Five Forgetful Hospitals

Five Forgetful Hospitals in West Los Angeles. Major players, big names. If we don't intervene, they will forget, as before, to include healthy transportation in their program of community benefits. The process, required by the IRS, is called CHNA: Community Health Needs Assessment: It serves to confirm the non-profit status of a hospital. Currently they are working on a plan for the period 2019 - 2021.

While many doctors and all public health experts do know a whole lot about the health benefits of active modes (walking, cycling), the five forgetful hospitals are on the path to overlook the disease burden in their communities that could be lifted if people had more opportunities, and more encouragement, to leave the car at home. Prevention. Population Health. Cheap and effective.

Whence that forgetfulness? Why is it so difficult to implement public health knowledge in our local community? The stereotype that everybody drives in LA is overwhelming. The roads so crowded, the parking lots so full, the cyclists so few. Pedestrians? - Send the police to arrest them. We have been so firmly socialized into vehicular living that a special mental effort is required to recognize automobility as a health condition. But reduce driving we must, for our own well-being, and for that of our planet.

Hospitals are only in the business of curing bodies broken by too little exercise, bodies shattered by vehicles which move too fast? Prevention is none of their business? Not according to the IRS. Prevention is right up the CHNA alley. Even better, the IRS allows expenses for lobbying (like lobbying a council member for more and safer bicycle infrastructure!) Also allowed are expenses for community building activities like environmental improvements, community health improvement advocacy, leadership development and training for community members, coalition building, etc. IRS (schedule H, part II)

If that sounds like an opportunity, here are the CHNAs that currently face updating: Cedars Sinai (pdf), UCLA Ronald Reagan (pdf), UCLA Medical Center, Santa Monica (pdf), Kaiser Permanente West Los Angeles Medical Center, (pdf) (See also KP Data), Providence Saint Johns (Santa Monica) (pdf)

The CHNA process takes into account input from persons who represent the broad interests of the community served by the hospital, including those with special knowledge of , or expertise in, public health, or expertise relevant to the health needs of the community. There is a great deal of demand for healthy transportation in the Westside. Active transportation is an emerging issue that will be overlooked if stakeholders do not share their local knowledge. We need much much much more than the famous Westside Walkers who meet (drive there, of course) in a shopping mall to walk (laughter). What about a concerted effort, with local partners, aiming to offer our neighborhoods a safe way to leave the car at home and walk or ride a bike? Our hospitals must find a way to support advocates who demand healthy transport options for our neighborhoods. Doctors will be able to prescribe safe cycling training, hospital facilities will lead the way by conducting a bicycle master-plan for their premises and associated medical practices. Hospitals are quick to demand that streets must be suitable for their ambulances, now we want to hear from them that streets also need to be suitable for those neighbors who should move about without a car. Now is the time to take apart the poisonous notion that everybody drives in LA.

The current CHNA process for five forgetful hospitals is conducted by Biel Consulting. So far no public meetings have been scheduled. Which is a not a good sign. Through public meetings the hospital can build essential partnerships with community stakeholders. Failing a public meeting, the next best way to have your voice heard is to make written comments on the previous CHNA. Pick your favorite hospital and send emails to CommunityBenefit@cshs.org, smunoz@mednet.ucla.edu, CHNA-communications@kp.org, Ronald.Sorensen@providence.org. These comments count as public input and offer a privileged way to participate in the process. Now. Or wait three years for the long overdue dialogue of transportation and health.

Community Health Needs Assessment (CHNA)

Every three years, hospitals need to submit a CHNA to the IRS to secure their status as a tax-exempt organisation. Community health benefits listed in the CHNA can take many forms. They should be based on statistical data, but also on community input to identify emerging issues. The CHNA for the Ronald Reagan UCLA Medical Center (2016) often reminds us of an in-house questionnaire which includes the question: "Is this work a community benefit?" Adding up all the "Yes" answers in a large organization, you invariably end up with a very long list. These activities are then arranged in priority areas, but even at that level it lacks the overarching coherence of a well designed community intervention. The result is one grand confusion of initiatives and programs. It is hard to make out the encompassing vision for the community.

