Guest Op-Ed: The Role of Transportation in Improving America’s Health
The Eno Center for Transportation’s publication of my white paper, Increasing Access to Essential Health Functions: The Role of Transportation in Improving America’s Health, is something I’m very proud to see. I’ve been working across transportation, health, and policy for over a decade. In many ways, this paper includes what I wish I had known when I started.
As an urban planner, my education was grounded in the fundamental principles of good governance: that public agencies should protect the health, safety, and welfare of everyone in their purview. These principles have guided me as I’ve worked in local, regional, and federal agencies, and when government has been the client in my private sector jobs. I became an urban planner because I wanted to help solve difficult problems that have no easy answers, and I wanted to do that by focusing on the people who are disproportionately hurt by them. Trying to solve those problems led me into public health, human services, healthcare, and technology roles, but my goal remains the same.
Within transportation, most practitioners have known for a number of years that our traditional method of prioritizing capital improvements funding over maintenance, and driving over other modes, is becoming less and less sustainable. Yet even in 2018, the American Road & Transportation Builders Association showed that 73% of federal highway funds were spent on new capacity, compared to 20% spent on repairs. More people are walking and biking, but the Governors Highway Safety Association’s research shows that pedestrian deaths are also continuing to rise. In 2019, 6,590 pedestrians were killed on U.S. roads, the highest number since 1988.
Our colleagues in health face similar challenges. Experts have warned for years that our costs are rising unsustainably; healthcare is now 17% of GDP compared to 10% in peer countries. Despite paying more for healthcare, the United States ranks at or near the bottom on most major indicators of health such as life expectancy, access, administrative efficiency, and equity. In part that’s because the system we’ve built prioritizes spending on healthcare over public health interventions and policies that support health, such as safe and convenient multimodal transportation access.
A number of state and local governments have recognized the burden of unsustainable healthcare costs and adopted a Health in All Policies approach. This idea helps government identify areas of improvement across all sectors to better integrate health-supporting policy and programs, and expanding Health in All Policies is a key recommendation I make.
One challenge we face in public policy is that a policy or program that works for one part of government causes negative externalities in another. Fortunately, there are also policy changes that can have positive benefits across multiple agencies. I took the broadest possible view of transportation access in my paper, focusing not only on reducing barriers to travel, but also on how the need to travel could be reduced by programs such as grocery delivery and telehealth. My recommendations cover all levels of government, as well as agencies that manage transportation, public health, healthcare, and food access. They are pragmatic changes to policy and regulations that can be handled administratively, without requiring new legislation or new funding sources.
As I wrote this paper, I had valuable discussions with colleagues I’ve met across the span of my career and who have expertise in different areas of transportation and health. What struck me in those conversations was the number of times they mentioned learning something new. I hope the same is true for everyone who reads this paper.
The views expressed above are those of the author and do not necessarily reflect the views of the Eno Center for Transportation.