Transportation and health are interconnected. Beyond moving people and goods, transportation plays a key role in improving physical, mental, social, environmental, and economic health. Through programs, policies, and infrastructure investment, the U.S. Department of Transportation and its Federal partners, such as the U.S. Environmental Protection Agency (EPA) and the Centers for Disease Control and Prevention (CDC), are working together to improve the connection between transportation and health, underscoring the vital importance of making equitable investments in our communities.

Building and strengthening partnerships will help leverage Federal programs and funding opportunities, including programs established by the Bipartisan Infrastructure Law (BIL) (Pub. L. 117-58, enacted as the Infrastructure Investment and Jobs Act) and the Inflation Reduction Act (IRA) (Pub. L. 117-169). These programs and funding opportunities, such as the Reconnecting Communities Pilot (RCP) Program and the Thriving Communities Program (TCP) can empower communities in the transportation decisionmaking process and continue moving the Nation toward a safer, healthier, and more equitable transportation system.

Transportation and Health Connections

Safe and reliable transportation is fundamental to the health of people, communities, and economies, making it a social determinant of health. The factors that influence health outcomes—including overall health status and individual and community quality of life—are known as social determinants of health. The places where people live, learn, work, and play have a large effect on an individual’s health outcomes. Transportation has the potential to negatively affect communities by limiting opportunities for safe physical activity, increasing exposure to pollution, and impacting community design. Increasing transportation connections can improve access to health-supporting activities, medical services, recreational facilities, and healthy food, as well as other destinations including schools, jobs, and community centers.

Efforts to improve health outcomes through transportation investments can help address the leading causes of U.S. deaths, many of which can be directly or indirectly attributed to transportation. According to the National Highway Traffic Safety Administration’s (NHTSA) estimates, 42,915 people died in motor vehicle traffic crashes in 2021, including 7,342 pedestrians and 985 cyclists. Enhanced safety measures, such as speed control management strategies and properly designed lighting deployment, can reduce traffic deaths and serious injuries. Also, less vehicle traffic can improve air quality and reduce chronic lower respiratory diseases. According to the CDC, chronic lower respiratory diseases claimed a total of 142,342 lives in 2021. Similarly, the U.S. Surgeon General reported that regular physical activity can reduce the risk of heart disease, diabetes, and certain cancers. These illnesses led to approximately 696,000, 103,000, and 605,000 deaths, respectively, in 2021. Active transportation, including walking, biking, and rolling, positively contributes to people’s physical activity.

Barriers that limit community access—such as arterials and highways that cut through communities—can discourage physical activity, exacerbate air and noise pollution exposure from roadways, and disconnect people from the places that matter most. In addition, socioeconomic inequities can contribute to (and can occur because of) disproportionate exposure to transportation-related negative impacts for underserved, overburdened, and disadvantaged communities. These communities can include people of color, people with disabilities, Native Americans, older adults, and people living in lower income neighborhoods.

Health and Equity Benefits of Safety for All Road Users: Working Together Toward Zero Deaths

Increases in road fatalities and injuries persist even though vehicles have become safer to drive. The rate of roadway fatalities per 100 million vehicle miles traveled has not substantially improved over the last 10 years, and increased significantly in 2020. In 2020, a pedestrian was killed every 81 minutes in traffic crashes according to NHTSA. The increasing rate of fatalities and injuries on the Nation’s roadways disproportionally affect underserved, overburdened, and disadvantaged communities. For instance, higher risks of crash deaths are concentrated in lower income neighborhoods where exposure to traffic volume and speed may be higher because of factors such as inadequate road safety infrastructure and reduced community engagement in the transportation planning process. Fatal and injury statistics grow yearly, in part, because of roadway designs that prioritize speed over the safety of people inside and outside of vehicles.

Through the National Roadway Safety Strategy and the Safe System Approach, USDOT aims to address the unprecedented public health issue of deaths and serious injuries from road traffic. As part of an ambitious long-term goal to reach zero roadway fatalities and serious injuries, USDOT has committed to focusing its safety programs and resources on infrastructure, human behavior, speeds, responsible oversight of the vehicle and transportation industry, and emergency response. According to the National Roadway Safety Strategy, “No one will reach this goal acting alone. Reaching zero will require USDOT to work with the entire roadway transportation community and the American people to lead a significant cultural shift that treats roadway deaths as unacceptable and preventable.”.

