transportation rx_bold new ideas for healthy, equitable transportation reform in america

8/14/2019 Transportation RX_bold New Ideas for Healthy, Equitable Transportation Reform in America

1/36

the

transportation

prescription

BOLD NEW IDEAS FOR HEALTHY, EQUITABLETRANSPORTATION REFORM IN AMERICA


2/36

Design by Chen Design Associates

Leslie Yang for PolicyLink

PolicyLinkPolicyLink is a national research and actioninstitute advancing economic and socialequity by Lifting Up What Works.

Prevention InstitutePutting prevention and equitable health

outcomes at the center of communitywell-being.

This report was commissioned by theConvergence Partnership which includesthe ollowing institutions:

The California EndowmentKaiser PermanenteThe Kresge FoundationNemoursRobert Wood Johnson FoundationW.K. Kellogg FoundationCenters for Disease Control and Preventionas technical advisers


3/36

BY

Judith Bell

PresidentPolicyLink

Larry Cohen

Founder and Executive Director

Prevention Institute

EDITED BY

Shireen Malekafzali

Senior Associate

PolicyLink

thetransportation prescription

BOLD NEW IDEAS FOR HEALTHY, EQUITABLETRANSPORTATION REFORM IN AMERICA


4/36

A NOTE ABOUT THIS REPORT

The Transportation Prescription: Bold New Ideas or Healthy, Equitable Transportation Reorm in Americabuilds on the research and analysis o a number o experts who are working at the intersection otransportation, equity, and public health. The ideas that collectively orm the heart o this paper are exploredin depth in the book, Healthy, Equitable Transportation Policy: Recommendations and Research. Chaptersare written or co-written by the authors listed below. Each chapter and the entire book can be ound onlineat www.convergencepartnership.org/HealthyEquitableTransport.

Larry Cohen, co-author, Trac Injury Prevention: A 21st-Century Approach, ounder and executive director,Prevention Institute, Oakland

Susan Handy, Walking, Bicycling, and Health, proessor o Environmental Science and Policy and director othe Sustainable Transportation Center, University o Caliornia, Davis

Todd Litman, Public Transportation and Health, ounder and executive director o the Victoria TransportPolicy Institute, British Columbia

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

Kami Pothukuchi, co-author, Sustainable Food Systems: Perspectives on Transportation Policy, associateproessor o Urban Planning, Wayne State University, Detroit

Catherine L. Ross, Roadways and Health: Making the Case or Collaboration, director, Georgia Tech Center

or Quality Growth and Regional Development and the Harry West Chair or Quality Growth and RegionalDevelopment, Atlanta

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

Todd Swanstrom, Breaking Down Silos: Transportation, Economic Development, and Health, E. Desmond LeeProessor o Community Collaboration and Public Policy Administration at the University o Missouri, St. Louis

Richard Wallace, co-author, Sustainable Food Systems: Perspectives on Transportation Policy, senior projectmanager, Center or Automotive Research, Ann Arbor

We owe a sincere debt o gratitude to these progressive individuals who recognize the value o working across

elds to identiy eective and long-term solutions to multiple problems.


5/36

Contents

ForewordCongressmanJames Oberstar, Chairman o the House Transportation and Inrastructure Committee

PrefaceAngela Glover Blackwell, Founder and CEO, PolicyLink

Introduction

Transportation in America: A New Vision

How Transportation Policies and Plans Influence Health

Direct Health Eects

PollutionClimate ChangePhysical ActivityMental HealthSafety

Indirect Health EectsTransportation, Income, and HealthOlder Adults and People with Disabilities

What Does Healthy, Equitable Transportation Policy Look Like?

The Federal Transportation Legacy and Challenges Ahead

A Foundation for 21st-Century Transportation Policy

Policy and Program Priorities to Improve Health and Equity

Conclusion

Author Biographies

Acknowledgments

Notes

5

6

9

10

13

13

16

18

21

23

24

26

27

28

29


6/36


7/36

Discussions o public health and wellness otenare limited to the health and medical elds. Itis my hope that soon, the transportation sectorwill be part o the discussion and play a role inproviding solutions to improving the nationsoverall health, well-being, and quality o lie.

One o my goals as Chairman o the Committeeon Transportation and Inrastructure is to createa new model or surace transportation, onethat invests in alternative modes and promotesactive, healthy liestyles. Public health andtransportation policy choices are inextricably

linked. The transportation sector is responsibleor one-third o the greenhouse gas emissionsin the United States. Our inrastructure and landuse choices oten dictate our daily travel, andwhether or not we have access to clean, healthytransportation options. And in any given year,approximately 40,000 Americans are killed onour roadways. The policy decisions we makeregarding transportation have repercussions onpublic health throughout our society.

For too long now, our transportation decision-making has ailed to address the impacts

that our inrastructure network has on publichealth and equity. The asphalt poured and lanemiles constructed enhanced our mobility andstrengthened our economic growth; but toooten, this auto-centric mindset took hold andcrowded out opportunities to invest in a trulysustainable intermodal transportation system,in particular a system that meets the needs ounderserved communities.

The ailure to link transportation and land usedecision making, and to consider the public

health eects o these choices, has led toa tilted playing eld that has made drivingthe easiestand oten the onlyoptionavailable in many parts o the country. Ourtransportation policies and investments mustdo more to provide access or all throughvarious modes. Transit, walking, and bicyclingall have a signicant role to play in loweringour dependence on oreign oil, reducing ourgreenhouse gas emissions and air pollutants,

and helping Americans incorporate exerciseand resh air into their daily travel routines. Wemust also continue our pursuit to reduce thenumberand rateo trac atalities andinjuries that occur each year.

Our most recent surace transportationlegislation, enacted in 2005, took importantsteps toward building a healthier inrastructureby investing billions o dollars in saety, publictransit, walking, and bicycling. This legislation ishelping to construct saer inrastructure, enableworkorce development, build new transit

lines, repair existing systems, and establishnon-motorized transportation networks.We also enacted the Sae Routes to Schoolprogram, which allows states to invest in saetyimprovements and education campaignsto get kids walking and biking toschool again. This program has showngreat early success and has the abilityto change the habits o an entiregeneration.

Environmental sustainability, access,and our collective well-being

must combine with mobility andsaety as the cornerstones o ourtransportation investments. The ollowing reportrepresents an important contribution to ouremerging understanding o the connectionsbetween transportation and public healthand is an invaluable resource or policymakersand all those interested in building healthycommunities. With a greater recognition othe strong linkage between public health andtransportation, I believe we can build a networkthat supports our mobility and creates access

and economic strength while promoting equity,sustaining our good health and quality o lie.

Congressman James Oberstar

Chairman o the House Transportation

and Inrastructure Committee

Foreword Congressman James Oberstar


8/36

T

he

Transportation

Prescription

pg.6

>>

Preface

Transportation policy has enormouspotential to catalyze the development ohealthy communities o opportunity. Theupcoming authorization o the ederal suracetransportation bill represents the single biggestederal opportunity to infuence how ourcommunities, cities, and regions are shaped.

Transportation impacts health directly: it aectsair quality, injury risk, physical activity levels,and access to necessities such as grocery stores.Transportation is also one o the largest driverso land use patterns; it thus determines whether

communities have sidewalks and areas to playand be physically active as well as whethercommunities are connected to or isolated romeconomic and social opportunities.

Research shows that low-income communitiesand communities o color oten do not haveaccess to the benets our transportation systemcan provide, yet they bear the burdens othat system. For example, many low-incomeneighborhoods have little or no ecient,reliable public transportation to get them to

jobs and essential goods and services. But these

communities are oten situated near bus depots,highways, and truck routes, where pollutionlevels are highand not coincidentally, asthmarates are high as well. In addition, many o thesesame communities live without sae, completesidewalks or bike paths, making walking andbiking dicult and oten dangerous. As a result,

these neighborhoods have low levels o physicalactivity and high rates o chronic diseases.Creating a more equitable transportationsystem must lie at the core o any analysis otransportation or health, and it must guide allreorm.

The Convergence Partnership, the collaborativeo unders that commissioned this project,embraces the imperative that health and equitybe central to transportation policy debates.Further, the Convergence Partnership recognizeshow transportation policy is connected to

the Partnerships broader eorts to supportenvironmental and policy changes that willcreate healthy people and healthy places. ThePartnerships steering committee includes: TheCaliornia Endowment, Kaiser Permanente, theKresge Foundation, Nemours, the Robert WoodJohnson Foundation, and the W. K. KelloggFoundation. The Centers or Disease Control andPrevention serves as technical advisor.

In this project, leading academic researchersand advocates working at the intersection otransportation policy, equity, and public health

identiy opportunities or creating transportationsystems that promote health and equity. Thisreport synthesizes their insights and oersconcrete recommendations or change.

