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BOLD NEW IDEAS FOR HEALTHY, EQUITABLE
 TRANSPORTATION REFORM IN AMERICA
PolicyLink
PolicyLink is a national research and action
institute advancing economic and social
equity by Lifting Up What Works.®

Prevention Institute
Putting prevention and equitable health
outcomes at the center of community
well-being.

This report was commissioned by the
Convergence Partnership which includes
the 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 advisers




Design by Chen Design Associates
Leslie Yang for PolicyLink
the
transportation
		         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
A NOTE ABOUT THIS R EPORT



The Transportation Prescription: Bold New Ideas for Healthy, Equitable Transportation Reform in America
builds on the research and analysis of a number of experts who are working at the intersection of
transportation, equity, and public health. The ideas that collectively form the heart of this paper are explored
in depth in the book, Healthy, Equitable Transportation Policy: Recommendations and Research. Chapters
are written or co-written by the authors listed below. Each chapter and the entire book can be found online
at www.convergencepartnership.org/HealthyEquitableTransport.

Larry Cohen, co-author, “Traffic Injury Prevention: A 21st-Century Approach,” founder and executive director,
Prevention Institute, Oakland

Susan Handy, “Walking, Bicycling, and Health,” professor of Environmental Science and Policy and director of
the Sustainable Transportation Center, University of California, Davis

Todd Litman, “Public Transportation and Health,” founder and executive director of the Victoria Transport
Policy Institute, British Columbia

Leslie Mikkelsen, co-author, “Traffic Injury Prevention: A 21st-Century Approach,” managing director,
Prevention Institute, Oakland

Kami Pothukuchi, co-author, “Sustainable Food Systems: Perspectives on Transportation Policy,” associate
professor of Urban Planning, Wayne State University, Detroit

Catherine L. Ross, “Roadways and Health: Making the Case for Collaboration,” director, Georgia Tech Center
for Quality Growth and Regional Development and the Harry West Chair for Quality Growth and Regional
Development, Atlanta

Janani Srikantharajah, co-author, “Traffic Injury Prevention: A 21st-Century Approach,” program coordinator,
Prevention Institute, Oakland

Todd Swanstrom, “Breaking Down Silos: Transportation, Economic Development, and Health,” E. Desmond Lee
Professor of Community Collaboration and Public Policy Administration at the University of Missouri, St. Louis

Richard Wallace, co-author, “Sustainable Food Systems: Perspectives on Transportation Policy,” senior project
manager, Center for Automotive Research, Ann Arbor

We owe a sincere debt of gratitude to these progressive individuals who recognize the value of working across
fields to identify effective and long-term solutions to multiple problems.
Contents




	 5	   Foreword
       Congressman James Oberstar, Chairman of the House Transportation and Infrastructure Committee

	 6	   Preface
       Angela Glover Blackwell, Founder and CEO, PolicyLink

	 9	   Introduction
10	
	      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?




                                                                                                       3
21	
	      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
Transportationrx
Foreword Congressman James Oberstar




Discussions of public health and wellness often     and helping Americans incorporate exercise
are limited to the health and medical fields. It    and fresh air into their daily travel routines. We
is my hope that soon, the transportation sector     must also continue our pursuit to reduce the
will be part of the discussion and play a role in   number—and rate—of traffic fatalities and
providing solutions to improving the nation’s       injuries that occur each year.
overall health, well-being, and quality of life.
                                                    Our most recent surface transportation
One of my goals as Chairman of the Committee        legislation, enacted in 2005, took important
on Transportation and Infrastructure is to create   steps toward building a healthier infrastructure
a new model for surface transportation, one         by investing billions of dollars in safety, public
that invests in alternative modes and promotes      transit, walking, and bicycling. This legislation is
active, healthy lifestyles. Public health and       helping to construct safer infrastructure, enable
transportation policy choices are inextricably      workforce development, build new transit
linked. The transportation sector is responsible    lines, repair existing systems, and establish
for 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 School
use choices often dictate our daily travel, and     program, which allows states to invest in safety
whether or not we have access to clean, healthy     improvements and education campaigns
transportation options. And in any given year,      to get kids walking and biking to
approximately 40,000 Americans are killed on        school again. This program has shown
our roadways. The policy decisions we make          great early success and has the ability
regarding transportation have repercussions on      to change the habits of an entire
public health throughout our society.               generation.




                                                                                                           <<	
                                                                                                           5
For too long now, our transportation decision-      Environmental sustainability, access,




                                                                                                           pg.
making has failed to address the impacts            and our collective well-being
that our infrastructure network has on public       must combine with mobility and
health and equity. The asphalt poured and lane      safety as the cornerstones of our
miles constructed enhanced our mobility and         transportation investments. The following report




                                                                                                           The Transportation Prescription	
strengthened our economic growth; but too           represents an important contribution to our
often, this auto-centric mindset took hold and      emerging understanding of the connections
crowded out opportunities to invest in a truly      between transportation and public health
sustainable intermodal transportation system,       and is an invaluable resource for policymakers
in particular a system that meets the needs of      and all those interested in building healthy
underserved communities.                            communities. With a greater recognition of
                                                    the strong linkage between public health and
The failure to link transportation and land use     transportation, I believe we can build a network
decision making, and to consider the public         that supports our mobility and creates access
health 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—option
available in many parts of the country. Our
transportation policies and investments must
do more to provide access for all through
                                                                                                           	




various modes. Transit, walking, and bicycling      Congressman James Oberstar
all have a significant role to play in lowering
                                                    Chairman of the House Transportation
our dependence on foreign oil, reducing our
                                                    and Infrastructure Committee
greenhouse gas emissions and air pollutants,
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 will
Preface	




                                   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 researchers
6




                                   reliable public transportation to get them to         and advocates working at the intersection of
pg.




                                   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 offers
The 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
chronic diseases—transportation policy has
contributed to these problems, and now it must
address them. Increasing rates of poverty and a
severe economic downturn add to the urgency
for reform.

