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  2. 2. PolicyLinkPolicyLink is a national research and actioninstitute advancing economic and socialequity by Lifting Up What Works.®Prevention InstitutePutting prevention and equitable healthoutcomes at the center of communitywell-being.This report was commissioned by theConvergence Partnership which includesthe following institutions: The California Endowment Kaiser Permanente The Kresge Foundation Nemours Robert Wood Johnson Foundation W.K. Kellogg Foundation Centers for Disease Control and Prevention as technical advisersDesign by Chen Design AssociatesLeslie Yang for PolicyLink
  3. 3. thetransportation prescription BOLD NEW IDEAS FOR HEALTHY, EQUITABLE TRANSPORTATION REFORM IN AMERICA BY Judith Bell President PolicyLink Larr y Cohen Founder a nd Executive Director Prevention Institute EDITED BY Shireen Ma lekafza li Senior A ssociate PolicyLink
  4. 4. A NOTE ABOUT THIS R EPORTThe Transportation Prescription: Bold New Ideas for Healthy, Equitable Transportation Reform in Americabuilds on the research and analysis of a number of experts who are working at the intersection oftransportation, equity, and public health. The ideas that collectively form the heart of this paper are exploredin depth in the book, Healthy, Equitable Transportation Policy: Recommendations and Research. Chaptersare written or co-written by the authors listed below. Each chapter and the entire book can be found onlineat Cohen, co-author, “Traffic Injury Prevention: A 21st-Century Approach,” founder and executive director,Prevention Institute, OaklandSusan Handy, “Walking, Bicycling, and Health,” professor of Environmental Science and Policy and director ofthe Sustainable Transportation Center, University of California, DavisTodd Litman, “Public Transportation and Health,” founder and executive director of the Victoria TransportPolicy Institute, British ColumbiaLeslie Mikkelsen, co-author, “Traffic Injury Prevention: A 21st-Century Approach,” managing director,Prevention Institute, OaklandKami Pothukuchi, co-author, “Sustainable Food Systems: Perspectives on Transportation Policy,” associateprofessor of Urban Planning, Wayne State University, DetroitCatherine L. Ross, “Roadways and Health: Making the Case for Collaboration,” director, Georgia Tech Centerfor Quality Growth and Regional Development and the Harry West Chair for Quality Growth and RegionalDevelopment, AtlantaJanani Srikantharajah, co-author, “Traffic Injury Prevention: A 21st-Century Approach,” program coordinator,Prevention Institute, OaklandTodd Swanstrom, “Breaking Down Silos: Transportation, Economic Development, and Health,” E. Desmond LeeProfessor of Community Collaboration and Public Policy Administration at the University of Missouri, St. LouisRichard Wallace, co-author, “Sustainable Food Systems: Perspectives on Transportation Policy,” senior projectmanager, Center for Automotive Research, Ann ArborWe owe a sincere debt of gratitude to these progressive individuals who recognize the value of working acrossfields to identify effective and long-term solutions to multiple problems.
  5. 5. Contents 5 Foreword Congressman James Oberstar, Chairman of the House Transportation and Infrastructure Committee 6 Preface Angela Glover Blackwell, Founder and CEO, PolicyLink 9 Introduction10 Transportation in America: A New Vision 13 How Transportation Policies and Plans Influence Health 13 Direct Health Effects Pollution Climate Change Contents Physical Activity Mental Health Safety 16 Indirect Health Effects Transportation, Income, and Health Older Adults and People with Disabilities << 18 What Does Healthy, Equitable Transportation Policy Look Like? 321 The Federal Transportation Legacy and Challenges Ahead pg. 23 A Foundation for 21st-Century Transportation Policy 24 Policy and Program Priorities to Improve Health and Equity Healthy, Equitable Transportation Policy 26 Conclusion 27 Author Biographies 28 Acknowledgments 29 Notes
  6. 6. Foreword Congressman James OberstarDiscussions of public health and wellness often and helping Americans incorporate exerciseare limited to the health and medical fields. It and fresh air into their daily travel routines. Weis my hope that soon, the transportation sector must also continue our pursuit to reduce thewill be part of the discussion and play a role in number—and rate—of traffic fatalities andproviding solutions to improving the nation’s injuries that occur each year.overall health, well-being, and quality of life. Our most recent surface transportationOne of my goals as Chairman of the Committee legislation, enacted in 2005, took importanton Transportation and Infrastructure is to create steps toward building a healthier infrastructurea new model for surface transportation, one by investing billions of dollars in safety, publicthat invests in alternative modes and promotes transit, walking, and bicycling. This legislation isactive, healthy lifestyles. Public health and helping to construct safer infrastructure, enabletransportation policy choices are inextricably workforce development, build new transitlinked. The transportation sector is responsible lines, repair existing systems, and establishfor one-third of the greenhouse gas emissions non-motorized transportation networks. Foreword in the United States. Our infrastructure and land We also enacted the Safe Routes to Schooluse choices often dictate our daily travel, and program, which allows states to invest in safetywhether or not we have access to clean, healthy improvements and education campaignstransportation options. And in any given year, to get kids walking and biking toapproximately 40,000 Americans are killed on school again. This program has shownour roadways. The policy decisions we make great early success and has the abilityregarding transportation have repercussions on to change the habits of an entirepublic health throughout our society. generation. << 5For too long now, our transportation decision- Environmental sustainability, access, pg.making has failed to address the impacts and our collective well-beingthat our infrastructure network has on public must combine with mobility andhealth and equity. The asphalt poured and lane safety as the cornerstones of ourmiles constructed enhanced our mobility and transportation investments. The following report The Transportation Prescription strengthened our economic growth; but too represents an important contribution to ouroften, this auto-centric mindset took hold and emerging understanding of the connectionscrowded out opportunities to invest in a truly between transportation and public healthsustainable intermodal transportation system, and is an invaluable resource for policymakersin particular a system that meets the needs of and all those interested in building healthyunderserved communities. communities. With a greater recognition of the strong linkage between public health andThe failure to link transportation and land use transportation, I believe we can build a networkdecision making, and to consider the public that supports our mobility and creates accesshealth effects of these choices, has led to and economic strength while promoting equity,a tilted playing field that has made driving sustaining our good health and quality of life.the easiest—and often the only—optionavailable in many parts of the country. Ourtransportation policies and investments mustdo more to provide access for all through various modes. Transit, walking, and bicycling Congressman James Oberstarall have a significant role to play in lowering Chairman of the House Transportationour dependence on foreign oil, reducing our and Infrastructure Committeegreenhouse gas emissions and air pollutants,
