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Public Transportation as Public Health Policy

Posted on March 30, 2021
empty subway car

By Ana V. Diez Roux, MD, PhD, MPH

A recent article in The New York Times highlighted the dramatic impact that the pandemic has had on the use of public transportation in a few cities across the globe. As one would expect, the use of public transportation dropped dramatically about this time last year when the lockdowns began. This is not surprising and is the result of the abrupt slowdown in economic activities. What the data also show is that in many cities reopening was not associated with the expected increases in the use of public transportation. There are some marked differences across cities: in Shanghai for example, use has returned to (and even exceeds) prior levels. But in New York City, London, Rio de Janeiro, and several other cities ridership remains far below earlier levels.

The lack of return to earlier levels may simply be because reopening has not fully occurred. It is possible that remote and flexible work arrangements will remain with us at least to some extent, reducing the need for commutes. But other worrisome trends suggest that the public may be moving away from public transportation. The rich are leaving cities for the suburbs. The sale of used cars has increased and perceptions of public transport as unsafe and undesirable abound.

In many countries, public transportation is perceived to be primarily for the poor. The wealthy drive their cars while the poor often travel for hours each day in what are frequently crowded and hazardous conditions, clinging to buses, packed into trains, or even piled into the backs of trucks. In a perversely unfair and unequal system, the rich travel on ever-expanding subsidized highways developed and maintained by government taxes, while the poor pay a significant part of their own way. And to make matters even worse, as more people commute by private vehicle (often one person to each car) the buses they share the road with travel slower and slower condemning their riders to an even longer commute and forcing any who can afford it to purchase their own cars. As public transportation use declines, fare revenue drops leading to cuts in services further reinforcing loss of ridership and further affecting what are already deficient and fragile systems.

The lack of robust public transportation systems has dramatic consequences for our health, our planet, and for social inequality. Automobiles are a major source of air pollution and greenhouse gas emissions. A dependence on automobile transportation is linked to more traffic-related injuries and deaths and less physical activity. Long commutes have even been linked to poor mental health. Lack of access to transportation affects access to jobs and services like healthcare. Given all this, there is something highly irrational and also unfair about a system in which each of us travels in his or her own private vehicle. Surely there is a better way to organize how we move around.

The decline of public transportation would be a terrible consequence of the pandemic, with many long-term adverse implications. But it does not have to be that way. In fact, the post-pandemic can create opportunities to build and expand public transportations systems that are efficient and safe through strategies that reduce overcrowding, increase ventilation, promote more frequent service, and incentivize use while disincentivizing the use of private vehicles. Developing and sustaining public transportation systems is perhaps one of the most impactful policies we can implement to promote health and environmental sustainability. It has major implications for promoting social and health equity through access to jobs and services and through the effects that public transportation (and reduced automobile traffic) can have on the physical and social environments of neighborhoods.

Now is the time to think outside the box and not return endlessly to our old systems and models. Imagine a system where public transportation is convenient, efficient, safe, and, yes, even free to the user. Examples of such systems are beginning to emerge and many are thinking about how the pandemic can create opportunities to rethink how we organize mobility in cities. It will be difficult and will take time. But the first step is to let ourselves imagine something different. Promoting our health, equity, and our environment demands it.