This report intentionally uses the term
authorization and not the more common word,
reauthorization, in reference to the surface
transportation bill. We want to make clear that
new thinking and innovative approaches are
necessary to meet the needs of a changing and
diverse America.

Many advocates are already working hard to




                                                     Preface	
push for fundamental reform. This report was
written for community leaders, policymakers,
funders, practitioners, and advocates interested
in an overarching strategy to promote active
living and to build healthy communities of
opportunity. PolicyLink, Prevention Institute,
and the Convergence Partnership believe
that building healthy communities requires a




                                                     <<	
collaboration of stakeholders from diverse fields




                                                     7
and sectors. Together, we can identify and




                                                     pg.
support shared solutions.

The project recognizes that effective strategies
to improve health, particularly in vulnerable




                                                     The Transportation Prescription	
communities, often fall outside the conventional
domain of health policy, yet deserve equal
attention. Federal transportation policy is a
critical opportunity at our fingertips. Leveraging
the strength of collaboration and networking can
yield powerful results. Let’s seize the moment.




Angela Glover Blackwell
Founder and CEO
PolicyLink
Transportationrx
Introduction




In St. Louis, MO, major cuts in bus service this spring left workers, students, people with
disabilities, and older residents stranded and feeling bereft. Stuart and Dianne Falk, who
are both in wheelchairs, told CNN they no longer would be able to get to the gym or the
downtown theater company where they volunteer. “To be saddled, to be imprisoned, that is
what it is going to feeling like,” Stuart Falk said.1

In West Oakland, CA, families have no escape from the diesel exhaust belching from trucks at
the nearby port: The air inside some homes is five times more toxic than in other parts of the
city. “I’m constantly doing this dance about cleaning diesel soot from my blinds and window
sills,” 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-long
bus ride to buy fresh fruits and vegetables. She cannot haul more than a few small bags at a
time so she shops frequently—if she feels well enough. “It depends on what kind of day I’m
having with my diabetes to decide whether I’m going to make do with a bowl of cereal or try
to go get something better,” she told the Seattle Post-Intelligencer.3


Our 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




                                                                                                        9
breathe, 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. They
decisions 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 community
stress levels, family budgets, and the time we     economic development.




                                                                                                        The Transportation Prescription	
spend with our children. Although most people
don’t think of it as a determinant of health,      Streets and roads are the largest chunks of
our transportation system has far-reaching         property owned by most cities and states. We
implications for our risk of disease and injury.   have choices to make about how to use, and
Transportation policies and accompanying land      share, that real estate. Who decides? Who
use patterns contribute to the glaring health      benefits? Who pays? Transportation policy at
disparities between the affluent and the poor      all levels of government can be a vehicle to
and between white people and people of color.      promote public health, sustainability, equitable
                                                   opportunity, and the economic strength of
This report demonstrates that transportation       neighborhoods, cities, and regions. But that
policy is, in effect, health policy—and            will happen only if advocates, experts, and
environmental policy, food policy, employment      organizers steeped in all these issues bring their
policy, and metropolitan development policy,       knowledge and passion to critical transportation
each of which bears on health independently        decisions. The upcoming authorization of
and in concert with the others. Longstanding       the most important transportation legislation
                                                                                                        	




transportation and land use policies are at        in the United States, the federal surface
odds with serious health, environmental, and       transportation bill, makes this a pivotal moment
economic needs of the country, and they            to bring a broad vision for health and equity to
have harmed low-income communities and             transportation policy.
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 transportation
Transportation 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 package
10




                                           passed by Congress and signed by President           A new framework for transportation policy and
pg.




                                           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;
less emotional stress; cleaner air; quieter streets;   But the push to reform transportation (along
fewer traffic injuries and deaths; and greater         with its cousin, land use planning) has gained
access to jobs, nutritious foods, pharmacies,          urgency in the face of three massive challenges
clinics, and other essentials for healthy,             that are upending the status quo of every field
productive 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 of
This new vision is at the core of a burgeoning         global ecological upheaval; (2) U.S. dependence
movement to shape transportation policy                on foreign oil, which carries grave risks for our
to support work in a number of critical                economy and security; (3) a healthcare system
areas, such as climate change, sustainable             crumbling under the demands of skyrocketing
agriculture, the prevention of chronic diseases,       rates of diabetes and other chronic diseases
workforce development, and neighborhood                associated with sedentary lifestyles, and
revitalization. Advocates and experts in public        astronomical costs. Transporting goods, services,
health, environmental justice, labor, community        and people accounts for about one-third of
economic development, food policy, and other           greenhouse gas emissions and two-thirds of
fields and disciplines have important roles to         petroleum consumption in the United States.7
play in transportation debates. A broad range          As the National Surface Transportation Policy
of interests, working in partnership, can craft        and Revenue Study Commission noted in its
innovative, environmentally sound solutions that       landmark report, Transportation for Tomorrow,
benefit everyone, rather than plans that reflect       the environmental gains we achieve through
the motor vehicle orientation of road engineers        incremental fixes such as higher fuel-efficiency
and builders. Government transportation                standards, though important, will be trumped




                                                                                                            <<	
agencies and developers—the architects of our          by increases in driving and traffic if we continue
transportation systems for decades—must be             on our current policy course.




                                                                                                            11
held 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 public
This 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 vanpools
stems 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.8
areas; renewed interest in city living and a
hunger for shorter commutes; demographic               In Chicago’s West Garfield Park, an alliance
changes (including the increasing number of            of residents, activists, and faith-based
people over 65 and immigrants, two groups              organizations not only successfully fought
less likely to drive or own cars); the rise in         the closure of the rail line that linked the
obesity; the enduring poverty in inner-city and        neighborhood to downtown; they also
rural communities; the growing understanding           transformed a transit stop into an anchor
of the connections among health, the built             development of shops, community services,
environment, and transportation plans; and             and moderately priced housing.9
the increasing frustration among residents and
advocates about the limited accountability and         In port cities around the country, many groups
inequitable transportation decision-making             are working to reduce pollution from ships,
                                                                                                            	




processes at the state and regional levels which       locomotives, and trucks, some of the worst
over 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
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 invest
Transportation 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 get
pg.




