Improving Public Transport Systems After COVID-19 Will Make A Big Difference To Health Equity

The coronavirus pandemic has shined a harsh spotlight on the importance of public health. Everything from the global economy all the way down to the local bus system has been affected.

As health, transportation and economic experts look ahead to recovery, some are focusing on how different systems can work together to achieve better health equity in the community and more resilience against future health threats.

“I think [what] the accelerant of the pandemic has laid bare is, mobility and transportation and healthcare need to get fixed,” University of Pennsylvania Health System CEO Kevin Mahoney said during a Bisnow webinar on Oct. 22.

Telehealth platforms have allowed many people to seek medical help during the pandemic without stepping foot in a hospital or clinic. The Penn Medicine system used telemedicine to see 150 patients during the first two weeks of March. By the end of September, the system had conducted around 600,000 telemedicine visits, according to Mahoney.

The problem is that some people are on the other half of the digital divide. They may not have a computer or may lack an internet connection fast enough to access that kind of care. Those people must see health professionals in person, and they often must catch public transportation to get there, placing themselves at higher risk and possibly also encountering problems like limited bus or train schedules.

“For centuries, but ever more so since George Floyd's death at the end of May, a lot of health equity comes down to that access and mobility,” Mahoney said.

To move forward in a post-pandemic world, more creative partnerships between sectors will be needed, such as between healthcare and transportation.

Jacksonville Transportation Authority CEO Nathaniel Ford said in places like Jacksonville, Florida, the people who catch public transportation usually have no other choice. Figuring out how to move those people while conducting rigorous additional cleaning and operating at reduced capacity has been difficult.

“I think there is a natural partnership here that needs to be strengthened. Because … as public transportation, those folks who don't use our systems may not recognize the importance that we have, in terms of the quality of life that then eventually supports them,” Ford said.

“And so, I think this partnership going forward is one about adequate funding and support for the public transportation system, to make sure that we help with equity issues and opportunity issues across our community.”

Partnership for New York City President and CEO Kathryn Wylde said that to really improve public health outcomes, there needs to be an integrated approach that can account for everything from education to transportation to healthy food access.

“I really think it starts with public policy in the federal government,” Wylde said. “These are all separate legislative programs. So I think that that's the opportunity that we all have to work on together.”

Developers can also play a role in improving long-term health outcomes for communities. As cities across the U.S. become more dense, developers can ensure there is an affordable housing component to new developments around major transportation nodes, Ford said.

Gentrification eventually leads to people being pushed out of well-situated neighborhoods, often farther away from hospitals. In some cases, transportation systems may not be well-developed enough to easily allow those people to access the care they need.

Multiple solutions could address that trend, such as building more public transportation and requiring affordable or workforce housing to be a compulsory element of new multifamily developments in those gentrifying areas, Mahoney said.

Howard University Hospital CEO Anita Jenkins said the mindset around how healthcare is provided needs to shift and start focusing on the continuum of how people are living.

“You have to begin with the end in mind, and you want to find out, what is it that we want? How do we want our cities to be structured?” Jenkins said. “They tend to just morph into something, and sometimes that's not as helpful to the greater population as one might think.”