Public and Active Transportation Can Provide Opportunities to Address Our Nation’s Health Crises

Active transportation, such as walking, biking, and rolling, is an essential component of safe multimodal networks. The resulting increased physical activity can lower rates of chronic diseases. Similarly, people who use public transit, including young adults, older adults, and disabled populations and those who do not drive or have access to a car, can improve their physical activity and health and increase their social connectivity, while meeting their mobility needs across their lifespan. In addition, motor vehicle-related injuries and fatalities are expected to decrease with fewer drivers on the roads. Activity friendly routes that include multimodal options decrease crash risk for people walking and biking the first and last mile to transit or all the way to their destinations. Safe multimodal transportation options and land-use policies can also increase community-wide access to everyday destinations and services, such as healthcare, which can help reduce health inequities. Transportation agencies and communities can enable safe, equitable, active, and public transportation access for all users by providing sidewalks and crosswalks, bike lanes, multiuse paths, and trails that connect people to essential daily destinations, like schools and grocery stores. Communities can also invest in more efficient and accessible transit options, such as new bus routes, ensuring existing transit routes are providing the levels of high-quality service for which they were designed. They can also support active transportation by installing streetlights and increasing green space.

High-speed, high-traffic roadways and other transportation infrastructure can act as community barriers and discourage active transportation because people do not feel safe walking, biking, or rolling along them. Barriers to active transportation and public transportation can lead to reduced physical activity and can affect access to jobs, healthcare, education, governmental services, and fresh and nutritious food.

A recent study published by the Preventive Medicine Reports journal, entitled “Traffic as a barrier to walking safely in the United States: Perceived reasons and potential mitigation strategies,” found that nearly one in four U.S. adults reported traffic as a barrier to walking where they live and 80% of these people cited speed as their most important concern. Lack of access to active transportation infrastructure or public transit, including transit availability during nonpeak hours, can disproportionally harm underserved, overburdened, and disadvantaged communities. Barriers arising from land use patterns, historic discriminatory lending practices known as “redlining,” and community designs (e.g., urban sprawl, dispersion of job locations, and rapid rise of the cost of housing) exacerbate transportation inequity. Also, a report from the Society for Public Health Education, entitled Interviews with Black Scholars in Transportation, Public Health, and Land Use, identified overpolicing and fear of harm or harassment by law enforcement as another barrier to people feeling safe when using active transportation.

Investments that promote active and public transportation benefit people’s health, their quality of life, the environment, and the economy. In a letter published in the CDC report, Step It Up! A Partners Guide to Promote Walking and Walkable Communities, U.S. Surgeon General Vice Admiral Vivek H. Murthy described physical activity as “one of the most important things Americans can do to improve their health, and walking is an easy way to get moving.” USDOT supports active transportation through various programs and associated funding opportunities through the Federal Highway Administration, Federal Transit Administration (FTA), NHTSA, and the Office of the Secretary of Transportation (OST) as does its Federal partner, the CDC, through, for example, its website, “Active People, Healthy Nation (https://www.cdc.gov/physicalactivity/activepeoplehealthynation/index.html).
FHWA, for instance, provides a range of resources through its Bicycle and Pedestrian Program. Furthermore, the FTA’s competitive Pilot Program for Transit-Oriented Development (TOD) Planning focuses on improved access and provides funding to local communities to integrate land use and transportation planning with a new fixed guideway or core capacity transit capital investment, which can enhance the linkages between where people live, work, and play (Note: The Pilot Program for TOD Planning was originally enacted in Section 20005(b) of the Moving Ahead for Progress in the 21st Century Act (P.L. 112-141) and amended by Section 30009 of BIL). This form of development can improve housing affordability, recreation, and mixed-use development along transit corridors and near bus and rail stops. Since 2014, FTA has provided $104 million in TOD planning funding for 129 projects.

