Accessibility is one of the fundamental goals of transportation. Access can be increased by making destinations seem proximate by increasing awareness or by providing convenient and affordable transportation. The quality of life in a community changes significantly with the types of employment opportunities, services and amenities, educational institutions, and leisure activities that individuals are able to access. Affordable transportation options allow more of the household budget to be spent on medical care or healthy food.
Communities are rarely monolithic. Differential access to health care, healthy food, parks and recreational facilities, etc., are all factors that contribute to differential morbidity and mortality rates for various socioeconomic groups within a community, including races, ages, sexes, physical abilities, and geographic locations. Transportation policies, programs, and infrastructure play a major role in providing equitable access or increasing access for everyone.
Access to health care
A 2005 study (Wallace, et al.) showed that about 3.6 million individuals missed at least one medical trip over the course of 1 year because of transportation barriers. Compared with the rest of the U.S. population, this population had a higher prevalence of every medical condition that was examined as well as other diseases discovered while under examination. Severity of the disease was also higher. This population had the following common characteristics as compared to those who did not miss care owing to a lack of non-emergency medical transportation (NEMT):
- Poorer (55 percent have household incomes below $20,000 per year versus 18 percent for those who did not miss care owing to a lack of NEMT)
- Older (16 percent age 70 or older versus 11 percent)
- Disproportionately female (66 percent versus 52 percent)
- Made up of fewer whites (65 percent versus 81 percent)
- Roughly half as likely to have a 4-year college degree
Numerous studies have shown that transportation barriers have resulted in a lack of care for chronic diseases. A study by Conover and Whetten-Goldstein found that 16.7% of AIDS and HIV patients reported difficulties in obtaining transportation and as a result were much less likely to have a primary care physician or to obtain regular care. Other studies have shown that patients with asthma entering the emergency room were much less likely to obtain follow-up care if they did not have access to transportation.
The potential effects of missed visits for preventive care included under-immunization, difficulties in administering screening programs, failure to attend pediatric checkups, and lack of prenatal care for women. Diabetes patients who missed more than 30% of scheduled appointments experienced worse health outcomes than those who attended more often.
Proper disease management and preventative care has the potential to both reduce healthcare expenditures in the long term and improve the health of the patients. Most of this monitoring depends on a high number of routine physician visits, thus transportation plays a critical role in ensuring appropriate care.
The above study by Wallace, et al. also identified that children lacking transportation were more concentrated in urban areas. The Access to Health-Related Goods and Services chapter in a VTPI study identified a survey finding that 4 percent of children (3.2 million) either missed a scheduled health care visit, or did not schedule a visit, during the preceding year because of transportation restrictions.
Access to Jobs
A 2004 paper that examined the relationship between income inequality and health stated that income poverty is a risk factor for premature mortality and increased morbidity (see chart below) and there is a reverse pathway as well, from poor health status to persistent poverty and poorer economic growth. However, it is difficult to isolate the effects of individual income (and income poverty) from the contextual effects of income inequality. Other things being equal, a population with more egalitarian distribution of income is predicted to have better health than another with the same average income but greater income inequality. Education is closely related to types of jobs and an individual’s income. Education could be a better indicator for social factors related to health than income.
Access to Healthy Food
Transportation options play an important role in a community’s access to healthy food choices. Areas where healthy food is not readily available are called “food deserts”, where residents have few options to purchase healthy food. Transportation from food deserts to stores that provide healthy food choices can play an important role in improving health outcomes for residents in these communities. While transportation options to healthy food providers do not guarantee that all residents will choose to purchase healthy food, the lack of transportation to such providers hinders healthy choices.
In 2009, the US Department of Agriculture’s Economic Research Service (ERS) reported that 23.5 million Americans live in low-income areas that are more than one mile from a supermarket. For individuals and families without access to a car or direct transportation to supermarkets, getting to such stores, and therefore to healthy food options, is a barrier to making healthy food choices.
The USDA ERS has developed two mapping tools that display data about access to healthy food:
- The Food Access Research Atlas presents a spatial overview of food access indicators for low-income and other census tracts using different measures of supermarket accessibility. Food access data can be downloaded for community planning or research purposes.
- The Food Environment Atlas assembles statistics on food environment indicators to stimulate research on the determinants of food choices and diet quality, and to provide a spatial overview of a community’s ability to access healthy food and its success in doing so.
This map identifies the food deserts of Washington D.C. region relative to the low income areas. The majority of Arlington County appears to have easy access to supermarkets. It is important to note that the combination of the presence of healthy food and transportation options provide access to healthy food. While some higher-income residential areas may fall outside the one-mile radius to a supermarket, residents have access to private vehicles and may not be deprived of healthy food choices. Conversely, while there are numerous affordable housing units within the Metrorail corridors of Arlington, individuals may not be able to take advantage of the healthy food options accessible from these locations. Access can be evaluated through area-based or individual-based measures.
The concentration of fast food outlets and convenience stores has been correlated to obesity in the community. The availability of healthy foods, and a person’s decision or ability to choose healthy foods over unhealthy alternatives contributes to health outcomes. Providing transportation to healthy food providers broadens the range of food options available to consumers, allowing them the ability to make better choices.
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