Health, Transportation, and the Power of Prevention: Reinventing Los Angeles for the Next Generation

L.A. in Motion, a series exploring transportation equity in Los Angeles, is produced in partnership with the California Endowment.
If Los Angeles is really in the process of reinventing itself, how will we make sure that the "Next Los Angeles" works for future generations of Angelenos? Our children and their children will be more racially and ethnically diverse than we are. How will they navigate rising economic inequalities? What tools will they have to deal with the impacts of climate change? Will their neighborhood conditions prevent them from getting sick and injured in the first place?

More and more, research confirms that the places where we live, learn, work, and play shape our health. According to the Robert Wood Johnson Foundation, "nearly one-fifth of all Americans live in unhealthy neighborhoods that are marked by limited job opportunities, low-quality housing, pollution, limited access to healthy food, and few opportunities for physical activity." People of color, low income people, and particularly African American children, are more likely than the rest of the population to live in unhealthy neighborhoods.

If the "Next Los Angeles" will be characterized by a fair, just transportation system, let's make sure health and safety concerns help guide where we invest our dollars. Transportation -- the way we walk, bike, ride and move between neighborhoods and whether we're able to do it conveniently, affordably and safely -- can have profound impacts on health. Transportation options have the power to enliven or isolate neighborhoods, and support or undercut the health of the people who call those neighborhoods home. Transportation affects health in a number of ways:

1. How we get around influences how much physical activity we are likely to get. Access to public transit can have major health benefits -- one in three transit riders gets their daily recommended level of physical activity just by walking to and from bus stops or rail stations.
2. The type of transportation that dominates our streets is associated with how much pollution we are exposed to.
3. The speed at which traffic moves and the design of our roadways and rail crossings are associated with fatalities and injuries to pedestrians, bicyclist, and motorists.

Another reason that people who, like us, spend their lives thinking about health believe transportation is so important is that our current health care system is not working as it should. Health care expenditures now account for 18 percent of our nation's gross domestic product, and the million dollar question -- or, rather, the $2.8 trillion question -- is: how are we going to bring health care costs down to levels that we can afford? Transportation could play an important role in reducing these costs. First, we've got to get a handle on diseases, injuries, and conditions that could have been prevented in the first place. A flexible, safe transportation system can help get more people out walking and biking as part of their daily commutes, and that is good for preventing a whole host of physical activity related illnesses, like type 2 diabetes and hypertension. A safe transportation system can also reduce costly and debilitating injuries, particularly for our most vulnerable road users: children and seniors. And now that hundreds of thousands of Angelenos have signed up for health care coverage through the Patient Protection and Affordable Care Act ("Obamacare"), accessible and affordable transportation options are vital to getting them to their providers for preventive services, well-child visits, and regular care.

Health equity means that every person has an opportunity to achieve optimal health regardless of the color of their skin, level of education, gender identity, sexual orientation, the job they have, the neighborhood they live in or whether or not they have a disability. Too frequently, though, transportation decisions and projects have diminished health and safety for some populations. Freeways that sliced up stable neighborhoods left some people dangerously close to pollution and in the wake of disinvestment. Public housing has been built along polluted roadways. Unmarked crosswalks, broken or no sidewalks and high-speed thoroughfares have put pedestrians and bicyclists at risk of injury or death. And while transportation planners, engineers and other decision-makers have embraced the need to think about safety, for the most part this has been to the benefit of drivers with the primary goal of moving cars efficiently.

But now that there's a multi-million dollar build-out of our transit system planned, we have an opportunity to elevate the transportation discussion to include our shared health, safety, economic and environmental goals. The Crenshaw community of South Los Angeles is a case in point. The area has seen more than its fair share of disinvestment over the years. The neighborhood has one of the highest proportions of Black residents in L.A., as well as a high number of low-income households relative to the city and county, and has often been overlooked in the past. But now that the Crenshaw area has become a focal point in L.A.'s transit expansion, including the new Metro Expo Line and the future Crenshaw Line, local residents are seeing signs of change.