In the following we outline a new area of community benefits which is currently missing. Healthy transportation initiatives will have a positive effect on many of the health needs listed. They impact the community as a whole. They comprehensively address separately listed health needs such as diabetes, heart disease, cancer, obesity, mental health, etc. The empirical evidence for the effectiveness of such interventions is not in doubt. We hope the hospital will consider these suggestions and include support for healthy transportation as an overarching community benefit in the next CHNA.

1) UCLA Health Bikeway Corridor: This innovative project provides a comprehensive plan for a bike route between the hospitals in Westwood and Santa Monica. It is currently managed by UCLA Transportation. The implementation itself is not funded. It represents a tangible community benefit by supporting safe infrastructure for healthy modes. It is part of the evolving issue of healthy transportation and sustainability which has received much attention recently. UCLA Health should associate its brand with this admirable project. I would also have a role in educating the community about the health benefits of active modes. As the pathway nears its implementation phase, UCLA Health should take full ownership of this project, provide funding and help present its advantages to stakeholders in the community. It should lobby local agencies for it. IRC 501(h) allows lobbying expenses. Bicycle infrastructure is a evidence-based community health intervention <link>.

2) Additional Interviews, Community Meetings, Partnerships: Prioritizing local needs is partly based on interviews with community stakeholders. The list of stakeholders is impressive but is biased by the leadership roles of those included. Do they live in the community? How are these selected? What kind of expertise do they have? Is the selection biased because it fails to include persons who commute by bicycle?
A well facilitated stakeholder meeting provides much better insight into community needs. A series of interviews lacks transparency and dialogue, whereas a series of meetings can lead to local partnerships which are the best way to implement community benefits. The next CHNA should include such meetings for stakeholders. The following stakeholder groups should be consulted in future CHNAs.

• The Healthy Campus Initiative at UCLA is a very valuable interlocutor, both for their expertise, but also for the community connections they have developed. It seems negligent to exclude these local experts from this process 
• The list does not include researchers from the Fielding School of Public Health who have worked on population health. It seems negligent to exclude these local experts from this process 
• Community groups advocating for healthy and sustainable transportation in the community (Calbike, Los Angeles County Bicycle Coalition, UCLA Bicycle Academy, Better Bike Beverly Hills, Santa Monica Spoke, losangeleswalks.org, etc)
• Neighborhood groups or councils (The new NWWNC, midcityneighbors.org, etc)
• Youth groups and educational stakeholders, especially the Saferoutespartnership.org which advocates for safe ways to get kids to school without a car
• The AARP has taken very progressive positions on transport policy and health for the elderly recently. They support Ciclavia events in Los Angeles and have a clear view of the transportation needs of those who can no longer drive a car (Stephanie Ramirez sramirez@aarp.org)
• DPP Diabetes Prevention is an important aspect of population health and its voice should not be missing here

3) Modeling Best Practice: UCLA Health should make community involvement a central part of its mission, not a triennial statistical exercise. This will require some input from the leadership. Spisso has repeatedly spoken about the importance of community health. She says that health is not only about repairing a broken organ, it is about healthy practices and healthy contexts. Establishing healthy practices in and around the hospital and the medical offices in the community can transform the UCLA Health into a local leader, but the leadership needs to think "outside the bed". The NHS in the UK has developed some guidelines as to how a health provider should do business in the community: Bicycle parking is better than valet car parking. Inviting stairs are better than elevators. Bike parking and transit information is absent from all UCLA Health webpages that contain way-finding info.

4) UCLA Health and its Communities. Recently the UCLA Vice Chancellor has conducted a discussion about a revised mission statement for the campus. During this process, UCLA Health has remained largely silent or MIA. Does the hospital have a vision for community involvement? Perhaps it could be of interest to the leadership that Part II of IRS Schedule H (Form 990) allows expenses for community building activities like environmental improvements, community health improvement advocacy, leadership development and training for community members, coalition building, etc

Healthy transportation programs are a perfect fit with the UCOP 2025 Carbon Neutrality Initiative. In order to see results in this area, leadership is needed, work needs to be done, relationships with community stakeholders need to be developed, advocacy needs to be prepared, and effects need to be evaluated. In short: UCLA Health needs to actively dismantle the stereotype that everybody drives in LA. The process of converting car parking into bicycle parking will position UCLA Health at the vanguard of population health and sustainability in California. Which is exactly where you want to be.

Lawyers to the Rescue

In our discussion with UCLA Health we were told that the difficulties of renting and improving medical office space that would be bicycle perfect (bicycle parking, showers, no bundled parking to allow parking cash out) goes back to the lease template provided by the University of California, Office of the President.