Air, Noise, and Greenhouse Gas Pollution Reductions Through Transportation Choice

Air and noise pollution negatively impact health. The transportation sector emits air pollutants—such as nitrogen oxides, volatile organic compounds, particulate matter, and various air toxics—that negatively impact environment and public health. Elevated ozone and particulate matter levels increase the amount and seriousness of lung and heart disease. Breathing ozone can also trigger a variety of health problems, particularly for children and older adults. People who live, work, or attend school near major roads have an increased incidence and severity of health problems associated with air pollution exposures. In addition, people living in urban areas are at higher risk of developing neurological, reproductive, developmental, or respiratory disorders, given their prolonged exposure to higher levels of air toxics. As a stressor, air pollution can cause illnesses such as heart disease and cancer that are among the leading causes of death in the United States. Similarly, traffic noise can interfere with people’s quality of life and is associated with negative health outcomes, including activity interference, sleep impacts, and cognitive effects.

An EPA report found that transportation sources accounted for about 28 percent of the national greenhouse gas emissions in 2021, and greenhouse gases are a leading contributor to climate change. Socially vulnerable populations— including low income, older adults, and communities of color individuals—are more likely to experience impacts from climate change and extreme weather than other groups since they:

• Are likely already living in risk-prone areas or exposed to poor environmental conditions (e.g., living in urban heat islands or within flood-prone areas).
• Are often excluded in planning processes.
• Typically have less access to climate change information and resources.
• Have limited financial resources to mitigate or rebound from climate-related disasters.

Air and noise pollution and climate change disproportionately impact the health outcomes of underserved, overburdened, and disadvantaged communities. These communities are overrepresented in areas with higher levels of air and noise pollution such as near ports, in dense urban areas, and within close proximity to highways and high-volume roadways. In many urban areas, these same communities are at greater risk for extreme heat and associated heat-related illness because, for example, they are less likely to have the resources to adapt to extreme heat (e.g., having or running air conditioning units), are more likely to have underlying chronic diseases that can be exacerbated by heat, are more likely to have jobs that require exposure to heat (e.g., construction and agricultural workers), and are less likely to be surrounded by green spaces.

Improving opportunities for safe, active, multimodal transportation can help reduce dependence on vehicles that produce air and noise pollution and greenhouse gas emissions. Including strategically placed trees, shade, and green space when building infrastructure may provide additional support to underserved communities and reduce skin cancer which is one concern for outdoor physical activity. USDOT and its partner agencies employ numerous programs to address air and noise pollution and reduce greenhouse gas emissions, including:

• Clean Air Act requirements for States’ air quality planning efforts, including mobile source pollution reduction (42 U.S.C. 7401 et seq.).
• EPA-promulgated emissions standards for passenger and heavy-duty vehicles under the Clean Air Act (42 U.S.C. 7521(a)).
• Diesel Emission Reduction Act Program, which funds grants and rebates that protect human health and improve air quality by reducing harmful emission from diesel engines (42 U.S.C. 16132, 16133).
• Clean Air Act transportation conformity provisions to help integrate the air quality and transportation planning processes.
• Congestion Mitigation and Air Quality Improvement (CMAQ) Program to support transportation projects and programs that improve air quality and provide traffic congestion relief (23 U.S.C. 149).
• FHWA’s Infrastructure Voluntary Evaluation Sustainability Tool (INVEST), which can be used by transportation agencies to assess and enhance the sustainability of their projects and programs.
• FHWA’s National Electric Vehicle Infrastructure (NEVI) Formula Program to strategically deploy electric vehicle charging infrastructure and establish and interconnected network (BIL, Division J, Title VIII, Highway Infrastructure Program heading, paragraph (2)).

All Hands: Partnerships to Support Health and Transportation Connections

Addressing health inequities in the transportation sector cannot be done by one agency or State alone. Transportation agencies may consider partnering and engaging with public health, housing, environmental, business, and community-based organizations—as well as the affected communities themselves—in promoting transportation connections that support the U.S. population’s health. USDOT fosters partnerships among its Operating Administrations and with other Federal departments and agencies as well as encourages partnerships with Tribal, State, territorial, and local transportation agencies. As an example, FHWA developed a Framework for Better Integrating Health into Transportation Corridor Planning to provide action-oriented information that can assist transportation practitioner efforts to incorporate health into corridor planning processes.