Reorm is long overdue. Climate change,shameul health disparities, growing rates o

Preace Angela Glover Blackwell


9/36

chronic diseasestransportation policy hascontributed to these problems, and now it mustaddress them. Increasing rates o poverty and asevere economic downturn add to the urgencyor reorm.

This report intentionally uses the termauthorization and not the more common word,reauthorization, in reerence to the suracetransportation bill. We want to make clear thatnew thinking and innovative approaches arenecessary to meet the needs o a changing anddiverse America.

Many advocates are already working hard topush or undamental reorm. This report waswritten or community leaders, policymakers,unders, practitioners, and advocates interestedin an overarching strategy to promote activeliving and to build healthy communities oopportunity. PolicyLink, Prevention Institute,and the Convergence Partnership believethat building healthy communities requires acollaboration o stakeholders rom diverse eldsand sectors. Together, we can identiy andsupport shared solutions.

The project recognizes that eective strategiesto improve health, particularly in vulnerablecommunities, oten all outside the conventionaldomain o health policy, yet deserve equalattention. Federal transportation policy is acritical opportunity at our ngertips. Leveragingthe strength o collaboration and networking canyield powerul results. Lets seize the moment.

Angela Glover Blackwell

Founder and CEO

PolicyLink


10/36


11/36

Our transportation system has an enormousimpact on our way o lie, on the air webreathe, and on the vitality o our communities.Transportation choices infuence personal

decisions about where to live, shop, attendschool, work, and enjoy leisure. They aectstress levels, amily budgets, and the time wespend with our children. Although most peopledont think o it as a determinant o health,our transportation system has ar-reachingimplications or our risk o disease and injury.Transportation policies and accompanying landuse patterns contribute to the glaring healthdisparities between the afuent and the poorand between white people and people o color.

This report demonstrates that transportationpolicy is, in eect, health policyandenvironmental policy, ood policy, employmentpolicy, and metropolitan development policy,each o which bears on health independentlyand in concert with the others. Longstandingtransportation and land use policies are atodds with serious health, environmental, andeconomic needs o the country, and theyhave harmed low-income communities and

communities o color especially. Forward-thinking transportation policies must promotehealthy, green, sae, accessible, and aordableways o getting where we need to go. They

also must go hand in hand with equitable,sustainable land use planning and communityeconomic development.

Streets and roads are the largest chunks oproperty owned by most cities and states. Wehave choices to make about how to use, andshare, that real estate. Who decides? Whobenets? Who pays? Transportation policy atall levels o government can be a vehicle topromote public health, sustainability, equitableopportunity, and the economic strength o

neighborhoods, cities, and regions. But thatwill happen only i advocates, experts, andorganizers steeped in all these issues bring theirknowledge and passion to critical transportationdecisions. The upcoming authorization othe most important transportation legislationin the United States, the ederal suracetransportation bill, makes this a pivotal momentto bring a broad vision or health and equity totransportation policy.

Introduction

In St. Louis, MO, major cuts in bus service this spring let workers, students, people with

disabilities, and older residents stranded and eeling beret. Stuart and Dianne Falk, who

are both in wheelchairs, told CNNthey 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 eeling like, Stuart Falk said.1

In West Oakland, CA, amilies have no escape rom the diesel exhaust belching rom trucks at

the nearby port: The air inside some homes is ve times more toxic than in other parts o the

city. Im constantly doing this dance about cleaning diesel soot rom my blinds and window

sills, 57-year-old Margaret Gordon told the San Francisco Chronicle.2

In Seattle, WA, Maggieh Rathbun, a 55-year-old diabetic who has no car, takes an hour-long

bus ride to buy resh ruits and vegetables. She cannot haul more than a ew small bags at a

time so she shops requentlyi she eels well enough. It depends on what kind o day Im

having with my diabetes to decide whether Im going to make do with a bowl o cereal or try

to go get something better, she told the Seattle Post-Intelligencer.3


12/36

T

he

Transportation

Prescription

pg.10

>>

TransportationinAmerica:ANew

Vision

Underlying this report is a vision otransportation as more than a means to movepeople and goods, but also as a way to buildhealthy, opportunity-rich communities. Health isoten viewed rom an individual perspective. Yet,each resident in a region is both an individualand part o a larger community. Thereore, ourvision or healthy, equitable communities is onethat extends beyond individual outcomes andcreates conditions that allow all to reach theirull potential. It does not orce us to balanceone individual against another. It provides theopportunity or everyone to participate in their

community, be healthy, and prosper.

Transportation systems are essential to thecompetitiveness o the nation and the viability oregions. Building Americas Future, a bipartisancoalition o elected ocials, views increasedtransportation investment as a key to theeconomic growth and job creation neededto strengthen cities and rural communities.4TheAmerican Recovery and Reinvestment Act(ARRA), the nearly $1 trillion stimulus packagepassed by Congress and signed by PresidentObama in early 2009, emphasizes transportation

investments to revive the ailing economy andrebuild regions.5 The act galvanized advocatesto push government agencies to spend themoney in ways that promote health, protectthe environment, and benet everyone. Nowmomentum is building to bring a ocus onhealth and equity to the next version o theederal surace transportation bill.6

Over the past hal-century, ederaltransportation policy has changed the Americanlandscape, physically, socially, and culturally.

Beginning with the Federal-Aid Highway Acto 1956 authorizing the Interstate HighwaySystem, the leading transportation priority byar has been what planners call mobility andwhich became synonymous with the movemento more and more cars and goods arther andaster. Mobility advanced the nations growthand prosperity, and it ormed our sense oidentity as well as our image abroad. The carwas more than a machine to get us around;

it stood as a symbol o American reedom,ingenuity, and manuacturing prowess.

While some have ew or no transportationchoices due to limited transportationinrastructure and resources in theircommunities, many Americans do have theopportunity to make choices about how totravel and where to go. For these people, thecar provided the means to fee the city, buy aquarter-acre patch o suburbia, and drive to theirhearts content without giving much thought tothe disinvested neighborhoods let behind, or

the armland lost to development, or the ossiluels and other natural resources their liestylesconsumed. Community environments, however,aect the choices individuals make, and publicpolicy molds those environments. As the nationconronts severe economic, environmental, andhealth challenges as well as the widening gulbetween rich and poor, it is becoming clear thatwe must make dierent choices as individualsand as a society.

A new ramework or transportation policy andplanning is emerging. Rather than ocus almost

exclusively on mobility (and its corollaries, speedand distance), this ramework also emphasizestransportation accessibility. In other words,instead o designing transportation systemsprimarily to move cars and goods, the newapproach calls or systems designed to servepeopleall peopleeciently, aordably, andsaely. This approach prioritizes investmentsin: (1) public transportation, walking, andbicyclingtransportation modes that canpromote health, opportunity, environmentalquality, and indeed mobility or people who do

not have access to cars; and (2) communitieswith the greatest need or aordable, sae,reliable transportation linkages to jobs, andessential goods and serviceschiefy, low-income communities and communities o color.

The goal is to improve transportation oreveryone while delivering other importantpayos, including better respiratory andcardiovascular health; improved physical tness;

Transportation in America: A New Vision


13/36

less emotional stress; cleaner air; quieter streets;ewer trac injuries and deaths; and greateraccess to jobs, nutritious oods, pharmacies,clinics, and other essentials or healthy,productive living.

This new vision is at the core o a burgeoningmovement to shape transportation policyto support work in a number o criticalareas, such as climate change, sustainableagriculture, the prevention o chronic diseases,workorce development, and neighborhoodrevitalization. Advocates and experts in public

health, environmental justice, labor, communityeconomic development, ood policy, and otherelds and disciplines have important roles toplay in transportation debates. A broad rangeo interests, working in partnership, can cratinnovative, environmentally sound solutions thatbenet everyone, rather than plans that refectthe motor vehicle orientation o road engineersand builders. Government transportationagencies and developersthe architects o ourtransportation systems or decadesmust beheld accountable or how their investments aectthe economic prospects o regions, the health o

communities, and the well-being o residents.

This shit in thinking about what transportationpolicy must achieve and who should drive itstems rom a long list o actors. Among them:near-crippling congestion in many metropolitanareas; renewed interest in city living and ahunger or shorter commutes; demographicchanges (including the increasing number opeople over 65 and immigrants, two groupsless likely to drive or own cars); the rise inobesity; the enduring poverty in inner-city and

rural communities; the growing understandingo the connections among health, the builtenvironment, and transportation plans; andthe increasing rustration among residents andadvocates about the limited accountability andinequitable transportation decision-makingprocesses at the state and regional levels whichover represent suburban and white male interests.

