How Current Transportation Policy Affects Access to Health Care

The following is excerpted from a new report by The Leadership Conference Education Fund entitled “The Road to Health Care Parity: Transportation Policy and Access to Health Care” (April 2011).

Lack of access to affordable transportation is a major contributor to health disparities. It isolates low-income people from health care facilities and forces families to spend a large percentage of their budgets on cars and other expensive options, at the expense of other needs, including health care. Our transportation policy also generates public health problems that disproportionately affect low-income communities and communities of color. As Congress considers a reauthorization of our nation’s surface transportation programs, which will allocate significant federal funds to transportation infrastructure, civil and human rights advocates have an opportunity to advance public health through participation in the transportation policy-making process.

a. Disproportionate investment in expanding road networks and car-based transportation

For several decades, we have invested the overwhelming majority of federal transportation funds in new highway construction. People from urban areas and people of color are significantly underrepresented in the institutions that decide how to invest transportation funds for metropolitan areas, which results in a strong preference for transportation benefiting suburbs and outlying areas. As a result, we now have a landscape of metropolitan sprawl and a predominately car-based transportation system across the country.

b. Transportation investments to date have limited access to health care for low-income people

Because a very small percentage of federal funds have been used for affordable public transportation and for active transportation (i.e. walking, biking) opportunities, people without access to cars have been isolated from opportunities and services—including health care providers. By underinvesting in walkable communities, rapid bus transit, rail, and bicycle-friendly roads, our policies contribute to high concentrations of poor air quality, pedestrian fatalities, obesity, and asthma in urban areas. All of these public health risks have disproportionately affected low-income people and people of color.

i. Lack of access to health care facilities

Without affordable and accessible transportation, many Americans are physically isolated from health providers. As poverty in suburban areas grows, increasing numbers of people are unable to reach providers and services that are spread out among non-walkable areas with limited public transportation. People of color, households in rural areas, and people with disabilities face significant hurdles because many cannot drive and public transportation is often unavailable, inaccessible, or unreliable. Studies show that lack of access to transportation reduces health care utilization among children, seniors, low-income people, and people with disabilities. One survey found that 4 percent of U.S. children (3.2 million in total) either missed a scheduled health care visit or did not schedule a visit during the preceding year because of transportation restrictions.

ii. Pedestrian fatalities

Children, seniors, and people of color are disproportionately represented in the 76,000 Americans who, in the last 15 years, have been killed in pedestrian accidents. Pedestrians account for 15 percent of traffic fatalities among people 65 and over. Hispanics die at a higher rate in pedestrian accidents than non-Hispanics, and although they make up about 12 percent of the U.S. population, African Americans account for 20 percent of pedestrian fatalities. Streets that are safe for all road users, including pedestrians, are critical to keeping our neighborhoods livable.

iii. Relationship to obesity

Streets and highways without sidewalks present an unnecessary barrier to walking. Auto-oriented transportation and limited access to walkable streets have resulted in an unhealthy, sedentary lifestyle with material consequences for public health. Over the past 25 years, childhood obesity has steadily increased as walking trips among children have steadily decreased. Obesity and related illnesses disproportionately affect low-income people and people of color, and these public health hazards cost billions of dollars annually. Obesity costs account for approximately 9 percent of all health care spending in the U.S., and part of these costs are attributable to auto-oriented transportation that inadvertently limits opportunities for physical activity.

iv. Reduced resources for health care expenses, nutritious food, and other health-related needs

The poorest fifth of American families spend 42 percent of their incomes on transportation. This massive expenditure can wipe out already limited budgets for out-of-pocket medical expenses, nutritious food, and healthy recreational activities. Because affordable housing is increasingly located far from main transportation lines and jobs, low-income people and people of color are more likely to have long commutes—which reduce time for exercise, shopping for healthy foods, and additional earning opportunities. Fast-moving traffic on highways literally may divide communities, especially those with elderly people and people with disabilities, and this isolation is associated with higher mortality and morbidity in the elderly.

v. Pollution-related public health risks

Traffic congestion in major metropolitan areas is on the rise. As a result, urban centers are exposed to increased vehicle emissions. Transportation-related air quality is causing serious public health problems in cities, most notably asthma. There is a direct relationship between emissions and health: A study in Atlanta documented a significant drop in children’s asthma attacks when single-occupancy vehicle use decreased during the 1996 Olympic Games. Minority children disproportionately suffer from asthma; among Puerto Rican children, the rate is 20 percent and among African-American youth, the rate is 13 percent, compared with the national childhood average of 8 percent. The health impacts spread beyond asthma: People living within 300 meters of major highways are more likely to have leukemia and cardiovascular disease. The health costs associated with poor air quality from the transportation sector is estimated at $50–$80 billion per year.