.10.4% in NC. • Stokes County has 16.2% persons living below poverty level in Stokes County vs.14.3% statewide.

• In 2009, the number of persons per primary care provider was 3,599 compared to state ratio of 1,008 per primary care provider.

Industry - Duke Power - Wieland Copper Products - Parkdale America - RJ Reynolds Tobacco Company - Energy United EMC Public Health Priority Areas identified in Community Health Assessment 1. Youth Obesity Prevention 2. Adult Obesity Prevention 3. Smoking Cessation During Pregnancy The top three leading causes of death in the County are: - Cancer - Heart Disease - Chronic Lower Respiratory Disease.

Youth Statistics Stokes County had 10,227 residents under 18 years old in 2009, or 22.2% of the population. In 2009, Stokes County had an obesity rate of 23% among children age 2-18 years compared to the overall NC rate of 18%. In 2009, Stokes County had rate of 42.6% of children age 2-18 obese or overweight compared to the overall NC rate of 34.2%.

Co

Sparta Jefferson

ALLEGHANY Danbury Dobson

Surry County

ASHE

STOKES

SURRY WATAUGA

WILKES

Boone

FORSYTH YADKIN Wilkesboro

Total Health Model

Yadkinville

®

Winston-Salem

DAVIE

Based on natural breaks within the data distribution, three tiers have been established to provide a relative understanding of health determinants throughout the region.

11 - 20%

Tier 2

20.1- 27 %

Tier 1

27.1 - 36 %

Surry

e

Demographics County Population: 73,643 (2010) • Ethnicity: The United States Census Bureau indicates percent of residents identified themselves as follows: Caucasian 87%, African American 3% Hispanic or Latino 9% • Males comprise 48.7% of the county population over the age of 18 • Females comprise 51.3%.

• Altogether, 76.7% of the county population is over the age of 18.

Mocksville

Tier 1 areas, or those with higher percentages, are most vulnerable.

Tier 3

Prof y t n u il

Lexington

DAVIDSON

This analysis combines data associated with Social Determinants of Health (poverty, education, and minority populations), Community Risk Factors (number of health care workers and access to grocery stores), and Health Risk Behavior/Outcomes (heart disease, stroke, and cancer).

0

5

10

20 Miles

Data Sources: NC State Center for Health Statistics, NC Center for Geographic Information and Analysis, US Census

Socio-economic Status 18% of Surry County citizens’ income is below poverty level, and 13.9 % of all families have income below the poverty level. Approximately 85% of the population is high school graduates, and the unemployment rate is 11.3 %. 3% of the population has limited access to healthy foods, and 46 % of all restaurants in the county are considered fast food. And there are 7 recreational facilities dispersed throughout the county, and only 5% of all residents live within half a mile of a park.

Industry The top industries are education, construction, poultry, public administration, health services, trade, manufacturing, and hospitality. The top five employers are as follows: - Surry County Board of Education - Pike Electric Inc. - Wayne Farms Poultry - Surry County - Hugh Chatham Memorial Hospital Public Health Priority Areas identified in Community Health Assessment 1. Obesity 2. Substance Abuse 3. Healthy Aging 4. Injury Prevention The top three leading causes of death in the County are: - Cancer- 23.8% - Disease of the Heart - 20.3% - Chronic lower respiratory disease - 9.0% Youth Statistics As of 2010, 20.3% of children ages 2-4 were obese in Surry County, and 31.9% of children ages 5-11 were obese.

Study Area Profile

31

Co Watauga County

32

e

Watauga

Sparta Jefferson

Prof y t n u il

ALLEGHANY Danbury Dobson

ASHE

STOKES

SURRY WATAUGA

WILKES

Boone

FORSYTH YADKIN Wilkesboro

Total Health Model

Yadkinville

®

Winston-Salem

DAVIE

Based on natural breaks within the data distribution, three tiers have been established to provide a relative understanding of health determinants throughout the region.

Mocksville

Tier 1 areas, or those with higher percentages, are most vulnerable.

Tier 3

11 - 20%

Tier 2

20.1- 27 %

Tier 1

27.1 - 36 %

Lexington

DAVIDSON

This analysis combines data associated with Social Determinants of Health (poverty, education, and minority populations), Community Risk Factors (number of health care workers and access to grocery stores), and Health Risk Behavior/Outcomes (heart disease, stroke, and cancer).

0

5

10

20 Miles

Data Sources: NC State Center for Health Statistics, NC Center for Geographic Information and Analysis, US Census

Demographics • Population: 51, 079 (2010).

• Ethnicity: 94.5% White, 1.7% Black, 0.3% Native American, and 3.77% Other.

• Of the total population 3.4% self-reported being Hispanic or Latino.

• Watauga County has a median age of 28.4 years old.

• People over the age of 65 make up 12.4% of the Watauga County population.

Watauga County is roughly 48.8% male.

Socio-economic Status • According to the 2009 US Census, the median income in Watauga County was $33,501.

• Approximately 18.1% of Watauga County residents live in poverty.

• In 2009, 18.4% of Watauga County residents under the age of 18 lived in poverty, a proportion 22% lower than the comparable state proportion.

• In 2011, Watauga County had an 8.1% unemployment rate.

• In Watauga County, 80.4% of the residents have completed high school.

Industry Leading industry: education and health services, public transportation and trade, transportation and utilities. The top five employers are as follows: - Appalachian State University - Appalachian Regional Healthcare System - Watauga County Board of Education - Samaritans Purse, Inc - Watauga County Public Health Priority Areas identified in Community Health Assessment 1. Obesity 2. Access and affordability of health care services The top three leading causes of death in the County are: - Disease of Heart- 25.3% - Cancer-23.4% - Chronic Lower Respiratory Diseases- 6.9% Youthoo Statistics: In Watauga County, 31.4% of high school aged students have ever smoked cigarettes.

According to the Youth Risk Behavioral Survey, 19.8% of high school students were considered overweight or obese. Students reported being active an average of 4.51 days.

Less than1 in 10 of all student respondents reported riding a bike to school in the past 7 days.

Co

Wilkes County

Sparta Jefferson

ALLEGHANY Danbury Dobson

ASHE

WILKES

Boone

FORSYTH YADKIN Wilkesboro

Total Health Model

Yadkinville

®

Winston-Salem

DAVIE

Based on natural breaks within the data distribution, three tiers have been established to provide a relative understanding of health determinants throughout the region.

Mocksville

Tier 1 areas, or those with higher percentages, are most vulnerable.

Tier 3

11 - 20%

Tier 2

20.1- 27 %

Tier 1 27.1 - 36 %

Lexington

DAVIDSON

This analysis combines data associated with Social Determinants of Health (poverty, education, and minority populations), Community Risk Factors (number of health care workers and access to grocery stores), and Health Risk Behavior/Outcomes (heart disease, stroke, and cancer).

0

5

Wilkes

e

STOKES

SURRY WATAUGA

Prof y t n u il

10

20 Miles

Data Sources: NC State Center for Health Statistics, NC Center for Geographic Information and Analysis, US Census

Demographics • Population: 69,306 (2012), including 33,330 households.

• Ethnicity: 93.6% White or European American, 4.4% African American, 0.3% Native American, 0.4% Asian, 0.1% Pacific Islander, and 1.2% from two or more races.

• 5.6% of the populations were Hispanic or Latino.

Socio-economic Status • The median income for a household in the county was $30,668, and the median income for a family was $39,670.

• Males had a median income of $30,917 versus $26,182 for females.

• The per capita income for the county was $18,319.

• About 17.60% of families and 21.50% of the population were below the poverty line, including 32.60% of those under age 18 and 13.40% of those ages 65 or over.

Industry The top 5 employers in Wilkes County are as follows: • Tyson Farms, Inc. • Lowe’s Companies, Inc. • Wilkes County Board of Education • Wilkes Regional Medical Center • Wilkes County Public Health Priority Areas identified in Community Health Assessment 1. Access to Care 2. Mental Health 3. Substance Abuse 4. Physical Activity and Nutrition The top three leading causes of death in the County are: - Cancer- 26% - Diseases of the Heart- 19.6% - Chronic Lower Respiratory Disease- 7.7%

Study Area Profile

33

Co

34

Yadkin County

Sparta Jefferson

ALLEGHANY Danbury Dobson

ASHE

STOKES

SURRY WATAUGA

WILKES

Boone

FORSYTH YADKIN Wilkesboro

Total Health Model

Yadkinville

®

Winston-Salem

DAVIE

Based on natural breaks within the data distribution, three tiers have been established to provide a relative understanding of health determinants throughout the region.

11 - 20%

Tier 2

20.1- 27 %

Tier 1

27.1 - 36 %

Yadkin

e

Demographics • Population: 38,406 (2010), a 5.7% increase in population since the 2000 US Census data was collected.

• Notable population data points: 23% of the population is under the age of 18 and 16% are over the age of 65.

• The two largest ethnic groups in the county are White at 88.5% and Persons of Hispanic or Latino origin at 9.8%.

Mocksville

Tier 1 areas, or those with higher percentages, are most vulnerable.

Tier 3

Prof y t n u il

Lexington

DAVIDSON

This analysis combines data associated with Social Determinants of Health (poverty, education, and minority populations), Community Risk Factors (number of health care workers and access to grocery stores), and Health Risk Behavior/Outcomes (heart disease, stroke, and cancer).

0

5

10

20 Miles

Data Sources: NC State Center for Health Statistics, NC Center for Geographic Information and Analysis, US Census

Socio-economic Status • According to the 2009 US Census, the median income in Yadkin County was $40,939.

• Approximately 13.4% of Yadkin County residents live in poverty.