But the push to reorm transportation (alongwith its cousin, land use planning) has gainedurgency in the ace o three massive challengesthat are upending the status quo o every eldand that go to the heart o our love aair withthe car: (1) climate change, with its threat oglobal ecological upheaval; (2) U.S. dependenceon oreign oil, which carries grave risks or oureconomy and security; (3) a healthcare systemcrumbling under the demands o skyrocketingrates o diabetes and other chronic diseasesassociated with sedentary liestyles, andastronomical costs. Transporting goods, services,

and people accounts or about one-third ogreenhouse gas emissions and two-thirds opetroleum consumption in the United States.7As the National Surace Transportation Policyand Revenue Study Commission noted in itslandmark report, Transportation or Tomorrow,the environmental gains we achieve throughincremental xes such as higher uel-eciencystandards, though important, will be trumpedby increases in driving and trac i we continueon our current policy course.

The good news is that change can happen,

and inspiring examples abound. In the ruralSan Joaquin Valley in Caliornia, where publictransportation has been virtually nonexistent,a new system o publicly managed vanpoolsis connecting arm worker amilies to jobs,schools, and medical services.8

In Chicagos West Gareld Park, an allianceo residents, activists, and aith-basedorganizations not only successully oughtthe closure o the rail line that linked theneighborhood to downtown; they also

transormed a transit stop into an anchordevelopment o shops, community services,and moderately priced housing.9

In port cities around the country, many groupsare working to reduce pollution rom ships,locomotives, and trucks, some o the worstemitters o soot and greenhouse gases. Inthe Los Angeles regionone o a numbero regions where the movement o goods


14/36

T

he

Transportation

Prescription

pg.12

>>

TransportationinAmerica:ANew

Vision

represents a signicant part o transportationinvestment and economic activity, andwhere ports and reeways abut low-incomeneighborhoodsthe Coalition or Clean andSae Ports has ormed an eective alliance oresidents, truck drivers, public health experts,environmentalists, environmental justiceactivists, unions, immigrant groups, and publicocials to push or clean air solutions.10

The authorization o the next ederal suracetransportation bill presents an immenseopportunity to broaden such engagement and

to orge an equitable policy response to theunprecedented challenges acing the country.The bill authorizes ederal unding or highways,highway saety, public transportation, andbicycling and pedestrian inrastructure orapproximately six years.11 It transers hundreds obillions o dollars rom the ederal governmentto states and localities. It also triggershundreds o billions more in matching stateand local spending. The bill marks the largesttransportation expenditure in the United States.

But the legislation does more than providemoney. It also communicates national policypriorities. Will we build roads on the arthestedges o regions or x aging roads and bridgesin cities and inner-ring suburbs? Will we investin healthy, green transportationbicyclelanes, sae sidewalks or walking, cleanbuses, ridesharing, light rails? Will we ensurethat all voices are equitably represented intransportation decision-making processes? Andwill we include incentives and requirements oraordable housing near public transportationto ensure broad access to the job opportunities

and services that transit oriented developmentstimulates? Or will we spend most o the moneyas we have or decades: on new and biggerhighways with little public accountability?The bill establishes unding categoriesand requirements and in some cases givescommunities and metropolitan regions fexibilityto shape strategies to local needs. The new lawis a chance to design communities or health,sustainability, and opportunityand to give allAmericans physically active, clean, aordable,convenient, reliable, and sae options to getwhere they need to go.


15/36

Our current transportation system has manydirect health consequences: Pollution-relatedasthma, steep declines in physical activity,and the associated rise in obesity and chronicillnesses are just a ew examples. Transportationaects health indirectly by connecting peopleor by ailing to provide connectionsto jobs,medical care, healthy ood outlets, and othernecessities. The National Surace TransportationPolicy and Revenue Study Commissioncreatedby Congress in 2005 to examine the conditionand uture needs o our network o highways,ports, reight and passenger railroads, and

public transportation systemsreached asobering conclusion: The nations suracetransportation network regrettably exacts aterrible toll in lost lives and damaged health.12Nowhere is the toll higher than among low-income people and people o color.

There is a deep and evolving knowledgebase about the links between transportationand health. Research shows that whenproperly designed, transportation systemscan provide exercise opportunities, improvesaety, lower emotional stress, link poor

people to opportunity, connect isolated olderadults and people with disabilities to crucialservices and social supports, and stimulateeconomic development. Conventional mobility-ocused planning by local, regional, and statetransportation agencies generally overlooksor undervalues the impacts o transportationinvestments on health and equity.

Direct Health Effects

Pollution

Pollutants rom cars, buses, and trucks areassociated with impaired lung development andunction in inants13 and children,14 and withlung cancer,15 heart disease, respiratory illness,16and premature death.17 Long-term exposure topollution rom trac may be as signicant athreat or premature death as trac crashes andobesity.18 In Caliornia alone, pollution is a actorin an estimated 8,800 premature deaths a year.19

The main culprits are ne particulate matter,including: diesel exhaust particles, ground-levelozone, a toxic component o smog ormedwhen tailpipe emissions rom cars and trucksreact with sunlight and oxygen, and nitrogenoxide (NOx), which contributes to the ormationo ozone and smog. The health risks areexacerbated by transportation patterns thatoten embed heavy trac and diesel-spewingacilities in poor and predominantly minorityneighborhoods. The American Lung Associationhas ound that 61.3 percent o Arican Americanchildren, 67.7 percent o Asian American

children, and 69.2 percent o Latino childrenlive in areas that exceed air quality standardsor ozone, compared with 50.8 percent owhite children.20 Ground-level ozone, a gas, canchemically burn the lining o the respiratory tract.

Air pollution is also one o the mostunderappreciated triggers o asthma attacks,according to the Centers or Disease Controland Prevention (CDC).21 More than 20 millionAmericansroughly seven percent o adultsand nearly nine percent o all childrenhaveasthma. In poor and minority communities, the

rates are considerably higher. For example, inHarlem and Washington Heights in northernManhattan, home to mostly low-incomeArican American and Latino residents, onein our children suers rom the disease.22Research shows that air pollution can triggerthe wheezing, coughing, and gasping or breaththat signal an attack in people with asthma. Buta study in 10 Southern Caliornia cities raises thetroubling possibility that pollution can also leadto the onset o the disease. The study oundthat the closer children live to a reeway, the

more likely they are to develop asthma.23

Environmental justice activists have calledattention or years to the connections amongpollution, illness, and transportation policyand the burden on communities o color.For instance, in the mid-1990s, West HarlemEnvironmental Action (WE ACT) used mapping,air monitoring, and resident surveys to showthat the neighborhoods asthma rates were

How Transportation Policies and Plans Infuence Health


16/36

T

he

Transportation

Prescription

pg.14

>>

How

TransportationPoliciesandPlansInfluenceHealth

linked to its dubious status as the diesel capitalo New York City. When WE ACT began workon the issue, Harlem housed six o the cityseight bus depots and 650 Port Authority buses.The group played an important role in gettingthe city to convert buses to clean uel.24

Pollution rom reight transport is anotherbig concern around the country. To meetAmericas insatiable demand or goods, portsand highways are continually expanding toaccommodate more ships, locomotives, andtrucks. Ports requently border low-income

and minority neighborhoods, and highwaysoten run through them. The upshot: Someo the worst emitters o ne particles, soot,and greenhouse gases (GHGs) are a growingpresence in already vulnerable communities.

Climate Change

GHGs are not pollutants in the classical sense.They cause the atmospheric changes andresulting climate disruptions that are projectedto alter the natural and built environments onwhich society relies.25 The health risks come

largely rom those environmental alterations. Ina major shit in ederal policy, the EnvironmentalProtection Agency in April 2009 adopted theposition that greenhouse gases pose a dangerto human health and welare. A ew weekslater, the Climate Change and Health Protectionand Promotion Act, H.R. 2323, was introducedin the House o Representatives.26 The bill woulddirect the Department o Health and HumanServices to develop a national strategic actionplan to prepare or and respond to the healtheects o climate change.

Researchers are just beginning to assess thespecic health dangers in the United States;to date, most o the published data comerom abroad. So ar, however, there are morequestions than answers. How will less rainallaect the potential or waterborne diseases?Food supplies? Food prices? How will extremeweather conditions such as heat waves orhurricanes aect mental health? Physicalactivity? Population displacement?

Scientists believe that climate change couldexacerbate a number o current healthproblems, including heat-related deaths,diarrheal diseases, allergies, and asthma.28Those already at highest riskthe poor,minorities, children, and older adultswill beeven more vulnerable. Policy neglect wouldcompound the problems. Hurricane Katrinarevealed, to a horried public, the disastrousresults that can occur when nature (the sorto extreme storm that experts expect to occurmore requently as the earths temperaturechanges) combines with government disregard

(in this case, the poorly maintained levees thatailed to protect New Orleans rom catastrophicfooding) as well as resource inequities (thelack o transportation, which made evacuationimpossible or thousands o people).

