The Federal Transportation Bill Is a Health Care Bill

Dr. Richard J. Jackson is Professor and Chair of Environmental Health Science in the UCLA School of Public Health.

On February 23, Senator Barbara Boxer and Representative John Mica held a congressional hearing here in Los Angeles to discuss the federal transportation bill. The dominant theme of the hearing was expanding and establishing federal financing programs to provide capital for major infrastructure projects such as Los Angeles's 30/10 plan, an initiative to build 12 major transit projects in 10 years. The elected leaders and assembled experts lauded the proposed programs for their potential to rapidly stimulate job creation and economic growth. Very little was mentioned, however, about the need for transportation investments to also be guided by other objectives, such as reducing air pollution, investing in biking and walking networks, and improving safety – all critical elements for improving the economy and public health. Transportation has immense impacts on human health, both positive and negative. Current policies fail to consider and value these impacts, but they must.

Traditionally, federal transportation funds have been given to states according to formula and with little accountability for how they are used. In Los Angeles the results are staggering. The annual health impacts from air pollution in our region alone are conservatively estimated at $22 billion, or $1,250 per person per year. Also, while pedestrians or cyclists account for 12 percent of all trips, they suffer 25 percent of all traffic fatalities. And as we have become more dependent on cars as a way to get to our jobs, to the store, to our doctors’ offices, and to every place else, our physical activity has declined, and coronary heart disease has become the number one killer of LA County residents.

To the credit of many public health leaders, elected officials, local policymakers, and engaged citizens, cities throughout the region are investing in biking and walking infrastructure to address these issues, revitalize local economies, and increase the effectiveness of transit systems. Planners in numerous cities -- including Pasadena, Long Beach, Culver City, Glendale, Santa Monica, and Los Angeles -- are setting strategic long-term goals and formulating plans to expand biking and walking networks, make them safer, and integrate them into existing and future public transit networks.

California is moving forward with its SB 375 law to reduce emissions by focusing on the communities we build and the types of transportation we use. This landmark law has initiated a process where planners, regulators, and the public have come together to set long-term goals and plan to achieve them. One purpose of this law is to comprehensively evaluate how different projects -- including public transit, bicycle and pedestrian infrastructure, car-pool lanes, and roads -- contribute collectively to achieving these goals.

But federal transportation bills have not set these strategic goals. As a result, despite continuous increases in federal funding, public health has not been a major factor as transportation projects are selected. Los Angeles, for example, has seen its air quality improve significantly but not as a result of more public transportation or communities where people can bike and walk safely and efficiently, but rather because cars are cleaner. At the same time, sprawl has continued to increase to a point where, in Los Angeles alone, we spend 490 million hours annually stuck in traffic. The combined weight of the health impacts from air pollution, traffic accidents, and lack of physical activity along with the costs of wasted fuel and time is a collective drag on our health and economy.

To address these issues, our next federal transportation bill should contain long-term goals, measure progress toward achieving them, and provide the funding needed to do so. Such goals should include measuring whether infrastructure investments contribute towards achieving needed public health improvements, such as: improving air quality to healthy levels; improving traffic safety for all users regardless of whether they walk, ride, or bike; increasing biking and walking trips; and improving and expanding public transit, as well as fixing the infrastructure we have.

During the worst and most prolonged economic downturn in many decades, it is critical for the health of our economy and our public health that we get the most bang for every transportation dollar we have available. As Senator Boxer and Representative Mica return to Washington to write the next federal transportation bill, we ask them to focus on a bill that will set these goals and provide funding to build the projects needed to achieve them.

Dr. Richard J. Jackson is Professor and Chair of Environmental Health Science in the UCLA School of Public Health. He has done extensive work on the impact of the environment on health, particularly relating to children.

Jackson chaired the American Academy of Pediatrics Committee on Environmental Health. He has served many leadership positions in both environmental health and infectious diseases with the California Health Department, including the highest State Health Officer. For nine years, he was director of the CDC's National Center for Environmental Health in Atlanta, and received the Presidential Distinguished Service ward. He co-authored Urban Sprawl and Public Health, published in 2004. Over the past decade much of his work has focused on how the built environment affects health. He recently served on the Board of Directors of the American Institute of Architects and has written and spoken extensively on the above areas.

Jackson holds an MD from the University of California, San Francisco and an MPH from the University of California, Berkeley.