Health equity is achieved when everyone has the opportunity to attain their full health potential.

Inequities in health stem from structural inequities—the systemic disadvantage of one social group compared to other groups—deeply embedded in the fabric of society and encompassing policy, law, governance, and culture. Health inequities in large part result from historic and ongoing poverty, structural racism, and discrimination, and they can be mitigated by policies and community action in powerful ways.

Community-wide problems such as poverty, unemployment, low educational attainment, lack of public transportation, inadequate housing, and exposure to violence all shape health and contribute to health inequities. How people get around their communities can affect health and well-being, in addition to access to important opportunities and services. To address the underlying conditions and root causes of health inequities, new partners in transportation and other sectors are joining forces with community members to promote health equity.

When it comes to important health metrics, your zip code may matter more than your genetic code.

Map of life expectancy disparities in Kansas City, Missouri.
SOURCE: RWJF. Used with permission from the Robert Wood Johnson Foundation.

Map of life expectancy disparities in New Orleans, Louisiana.
SOURCE: RWJF. Used with permission from the Robert Wood Johnson Foundation.

For example:

life expectancy in the U.S. can vary by 15 years, depending on income level, education, and where a person lives.
while the mortality rate for non-Hispanic white babies is 5 in every 1,000, that rate jumps to 11 in every 1,000 for African Americans.
rates of serious conditions like obesity, heart disease, cancer, and stroke are substantially higher in the poorest parts of the country.

Disparities like these stem from systems and structures that make it a lot harder for poor people to live healthy lives. Health inequities are a problem for us all, adversely affecting our nation’s children, our business efficiency and competitiveness, our economic strength and national security, and our standing in the world.

Communities are able to take action on the factors that shape health, but they can’t do it alone. Community-based solutions rely on multi-sectoral collaborations ensuring varied approaches to improving community health equity and well-being. A report from the National Academies of Sciences, Engineering, and Medicine offers promising approaches for promotion of health equity. What is the role of the transportation sector?

The transportation–health link

Transportation is the networks, services, and infrastructure necessary to provide community residents with the means to get from one place to another. It is vital to accessing goods, services (including health and social services), social networks, housing, education, employment, and more. If designed and maintained properly, transportation facilitates safe and efficient mobility and is accessible to all residents, regardless of geographic location, age, or disability status. And yet:

Transportation costs are a barrier to mobility for households in poverty, disproportionately represented by African Americans and Hispanics.
Long commute times and high transportation costs are significant barriers to employment and financial stability.
For rural and other underserved communities, inadequate or complete lack of public transportation poses a barrier to accessing health care and other vital services.
Low-income and minority populations are more likely to live near environmental hazards that can contribute to poor health, including transportation related sources of pollution and toxic emissions such as roadways, bus depots, and ports.

Examples of Action

Community-driven solutions can take into account the range of factors that contribute to health inequity in the United States, such as income and wealth or employment. These factors are the social determinants of health. The IndyCan example below works in the areas of employment, public safety, transportation, education, and social environment.

IndyCan

IndyCAN is a multiracial, nonpartisan organization in central Indiana that catalyzes marginalized people and faith communities to act collectively for racial and economic equity. One of its programs, the Ticket to Opportunity initiative, works to mitigate the effects of inadequate transit as a barrier to employment opportunities.

The initiative organized to pass a regional transit expansion referendum to triple bus service in Indianapolis. Key partners included faith-based organizations, businesses, government, and community leaders. Ticket to Opportunity created dialogue with 80,000 marginalized voters of color through large-scale integrated voter engagement to build sustained capacity for achieving transit equity, including an expanded bus service that would fuel economic development and increase job access threefold for low-income communities.

These and other efforts highlight how multiple sectors can successfully work together to address multiple determinants of health through community-driven work.

IndyCAN Ban the Box action, 2014.

Ticket to Opportunity Website

Nashville Metropolitan Planning Organization

The Nashville Metropolitan Planning Organization (MPO) is a local planning agency for seven counties in Tennessee that also functions as a convener for local communities and state leaders to collaborate on strategic planning for the region’s multi-modal transportation system.

The mission of the organization is to “develop policies and programs that direct public funds to transportation projects that increase access to opportunity and prosperity, while promoting the health and wellness of Middle Tennesseans and the environment.”

The Nashville MPO developed a regional transportation plan in 2015 to help communities grow in a healthy and sustainable way by:

Aligning transportation decisions with economic development initiatives, land use planning, and open-space conservation efforts;
Integrating healthy community design strategies and promoting active transportation to improve the public health outcomes of the built environment;
Pursuing solutions that promote social equity and contain costs for transportation and housing; and
Minimizing the vulnerability of transportation assets to extreme weather events.

The criteria by which the Nashville MPO plans to evaluate its projects include indicators related to health, such as physical activity, air quality, and traffic collisions.

What Can the Transportation Sector Do to #PromoteHealthEquity?

Multiple national initiatives in the past 20 or 30 years have aimed to improve livability and sustainability in places across the United States, and transportation equity is a mainstay of much of this work. For instance, the U.S. Department of Transportation (DOT), with the U.S. Department of Housing and Urban Development and the U.S. Environmental Protection Agency, launched the federal Sustainable Communities Partnership in 2009. This initiative works to help U.S. communities “improve access to affordable housing, increase transportation options, and lower transportation costs while protecting the environment.”

Supportive policies, like funding initiatives, can support community action. For instance, the DOT’s Transportation Investment Generating Economic Recovery (TIGER) discretionary grants program is helping jurisdictions such as Pittsburgh build infrastructure that will “reconnect the Hill District to downtown Pittsburgh, more than 60 years after highway and arena construction razed a middle income African American community” through a project to improve neighborhood streets, sidewalks, and crosswalks; add a bus stop, bike-sharing station, and Americans with Disabilities Act–compliant walkways; and create open space for transportation and recreation.

Government agencies that support or conduct planning related to transportation can:

Add specific requirements to outreach processes to ensure robust and authentic community participation in policy development.
Collaborate with public health agencies and others to ensure a broad consideration of unintended consequences for health and well-being, including whether the benefits and burdens will be equitably distributed.
Highlight the co-benefits of—or shared “wins” that could be achieved by—considering health equity in the development of comprehensive plans (for example, improving public transit in transit poor areas supports physical activity, promotes health equity, and creates more sustainable communities.)

Safe Routes to School, an example of active transportation targeted at the local level, aims to improve children’s safety while walking and riding bicycles.

FIGURE 5-26 Harlem Piers Park.

WEACT, a nonprofit community organization in Harlem, NY, transformed a 69,000 square foot parking lot into a 105,526 square foot park to promote active transportation options.

Did you know?

Promoting means of active transportation—like walking, cycling, and access to public transportation—helps reduce environmental barriers to physical activity and can improve health outcomes.

Communities in Action

Pathways to Health Equity

Opportunities for the Transportation Sector