The urgent need to reduce GHGs has catapultedtransportation policy into the limelight. TheUnited States has only about ve percent othe worlds population but contributes nearly25 percent o GHGs, mainly because o ossiluel consumption, motor vehicle emissions,and industrial agricultural practices (which

themselves are promoted by our transportationsystem). Improving vehicle technology, whileimportant, is not enough. Americans need todrive less. That will happen only i walking,bicycling, and public transportation becomeeasible, ecient alternatives to driving in manymore communities, and i land use patterns arechanged so people no longer have to jump inthe car or every trip.

Physical Activity

Sixty percent o adults in the United Statesdo not meet recommended levels o physicalactivity, and 25 percent are completelysedentary.29 Arican Americans and Latinosare less likely than whites to get enough dailyphysical activity.30 The links between physicalactivity and health are well established.Sedentary liestyles are estimated to contributeto as many as 255,000 deaths each year.31 Manychildren and teens are already at risk or heartdisease and type 2 diabetes, once considered


17/36

adult ailments. Todays youth may turn out tobe the rst generation in modern history to liveshorter lives than their parents.32

Physical inactivity is an important actor in therising rates o obesity and chronic diseaseandtransportation practices strongly infuencephysical activity habits. The more time a personspends in a car, the more likely he or she isto be overweight. Conversely, higher rates owalking and bicycling are associated with lowerrates o obesity. A 2004 study ound that everyadditional hour spent in a car is associated

with a six percent increase in the likelihood oobesity, and every additional kilometer walked isassociated with a 4.8 percent reduction.33

There are many ways to be physically active,but quite a ew require time, skill, and money.Walking and bicycling not only or recreationbut also or transportation are the most practicalways to improve tness. They are oten the onlyviable option or low-income residents who livein neighborhoods without parks, who cannotaord gym memberships, and who do not havethe luxury o leisure time.

People who use public transportation tend towalk to and rom bus stops and train stations,increasing their likelihood o meeting physicalactivity recommendations.34 Residents ocompact neighborhoods walk, bike, and usepublic transportation more than residents ospread-out communities, and they have lowerrates o obesity.

Mental Health

Rush-hour gridlock, long waits or the bus, andarduous commutes are stressul. They take timeaway rom amily, riends, and the activitiesthat provide emotional sustenance: hobbies,religion, sports, clubs, civic engagement, andvolunteer commitments. Every 10 minutes spentcommuting is associated with a 10 percent dropin the time spent traveling or social purposes.35

Many people nd commuting by high-qualitypublic transportation to be less stressul thancommuting by car. As we discuss below, thenancial costs associated with long commutesexacerbate the stress, particularly in low-income households.

Saety

Trac crashes are a leading cause o death andinjury or Americans in the prime o lie.36 In2000, motor vehicle crashes cost $230.6 billionin medical costs, property damages, lost worker

productivity, travel delays, and other expenses.37

That gure equals about hal o all spendingon public education rom kindergarten through12th grade.

Native Americans die in trac crashes at morethan 1.5 times the rate o other racial groups.38Arican Americans drive less than whites but dieat higher rates in car crashes. Walking, too, isalso more dangerous in communities o color.CDC data in the mid-1990s revealed that thepedestrian death rate or Latino males in theAtlanta metropolitan area was six times greater

than or whites.39 Arican Americans make up12 percent o the U.S. population but accountor 20 percent o pedestrian deaths.40

Inequitable transportation policies andresources contribute to these disparities. Low-income people and people o color have ewerresources to buy products that improve saety,such as late-model cars and new child saetyseats. In underinvested neighborhoods, poorlydesigned streets, neglected road maintenance,inadequate lighting, limited sidewalks, and

minimal trac enorcement place residents athigher risk o injury.

Saety is also a huge concern or olderadultsthe astest-growing segment o thepopulationand or rural residents. Drivingskills decline with age, and railty makes olderadults especially vulnerable in a collision.41 Theyare more likely to be killed or injured in a crash


18/36

T

he

Transportation

Prescription

pg.16

>>

How

TransportationPoliciesandPlansInfluenceHealth

o a given severity than any other age group.42Older adults also walk slower and are moresusceptible to pedestrian injuries.

Although less than a quarter o all driving inthe United States takes place in rural settings,43more than hal o all motor vehicle crashesoccur there.44

The more we drive, the more likely we are toget hurt or die in a crash; there is a strongpositive relationship between per capita vehiclemiles traveled and trac casualty rates.45

Communities with high annual mileage tend tohave higher trac death rates than communitieswhere people drive less. Passengers on buses,light rail, and commuter rail have about one-tenth the trac death rate as people in cars.

Investments in public transportation andwalking and bicycling inrastructure can reduceinjuries and deaths. Contrary to popular beliethat more walkers and cyclists lead to morecasualties, greater numbers o walkers andbicyclists actually decrease the risks.46

Indirect Health Effects

Transportation is a lieline. We depend on itto get to work, school, the doctors oce, thebank, the supermarket, the gym, or a riendshouse. People without reliable, ecient,aordable ways to get around are cut o rom

jobs, social connections, and essential services.Access to transportation, to economic and socialopportunity, and to resources or healthy livingare inextricably linked. Gaps in all three areaseed on one another in complex ways. Policy

reorms that put health equity objectives at thecenter o transportation planning and undingdecisions can reduce these inequities.

Transportation, Income, and HealthAs housing and jobs have moved arther apart,the distance has created employment barriersor anyone without unlimited ability to drive.Nineteen percent o Arican Americans and 13.7percent o Latinos lack access to automobiles,compared with 4.6 percent o whites. Povertycomplicates the problem: 33 percent o poorArican Americans and 25 percent o poorLatinos lack automobile access, compared with12.1 percent o poor whites.47 Cars ownedby low-income people tend to be older, less

reliable, and less uel-ecient. This makescommuting to work unpredictable and moreexpensive, at best.

Income is an important determinant o health.48The association between poverty and poorhealth is well documented. Jobs with goodwages, including those in the transportationsector, are essential to sustaining health.

Transportation impacts not only amily earningsbut also expenses. The cost o getting aroundtakes a signicant bite out o householdbudgets. The general standard holds that aamily should spend no more than 20 percento income on transportation, or the costs willeat into other necessities, such as nutritiousoods, and medical care.49 The averageamily in the United States spends about 18percent o ater-tax income on transportation,but this varies signicantly by income andgeography. For example, low-wage households(earning $20,000 to $35,000) living ar romemployment centers spend 37 percent o theirincomes on transportation.50 In neighborhoods

well served by public transportation, amiliesspend an average o nine percent.51


19/36

Older Americans and People withDisabilities

More than one in ve Americans ages 65 andolder do not drive because o poor health oreyesight, limited physical or mental abilities,concerns about saety, or because they have nocar. More than hal o nondrivers, or 3.6 millionAmericans, stay home on any given dayandmore than hal o that group, or 1.9 million,have disabilities.52 Isolation is especially acutein rural communities, sprawling suburbs, andblack and Latino communities. Compared with

older drivers, older nondrivers take 15 percentewer trips to the doctor; 59 percent ewer tripsto shops and restaurants; and 65 percent ewertrips or amily, social, and religious activities.53

When aordable, high-quality publictransportation and sae, walkable streets are

available, older adults take advantage o them.More than hal o older adults make walkinga regular activity. More than hal o oldernondrivers in dense communities use publictransportation at least occasionally, comparedwith one in 20 in spread-out communities.54

TheAmericans with Disabilities Act (ADA) o1990 signicantly expanded transportationoptions or people with disabilities. ADArequired public bus and rail operators to provideaccommodations, such as lits and ramps, toenable people in wheelchairs to ride. But street

design in most communities makes travelingto and rom bus stops challengingand otenunsaeor people with disabilities. Paratransitsystems, which use vans or shared taxis totransport people door-to-door, are helpul, butmany systems are stretched thin and require

appointments well in advance.


20/36

Healthy, equitable, transportation policysupports the development o accessible,ecient, aordable, and sae alternatives tocar travel, and especially to driving solo. Thesealternatives enable everyone to walk more,travel by bicycle, and use public transportationmorein other words, to get around inways that improve health, expand access toopportunity, and reduce toxic pollutants andgreenhouse gas emissions.

Healthy, equitable transportation policy isorged and implemented in concert with

sustainable land use planning. Together, theyencourage and support high-density, mixed-use, mixed-income metropolitan developmentand aordable housing with good access totransportation options. Together, they ocus,particularly, on underserved and economicallyisolated communities.

Healthy, equitable transportation policyrecognizes that income is important to health,and it encourages hiring low-income residentso color or well-paying jobs in transportationconstruction, maintenance, and service.