  7. 7. Preface Angela Glover Blackwell Transportation policy has enormous these neighborhoods have low levels of physical potential to catalyze the development of activity and high rates of chronic diseases. healthy communities of opportunity. The Creating a more equitable transportation upcoming authorization of the federal surface system must lie at the core of any analysis of transportation bill represents the single biggest transportation or health, and it must guide all federal opportunity to influence how our reform. communities, cities, and regions are shaped. The Convergence Partnership, the collaborative Transportation impacts health directly: it affects of funders that commissioned this project, air quality, injury risk, physical activity levels, embraces the imperative that health and equity and access to necessities such as grocery stores. be central to transportation policy debates. Transportation is also one of the largest drivers Further, the Convergence Partnership recognizes of land use patterns; it thus determines whether how transportation policy is connected to communities have sidewalks and areas to play the Partnership’s broader efforts to support and be physically active as well as whether environmental and policy changes that willPreface communities are connected to or isolated from create healthy people and healthy places. The economic and social opportunities. Partnership’s steering committee includes: The California Endowment, Kaiser Permanente, the Research shows that low-income communities Kresge Foundation, Nemours, the Robert Wood and communities of color often do not have Johnson Foundation, and the W. K. Kellogg access to the benefits our transportation system Foundation. The Centers for Disease Control and can provide, yet they bear the burdens of Prevention serves as technical advisor. that system. For example, many low-income>> neighborhoods have little or no efficient, In this project, leading academic researchers6 reliable public transportation to get them to and advocates working at the intersection ofpg. jobs and essential goods and services. But these transportation policy, equity, and public health communities are often situated near bus depots, identify opportunities for creating transportation highways, and truck routes, where pollution systems that promote health and equity. This levels are high—and not coincidentally, asthma report synthesizes their insights and offersThe Transportation Prescription rates are high as well. In addition, many of these concrete recommendations for change. same communities live without safe, complete sidewalks or bike paths, making walking and Reform is long overdue. Climate change, biking difficult and often dangerous. As a result, shameful health disparities, growing rates of
  8. 8. chronic diseases—transportation policy hascontributed to these problems, and now it mustaddress them. Increasing rates of poverty and asevere economic downturn add to the urgencyfor reform.This report intentionally uses the termauthorization and not the more common word,reauthorization, in reference to the surfacetransportation bill. We want to make clear thatnew thinking and innovative approaches arenecessary to meet the needs of a changing anddiverse America.Many advocates are already working hard to Preface push for fundamental reform. This report waswritten for community leaders, policymakers,funders, practitioners, and advocates interestedin an overarching strategy to promote activeliving and to build healthy communities ofopportunity. PolicyLink, Prevention Institute,and the Convergence Partnership believethat building healthy communities requires a << collaboration of stakeholders from diverse fields 7and sectors. Together, we can identify and shared solutions.The project recognizes that effective strategiesto improve health, particularly in vulnerable The Transportation Prescription communities, often fall outside the conventionaldomain of health policy, yet deserve equalattention. Federal transportation policy is acritical opportunity at our fingertips. Leveragingthe strength of collaboration and networking canyield powerful results. Let’s seize the moment.Angela Glover BlackwellFounder and CEOPolicyLink
  9. 9. IntroductionIn St. Louis, MO, major cuts in bus service this spring left workers, students, people withdisabilities, and older residents stranded and feeling bereft. Stuart and Dianne Falk, whoare both in wheelchairs, told CNN they no longer would be able to get to the gym or thedowntown theater company where they volunteer. “To be saddled, to be imprisoned, that iswhat it is going to feeling like,” Stuart Falk said.1In West Oakland, CA, families have no escape from the diesel exhaust belching from trucks atthe nearby port: The air inside some homes is five times more toxic than in other parts of thecity. “I’m constantly doing this dance about cleaning diesel soot from my blinds and windowsills,” 57-year-old Margaret Gordon told the San Francisco Chronicle. 2 Introduction In Seattle, WA, Maggieh Rathbun, a 55-year-old diabetic who has no car, takes an hour-longbus ride to buy fresh fruits and vegetables. She cannot haul more than a few small bags at atime so she shops frequently—if she feels well enough. “It depends on what kind of day I’mhaving with my diabetes to decide whether I’m going to make do with a bowl of cereal or tryto go get something better,” she told the Seattle Post-Intelligencer.3Our transportation system has an enormous communities of color especially. Forward- << impact on our way of life, on the air we thinking transportation policies must promote 9breathe, and on the vitality of our communities. healthy, green, safe, accessible, and affordable pg.Transportation choices influence personal ways of getting where we need to go. Theydecisions about where to live, shop, attend also must go hand in hand with equitable,school, work, and enjoy leisure. They affect sustainable land use planning and communitystress levels, family budgets, and the time we economic development. The Transportation Prescription spend with our children. Although most peopledon’t think of it as a determinant of health, Streets and roads are the largest chunks ofour transportation system has far-reaching property owned by most cities and states. Weimplications for our risk of disease and injury. have choices to make about how to use, andTransportation policies and accompanying land share, that real estate. Who decides? Whouse patterns contribute to the glaring health benefits? Who pays? Transportation policy atdisparities between the affluent and the poor all levels of government can be a vehicle toand between white people and people of color. promote public health, sustainability, equitable opportunity, and the economic strength ofThis report demonstrates that transportation neighborhoods, cities, and regions. But thatpolicy is, in effect, health policy—and will happen only if advocates, experts, andenvironmental policy, food policy, employment organizers steeped in all these issues bring theirpolicy, and metropolitan development policy, knowledge and passion to critical transportationeach of which bears on health independently decisions. The upcoming authorization ofand in concert with the others. Longstanding the most important transportation legislation transportation and land use policies are at in the United States, the federal surfaceodds with serious health, environmental, and transportation bill, makes this a pivotal momenteconomic needs of the country, and they to bring a broad vision for health and equity tohave harmed low-income communities and transportation policy.