So we wrote to the UCOP Real Estate Services with some suggestions how to turn the lease template into a path towards better transport choices. We look forward to their response!

Dear Allen Meacham, 

The UCLA Bicycle Academy is concerned that leases used for UC premises have insufficient regard to sustainability issues. We are especially concerned that UCLA Health affiliated medical offices operate without adequate facilities that would support healthy modes of transport. This leads to a system-wide dissonance: The mode of transport most often recommended by doctors is very poorly served at the very premises where these doctors see patients. We were advised that the UCOP lease template prevented better accommodation of healthy and sustainable modes. 

Your colleague Julie Wong shared the standard lease template for leases where the UC Regents are the tenant. (Rev. 12/2016 4821-2942-8779 v. 3)

This templates includes only references to petrol burning vehicles (cars). From this exclusive focus a direct line can be drawn to the deplorable state of bicycle provision at premises used by UCLA Health (and on other campuses)

We would like you to make the following changes to the template

• 1. 1. 2. (Premises) ... loading and unloading areas, visitor parking areas,  - add: loading and unloading areas, visitor parking areas, shower facilities for bicycle commuters ... (LEED certification considers such facilities a necessity)

• 11.1.e.(xxiv): any other parking facilities associated with the Building  - add: any other parking facilities for cars or bicycles associated with the Building,  (it is important to be clear and explicit about transport options)

• 11.1.e.(xxiv): utilities, insurance of any form, real   - add: utilities, vehicle charging points, shower facilities for bicycle commuters, insurance of any form, real  (it is important to be clear and explicit about vehicle types and required facilities)

• Addendum 4, #2: Tenant Improvements must satisfy the Campus Fire Marshall, State Building Code and Federal Americans with Disabilities Act.  Add: Bicycle parking must be designed according to the bicycle parking guidelines of the APBP  (Where bicycle facilities are present, they invariably fail to meet the standards set by APBP and become an embarrassment in the eyes of bicycle user) 

In addition, the UCOP leases should NEVER include bundled parking. Bundled parking is a sure way to remove incentives, for the entire duration of the lease, for users and organisations to reduce car use. Bundled parking effectively removes the ability to offer financial incentives for modes other than cars (Parking Cash Out). From the point of view of the sustainable transportation advocate, bundled parking is the prime source of unsustainable and unhealthy transportation choices. From the environmental point of view, it is a very bad idea. It should never be part of a UCOP lease. (Remove first Option in Addendum 1, or strongly discourage it)

In a perfect world, the current template could well encompass sustainable and healthy modes of transportation. But experience shows that without explicit reference to these modes, administrators have consistently overlooked these issues. As it stands, the template enables and encourages administrators contract for facilities where EVERYBODY DRIVES. As amended, the template would better project the interest of UCOP in supporting and planning for sustainable and healthy forms of transportation. The amended template would also lead to lease negotiations that act in the best interests of those campus members (and the public) who would prefer to get around without a car. It is crucial that such improvements are planned in the early stages, because adding such facilities at a later stage is a very burdensome and complicated process.

We believe making such changes to the UCOP lease template could well qualify for an Higher Education Energy Efficiency and Sustainability Best Practice Award issued by CHESC, for instance in the new Large-scale Planning category

Sincerely

-- 

Dr Michael Cahn

Secretary, UCLA Bicycle Academy 

Transportation Wellness Task Force

When we made the case for an active transportation policy to the UC Regents Health Services Committee, there was no opportunity for a dialogue. That is why we are very grateful that UCLA Health offered us the opportunity for such a dialogue. UCLA Health already has a No Smoking Policy, it serves antibiotic free meat, and it has recently been named LGBTQ Healthcare Equality Leader. Perhaps our medical provider should also consider its role in the (healthy or not) transport choices its staff and patients are making every day? What would President Johnese Spisso, Richard Azar (General Services), and Joe Earnest (Media Relations) think?

We very much looked forward to this meeting. The lack of conversation over many years leads to a great deal of urgency: The more you have the conversation only in your own head, the more you are disappointed about the lack of results.