Recognizing the need for multisectoral engagement to plan and implement safe and equitable transportation programs, USDOT expanded its focus on public participation and community engagement. USDOT recently published Promising Practices for Meaningful Public Involvement in Transportation Decision-Making (https://www.transportation.gov/sites/dot.gov/files/2022-10/Promising_Practices_for_Meaningful_Public_Involvement_in_Transportation_Decision_making.pdf), which provides practices that can promote a shared understanding of meaningful public involvement. The guide is intended to support practitioners of all modes of transportation in various roles, including policy, planning, engineering, operations, civil rights, environmental justice, and public involvement. It also contains promising practices that can help USDOT funding recipients meet the requirements of meaningful public involvement and participation under Federal statutes, such as Title VI of the Civil Rights Act of 1964 and the National Environmental Policy Act of 1969.

USDOT recently rolled out two community-focused programs that highlight transportation and health connections:

• The RCP provides Planning Grants and Capital Construction Grants, with the purpose of reconnecting communities by removing, retrofitting, or mitigating transportation facilities, like highways or rail lines, that create barriers to community connectivity, including to mobility, access, or economic development (BIL Section 11509).
• The TCP funds Capacity Builder teams to provide technical assistance, planning, and capacity building to disadvantaged communities. The program aims to ensure that disadvantaged communities adversely or disproportionately affected by environmental, climate, and human health policy outcomes have the technical tools and organizational capacity to comprehensively plan for and deliver quality infrastructure projects and community development projects that enable their communities and neighborhoods to thrive (Consolidated Appropriations Act, 2022 (Pub. L. 117-103, Division L, Title I)). The TCP Program is part of a larger Federal initiative in which USDOT, in coordination with other Federal agencies, such as the EPA, the Department of Housing and Urban Development, and the Department of Energy, created a Federal Interagency Thriving Communities Network (TCN) to guarantee that communities can access Federal resources, including those under the BIL and the IRA.

Results-driven collaboration with other Federal agencies produces more holistic programs that benefit communities and provide agencies an opportunity to leverage funding resources to broaden the impact of those programs within communities. USDOT has partnered with key Federal agencies focused on health, including CDC and EPA.

A constellation of recent events helped to accelerate collaborations between CDC and USDOT. These events include, but are not limited to, policies established under BIL directing cross-agency collaboration; the Coordinating Council on Access and Mobility (CCAM) 2023–2026 Strategic Plan, which includes metrics for multisector collaborations and equitable transportation; and memorandums of understanding (MOU) between USDOT and CDC. One such MOU was between the CDC National Center for Injury Prevention and NHTSA to prevent motor vehicle crash-related injuries and deaths, including among vulnerable road users (VRUs). Programmatic activities such as CDC participation in the FHWA National Complete Streets Assessment and the Vision Zero peer exchange have furthered information exchange between transportation and public health professionals. Together, these efforts can help improve data collection, strengthen evidence for policies to protect VRUs, synergize programs and research, and promote evidence-based interventions, particularly related to equity.

Similarly, for the Fiscal Year (FY) 2022 RCP Notice of Funding Opportunity, USDOT and Federal interagency partner staff, including staff from the EPA, conducted the grant evaluation process. EPA staff and subject matter experts served as advisors to USDOT’s application review teams, advising USDOT on topics including environmental justice, strategies for equity, community engagement and stewardship, equitable development, and revitalization strategies. USDOT and EPA carried out a similar effort with the TCP Program. These efforts are reflective of USDOT and EPA past collaborations to bring communities together and foster new opportunities for both agencies to more regularly work together to protect public health and the environment.

A Whole-Government Approach to Improve Transportation Access

Led by FTA, the Federal interagency CCAM is an example of multisector collaboration among 11 Federal agencies to improve the efficiency and reliability of transportation networks across the country for low-income individuals, older adults, and people with disabilities. This type of partnership could be replicable at the State and territorial level.

Opportunity to Make Bigger Strides Toward Healthy and Equitable Transportation: BIL and IRA

The historic 2021 BIL and 2022 IRA provide funding to foster safer, healthier, and more equitable transportation and to change the current car-dependent transportation network that has exacerbated the issues described in this article. BIL provides transformative transportation investments, including those for improving public safety and climate resilience, allowing for the creation of jobs, and delivering a more equitable future. IRA provides investments in a range of areas, including environmental programs, and aims to improve public health, reduce pollution, and revitalize marginalized, underserved, and overburdened communities. Programs under both statutes can help to reconnect communities divided by existing infrastructure, mitigate negative impacts of transportation facilities, support equitable transportation planning, and make our existing transportation system cleaner by providing healthier and more sustainable transportation options, including walking, biking, and using public transportation.