                                                                                                 where they need to go.
The Transportation Prescription
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-level
asthma, steep declines in physical activity,            ozone, a toxic component of smog formed
and the associated rise in obesity and chronic          when tailpipe emissions from cars and trucks
illnesses are just a few examples. Transportation       react with sunlight and oxygen, and nitrogen
affects health indirectly by connecting people—         oxide (NOx), which contributes to the formation
or by failing to provide connections—to jobs,           of ozone and smog. The health risks are
medical care, healthy food outlets, and other           exacerbated by transportation patterns that
necessities. The National Surface Transportation        often embed heavy traffic and diesel-spewing
Policy and Revenue Study Commission—created             facilities in poor and predominantly minority
by Congress in 2005 to examine the condition            neighborhoods. The American Lung Association
and future needs of our network of highways,            has found that 61.3 percent of African American
ports, freight and passenger railroads, and             children, 67.7 percent of Asian American
public transportation systems—reached a                 children, and 69.2 percent of Latino children
sobering conclusion: “The nation’s surface              live in areas that exceed air quality standards
transportation network regrettably exacts a             for ozone, compared with 50.8 percent of
terrible toll in lost lives and damaged health.”12      white children.20 Ground-level ozone, a gas, can
Nowhere 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 most
There 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 million
properly designed, transportation systems               Americans—roughly seven percent of adults




                                                                                                               13
can provide exercise opportunities, improve             and nearly nine percent of all children—have




                                                                                                               pg.
safety, lower emotional stress, link poor               asthma. In poor and minority communities, the
people to opportunity, connect isolated older           rates are considerably higher. For example, in
adults and people with disabilities to crucial          Harlem and Washington Heights in northern
services and social supports, and stimulate             Manhattan, home to mostly low-income




                                                                                                               The Transportation Prescription	
economic development. Conventional mobility-            African American and Latino residents, one
focused planning by local, regional, and state          in four children suffers from the disease.22
transportation agencies generally overlooks             Research shows that air pollution can trigger
or undervalues the impacts of transportation            the wheezing, coughing, and gasping for breath
investments on health and equity.                       that signal an attack in people with asthma. But
                                                        a study in 10 Southern California cities raises the
Direct 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, the
Pollution
                                                        more likely they are to develop asthma.23
Pollutants from cars, buses, and trucks are
                                                        Environmental justice activists have called
associated with impaired lung development and
                                                        attention for years to the connections among
function 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 Harlem
pollution 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 show
obesity.18 In California alone, pollution is a factor
                                                        that the neighborhood’s asthma rates were
in an estimated 8,800 premature deaths a year.19
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 fossil
14




                                                           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 to
The 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
How Transportation Policies and Plans Influence Health		
“adult” ailments. Today’s youth may turn out to      Many people find commuting by high-quality
be the first generation in modern history to live    public transportation to be less stressful than
shorter lives than their parents.32                  commuting by car. As we discuss below, the
                                                     financial costs associated with long commutes
Physical 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 influence
physical activity habits. The more time a person     Safety
spends in a car, the more likely he or she is
to be overweight. Conversely, higher rates of        Traffic crashes are a leading cause of death and
walking and bicycling are associated with lower      injury for Americans in the prime of life.36 In
rates of obesity. A 2004 study found that every      2000, motor vehicle crashes cost $230.6 billion
additional hour spent in a car is associated         in medical costs, property damages, lost worker
with a six percent increase in the likelihood of     productivity, travel delays, and other expenses.37
obesity, and every additional kilometer walked is    That figure equals about half of all spending
associated 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 more
Walking and bicycling not only for recreation        than 1.5 times the rate of other racial groups.38
but also for transportation are the most practical   African Americans drive less than whites but die
ways 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 color.
in neighborhoods without parks, who cannot           CDC data in the mid-1990s revealed that the




                                                                                                           15
afford 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 up
People who use public transportation tend to         12 percent of the U.S. population but account
walk to and from bus stops and train stations,       for 20 percent of pedestrian deaths.40




                                                                                                           The Transportation Prescription	
increasing their likelihood of meeting physical
activity recommendations.34 Residents of             Inequitable transportation policies and
compact neighborhoods walk, bike, and use            resources contribute to these disparities. Low-
public transportation more than residents of         income people and people of color have fewer
spread-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, poorly
Mental Health                                        designed streets, neglected road maintenance,
                                                     inadequate lighting, limited sidewalks, and
Rush-hour gridlock, long waits for the bus, and      minimal traffic enforcement place residents at
arduous commutes are stressful. They take time       higher risk of injury.
away from family, friends, and the activities
that provide emotional sustenance: hobbies,          Safety is also a huge concern for older
religion, sports, clubs, civic engagement, and       adults—the fastest-growing segment of the
volunteer 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 older
in 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
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 earnings
16




                                                           bicyclists actually decrease the risks.46            but also expenses. The cost of getting around
pg.




                                                                                                                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 percent
The 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.
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 older
More than one in five Americans ages 65 and             nondrivers in dense communities use public
older do not drive because of poor health or            transportation at least occasionally, compared
eyesight, limited physical or mental abilities,         with one in 20 in spread-out communities.54
concerns about safety, or because they have no
car. More than half of nondrivers, or 3.6 million       The Americans with Disabilities Act (ADA) of
Americans, stay home on any given day—and               1990 significantly expanded transportation
more than half of that group, or 1.9 million,           options for people with disabilities. ADA
have disabilities.52 Isolation is especially acute      required public bus and rail operators to provide
in rural communities, sprawling suburbs, and            accommodations, such as lifts and ramps, to
black and Latino communities. Compared with             enable people in wheelchairs to ride. But street
older drivers, older nondrivers take 15 percent         design in most communities makes traveling
fewer trips to the doctor; 59 percent fewer trips       to and from bus stops challenging—and often
to shops and restaurants; and 65 percent fewer          unsafe—for people with disabilities. Paratransit
trips for family, social, and religious activities.53   systems, which use vans or shared taxis to
                                                        transport people door-to-door, are helpful, but
When affordable, high-quality public                    many systems are stretched thin and require
transportation and safe, walkable streets are           appointments well in advance.