"These are all good ideas." "You will not find many doctors who would oppose such initiatives." But is there a constituency that could move things ahead? "Perhaps we could look into a certification as a bicycle friendly employer." "The staircases are really difficult because of building standards and fire regulations." "The leases which govern parking cash out and bike parking improvements come from UCOP, the Office of the President." "Perhaps we could do some bike commuter courses for staff, or something in the Vital Signs magazine." I like the idea of a UCLA Health branded bike rack said the President, perhaps we can do it like a wrap, and we shook hands on that (Full list here). In the end, it is about an institutional attitude, and that needs time. But health impacts and climate impacts don't wait for us to make up our minds. Urgency? And how!

Thirty minutes with the leadership of a national "Best in the West" health care institution is one big deal. We recognize this and we appreciate it. On the other hand, the institution has no plan how to increase cycling among staff and clients, it has no plan how to improve bicycle facilities at all its locations, it does not assess the health effects of all this driving. UCLA Health has a community relations department, but it does not get involved in local planning discussions, does not remind Caltrans and METRO that the I-405 widening has discouraged more people to ride a bike to UCLA Health destinations. It is mum about a the slow death of a Great Streets Initiative for Westwood Blvd that would have included a much needed bikelane to our Medical Plaza, torpedoed by homeowners in Holby Hills and LA city council-member Paul Koretz. But a health system that prides itself on its local connection - "See you in the Neighborhood" - can ill afford to remain quiet when neighborhoods fail to safely accommodate the modes of transport doctors recommend most often.

Supporting healthy and sustainable modes is not about privileges for a few determined and reckless bike riders: It is about inviting the entire community to consider that car-centric policies and organizations have made us unwell. And that a health provider must not unwittingly lend support to the false notion that everybody drives in LA. A first class health system at a world class university should really be a leader on the bike-path towards healthy communities. It would be good to establish a formal forum in which active transportation advocates and public health experts can help the UCLA Health to address the unhealthy car bias of the organization. We would call it the Transportation Wellness Task Force.

Transportation Wellness Task Force.
(Draft Remit) 
The purpose of the task force is enhance transportation wellness for staff, patients and the communities where UCLA Health operates. It provides a comprehensive perspective on the health implications of transport choices - for the individual, the enterprise and for the community.

The purpose of the task force is

• to integrate the public health research into the daily practice of a large medical institution
• to provide recommendations to the leadership for programs and investments which improve transportation wellness for staff, patients and the community
• to identify facilities improvements that would encourage more to use healthy modes
• to identify areas where improved messaging can increase the visibility and attractiveness of healthy modes
• to identify perverse incentives and address their impact on transport choices
• to share its recommendations with related institutions in the UC Health system 
• to pursue certification of these efforts and to educate the public 
• to support the collection of trip data for staff and patients for scholarly analysis, including a quantitative study the health benefits delivered over a longer period, to engage campus expertise from urban planning and public health, and to contribute to a discussion of transportation wellness in the academic community
• to make its insights available in the context of local and regional transport planning, and to provide community facilitation to increase availability of healthy options in the communities where UCLA Health operates 

The members of the task force represent the following areas of expertise:

• Public health 
• Population health, diabetes prevention 
• UCLA Transportation Planning
• UCLA Health - Marketing 
• UCLA Health - Sustainability
• UCLA Health - Community Relations 

Two members of the committee use a bicycle for their commute. The task force produces an annual report.

The following have supported the establishment of such a task force:

Bicycle Academy Meets UCLA Health

In preparation for a meeting with UCLA Health leadership (Johnese Spisso, Richard Azar, Nancy Jensen) we have put some words to paper to remind everybody of the larger picture: How active transportation and health in our communities belong together. And how our Health System should educate itself, and the community, about the impacts of too much driving and too little walking and cycling.

It is not  itemized agenda for a meeting. I'd call it the necessary background music for an attempt to find a path forward to help our Health System to recognize how active modes should become a part of its healing mission. We wanted to recap the large issues on paper so that in the meeting itself we can focus on the specific steps the organisation can take to move beyond the car bias which is still so well entrenched in our region. It is time to recognize the negative health impacts of such a bias and to reap the large health benefits which happen when active modes are properly supported. In the meeting we want to focus on small steps, measurable outcomes, specific projects, clear directions, both for staff and for patients. All this is complex enough, because it involves so many parts of a large organisation: Facilities, medical expertise, marketing, community relations.