  10. 10. Transportation in America: A New Vision Underlying this report is a vision of it stood as a symbol of American freedom, transportation as more than a means to move ingenuity, and manufacturing prowess. people and goods, but also as a way to build healthy, opportunity-rich communities. Health is While some have few or no transportation often viewed from an individual perspective. Yet, choices due to limited transportationTransportation in America: A New Vision each resident in a region is both an individual infrastructure and resources in their and part of a larger community. Therefore, our communities, many Americans do have the vision for healthy, equitable communities is one opportunity to make choices about how to that extends beyond individual outcomes and travel and where to go. For these people, the creates conditions that allow all to reach their car provided the means to flee the city, buy a full potential. It does not force us to balance quarter-acre patch of suburbia, and drive to their one individual against another. It provides the hearts’ content without giving much thought to opportunity for everyone to participate in their the disinvested neighborhoods left behind, or community, be healthy, and prosper. the farmland lost to development, or the fossil fuels and other natural resources their lifestyles Transportation systems are essential to the consumed. Community environments, however, competitiveness of the nation and the viability of affect the choices individuals make, and public regions. Building America’s Future, a bipartisan policy molds those environments. As the nation coalition of elected officials, views increased confronts severe economic, environmental, and transportation investment as a key to the health challenges as well as the widening gulf economic growth and job creation needed between rich and poor, it is becoming clear that to strengthen cities and rural communities.4 we must make different choices as individuals>> The American Recovery and Reinvestment Act and as a society. (ARRA), the nearly $1 trillion stimulus package10 passed by Congress and signed by President A new framework for transportation policy andpg. Obama in early 2009, emphasizes transportation planning is emerging. Rather than focus almost investments to revive the ailing economy and exclusively on mobility (and its corollaries, speed rebuild regions.5 The act galvanized advocates and distance), this framework also emphasizes to push government agencies to spend the transportation accessibility. In other words,The Transportation Prescription money in ways that promote health, protect instead of designing transportation systems the environment, and benefit everyone. Now primarily to move cars and goods, the new momentum is building to bring a focus on approach calls for systems designed to serve health and equity to the next version of the people—all people—efficiently, affordably, and federal surface transportation bill.6 safely. This approach prioritizes investments in: (1) public transportation, walking, and Over the past half-century, federal bicycling—transportation modes that can transportation policy has changed the American promote health, opportunity, environmental landscape, physically, socially, and culturally. quality, and indeed mobility for people who do Beginning with the Federal-Aid Highway Act not have access to cars; and (2) communities of 1956 authorizing the Interstate Highway with the greatest need for affordable, safe, System, the leading transportation priority by reliable transportation linkages to jobs, and far has been what planners call mobility and essential goods and services—chiefly, low- which became synonymous with the movement income communities and communities of color. of more and more cars and goods farther and faster. Mobility advanced the nation’s growth The goal is to improve transportation for and prosperity, and it formed our sense of everyone while delivering other important identity as well as our image abroad. The car payoffs, including better respiratory and was more than a machine to get us around; cardiovascular health; improved physical fitness;
  11. 11. less emotional stress; cleaner air; quieter streets; But the push to reform transportation (alongfewer traffic injuries and deaths; and greater with its cousin, land use planning) has gainedaccess to jobs, nutritious foods, pharmacies, urgency in the face of three massive challengesclinics, and other essentials for healthy, that are upending the status quo of every fieldproductive living. and that go to the heart of our love affair with Transportation in America: A New Vision the car: (1) climate change, with its threat ofThis new vision is at the core of a burgeoning global ecological upheaval; (2) U.S. dependencemovement to shape transportation policy on foreign oil, which carries grave risks for ourto support work in a number of critical economy and security; (3) a healthcare systemareas, such as climate change, sustainable crumbling under the demands of skyrocketingagriculture, the prevention of chronic diseases, rates of diabetes and other chronic diseasesworkforce development, and neighborhood associated with sedentary lifestyles, andrevitalization. Advocates and experts in public astronomical costs. Transporting goods, services,health, environmental justice, labor, community and people accounts for about one-third ofeconomic development, food policy, and other greenhouse gas emissions and two-thirds offields and disciplines have important roles to petroleum consumption in the United States.7play in transportation debates. A broad range As the National Surface Transportation Policyof interests, working in partnership, can craft and Revenue Study Commission noted in itsinnovative, environmentally sound solutions that landmark report, Transportation for Tomorrow,benefit everyone, rather than plans that reflect the environmental gains we achieve throughthe motor vehicle orientation of road engineers incremental fixes such as higher fuel-efficiencyand builders. Government transportation standards, though important, will be trumped << agencies and developers—the architects of our by increases in driving and traffic if we continuetransportation systems for decades—must be on our current policy course. 11held accountable for how their investments affect pg.the economic prospects of regions, the health of The good news is that change can happen,communities, and the well-being of residents. and inspiring examples abound. In the rural San Joaquin Valley in California, where publicThis shift in thinking about what transportation transportation has been virtually nonexistent, The Transportation Prescription policy must achieve and who should drive it a new system of publicly managed vanpoolsstems from a long list of factors. Among them: is connecting farm worker families to jobs,near-crippling congestion in many metropolitan schools, and medical services.8areas; renewed interest in city living and ahunger for shorter commutes; demographic In Chicago’s West Garfield Park, an alliancechanges (including the increasing number of of residents, activists, and faith-basedpeople over 65 and immigrants, two groups organizations not only successfully foughtless likely to drive or own cars); the rise in the closure of the rail line that linked theobesity; the enduring poverty in inner-city and neighborhood to downtown; they alsorural communities; the growing understanding transformed a transit stop into an anchorof the connections among health, the built development of shops, community services,environment, and transportation plans; and and moderately priced housing.9the increasing frustration among residents andadvocates about the limited accountability and In port cities around the country, many groupsinequitable transportation decision-making are working to reduce pollution from ships, processes at the state and regional levels which locomotives, and trucks, some of the worstover represent suburban and white male interests. emitters of soot and greenhouse gases. In the Los Angeles region—one of a number of regions where the movement of goods