• In 2011, Yadkin County had a 10.3% unemployment rate.

Industry - Private Industry - Manufacturing - Government - Transportation and Warehousing - Accommodation and Food Services Public Health Priority Areas identified in Community Health Assessment 1. Access to dental care 2. Diabetes management and education 3. Obesity 4. Teen Pregnancy The top three leading causes of death in the County are: - Cancer-22.7% - Diseases of the Heart- 20.0% - Chronic Lower Respiratory Diseases- 8.5%

Study Area Profile

35

photo by www.bikepedimages.org Dan Burden

Chapter Three PRIORITY INITIATIVES FOR AN ACTIVE LIVING ENVIRONMENT

Priority Initiatives for an Active Living Environment

38

Local government and community leaders throughout the region submitted forty (40) Priority Initiatives to help improve their communityâ&#x20AC;&#x2122;s built environment, make active living more possible, and to be considered for CTG Project support. All project descriptions provided in this chapter are adapted from information submitted by these regional leaders. The Initiatives are listed using a letter, which is associated with its county, and then a number. This will allow for additional Priority Initiatives to be easily incorporated into future plan updates.

Priority Initiatives are projects that both meet the goals of the CTG Project and Region 3 local communities.

Planning Goal #7

Create a document that can easily be modified and updated as new priorities and projects are identified.

Chapter Organization

This chapter is organized into three parts: A) Priority Initiatives Overview and Matrix, B) Category I Priority Initiatives, and C) Category II Priority Initiatives.

A. Priority Initiatives Overview and Matrix This section provides a complete listing of all forty (40) Priority Initiatives submitted from regional leaders. These are listed within a Prioritization Matrix that includes criteria established by the Northwest Partnership for Public Health.

This section ends with the Total Health Model Map, including the spatial placement of the Priority Initiatives; this map reflects a significant criteria used within the Prioritization Matrix.

B. Category I Priority Initiatives The Category I projects have been established by Northwest Partnership for Public Health as the highest ranking Priority Initiatives for the region. This section provides an extenisive description of these eight (8) major projects.

C. Category II Priority Initiatives This section provides a description of the other 32 Priority Initiatives. These projects are organized according to their county.

4. Supports a State or Regional Plan

Ti

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6. Serves both Workplace and Residential Areas

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3. Multi-jurisdictional Impact

Pr io

2. Serves a Tier 1 or Tier 2 Health Distressed Area 5. Identified within a Local Plan

rit yf or Mu er Lo 1 lti ca or lH -j Ti ur ea er isd lth Id 2 en ict St H tif io ea af ie na l f t d h lI in Di Id m st en pa aS re tif ct ta ss ie te ed d or Wi Se Ar Re th ea rv in es gi on aL Wo al oc rk Pl al pl an ac Pl e a n an d Re sid en tia lA re as

1. Local Health Staff Short-Term Priority

Ne a

Matrix Criteria

Priority Initiatives Overview and Matrix

Alleghany A.1

Alleghany Wellness Center Design

A.2

Alleghany Recreation Master Plan

A.3

Crouse Park Site Master Plan

A.4

Sparta Greenway Phase I Engineering

A.5

Downtown Sparta Streetscape Phase II Engineering and Design

 

  

   

 

   

Prioritization Matrix

Ashe

Category

B.1

Beaver Creek Greenway Trail Plan

B.2

Multi-Purpose Trail Implementation

B.3

Ashe County Outdoor Recreation Plan



C.1

Davidson Lake Thom-A-Lex Environmental Education Trail Construction Documents



C.2

Thomasville Parks and Recreation Master Plan

C.3

Bike Transportation Implementation

C.4

Wilcox Bridge Plan

C.5

Hughes Park Planning

C.6

Abbotts Creek Greenway Phase II



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 

     



 



    



 

  





   

 



Davie D.1

Greenway Master Plan

D.2

Old High School Re-Purposing Engineering and Design

 

E.1

Forsyth Stratford Road Rail-Trail Feasibility



E.2

Downtown Pedestrian Environment Study

E.3

Sidewalk Missing Link Study

E.4

Development Ordinance Review and Overhaul

Wake Forest Innovation Quarter Trail North Planning E.5 Priority Initiatives

 



    

    

39 39

al Di Im St st pa re at ct ed e ss or ed Se Wi R Ar rv th eg es ea in Wo a L iona lP oc rk pl al la ac n P lan e an d Re s id en tia lA re as

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Pl an an

Stokes F.1

Comprehensive Land Use Master Plan



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 



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



  

Surry

Prioritization Matrix

ce

la

40 G.1

Stone Mtn. to Elkin Trail Master Plan

G.2

Wayfinding Signage Plan

G.3

Greenway Feasibility Analysis

G.4

Pedestrian Plan Implementation

G.5

Surry County Regional Recreation Master Plan

G.6

Mountains-to-Sea Trail Foot Bridge Design

G.7

Trail Master Plan: Elkin Municipal Park to Crater Park to Chatham Park







        

   

Watauga H.1

Middle Fork Greenway Phase II Design/Development

H.2

Historic Valle Crucis Village Trail Engineering Wilkes

I.1

Stone Mtn. to Elkin Trail Master Plan

I.2

Town of North Wilkesboro Parks and Recreation Master Plan

I.3

North Wilkesboro Downtown Engineering



Yadkin J.1

Yadkinville Community Park Phase II Engineering and Design

J.2

Jonesville Greenway Extension

J.3

Yadkin County Park Design and Engineering

J.4

5-D Engineering

J.5

Rockford River Access

    

  

     

 

Total Health Model and Priority Initiatives ALLEGHANY

ASHE

g and Design

A.3 Sparta A.4 A.5

G.2 G.3

A.1 B.3

A.2

G.4

Jefferson

G.5

B.2

Danbury

Dobson

B.1

nstruction Documents

F.1

SURRY

I.1

WATAUGA

WILKES

G.6 J.5

G.7

H.2

sign

Boone I.3

I.2

Wilkesboro

J.4

Study

J.1

Yadkinville J.3

E.2 E.4

Overhaul g

速

Based on natural breaks within the data distribution, three tiers have been established to provide a relative understanding of health determinants throughout the region.

Mocksville C.5

Lexington C.6

Tier 3

11 - 20%

Tier 2

20.1- 27 %

n Tier 1

27.1 - 36 %

0

5

10

C.2

C.1 D.2

k to Chatham Park

Master Plan

E.5 E.1

DAVIE

D.1

Tier 1 areas, or those with higher percentages, are most vulnerable. Note that some

y Phase II Design

E.3

Winston-Salem

Total Health Model Percentage* Master Plan

FORSYTH

YADKIN

J.2

H.1

STOKES

G.1

20 Miles

C.4

DAVIDSON

*This analysis combines data associtated with Social Determinants of Health (poverty, education, and minority populations), Community Risk Factors (number of health care workers and access to grocery stores), and Health Risk Behavoir/Outcomes (heart disease, stroke, and cancer).

nd Design Data Sources: NC State Center for Health Statistics, NC Center for Geographic Information and Analysis, US Census

C.3

A1: Alleghany Wellness Center

Project Name: Alleghany Wellness Center

General Description This project includes developing a site master plan for the Alleghany Wellness Center along with detailed schematics for a multi-use gymnasium facility. This initial design work will help launch a capital campaign to secure project funding. The campaign materials must show an artistic schematic and preliminary budget.

42

Need The only gyms available in Alleghany County are related to the school system. Although the school system does allow public use, school functions take a priority. This often leaves other public (Alleghany Recreation Department) and private (Alleghany Wellness Center) entities without available space for their programming. This also leaves the general public without indoor space available for free play, especially in the winter season when school athletics are most active.

Priority Initiative #: A1 Location: Alleghany County Key Partner(s): Alleghany Wellness Center & Alleghany County Goal: Develop a complete site plan for the Alleghany Wellness Center including design schematics for the future multi-use gymnasium facility expansion.

Alleghany Wellness Center Located Outside of Sparta, NC is poised to launch a campaign for a new gymnasium and master plan.

Sparta Co oa sR llin

d

Alleghany County Manager and board members of the Alleghany Wellness Center discuss with the consultant team how to make the grounds more activity focused.

Alleghany County

Wellness Center

Health Impact Access to additional indoor recreational space will allow for a significant expansion in exercise opportunities for both adults and youth. The wellness center is primarily geared toward adults, but a detached multi-use gym will provide a host of new youth-centered programming opportunities. This facility will increase active living during the winter months.

Making the grounds more active is one goal of this project.

Existing Wellness Center Building

West side of Wellness Center as it currently exists.

Category I Priority Initiatives

43

B1: Beaver Creek Wellness Trail

Project Name: Beaver Creek Wellness Trail

General Description The old Beaver Creek School in West Jefferson no longer exists, but its former grounds now serve as public recreation space and an industrial park, which will anchor the planning effort. This greenway plan and process will include landowner outreach, the identification of alternative trail routes, and the location and design of support facilities. The trail plan will show linkages between existing recreation facilities and surrounding businesses and neighborhoods.

44

Need This location is situated in a highly populated residential area with an opportunistic neighborhood connection. The Beaver Creek Greenway Trail will establish a safe area for workers and residents of all ages to walk or run. There are currently no existing multi-use trails within this area of the county.

Priority Initiative #: B1 Location: Ashe County, NC Key Partner(s): Ashe County Parks & Recreation; Ashe County; Appalachian Regional Health District.

Goal: Develop a greenway master plan to connect Ashe County recreation facilities, a residential neighborhood, an industrial park, and Ashe County Project on Aging and Day Facility.

