Towards Healthier Outcomes in Surface Transportation

The Environmental and Energy Study Institute (EESI), the American Public Health Association, and Transportation for America held a briefing about the public health implications of transportation policy. As Congress embarks on the surface transportation reauthorization process, policymakers have the opportunity to revisit federal policies and investments that also shape public health, prosperity, and climate outcomes.

This briefing explored the nexus of transportation, public health, and climate change. Panelists described potential negative health outcomes, stemming from issues like air pollution and road crashes. The briefing also provided policy, process, and funding solutions that weave public health considerations into the surface transportation reauthorization process in a way that benefits both people and climate.

Highlights

KEY TAKEAWAYS

The surface transportation reauthorization process is a unique opportunity to address the nexus of public health and critical infrastructure projects.
Health in All Policies is a framework that looks at how to change systems across sectors to promote health considerations. For example, it envisions creating cross-sector government structures, integrating health into planning processes like zoning updates, and including health in requests for funding and grant scoring criteria.
Smart surfaces—like natural storm water infrastructure, green roofs, permeable pavers, and porous concrete—are cost effective infrastructure strategies that manage urban heat and storm water, while maximizing public health, climate, and equity benefits.

Rep. Mark Takano, U.S. Representative (D-Calif.)

The surface transportation reauthorization process is a unique opportunity to address the nexus of public health and critical infrastructure projects.
Riverside, California, has experienced rapid economic growth in the last 13 years. With that growth has come increased pollution spurred by commercial traffic and vehicle emissions.
Poor air quality has led to more children with asthma and more elderly individuals with lung issues. Air pollution costs Riverside families over $4,000 on average each year in health care costs.
The House Future of Transportation Caucus addresses air pollution from the transportation sector and its climate change impacts to work towards a future with clean air.

Megan Latshaw, Associate Teaching Professor, Johns Hopkins University Department of Environmental Health and Engineering

In 2023, the top five causes of death in the United States were heart disease, cancer, unintentional injury, stroke, and lower respiratory disease. These are not the infectious diseases that public health often focuses on. These top causes of death, which are linked to transportation, would benefit from more public health focus and research.
Maps of obesity in the United States shows increasing rates of people who self-identify as obese from 2011 to 2022. Public health officials and experts seek to prevent chronic disease like obesity by looking at risk factors that include age, family history, diet, exercise, smoking, environmental factors, stress, and sleep. There are controllable factors like behavior and uncontrollable factors like genetics. Environmental factors also play a large role, and can be addressed to reduce obesity rates.
When society prioritizes convenience and speed, the healthier transportation choice is a harder choice. America is a car-centered society where people drive an average of 15,000 miles per year. Unintentional injuries, including motor vehicle accidents, are the leading cause of death in an American’s first 30 years of life.
Air pollution is linked to asthma, heart disease, cancer, and adverse birth outcomes. Cars contribute to this air pollution, and are often used instead of walking and cycling. In 1969, half of kids walked or biked to school, but in 2009, only 10% did. Limited physical activity contributes to $117 billion in health care costs every year. Only one in four adults and one in five high school students achieve the recommended activity level per day.
A public transportation study in Baltimore showed that public transportation would increase residents' access to jobs, schools, and communities. Currently, school buses in Baltimore that arrive seven minutes late to pick up students are considered on time. But if students take these buses, they are considered late for arriving at school seven minutes late.
Improving access to nature through public transportation positively impacts physical and mental health by reducing stress, improving sleep, reducing depression and anxiety, lowering diabetes, expediting post-surgical recovery, and increasing social interaction. A healthy community design prioritizes active and public transportation and makes the healthy choice the easy choice.

Keshia Pollack Porter, Bloomberg Centennial Chair and Professor, Johns Hopkins University Department of Health Policy and Management

Transportation, energy, housing, and education—and the decisions made in these sectors—all influence people’s health. Health equity means improving health for individuals regardless of zip code, income, or proximity to the closest city.
Underresourced communities have fewer opportunities for physical activity, increased risk of traffic crashes and fatalities, increased air pollution, and increased greenhouse gas emissions. Additionally, outdated policies often limit transportation options in these communities, with highways leading to “nowhere;” highways separating communities from areas with more resources; and very few sidewalks, bike lanes, and well-maintained highways.
Prevention, or addressing the root causes of problems, is more beneficial than reacting to problems after the fact. Engaging with communities to promote participation in offering solutions and garnering civic engagement builds accountability and makes health a cornerstone of projects.
Health in All Policies is a framework created by the American Public Health Association that looks at how to change systems across sectors to promote health considerations. It encourages decision-makers to think about equity and sustainability. For example, in Baltimore, the health department developed a Cross Agency Health Taskforce to reevaluate the approach to community policies and amplify cross-sectoral data.
Health in All Policies can include creating cross-sector government structures, integrating health into planning processes like zoning updates, and including health in requests for funding and grant scoring criteria.
Health Impact Assessments are a useful tool to help decision-makers consider how health will be impacted by different policies.
Legislative Health Notes are similar to fiscal notes, which analyze proposed bills to determine the cost of legislation, but instead assess how health is considered in the legislation. This tool is being used by state-level legislative transportation committees, education committees, and other committees where health is not always the priority.