  12. 12. represents a significant part of transportation But the legislation does more than provide investment and economic activity, and money. It also communicates national policy where ports and freeways abut low-income priorities. Will we build roads on the farthest neighborhoods—the Coalition for Clean and edges of regions or fix aging roads and bridges Safe Ports has formed an effective alliance of in cities and inner-ring suburbs? Will we investTransportation in America: A New Vision residents, truck drivers, public health experts, in healthy, green transportation—bicycle environmentalists, environmental justice lanes, safe sidewalks for walking, clean activists, unions, immigrant groups, and public buses, ridesharing, light rails? Will we ensure officials to push for clean air solutions.10 that all voices are equitably represented in transportation decision-making processes? And The authorization of the next federal surface will we include incentives and requirements for transportation bill presents an immense affordable housing near public transportation opportunity to broaden such engagement and to ensure broad access to the job opportunities to forge an equitable policy response to the and services that transit oriented development unprecedented challenges facing the country. stimulates? Or will we spend most of the money The bill authorizes federal funding for highways, as we have for decades: on new and bigger highway safety, public transportation, and highways with little public accountability? bicycling and pedestrian infrastructure for The bill establishes funding categories approximately six years.11 It transfers hundreds of and requirements and in some cases gives billions of dollars from the federal government communities and metropolitan regions flexibility to states and localities. It also triggers to shape strategies to local needs. The new law hundreds of billions more in matching state is a chance to design communities for health,>> and local spending. The bill marks the largest sustainability, and opportunity—and to give all transportation expenditure in the United States. Americans physically active, clean, affordable,12 convenient, reliable, and safe options to getpg. where they need to go.The Transportation Prescription
  13. 13. How Transportation Policies and Plans Influence Health How Transportation Policies and Plans Influence Health Our current transportation system has many The main culprits are fine particulate matter,direct health consequences: Pollution-related including: diesel exhaust particles, ground-levelasthma, steep declines in physical activity, ozone, a toxic component of smog formedand the associated rise in obesity and chronic when tailpipe emissions from cars and trucksillnesses are just a few examples. Transportation react with sunlight and oxygen, and nitrogenaffects health indirectly by connecting people— oxide (NOx), which contributes to the formationor by failing to provide connections—to jobs, of ozone and smog. The health risks aremedical care, healthy food outlets, and other exacerbated by transportation patterns thatnecessities. The National Surface Transportation often embed heavy traffic and diesel-spewingPolicy and Revenue Study Commission—created facilities in poor and predominantly minorityby Congress in 2005 to examine the condition neighborhoods. The American Lung Associationand future needs of our network of highways, has found that 61.3 percent of African Americanports, freight and passenger railroads, and children, 67.7 percent of Asian Americanpublic transportation systems—reached a children, and 69.2 percent of Latino childrensobering conclusion: “The nation’s surface live in areas that exceed air quality standardstransportation network regrettably exacts a for ozone, compared with 50.8 percent ofterrible toll in lost lives and damaged health.”12 white children.20 Ground-level ozone, a gas, canNowhere is the toll higher than among low- chemically burn the lining of the respiratory tract.income people and people of color. Air pollution is also “one of the mostThere is a deep and evolving knowledge underappreciated” triggers of asthma attacks,base about the links between transportation according to the Centers for Disease Control << and health. Research shows that when and Prevention (CDC).21 More than 20 millionproperly designed, transportation systems Americans—roughly seven percent of adults 13can provide exercise opportunities, improve and nearly nine percent of all children—have, lower emotional stress, link poor asthma. In poor and minority communities, thepeople to opportunity, connect isolated older rates are considerably higher. For example, inadults and people with disabilities to crucial Harlem and Washington Heights in northernservices and social supports, and stimulate Manhattan, home to mostly low-income The Transportation Prescription economic development. Conventional mobility- African American and Latino residents, onefocused planning by local, regional, and state in four children suffers from the disease.22transportation agencies generally overlooks Research shows that air pollution can triggeror undervalues the impacts of transportation the wheezing, coughing, and gasping for breathinvestments on health and equity. that signal an attack in people with asthma. But a study in 10 Southern California cities raises theDirect Hea lth Effects troubling possibility that pollution can also lead to the onset of the disease. The study found that the closer children live to a freeway, thePollution more likely they are to develop asthma.23Pollutants from cars, buses, and trucks are Environmental justice activists have calledassociated with impaired lung development and attention for years to the connections amongfunction in infants13 and children,14 and with pollution, illness, and transportation policy—lung cancer,15 heart disease, respiratory illness,16 and the burden on communities of color. and premature death.17 Long-term exposure to For instance, in the mid-1990s, West Harlempollution from traffic may be as significant a Environmental Action (WE ACT) used mapping,threat for premature death as traffic crashes and air monitoring, and resident surveys to showobesity.18 In California alone, pollution is a factor that the neighborhood’s asthma rates werein an estimated 8,800 premature deaths a year.19