The Crenshaw area exemplifies the notion of the "Next Los Angeles" and its investment in a more equitable transit system, but unless resident voices are heard loud and clear, achieving health and safety goals along the new rail lines are far from certain. That's part of the reason that area residents have banded together under the banner of Crenshaw Walks (an affiliate of L.A. Walks) to increase walking, biking and active transportation in the multi-cultural Crenshaw community and along the Crenshaw corridor. The Crenshaw Streetscape Plan(s), discussions about street trees for South L.A., and new development along the corridor will all impact whether residents can safely walk and bike in their neighborhoods, to school and work, or to their local businesses. Crenshaw Walks is organizing local residents to help articulate a shared vision and amplify neighborhood priorities in transportation decisions.

Thanks to the tremendous efforts of numerous resident groups, community based organizations and non-profits, as well as their governmental, academic, and philanthropic supporters, there seems to be growing recognition throughout the city and county that transportation and neighborhood conditions matter for Angelenos' health. Los Angeles is demonstrating its commitment to residents' health through some key transportation and planning decisions -- in the last several years alone, we've seen the establishment of a citywide Bicycle Plan, Model Design Manual for Living Streets, climate action plan, CicLAvia, and citywide Safe Routes to School Strategic Plan, as well as the opening of six new Metro rail lines by 2020. In perhaps its most ambitious healthy planning effort to date, the city is developing the Plan for a Healthy Los Angeles, L.A.'s first General Plan Health and Wellness Element, which drew heavily from the city's Health Atlas. We may be witnessing the birth of a culture of health within transportation decisions, and that would be a good thing for the "Next Los Angeles."

Healthier transportation options can make a world of difference for our economy and our planet, too. Not only can effective transportation planning and projects -- from building sidewalks and bike lanes in low-income neighborhoods to reducing congestion throughout the city -- help prevent injuries and activity-related chronic diseases, they can also decrease household transportation expenses, boost local business revenues, and cut greenhouse gas emissions. Here are just a few "transportation" ideas that could help Los Angeles realize a healthier, more equitable future:

1. Increase investment in active transportation modes (walking and bicycling) and public transit, in order to help make healthy choices easy choices. While L.A. County residents make nearly 20 percent of their daily trips on foot or bicycle, Metro dedicates just one percent of its funding to pedestrian and bicycle projects. City and county agencies should target investments in areas with high rates of pedestrian and cyclist injuries, and those with a high proportion of transit-dependent residents.
2. Prioritize health-promoting investments within transit-oriented developments and along key corridors. Ensure that people can access daily resources on foot, bicycle, or transit (including rail and bus). Affordable housing and childcare, urban green space and healthy food retailers, are just a few types of infrastructure that every neighborhood needs for a healthy future.
3. Strive to be more student-, senior- and family-friendly. The cost of transit can be prohibitive for L.A. families, seniors. and students, but if we take into account all of the health, economic. and environmental benefits of getting people to use public transportation, we can make a strong case for family passes, universal student passes. and subsidies for seniors. One way to keep transit affordable for everyone is to charge for automobile parking at rail stations rather than raising transit fares, as Metro has recently proposed.
4. Don't leave buses and bus-riders behind. Clean, low-emission buses offer flexibility that can't be matched by light rail. Investing in our bus system is also an equity issue, as people who ride the bus in L.A. tend to have lower household incomes and less access to automobiles than those who ride rail. More bus routes running more often and providing better connections to key destinations are all important goals for improving transportation equity.
5. Deal with the noise. Noise is a health concern because it is associated with psychological distress. Pedestrians and bicyclists endure a disproportionate burden of noise pollution generated by automobile traffic. Noise pollution is also particularly severe, inescapable, and unjust at stations along the Metro Blue and Green Lines, which sit in the middle of freeways and serve large populations of people of color and transit-dependent riders. Whenever possible, transportation decisions should prioritize minimizing and mitigating noise pollution.

We have within our power the ability to create a thriving region that offers prosperity and opportunities for our entire multicultural population, not just for some. Los Angeles is already a majority-minority county. A lot of U.S. counties won't reach that milestone for another 20 years or more. What we do here sparks the imagination of the rest of the nation. And while achieving a just, health-promoting transportation system won't solve all of our nation's health problems, it does offer real potential for reducing costly, preventable injuries, and illnesses. A healthy, equitable transportation system has the potential to save money and lives -- not just in L.A. but for the entire nation, and not just now, but for generations to come.