Table of Contents
II. Transportation and Health- Physical Activity, Safety, and Health Access
III. How to Screen for Transportation Issues
IV. How to Help Patients with Transportation Issues
V. About the Author
The relationship between transportation and health is multifaceted. How Americans transport themselves from place to place influences levels of physical activity and obesity rates. Mode of transportation itself is associated with safety risks such as motor vehicle or pedestrian accidents. Vehicle emissions effect environmental health, exacerbate respiratory illnesses, and expose people to carcinogens [v]. And of course, access to reliable transportation can facilitate or limit a person’s ability to get to a health provider [vii][x].
The percentage of school-age children nationwide that commute to school by walking or bicycling decreased nearly 70% percent from 1969 to 2001, while at the same time less than half of U.S. children meet recommended guidelines of daily physical activity [i]. Most Americans spend over $7000 per year (and often forgo paying for health insurance or other bills) in order meet the costs of maintaining a vehicle [iv]. For trips shorter than one mile, Americans walk and bike only 20% of the time [i].
Reversing these transportation-related trends represent major opportunities to improve health.
A. Physical Activity
C. Health Access
You can also review the collaborative report The Transportation Prescription from PolicyLink, Prevention Institute and the Convergence Partnership to find other ways in which transportation policies and plans can affect health outcomes. TRANSPORTATIONRX.pdf
To our knowledge, transportation screening has not been tested specifically in clinical settings. That said, there are existing survey items used by transit authorities and other social service providers that may be appropriate in clinical scenarios.
Consider asking your patients the following questions:
A. Discuss transportation safety:
For example, parental safety concerns about traffic limit biking and walking to school, but addressing these concerns through education increases walking or biking to school [i].
B. Connect patients to available resources:
C. Promote walking- this is the most practical way to achieve healthful levels of physical activity. [vi]
D. Offer home visits or visiting nurse services for elderly or disabled patients who may not be able to easily transport themselves to health centers.
Linda Sharp, MD is a physician at Harbor UCLA Medical Center in Los Angeles, CA. She is also a content editor for HealthBegins.
[i]. Robert Wood Johnson Foundation. Summer 2009. Active Transportation- Making the Link from Transportation to Physical Activity and Obesity.
[ii]. Lobstein T, Baur L, Uauy R. 2004. Obesity in Children and Young People: A Crisis in Public Health. Obesity Reviews, 5 (Suppl. 1)
[iii] Robert Wood Johnson Foundation Center to Prevent Childhood Obesity Toolkit: Keeping Kids Moving: How Equitable Transportation Policy Can Prevent Childhood Obesity Toolkit. (Accessed July 15th, 2012).
[iv] Jackson, RJ. 2003. The Impact of the Built Environment on Health- An Emerging Field. American Journal of Public Health. Vol 93, No. 9
[v]. Frank DL, Sallis JF, Conway TL, Chapman JE, Saelens BE, Bachman W. 2006. Many Pathways from Land Use to Health
Associations between Neighborhood Walkability and Active Transportation, Body Mass Index, and Air Quality. Journal of the American Planning Association, Vol. 72 No. I.
[vi]. Lee C, Vernez A. 2004. Physical Activity and Environment Research in the Health Field: Implications for Urban and Transportation Planning
Practice and Research. Journal of Planning Literature, Vol. 19, No. 2.
[vii]. 2005 “Barriers to Health Care for Children on Medical Assistance; A Case Study of Vietnamese and Chinese Speaking Families": https://www.pccy.org/index.php?page=HealthReports__113 (accessed July 15th, 2012)
[ix]. Litman T. 2003. Integrating Public Health Objectives in Transportation Decision-Making. American Journal of Health Promotion. Vol. 18, No. 1.
[x]. Rittner B, Kirk AB. 1995. Health care and public transportation use by poor and frail elderly people. Social Work, Vol 40(3); 365-373.
[xi]. Mattson, J. 2009. North Dakota Transportation Survey. http://www.ugpti.org/pubs/pdf/DP221.pdf