  14. 14. How Transportation Policies and Plans Influence Health linked to its dubious status as the diesel capital Scientists believe that climate change could of New York City. When WE ACT began work exacerbate a number of current health on the issue, Harlem housed six of the city’s problems, including heat-related deaths, eight bus depots and 650 Port Authority buses. diarrheal diseases, allergies, and asthma.28 The group played an important role in getting Those already at highest risk—the poor, the city to convert buses to clean fuel.24 minorities, children, and older adults—will be even more vulnerable. Policy neglect would Pollution from freight transport is another compound the problems. Hurricane Katrina big concern around the country. To meet revealed, to a horrified public, the disastrous America’s insatiable demand for goods, ports results that can occur when nature (the sort and highways are continually expanding to of extreme storm that experts expect to occur accommodate more ships, locomotives, and more frequently as the earth’s temperature trucks. Ports frequently border low-income changes) combines with government disregard and minority neighborhoods, and highways (in this case, the poorly maintained levees that often run through them. The upshot: Some failed to protect New Orleans from catastrophic of the worst emitters of fine particles, soot, flooding) as well as resource inequities (the and greenhouse gases (GHGs) are a growing lack of transportation, which made evacuation presence in already vulnerable communities. impossible for thousands of people). Climate Change The urgent need to reduce GHGs has catapulted transportation policy into the limelight. The GHGs are not pollutants in the classical sense. United States has only about five percent of>> They cause the atmospheric changes and the world’s population but contributes nearly resulting climate disruptions that are projected 25 percent of GHGs, mainly because of fossil14 to alter the natural and built environments on fuel consumption, motor vehicle emissions,pg. which society relies.25 The health risks come and industrial agricultural practices (which largely from those environmental alterations. In themselves are promoted by our transportation a major shift in federal policy, the Environmental system). Improving vehicle technology, while Protection Agency in April 2009 adopted the important, is not enough. Americans need toThe Transportation Prescription position that greenhouse gases pose a danger drive less. That will happen only if walking, to human health and welfare. A few weeks bicycling, and public transportation become later, the Climate Change and Health Protection feasible, efficient alternatives to driving in many and Promotion Act, H.R. 2323, was introduced more communities, and if land use patterns are in the House of Representatives.26 The bill would changed so people no longer have to jump in direct the Department of Health and Human the car for every trip. Services to develop a national strategic action plan to prepare for and respond to the health Physical Activity effects of climate change. Sixty percent of adults in the United States Researchers are just beginning to assess the do not meet recommended levels of physical specific health dangers in the United States; activity, and 25 percent are completely to date, most of the published data come sedentary.29 African Americans and Latinos from abroad. So far, however, there are more are less likely than whites to get enough daily questions than answers. How will less rainfall physical activity.30 The links between physical affect the potential for waterborne diseases? activity and health are well established. Food supplies? Food prices? How will extreme Sedentary lifestyles are estimated to contribute weather conditions such as heat waves or to as many as 255,000 deaths each year.31 Many hurricanes affect mental health? Physical children and teens are already at risk for heart activity? Population displacement? disease and type 2 diabetes, once considered
  15. 15. How Transportation Policies and Plans Influence Health “adult” ailments. Today’s youth may turn out to Many people find commuting by high-qualitybe the first generation in modern history to live public transportation to be less stressful thanshorter lives than their parents.32 commuting by car. As we discuss below, the financial costs associated with long commutesPhysical inactivity is an important factor in the exacerbate the stress, particularly in low-rising rates of obesity and chronic disease—and income households.transportation practices strongly influencephysical activity habits. The more time a person Safetyspends in a car, the more likely he or she isto be overweight. Conversely, higher rates of Traffic crashes are a leading cause of death andwalking and bicycling are associated with lower injury for Americans in the prime of life.36 Inrates of obesity. A 2004 study found that every 2000, motor vehicle crashes cost $230.6 billionadditional hour spent in a car is associated in medical costs, property damages, lost workerwith a six percent increase in the likelihood of productivity, travel delays, and other expenses.37obesity, and every additional kilometer walked is That figure equals about half of all spendingassociated with a 4.8 percent reduction.33 on public education from kindergarten through 12th grade.There are many ways to be physically active,but quite a few require time, skill, and money. Native Americans die in traffic crashes at moreWalking and bicycling not only for recreation than 1.5 times the rate of other racial groups.38but also for transportation are the most practical African Americans drive less than whites but dieways to improve fitness. They are often the only at higher rates in car crashes. Walking, too, is << viable option for low-income residents who live also more dangerous in communities of neighborhoods without parks, who cannot CDC data in the mid-1990s revealed that the 15afford gym memberships, and who do not have pedestrian death rate for Latino males in the pg.the luxury of leisure time. Atlanta metropolitan area was six times greater than for whites.39 African Americans make upPeople who use public transportation tend to 12 percent of the U.S. population but accountwalk to and from bus stops and train stations, for 20 percent of pedestrian deaths.40 The Transportation Prescription increasing their likelihood of meeting physicalactivity recommendations.34 Residents of Inequitable transportation policies andcompact neighborhoods walk, bike, and use resources contribute to these disparities. Low-public transportation more than residents of income people and people of color have fewerspread-out communities, and they have lower resources to buy products that improve safety,rates of obesity. such as late-model cars and new child safety seats. In underinvested neighborhoods, poorlyMental Health designed streets, neglected road maintenance, inadequate lighting, limited sidewalks, andRush-hour gridlock, long waits for the bus, and minimal traffic enforcement place residents atarduous commutes are stressful. They take time higher risk of injury.away from family, friends, and the activitiesthat provide emotional sustenance: hobbies, Safety is also a huge concern for olderreligion, sports, clubs, civic engagement, and adults—the fastest-growing segment of thevolunteer commitments. Every 10 minutes spent population—and for rural residents. Driving commuting is associated with a 10 percent drop skills decline with age, and frailty makes olderin the time spent traveling for social purposes.35 adults especially vulnerable in a collision.41 They are more likely to be killed or injured in a crash
