Transportation as a Health Concern: How Technology Can Help

During a recent stay in an unfamiliar city, I found myself booked at a hotel that did not offer food service. When I asked about local options at the front desk, the employee informed me that it would be a 20–30 minute walk to get to the nearest grocery store, and that the most direct route would require crossing over a major highway. As I set out on foot in search of a meal, I realized that a resident without a car, or one who does not drive due to preference, age, or disability, or even one without the capacity to walk long distances, would have little option but to eat at the handful of fast food restaurants nearby or survive on snack foods from the neighborhood convenience store. I was in what the USDA would label a “food desert,” an area where the population has limited access to a variety of healthy and affordable food. ¹

A recent study revealed that nearly 39.5 million people in the United States were living in such an area several years ago. ² It stands to reason that this number has only increased, both within the United States and around the world, especially with the pandemic forcing many businesses to either adapt to new ways of delivering goods to consumers or to close altogether.

There are many factors that contribute to an area becoming a food desert, including dwindling populations and shuttering businesses. Areas of food scarcity often have higher rates of abandoned or vacant homes and residents with lower incomes and lower levels of education. ¹ Food deserts disproportionately impact multiracial and minority communities, regardless of income level. It can be argued, however, that one of the most significant contributing factors to a lack of access to healthy food is the absence of a convenient and safe public transit system.

Transportation and access to mass transit is often viewed as an economic issue. After all, areas that have more to spend on infrastructure tend to have better public transportation options—which is why low-income areas are more severely impacted by phenomena like food deserts. In light of this, I would like to propose that transportation is actually a significant health care issue above all else.

Of course, the most obvious connection between transportation and public health relates to physical safety. Between January and June of 2020, almost 19,000 Americans were killed as a result of motor vehicle accidents. ³ Despite the fact that many fewer people were driving due to the pandemic and shelter-at-home orders, these numbers put 2020 on track to be the deadliest year for motor vehicle accidents in more than a decade. There is no question that driving, as it exists today, puts people at risk for injury and death.

But the connection between transportation and health goes far beyond the physical risk of car accidents. Transportation can be a significant metric of a population's overall health. It directly shapes both social and physical environments and determines how and where people live their everyday lives. ⁴ Transport systems affect environmental health (including the actual and perceived safety of its users), behavioral health (providing access to necessities, physical activity, and nature), and social inclusion (through promoting community connection). ⁴ While this means that safe, affordable, and convenient public transportation systems can significantly benefit the local population, it also means that poor or absent mass transit can be a danger to residents' health.

Even prior to COVID, mobility issues were common in both rural and urban environments. Many city transit systems were incomplete or in disrepair, causing its residents to either use cars, risk their health on an unsafe journey, or to miss out on accessing vital resources. Outside of urban areas, public transit offerings were often paltry, forcing the population to either brave dangerous roadways, navigate a flawed system of buses and trains, or to forego the trip altogether. For a while, fewer people were leaving home, so transportation became less of a concern.

Yet, public mobility is again at the forefront as many return to the office, long-distance travel, and social gatherings. Unfortunately, transit has improved little since 2020. Not only are the same barriers in place for those who were struggling with mobility before, but there are also those who have newly-developed physical and mental limitations and considerations. Recent statistics show that many individuals are experiencing increased stress due to things like unstable economic circumstances, heightened social stressors, and health anxiety. This rise in stress has contributed to an upsurge of incidents involving impaired driving (drugs, alcohol), ⁵ distracted driving (mobile phones, texting), ⁶ and road rage. ⁷

The pandemic has also created more people with special transportation considerations. For example, there are those struggling with new ailments caused by exposure to COVID-19, including those who may have difficulty walking or biking a significant distance, and those who are struggling with cognitive issues that make it unsafe for them to drive. In addition, many drivers who already felt anxious about driving prior to the pandemic (whether due to panic disorder, agoraphobia, traumatic brain injury, or PTSD following a car accident) have experienced a skill decrement from remaining at home without the incentive to drive. These same people are now being asked to go back to the office, and many feel ill-equipped to deal with the harrowing commute.

These difficulties can interfere with all aspects of life, from work, to socializing, to travel. While many cities are to be commended for providing wheelchair-accessible transportation services (even if wait times are often excessive and solutions inconvenient) these same adaptations do not necessarily extend to those who are neurodiverse or experiencing mental health issues.

Fortunately, we are beginning to see the glimmers of innovative transportation improvements, and many of these have come about due to the advancement of technology. For instance, several cities in Europe have labeled themselves as “smart cities” in which infrastructure and technology are combined to help connect people with essential services, enhancing quality of life and improving economic opportunities.

Case in point: Barcelona has constructed a network of fiber optics throughout the city, providing free high-speed Wi-Fi for its residents. Incredibly, in doing so, the city saved €75 million of city funds and created 47,000 new jobs. ⁸ Amsterdam, too, uses technology to monitor traffic flow, energy usage, and public safety, making adjustments to systems based on real-time data. ⁹ Several cities worldwide are now using sensors and cameras to track both vehicle and pedestrian traffic, allowing officials to identify bottlenecks and make changes to traffic patterns, reducing congestion and pollution.

But the solutions do not all have to be so technologically complex. The navigation and GPS apps pre-loaded on many smartphones can help to make cities safer and easily walkable, and ridesharing apps like Uber and Lyft were created to deliver transportation to all. In fact, one of Lyft's taglines is “The Whole City. In the Palm of Your Hand.” Technology has also made it easier to find information about public transportation options. There are now apps and websites that work to help people plan their trips ahead of time, including routes and schedules, and even allows for the seamless payment of fares.

When it is necessary to use a personal vehicle, technology can help make driving safer and less stressful as well. While we are still a fair distance from safe and affordable fully autonomous vehicles, many cars now have driver assistance features like back-up cameras, collision avoidance, and can even help with parallel parking. Most newer cars are also compatible with hands-free technology systems (like Android Auto or Apple CarPlay) to help reduce driver distraction. These technologies help make the road safer and reduce anxiety for all.

Technology also has a significant role to play in training both new and anxious drivers. Virtual reality (VR) has been successfully used as a part of exposure therapy to help treat those with PTSD and other types of driving anxiety. ¹⁰ It can also be used to assist with mindfulness and biofeedback techniques that help drivers remain calm in stressful situations. ¹¹ VR can also provide training for new drivers by allowing them to safely practice responding to dangerous situations they may encounter on the road. ¹² Just as VR can be used to train first responders to handle stressors before they occur, it can also help train novice drivers to deal with stressful experiences before they get behind the wheel of a real car.

It is easy to get wrapped up in the excitement of technological innovation. No doubt, these apps and rideshare systems will increase productivity and help bolster the economy in uncertain times. Yet, it is also important to remember that efficient transportation is essential for both the mental and physical health of our population. An effective marriage of technology and transportation will lead to a community that is safe, sustainable and interconnected. A successful transportation system needs to be affordable, reliable, and accessible for all people. Because, while transportation is about getting people from Point A to Point B, it is that first part, the “people” part, that is most important.