Health Impact A Beaver Creek Greenway would make walking highly accessible and easy to local residents, workers, and visitors. Local health staff can develop new greenway-centered programs and fun activities to encourage fitness and community growth.

Ashe County Parks & Recreation Director, Scott Turnmyre along with local resident Hannah Abee, who is spearheading the effort, walk the location for the proposed trail with the consultant team. Significant views of the northern peaks of Ashe County would be an asset for trail users.

Ashe County

Ingles

The proposed trail would connect residential neighborhoods (shown in light green), work places (shown in purple) and potentially the Ashe County Project on Aging facility (Generations Developmental Day).

Generations Developmental Day

Smith Aerospace Components, Inc.

Mount Jefferson

Co

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act

Res

cho ol R d.

n ty L a n d

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B ea ver Cre ek S

Neighborhood Connector

Sch o l Street o T Ashe Co u

kk

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B e a v ee rr CC rr ee ee

Light Industry/ Workplace

oo

Workplace Connector

Smith Aerospace Components, Inc.

rh

R ay Taylor R oad

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V fr

A vision for the proposed trail would include a connector to growing industry and workplaces such as the Smith Aerospace Components, Inc.

Category I Priority Initiatives

45

C1: Lake Thom-A-Lex Environmental Education Trail General Description The Lake Thom-A-Lex Environmental Education Trail will implement a major element identified within the Lake Thom-A-Lex Master Plan. The trail will traverse the lake’s northern shoreline, which is owned by the cities of Lexington and Thomasville. The trail will provide for educational interpretive sites, campsites, and passive recreational opportunities.

46

Need Although Davidson County has a population of 163,000, there are few facilities for passive or active recreation, particularly for adults. In 1999, the Lake Thom-A-Lex Recreational Authority Committee (RAC), which is comprised of appointed private citizens, governmental staff, and an elected official from the cities of Thomasville and Lexington and Davidson County, adopted a Master Recreation Plan for Lake Thom-A-Lex. All three governing bodies approved the Master Plan and trail development remains the priority for implementation. With a renewed interest in the public health and welfare, as well as a desire for increasing tourism, Lake Thom-A-Lex is recognized as an untapped opportunity for creating a significant passive recreational site in the heart of Davidson County.

Davidson County Planners and Public Health Professionals discuss the Lake Thom-A-Lex Master Plan, shown at right.

Davidson County

Project Name: Lake Thom-A-Lex Environmental Education Trail Priority Initiative #: C1 Location: 814 Yokley Road, Lexington, NC 27295 Key Partner(s): Lake Thom-A-Lex Recreational Authority Committee, Davidson County Planning and Davidson County Health Department Goal: Design six miles of educational trail and get trail “shovel ready” for bidding of construction.

Health Impact The Master Plan calls for six (6) miles of nature trails, educational interpretive sites, canoeing/kayaking opportunities, and an active recreation playground. The trail system is the priority for implementation and will anchor all other recreation amenities. The interpretive sites will provide incentive for school children to visit and walk the trail, and the passive nature of the activities will provide physical activity options for all ages. The lake is centrally located and conveniently serves the county’s population center.

This northern section of the park could include two trails: the main nature education trail as well as a multi-use trail for varied user experiences. A kiosk would direct trail users from the parking lot and provide “Kids in Parks” activity pamphlets.

Lake Thom-A-Lex Category I Priority Initiatives

Planted buffer (30’ Minimum)

Educational Trail 6’ width with natural surface

Multi-Use Trail 10’ Wide Paved

Existing Cove and Parking at Marina

Trailhead Kiosk

Parking

47

D1: Davie County Greenway Master Plan General Description The Davie County Greenway Master Plan will create public interest and provide a strategic plan for creating a multi-use trail system to connect county residents and visitors to parks, schools, historical sites, workplaces, medical facilities, commercial areas, and other community assets.

48

Need No significant multi-use trails exist in the county. A well-planned multi-use trail system will connect Davie County and its many assets and communities. As Davie County and its Recreation Advisory Council plan for a re-purposing project on the county’s soon-to-be abandoned high school, this major asset can serve as a key anchor for a greenway system. The Town of Mocksville currently has a greenway plan, but a plan has never been created for the county as a whole.

Furthermore, a key “action strategy” of the recently developed Davie County Recreation Master Plan is to develop a county-wide greenway plan.

The Davie County Comprehensive Recreation Master Plan calls for the following Action Strategies: -Commission a county-wide Greenway/Bikeway Master Plan.

-Select a strategic pilot project and construct a quality greenway section for the public to enjoy and build excitement for additional trail sections.

Davie County

Project Name: Davie County Greenway Master Plan Priority Initiative #: D1 Location: Davie County Key Partner(s): Davie County Planning and Davie County Health Department Goal: Develop a greenway & blueway master plan for Davie County while generating community interest and momentum for implementation.

Health Impact Davie County has limited passive recreation opportunities. While youth sports remain popular among area residents, there are no linear parks that connect and encourage walking. A greenway system will not only provide an easy outlet for all types of residents, but will also provide health staff with a new resource from which they can establish new programs and activities.

A county-wide greenway plan would identify opportunities to link together the countyâ&#x20AC;&#x2122;s community centers, schools and college campuses with its natural assets such as the Yadkin River and its tributaries.

Vision for greenway trail along Yadkin River.

Bull Hole i Yadk

r i ve nR Category I Priority Initiatives

49

E1: Stratford Road Rail-Trail Feasibility General Description This trail master plan will explore the rail line along US 158 (Stratford Road), which has remained idle for years. Stratford Road serves as a critical transportation corridor connecting various community assets, commercial areas, destinations, and neighborhoods. However, this corridor fails to provide any means of alternative transportation. This plan will provide a strategy and plan for connecting area resources to the rail trail.

50

Need Stratford Road is a traffic-laden, four-lane highway with disconnected sidewalks, no bicycle facilities, and insufficient right-of-way for providing such amenities. A rail trail path along Stratford Road would be ideal, providing a safe and convenient avenue for bicycle and pedestrian travel along the busy corridor. This project would be a â&#x20AC;&#x153;game changerâ&#x20AC;? for the City of Winston-Salem, serving as a major alternative transportation corridor with high public visibility.

Project Name: Stratford Road Rail-Trail Feasibility Study Priority Initiative #: E1 Location: Winston-Salem Key Partner(s): City of Winston-Salem; Forsyth County Health Department; Local Trail Groups Goal: Create a trail master plan that focuses upon the abandoned rail line along Stratford Road between Winston-Salem and the Village of Clemmons.

The Study Area: a 10+ mile corridor between Winston-Salem and Clemmons, NC.

Key issues for urban greenways are safe intersections and creating a pleasing environment where users feel a sense of security.

Forsyth County

Health Impact According to a recent survey, many residents do not feel comfortable bicycling on roads with motor vehicles travelling at high speeds. To establish a successful alternative transportation system, the city must create an independent trail system that connects residential, commercial, office, and other land uses. The Stratford Road Rail Trail will serve as a model facility for launching a new era of active living in Winston-Salem.

Stratford Road

“It would highlight active transportation unlike any other project [in the region]” -Matthew Burczyk, AICP Bicycle and Pedestrian Coordinator, City of Winston-Salem The rail-trail could provide for a 12’ wide paved multiple-use trail.

The abandoned railway line makes for significant opportunities to connect destinations such as schools, stores and neighborhoods.

Opportunities abound for re-using existing infrastructure, such as bridges, along the corridor.

Category I Priority Initiatives

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F1: Stokes County Comprehensive Plan General Description The Stokes County Comprehensive Land Use Plan will examine planning needs for the next 20 years related to land development, transportation, recreation, economic development, tourism, and infrastructure. The planning process will incorporate extensive citizen input and collaboration. This plan will ensure that future growth is thoughtful, protects natural resources, and increases opportunities for new business.

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Need The last plan was developed in 1994 and today serves as a general land use guideline. The plan does not provide the detail necessary to provide for growth and land use protection in the 21st century. The county needs to undertake a proactive process and plan to generate and prepare for future growth.

Stokes County has many assets and opportunities for both growth and protection; without a well devised land use plan, growth will continue to occur in an incoherent manner, and the county will remain vulnerable to development not in the best interest of its citizens.

Health Impact The county is bisected by a mountain range that geographically divides its commercial and industrial base from its rural and outdoor roots. A comprehensive plan will provide county leaders with strategic direction as they work to create greater accessibility to community assets and public land. It will also identify the opportunities to create new jobs and a better lifestyle for county citizens.

Photo by others

Stokes County

Project Name: Stokes County Comprehensive Plan Priority Initiative #: F1 Location: Stokes County Key Partner(s): Stokes County Economic Development and Planning, Stokes County Health Department.

Goal: Develop a Comprehensive Land Use Plan for Stokes County to address growth needs for the next 20 years.

Forsyth Tech is an anchor around which new development will likely occur. The Comprehensive Plan can identify community goals for how that new development should occur.

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G1: Stone Mountain to Pilot Mountain Trail Master Plan

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General Description This planning initiative will identify preferred and alternative trail routes and recreation support facilities necessary for connecting Stone Mountain State Park and Pilot Mountain State Park via 50 miles of hiking trails and multi-use greenways. This plan will incorporate existing regional trail systems including the Mountains-to-Sea Trail, Overmountain Victory National Historic Trail, and the Yadkin Valley Heritage Corridor.

Need This trail project is a priority for Wilkes County, Surry County, the Yadkin Valley Heritage Corridor Partnership, the North Carolina State Trails Program, and Elkin Valley Trails Association (EVTA), which is the non-profit entity spearheading this effort. Many landowners have provided verbal commitments between Stone Mountain and Elkin, and the State is prepared to support project funding with proper planning in place. This project is recognized within the Surry County Greenway Master Plan and dovetails into the Town of Elkin Greenway Master Plan. From Elkin to Pilot Mountain the trail will parallel the Yadkin River and ultimately connect to the existing 25-mile Sauratown Trail that connects to Hanging Rock State Park.