  16. 16. How Transportation Policies and Plans Influence Health of a given severity than any other age group.42 Transportation, Income, and Health Older adults also walk slower and are more susceptible to pedestrian injuries. As housing and jobs have moved farther apart, the distance has created employment barriers Although less than a quarter of all driving in for anyone without unlimited ability to drive. the United States takes place in rural settings,43 Nineteen percent of African Americans and 13.7 more than half of all motor vehicle crashes percent of Latinos lack access to automobiles, occur there.44 compared with 4.6 percent of whites. Poverty complicates the problem: 33 percent of poor The more we drive, the more likely we are to African Americans and 25 percent of poor get hurt or die in a crash; there is a strong Latinos lack automobile access, compared with positive relationship between per capita vehicle 12.1 percent of poor whites.47 Cars owned miles traveled and traffic casualty rates.45 by low-income people tend to be older, less Communities with high annual mileage tend to reliable, and less fuel-efficient. This makes have higher traffic death rates than communities commuting to work unpredictable and more where people drive less. Passengers on buses, expensive, at best. light rail, and commuter rail have about one- tenth the traffic death rate as people in cars. Income is an important determinant of health.48 The association between poverty and poor Investments in public transportation and health is well documented. Jobs with good walking and bicycling infrastructure can reduce wages, including those in the transportation injuries and deaths. Contrary to popular belief sector, are essential to sustaining health.>> that more walkers and cyclists lead to more casualties, greater numbers of walkers and Transportation impacts not only family earnings16 bicyclists actually decrease the risks.46 but also expenses. The cost of getting aroundpg. takes a significant bite out of household Indirect Hea lth Effects budgets. The general standard holds that a family should spend no more than 20 percentThe Transportation Prescription Transportation is a lifeline. We depend on it of income on transportation, or the costs will to get to work, school, the doctor’s office, the eat into other necessities, such as nutritious bank, the supermarket, the gym, or a friend’s foods, and medical care.49 The average house. People without reliable, efficient, family in the United States spends about 18 affordable ways to get around are cut off from percent of after-tax income on transportation, jobs, social connections, and essential services. but this varies significantly by income and Access to transportation, to economic and social geography. For example, low-wage households opportunity, and to resources for healthy living (earning $20,000 to $35,000) living far from are inextricably linked. Gaps in all three areas employment centers spend 37 percent of their feed on one another in complex ways. Policy incomes on transportation.50 In neighborhoods reforms that put health equity objectives at the well served by public transportation, families center of transportation planning and funding spend an average of nine percent.51 decisions can reduce these inequities.
  17. 17. How Transportation Policies and Plans Influence Health Older Americans and People with available, older adults take advantage of them.Disabilities More than half of older adults make walking a regular activity. More than half of olderMore than one in five Americans ages 65 and nondrivers in dense communities use publicolder do not drive because of poor health or transportation at least occasionally, comparedeyesight, limited physical or mental abilities, with one in 20 in spread-out communities.54concerns about safety, or because they have nocar. More than half of nondrivers, or 3.6 million The Americans with Disabilities Act (ADA) ofAmericans, stay home on any given day—and 1990 significantly expanded transportationmore than half of that group, or 1.9 million, options for people with disabilities. ADAhave disabilities.52 Isolation is especially acute required public bus and rail operators to providein rural communities, sprawling suburbs, and accommodations, such as lifts and ramps, toblack and Latino communities. Compared with enable people in wheelchairs to ride. But streetolder drivers, older nondrivers take 15 percent design in most communities makes travelingfewer trips to the doctor; 59 percent fewer trips to and from bus stops challenging—and oftento shops and restaurants; and 65 percent fewer unsafe—for people with disabilities. Paratransittrips for family, social, and religious activities.53 systems, which use vans or shared taxis to transport people door-to-door, are helpful, butWhen affordable, high-quality public many systems are stretched thin and requiretransportation and safe, walkable streets are appointments well in advance. << 17 pg. The Transportation Prescription
  18. 18. What Does Healthy, Equitable Transportation Policy Look Like?What Does Healthy, Equitable Transportation Policy Look Like? Healthy, equitable, transportation policy of funders. The book describes innovative supports the development of accessible, transportation and land use policies, strategies, efficient, affordable, and safe alternatives to and programs built on a foundation of equity car travel, and especially to driving solo. These and sustainability. It includes six key chapters alternatives enable everyone to walk more, authored by academics and advocates travel by bicycle, and use public transportation working at the intersection of transportation, more—in other words, to get around in health, and equity. The book is available ways that improve health, expand access to online at opportunity, and reduce toxic pollutants and HealthyEquitableTransport. greenhouse gas emissions. Three chapters in the book address Healthy, equitable transportation policy is transportation options: forged and implemented in concert with sustainable land use planning. Together, they • Todd Litman, M.E.S., founder and executive encourage and support high-density, mixed- director of the Victoria Transport Policy use, mixed-income metropolitan development Institute in British Columbia, identifies and affordable housing with good access to numerous economic, social, and transportation options. Together, they focus, environmental benefits that can result from particularly, on underserved and economically public transportation improvements. isolated communities. Among them: reduced traffic crashes, improved physical fitness and health, energy Healthy, equitable transportation policy conservation, reduced pollution emissions,>> recognizes that income is important to health, increased community livability, increased and it encourages hiring low-income residents affordability, consumer savings, economic18 of color for well-paying jobs in transportation development, and expanded construction, maintenance, and service. Litman contends that improving public transportation is one of the most cost- Healthy, equitable transportation policy effective ways to improve public health, and understands the importance of ensuring equal better health is one of the most significantThe Transportation Prescription representation. All community members, potential benefits of public transportation regardless of race, gender, or geographical improvements. Litman identifies policy and location should be equitably represented and planning reforms to create a more diverse involved in making decisions which impact their