                                                                                                            <<	
                                                                                                            17
                                                                                                            pg.
                                                                                                            The Transportation Prescription
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 www.convergencepartnership.org/
                                                                     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, economic
18




                                                                     of color for well-paying jobs in transportation        development, and expanded opportunity.
pg.




                                                                     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 significant
The 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
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 communities
policy perspectives in key areas that have a            often have fewer and smaller supermarkets
significant 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
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.
>>	
20
pg.
The Transportation Prescription
The Federal Transportation Legacy
and Challenges Ahead




                                                                                                           The Federal Transportation Legacy and Challenges Ahead	
Transportation in America is a federal system,         and dynamic American surface transportation
not a centralized, national system. Federal policy     system is becoming a thing of the past.”
plays a critical role, not by dictating practices
but by enabling and encouraging innovation by          At 300 million people, the nation’s population
states, regional transportation organizations,         has doubled since the creation of the
transit operators, and other agencies. This            Interstate Highway System. We will number
happens in several ways.                               420 million by 2050. “Congestion was once
                                                       just a nuisance. Today gridlock is a way of
First, the federal government sends billions of        life,” the commission’s report said. Growing
dollars for transportation to states and localities.   transportation demand threatens to dwarf
For example, the American Recovery and                 regulatory and legislative efforts to mitigate
Reinvestment Act provides nearly $50 billion           its health and environmental consequences.
to build and repair roads, bridges, railways,          Increases in total vehicular mileage have all but
and ports. The current surface transportation          wiped out the gains achieved through hard-won
bill, SAFETEA-LU (Safe, Accountable, Flexible,         regulations on fuel efficiency and emissions
Efficient Transportation Equity Act: A Legacy          control. Expansion of freeways cannot get us
for Users), set to expire in September 2009,           out of these problems; it will only make them
guaranteed $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 United
investments by state governments, local                States needs multi-modal systems with public
governments, 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




                                                                                                           21
influence 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 to
Many observers contend that transportation             lead us there. The act incorporated significant
stands 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 to
Act of 1956 and its progeny promoted mobility,         expand access and improve efficiency through
which contributed mightily to American growth          an interconnected multi-modal system that
and 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 be
point to the health, equity, and environmental         achieved. Funding mechanisms and formulas
consequences of an ethic that held the                 have continued to favor highway construction
faster, the farther, the better, as well as the        and car travel. For example, the allocation
consequences of policies focused almost wholly         formula for the Surface Transportation Program
on car and truck travel, with little accountability    (STP), the largest program within the federal
to goals beyond mobility.                              bill, rewards states that consume more gas,
                                                       have more miles of highway, and have residents
Either way, the current transport system is no         who drive a lot.57 Alternatives to driving remain
longer sustainable or fixable by incremental           underinvested. Approximately 80 percent
changes such as pilot projects, encouragements,        of the surface transportation bill is allocated
                                                                                                           	




and small incentives. As the National Surface          for distribution through the Federal Highway
Transportation Policy and Revenue Study                Administration for mostly highway programs,
Commission, created by SAFETEA-LU, wrote               while less than 20 percent goes to the Federal
in its final report to Congress: “The strong           Transit Agency for public transportation. Other
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.
>>	
22
pg.
The Transportation Prescription
A Foundation for 21st-Century
Transportation Policy



Healthy, 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 transportation
serve as benchmarks to assess the impacts of            policies and programs at all levels of
transportation plans on public health, equity,          government as well as across sectors
and environmental quality:                              and policy silos. Transportation systems
                                                        should give communities wider access
1.	 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 different
2.	 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.
Policy and Program Priorities to Improve
                                                              Health and Equity
Policy and Program Priorities to Improve Health and Equity	




                                                              Government at all levels must consider the                affordability and accessibility. It also
                                                              health and equity impacts of transportation               must incorporate affordable housing and
                                                              investments at the beginning of decision-making           commercial properties that provide jobs,
                                                              processes. Public and private transportation              services, and essential goods near people’s
                                                              investments must be designed to promote                   homes. Because people of all income
                                                              health rather than to erode it. The following             levels desire walkable neighborhoods
                                                              recommendations can help policymakers and                 and shorter commutes, displacement of
                                                              planners achieve these ends:                              longtime neighborhood residents can be an
                                                                                                                        unintended consequence of transit oriented
                                                              1.	 Prioritize investments in public                      development. Policymakers must ensure
                                                                  transportation, including regional                    that the local residents guide planning and
                                                                  systems that connect housing and jobs                 development and that equity is a goal from
                                                                  as well as local services that improve                day one.
                                                                  access to healthy foods, medical care,
                                                                  and other basic services. Investments             4. 	 Create incentives and accountability
                                                                  should include capital costs as well as costs          measures to ensure that transportation
                                                                  for maintenance and operations. Because                plans account for their impacts on
                                                                  older diesel buses have high emission rates            health, safety, and equity. New projects
                                                                  and since bus depots and other facilities              must be held accountable for better results.
                                                                  are often concentrated in low-income                   Government investment should support
                                                                  and minority neighborhoods, policies                   the creation of tools that more sensitively
                                                                  must be in place to ensure that expanded               and accurately measure walking and
>>	




                                                                  public transportation does not lead to                 bicycling practices and improved outcomes.
                                                                  increased exposure to pollutants in these              Health impact assessment is an emerging
24




                                                                  same communities.                                      methodology to evaluate the effects of
pg.