Healthy, equitable transportation policyunderstands the importance o ensuring equalrepresentation. All community members,regardless o race, gender, or geographicallocation should be equitably represented andinvolved in making decisions which impact theircommunities, their inrastructure, and theiroptions or travel.

Because access to healthy oods is integralto good health and because transportation

systems are integral to ood production anddistribution, healthy, equitable transportationpolicy specically addresses ood access issues,including transportation to grocery stores andood transport practices.

This report draws on the book, Healthy,Equitable Transportation Policies:Recommendations and Research commissionedby the Convergence Partnership, a collaborative

o unders. The book describes innovativetransportation and land use policies, strategies,and programs built on a oundation o equityand sustainability. It includes six key chaptersauthored by academics and advocatesworking at the intersection o transportation,health, and equity. The book is availableonline at www.convergencepartnership.org/HealthyEquitableTransport.

Three chapters in the book addresstransportation options:

ToddLitman,M.E.S.,founderandexecutivedirector o the Victoria Transport PolicyInstitute in British Columbia, identiesnumerous economic, social, andenvironmental benets that can result rompublic transportation improvements.Among them: reduced trac crashes,improved physical tness and health, energyconservation, reduced pollution emissions,increased community livability, increasedaordability, consumer savings, economicdevelopment, and expanded opportunity.Litman contends that improving public

transportation is one o the most cost-eective ways to improve public health, andbetter health is one o the most signicantpotential benets o public transportationimprovements. Litman identies policy andplanning reorms to create a more diverseand ecient transportation system. Litmanrecommends developing a strategic vision ohigh-quality public transportation services,with supportive land use policies to providebasic mobility to people who are sociallyisolated, economically disadvantaged, or

physically disabled, as well as to attractdiscretionary travelers, or people whowould otherwise drive or a particular trip.

SusanHandy,Ph.D.,directoroftheSustainable Development Center at theUniversity o Caliornia at Davis, argues thatincreasing walking and bicycling whileassuring saety, particularly or low-incomeamilies, children, and older adults, is an

What Does Healthy, Equitable TransportationPolicy Look Like?

T

he

Transportation

Prescription

pg.18

>>

Wha

tDoes

Hea

lthy,

Equ

ita

bleTransporta

tion

Po

licy

Loo

kLike

?


21/36

important goal or ederal transportationpolicy. Walking and bicycling, or activetravel, are low-cost, physically active, andenvironmentally clean alternatives to driving,yet they represent ewer than 10 percent oall trips in the United States. In addition toexpanding specialized programs or activetravel, the ederal government should assist,enable, encourage, and, in some instances,require state, regional, and local governmentsto address pedestrian and bicycling needs.

CatherineL.Ross,Ph.D.,theHarryWest

Chair and director o the Center or QualityGrowth and Regional Development atGeorgia Institute o Technology, arguesthat roadways are more than transportroutes; they are also our primary spacesor civic, social, and commercial enterprise.Roadwayshighways in particularreceivethe largest share o ederal transportationdollars by ar. Federal policy has historicallyemphasized highways designed to movelarge numbers o cars and reight vehiclesat high speeds. Ross argues or greaterinvestments in roadways that integrate

physical activity, enrich social interaction,increase saety, and provide transportationlinkages in underserved communities. Sheurges policymakers and others to considerexpanded assessments o the eects oroadways on health, through the use omethodologies similar to health impactassessment (HIA).55

Three additional chapters oer transportationpolicy perspectives in key areas that have asignicant impact on public health and equity:

ToddSwanstrom,Ph.D.,theE.DesmondLeeProessor o community collaboration andpublic policy administration at the Universityo Missouri St. Louis, makes the casethat ederal transportation policy can andshould address economic development,particularly in communities let behindby decades o transportation planningthat avored car travel and encouraged

sprawl. Targeted transportation investmentcan promote economic opportunity andreduce health disparities by (1) improvingtransportation linkages between housing andemployment hubs and between residentialneighborhoods and clinics, pharmacies, andgrocery stores; (2) encouraging aordable,high-density, mixed-use transit orienteddevelopment;56 and (3) creating workorcestrategies to ensure that jobs in the large,growing transportation sector are open toall, including minority and women workersand contractors. Swanstrom also asserts that

while the goals o equity and environmentalsustainability are not mutually exclusive,policymakers and advocates must address theshort-term needs o low-income amilies wholive in places where driving is essential.

KamiPothukuchi,Ph.D.,associateprofessoro urban planning at Wayne State University,and Richard Wallace, M.S., senior projectmanager at the Center or AutomotiveResearch, argue that ederal transportationpolicy should seek to increase access tohealthy oods. Todays transportationnetworks make large quantities o oodsrom around the nation and the globereadily available or many Americans,but industrialized agriculture and theconcentrated structure o ood retailhave negative health and environmentalconsequences or low-income communities,especially people o color, inner-city andrural residents, and immigrant arm workers.For example, urban and rural communitiesoten have ewer and smaller supermarketsthan suburban communities (i they have any

at all) as well as more limited selections ohealthy oods. As a result, residents eat ewerruits and vegetables and have higher rateso diet-related illnesses. In addition, long-distance ood hauling has a disproportionateimpact on the air quality and noise levels inpoor and minority communities along reightroutes. Although ood access alls outsidethe traditional realm o transportation policy,improved public transportation, transit


22/36

T

he

Transportation

Prescription

pg.20

>>

WhatDoesHealthy,

EquitableTransportationPolicyLookLike?

oriented development, and cleaner methodsto move reight can increase access to healthyoods in underserved communities, reduceair and noise pollution, and oster local,sustainable agri-ood systems.

LarryCohen,M.S.W.,LeslieMikkelsen,R.D.,M.P.H., and Janani Srikantharajah, B.A.,o Prevention Institute argue that traccrashes are preventable and that ederaltransportation policy must make saety orall travelers a priority. Trac crashes rank

as the leading cause o death or peopleages one to 34 and contribute to unnecessaryhuman, social, and economic costs. Resourcesshould be directed to communities with theleast inrastructure to support sae walking,bicycling, and public transportation useand continue to support eective vehiclesaety and occupant protection strategies.Trac saety is an important strategy notonly to reduce injuries and death but also toencourage physical activity, improve air quality,and increase transportation accessibility.


23/36

Transportation in America is a ederal system,not a centralized, national system. Federal policyplays a critical role, not by dictating practicesbut by enabling and encouraging innovation bystates, regional transportation organizations,transit operators, and other agencies. Thishappens in several ways.

First, the ederal government sends billions odollars or transportation to states and localities.For example, theAmerican Recovery andReinvestment Actprovides nearly $50 billionto build and repair roads, bridges, railways,

and ports. The current surace transportationbill, SAFETEA-LU (Sae, Accountable, Flexible,Efcient Transportation Equity Act: A Legacyor Users), set to expire in September 2009,guaranteed $244.1 billion over six years. Thesedollars, in turn, leverage direct inrastructureinvestments by state governments, localgovernments, and private investors.

Second, the policies and requirementsembedded in ederal transportation programsinfuence state and local land use decisions andtransportation priorities.

Many observers contend that transportationstands as one o the biggest policy successes inUnited States history. The Federal-Aid Highway

Act o 1956 and its progeny promoted mobility,which contributed mightily to American growthand prosperity. However, many advocates take amore nuanced view o the ederal legacy. Theypoint to the health, equity, and environmentalconsequences o an ethic that held theaster, the arther, the better, as well as theconsequences o policies ocused almost wholly

on car and truck travel, with little accountabilityto goals beyond mobility.

Either way, the current transport system is nolonger sustainable or xable by incrementalchanges such as pilot projects, encouragements,and small incentives. As the National SuraceTransportation Policy and Revenue StudyCommission, created by SAFETEA-LU, wrotein its nal report to Congress: The strong

and dynamic American surace transportationsystem is becoming a thing o the past.

At 300 million people, the nations populationhas doubled since the creation o theInterstate Highway System. We will number420 million by 2050. Congestion was once

just a nuisance. Today gridlock is a way olie, the commissions report said. Growingtransportation demand threatens to dwarregulatory and legislative eorts to mitigateits health and environmental consequences.Increases in total vehicular mileage have all but

wiped out the gains achieved through hard-wonregulations on uel eciency and emissionscontrol. Expansion o reeways cannot get usout o these problems; it will only make themworse. The more we have expanded highways,the more trac we have created. The UnitedStates needs multi-modal systems with publictransportation that eciently serves a largesegment o the population, using existingstreets and highways.

