A Clinician’s Guide to Addressing Transportation Issues

Table of Contents

I. Background
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
VI. References


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.

II.Transportation and Health- Physical Activity, Safety, and Health Access

A. Physical Activity

  • Walking and biking can reduce obesity, hypertension, type 2 diabetes, sleep apnea, and other illnesses [ii];
  • People who live in more “walkable” neighborhoods have lower BMIs, drive less, and produce less air pollution than those in less walkable neighborhoods [v];
  • People who use public transportation are less likely to be obese/sedentary; reliance on cars for travel is associated with higher obesity [i].

B. Safety

  • Improving transportation safety prevents injuries and premature death [ix].
  • Improved safety and infrastructure of the built environment creates opportunities for physical activity, especially in children and the elderly (link here after Build Environment link uploaded) [iv]

C. Health Access

  • Low-income and immigrant community members often report difficulty making it to health care visits due to transportation issues, and may not be aware of or use available transportation resources [vii];
  • Lack of available, affordable transportation for the low-income elderly increases social isolation and limits ability to access health services [x].

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

III.How To Screen for Transportation Issues

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:

  • Do you use public transportation?
  • How informed are you about public transportation options in your community? [xi]
  • Do you walk or bike 2 or more times per week?
  • Do you ever have trouble paying for your transportation (tickets, gas)?
  • Is transportation a limiting factor for you in making it to health appointments, or to pick up prescriptions, food or other health-related supplies?

IV.How to Help Patients with Transportation Issues

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].

  • Give parents and children handouts on pedestrian and bicycle safety;
  • Screen for seatbelt use in your clinic and remind patients about safe driving practices, including weather and substance precautions;
  • For elderly patients who drive, encourage annual vision screenings.

B. Connect patients to available resources:

  • Learn where safe walking and biking trails are locally available, and distribute this information in your clinic;
  • Encourage the use of public transportation when these are safe options for your patients;
  • Team up with social workers or case managers to help patients get connected with low-cost or free transportation services. Some of these are available through Medicaid or other social services for patients with chronic diseases, particularly, but may require separate application processes. [vii]

C. Promote walking- this is the most practical way to achieve healthful levels of physical activity. [vi]

  • Encourage patients to be mindful of safe surroundings, hydrate, wear safe walking shoes/clothes.

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. 

V.About the Author

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




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