TheHiddenHealthCostsofTransportation
EXECUTIVESUMMARY
Transportationinvestmentsandthesystemsthataredevelopedfromthemshapelivesandcommunities.Thetransportationsystemisacomplexwebofhighways,sidewalks,bikepaths,trainsandbusservicesthatconnectpeopletoeachotheraswellastoplacesofwork,play,prayer,medicalcare,andshopping.Transportationpoliciesanddecisionsinfluencelanduseandhowcommunitiesandneighborhoodsaredesignedandbuilt—whethersprawlinganddisconnected,orcentralandconnected.Thecombustionengineandthecreationofthehighwaysystemincreasedmobilityandaccesstogoodsandservices.However,investmentsinhighwayshavecomeattheexpenseofothertransportationmodes.Overtheyearsthishasledtoaheavierrelianceonvehiclesandroadwaysandlessonwalking,bicyclingandtransituse.Further,suburbandevelopmenthasresultedincommunitiesthatareawayfromtowncentersandpublictransitandrequireanear-totalrelianceontheautomobilefortransportandaccess.Ourdependenceonautomobilesandroadwayshasprofoundnegativeimpactsonhumanhealth:decreasedopportunitiesforphysicalactivity,andincreasedexposuretoairpollution,andthenumberoftrafficcrashes.Thehealthcostsassociatedwiththeseimpacts,includingcostsassociatedwithlossofworkdaysandwages,painandsuffering,andprematuredeath,maybeashighasseveralhundredbilliondollars.Aninvestmentina“healthier”transportationsystemiscritical.Providingconvenientalternatives,encouragingactivemodesoftransport,andaestablishingatransportationsystemthatfostersconnectivityandsocialinteractioncannotonlyoffsethealthimpactsandcosts,butgeneratehealthbenefits.Healthimpactsandcostshavetypicallynotbeenconsideredinthetransportationpolicy,planning,andfundingdecision-makingprocess.Therearefewstandardsormodelsforestimatinghealthcosts.However,existingresearchcanbeusedtoestimatethepopulationatrisk,themagnitudeofthehealthimpact,andthehealthcostsassociatedwiththoseimpacts.Growingrecognitionoftheconnectionbetweentransportation,landdevelopmentandhealthhasresultedinsomestudiesandexampleswherehealthimpactsandcostshavebeenconsideredandassessed.Theseexamplesnotonlydemonstratethathealthcostsshouldbeasignificantfactorindecision-making,butalsoshowthatcalculatingsuchcostsisindeedpossible.Muchmoreworkisneededintheareaofhealthevaluationandcostassessmentintransportationpolicy.Investmentsinhealthiertransportationarealsocriticallyneeded.Afewkeypolicychangescanhelprealizebothoftheseobjectives.
Policies that
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Encouragefederalplanning,fundingpractices,anddecisionmakingtoincludehealthimpacts,costsandbenefits
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Supportdevelopmentofhealthycommunities,activetransportandincentivesfortransportationinvestmentsthatsupporthealth
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Promotemeasurementandevaluationofhealth,safetyandequityinplanninganddevelopmentprocesses
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FundresearchtoevaluatehealthimpactsandcostsoftransportationandlanduseactionsSuchpoliciesmustbeintegratedintotransportationpolicy—especiallynationaltransportationpolicy.Theupcomingreauthorizationofthefederalhighwaytransportationbillprovidesanimportantopportunitytoadvocateforhealthierandmoreactivetransporationsystems.
AreportpreparedfortheAmericanPublicHealthAssociationbyUrbanDesign4Health,Inc.February10,2010
Overview:HealthCostsAssociatedwithTransportation
Transportationinvestments,andthetransportationsystemsthatemergefromthem,shapelivesandcommu-nities.Highways,sidewalks,bikepaths,trainsandbusserviceconnectpeopletofriendsandfamily,jobs,shopping,school,andcountlessotheractivities.Thesetransportationsystemsalsoshapethedesignofthebuildingsandneighborhoodsthattheylinktogether.Transportationsystemsandneighborhooddesigntogetherdeterminetheoutofpocketcost,convenience,andcomfortofdifferenttraveloptions.
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Thetravelchoiceswemakeonadailybasis—whetherwegetaroundviaactiveorsedentary,pollutingornon-polluting modesoftravel—areaproductoftheseinvestmentanddevelopmentdecisions(seeTable1).Sincethe1950sourcountryhasprioritizedroadbuildingandtheprivateautowhenfundingtransportation,withproportionatelylittleinvestmentintransit,bicycleandpedestrianinfrastructure.
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TheU.S.is,therefore,acountryofdrivers–despiterecentdownwardtrendsindriving,over80percentofthecountry’sworkersdroveorrodeinacartoworkin2007,
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andin2008theaverageAmericandrovenearly10,000miles.InvestmentsinhighwaysandroadshaveclearlyprovidedtheU.S.anditsresidentswithbenefits–convenienceandcomfort,economicopportunities,accessandmobility–andahighdegreeofindependence.However,ourautodependentlifestyleshavealsoimpactedourhealthandourenvironmentinmanyways.Trafficcrashescauseover40,000deathsayear.Thirty-fivemillionpeoplelivewithin300feetofamajorroadway,andareathigherriskofrespiratoryillnessduetoexposuretotraffic-relatedairpollution.
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Aboutone-thirdofadultsareesti-matedtobeobese,andanotherthirdareoverweight,
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dueinparttosedentarylifestylesandthelackofoppor-tunityforeverydayphysicalactivity.Themobilitybenefitsofourcurrentinvestmentparadigmhavealsobeeninequitablydispersed—low-income,non-drivingandethnicminoritypopulationsarelesslikelytorealizethebenefitsfromroadinvestment,andoftensuffermoreoftheadverseimpacts.
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TotalhealthcarespendingintheU.S.isalreadyastronomical,andincreasingrapidly,withestimatedspendingof $2.4trillionin2008,$3.1trillionin2012,and$4.3trillionby2016.
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Thehealthimpactsoftrafficcrashes,airpollution,andphysicalinactivityaloneaddhundredsofbillionsofdollarsincosts—costsofhealthcare,lost
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TABLE 1
HOW TRANSPORTATION IMPACTS HEALTH AND EQUITY COSTS
THE HIDDEN HEALTH COSTS OF TRANSPORTATION
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