                                                                                                                         policies, programs, and plans on the health
                                                              2. 	 Prioritize investments in bicycle and                 of a population and should be considered an
                                                                   pedestrian infrastructure to make                     important tool. People should also have the
                                                                   walking and biking safer and more                     right to sue under Title VI of the Civil Rights
The Transportation Prescription	




                                                                   convenient. Strategies include complete               Act of 1964 if they suffer disparate impacts
                                                                   streets designed with all users in mind,              from federal transportation investments,
                                                                   not just drivers; traffic-calming measures;           and the U.S. Department of Transportation
                                                                   and safe routes to transit and Safe Routes            should have the power to withhold dollars if
                                                                   to Schools programs, which create                     investments are not made equitably.60
                                                                   infrastructure and programming to support
                                                                   safe walking and bicycling to bus stops, rail    5. 	 Give state, regional, and local
                                                                   stations, and schools. Targeted infrastructure        government agencies and organizations
                                                                   investments should also support walking               more flexibility to move dollars among
                                                                   and bicycling in rural communities by, for            funding categories and to target
                                                                   example, improving road shoulders and                 spending to meet local needs. Greater
                                                                   building trails to town centers.                      flexibility would give communities more
                                                                                                                         leeway to fund walking, bicycling, and
                                                              3. 	 Encourage equitable transit                           public transportation programs. It would
                                                                   oriented development by creating                      also enable communities to invest in fixing,
	




                                                                   incentives for integrated land use                    maintaining, and operating local bus and
                                                                   and transportation planning. Transit                  rail systems. Flexibility should be strongly
                                                                   oriented development must emphasize                   tied to new standards for accountability,
Transportationrx
Transportationrx
Transportationrx
Transportationrx
Transportationrx
Transportationrx
Transportationrx
Transportationrx
Transportationrx
Transportationrx