The Intermodal Transportation EfciencyAct (ISTEA), the 1991 version o the ederal

surace transportation bill, was supposed tolead us there. The act incorporated signicantpolicy change. Since then, the stated goalo ederal transportation policy has been toexpand access and improve eciency throughan interconnected multi-modal system thatsupports highways, public transportation,walking, and biking. This goal has yet to beachieved. Funding mechanisms and ormulashave continued to avor highway constructionand car travel. For example, the allocationormula or the Surace Transportation Program

(STP), the largest program within the ederalbill, rewards states that consume more gas,have more miles o highway, and have residentswho drive a lot.57 Alternatives to driving remainunderinvested. Approximately 80 percento the surace transportation bill is allocatedor distribution through the Federal HighwayAdministration or mostly highway programs,while less than 20 percent goes to the FederalTransit Agency or public transportation. Other

The Federal Transportation Legacyand Challenges Ahead


24/36

T

he

Transportation

Prescription

pg.22

>>

TheFederal

TransportationLegacyandChallengesA

head

modes o travel constitute a minute amount ospending in comparison to highways and publictransportation.

Case in point: Walking is the only travelmode that has not had signicant declines incasualties in 40 years. Yet only a tiny share otransportation unding goes to inrastructureinitiatives that would make walking and bikingsaer. Walking and bicycling accounted or 8.6percent o all trips in 2001 but 12 percent otrac deaths.58

Another case in point: Operating costs orpublic transportation systems present a hugechallenge or many communities. Yet ederaltransportation investment is ocused on capitalprojects. For example, cities with 200,000people or more may not use grants rom the

U.S. Department o Transportations main publictransportation programs or transit operatingcosts.59 In the ace o budget shortalls, local andregional transportation agencies throughoutthe country have cut service, hiked ares, anddeerred maintenancearguably at a time whenpeople need aordable, reliable links to jobsmore than ever.

While ederal policy plays a signicant role inshaping transportation systems, states andmetropolitan regions are also critical agentso change. The new surace transportation

bill oers an opportunity to increase support,encouragement, and pressure or integratingland use and transportation planningto promote balanced regional growth,equitable economic opportunity, and healthycommunities or all.


25/36

Healthy, equitable transportation policy isgrounded in our principles. These may alsoserve as benchmarks to assess the impacts otransportation plans on public health, equity,and environmental quality:

1. Develop transportation policies andplans that support health, equity,and environmental quality. Federal,state, and local transportation policiesshould be aligned with the top health andenvironmental goals o ederal departmentsand agencies. For example, transportation

policies should be aligned with theDepartment o Health and Human Servicesstrategic goals to promote health equity andoster the economic and social well-beingo individuals, amilies, and communities.Transportation policies should also supportthe CDCs commitment to eliminate healthdisparities and to promote its healthypeople in healthy places goals.

2. Prioritize transportation investmentsin distressed regions, low-incomeneighborhoods, and communitieso color. Federal, state, and localtransportation agencies should emphasizeprojects that will revitalize the economyo struggling communities, lower healthdisparities, and will connect vulnerablepopulations to jobs, business opportunities,healthy ood outlets, medical services, andother necessities. Government agenciesmust ensure that these projects arenancially sustainable by providing adequateunding or maintenance and operations.The jobs associated with transportation

construction, maintenance, and serviceshould be available to low-income peopleand communities o color.

3. Emphasize accessibility, instead osimply mobility, in transportationpolicies and programs at all levels ogovernment as well as across sectorsand policy silos. Transportation systemsshould give communities wider accessto all the things that are necessary or agood lie, not to move people aster andarther. The denition o access must alsoinclude aordability. I transportation isphysically accessible, yet unaordable, it isnot truly accessible. Accessibility-orientedtransportation policies can catalyze and

support balanced regional growth, walkablecommunities, the renewal o long-neglectedneighborhoods, and street design thatmakes walking and bicycling sae, populartransportation options.

4. Ensure transparency, accountability,and meaningul participation byresidents, advocates with diverseinterests, and experts rom dierentelds. State and regional transportationocials and private developers must engagenew partners in decision-making and

provide the data, training, and resourcesto allow ull, inormed participation by thepeople aected most by decisions andinvestments. Voices and expertise rom localcommunities, public health, environmental

justice, community development, and otherarenas can help ensure that transportationplans respond to local needs and deliverhealth, environmental, and economicbenets broadly.

A Foundation or 21st-CenturyTransportation Policy


26/36

T

he

Transportation

Prescription

pg.24

>>

PolicyandP

rogram

PrioritiestoImproveHealthand

Equity

Government at all levels must consider thehealth and equity impacts o transportationinvestments at the beginning o decision-makingprocesses. Public and private transportationinvestments must be designed to promotehealth rather than to erode it. The ollowingrecommendations can help policymakers andplanners achieve these ends:

1. Prioritize investments in publictransportation, including regionalsystems that connect housing and jobsas well as local services that improve

access to healthy oods, medical care,and other basic services. Investmentsshould include capital costs as well as costsor maintenance and operations. Becauseolder diesel buses have high emission ratesand since bus depots and other acilitiesare oten concentrated in low-incomeand minority neighborhoods, policiesmust be in place to ensure that expandedpublic transportation does not lead toincreased exposure to pollutants in thesesame communities.

2. Prioritize investments in bicycle andpedestrian inrastructure to makewalking and biking saer and moreconvenient. Strategies include completestreets designed with all users in mind,not just drivers; trac-calming measures;and sae routes to transit and Sae Routesto Schools programs, which createinrastructure and programming to supportsae walking and bicycling to bus stops, railstations, and schools. Targeted inrastructureinvestments should also support walking

and bicycling in rural communities by, orexample, improving road shoulders andbuilding trails to town centers.

3. Encourage equitable transitoriented development by creatingincentives or integrated land useand transportation planning. Transitoriented development must emphasize

aordability and accessibility. It alsomust incorporate aordable housing andcommercial properties that provide jobs,services, and essential goods near peopleshomes. Because people o all incomelevels desire walkable neighborhoodsand shorter commutes, displacement olongtime neighborhood residents can be anunintended consequence o transit orienteddevelopment. Policymakers must ensurethat the local residents guide planning anddevelopment and that equity is a goal romday one.

4. Create incentives and accountabilitymeasures to ensure that transportationplans account or their impacts onhealth, saety, and equity. New projectsmust be held accountable or better results.Government investment should supportthe creation o tools that more sensitivelyand accurately measure walking andbicycling practices and improved outcomes.Health impact assessment is an emergingmethodology to evaluate the eects opolicies, programs, and plans on the health

o a population and should be considered animportant tool. People should also have theright to sue under Title VI o the Civil Rights

Act o 1964 i they suer disparate impactsrom ederal transportation investments,and the U.S. Department o Transportationshould have the power to withhold dollars iinvestments are not made equitably.60

5. Give state, regional, and localgovernment agencies and organizationsmore fexibility to move dollars among

unding categories and to targetspending to meet local needs. Greaterfexibility would give communities moreleeway to und walking, bicycling, andpublic transportation programs. It wouldalso enable communities to invest in xing,maintaining, and operating local bus andrail systems. Flexibility should be stronglytied to new standards or accountability,

Policy and Program Priorities to ImproveHealth and Equity


27/36

transparency, and inclusion which ensure allpeople impacted by transportation decisionsare equitably represented in the decision-making process.

6. Prioritize transportation investments incommunities with high unemploymentand poverty rates to stimulate economicgrowth and provide access to jobs. TheAmerican Recovery and Reinvestment Act(ARRA) has language to direct resources tostruggling and disinvested communities. Thenew version o the surace transportation

bill should include similar language andexpand on this commitment by creating strongaccountability and enorcement measures tiedto achieving equitable economic benets.

7. Make sure that jobs and contractscreated by ederal transportationinvestments reach low-income peopleand communities o color. A Sense oCongress amendment to SAFETEAU-LU,passed in 2005, encourages local hiringprovisions or highway construction projects.Some projects aim or 30 percent o

workorce hours to be lled by employeeswho live in the community. Local hiringshould be made a requirement, not justencouraged. It should also be expandedbeyond highway projects to include publicand mass transit development. Capitalinvestments should also und workorcedevelopment programs to train local residentsor jobs in the transportation sector.61

8. Support the development o cleanerbus and truck feets and invest in

reight rail inrastructure to reduce

greenhouse gas emissions, improvelocal air quality, promote health, andoster energy independence.

9. Advance saety or all travelers, withparticular emphasis on those at thehighest risk o car injuries and death.Investments should continue advancingknown vehicle saety and occupant-protection strategies as well as roadway andcommunity design modications to protectthe saety o pedestrians, bicyclists, drivers,and passengers.

10. Support policies and programs thatincrease access to healthy oods.Promote public-private van and bus systemsto shuttle customers to grocery stores.Expand weekend bus service to connectlow-income neighborhoods to supermarketsand other ood outlets. Invest in sae andaordable transportation or arm and oodproduction workers. Promote sustainablemodes o transporting oods rom armsto stores as well as policies to increase theviability o local and regional arming.

