Transportation + Social Determinants of Health
Good health and well-being are the result of myriad personal (biological, genetic), social, economic, policy, and environmental factors as well as health care services themselves. These wide-ranging group of factors are often referred to as the determinants of health. Those factors in the social realm, known as “social determinants of health” (SDOHs), are defined as the environments in which people are “born, live, learn, work, play, worship, and age.” These factors are known to affect a wide range of health, functioning, and quality-of-life outcomes and risks.
Transportation's role in social determinants of health
Not only is transportation itself a critical social determinant of health, but it also impacts almost every other social determinant by either providing or hindering access to those services or destinations. A 2019 survey by Kaiser Permanente showed that:
- Americans view social needs, such as housing and transportation, as equally important to their health as medical care.
- The vast majority of Americans want their medical providers to ask about social needs.
- Those experiencing unmet social needs were twice as likely to rate their health as fair or poor compared to those who did not.
- Social needs are predictors of physical and mental health.
Another 2019 survey, by the McKinsey & Co., showed that individual’s with unmet social needs were more likely to self-report poor health and/or increased health care utilization.
Given the complexity of what influences our health, there is a growing recognition that no single entity alone can tackle the wide gamut of social conditions that affect health and well-being. Improving health outcomes in the U.S. will require new partnerships that break down the silos among health care, public health, social services agencies, and the mobility sector to better address the varied and dynamic factors that affect our health.
To date, however, addressing overlapping and cross-sector factors has proven challenging as health care, public health, human services, and transportation have historically operated within separate and distinct divisions: health care focuses on clinical care, public health targets broader population-level health and disease, and human services provide specific resources and services such as education, housing and transportation. The differing goals of each sector create unique challenges in developing programs and policies that span them. For this reason, it is critical for transportation and mobility professionals to understand not only the impact of their work on individual and community health, but also the value and potential that partnerships could provide to the health and well-being of your community.
For further investigation . . .
Healthy, Equitable Transportation Policy: Recommendations and Research
This edited volume, published by PolicyLink and Prevention Institute, provides in-depth information on the intersection of transportation, equity and health.
Prevalence of Screening for Food Insecurity, Housing Instability, Utility Needs, Transportation Needs, and Interpersonal Violence by US Physician Practices and Hospitals
This study’s findings suggest that few US physician practices and hospitals screen patients for all 5 key social needs associated with health outcomes. Practices that serve disadvantaged patients report higher screening rates.
In-depth topics
The following pages take a deeper look at the issues surrounding public health and transportation. On these pages, you will find deeper explanations on the factors that impact social determinants, as well as more resources to help grow your understanding.
Additional resources
Needham Community Council Rides to Health Care
Needham Community Council – Needham, MA
In 2017, the Needham Community Council began supplementing its volunteer driver medical transportation program with trips provided through the ridehailing company, Lyft. Lyft rides were funded through the Needham Community Council operating budget and a donation from Beth Israel Deaconess Hospital – Needham.
Long-distance Medical Transportation
Cape Cod Regional Transit Authority – Hyannis, MA
To promote access for Cape Cod residents to specialty medical appointments in Boston, the Cape Cod Regional Transit Authority (CCRTA) has run a Boston Hospital shuttle since 2001. The shuttle starts on the Outer Cape and picks passengers up at seven stops in different Cape towns, and then drives into Boston and drops passengers off at their appointments. In the early afternoon, the shuttle picks riders back up for the return trip to the Cape. Prior to the pandemic, service ran one daily round trip five days a week; since the pandemic, the shuttle runs Monday through Thursday. In order to serve as many residents as possible, the shuttle is open to the general public.
Expanding Specialized Transportation: New Opportunities under the Affordable Care Act
Explains how states can use untapped funding options under the Affordable Care Act to expand services for targeted low-income populations
Transportation Barriers to Health Care in the United States: Findings From the National Health Survey
This American Journal of Public Health article quantifies the number of people in the US who delay medical care annually
Transportation to Support Rural Healthcare
This guide focuses on how communities can provide transportation services to support access to rural healthcare, which may also benefit
The Hidden Risk of Cutting Medicaid NEMT: An Examination of Transportation Service Interdependency at the Community Level
This report unpacks the interdependency between the provision of Medicaid NEMT and local public transportation. It uses case studies of