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Transportationrx

  • 1. the transportation prescription BOLD NEW IDEAS FOR HEALTHY, EQUITABLE TRANSPORTATION REFORM IN AMERICA
  • 2. PolicyLink PolicyLink is a national research and action institute advancing economic and social equity by Lifting Up What Works.® Prevention Institute Putting prevention and equitable health outcomes at the center of community well-being. This report was commissioned by the Convergence Partnership which includes the 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 advisers Design by Chen Design Associates Leslie Yang for PolicyLink
  • 3. the transportation 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. A NOTE ABOUT THIS R EPORT The Transportation Prescription: Bold New Ideas for Healthy, Equitable Transportation Reform in America builds on the research and analysis of a number of experts who are working at the intersection of transportation, equity, and public health. The ideas that collectively form the heart of this paper are explored in depth in the book, Healthy, Equitable Transportation Policy: Recommendations and Research. Chapters are written or co-written by the authors listed below. Each chapter and the entire book can be found online at www.convergencepartnership.org/HealthyEquitableTransport. Larry Cohen, co-author, “Traffic Injury Prevention: A 21st-Century Approach,” founder and executive director, Prevention Institute, Oakland Susan Handy, “Walking, Bicycling, and Health,” professor of Environmental Science and Policy and director of the Sustainable Transportation Center, University of California, Davis Todd Litman, “Public Transportation and Health,” founder and executive director of the Victoria Transport Policy Institute, British Columbia Leslie Mikkelsen, co-author, “Traffic Injury Prevention: A 21st-Century Approach,” managing director, Prevention Institute, Oakland Kami Pothukuchi, co-author, “Sustainable Food Systems: Perspectives on Transportation Policy,” associate professor of Urban Planning, Wayne State University, Detroit Catherine L. Ross, “Roadways and Health: Making the Case for Collaboration,” director, Georgia Tech Center for Quality Growth and Regional Development and the Harry West Chair for Quality Growth and Regional Development, Atlanta Janani Srikantharajah, co-author, “Traffic Injury Prevention: A 21st-Century Approach,” program coordinator, Prevention Institute, Oakland Todd Swanstrom, “Breaking Down Silos: Transportation, Economic Development, and Health,” E. Desmond Lee Professor of Community Collaboration and Public Policy Administration at the University of Missouri, St. Louis Richard Wallace, co-author, “Sustainable Food Systems: Perspectives on Transportation Policy,” senior project manager, Center for Automotive Research, Ann Arbor We owe a sincere debt of gratitude to these progressive individuals who recognize the value of working across fields to identify effective and long-term solutions to multiple problems.
  • 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 Introduction 10 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? 3 21 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
  • 7. Foreword Congressman James Oberstar Discussions of public health and wellness often and helping Americans incorporate exercise are limited to the health and medical fields. It and fresh air into their daily travel routines. We is my hope that soon, the transportation sector must also continue our pursuit to reduce the will be part of the discussion and play a role in number—and rate—of traffic fatalities and providing solutions to improving the nation’s injuries that occur each year. overall health, well-being, and quality of life. Our most recent surface transportation One of my goals as Chairman of the Committee legislation, enacted in 2005, took important on Transportation and Infrastructure is to create steps toward building a healthier infrastructure a new model for surface transportation, one by investing billions of dollars in safety, public that invests in alternative modes and promotes transit, walking, and bicycling. This legislation is active, healthy lifestyles. Public health and helping to construct safer infrastructure, enable transportation policy choices are inextricably workforce development, build new transit linked. The transportation sector is responsible lines, repair existing systems, and establish for 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 School use choices often dictate our daily travel, and program, which allows states to invest in safety whether or not we have access to clean, healthy improvements and education campaigns transportation options. And in any given year, to get kids walking and biking to approximately 40,000 Americans are killed on school again. This program has shown our roadways. The policy decisions we make great early success and has the ability regarding transportation have repercussions on to change the habits of an entire public health throughout our society. generation. << 5 For too long now, our transportation decision- Environmental sustainability, access, pg. making has failed to address the impacts and our collective well-being that our infrastructure network has on public must combine with mobility and health and equity. The asphalt poured and lane safety as the cornerstones of our miles constructed enhanced our mobility and transportation investments. The following report The Transportation Prescription strengthened our economic growth; but too represents an important contribution to our often, this auto-centric mindset took hold and emerging understanding of the connections crowded out opportunities to invest in a truly between transportation and public health sustainable intermodal transportation system, and is an invaluable resource for policymakers in particular a system that meets the needs of and all those interested in building healthy underserved communities. communities. With a greater recognition of the strong linkage between public health and The failure to link transportation and land use transportation, I believe we can build a network decision making, and to consider the public that supports our mobility and creates access health 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—option available in many parts of the country. Our transportation policies and investments must do more to provide access for all through various modes. Transit, walking, and bicycling Congressman James Oberstar all have a significant role to play in lowering Chairman of the House Transportation our dependence on foreign oil, reducing our and Infrastructure Committee greenhouse gas emissions and air pollutants,
  • 8. 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 will Preface 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 researchers 6 reliable public transportation to get them to and advocates working at the intersection of pg. 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 offers The 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
  • 9. chronic diseases—transportation policy has contributed to these problems, and now it must address them. Increasing rates of poverty and a severe economic downturn add to the urgency for reform. This report intentionally uses the term authorization and not the more common word, reauthorization, in reference to the surface transportation bill. We want to make clear that new thinking and innovative approaches are necessary to meet the needs of a changing and diverse America. Many advocates are already working hard to Preface push for fundamental reform. This report was written for community leaders, policymakers, funders, practitioners, and advocates interested in an overarching strategy to promote active living and to build healthy communities of opportunity. PolicyLink, Prevention Institute, and the Convergence Partnership believe that building healthy communities requires a << collaboration of stakeholders from diverse fields 7 and sectors. Together, we can identify and pg. support shared solutions. The project recognizes that effective strategies to improve health, particularly in vulnerable The Transportation Prescription communities, often fall outside the conventional domain of health policy, yet deserve equal attention. Federal transportation policy is a critical opportunity at our fingertips. Leveraging the strength of collaboration and networking can yield powerful results. Let’s seize the moment. Angela Glover Blackwell Founder and CEO PolicyLink
  • 11. Introduction In St. Louis, MO, major cuts in bus service this spring left workers, students, people with disabilities, and older residents stranded and feeling bereft. Stuart and Dianne Falk, who are both in wheelchairs, told CNN they no longer would be able to get to the gym or the downtown theater company where they volunteer. “To be saddled, to be imprisoned, that is what it is going to feeling like,” Stuart Falk said.1 In West Oakland, CA, families have no escape from the diesel exhaust belching from trucks at the nearby port: The air inside some homes is five times more toxic than in other parts of the city. “I’m constantly doing this dance about cleaning diesel soot from my blinds and window sills,” 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-long bus ride to buy fresh fruits and vegetables. She cannot haul more than a few small bags at a time so she shops frequently—if she feels well enough. “It depends on what kind of day I’m having with my diabetes to decide whether I’m going to make do with a bowl of cereal or try to go get something better,” she told the Seattle Post-Intelligencer.3 Our 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 9 breathe, 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. They decisions 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 community stress levels, family budgets, and the time we economic development. The Transportation Prescription spend with our children. Although most people don’t think of it as a determinant of health, Streets and roads are the largest chunks of our transportation system has far-reaching property owned by most cities and states. We implications for our risk of disease and injury. have choices to make about how to use, and Transportation policies and accompanying land share, that real estate. Who decides? Who use patterns contribute to the glaring health benefits? Who pays? Transportation policy at disparities between the affluent and the poor all levels of government can be a vehicle to and between white people and people of color. promote public health, sustainability, equitable opportunity, and the economic strength of This report demonstrates that transportation neighborhoods, cities, and regions. But that policy is, in effect, health policy—and will happen only if advocates, experts, and environmental policy, food policy, employment organizers steeped in all these issues bring their policy, and metropolitan development policy, knowledge and passion to critical transportation each of which bears on health independently decisions. The upcoming authorization of and in concert with the others. Longstanding the most important transportation legislation transportation and land use policies are at in the United States, the federal surface odds with serious health, environmental, and transportation bill, makes this a pivotal moment economic needs of the country, and they to bring a broad vision for health and equity to have harmed low-income communities and transportation policy.