11. Give low-income rural communitiesgreater access to public transportationunds rom the surace transportationbill providing the opportunity toaccess employment and educationopportunities. Low-density and long traveldistances make developing and operatingconventional bus and rail systems nanciallychallenging. Federal public transportationdollars should support economicallyecient innovations, such as vanpools and

voucher programs.


28/36

T

he

Transportation

Prescription

pg.26

>>

Conclusion

The authorization o the next ederal suracetransportation bill can be a starting point orcreating many changes Americans say theywant: better health, cleaner air, more time withour amilies, opportunities to connect with ourneighbors. The new legislation can also markan important step toward building a society inwhich everyone can participate and prosper, andno community is let behind.

Change will not come easily. The car culturehas deep roots in America. The interest groupssupporting highway investment are powerul

and well unded. But advocates and grass-rootsactivists around the country have demonstratedthat change can happen. They have successullyought or cleaner buses and or publictransportation in communities that never had it.They have transormed train stations into centers

o vibrant community development in disinvestedneighborhoods. They have pressured localocials and supermarket operators to provideree bus rides so amilies can shop or ood.

Now is the time to tap into that kind oenergy and lit successes like these to thelevel o ederal policy. Leaders, experts,and advocates rom many spherespublichealth, environmental justice, ood policy,agriculture, labor, equity, community economicdevelopment, business, and governmentmust

join in partnership to push or broad reorm.

Collectively, we can gain power and buildpolitical support or creating transportationsystems that address the big challenges weace and that nourish healthy communitiesthroughout our nation.

Conclusion


29/36

Judith Bell is the President o PolicyLink in

Oakland, CA, and oversees policy development,strategic planning, program implementation,and policy campaign strategy; she leads projectsocused on equitable development, such as theair distribution o aordable housing, equityin public investment, and community strategiesto improve health. Bell is a requent speaker,trainer, and consultant on advocacy strategy.Her work at PolicyLink includes access tohealthy oods, transportation, and inrastructureinvestment. In addition, Bell leads PolicyLinkwork with the Convergence Partnership, a multi-oundation initiative to support equity-ocused

eorts to advance policy and environmentalchanges or healthy people and healthy places.For more inormation: http://www.policylink.org/JudithBell.

Larry Cohen is Founder and Executive

Director o Prevention Institute, a nonprotnational center that moves beyond approachesthat target individuals to create systematic,comprehensive strategies that alter theconditions that impact community health. Withan emphasis on health equity, Cohen has ledmany successul public health eorts at thelocal, state, and ederal levels on injury andviolence prevention, mental health, trac saety,and ood- and physical activity-related chronicdisease prevention. Prior to ounding PreventionInstitute in Oakland, CA, Cohen participated inpassing the nations rst multi-city smoking ban.

He established the Food and Nutrition PolicyConsortium, which catalyzed the nations oodlabeling law. Cohen also helped shape strategyto secure passage o bicycle and motorcyclehelmet laws and to strengthen child and adultpassenger restraint laws. For more inormation:http://www.preventioninstitute.org/larry.html.

Author Biographies


30/36

T

he

Transportation

Prescription

pg.28

>>

Acknowledg

ments

This publication is a collaborative eort including the insights and assistance o numerous individuals.

Our sincerest thanks to the ollowing or their contributions to the development o this report:

ToddLitman, Manuel Pastor, Carli Paine, Jason Corburn, and Larry Frank or their careulreviews o various portions o the report.

FranSmith, or her skillul writing, editing, and research assistance, as well as her valuable inputthroughout the development o this report.

VictorRubin, Janani Srikantharajah, and Leslie Mikkelsen or their insightul reviewand input.

PauletteJonesRobinson,ArianaZeno,and Erika Bernabei, or their thorough and diligentcopyediting, act-checking, and proong.

The members o the Convergence Partnership, or their guidance throughout this project:

Linda Jo Doctor, W. K. Kellogg Foundation

David Fukuzawa, Kresge Foundation

Allison Gertel-Rosenberg and Rich Killingsworth, Nemours

Laura Kettel-Khan, Centers or Disease Control and Prevention

Angie McGowan and Maisha Simmons, Robert Wood Johnson Foundation

Brian Raymond and Loel Solomon, Kaiser Permanente

Marion Standish, The Caliornia Endowment

Acknowledgments


31/36

1 John King, Bus Route Closing DevastatesDisabled Couple, CNN, March 27, 2009,http://www.cnn.com/2009/POLITICS/03/27/st.louis.no.bus/.

2 Henry K. Lee, Diesel Exhaust Poses HealthRisks in West Oakland, Study Finds, SanFrancisco Chronicle, November 16, 2003,http://www.sgate.com/cgi-bin/article.cgi?le=/c hronicle/archive/2003/11/16/BAGQE334JL1.DTL.

3 Jennier Langston, No Easy Access to Fresh

Groceries in Many Parts o Seattle, SeattlePI.com, May 1, 2008, http://www.seattlepi.com/local/361235_oodvoid01.html.

4 See http://www.investininrastructure.org/.

5 President Franklin D. Roosevelt took a similartack during the Great Depression. Addressingtransportation needs accounted or mucho the work o the WPA. By 1938, the WPAhad paved or repaired 280,000 miles oroad and had built 29,000 bridges and 150airelds, according to Jim Couch, proessor

o economics and nance at the University oNorth Alabama and co-author o The PoliticalEconomy o the New Deal(Williston, VT:Edward Elgar Publishing, 1998).

6 See the policy platorm o the TransportationEquity Network, a national coalition omore than 300 grassroots and partnerorganizations working to reormtransportation and land use policies,http://transportationequity.org/index.php?option=com_content&task=view&id

=15&Itemid=32. See also American PublicHealth Association,At the Intersection oPublic Health and Transportation: PromotingHealthy Transportation Policy, 2009, http://www.apha.org/NR/rdonlyres/43F10382-FB68-4112-8C75-49DCB10F8ECF/0/TransportationBrie.pd.

7 National Surace Transportation Policyand Revenue Commission, Transportation

or Tomorrow, December 2007, http:/ /transportationortomorrow.org/nal_report/.

8 E. Burgess and A. Rood, Reinventing Transit:American Communities Finding Smarter,Cleaner, Faster Transportation Solutions (NewYork: Environmental Deense Fund, 2009),http://www.ed.org/documents/9522_Reinventing_Transit_FINAL.pd.

9 M. Turner, Transit Oriented DevelopmentRevitalizes Chicago Neighborhood, Race,Poverty, and the Environment(Winter

2005/2006), http://www.urbanhabitat.org/les/24.Marcia.Turner.pd.

10 See http://www.cleanandsaeports.org.Inormation and resources on the impactsthat transporting goods have on health andcommunity lie is available rom the Trade,Health, & Environment Impact Project, acommunity-academic partnership, http://hydra.usc.edu/scehsc/web/Welcome/Welcome.html.

11 For inormation on authorizations and

allocations under SAFETEA-LU, the suracetransportation bill that expires in September2009, see http://www.hwa.dot.gov/saetealu/actsheets/step.htm.

12 Transportation or Tomorrow(see endnote 7).

13 P. Latzin et al., Air Pollution duringPregnancy and Lung Function in Newborns:A Birth Cohort Study, European Respiratory

Journal33 (2009): 594603.

14

W. J. Gauderman et al., The Eect o AirPollution on Lung Development rom 10 to18 Years o Age, New England Journal oMedicine 351, no. 11 (2004): 105787.

15 C. A. Pope III et al., Lung Cancer,Cardiopulmonary Mortality, and Long-TermExposure to Fine Particulate Pollution,

Journal o the American Medical Association(JAMA) 287, no. 9 (2002): 113241.

Notes


32/36

T

he

Transportation

Prescription

pg.30

>>

Notes

16 American Lung Association, Highlights oRecent Research on Particulate Air Pollution:Eects o Long-term Exposure, 2008,http://www.lungusa.org/at/c/{7a8d42c2-cca-4604-8ade-75d5e762256}/ANNUAL-AVERAGE-PM-STUDIES-OCTOBER-2008.PDF.

17 M. Bell et al., Ozone and Short-TermMortality in 95 U.S. Urban Communities,19872000, The Journal o the AmericanMedical Association 292, no. 19 (2004):237289, http://research.yale.edu/environment/bell/research/les/bell_

mortality_jama.pd.

18 American Lung Association, Highlights oRecent Research (see endnote 16).

19 See http://www.arb.ca.gov/research/health/s/pm_ozone-s.pd.

20 See http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=44567.

21 Centers or Disease Control and Prevention(CDC), America Breathing Easier, http://

www.cdc.gov/asthma/pds/breathing_easier_brochure.pd.