Project Name: Stone Mountain to Pilot Mountain Trail Master Plan Priority Initiative #: G1 Location: Wilkes & Surry Counties Key Partner(s): Elkin Valley Trails Association; Surry County Health Department; Wilkes County Health Department.

Goal: Stone Mountain to Pilot Mountain Trail Master Plan

In 2007, The Town of Elkin adopted a Greenway Master Plan. This larger planning effort will incorporate and connect to the proposed Elkin Greenway system.

Representatives from the Elkin Valley Trails Association and the Surry County Director of Parks and Recreation discuss key trail sections with the consultant team.

Wilkes and Surry Counties

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Health Impact This trail will increase quality of life and serve as one of the most significant recreational resources in the region and state. This would create extensive opportunities for hikers, runners, cyclists and equestrian users and make participation in these activities much more attractive.

The trail will traverse scenery such as the above waterfalls, edges of vineyards and farmland as well as the dramatic views of Pilot Mountain.

Category I Priority Initiatives

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H1: New River Headwaters Trail: Middle Fork Greenway Design General Description This engineering study will focus on a 1.5 mile greenway section connecting Town of Blowing Rock sidewalks to the new Blowing Rock Acute Care Facility on Highway 321. All landowners, including the Town of Blowing Rock, National Park Service, NC Department of Transportation, and Appalachian Regional Health Care have all agreed to provide a trail easement. The study will identify the precise trail alignment, prepare for easement recording, and provide documents for construction.

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Upon completion, the Middle Fork Greenway will be six miles and connect the towns of Blowing Rock and Boone. This greenway is part of the proposed 35-mile New River Headwaters Trail, which will connect Blowing Rock, Boone, and Todd in Ashe County.

Need The Middle Fork Greenway will connect Boone and Blowing Rock, two major communities in the region. This specific section will also connect major assets that include a shopping center, the Blue Ridge Parkway, Mountains-to-Sea Trail, and the new Appalachian Health Clinic. This greenway is identified as part of the 2013 NC Department of Transportation Bicycle Master Plan, the 2011 Boone Area Outdoor Recreation Plan, and the 2010 Citizensâ&#x20AC;&#x2122; Plan for Watauga County.

Middle Fork Greenway is a section of the New River Headwaters Trail which will connect Blowing Rock to Todd through Boone, NC. D L E M I D

Watauga County

K F O R

Project Name: New River Headwaters Trail: Middle Fork Greenway Design Priority Initiative #: H1 Location: Blowing Rock, NC Key Partner(s): High Country Pathways; Middle Fork Greenway Task Force; Appalachian District Health Department, Appalahcian Regional Healthcare System.

Goal: Develop engineering documents for the Phase II section of the Middle Fork Greenway

Representatives from High Country Pathways, a local nonprofit dedicated to new trails in the NC High Country, NC Department of Transportation representative and the consultant team identify possible trail locations.

Health Impact This greenway will provide easy access to a major regional population center. This will benefit families with young children, the elderly, students, and those seeking alternative transportation opportunities. The preservation of open green space provides for an improved quality of life.

The greenway section would connect Shoppes on the Parkway to the proposed Blowing Rock Acute Care Facility.

Blowing Rock Water Treatment Plant

Blowing Rock Road

Middle Fork of the New River

The trail would parallel Blowing Rock Road (Hwy 321) before entering National Park Service property.

Category I Priority Initiatives

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J1: Yadkin County Park

Project Name: Yadkin County Park Improvements

General Description This project includes the renovation of existing facilities and proposes additional recreational opportunities at Yadkin County Park. Facility improvements include additional baseball/ softball fields and lighting to the existing fields.

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Need Yadkin County Park has been in operation since the mid 1970â&#x20AC;&#x2122;s with few updates or new facilities. Yadkin County currently has a Yadkin County Park Master Plan available for this project.

Adopted in 2012, the Yadkin County Park Master Plan documents the public participation process and describes in detail the proposed expansions and improvements to the existing park.

Yadkin County

Priority Initiative #: J1 Location: Yadkin County, NC Key Partner(s): Yadkin County Goal: Develop new recreation facilities in the exisitng park

Health Impact This project will provide the opportunity for citizens to exercise and stay healthy through outdoor recreation.

By providing improved facilities, a greater sense of care and safety can be established. Furthermore, by providing a multitude of opportunities, the park improvements will serve both old and young visitors.

The Master Plan calls for new active recreation such as ballfields as well as passive recreation including expanding the existing trail facilities.

Category I Priority Initiatives

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Category II Priority Initiatives There are 32 Category II Priority Initiatives, which are eligible for future CTG Project funding, but did not rank as high as the Category I projects (see Prioritization Matrix, page 40). The project descriptions were provided by local community leaders working to develop these projects. All initiatives are organized by county.

60 Alleghany County A.2 Alleghany County / Town of Sparta Recreational Master Plan General Description Facilitate, develop and write a joint recreational master plan for Alleghany County and the Town of Sparta.

Need Alleghany County and the Town of Spartaâ&#x20AC;&#x2122;s current master plan was written in 2005 using public input information from 2003-2004. The written plan is 8 years old and the public input portion is 10 years old.

This plan helped the County and Town achieve many goals and receive significant funding from the NC Parks and Recreation Trust Fund. It is time to update this plan.

Health Impact This plan will be the basis for all recreational facilities and programming/opportunities for the next 5-10 years. There will be no other document created that has more impact on recreational built environments or recreational programming than this plan.

A.3 Crouse Park Site Planning General Description The Town needs to complete a master plan for Crouse Park which offers many activities including a stage, basketball, volleyball, walking trail, playground, stream, picnic areas and a house for hosting events. The Town and Blue Ridge Business Development Center recently acquired two additional properties.

Need A master plan is needed for Crouse Park as one has never been completed. With the addition of the two properties a plan regarding current use and future expansion is needed. The park is located one block off Main Street and is used by many county residents. A formal plan will ensure that the park will continue as an asset for the town.

Health Impact Crouse Park is one block from Main Street and within walking distance of two apartment complexes, senior citizens center, the hospital, and two schools. Appropriate planning will encourage and enable all citizens to utilize the park to its fullest potential and add to the overall health of the community.

The above custom online form was developed for local communities to submit Priority Initiatives to be included within the Health by Design Plan.

A.4 Sparta Greenway - Phase I General Description The next step for Phase I construction of the Sparta Greenway is the need for construction documents. The greenway begins at Crouse Park, crosses over East Whitehead St., and ends at Memorial Park Drive. From there the greenway connects to sidewalks and incorporates a section of Main Street before connecting back into Whitehead Street and Crouse Park.

Need Alleghany County’s 2005 Parks and Recreation Plan states that 83% of respondents indicated they currently use walking or jogging trails or plan to in the future. The Town of Sparta’s 2006 Pedestrian Transportation Plan states that 78% of citizens walk for exercise/recreation. Greenways were identified as a major need to accommodate this form of recreation. The Town has a Council approved Greenway Master Plan and the Phase I Plan.

Health Impact Phase I will provide recreational opportunities currently not available. The greenway will afford convenient access to destinations, encouraging citizens to walk instead of drive and with less traffic thus improving air quality. Phase I of the greenway will connect park, outdoor spaces, retail, and provide improved safety for downtown pedestrians.

A.5 Phase II Downtown Engineering Plans General Description The Town of Sparta is seeking to complete Phase II Engineering Plans for the Downtown Streetscape. The streetscape plan is an overall plan for the core downtown section of Sparta which will encourage more pedestrian traffic by making it safer for pedestrians and motorists while making it more attractive for citizens and visitors.

Need Engineering Plans for this project will enable the Town to be ready to begin the process of construction and/or rehabilitation of the downtown sidewalks, traffic lanes, storm water control, etc. This project is the next step for implementing the Streetscape Conceptual Design adopted by the Town Council.

Health Impact Engineering for the Streetscape will provide plans that will design roads and sidewalks that will connect downtown destinations, residences, businesses and encourage more walking offering opportunity for health benefits. The improved sidewalks and roads will be safer for pedestrians and motorists which will also benefit the public’s health.

Category II Priority Initiatives

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Ashe County B.2 West Jefferson Trail Development

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General Description The 2010 Comprehensive Pedestrian Plan for the Town of West Jefferson calls for a multi-purpose greenway trail connecting the existing sidewalk system and the proposed Assisted Living Center to the existing trail at Ashe Services for the Aging.

Need The trail will provide much needed connectivity between the downtown and its rural surroundings.

Health Impact Residents at Ashe Services for the Aging and the proposed Assisted Living Center can exercise on a longer trail, creating longer exercise times and more fit residents. The trail can also be used by Town residents and visitors.

B.3 Ashe County Park Outdoor Fitness Course General Description This course will provide specific fitness stations to allow for a self-paced fitness course. Some stations will simply allow calisthenics while others will involve stationary built-in exercise areas. Plaques and illustrations will be provided to explain the exercise. The course will also provide a measured walking trail.

Need This project would be located within the population center and allow park visitors to participate in a self-paced fitness course and develop a better plan for personal fitness. The course would have stations and exercises for all age groups and provide repetition options for beginner, intermediate, and advanced. There are currently no existing plans that relate to this initiative.

Health Impact The course would allow residents of all ages and diverse physical abilities to become involved in developing and initiating a personal wellness plan with a self-paced course. The course would be designed to promote success and present a challenge based on current physical status and encourage continued progress.