But make no mistake about it, when a health system wants to change its attitude towards active modes, it will take some decisive leadership for the organisation to make the changes that are needed. Changes that will make sure that UCLA Health remains at the forefront of medical progress and community health impacts.

If you want to participate in this discussion, have suggestions for low hanging fruits that could be part of this program, or want to support our effort, please get in touch!

More Healthy Cycling? Meet the Regents!

It is really easy

Tuesday February 6, 2018. The Regents Health Services Committee is meeting at UCLA. The time: 12:15 pm in the new Luskin Conference Center (agenda). This is a sub-committee of the UC Regents tasked to guide the UC Health system. During public comment, the Bicycle Academy will highlight the need for our state-wide health provider to address its automotive bias and to assert more clearly, in actions and in words, that cycling is good for you. We no longer can afford to ignore what public health experts are teaching us about the health benefits of active transportation. Please join us for this event, and share how you want this health system to improve its attitude towards active modes of transport. 

We will remind the Regents and the experts present that a bicycle friendly health system 

1. offers significant financial benefits because for a self-insured employer a healthier workforce means real savings
2. offers a low cost yet highly effective way to improve population health, well-being and disease prevention in the community

We will also remind the Regents and the experts 

1. that in spite of wide-spread anxieties about bicycle use, obesity and its attendant co-morbidities are a far bigger public health hazard than cycling injuries
2. that the lack of active living options is responsible for a large part of our fast growing health expenditure
3. that guidance from the highest level of the organisation is required, comparable to the surgeon generals warning about smoking, 
4. that the established division between transport planning and health policies effectively prevents accessing the multiple benefits (health, sustainability, community) of the medical device with two wheels
5. that other health systems (NHS, Canada) have developed guidance that requires medical offices and hospitals to prioritize active modes, and to collaborate with local authorities to achieve a street network that can safely accommodate active modes
6. that the League of American Bicyclists offers a program that can certify a Hospital as a Bicycle Friendly Business
7. that there is a large unmet demand for CDC accredited Diabetes Prevention Programs with an emphasis on safe and confident cycling, or similar "Cycling on Prescription" programs
8. that this innovative program is very much of the Golden State, that it should be spearheaded by an academic health center, and that it should be initiated right here, on the most healthy campus of the system (etc)

We will ask the Regents to adopt motion to convene a working group of UC Health, UC Sustainability and UC Marketing and bicycle experts or advocacy groups, to design a UC branded bicycle rack that would serve to assert and advertise UC Health's support for active modes. Once a health system manages to put its logo on a bike rack, great things happen.

Did it ever occur to you how weird it is that your medical office offers plenty of car parking, and nothing for bikes? Were you ever looking for a staircase in a medical office but only found the elevator? Did you ever feel your doctor should assert more firmly the health benefits of active transportation? Then the Regents committee should hear from you. 

Our proposal has already received a good amount of support. Regent Lansing, the chair of the committee, has expressed interest. Dr Stobo, Executive Vice President of UC Health, expressed interest in the financial savings that a healthier workforce would mean for UC as a self-insured employer. He did not object to the proposal to share this with the regents and the experts. Even the good folks from AARP, who have shown great leadership in healthy transport issues, expressed support. This committee is a sympathetic and powerful forum. Because we are looking for an explicit medical acknowledgement of the benefits of active modes, the issue exceeds the level of facilities management and requires an rarely seen level of collaboration between health policy and transport planning at the highest level. We hope that the Regents can establish some guidance for the entire UC Health system to recognize the bicycle as a cheap and effective medical device. A medical office without bicycle parking really does send the wrong message. And a location webpage with advertises valet parking for cars, but is quiet about walking, cycling and transit routes, should not be difficult to remedy, once the regents have given the necessary guidance. 

We hope to see you on Tuesday. A few more talking points are here.

Update: Public comment has been recorded and is available here https://youtu.be/BdT5KkY5ZJk?t=140

UCLA Athletes as bicycle advocates

This is an invitation for UCLA Athletes to join us for the meeting of the UC Regents Health Services Committee at UCLA on the 6th of February 2018. The meeting of Bruins, of Athletes and the Health System, is a meeting of giants. Because UCLA is really about our athletes, and about the campus health business. Five hospitals and 160 medical offices throughout LA county, the budget of UCLA Health actually exceeds that of the rest of the campus, that little world-class university we also call UCLA.