and efficient transportation system. Litman communities, their infrastructure, and their recommends developing a strategic vision of options for travel. high-quality public transportation services, with supportive land use policies to provide Because access to healthy foods is integral basic mobility to people who are socially to good health and because transportation isolated, economically disadvantaged, or systems are integral to food production and physically disabled, as well as to attract distribution, healthy, equitable transportation “discretionary” travelers, or people who policy specifically addresses food access issues, would otherwise drive for a particular trip. including transportation to grocery stores and food transport practices. • Susan Handy, Ph.D., director of the Sustainable Development Center at the This report draws on the book, Healthy, University of California at Davis, argues that Equitable Transportation Policies: increasing walking and bicycling while Recommendations and Research commissioned assuring safety, particularly for low-income by the Convergence Partnership, a collaborative families, children, and older adults, is an
  19. 19. What Does Healthy, Equitable Transportation Policy Look Like? important goal for federal transportation sprawl. Targeted transportation investment policy. Walking and bicycling, or “active can promote economic opportunity and travel,” are low-cost, physically active, and reduce health disparities by (1) improving environmentally clean alternatives to driving, transportation linkages between housing and yet they represent fewer than 10 percent of employment hubs and between residential all trips in the United States. In addition to neighborhoods and clinics, pharmacies, and expanding specialized programs for active grocery stores; (2) encouraging affordable, travel, the federal government should assist, high-density, mixed-use transit oriented enable, encourage, and, in some instances, development;56 and (3) creating workforce require state, regional, and local governments strategies to ensure that jobs in the large, to address pedestrian and bicycling needs. growing transportation sector are open to all, including minority and women workers• Catherine L. Ross, Ph.D., the Harry West and contractors. Swanstrom also asserts that Chair and director of the Center for Quality while the goals of equity and environmental Growth and Regional Development at sustainability are not mutually exclusive, Georgia Institute of Technology, argues policymakers and advocates must address the that roadways are more than transport short-term needs of low-income families who routes; they are also our primary spaces live in places where driving is essential. for civic, social, and commercial enterprise. Roadways—highways in particular—receive • Kami Pothukuchi, Ph.D., associate professor the largest share of federal transportation of urban planning at Wayne State University, dollars by far. Federal policy has historically and Richard Wallace, M.S., senior project << emphasized highways designed to move manager at the Center for Automotive large numbers of cars and freight vehicles Research, argue that federal transportation 19 at high speeds. Ross argues for greater policy should seek to increase access to pg. investments in roadways that integrate healthy foods. Today’s transportation physical activity, enrich social interaction, networks make large quantities of foods increase safety, and provide transportation from around the nation and the globe linkages in underserved communities. She readily available for many Americans, The Transportation Prescription urges policymakers and others to consider but industrialized agriculture and the expanded assessments of the effects of concentrated structure of food retail roadways on health, through the use of have negative health and environmental methodologies similar to health impact consequences for low-income communities, assessment (HIA).55 especially people of color, inner-city and rural residents, and immigrant farm workers.Three additional chapters offer transportation For example, urban and rural communitiespolicy perspectives in key areas that have a often have fewer and smaller supermarketssignificant impact on public health and equity: than suburban communities (if they have any at all) as well as more limited selections of• Todd Swanstrom, Ph.D., the E. Desmond Lee healthy foods. As a result, residents eat fewer Professor of community collaboration and fruits and vegetables and have higher rates public policy administration at the University of diet-related illnesses. In addition, long- of Missouri – St. Louis, makes the case distance food hauling has a disproportionate that federal transportation policy can and impact on the air quality and noise levels in should address economic development, poor and minority communities along freight particularly in communities left behind routes. Although food access falls outside by decades of transportation planning the traditional realm of transportation policy, that favored car travel and encouraged improved public transportation, transit
  20. 20. What Does Healthy, Equitable Transportation Policy Look Like? oriented development, and cleaner methods as the leading cause of death for people to move freight can increase access to healthy ages one to 34 and contribute to unnecessary foods in underserved communities, reduce human, social, and economic costs. Resources air and noise pollution, and foster local, should be directed to communities with the sustainable agri-food systems. least infrastructure to support safe walking, bicycling, and public transportation use • Larry Cohen, M.S.W., Leslie Mikkelsen, R.D., and continue to support effective vehicle M.P.H., and Janani Srikantharajah, B.A., safety and occupant protection strategies. of Prevention Institute argue that traffic Traffic safety is an important strategy not crashes are preventable and that federal only to reduce injuries and death but also to transportation policy must make safety for encourage physical activity, improve air quality, all travelers a priority. Traffic crashes rank and increase transportation accessibility.>> 20pg.The Transportation Prescription
  21. 21. The Federal Transportation Legacyand Challenges Ahead The Federal Transportation Legacy and Challenges Ahead Transportation in America is a federal system, and dynamic American surface transportationnot a centralized, national system. Federal policy system is becoming a thing of the past.”plays a critical role, not by dictating practicesbut by enabling and encouraging innovation by At 300 million people, the nation’s populationstates, regional transportation organizations, has doubled since the creation of thetransit operators, and other agencies. This Interstate Highway System. We will numberhappens in several ways. 420 million by 2050. “Congestion was once just a nuisance. Today gridlock is a way ofFirst, the federal government sends billions of life,” the commission’s report said. Growingdollars for transportation to states and localities. transportation demand threatens to dwarfFor example, the American Recovery and regulatory and legislative efforts to mitigateReinvestment Act provides nearly $50 billion its health and environmental build and repair roads, bridges, railways, Increases in total vehicular mileage have all butand ports. The current surface transportation wiped out the gains achieved through