Jacob Miller, Senior Project Manager, Smart Surfaces Coalition

Smart surfaces are cost-effective infrastructure strategies that manage urban heat and stormwater, while maximizing public health, climate, and equity benefits. Cool roofs and cool pavement coatings can help reduce the urban heat island effect by reflecting more solar energy out of the city.
Urban trees, natural stormwater infrastructure, and green roofs improve air and water quality, provide shade, and reduce flooding. Permeable pavers and porous concrete are stormwater management options that help reduce flooding where paving is necessary. Solar panels and low-carbon concrete are also smart surfaces under the framework of the Smart Surfaces Coalition.
With smarter surfaces, cities reduce their energy consumption and become more livable, healthier, cooler, and safer.
In Washington, D.C., the city has retrofitted intersections with green stormwater infrastructure. This is expected to save the city up to $7 for every dollar spent on the project. In Los Angeles, California, the city is using solar reflective pavement coating that reduces pavement and air temperature, benefits pedestrians, and reduces pavement cracking. These reflective paints can also be used in areas that already get painted, like bus lanes. In Boston, Massachusetts, the city is putting green roofs on bus shelters.
These strategies are effective in isolation but can also be used together to amplify results. Meteorological modeling conducted with Altostratus, Inc., shows that, when used together, reflective surfaces such as tree canopies, cool roofs, and cool roads can reduce urban temperatures by up to 7.5°F on a hot summer day in Dallas, Texas.
Cities for Smart Surfaces is a technical assistance program launched in 2023 that helps cities and communities with grant applications, policy implementation, and goal development. Ten cities are already part of the program. In Boston, a new design standard requires that all curb extensions use green infrastructure alternatives (e.g., rain gardens, bioswales, tree trenches, porous paving) in place of impervious materials.
The Cool Roadways Partnership of 25 cities shares progress and techniques for cool pavements, and the Peer Learning Network of over 60 cities shares lessons and resources from the Cities for Smart Surfaces program.

Benito Pérez, Policy Director, Transportation For America

As Congress considers the next surface transportation reauthorization, a main question is, who is transportation for?
Transportation planning must be reframed with a people-first mindset, recognizing the needs of aging adults, people with disabilities, and marginalized communities, instead of treating the public as a monolithic group.
Since the 1991 Intermodal Surface Transportation Efficiency Act (P.L. 102-240), the United States has invested $1.5 trillion in surface transportation, yet key goals like safety, reliability, congestion relief, environmental sustainability, and economic vitality remain unmet. In fact, roadway congestion and fatalities are worsening and system reliability is declining. States often have ineffective or inconsistent performance metrics and there are limited accountability mechanisms.
The Infrastructure Investment and Jobs Act (IIJA) (P.L. 117-58) increased local funding access and launched new programs like Safe Streets and Roads for All, the Carbon Reduction Program, and the Reconnecting Communities Pilot Program, yet some investments have led to increased greenhouse gas emissions, challenging the law’s climate-positive framing.
The U.S. Department of Transportation has adopted a safe system approach and made updates to the Manual on Uniform Traffic Control Devices to move in the direction of being more “people focused.” But these outputs remain guidance-based and shaped by a car-centric culture.
The scale of IIJA funding has overwhelmed the capacity of local, state, and federal partners, exposing a disconnect between federal transportation policy and actual outcomes. Future transportation planning must integrate health, enhance local access to funding, and embrace behavior change initiatives.
There is a need to address outdated concepts like “value of time”, which translates travel time into monetary value and therefore discourages investment in forms of travel that can take longer (i.e., walking, biking, and public transit).
The surface transportation reauthorization presents an opportunity to embed stronger equity and safety language and prevent negative safety targets.

Q&A

How can transportation and infrastructure-focused Congressional staff incorporate health considerations into what their bosses are working on?

Latshaw

Johns Hopkins’s Bloomberg American Health Initiative allows people from all sectors, but especially those who work with the built environment, to earn a Master’s degree in Public Health at no cost.
A federal interagency working group that brings together the different agencies at the intersection of health and transportation would help with coordination.
Some states require Health Impact Assessments before a project is carried out. This could also be done at the federal level to assess how proposed projects would impact public health. Importantly, these assessments could include analysis of cumulative health impacts.