Davidson County C.2 City of Thomasville Parks and Recreation Master Plan General Description Develop a City-wide recreation plan for improving and expanding the City recreation system.

Need The last Master Plan was done in 1999 and the plan needs to be completely updated. Thomasville has experienced much change in the last decade and a new plan will reflect the changing population, economy, and recreation needs.

Health Impact This plan will improve the community’s ability to promote healthy programs and activities for the citizens of Thomasville. Parks and recreation facilities must provide for exercise classes and sporting events.

C.3 City of Thomasville Bicycle Transportation Plan General Description This plan was adopted by the Thomasville City Council in 2009. It provides a broad vision and a more specific set of goals and strategies to improve the City of Thomasville’s bicycle transportation system.

Need The City is in need of a more accessible bicycle-friendly transportation network.

Health Impact This will provide a safe and accessible place to walk and bicycle, which can help communities reduce automobile trips and traffic congestion, and in turn, reduce air pollutants and increase the overall health of the community.

C.4 Wilcox Bridge Plan General Description The Wilcox Bridge spans the Yadkin River and connects Davidson and Rowan Counties. This 1920’s bridge will soon be abandoned and Davidson County will take over ownership. The bridge will ultimately provide a pedestrian connection between a Davidson County Civil War site and a proposed bikeway extension planned

by Rowan County.

Category II Priority Initiatives

Need NCDOT will soon provide ownership of this bridge to Davidson County. The Wilcox Bridge Plan will provide details for bicycle and pedestrian use, parking areas, and a Civil War interpretive center.

The existing Civil War site has no parking availability.

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Davidson County Health Impact A pedestrian bridge with parking on the opposite side of the Yadkin River will allow not only local citizens the chance to walk, but also allow for I-85 travelers to stop for a visit. Also, the Town of Spencer would like to expand their bikeway to the river and pedestrian bridge.

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C.5 Hughes Park Improvement Plan

General Description Three little league ballfields currently exist on the 17.5 acre park. Improvements needed include additional parking, ballfields, and soccer fields.

Need Davidson County needs additonal ballfields for their growing youth sports programs. Only 50% of this property is currently occupied. An improvement plan to utilize the remaining acreage would help the County meet the public demand.

Health Impact Davidson County has a health initiative to combat childhood obesity. Therefore, youth sports programs are highly promoted. However, available parks are limited. Improving this park would further the County’s initiative.

C.6 Abbotts Creek Greenway Feasibility Study Phase II General Description A greenway study is needed for approximately six (6) miles along Abbotts Creek from the Business 85 Bridge to Finch Park south of Lexington.

Need This particular greenway will create passive and active recreational opportunities for those who enjoy off-road bicycling and horseback riding.

Health Impact Davidson County is promoting bicycling as a physical activity for its citizens. There are segments of bicyclists who wish to ride “off road,” and those who have safety concerns with riding on the road. This greenway will serve as both an interesting and safe place for cycling.

Davie County D.2 Re-Purposing Old High School Engineering and Design General Description There are plans to replace the county high school, which would allow the current school to be re-purposed for recreation.

Project Need A plan is needed to begin developing public and political support for the project. Also, the plan should allow the community to procure grant funds.

Health Impact The existing high school is located in the southern area of the county, providing access to the Countyâ&#x20AC;&#x2122;s most

Forsyth County E.2 Downtown Pedestrian Environment Study General Description Perform a study of the pedestrian environment in downtown Winston-Salem to determine where improvements are most needed and assess criteria such as sidewalk width, pedestrian signals, curb ramps, ADA accessibility.

Need Winston-Salemâ&#x20AC;&#x2122;s downtown pedestrian facilities range in quality and style and do not present a uniform appearance or user experience. Some intersections have pedestrian signals, curb ramps, crosswalks, and other features, and some sidewalks are wide and comfortable for walkers. However, some streets and intersections have lower quality facilities, or no facilities at all. To continue to improve the most walkable sections of Winston-Salem, it would be beneficial to have a set of recommendations for where improvements are most needed.

Health Impact Downtown Winston-Salem has seen a resurgence in activity over the past 5-10 years with shopping, restaurants, and other features. By its nature, the downtown area encourages walking and physical activity over motor vehicle travel. Making downtown as walkable as possible will serve to continue that trend.

Category II Priority Initiatives

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E.3 Sidewalk Missing Link Study General Description Sidewalks were a part of development in the City of Winston-Salem for many years. However, from about 1950 to 2000, the city was built without sidewalks for the most part. There is now a concerted effort to go back and build sidewalks where they are most needed. This study would help us identify and prioritize missing segments in the network.

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Need The City collects sidewalk requests from residents and performs analyses to determine where sidewalks are needed. However, the City does not have the resources necessary to perform an exhaustive study of the existing sidewalk network to determine where the most critical missing sidewalk segments are located. Connections between residential areas and schools, employment centers, shopping areas, etc. are crucial and it will be beneficial to perform a study of how to best invest limited sidewalk construction funds.

Health Impact A complete sidewalk network is one of the most basic elements of an active transportation system. Nearly all residents can benefit from a complete sidewalk network, whether people walk for recreation or transportation. Providing well-connected sidewalks is crucial to encourage more activity.

E.4 Development Ordinance Review and Overhaul General Description The Unified Development Ordinance (UDO) for the City of Winston-Salem dictates how the Cityâ&#x20AC;&#x2122;s physical infrastructure will develop. One of the toughest challenges for creating a walkable and bikeable community is the sprawling nature of the development in Winston-Salem. This project would review the current UDO and provide policy improvement recommendations.

Need City/County Planning and City DOT have worked to improve the UDO as much as possible. However, the City has never had the resources to perform a full review of the UDO or to provide a strategic set of changes with a recommended implementation plan.

Health Impact The UDO dictates how the community will develop, and the current version contains some elements that will help build an active community. However, much of the UDO still provides for the continuation of sprawling development patterns. Local policy and ordinances must reflect the Cityâ&#x20AC;&#x2122;s stated desire to provide more active living opportunities.

E. 5 Wake Forest Innovation Quarter Trail North General Description The City of Winston-Salem is partnering with Wake Forest Innovation Quarter to build a bicycle/pedestrian path along an abandoned rail line between 3rd Street and Martin Luther King, Jr. Drive. That rail line continues to the north and is abandoned to 25th Street and would be replaced by a 10-foot bicycle/pedestrian path.

Need The City of Winston-Salem Greenway Plan includes a reference to this proposed project and its potential to connect downtown Winston-Salem to northeast section of the city. Providing a safe route between this neighborhood and downtown, Salem Lake, and the Wake Forest Innovation Quarter is a priority for the city.

Health Through surveys and public input, the City of Winston-Salem has heard repeatedly that for people to embrace active transportation options, there must be separate paths for walking and biking. Many residents do not feel comfortable bicycling on roads with motor vehicle drivers. In order to have a transportation system that promotes activity, the city must construct a complete network of paths that connects housing to jobs, recreation, entertainment, etc.

Category II Priority Initiatives

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Surry County G.2 Wayfinding Signage Plan

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Project Description To create wayfinding signage for public recreational opportunities that improve the health and wellness of the overall community and region.

Need The Pedestrian Plan that is still underway and the Mount Airy Parks and Recreation Comprehensive Master Plan, both recommend branded signage that identifies these facilities and helps direct user groups.

Health Impact This project can be implemented/duplicated in many other communities. Communities such as Chapel Hill have successfully implemented wayfinding signage and this serves as a unique opportunity to promote public health.

G.3 Greenway Masterplan Update and Feasibility Analysis Project Description The city has created 4.4 miles of greenway and has received funding for another 2.2 miles to connect the southern portion. A updated plan will assess the proposed southern greenway system and provide a feasibility study for greenway needs.

Need The Mount Airy Parks and Recreation Comprehensive Master Plan and the Ped Plan (underway) both advocate for the developement of improved connectivity. The city has invested in both of these documents as well as significant contributions for greenway development.

Health Impact This project will allow for improved health promotion opportunities as well as a strategic trail development. This project will also identify new and creative ways that greenways can be utilized to promote public health initiatives.

G.4 Pedestrian Plan Implementation General Description The implementation of the Pedestrian Plan will create greater connectivity and walkability throughout the community. This project seeks to address the identified sidewalks gaps and to fix sections of sidewalk that have potential safety issues.

Need The Ped Plan that is still underway and the Mount Airy Parks and Recreation Comprehensive Master Plan both advocate for the developement of improved connectivity. The city has invested in both of these documents and implementation assistance is critical.

Health Impact This project will promote physical fitness opportunities in a mixed-use environment. These areas are free to the public and these changes will significantly impact use for residents and visitors.

G.5 Surry County Regional Master Plan General Description This project would take a regional approach in recreation for Surry County and its neighboring counties. These counties include Wilkes, Alleghany, Grayson, Carroll, Stokes, Forsyth, and Yadkin populations.

Need The current Surry County Master Plan will no longer be viable past December 20, 2015. It is imperative that the Parks and Recreation Master Plan stay up to date and keep pace with the current needs of the citizens.

Health Impact This project will provide a direction for multiple parks and recreation departments to develop future active lifestyle initiatives and activities. This will help target the development of facilities within Surry County.

G.6 Design/Engineering for Footbridge on Developing NCMST Segment in Elkin General Description This project includes the design and engineering for a footbridge crossing over the Elkin Creek on a developing segment of the NC Mountains-to-Sea Trail in the city limits of Elkin, NC. Need This project will help complete a segment of the NC Mountains-to-Sea Trail from Stone Mountain State Park to Elkin. Elkin Valley Trails Association (EVTA) is spearheading this effort in partnership with NC State Trails, Friends of the NCMST, NC Rail-Trails, Inc., Wilkes and Surry Counties, Town of Elkin, corporate partners, private donors and a multitude of local volunteers.

