by Rich Wolferz, MD
Public health promotes beneficial behaviors among individuals and communities to prevent disease and improve health. Public transit helps people commute from one place to another. I know what you are saying, policy to ban smoking indoors and a city bus are not the same thing. Before you hop in your car to drive two blocks down the road the grocery store, let me explain.
Public transit is more than just city buses, trolleybuses, trams (or light rail) and passenger trains, rapid transit (metro/subway/underground, etc.) and ferries; taking a broader context, it also includes transit oriented development (DOT) – land use patterns designed to support equitable and accessible transit opportunities. Think of communities surrounding transit stations; compact and walkable with employment, food, entertainment, healthcare destinations within reach by walking, biking, bus, train, or less likely driving. Now I hope with this broader definition you are beginning to see the opportunity public transit may have in our health.
The built environment often dictates behaviors and has a significant impact on quality of life. Those living in a community designed around safe pedestrian infrastructure are much more likely to walk to destinations. For Americans, this means a significant increase in their daily physical activity compared to those living in communities that require a car to access anything outside of their driveway. (Various policy and infrastructure decisions starting in the 1920s have created the car-centric America we know today; fortunately for you, I do not have the space today to delve into this rant); unfortunately for us all, our communities make it difficult for us to travel anywhere without driving.
Back to public health: The Department of Health and Human Services publishes public health targets each decade, the most recent being Healthy People 2030 benchmarks. These focus on all aspects of health for Americans – specific conditions like diabetes to behaviors like tobacco use to social determinants of health. What if I told you there are specific objectives mentioning public transit and commuting behaviors for Americans? That’s right, I am not the only one out here on a soapbox about how walking to the bus stop can improve the health of our communities. Specifically, physical activity objectives (PA-10 and PA-11) include increasing the proportion of adults and adolescents who walk or bike to get places – current rates are 22.5% and 39.8%, respectively. Neighborhoods and environment objectives complete the intersection with the goal to increase trips to work made by mass transit (EH-02) – current rate a measly 5%.
Okay, so less than a quarter of Americans walk anywhere and nearly no-one takes public transit, obviously they are all just driving to the gym and crushing the recommendations for physical activity so no one needs to do any walking, right? No. Most recent data from CDC found nearly half of Americans do not meet the minimum recommended weekly physical activity.
Increasing the number of Americans who meet physical activity guidelines is not just about checking some box on a government report but has significant impact on morbidity and mortality of the population. Being more physically active is associated with reductions in heart disease, stroke, diabetes, breast cancer, colon cancer, obesity, and more. Lucky for us all, much of the risk reduction is achieved in the first steps; going from zero to even a little physical activity each day offers the significant impacts. For most Americans this would be the difference of traveling by foot or bike even for a handful of trips each week. (For the data-oriented and philomaths, walking 30-60 minutes each day would be about 15 MET-hours/week which has been associated with a 20% reduction in ischemic heart disease and stroke).
Those most effected by chronic disease are often also those who have the least opportunity for leisure time physical activity (living below the poverty line, working multiple jobs, etc); which is why many experts consider walking and cycling commutes one of the most practical ways to increase public fitness and health. Even if walking or cycling are not practical to complete the whole trip (imagine a mother in the West Valley working as a nurse in Salt Lake City), most transit trips include walking or cycling to complete their door-to-door commute (walking from home to the Trax stop and then from the station to the hospital). This is underlined by studies finding that transit riders are more likely to walk daily and have a great average daily walking distance than non-transit users; upwards of three times as much walking as those who rely on an automobile.
Alright, so we learned that public transit and built environment in communities can lead to great amounts of physical activity and that even pedestrian amounts of physical activity can have an impact on our health, now what? Well, I want to encourage you to try this yourself – take the bus to work or try walking to your next errand. Maybe this will be very simple and you will have a new option for when you don’t want to scrape off your car after the next snow storm or this will be terribly inconvenient and you might ask, how did we get a world where I can’t even get to the grocery store without personal vehicle requiring costly gas, insurance, registration, and a state-issued license to operate? Ultimately, think about how transportation impacts the lives our patients live and how rethinking our current built environment and access to public transit could drastically improve their opportunity for healthy behaviors.
(Of note, I did not address how public transit can increase access to health care for under-resourced individuals – elderly, adolescents, immigrants, chronically ill, impoverished – or how commuting by foot or bike is associated with happiness and life satisfaction, or pedestrian deaths due to car infrastructure, or impact of air and noise pollution, the list goes on. If you are interested in any of these topics, please reach out and I am happy to meet up to talk or write more.)
Dr. Wolferz is from Asbury, New Jersey. He completed his undergraduate degree in biology and neurobiology at the University of Connecticut. After a year volunteering and working in a community hospital, he completed a medical degree at Rutgers New Jersey Medical School in Newark, NJ. His medical interests include plant-based nutrition, exercise as medicine, public health, and community outreach. When outside the clinic, he enjoys marathon running, hiking, and cooking for friends and family. He chose the University of Utah for its distinctive blend of community and university clinical training with extensive academic opportunities situated in the outdoor-adventure capital of the country.