Pollack Porter

Education and opportunities for training and capacity building is key.
Gathering people from a variety of backgrounds is also critical to promoting human and environmental health in community planning efforts.

Miller

The transportation sector would benefit from comprehensive, comparative analysis of different smart surfaces to make sure solutions are implemented effectively.

Pérez

The topics covered today span multiple federal agencies and Congressional committee jurisdictions. This can lead to inefficiencies and disjointed efforts. It is important to find ways to work across these boundaries in the federal government to make things easier for practitioners on the ground.

What are your thoughts on high-speed rail initiatives in terms of health, environment, and economic benefits as well as community separation, displacement, and gentrification?

Pérez

Conventional rail, which we have in the United States, as well as high-speed rail provide connectivity to jobs and health care.
For the next surface transportation bill reauthorization, it is important to look at the existing train system and how it can be strengthened, so that it can be enhanced to high-speed rail in the future.
Some parts of the country still have intermittent passenger rail service. Focusing on the foundational system first is important because it provides a lifeline for many communities.
Transportation for America is working with the Gulf Coast region to open new Amtrak services.

Latshaw

Rail gets people out of cars, makes people more social, and reduces air pollution and greenhouse gases.
Data is important to inform decision-making, including data on accessibility, the number of people who live within a certain distance of a train station, and how long it takes people to get where they need to go.

Pollack Porter

Different agencies might collect different types of data, so that is another opportunity for interagency collaboration.

With the recent reorganization happening within federal agencies, do you foresee potential impacts on collaboration, specifically in the public health and transportation sectors and in the work to advance health equity?

Pérez

An example that is of concern to Transportation for America is car crash and health data. A National Highway Traffic Safety Administration memo recently said that the 2023 car crash data will be finalized in 2026 and preliminary 2024 data will be released then as well. That is a 24- to 30-month lapse. The lag of data collection and analysis is only going to get longer as federal agency staff are removed. Without this data, states have to make decisions without updated information.

Pollack Porter

There are also concerns about health data more broadly—how are we going to get this data going forward and who is monitoring the data? It might be harder to get data looking ahead.

Where are you meeting resistance to the message of prioritizing people over cars, and how are you addressing it?

Latshaw

Cars are convenient and part of American culture. If we are going to shift to active transportation, it is going to have to be a cultural change, which is why we need to change the environment to make the active choice the easier choice.

Miller

Looking at the city level, one of the challenges is that the economic benefits of implementing a smart surface solution could be spread across a number of different departments and so the overall financial savings go unnoticed. It is harder to see that a single investment can help everyone achieve their goals more cost effectively. Conversations between departments must happen in an integrated way.

Pérez

At the federal level, many Congressional offices do not know how federal transportation dollars are being spent. This is because although states are required to deliver a State Transportation Improvement Program, they are written differently in each state, making it difficult to aggregate information and understand what is happening across the whole country.

Pollack Porter

Many people own cars because they cannot reliably access everyday goods and services via their local public transportation.
Housing affordability is also a relevant issue in terms of where people end up living based on transportation accessibility.

How do you communicate the benefits of active transportation and sustainable infrastructure so that people who live in a particular city appreciate where the solution came from and what it entails?

Miller

CAPA Strategies runs a community science campaign where residents measure the temperature of their neighborhood. This way people can see firsthand how the built environment is influencing urban temperature. Community members are experiencing the story and telling the story themselves.

Pollack Porter

Telling the story is a critical point, and considering what narrative is being told. We can all do better to tell those stories and connect with community members, sharing their stories to build that dominant narrative.

Pérez

The key is communicating information in clear, simple, and relatable ways, meeting people where they are.

With the Legislative Health Notes project, how do you score bills for health impacts, and does that method apply to scoring federal legislation as well?

Pollack Porter

The methodology is a rapid literature review looking at how the bill will impact health. They pull local data into the health notes to make the review context specific. If there is cost data available, that is included in the analysis.
Each note describes how likely a bill is to lead to particular health outcomes. The narrative summaries of the reports are posted online.
The same methodology can be used on federal legislation.

What counts as access to nature when it comes to deriving health benefits?

Latshaw

Different studies define nature differently.
One study found that if patients could see green space from their hospital bed, they had faster recovery times.
Other studies look at the amount of time that people spend walking through nature.
The Trust for Public Land does work on this topic.
The National Aeronautics and Space Administration and the National Oceanic and Atmospheric Administration both collect data that can be used to measure green space.

Pérez