Category II Priority Initiatives

Health Impact Trails and greenways provide communities the opportunity to improve public health and quality of life. Increased physical activity can help to overcome the obesity epidemic and the resulting health problems that exist in the country today. This trail will encourage physical activity and enhance the health and quality of life of all users.

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G.7 Master Plan for Trail from Elkin Municipal Park to Crater Park to Chatham Park Project Description This planning area extends from Chatham Park to the campground and boat landing in Crater Park and then to the Elkin Municipal Park. This plan will explore a multi-use trail from Chatham Park to the Elkin Municipal Park and identify a primary route between these three parks. It would include bridges, road crossings, traffic patterns on roads, parking for cars and bicycles, trailheads, use designation, campsites and assist in developing policy.

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Need There are currently no designated biking, running or hiking trails connecting these three parks in Elkin. Citizens would benefit from a designated walking, running and biking connection to the three parks. Existing plans include the Elkin Master Plan and the Surry Greenway Plan.

Health Impact This master plan would provide an excellent opportunity for walking, running and cycling within the town limits and connecting our parks. A complete in-town trail would make participation in hiking, cycling and running activities much more attractive. The Elkin Valley Trails Association and Town of Elkin could promote outdoor activities on the trail once completed.

Watauga County H.2 Historic Valle Crucis Village Trail Engineering Project Description With a general plan complete and trail easements secure, this project is ready for engineering. This 1.5 mile trail will connect Valle Crucis Park, commercial areas, and an elementary school.

Need Valle Crucis is a state designated historic district and is host to many visitors and events each year. A safe trail connecting the communityâ&#x20AC;&#x2122;s unique resources is desperately needed.

Health Impact The trail will encourage walking among commercial area, the park, and the elementary school.

Wilkes County I.2 North Wilkesboro Recreation Master Plan General Description The Town of North Wilkesboro recognizes the need for a Parks and Recreation Master Plan. A plan will direct us on the future of our parks and recreation programs. The current park system needs to be updated to provide a more inviting atmosphere for users.

Need This project will be critical for determining the future of our parks and recreation program. With a Parks and Recreation Master Plan, the Town could attract visitors into North Wilkesboro by giving them more opportunity.

Health Impact Parks and recreation is going to create new opportunity and provide significant public health benefits. It is critical that we provide a variety of recreation options within the town.

I.3 Phase II Downtown N. Wilkesboro Engineering General Description The Town of North Wilkesboro has begun to focus its efforts on the central business district. Current efforts are focused on making the downtown more accessible, especially for pedestrians. With an increase in pedestrain activity, the downtown can begin to attract more business and futher establish itself as a destination.

Need By creating an active living environment, the Town can promote both human health and economic vitality. This project is a key component of our adopted Pedestrain Plan.

Health Impact With a more pedestrian-friendly downtown, residents will be encouraged to walk more regularly as part of daily life. Bicycle lanes will encourage people to engage in more healthy transportation options.

Category II Priority Initiatives

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Yadkin County J.2 Yadkinville Community Park Phase II Engineering and Design

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General Description The Phase II improvements would expand the range of recreation options available to local residents and double the size of the current Park facility. A current plan highlights potential improvements, including a soccer field, additional play ground equipment, and an expanded walking track on the site.

Need The improved facility would expand the recreation offerings provided to Town residents. Residents who cannot afford private gym memberships and rely on the park to meet their leisure and exercise needs would be well served. The park would also be able to handle larger events held at the facility. With improved parking and additional restrooms, the park could host traveling sports teams, family reunions, and civic and church functions. Park expansion and development was mentioned in the Yadkinville Community Park Master Plan, Economic Development Action Plan, and in the 2025 Yadkinville Land Use Plan.

Health Impact By expanding the existing facilities, citizens and visitors alike could benefit from new amenities and improved health.

Adding variety to the Park offerings would help to increase the use of the facility and could be realized by installing new equipment. Added playground equipment would increase the capacity of the facility. New fields and courts will help attract adults and youth. By adding variety, the Town wants to encourage greater use of the Park and promote healthier lifestyles.

J.3 Jonesville Greenway extension General Description The Town of Jonesville currently has a plan to develop a greenway along the Yadkin River. This project will help extend that greenway further downstream.

Need This project is needed in order to extend the current greenway plan that the Town of Jonesville has.

Health Impact This will allow citizens the opportunity to exercise outdoors by walking, biking etc.

J.4 Reservoir Park (5D Park) General Description This project will include a walking trail, boat ramp, fishing pier and picnic shelters.

Need This project will provide a much needed opportunity for citizens to exercise outdoors.

Health Impact The project will provide an outlet for outdoor recreation and exercise.

J.5 Rockford River Access General Description This project is intended to find a suitable location for an additional river access along the Yadkin River for citizens.

Need Access to the Yadkin River is very limited and this will provide an additional public assess point.

Health Impact This will allow citizens access to the River to paddle, swim etc for outdoor recreation and exercise.

Category II Priority Initiatives

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photo courtesy www.bikepedimages.org Carl Sundstrom

Chapter Four ACTIVE LIVING DESIGN GUIDELINES

Active Living Design Guidelines Letâ&#x20AC;&#x2122;s Get Moving

These guidelines are divided into several categories relevant to Region 3, including downtowns, parks and playgrounds, suburban workplace campuses and rural roads.

Furthermore, the guidelines are accompanied by a stamp indicating the state of the evidence underlying each strategy as follows:

Supported by an emerging pattern of evidence Supported by Planning Theory & Case Studies

Evidence Based This indicates design strategies supported by a pattern of evidence from multiple research studies, suggesting a direct relationship between the suggested design intervention and the behavioral outcome.

Emerging Evidence This indicates design strategies supported by an emerging pattern of research. Although not yet definitive, the research suggests the design intervention will likely lead to increased physical activity.

Best Practice Design strategies with this stamp are not based on formal evidence, but rather an understanding of theory, behavior, and experience from existing practice which, if implemented, have the goal to increase physical activity.

Planning Goal 4:

Hea lt h

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This chapter serves as a resource for health and planning professionals from across the region. These general active living guidelines can be applied throughout the region.

Adapted from active living guidelines for urban areas, these have been expanded to include suburban and rural contexts as well.

Supported by Evidence from multiple studies

Develop general by evidence-based Design guidelines and recommendations for how communities can increase active living opportunities.

Tree Canopy helps encourage activity

Downtowns: Pleasing environments result in more physical activity. While it is said that aesthetics are in the eye of the beholder, research literature actually indicates that people generally agree on what they find attractive and what motivates them to get outside and moving.

A wide sidewalk that is “buffered” from the street encourages walking www.bikepedimages.com / Laura Sandt

Quality buildings, streets, and landscaping—trees, shrubs, flowers, and other plantings—make a community a more appealing place to be active (Kaplan and Kaplan,1989). Furthermore, attractive and well-maintained buildings, fine public libraries, beautiful streetscapes, and public art create places that inspire people to be physically active (Brownson et al., 2001). Accordingly, the design guidelines begin with practices to create appealing downtown environments.

Use trees & landscaping to separate pedestrians from motor vehicle traffic. Plants provide interest; they soften the appearance of hard surfaces and provide color, fragrance, and seasonal interest. Other benefits of street trees include providing shade and reducing the heatisland effect in areas with extensive pavement. Creating a buffer to separate pedestrians from moving vehicles is associated with increased walking (Larsen K, et al. 2009).

Downtown Destinations are key to getting people walking

Residential uses can occupy the top floors of downtown commercial buildings, creating a mixed use environment Photo by others

Active Living Design Guidelines

Develop attractive plazas, with public art, which provide destinations for walkers or cyclists. A public plaza is a publicly accessible space that excludes cars and promotes walking by providing pedestrians with a safe, comfortable space to gather or play. (Ewing R 2009).

Embrace density and mixed-use. Density in a downtown means there are enough people and attractive destinations close together to encourage people to walk. A mix of land uses allows commercial spaces, such as retail shops, galleries and restaurants, to mingle with residential units, such as loft apartments and townhouses, and with public facilities and buildings, such as libraries and post offices. Mixing land uses encourages active living by bringing people’s homes and workplaces closer to each other and other destinations (Bailey L. 2004). Greater density and mixed-uses are achieved through zoning that allows and provides incentives for residential uses in downtowns.

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Downtowns (continued) Encourage transit use by providing better bus stops. Recent research demonstrates a strong link between access to public transportation and physical activity; after all, transit use typically involves walking to a bus stop. To encourage and make transit use more accessible, bus stops should include a shelter, clear signage, and comfortable seating. Seating is particularly important for the elderly who might not be able to stand for extended periods.

Research demonstrates a strong link between public transportation and physical activity.

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Where conditions warrant, separate bikeways and vehicular traffic lanes with physical demarcations. Adding a buffer between bicyclists and cars increases the number of riders and their confidence because of an increased feeling of safety. (NYC DCP/NYC DOT. NYC Bicycle Master Plan, 2010). A physical separation is especially valuable on busier streets and major bicycle routes. The buffer may take many forms, such as a median or a parked car lane between the bicycle path and traffic lanes.

Photo by Teresa Buckwalter

Parking Lane acts as buffer between travel lane and bike lane

Provide refuge islands and mid-block crossings on downtown streets. Mid-block crossings are an important component for any downtown, particularly for longer blocks. These crossings, paired with a refuge islands, generate more opportunities for pedestrian movement.