  • 12. 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 transportation Transportation 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 package 10 passed by Congress and signed by President A new framework for transportation policy and pg. 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;
  • 13. less emotional stress; cleaner air; quieter streets; But the push to reform transportation (along fewer traffic injuries and deaths; and greater with its cousin, land use planning) has gained access to jobs, nutritious foods, pharmacies, urgency in the face of three massive challenges clinics, and other essentials for healthy, that are upending the status quo of every field productive 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 of This new vision is at the core of a burgeoning global ecological upheaval; (2) U.S. dependence movement to shape transportation policy on foreign oil, which carries grave risks for our to support work in a number of critical economy and security; (3) a healthcare system areas, such as climate change, sustainable crumbling under the demands of skyrocketing agriculture, the prevention of chronic diseases, rates of diabetes and other chronic diseases workforce development, and neighborhood associated with sedentary lifestyles, and revitalization. Advocates and experts in public astronomical costs. Transporting goods, services, health, environmental justice, labor, community and people accounts for about one-third of economic development, food policy, and other greenhouse gas emissions and two-thirds of fields and disciplines have important roles to petroleum consumption in the United States.7 play in transportation debates. A broad range As the National Surface Transportation Policy of interests, working in partnership, can craft and Revenue Study Commission noted in its innovative, environmentally sound solutions that landmark report, Transportation for Tomorrow, benefit everyone, rather than plans that reflect the environmental gains we achieve through the motor vehicle orientation of road engineers incremental fixes such as higher fuel-efficiency and builders. Government transportation standards, though important, will be trumped << agencies and developers—the architects of our by increases in driving and traffic if we continue transportation systems for decades—must be on our current policy course. 11 held 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 public This 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 vanpools stems 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.8 areas; renewed interest in city living and a hunger for shorter commutes; demographic In Chicago’s West Garfield Park, an alliance changes (including the increasing number of of residents, activists, and faith-based people over 65 and immigrants, two groups organizations not only successfully fought less likely to drive or own cars); the rise in the closure of the rail line that linked the obesity; the enduring poverty in inner-city and neighborhood to downtown; they also rural communities; the growing understanding transformed a transit stop into an anchor of the connections among health, the built development of shops, community services, environment, and transportation plans; and and moderately priced housing.9 the increasing frustration among residents and advocates about the limited accountability and In port cities around the country, many groups inequitable transportation decision-making are working to reduce pollution from ships, processes at the state and regional levels which locomotives, and trucks, some of the worst over 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
  • 14. 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 invest Transportation 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 get pg. where they need to go. The Transportation Prescription
  • 15. 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-level asthma, steep declines in physical activity, ozone, a toxic component of smog formed and the associated rise in obesity and chronic when tailpipe emissions from cars and trucks illnesses are just a few examples. Transportation react with sunlight and oxygen, and nitrogen affects health indirectly by connecting people— oxide (NOx), which contributes to the formation or by failing to provide connections—to jobs, of ozone and smog. The health risks are medical care, healthy food outlets, and other exacerbated by transportation patterns that necessities. The National Surface Transportation often embed heavy traffic and diesel-spewing Policy and Revenue Study Commission—created facilities in poor and predominantly minority by Congress in 2005 to examine the condition neighborhoods. The American Lung Association and future needs of our network of highways, has found that 61.3 percent of African American ports, freight and passenger railroads, and children, 67.7 percent of Asian American public transportation systems—reached a children, and 69.2 percent of Latino children sobering conclusion: “The nation’s surface live in areas that exceed air quality standards transportation network regrettably exacts a for ozone, compared with 50.8 percent of terrible toll in lost lives and damaged health.”12 white children.20 Ground-level ozone, a gas, can Nowhere 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 most There 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 million properly designed, transportation systems Americans—roughly seven percent of adults 13 can provide exercise opportunities, improve and nearly nine percent of all children—have pg. safety, lower emotional stress, link poor asthma. In poor and minority communities, the people to opportunity, connect isolated older rates are considerably higher. For example, in adults and people with disabilities to crucial Harlem and Washington Heights in northern services and social supports, and stimulate Manhattan, home to mostly low-income The Transportation Prescription economic development. Conventional mobility- African American and Latino residents, one focused planning by local, regional, and state in four children suffers from the disease.22 transportation agencies generally overlooks Research shows that air pollution can trigger or undervalues the impacts of transportation the wheezing, coughing, and gasping for breath investments on health and equity. that signal an attack in people with asthma. But a study in 10 Southern California cities raises the Direct 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, the Pollution more likely they are to develop asthma.23 Pollutants from cars, buses, and trucks are Environmental justice activists have called associated with impaired lung development and attention for years to the connections among function 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 Harlem pollution 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 show obesity.18 In California alone, pollution is a factor that the neighborhood’s asthma rates were in an estimated 8,800 premature deaths a year.19
  • 16. 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 fossil 14 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 to The 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
  • 17. How Transportation Policies and Plans Influence Health “adult” ailments. Today’s youth may turn out to Many people find commuting by high-quality be the first generation in modern history to live public transportation to be less stressful than shorter lives than their parents.32 commuting by car. As we discuss below, the financial costs associated with long commutes Physical 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 influence physical activity habits. The more time a person Safety spends in a car, the more likely he or she is to be overweight. Conversely, higher rates of Traffic crashes are a leading cause of death and walking and bicycling are associated with lower injury for Americans in the prime of life.36 In rates of obesity. A 2004 study found that every 2000, motor vehicle crashes cost $230.6 billion additional hour spent in a car is associated in medical costs, property damages, lost worker with a six percent increase in the likelihood of productivity, travel delays, and other expenses.37 obesity, and every additional kilometer walked is That figure equals about half of all spending associated 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 more Walking and bicycling not only for recreation than 1.5 times the rate of other racial groups.38 but also for transportation are the most practical African Americans drive less than whites but die ways 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 color. in neighborhoods without parks, who cannot CDC data in the mid-1990s revealed that the 15 afford 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 up People who use public transportation tend to 12 percent of the U.S. population but account walk to and from bus stops and train stations, for 20 percent of pedestrian deaths.40 The Transportation Prescription increasing their likelihood of meeting physical activity recommendations.34 Residents of Inequitable transportation policies and compact neighborhoods walk, bike, and use resources contribute to these disparities. Low- public transportation more than residents of income people and people of color have fewer spread-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, poorly Mental Health designed streets, neglected road maintenance, inadequate lighting, limited sidewalks, and Rush-hour gridlock, long waits for the bus, and minimal traffic enforcement place residents at arduous commutes are stressful. They take time higher risk of injury. away from family, friends, and the activities that provide emotional sustenance: hobbies, Safety is also a huge concern for older religion, sports, clubs, civic engagement, and adults—the fastest-growing segment of the volunteer 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 older in 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