Health-related programs created or reauthorized by BIL or IRA include the following:

• Highway Safety Improvement Program (HSIP)—BIL provided this existing formula program approximately $15.6 billion for FY 22–26. The purpose of HSIP is to achieve significant reductions in traffic fatalities and serious injuries on all public roads (23 U.S.C. 148(b)(2)) and funds highway safety improvement projects and specified safety projects to achieve this goal (23 U.S.C. 148(e)). Specified safety projects allow HSIP funds to be used on certain noninfrastructure safety projects (e.g., education and emergency response programs), and States can spend up to 10 percent of their HSIP apportionment each fiscal year on specified safety projects (23 U.S.C. 148(a)(11), 148(e)(3)). Every State can use HSIP funds for bicycle and pedestrian highway safety improvement projects, but, depending on their total annual VRU fatalities, certain States are required to obligate at least 15 percent of their HSIP funds on highway safety improvement projects to address the safety of VRUs (23 U.S.C. 148(g)(3)).
• Safe Streets and Roads for All (SS4A) discretionary grant program—A new BIL program that provides more than $1 billion in annual grants from FY 22–26 to fund regional, local, and Tribal initiatives to prevent roadway deaths and serious injuries through the creation and implementation of safety action plans (Section 24112). SS4A can support projects such as developing comprehensive safety action plans and conducting safety analyses to transform a high-injury network into a Complete Street with safety improvements to control speed, separate users, and improve visibility. A Complete Street is safe, and feels safe, for everyone using the street.
• Carbon Reduction Program (CRP)—A new BIL formula program that provides more than $1.2 billion annually from FY 22–26 to reduce transportation emissions defined as carbon dioxide emissions from on-road highway sources (23 U.S.C. 175). Multimodal projects that help reduce dependence on single-occupancy vehicles are eligible for this funding such as public transportation projects and the construction, planning, and design of facilities for pedestrians, bicyclists, and other nonmotorized forms of transportation.
• CMAQ Improvement Program—BIL provided this existing formula program over $2.5 billion annually from FY22-26. CMAQ provides a flexible funding source to State and local governments for transportation projects and programs to help meet the requirements of the Clean Air Act in areas with air quality problems (23 U.S.C. 149). Eligible projects include fostering increased use of public transportation and bicycle and pedestrian transportation, retrofitting or replacing diesel trucks fleets to reduce emissions, funding shared micromobility projects, expanding zero-emission vehicle fleets and infrastructure, and improving traffic flow. CMAQ Program funds can also be used for any transit capital expenditures otherwise eligible for FTA funding, as long as they have an air quality benefit.

With these and other programs, BIL and IRA provide a once-in-a-generation opportunity for Federal agencies, Tribes, States, territories, local governments, and communities to use formula and discretionary funds to support an active, multimodal, resilient, and accessible transportation system to improve health outcomes of individuals and communities. BIL and IRA allow State and local transportation agencies to further consider public health in its projects and planning.

Several States have transformed project scoring processes to ensure health considerations are embedded in their planning processes. For instance, in Kentucky, “Building a safer, more equitable transportation system that serves all community members is a priority here in the Commonwealth, and that includes creating more options for bicyclists and pedestrians,” says Mikael Pelfrey, Kentucky Transportation Cabinet Division of Planning director. “The SHIFT [Strategic Highway Investment Formula for Tomorrow] scoring process takes all of these components into consideration to help us plan for the future and the generations of Kentuckians who will rely on our infrastructure for their daily needs.”

States may also develop new policies to ensure that all road projects include public-health-oriented corridor designs that are safe and accessible for users of all ages and abilities. New York enacted legislation to increase the State share of funding for municipalities incorporating such approaches as Complete Streets. The Washington State Department of Transportation issued a policy (Project Delivery Memo No. 22-03), requiring certain transportation projects greater than $500,000 to be screened and to incorporate Complete Streets design features. The Louisiana Department of Transportation & Development changed the requirement of the CDC-funded Louisiana High Obesity Program by reducing local match funding and removing local responsibility for design, construction, engineering, and inspection to make it easier and more equitable for communities under 50,0000 population to apply.