hard-wonbill, SAFETEA-LU (Safe, Accountable, Flexible, regulations on fuel efficiency and emissionsEfficient Transportation Equity Act: A Legacy control. Expansion of freeways cannot get usfor Users), set to expire in September 2009, out of these problems; it will only make themguaranteed $244.1 billion over six years. These worse. The more we have expanded highways,dollars, in turn, leverage direct infrastructure the more traffic we have created. The Unitedinvestments by state governments, local States needs multi-modal systems with publicgovernments, and private investors. transportation that efficiently serves a large segment of the population, using existing << Second, the policies and requirements streets and highways.embedded in federal transportation programs 21influence state and local land use decisions and The Intermodal Transportation Efficiency pg.transportation priorities. Act (ISTEA), the 1991 version of the federal surface transportation bill, was supposed toMany observers contend that transportation lead us there. The act incorporated significantstands as one of the biggest policy successes in policy change. Since then, the stated goal The Transportation Prescription United States history. The Federal-Aid Highway of federal transportation policy has been toAct of 1956 and its progeny promoted mobility, expand access and improve efficiency throughwhich contributed mightily to American growth an interconnected multi-modal system thatand prosperity. However, many advocates take a supports highways, public transportation,more nuanced view of the federal legacy. They walking, and biking. This goal has yet to bepoint to the health, equity, and environmental achieved. Funding mechanisms and formulasconsequences of an ethic that held the have continued to favor highway constructionfaster, the farther, the better, as well as the and car travel. For example, the allocationconsequences of policies focused almost wholly formula for the Surface Transportation Programon car and truck travel, with little accountability (STP), the largest program within the federalto goals beyond mobility. bill, rewards states that consume more gas, have more miles of highway, and have residentsEither way, the current transport system is no who drive a lot.57 Alternatives to driving remainlonger sustainable or fixable by incremental underinvested. Approximately 80 percentchanges such as pilot projects, encouragements, of the surface transportation bill is allocated and small incentives. As the National Surface for distribution through the Federal HighwayTransportation Policy and Revenue Study Administration for mostly highway programs,Commission, created by SAFETEA-LU, wrote while less than 20 percent goes to the Federalin its final report to Congress: “The strong Transit Agency for public transportation. Other
  22. 22. The Federal Transportation Legacy and Challenges Ahead modes of travel constitute a minute amount of U.S. Department of Transportation’s main public spending in comparison to highways and public transportation programs for transit operating transportation. costs.59 In the face of budget shortfalls, local and regional transportation agencies throughout Case in point: Walking is the only travel the country have cut service, hiked fares, and mode that has not had significant declines in deferred maintenance—arguably at a time when casualties in 40 years. Yet only a tiny share of people need affordable, reliable links to jobs transportation funding goes to infrastructure more than ever. initiatives that would make walking and biking safer. Walking and bicycling accounted for 8.6 While federal policy plays a significant role in percent of all trips in 2001 but 12 percent of shaping transportation systems, states and traffic deaths.58 metropolitan regions are also critical agents of change. The new surface transportation Another case in point: Operating costs for bill offers an opportunity to increase support, public transportation systems present a huge encouragement, and pressure for integrating challenge for many communities. Yet federal land use and transportation planning transportation investment is focused on capital to promote balanced regional growth, projects. For example, cities with 200,000 equitable economic opportunity, and healthy people or more may not use grants from the communities for all.>> 22pg.The Transportation Prescription
  23. 23. A Foundation for 21st-CenturyTransportation PolicyHealthy, equitable transportation policy is 3. Emphasize accessibility, instead of A Foundation for 21st-Century Transportation Policy grounded in four principles. These may also simply mobility, in transportationserve as benchmarks to assess the impacts of policies and programs at all levels oftransportation plans on public health, equity, government as well as across sectorsand environmental quality: and policy silos. Transportation systems should give communities wider access1. Develop transportation policies and to all the things that are necessary for a plans that support health, equity, good life, not to move people faster and and environmental quality. Federal, farther. The definition of access must also state, and local transportation policies include affordability. If transportation is should be aligned with the top health and physically accessible, yet unaffordable, it is environmental goals of federal departments not truly accessible. Accessibility-oriented and agencies. For example, transportation transportation policies can catalyze and policies should be aligned with the support balanced regional growth, walkable Department of Health and Human Services’ communities, the renewal of long-neglected strategic goals to promote health equity and neighborhoods, and street design that foster the economic and social well-being makes walking and bicycling safe, popular of individuals, families, and communities. transportation options. Transportation policies should also support the CDC’s commitment to eliminate health 4. Ensure transparency, accountability, disparities and to promote its “healthy and meaningful participation by people in healthy places” goals. residents, advocates with diverse << interests, and experts from different2. Prioritize transportation investments fields. State and regional transportation 23 in distressed regions, low-income officials and private developers must engage pg. neighborhoods, and communities new partners in decision-making and of color. Federal, state, and local provide the data, training, and resources transportation agencies should emphasize to allow full, informed participation by the projects that will revitalize the economy people affected most by decisions and The Transportation Prescription of struggling communities, lower health investments. Voices and expertise from local disparities, and will connect vulnerable communities, public health, environmental populations to jobs, business opportunities, justice, community development, and other healthy food outlets, medical services, and arenas can help ensure that transportation other necessities. Government agencies plans respond to local needs and deliver must ensure that these projects are health, environmental, and economic financially sustainable by providing adequate benefits broadly. funding for maintenance and operations. The jobs associated with transportation construction, maintenance, and service should be available to low-income people and communities of color.