A Research Roadmap for Transportation and Public Health (2019)

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16 Transit Transit planning and operational decision-making are often conducted separately from other surface transportation processes and may have unique needs, challenges, and opportunities for incorporating health considerations. Public transit is key to providing access to medical services, schools, work sites, grocery stores, and other community services, as well as reducing transportation-related inequities and providing more opportunities for aging in place for older adults that cannot or choose not to drive. In addition, transit use in itself may result in higher physical activity from accessing and egressing from transit vehicles and stations. See Section 2.8 of the contractor’s final report for more discussion. Research Gaps and Needs 1. Gap: Deficiency in research measuring the overall and potential health benefits of transit. a. Need: Research on the effects of transit use on specific attributes of health such as health equity, social cohesion, air quality, road safety, pollutants, physical activity, and overall well-being. b. Need: Research quantifying potential health benefits of using transit through scenario development and methods that take into account latent demand for transit rather than relying on current transit use to forecast future use. 2. Gap: Lack of ability to quantify health benefits of transit implementation and translate into health cost savings metrics. a. Need: Research to identify standardized metrics with which to assess, quantify, and forecast health outcomes, including cost savings. b. Need: Research to further quantify the full health benefits of transit, including showing system-level benefits on multiple health domains. c. Need: Research that provides wide-ranging overview of health impacts of transit, and conceptual framework to enhance agencies’ ability to consider health outcomes in transit planning. d. Need: Development of performance measures that help the transportation field align health objectives with transportation goals (see more research needs related to performance measures in the first section of Chapter 3, gap #5). e. Need: Development and validation of evaluation methods to determine whether transit projects are producing expected health outcomes. 3. Gap: Dearth of guidance on best practices for communicating the broader health benefits of transit to the public. a. Need: Research evaluating public perception and messaging around transit use and health outcomes. C H A P T E R 4 Specific Topics and Emerging Issues

Specific Topics and Emerging Issues 17 b. Need: Syntheses or assessments of the role of new technologies in framing mode choices around health benefits of increased transit access/use. c. Need: Guidance/case studies showing diverse practices among transit providers— including rural transit agencies—to link transit with health considerations and outcomes. 4. Gap: Lack of understanding of how emerging technologies can affect health, as well as complement and enhance current behaviors such as transit use. a. Need: Synthesize or assess the role of new technologies in supporting health through increased transit access/use. 5. Gap: Deficit in knowledge on how transit projects positively or adversely affect health equity. a. Need: Research to evaluate how transit improvement projects, such as first/last mile connection efforts, affect health outcomes (including physical activity, improved access, etc.) and what planning efforts can ensure that positive health outcomes are equitably distributed. Demographic, Cultural, and Travel Behavior Shifts Society is observing major shifts in demographic, cultural, and behavioral trends related to transportation and health. Some of these, but not all, are intertwined with emerging technologies and scientific-innovations that have occurred in transportation and other sectors (see the next section of the Research Roadmap). These changes present new challenges and often opportunities for further integrating health and transportation. See Section 2.9 of the contractor’s final report for more discussion. Research Gaps and Needs 1. Gap: Insufficient understanding of which populations experience positive or negative health outcomes related to transportation and the magnitude of such impacts on general public health, particularly in the face of shifting demographic trends. a. Need: Research explicit health impacts of the transportation system based on changing demographics, and growing inequities among different sub-populations. b. Need: Exploration of how demographic shifts affect transportation behavior and associated health impacts of both specific emerging populations and the future general population. c. Need: Research specific health and transportation needs of new and growing sub- populations and how to improve health outcomes for these populations. d. Need: Development of case studies on application of health equity processes and principles in urban and rural contexts, and documentation of DOT approaches to integrate/align equity considerations into methods and processes. e. Need: Study short- and longer-term behavioral adaptation related to health (including safety, health, social interaction, mode shift, etc.). 2. Gap: Lack of understanding of how specific populations utilize emerging technologies and innovative practices to make health and transportation choices. a. Need: Document direct health impacts from new transportation technologies and related policies, and differences among sub-populations. 3. Gap: Unknown or missed opportunities in transportation planning and other activities to advance health equity. a. Need: Research to develop and test the implementation of clear performance measures for health equity at the state level. b. Need: Case studies on application of health equity processes and principles in urban and rural contexts.

