Public Transportation in the U.S.: A Driver of Health and Equity

New or expanded public transportation options can improve health and health equity by reducing traffic crashes and air pollution, increasing physical activity, and improving access to medical care, healthy food, vital services, employment, and social connection.

What the Issue?

Health, functioning, and quality of life are products of the social and economic conditions in the environments where people are born, live, learn, work, play, worship, and age. Research suggests that an estimated 20 percent of a person’s health can be attributed to clinical care, whereas an estimated 30 percent can be attributed to health behaviors such as diet and exercise, and another 10 percent to the physical environment, including air and water quality, housing, and transit. The remaining 40 percent is related to social and economic factors such as education, employment, and income.

Transportation is a component of the built environment, with important impacts on public health and health equity. Transportation policies, planning efforts, and infrastructure investments have historically emphasized roads over public and active transportation, contributing to health hazards and segregating communities. New or expanded public transportation options can increase access to and use of transit and can improve health outcomes by promoting better air quality, increasing levels of physical activity, decreasing injuries from motor vehicle crashes, and improving mental health.

Women, young adults (ages 25–29), Black workers, and low-income workers in particular depend on public transportation for commuting. In addition, lack of access to public transportation can disproportionately harm older people and people with disabilities and can exacerbate racial and economic disparities by decreasing mobility and forcing dependance on car ownership.

This brief’s primary focus is the relationship between urban public transportation and health and health equity, highlighting policy and practice interventions that may help states and municipalities better align urban public transportation and public health goals.

What's Next?

Access to public transportation may reduce health disparities and promote health equity by increasing access to healthier food options, medical care, vital services, and employment for communities that do not have equal access to these fundamental daily necessities.

As the evidence linking access to public transportation, health, and health equity continues to grow and as transportation planners continue to incorporate health considerations into their work, several high-priority areas for future research have become clear.

First, aligned metrics that demonstrate how access to public transportation affects individual and population health outcomes and health equity have been shown to be important in guiding community planning efforts. Second, although state transportation laws may highlight public health concerns or goals, there is a lack of research on how these laws affect local transit decision making. Additional research in this area could provide insight regarding potential roles for public health practitioners to engage in and inform those processes. Third, more information on the link between access to transportation and poverty will help to inform equitable approaches to transportation planning and implementation.