  • 18. 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 earnings 16 bicyclists actually decrease the risks.46 but also expenses. The cost of getting around pg. 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 percent The 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.
  • 19. 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 older More than one in five Americans ages 65 and nondrivers in dense communities use public older do not drive because of poor health or transportation at least occasionally, compared eyesight, limited physical or mental abilities, with one in 20 in spread-out communities.54 concerns about safety, or because they have no car. More than half of nondrivers, or 3.6 million The Americans with Disabilities Act (ADA) of Americans, stay home on any given day—and 1990 significantly expanded transportation more than half of that group, or 1.9 million, options for people with disabilities. ADA have disabilities.52 Isolation is especially acute required public bus and rail operators to provide in rural communities, sprawling suburbs, and accommodations, such as lifts and ramps, to black and Latino communities. Compared with enable people in wheelchairs to ride. But street older drivers, older nondrivers take 15 percent design in most communities makes traveling fewer trips to the doctor; 59 percent fewer trips to and from bus stops challenging—and often to shops and restaurants; and 65 percent fewer unsafe—for people with disabilities. Paratransit trips for family, social, and religious activities.53 systems, which use vans or shared taxis to transport people door-to-door, are helpful, but When affordable, high-quality public many systems are stretched thin and require transportation and safe, walkable streets are appointments well in advance. << 17 pg. The Transportation Prescription
  • 20. 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 www.convergencepartnership.org/ 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, economic 18 of color for well-paying jobs in transportation development, and expanded opportunity. pg. 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 significant The 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
  • 21. 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 communities policy perspectives in key areas that have a often have fewer and smaller supermarkets significant 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
  • 22. 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. >> 20 pg. The Transportation Prescription
  • 23. The Federal Transportation Legacy and Challenges Ahead The Federal Transportation Legacy and Challenges Ahead Transportation in America is a federal system, and dynamic American surface transportation not a centralized, national system. Federal policy system is becoming a thing of the past.” plays a critical role, not by dictating practices but by enabling and encouraging innovation by At 300 million people, the nation’s population states, regional transportation organizations, has doubled since the creation of the transit operators, and other agencies. This Interstate Highway System. We will number happens in several ways. 420 million by 2050. “Congestion was once just a nuisance. Today gridlock is a way of First, the federal government sends billions of life,” the commission’s report said. Growing dollars for transportation to states and localities. transportation demand threatens to dwarf For example, the American Recovery and regulatory and legislative efforts to mitigate Reinvestment Act provides nearly $50 billion its health and environmental consequences. to build and repair roads, bridges, railways, Increases in total vehicular mileage have all but and ports. The current surface transportation wiped out the gains achieved through hard-won bill, SAFETEA-LU (Safe, Accountable, Flexible, regulations on fuel efficiency and emissions Efficient Transportation Equity Act: A Legacy control. Expansion of freeways cannot get us for Users), set to expire in September 2009, out of these problems; it will only make them guaranteed $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 United investments by state governments, local States needs multi-modal systems with public governments, 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 21 influence 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 to Many observers contend that transportation lead us there. The act incorporated significant stands 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 to Act of 1956 and its progeny promoted mobility, expand access and improve efficiency through which contributed mightily to American growth an interconnected multi-modal system that and 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 be point to the health, equity, and environmental achieved. Funding mechanisms and formulas consequences of an ethic that held the have continued to favor highway construction faster, the farther, the better, as well as the and car travel. For example, the allocation consequences of policies focused almost wholly formula for the Surface Transportation Program on car and truck travel, with little accountability (STP), the largest program within the federal to goals beyond mobility. bill, rewards states that consume more gas, have more miles of highway, and have residents Either way, the current transport system is no who drive a lot.57 Alternatives to driving remain longer sustainable or fixable by incremental underinvested. Approximately 80 percent changes such as pilot projects, encouragements, of the surface transportation bill is allocated and small incentives. As the National Surface for distribution through the Federal Highway Transportation Policy and Revenue Study Administration for mostly highway programs, Commission, created by SAFETEA-LU, wrote while less than 20 percent goes to the Federal in its final report to Congress: “The strong Transit Agency for public transportation. Other
  • 24. 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. >> 22 pg. The Transportation Prescription
  • 25. A Foundation for 21st-Century Transportation Policy Healthy, 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 transportation serve as benchmarks to assess the impacts of policies and programs at all levels of transportation plans on public health, equity, government as well as across sectors and environmental quality: and policy silos. Transportation systems should give communities wider access 1. 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 different 2. 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.
  • 26. Policy and Program Priorities to Improve Health and Equity Policy and Program Priorities to Improve Health and Equity Government at all levels must consider the affordability and accessibility. It also health and equity impacts of transportation must incorporate affordable housing and investments at the beginning of decision-making commercial properties that provide jobs, processes. Public and private transportation services, and essential goods near people’s investments must be designed to promote homes. Because people of all income health rather than to erode it. The following levels desire walkable neighborhoods recommendations can help policymakers and and shorter commutes, displacement of planners achieve these ends: longtime neighborhood residents can be an unintended consequence of transit oriented 1. Prioritize investments in public development. Policymakers must ensure transportation, including regional that the local residents guide planning and systems that connect housing and jobs development and that equity is a goal from as well as local services that improve day one. access to healthy foods, medical care, and other basic services. Investments 4. Create incentives and accountability should include capital costs as well as costs measures to ensure that transportation for maintenance and operations. Because plans account for their impacts on older diesel buses have high emission rates health, safety, and equity. New projects and since bus depots and other facilities must be held accountable for better results. are often concentrated in low-income Government investment should support and minority neighborhoods, policies the creation of tools that more sensitively must be in place to ensure that expanded and accurately measure walking and >> public transportation does not lead to bicycling practices and improved outcomes. increased exposure to pollutants in these Health impact assessment is an emerging 24 same communities. methodology to evaluate the effects of pg. policies, programs, and plans on the health 2. Prioritize investments in bicycle and of a population and should be considered an pedestrian infrastructure to make important tool. People should also have the walking and biking safer and more right to sue under Title VI of the Civil Rights The Transportation Prescription convenient. Strategies include complete Act of 1964 if they suffer disparate impacts streets designed with all users in mind, from federal transportation investments, not just drivers; traffic-calming measures; and the U.S. Department of Transportation and safe routes to transit and Safe Routes should have the power to withhold dollars if to Schools programs, which create investments are not made equitably.60 infrastructure and programming to support safe walking and bicycling to bus stops, rail 5. Give state, regional, and local stations, and schools. Targeted infrastructure government agencies and organizations investments should also support walking more flexibility to move dollars among and bicycling in rural communities by, for funding categories and to target example, improving road shoulders and spending to meet local needs. Greater building trails to town centers. flexibility would give communities more leeway to fund walking, bicycling, and 3. Encourage equitable transit public transportation programs. It would oriented development by creating also enable communities to invest in fixing, incentives for integrated land use maintaining, and operating local bus and and transportation planning. Transit rail systems. Flexibility should be strongly oriented development must emphasize tied to new standards for accountability,