2. Health Outreach Partners’ (HOP) “Outreach Across Populations: 2013 National Needs Assessment of Health Outreach Programs” identifies transportation as the second most prevalent barrier to accessing health care services among underserved populations served by health outreach programs at Community Health Centers (CHCs).Outreach Across Populations: 2013 National Needs Assessment of Health Outreach Programs cost of health services (57%) lack of transportation (52%) lack of knowledge about available services (47%) lack of insurance (44%).

3. Transportation is regularly cited as a barrier for access to health care--specifically for underserved populations. Respondents indicated that the top four barriers preventing access to transportation services are: 1) living in a rural area 2) cost 3) limited or a lack of transportation options; and 4) the inability to obtain a driver’s license. According to a 2005 study, in any given year at least 3.6 million Americans do not obtain medical care because of a lack of transportation.

4. Because affordable housing is increasingly located far from main transportation lines and jobs, low-income people and people of color are more likely to have long commutes—which reduce time for exercise, shopping for healthy foods, and additional earning opportunities. Increasingly, we are further segregating people of color to our inner cities, where crime is high, schools are low performing, and jobs are low paying

5. Relationship to Obesity Streets and highways without sidewalks present an unnecessary barrier to walking. Auto-oriented transportation and limited access to walkable streets have resulted in an unhealthy, sedentary lifestyle with material consequences for public health. 9% of health care costs are spent on obesity healthcare spending disproportionately affect low-income people and people of color

6. The poorest fifth of American families spend 42 percent of their incomes on transportation. Less left for medical expenses, healthy food, recreation

7. Air quality & Pollution Direct relationship between emissions and health More cars equal lower air quality, which causes asthma, leukemia and cardiovascular disease costs associated with poor air quality from the transportation sector is estimated at $50–$80 billion per year.

8. Prevent social isolation Civic engagement and volunteering can reduce mortality; increase physical function, muscular strength, and levels of self-rated health; reduce symptoms of depression and pain; and increase life expectancy. door-to-door transportation is often harder to come by, for those who need assistance from getting out their door to inside the doctor’s office, as opposed to curb-side service wheelchair-accessible infrastructure Between 2006 and 2030, the U.S. population of adults aged 65+ will nearly double from 37 million to 71.5 million people. In a survey of American adults 65 and older (APTA, 2005), 82% said they worry that they will be stranded and unable to get around when they can no longer drive. More than 50 percent of nondrivers over age 65 do not leave home most days, partly because of a lack of transportation options. Often the mentally ill are not covered by Medicaid programs

9. Low income & people of color a very small percentage of federal funds have been used for affordable public transportation and for active transportation (i.e. walking, biking) opportunities, people without access to cars have been isolated from opportunities and services—including health care providers. By underinvesting in walkable communities, rapid bus transit, rail, and bicycle-friendly roads, our policies contribute to high concentrations of poor air quality, pedestrian fatalities, obesity, and asthma in urban areas. All of these public health risks have disproportionately affected low-income people and people of color.

10. A safe and inviting walking and bicycling environment provides mobility and health benefits to many older Americans. More than half of older Americans make walking a regular activity, and nearly two-thirds walk a half mile at least once a month. Four percent of older Americans ride a bicycle at least once a week. Active commuting that incorporates cycling and walking is associated with an overall 11% reduction in cardiovascular risk.

11. Example: Great Lakes Bay Region Great Lakes Bay Region: Bay County (Bay City), Saginaw County (Saginaw), Midland County (Midland). Counties: 460,000 people / 2,331 square miles [197 people per square mile] Cities: 126,908 people / 65 square miles [1,952 people per square mile] Comparison: Capital Region (Ingham County): 282,234 people / 561 sq. miles [503 people per square mile] City of Lansing: 113,972 people / 36.68 sq. miles [3,107 people per square mile]

12. There is public transit available only to the City of Saginaw (25% of total in county)

13. Issues.. Limited routes/jurisdiction Limited hours (6am-8pm, every 40 minutes) and no weekend service Doesn’t connect to opportunity Completely separate systems with few connections A participant traveled from Midland, Michigan to Saginaw, Michigan and returned on the same route via the steps listed above. The total time to travel a distance of 70 miles (round trip) took 5 hours and 50 minutes. In a personal vehicle, it would take 1 hour and 20 minutes to complete the same trip (along the same route).

14. Alignment Saginaw: Health & Social Equity Community organizers have been meeting with coalition partners from the health community Transit Millage Renewal Returning Saturday Service County-wide Transit Authority Region-wide Transit Authority