Driving to UCLA

Remember how much our best athletes love the bicycle. Of course they would love to see more people cycling. A few images to do the talking:

Bill Walton jumped on his bicycle to get that famous haircut in Westwood

Bill Walton next to his sculpture with bicycle

Kareem Abdul Jabbar

Kareem as Grand Marshall for the 1979 Bike-a-Thon, Marina del Rey

And, yes, the wooden Bike, aka "The Coach" (?)

So when the UC Regents Health Services Committee meets at UCLA on the 6th of February 2018, this is a great opportunity to remind them that our athletes are watching how they bring this great tradition of cycling to all the medical establishments the UC system provides throughout California. Because a medical office or a hospital should be optimized for healthy modes of getting around, modes that are healthy for our bodies and healthy for our environment. 

And if you don't quite know what to say to the Regents, here is some language that may come in handy

We applaud the sustainability effort underway for the UC Health system, which is led by Paul Watkins of the UCLA Medical Center in Santa Monica. But the bicycle has not yet received the attention it naturally deserves in a medical context. Bicycles are wonderfully effective in preventing disease, improving health and achieving sustainability in our communities. A comprehensive program which includes staff, patients, but also negotiations with local agencies in charge of transport planning, is beyond the scope of the current effort. A broader initiative is urgently needed to reap the manifold benefits an increase in active transportation will bring. Its natural starting point are the UC Health campus locations and countless UC branded medical offices throughout California. In our vision UC Health is committed to improve its communities, creating instances of bicycle perfection in a geography that urgently needs more of them.

Given a broad body of scientific evidence, the Executive Vice President of UC Health should issue a declaration about the medical benefits of active transportation. Such policy guidance would lead the way for UC Health to become a more bicycle perfect institution throughout the state. The design of a UC Health branded bicycle rack, complete with a health related message, may be a suitable first step to assert and market this insight.

Public health experts tell us that automobilitis and the lack of physical activity account for a large proportion of poor health in our communities. Now is the time for UC Health to devote resources to liberate our communities from our sickening addiction to cars. An academic health center is a natural leader for such a broad effort. The state of California is the right place for this. This committee can make this happen. 

We support the proposal developed by the UCLA Bicycle Academy that lists a number of concrete steps through which a culture of health and sustainability can be generated. For those who have grown up to believe that the car is the only safe place on our roads, this proposal may seem scandalous. But the true scandal would be a UC Health system that fails to decisively support and encourage active transportation.

(See also: https://bicycleacademy.blogspot.com/2018/01/the-abc-123-of-bicycle-friendly-health.html)

The ABC 123 of a Bicycle Friendly Health System

Some steps towards a UC Health system that decisively supports and encourages active transportation.

• A design-guide for a UC Health branded bike rack in collaboration with UC marketing (color, design, health message on rack, placement according to APBP) 
• Review and improve access and attractiveness of staircases for all premises
• Evaluate the financial benefit for UC as a self-insured employer if more employees use active modes for their commute
• Pay staff  who commute by bike 10 cents for every mile cycled
• Normalize cycling and transit options on all "directions and parking" webpages which consistently assume that everybody drives 
• Create media opportunities for UC Leadership to be shown with a bicycle
• Evaluate improved productivity and work satisfaction if more staff uses active modes for the commute
• Conduct an annual Blessing of the Bicycles ceremony 
• Apply for certification as Bicycle Friendly Business through the League of American Bicyclists (Precedent: Seattle Childrens Hospital, etc)
• Offer CDC accredited Diabetes Prevention Programs which emphasize safe and confident cycling education
• Encourage development of "Cycling on Prescription" programs
• Develop a Public Service Announcement Campaign: "Surgeon General's Warning: Driving causes Obesity and Diabetes, Start Cycling now to Greatly Reduces Serious Risks to Your Health." (Preecedent: Cyclists are always Fragile campaign by the American Academy of Orthopaedic Surgeons
• Create the position of a Sustainable Transport Improver at each medical campus
• Engage with local agencies to improve transportation infrastructure for active modes in the communities were UC Health operates. Bring the voice of medical experts to the planning process
• Offer and advertise free bicycle valet parking at all locations that provide valet parking for cars
• Ensure that Capital Programs reviews all current and new off-campus premises for active transportation improvements

Because these interventions touch many different parts of the organisation, this proposals requires strong leadership.