And for wider roads, these islands provide a safe resting point for pedestrians to pause and avoid oncoming traffic.

Photo by Teresa Buckwalter

Create a buffer between sidewalks and vehicular traffic to generate more walking trips. Street trees, street furniture, and public spaces provide a buffer zone, create a safer walking environemnt, and are proven to increase walking (Boarnet M., Forsyth A., Day K., Oaks J.M.).

Provide seating, drinking fountains and restrooms. In focus groups, senior citizens reported that they would walk more often if benches and restrooms were provided. (Lockett D, Willis A, Edwards N 2005).

A mid-block crosswalk and pedestrian refuge island Photo by others

Increase a sense of personal security throughout the community.

Even when thoroughly pedestrian-oriented design is in place, people will not walk if they feel vulnerable to crime. The principals of Crime Prevention Through Environmental Design (CPTED), must be employed to create a true active living environment. Reducing crime and its associated fears can encourage people to walk and bike more often.

Outdoor cafes mean more “eyes on the street” Plants are kept low to the ground

Research shows that the key to helping people feel safe is to create a sense of community (Sampson et al., 1997). When neighbors share a sense of responsibility for each other and property, they are more likely to make safe places where people walk, bike, congregate or wait for transit.

Encourage new development to include porches, balconies, and windows that face streets, parks, and plazas. Such features help put more “eyes on the street.”

When people regularly keep a casual eye on public spaces, or even when building design provides an opportunity for people to watch the outside, crime decreases and pedestrians feel safe rather than isolated.

Schedule civic activities such as street festivals and outdoor concerts in public areas. These activities not only provide a chance for people to explore their downtown on foot, but it also increases the perception that these areas are patrolled and safe.

Appropriate amount of lighting and the addition of art work make for a more comfortable underpass.

Photos by others

Active Living Design Guidelines

Increase visibility by providing seating along the street. Encouraging the presence of street vendors and outdoor dining in areas that need the most surveillance.

Keep walls, fences and shrubs along the street below 5’ high. Keeping these elements low, eliminates potential hiding places and concealed pockets.

Place correct lighting along pathways and other pedestrian use areas. Avoid bright security lighting that can create blinding glares or deep shadows and hinder the view for potential observers. Eyes adapt to night lighting and have trouble adjusting to severe lighting disparities. Using lower intensity lights often requires more fixtures.

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Parks & Playgrounds

People with nearby access to parks are more likely to attain higher levels of physical activity (Giles-Corti et al, 2005). Furthermore, the presence of trees is associated with higher rates of walking among school-age children (Ewing 2009). While green spaces, parks and playgrounds are obvious places for activity, not all parks are designed to accommodate the full range of user groups. Furthermore, older facilities may not provide for the needed active living opportunities. This section addresses these opportunities and obstacles to active living.

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Natural Surface jogging trail

Paved path for cycling and other uses

Where possible incorporate dual paths in parks for a greater range of experience

Prioritize new paths, sidewalks and bus lines to connect existing parks. Many communities in northwest North Carolina might already have great parks and recreation areas, but a key challenge is to create easy access among all income groups and ages.

Consider range of age groups from elderly to children. Encourage design or redesign of parks, open spaces and recreational facilities to include a variety of recreation opportunities, which should include not only baseball diamonds and swing sets, but also natural areas and walking trails Encourage new residential development to incorporate green space and parks within the community. Local governments should provide incentives to developers for aggregating open space rather than creating small and effectively unusable spaces. Large areas that accommodate multiple forms of recreation allow the whole family to have fun together.

Reclaim abandoned infrastructure for new active purposes. The High Line in New York City is a well-known example of repurposing an old transit line to create an elevated park and walkway. Such reclamation and repurposing does not need to be relegated to large cities; this principal can apply in small towns and rural areas as well. For example, abandoned vehicular bridges can be repurposed as attractive pedestrian ways.

Photos by others

Reclaiming and re-purposing abandoned infrastructure for pedestrian plazas, walking paths and parks is an emerging trend.

Provide play area lighting to encourage physical activity into the evening. A nationwide study of adolescent girls indicates that streetlights and floodlights in recreation areas contributed to their increased activity levels.

Provide for multiple trail surfaces along a single trail corridor when possible.

An emerging sector of runners prefer a natural running surface to a paved trail. However, paved trails are preferable to many bikers, parents with strollers, in-line skaters and wheelchair users. In rural areas, equestrian trails can parallel paved trails as well.

Redesign playgrounds with ground markings to show dedicated areas for games, sports, and multiple use. A recent study found that redesigned color-coded activity zones engaged children in more vigorous activity compared to children at schools without the redesign.

Create interesting and challenging terrain in childrenâ&#x20AC;&#x2122;s outdoor play areas.

Children have been shown to physically acclimate to more demanding play areas. Additionally, children who played in natural areas scored better on physical fitness tests than children who played in conventional playgrounds.

Photos by others

Create a variety of climate environments to facilitate activity in different seasons and weather conditions. Provide sunny and wind-protected areas for use in the winter and shaded zones for use in the summer.

â&#x20AC;&#x153;Start with a hill! Playgrounds-should-not-be-flat, remember, and when in doubt start with a hill as the organizing feature of any playscape. Make it as big as your site and budget allows; a bigger hill is also great for bikes and winter sports.â&#x20AC;?

- from Playscapes Press

Active Living Design Guidelines

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Suburban Workplace Campuses Research indicates that access to trails and exercise facilities at work results in a significant increase in physical activity among workers (Emmons KM, Linnan, 1999). Conventional suburban campuses present several challenges for creating an environment conducive for walking. These areas are generally designed to only accommodate automobiles. Pedestrian infrastructure is often limited to only a front sidewalk for building access. Also, suburban campus environments tend to be somewhat sterile and generate little interest for potential lunch-time workers. However, with some basic design changes to improve the built environment and active living opportunities, research indicates that positive behaviors are likely to follow.

Conventional suburban workplace campus

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Provide well-marked and measured walking paths on sites to support pedestrian activity. On larger building sites and campuses, a marked, measured path has been shown to encourage employees to excercise (Project for Public Spaces, 2000). Effectiive wayfinding signs can provide distance points and estimate times to various points of interest.

Consider having a maximum number of parking spaces instead of a minimum.

Parking can affect the use of more active modes of travel such as walking, bicycling and public transit. In general, when parking is available, people use it. Research indicates that increased parking supply may result in reduced active transportation and public transit use. (Lund, Wilson, 2006).

Reduce parking spaces in parking lots that are under utilized.

Stripe bars can easily be added to existing pavement to indicate a pedestrian path around a parking lot. Adding bollards between the pedestrian way and travel lanes will help protect pedestrians.

Designed for automobiles, most suburban workplaces have a lot of room for trails, but rarely incorporate them.

Retrofitting suburban campuses to provide perimeter walking trails and distance markers can encourage greater activity during the work day.

25% Kids in rural areas are 25% more likely to be overweight than urban kids.

(Lutfiyya et al., 2007). www.bikepedimages.com Dan Burden

Active Transportation in Rural Areas Contrary to popular perception, biking and walking in rural areas plays a significanat role in the lives of the residents of those communities. The National Household Transportation Survey shows that in fact biking and walking are a significant and increasing part of small town life.

Residents within rural communities walk and bike almost as much (and in a few cases, even more) as residents of cities and inner suburbs. Bicycling, too, is far more prevalent outside of urban centers than many would expect. Among all bicycle trips taken in rural towns between 10,000 and 50,000 population, just as many people bike as in the urban core. Due in large measure to a lack of heavy traffic, smaller towns offer viable choices for people of all ages to travel without automobile dependence. Parents are more likely to let younger kids bike to school or baseball practice, while seniors feel more comfortable strolling to the library or local cafĂŠ, (Rails-to-Trails Conservancy).

Rural communities in Region 3 must continue efforts to improve and expand infrastructure to support rural interest in biking and walking. The NC Department of Transportation recently published a guide for Complete Streets in North Carolina which provides a resource for all communities in Region 3.

Establishing the Need for Active Transportation Infrastructure in Rural Areas Residents of certain types of rural communities walk and bike almost as much as residents of cities and inner suburbs.

Within small towns of 2,500-10,000 residents, people walk for work purposes (both community and during work) at a rate similar to cities and close in suburbs, (3.7 % of all trips, compared to 3.9%).

The share of work trips made by bicycle in small towns is nearly double that of urban centers.

-Active Transportation Beyond Urban Centers.

Rails-to-Trails Conservancys Conservancy.

Active Living Design Guidelines

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Active Transportation in Rural Areas Bikeways should be considered in all road projects. Pavement surface projects, signal replacement, re-striping, or pavement maintenance all provide an opportunity to improve rural bike infrastructure. Bikeways can be retrofitted onto existing streets and roads by making basic changes to signs, striping, and traffic signals

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Where feasible, provide a wide outside lane. The right-most through traffic lane is shared by bicyclists and motorists but designed with extra width to accommodate bicycles. A wide outside lane should be 14-16 feet wide.

Provide a Climbing Lane where terrain is steep and roads are narrow. On rural roads where downhill grades are long enough to result in bicycle speeds similar to typical motor vehicle speeds, a bike lane may be provided only in the uphill direction with shared-lane markings in the downhill direction.

One 10â&#x20AC;&#x2122; multiple use path separated from the road is more functional than two 5â&#x20AC;&#x2122; sidewalks along both sides of the road photo by Eric Woolridge

Provide for a multi-use path when feasible rather than installing narrow sidewalks.

A single 10â&#x20AC;&#x2122; wide, multi-use trail can support all user groups rather than narrow sidewalks on either side of the road.