18 A Research Roadmap for Transportation and Public Health c. Need: Exploration of the root causes of health inequities within and external to trans- portation systems. d. Need: Basic research or synthesis studies to estimate the relationship between changes in land use, population and job growth, availability or lack of affordable housing, and effects on travel/commute times by mode. e. Need: Development of qualitative approaches and practices (such as story-telling and socio-anthropological methods) to build transportation agency understanding of and sensitivity toward those who have experienced negative health outcomes as a consequence of transportation policy, planning, design, and implementation decisions and processes. Emerging Forms of Transportation and Mobility Concurrently emerging technologies of shared mobility, vehicle or device electrification, new modes of travel, and automation are positioned to radically alter the transportation landscape. With the range of new technologies being integrated into different contexts (with their own shifting social and demographic trends), there is a need to continue monitoring plans, the role of community engagement and literacy around these topics, and implementation. As opportunities arise, there is a need for research to re-examine health determinants and evaluate the health and transportation impacts from the standpoint of emerging mobility devices and services. These technologies hold the potential to be truly transformative to the way in which people travel in the future. See Section 2.9 of the contractor’s final report for more discussion. Research Gaps and Needs 1. Gap: Deficit in understanding of the overall health impacts or potential health impacts from new forms of mobility. a. Need: Partner with select agencies and/or providers to research how emerging micro- mobility providers (e.g., bicycle sharing, scooters) are influencing health outcomes and document evidence of health disparities among different population subgroups. b. Need: Develop guidance for the safe operation of micro-mobility modes or classes of technologies to increase user safety and decrease conflicts with other road and/or sidewalk users. c. Need: Estimate the potential changes in sedentary behaviors and concomitant health outcomes that can result from expected future increases in the prevalence and use of driverless vehicles. d. Need: Research systems impacts, including mode shift/substitution, safety, and environ- mental outcomes related to emerging technologies. Consider the net impact of car-shedding and the emergence of mobility as a service on population health. e. Need: Documentation of short- and longer-term behavioral adaptation related to health (including safety, health, social interaction, etc.). f. Need: Research into equitable distribution of hardware and software infrastructure needed to make new technologies fully operational and the effects if there is disparate distribution. 2. Gap: Absence of synopsis or centralized collection of innovative practices and use of new technologies with respect to advancing health in transportation. a. Need: Document direct health impacts from policies and practices around new technolo- gies as well as disparities among different sub-populations. 3. Gap: Lack of clarity on the role and impact of federal, state, and local governments in monitoring usage or testing of innovative technologies and fostering public engagement. a. Need: Develop guidance or consensus recommendations around the role of federal, state, and local governments in regulating usage or testing of technologies and fostering public engagement.

Specific Topics and Emerging Issues 19 b. Need: Analysis of public health impacts of policies and actions designed to regulate or test new technologies or forms of transportation. 4. Gap: Lack of insight into the implications of new technologies for resiliency and disaster planning. a. Need: Exploration of interactions of emerging technologies and disaster planning/hazard mitigation. b. Need: Examination of opportunities for new modes of transportation to augment recovery processes. c. Need: Identification of the relationship of emerging mobility services and system redundancy. Emerging Data Sources There are many emerging data sources that hold potential to improve the ability of practi- tioners and researchers to capture health determinants, in particular accessibility, active travel, and environmental exposures. These include GIS data gathered from phone-based sensing technologies (such as Strava and Waze), sources of biometric data, and other big data sources such as traffic camera footage and cell phone data. See page 31 of the contractor’s final report for more discussion. Research Gaps and Needs 1. Gap: Deficiency in knowledge as to how emerging data sources can be utilized to advance health in transportation. a. Need: Sound approaches for integrating determinants of health into emerging trans- portation data sources. b. Need: Testing and evaluation of new data sources from a health and a health equity perspective. c. Need: Assessment of ability to effectively link emerging data sets with existing data sets and knowledge. d. Need: Consideration of how new forms of data can be used to improve public engagement, data visualization, and messaging for better communication around transportation and health. e. Need: Research around where and how the infrastructure around “smart” connectivity will be distributed and related health impacts on areas where investments are made or not made.