With so many new medical findings coming out every year, and so many obvious health issues to warrant public attention, few people consider the effect of public transportation on a society’s overall wellness. An expanding body of research, however, now suggests that the availability of public transportation will play a growing role in the debate on public health.
According to medical transportation specialist Maureen Hensley-Quinn, cancer, diabetes, and kidney disease are all on the rise. Thanks to advances in medical technology, effective treatments now exist for many forms of these illnesses. Treatments that once took place over the course of an extended hospital stay, often at great cost, can now be performed on a daily, weekly, or monthly basis at an outpatient center. As a result, spending on outpatient care increased by 11% in 2004, nearly twice the rate of inpatient hospital care, reports the journal Health Affairs, But getting chronically ill patients to their outpatient centers is a growing problem.
“These two trends-an increasing number of chronic patients and the increasing dependence on outpatient care-demand more investment in community and public transportation,” Quinn writes in Community Transportation magazine.
Rising rates of outpatient care and chronic illness point to an issue that will demand much more public attention in coming decades: As the population of elderly Americans grows, and with it the number of ill or less-mobile individuals, the public transportation infrastructure will have to grow as well.
By the year 2025, the number of Americans aged 65 or older will expand from 35 million to more than 65 million. According to the U.S. Census Bureau, more than 21% of Americans 65 and older do not drive. Also, individuals in that age group are twice as likely to have a disability as those aged 16 to 65. If that figure remains unchanged, the number of disabled people living in the United States will grow to 24 million over the course of the next 20 years.
According to Linda Bailey of the American Public Transportation Association, this trend holds serious consequences for the future of both public health and public transportation. “Under the Americans with Disabilities Act, every public transportation agency is required to provide complimentary paratransit service along fixed routes. . . . But for those living away from fixed routes, there is no guarantee of access to any public transportation service. And the public transportation agency is under no obligation to provide access for older people without disabilities. For older adults, frailty or a chronic condition may rule out the use of traditional public transportation,” Bailey says.
The U.S. government has, in part, already responded to the challenge. On July 29, President Bush signed a bill that guarantees $52.6 billion for public transportation over the next six years, or roughly $8.6 billion per year. According to Bailey, however, maintaining the current system will require a capital investment of $14.8 billion annually. Improving the system to accommodate a growing number of disabled, chronically ill, or simply older Americans would require an additional annual outlay of $30 billion.
The choice is a difficult one. By the end of 2005, the U.S. budget deficit will grow to over $3,000 per household. Local and regional governments across the United States are reporting their own budgetary woes. At the same time, in a telephone survey conducted by Wirthlin Worldwide, 72% of those polled supported the use of public funds for the expansion and improvement of public transportation.
Bailey sums up the problem: “The United States is currently ill-prepared to provide adequate transportation choices for our rapidly aging population. Alternatives to driving are sparse, particularly in some regions and in rural and smalltown communities. As the number of older people increases, so too will their mobility needs. How the nation addresses this issue will have significant social and economic ramifications.” -Patrick Tucker
Sources: “Trends in Health Care Impact Trends in Medical Transportation” by Maureen Hensley-Quinn, Community Transportation magazine (Winter 2004-2005), 1341 G Street, N.W. 10th Floor, Washington, D.C. 20005. Web site http://www.ctaa.org/ct.
The American Public Transportation Association, 1666 K Street, N.W., Suite 1100, Washington, D.C. 20006. Telephone 202-496-4800; Web site http://www.apta.com.
Originally published, THE FUTURIST, November-December 2005