22 S. Nicholas et al., Addressing the ChildhoodAsthma Crisis in Harlem: The HarlemChildrens Zone Asthma Initiative,American

Journal o Public Health 95, no. 2 (2005):24549.

23 W. J. Gauderman et al., Childhood Asthmaand Exposure to Trac and NitrogenDioxide, Epidemiology16, no. 6 (2005):

73743.

24 Meredith Minkler et al., Promoting HealthyPublic Policy Through Community-basedParticipatory Research, PolicyLink, 2008,http://www.policylink.org/documents/CBPR_nal.pd. See also http://www.weact.org.

25 K. L. Ebi et al., U.S. Funding is Insucientto Address the Human Health Impactso and Public Health Responses toClimate Variability, Environmental HealthPerspectives Online, February 27, 2009, doi:10.1289/ehp.0800088, http://dx.doi.org/.

26 See http://thomas.loc.gov/cgi-bin/query/z?c111:H.R.2323.

27 T. Brikowski, Y. Lotan, and M. S. Pearle,Climate-related Increase in the Prevalence oUrolithiasis in the United States, Proceedings

o the National Academy o Sciences 105, no.28 (2008): 984146, http://www.pnas.org/content/105/28/9841.ull.pd+html.

28 Ebi et al., U.S. Funding (see endnote 25).

29 CDC, Preventing Obesity and ChronicDiseases Through Good Nutrition andPhysical Activity, 2008, http://cdc.gov/nccdphp/publications/actsheets/Prevention/pd/obesity.pd.

30 CDC, Prevalence o Regular Physical Activity

among AdultsUnited States, 2001 and2005, Morbidity and Mortality WeeklyReport56, no. 46 (November 23, 2007):120912, http:/ /www.cdc.gov/mmwr/preview/mmwrhtml/mm5646a1.h2tm#tab.

31 Transportation Research Board and Instituteo Medicine, Does the Built EnvironmentInfuence Physical Activity? Examining theEvidence, Special Report 282 (Washington,DC: National Academy Press, 2005).

32

S. J. Olshansky et al., A Potential Declinein Lie Expectancy in the United States inthe 21st Century, New England Journalo Medicine 352, no. 11 (March 17, 2005):113845, http://www.muni.org/iceimages/healthchp/lie%20expectancy1.pd.


33/36

33 L. D. Frank, M. Andresen, and T. L. Schmid,Obesity Relationships and CommunityDesign, Physical Activity, and Time Spentin Cars,American Journal o PreventiveMedicine 27, no. 2 (2004): 8796, http:/ /www.act-trans.ubc.ca/documents/ajpm-aug04.pd.

34 U. LaChapelle and L. D. Frank, Transitand Health: Mode o Transport, Employer-Sponsored Public Transit Pass Programs, andPhysical Activity,Journal o Public HealthPolicy30 Supplement (2009): S73S94,

http://www.palgrave-journals.com/jphp/journal/v30/nS1/pd/jphp200852a.pd.

35 L. Besser, M. Marcus, and H. Frumkin,Commute Time and Social Capital inthe U.S.,American Journal o PreventiveMedicine 34, no. 3 (2008): 20711.

36 U.S. Department o Transportation, MotorVehicle Trac Crashes as a Leading Causeo Death in the United States, 2005,Research Note DOT HS 810 936 (Washington,DC: National Highway Trac Saety

Administration, 2008).

37 Lawrence J. Blincoe et al., The EconomicImpact o Motor Vehicle Crashes, 2000,Report no. DOT HS-809-446 (Washington,DC: National Highway Trac SaetyAdministration, 2002), http://www.nhtsa.dot.gov/staticles/DOT/NHTSA/Communication%20&%20Consumer%20Inormation/Articles/Associated%20Files/EconomicImpact2000.pd.

38

CDC, Web-based Injury Statistics Query andReporting System (WISQARS), http://www.cdc.gov/ncipc/WISQARS/.

39 CDC, Pedestrian FatalitiesCobb, DeKalb,Fulton, and Gwinnett Counties, Georgia,19941998, Morbidity and Mortality Weekly

Report48 (1999): 60105, http://www.cdc.gov/mmwr/PDF/wk/mm4828.pd.

40 J. Pucher and J. L. Renne, Socioeconomics oUrban Travel: Evidence rom the 2001 NHTS,Transport Quarterly57 (2003): 4977,http://policy.rutgers.edu/aculty/pucher/TQPuchRenne.pd.

41 David A. Morena et al., Older Drivers ata Crossroads (Washington, DC: FederalHighway Administration, 2007), http://www.thrc.gov/pubrds/07jan/02.htm.

42 U.S. Department o Transportation, NationalHousehold Travel Survey, Older Drivers:Saety Implications (Washington, DC: FederalHighway Administration, 2006).

43 Federal Highway Administration, NationalHousehold Travel Survey, 2001.

44 Fatality Analysis Reporting SystemEncyclopedia, http://www-ars.nhtsa.dot.gov/Main/index.aspx.

45 T. Litman and S. Fitzroy, Sae Travels:Evaluating Mobility Management Trac SaetyBenets, Victoria Transport Policy Institute,2006, http://www.vtpi.org/saetrav.pd.

46 Peter L. Jacobsen, Saety in Numbers:More Walkers and Bicyclists, Saer Walkingand Bicycling, Injury Prevention 9 (2003):20509, http://www.tsc.berkeley.edu/newsletter/Spring04/JacobsenPaper.pd.

47 Steven Raphael and Alan Berube,

Socioeconomic Dierences in HouseholdAutomobile Ownership Rates: Implicationsor Evacuation Policy, paper prepared orthe Berkeley Symposium on Real Estate,Catastrophic Risk, and Public Policy, March23, 2006, http://urbanpolicy.berkeley.edu/pd/raphael.pd.


34/36

T

he

Transportation

Prescription

pg.32

>>

Notes

48 Overcoming Obstacles to Health, RobertWood Johnson Foundation, 2008, http://www.commissiononhealth.org/PDF/ObstaclesToHealth-Highlights.pd. See alsoR. D. Wilkinson and K. E. Pickett, IncomeInequality and Population Health: A Reviewand Explanation o the Evidence, SocialScience & Medicine 62 (2006): 176884.

49 Transportation Aordability: Strategies toIncrease Transportation Aordability, TDMEncyclopedia, updated July 2008, VictoriaTransport Policy Institute, http://vtpi.org/

aordability.pd.

50 Barbara Lipman, A Heavy Load: TheCombined Housing and TransportationBurdens o Working Families (Washington,DC: Center or Housing Policy, October2006), http://www.nhc.org/pd/pub_heavy_load_10_06.pd.

51 Realizing the Potential: ExpandingHousing Opportunities near Transit,Reconnecting Americas Center or TransitOriented Development, 2007, http://

www.reconnectingamerica.org/public/reports?page=2.

52 See http://www.bts.gov/publications/issue_bries/number_03/html/transportation_diculties_keep_over_hal_a_million_disabled_at_home.html.

53 L. Bailey, Aging Americans: StrandedWithout Options, Surace TransportationPolicy Project, 2004, http://www.apta.com/research/ino/online/documents/aging_

stranded.pd.

54 Ibid.

55 Health impact assessments are a combinationo procedures, methods, and tools toevaluate the potential health eects oa policy, program, or project as well asthe distribution o those eects withina population. See http://www.cdc.gov/healthyplaces/hia.htm.

56 Transit oriented development is a planningand design trend that seeks to createcompact, mixed-use, pedestrian-riendly

communities located around new or existingpublic transportation stations. For moreinormation, see Todd Swanstroms paper inthis series. See also http://www.policylink.org/EDTK/TOD/deault.html.

57 See http://www.hwa.dot.gov/saetealu/actsheets/stp.htm.

58 Pucher and Renne (see endnote 40).

59 See http://www.ta.dot.gov/unding/grants/grants_nancing_3561.html.

60 Transit Riders or Public Transportation,Ensuring Non-Discrimination inTransportation Investments, http://www.publicadvocates.org/ourwork/transportation/docs/TRPT-Ensuring_Non_Discrimination_in_Transportation_Investments_04-08-09.pd.

61 Swanstrom T. The Road to Good Jobs:Patterns o Employment in the ConstructionIndustry, (September 30, 2008), http://www.umsl.edu/services/media/assets/pd/study.

pd.


35/36


36/36

221 Oak St.Oakland, CA 94607t 510-444-7738f 510-663-1280

www.preventioninstitute.org

Headquarters:1438 Webster Street, Suite 303Oakland, CA 94612t 510 663-2333f 510 [email protected]

CommuniCations offiCe:55 West 39th Street, 11th foorNew York, NY 10018t 212 629-9570f 212 629-7328

www.policylink.org

Commissioned by:

transportation rx_bold new ideas for healthy, equitable transportation reform in america

Documents