Use pavement markings to visually reinforce the separation of areas for bicyclists and motorists.

Strategies include markings, painting bike lanes onto the road surface, or creating a printed buffer between the bike and traffic lanes.

Avoid hazards in the bicycle lane.

Drainage grates, with open slats that run parallel to the direction of travel, can catch a bike tire. Grates and utility covers present hazards to cyclists and need to be carefully designed.

A climbing lane on the uphill side for cyclists can be used on narrow rural roadways. photos by others

Bike tires can get stuck in drainage grates in the bike lane.

www.bikepedimages.com Dan Burden

Chapter Five STRATEGIC DIRECTION

Strategic Direction

88

Develop and Implement Plans Associated with the Highest Ranking Priority Initiatives within Each County.

This Strategic Direction represents the commitment of the Northwest Partnership for Public Health to create more active communities throughout the region and state.

Action Step 1.1 Commit Community Transformation Grant Project and other available resources toward the following Category I Priority Initiatives: • • • • • • • •

Alleghany Wellness Center Beaver Creek Greenway Wellness Trail Lake Thom-A-Lex Environmental Education Trail Davie County Greenway Master Plan Stratford Road Rail-Trail Feasibility Plan Stokes County Comprehensive Land Use Plan Stone Mountain State Park to Pilot Mountain State Park Trail Master Plan New River Headwaters Trail, Middle Fork Greenway Phase II

Action Step 1.2 Upon the Initiation of these detailed planning projects, reach out to potential future funding partners at the local, State, and national level.

These include the following: • • • • • • • • •

NC State Trails Program Parks and Recreation Trust Fund Clean Water Management Trust Fund Z. Smith Reynolds Foundation Kate B. Reynolds Charitable Trust Mary Reynolds Babcock Foundation Bikes Belong Foundation Active Living Research Appalachian Regional Commission

Grant Resources for Creating Active Communities Grant Resources for the Built-Environment Grant Agency Clean Water Management Trust Fund (www.cwmtf.net)

NC Water Resources (www.ncwater.org) Recreation Trails Program (ncparks.gov/About/grants/main.php) Parks and Recreation Trust Fund (ncparks.gov/About/grants/main.php)

NC Adopt a Trail Program (ncparks.gov/About/grants/main.php) Bikes Belong Foundation

NCDOT Transportation Plan For Bike and Pedestrian Projects

Active Living / Built-Environment Implications

Maximum Grant Amount

Matching Funds Required

Grant Deadlines

Land Acquisition: Fee Simple or Easement. Must protect floodplain areas.

Greenway trails and other park areas are allowed.

N/A`

Not specified, but 20% is competitive

February 1st

River access areas or greenways along rivers

N/A

50%

January 1st and June 1st

All types of trails and greenways

Normally: $75,000 2013: $200,000

25%

February 1st

All types of parks, trails, and recreation facilities

$500,000

50%

Small trail projects and trail signage

$10,000

0%

February 1st

Trails and Greenways

$10,000

20%

May 24th

Bike and Pedestrian Projects â&#x20AC;&#x201C; both engineering and construction

N/A (for major projects)

20% generally

Every two years (next request cycle fall 2013)

February 1st

www.dbdplanning.com Strategic Direction

89

Action Step 2.1

90

Establish the Northwest Partnership for Public Health (NWPPH)as the statewide leader for creating active communities.

Develop an Active Living Subcommittee within the NWPPH to support the Health

by Design Plan and its Priority Initiatives.

Action Step 2.2 Meet personally with State and Federal public health professionals to evaluate the Health

by Design planning model, including its strengths and lessons learned.

Action Step 2.3 Develop a Bi-Annual Health by Design Summit in North Carolina

Action Step 3.1 Establish a Summit/Conference where leading experts can help educate regional and state public health professionals about creating active communities.

Present the Health by Design plan, including its measured success, at future state and national professional conferences.

Action Step 3.2 Learn from each other by sharing local success stories and case studies from across the state.

Action Step 4.1 Strive to establish a Public Health Liaison to the local planning department. This health advocate would attend public meetings and seek to serve on planning boards or steering committees.

Utilize the Health by Design Plan to Further Integrate Public Health and Planning Goals Throughout the Region.

Action Step 4.2 Present to local planners and elected officials about the Health by Design Plan and the need for public health professionals to influence decision making about active living infrastructure.

Understanding the Process to Influence the Planning Process

Hea lt h

The best way for health professionals to influence the planning process is to understand the steps involved in a general or comprehensive plan and understand their role in shaping that plan.

The process of updating a communityâ&#x20AC;&#x2122;s general plan offers a critical opportunity to shape local development patterns for decades into the future, creating healthier communities.

By understanding how best to influence the process, public health professionals can ensure that public health goals are not only introduced at the start, but also carried through the process that may take multiple years. The diagram on the following page outlines key roles for health professionals in the long range planning process.

by

Design

Strategic Direction

91

Sourced from Change Lab Solutions, this diagram outlines the major stages of a general plan update, identifying ways for health department staff to champion health throughout the process.

References Brownson, R. C., E. A. Baker, R. A. Housemann, L. K. Brennan, and S. J. Bacak. 2001. “Environmental and Policy Determinants of Physical Activity in the United States.”

American Journal of Public Health, 91:1995–2003.

Cohen, D. A., Ashwood, J. S., Scott, M. M., Overton, A., Evenson, K. R., Staten, L. K., Porter, D., McKenzie, T. L., & Catellier, D. (2006). Public Parks and Physical Activity Among Adolescent Girls. Pediatrics. 118, e1381-1389.

Community Transformation Grant Program Fact Sheet. (2009). Retrieved from http://www.cdc.gov/communitytransformation/funds/index.htm Emmons, K. M., Linnan, L. A., Shadel, W. G., Marcus, B., & Abrams, D. B. (1999). The Working Healthy Project: A Work Site Health-Promotion Trial Targeting Physical Activity, Diet, and Smoking. Journal of Occupational and Environmental Medicine. 41(7), 545-555.

Ewing, R., & Bartholomew, K. (2009). Pedestrian and Transit-Friendly Design, Washington, DC: Urban Land Institute/ American Planning Association.

Eyler, A. A., Brownson, R. C., Evenson, K. R., Levinger, D., Maddock, J. E., Pluto, D., …& Steinman, L. E. (2008). Policy Influences on Community Trail Development. Journal of Health Politics, Policy and Law. 33(3), 407-427.

Giles-Corti, B. et al. (2005). Increasing Walking: How Important is Distance To, Attractiveness, and Size of Public Open Space? American Journal of Preventive Medicine.

19(4), 314-317.

Investments in Community Health: Community Transformation Grant Program. (2013). Retrieved from http://www.healthcare.gov/news/factsheets/2011/09/community09272011a.html.

Kaplan, R., and S. Kaplan. 1989. The Experience of Nature: A Psychological Perspective. New York: Cambridge University Press.

Kerr, J. (Fall, 2008). Designing for Active Living Among Adults. Active Living Research. Robert Wood Johnson Foundation. Retrieved from www.activelivingreseach.org.

Kung, H. C., Hoyert, D. L., Xu, J. Q., & Murphy, S. L. CDC, (2008). Deaths: Final Data for 2005. Retrieved from National Vital Statistics Reports website: http://www.cdc.gov/ nchs/data/nvsr/nvsr56/nvsr56_10.pdf.j Larsen K, et al. The Influence of the Physical Environment and Sociodemographic Characteristics on Children’s Mode of Travel To and From School. American Journal of Public Health. 2009;99(3).

Lockett, D., Willis, A., & Edwards, N. (2005). Through Seniorsâ&#x20AC;&#x2122; Eyes: An Exploratory Qualitative Study to Identify Environmental Barriers to and Facilitators of Walking.

Canadian Journal of Nursing Research. 37(3), 48-65.

Lund, H., Wilson, R. W., & Cervero, R. (2006). A Re-Evaluation of Travel Behavior in California TODs. Journal of Architectural and Planning Research. 23(3), 247-263.

Lutfiyya, M. N., Lipsky, M. S., Wisdom-Behounek, J., & Inpanbutr-Martinkus, M. (2007). Is Rural Residency a Risk Factor for Overweight and Obesity for U.S. Children? Obesity, 15(9), 2348-56.

New York City Department of Design and Construction, Center for Active Design. (2010). Active Design Guidelines: Promoting Physical Activity and Health in Design. Retrieved from: http://centerforactivedesign.org/guidelines/ Ogden, C. L., Carroll, M. D., McDowell, M. A., & Flegal, K. M. CDC, (2007). Obesity Among Adults in the United Statesâ&#x20AC;&#x201C;no change since 2003-2004. Retrieved from National Center for Health Statistics website: http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_10.pdf Project for Public Spaces, (2010). How to Turn a Place Around. New York: Project for Public Spaces, Inc. Pucher, J., Dill, J., & Handy, S. Infrastructure Programs and Policies to Increase Cycling: An Internal Review. Prepared for the Active Living Research Program of the Robert Wood Johnson foundation, and tentatively scheduled for publication in Preventive Medicine.

Rails-to-Trails Conservancy, (2012). Active Transportation Beyond Urban Centers: Walking and Bicycling in Small Towns and Rural America. Retrieved from: http://www. railstotrails.org/resources/documents/ourWork/reports/BeyondUrbanCentersReport.pdf Surface Transportation Policy Project. (2004). Aging Americans: Stranded Without Options. Washington, DC: Bailey, L. Wu S. Y., Green A. (2000). Projection of Chronic Illness Prevalence and Cost Inflation. Santa Monica, CA: RAND Health.