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Mechanisms for Advancing Health EquityNeighborhood and Built EnvironmentEnvironment, Climate and Health

Policies to Advance Mass Transit as a Driving Force for Health Equity

July 9, 2024


The absence of reliable mass transit in the United States disproportionately harms people of color, particularly Black adults, in addition to women, low-income workers, people with disabilities, and those living at the intersections of these identities. Recently announced Federal funding from the Federal Transit administration, along with regional initiatives, offer hope for a renewed commitment to addressing these disparities.

On June 6, 2024, Detroit’s own Diana Ross kicked off the reopening celebration for the Michigan Central Station, once one of the grandest railway stations in the country at a time when the city was incredibly wealthy and dominated by the automotive industry. A performance by Eminem with the Detroit Symphony Orchestra closed an epic evening that left those in the Motor City proper, as well as Metro Detroit, with a deep sense of pride and rebirth centered around this mass transit hub, which has long stood as a symbol of the city’s decay and hardships. The Ford Motor Company acquired the Station in 2018 with “the promise of a revitalization of the shuttered icon.”  

The Station serves as yet another symbol for the city that cars built — it harkens back to a time when trains were relied upon more heavily for public transportation, in stark contrast to the present day. Despite advances in infrastructure and technology since the Station’s heyday, Detroit lacks a reliable and robust mass transit system, both within the city and to connect to the wealthier metro-area, reflecting a broader national issue.

Close to 45 percent of people living in the U.S. lack access to any public transportation options at all. Access to transportation, a component of the built environment, is an important social determinant of health. The absence of reliable mass transit in the United States disproportionately harms people of color, particularly Black adults, in addition to women, low-income workers, people with disabilities, and those living at the intersections of these identities.

A 2022 Centers for Disease Control and Prevention report highlights key findings, including that 5.7 percent of adults lacked reliable transportation for daily living in the prior year, with a higher percentage of women lacking reliable transport compared to men. The report notes that 9.2 percent of Black non-Hispanic adults lacked reliable transportation for daily living in the preceding 12 months, as compared to Hispanic adults at 6.9 percent, and White, non-Hispanic adults at 4.8 percent. In addition, “[w]hile American Indian and Alaska Native adults were more likely to lack reliable transportation than Black adults, this difference was not significant.”

A 2021 report released by the American Public Health Association, AcademyHealth, and Kaiser Permanente, Transportation: A Community Driver of Health[KK1] , focuses on, among other points, the impact of transportation access on vulnerable populations. The report also makes the connection between transportation access and attaining and keeping employment as well as the overall barriers to economic prosperity that accompanies lack of reliable transportation. “Without access to transportation options like public transit, walking and rolling, or biking, those who live in auto-centric communities are more likely to fall into poverty due to transportation-related emergencies.”

Building on this, a 2021 Health Policy Brief from the Robert Wood Johnson Foundation (RWJF), provides, as a key takeaway, that “[n]ew or expanded public transportation options can improve health and health equity by reducing traffic crashes and air pollution, increasing physical activity, and improving access to medical care, healthy food, vital services, employment, and social connection.”  Another RWJF Health Policy Brief issued in April 2023 reported that “21 percent of U.S. adults without access to a vehicle or public transit went without needed medical care last year.”  

As a consequence, the U.S. Department of Health and Human Services lists transportation as an objective for Healthy People 2030, which sets data-driven national objectives to improve health and well-being over the next decade. The objective is currently listed as having “little or no detectable change” meaning that there either has been no progress on this objective or it has lost ground.

However, on June 6, 2024, the Federal Transit Administration (FTA)  announced $7.8 million for 17 projects to improve public transportation to better connect individuals to health care and other critical services. Earlier in the year, the FTA announced $20.5 billion in federal funding to support public transportation in communities around the country. Transportation agencies in Michigan received $194 million in FTA funds that may be used towards subways, light rail, buses, ferry systems and other public transit options that can help improve equity in the region.

Within the State of Michigan, a proposed reform of a large-scale business incentive would dedicate $2 billion over the next decade towards statewide transit. If the bill is enacted, the portion dedicated towards transportation would be the largest such sustained investment in the state’s history.

On May 28, 2024, Michigan Central Station and Henry Ford Health, an integrated, nonprofit health care organization in Metro Detroit, announced a partnership “aimed at revolutionizing the intersection of mobility and healthcare in Detroit.” The partnership “signifies a strategic alliance dedicated to pioneering new solutions that address critical issues facing Detroiters – including accessibility to healthcare, community health network, and workforce development…”

The hope felt in the region as home-grown and other legends took the stage with the restored Station as the backdrop seems well-founded. A renewed commitment to mass transit – and the funding to back it up – is taking center-stage and could well be a new era of Detroit, once again, setting a nation-wide example in transportation that could be a driving force to create meaningful progress towards equity and lead to better health outcomes.

This post was written by Phyllis Jeden, J.D., Senior Attorney, Network for Public Health Law – Mid-States Region Office.

The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this document do not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.

Support for the Network is provided by the Robert Wood Johnson Foundation (RWJF). The views expressed in this post do not represent the views of (and should not be attributed to) RWJF.