USDOT and EPA Collaborate on Programs Established in New Infrastructure Legislation

The BIL, IRA, and American Rescue Plan Act of 2021 (Pub. L. 117-2) all have provided a wealth of new opportunities for USDOT and EPA to work together to support public health in transportation infrastructure investments. An example of this collaboration includes TCN. DOT and EPA are co-chairs of this Federal Government program. TCN is designed to help Federal agencies coordinate strategy, collaborate across initiatives, and target deployment of a full range of Federal place-based technical assistance and capacity-building resources to urban, rural, and Tribal communities experiencing a history of economic distress and systemic disinvestment. This effort includes resources to help disadvantaged communities with grant and financial management, predevelopment assistance, community engagement, planning, and project delivery support. Each TCN partner agency is committed to coordinating and collaborating between their technical assistance programs, especially within regional or field offices that often serve as front doors and key points of contact to support communities. By working alongside and within communities, technical assistance programs can better support the locally identified needs and priorities.

Conclusion

While government agencies have made progress in bringing together transportation and health in the planning, programming, development, and maintenance of infrastructure investments, agencies still have a long way to go to secure a healthy and equitable transportation system. “There is nothing sacred about the status quo,” said U.S. Secretary of Transportation Pete Buttigieg in his remarks on the launch of the RCP Program in Birmingham, AL. “These highways, roads, and railways are not rivers, lakes, or mountains. They are not divinely ordained. They are decisions. And we can make better decisions than what came before.” Better transportation decisions benefit from putting people first, making health a transportation priority, and strengthening partnerships to help leverage Federal programs and funding opportunities, including the historically transformative ones under BIL and IRA.

Jhoset Burgos-Rodríguez is a policy analyst with the USDOT Volpe National Transportation Systems Center. Before joining USDOT, he served as a CDC quarantine public health officer at the CDC San Juan Quarantine Station. He holds a bachelor’s degree in biology from the University of Puerto Rico, a master’s degree in biology and environmental science from the University of Rhode Island, and a law degree from the University of Puerto Rico.

Victoria Martinez is an environmental protection specialist with the FHWA Office of Planning, Environment, and Realty Office of Natural Environment, specializing in health in transportation, mobile source air toxics, and near road emissions. She co-chairs the USDOT HinT WG. She holds a master’s degree in urban and regional planning from Florida State University, and a Bachelor of Arts degree in economics from the University of Florida. She is certified by the American Institute of Certified Planners.

Elliot Sperling is a transportation program analyst in FTA’s Office of Budget and Policy, focusing on advancing policy development and implementation and also providing engagement on efforts to advance health focuses. He holds a bachelor’s degree from Cornell University and a master’s degrees in civil engineering and city and regional planning from Georgia Institute of Technology.

Anthony Nicome is a stakeholder coalition coordinator in the EPA Office of Environmental Justice and External Civil Rights. He holds a Master of Health Science degree in environmental health from the Johns Hopkins University Bloomberg School of Public Health and a Bachelor of Science degree in geography from Texas Christian University. He is currently a graduate student at Yale University.

Wendy Heaps is a senior policy analyst at the CDC in the Office of Policy, Performance and Evaluation in the Office of the Director. She was a contributor to FTA’s Coordinating Council on Access and Mobility’s 2023 Strategic plan to improve access and mobility for people with disabilities, low-income, and older adult populations, and participates as a project panel member for the Transportation Research Board. As a public health expert, she works on population health policies and approaches to reduce the rate of infectious and non-infectious diseases. She holds a Master of Public Health from Emory University and a Bachelor of Arts in Political Science from the University of Toronto.

(Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention/the Agency for Toxic Substances and Disease Registry.)

The authors wish to thank the following individuals who played a key role in developing this article: April McLean-McCoy from FTA; Bernadette Dupont, Tameka Macon-Ryan, and Kamala Joy from FHWA; Hatidza Zaganior from CDC; and Larissa Ireland, Joan Chu, and Amy Plovnick from the Volpe Center.
For more information, see https://www.fhwa.dot.gov/planning/health_in_transportation/ or contact Victoria Martinez, 787-771-2524, victoria.martinez@dot.gov.