Urbanism, Public Transit, and Public Health

Introduction

Think of the great flagship cities of the world; New York, London, Seoul, Tokyo, Paris, Moscow, etc. What do they all have in common? Is it excellent roads? Is it excellent food? Is it a strong geographical location? While all of these certainly play a role, public transit is only of the main drivers of city growth - and it has become even more important in the 21st century.

In this article, we will discuss the basic history of transit in the United States along with the rise of car-based cities. We will explore the impact of car-based transit not only on cities and communities but also on public health and patient safety. It is the position of EMSAware that embracing public transit and focusing on living, walkable communities can boost health outcomes and save lives long term.

Public Transit in the United States - a History Refresher

The United States has a rich history of public transit innovation. Early cities first sprouted around major horseback carriage travel routes, but they transformed in time with the rollout of railways. Many of the US’ most famous major towns and cities began as railroad towns; for example, Sacramento owes a lot of its growth to its connection on the Transcontinental Railroad in 1869. Rail mileage peaked in 1916 at a staggering 254,000 miles of track laid across the US. Railroads were the backbone and the nexus to our country and our cities.

A map of most railways in the United States, 1916.

However, rail was not limited to merely intercity transit. As railways innervated the country, it became the backbone of early cities at the same time. Early cities began to build around streetcar lines, with the first opening in 1832 in New York City. The idea spread like wildfire as other major cities like Philadelphia, Boston, San Francisco, and Pittsburgh developed their own streetcar systems. The streetcar became a way for commuters and regular people alike to quickly traverse the city without the need for a house (or later on, a car). By 1920, most city residents used the approximately 17,000 miles of streetcar tracks throughout the US to commute to work. New Orleans, for instance, still makes use of streetcars for much of its downtown and continues to operate the longest-running streetcar service in the world.

Despite their progress, streetcars had their issues. By them running on the same city streets that horses and pedestrians used, they were slow and often held up by other forms of traffic. As cities grew in size, the speed of streetcars became a limiting factor and isolated many residents to their districts rather than allowing them to explore the whole city in a reasonable amount of time.

London made history with the opening of the first underground subway system in 1863: the London Tube. The London Tube expanded on existing train lines and offered a rapid, safe underground service for those traveling within the city limits. In 1868 - 5 years after London’s subway opening - New York City responded with the opening of the Ninth Avenue El. The Ninth Avenue Elevated ran from Battery Park all the way up to 155th St. Nearly 30 years later in 1897, Boston became the first city in the US to open a subway station with the Tremont Subway Station. It was initially a total of 3 miles of track connecting three stations in a loop. New York City followed close behind with the ambitious opening of the 9 mile, 28 stop subway system in Manhattan in 1904. The NYC subway system has swelled to a staggering 472 stops - the largest out of any single subway system in the world.

The Era of the Car

However, rail was not without its competitors. The first mainstream car - the Ford Quadricycle - rolled out of production in 1896. While cumbersome, slow, and largely reserved for the wealthy at first, cars The automotive industry grew rapidly, and with it came the development of highways. The Federal Government took an interest in the development of highways in the early 1900s and saw highways and automobile transport as the next step forward. The Federal Aid Road Act of 1916 coupled with the Federal Aid Highway Act of 1921 helped pave the way for the US’ modern-day highway web.

Urban renewal became a popular concept in the 1950s and 1960s. The idea was to reinvigorate decaying and rundown city sectors by adding new infrastructure, opportunities, and commerce. To help move this idea forward, new highways were constructed - often running directly through and around city cores. Homes, schools, and businesses were destroyed to make way for new multi-lane highways that would serve as de facto borders within each city. Notable examples of devastating urban renewal efforts include Baltimore, Philadelphia, Pittsburgh, New Orleans, and Syracuse. The goal was to connect cities with the surrounding suburbs and with other cities, but the act of putting a highway through previously dense downtowns and neighborhoods was devastating.

The Car Lobby

Car manufacturing interest groups sprung up throughout the 40s through the 60s. Similar to the federal government, they had a vested interest in ensuring that highways and major freeways were built throughout the United States. As cars became more and more affordable, the goal for auto manufacturers was to make automobile transport the de facto default mode of transport. They accomplished this through a variety of means including lobbying government officials, opposing new transit programs, and even purchasing existing, privately-owned public transit options with the sole purpose of shutting them down.

General Motors is one of the most notable examples of automakers purchasing public transit to either dismantle or downgrade it. GM formed a shell company called National City Lines in 1938 that went on to purchase the public transit apparatuses of over 25 cities. Their goal was simple; to replace trolley lines on rails with GM-manufactured buses or private transport. While GM did not set out to explicitly destroy public transit, they did want to monopolize it. Converting trolley lines into buses served both the purposes of incentivizing private automobiles and ensuring that GM had a steady supply of municipal customers for its bus sales.

GM most notably purchased the Los Angeles Railway in 1945 and “within 20 years diesel buses – or indeed private automobiles – would carry all the yellow cars’ former passengers." (The Guardian). Los Angeles, previously a city innervated by trolleys and railway, would rapidly begin its descent into the infamous “City of the Car”.

GM, along with 8 other automaker companies, was brought up on antitrust charges in 1948 as a result of their purchases. The federal government accused GM of attempting to establish a transit monopoly, forcing people to either choose between their provided buses or their automobiles to get around.

You’re probably thinking - “but they aren’t explicitly anti-public transit if they are trying to sell buses” - and you are partially correct. A bus is certainly an example of public transit, but to move from a trolley line to a bus is a purposeful and intentional downgrade from existing infrastructure. A trolley has a place in the city; it is permanently built, difficult to shut down (adding stability to community transit) because of its physical presence, predictable, and can move large numbers of people seamlessly. A bus line can be downgraded, rerouted, or shut down at will by the city government while a trolley brings permanency to the presence of public transit. A trolley is a fixed, integral part of a neighborhood; you step outside and the rails are always there, and the routes are pre-established. It trumps other traffic and carries you through the city while running alongside automobiles. A bus, on the other hand, is jammed in the same traffic, and its character is inherently different than a trolley or rail.

What does this mean for public health?

Walkability: imagine you are back in college, on-campus, walking down a bar or restaurant district, or even visiting Disney World or another theme park. These are all relatively common experiences that most Americans can relate to at some point in their life. Think of the ease that you experience as you stroll down the streets, heading to your next destination. Rather than experiencing the world at breakneck speed through the glass window of a car, you are a part of your surroundings. You are not merely traveling, but experiencing the area around you as you make your journey. When you walk, bike, or use any other means of transit beyond a car, you are able to become a part of the area instead of merely glancing at it.

I liken taking a car everywhere to eating every meal in that terrible 3 minute block before you have to go back to work. You pick up your sandwich, you sit in silence, and you jam the food into your mouth as fast as you can just to get it over with. The act of eating (or travel, in the case of cars) has become merely a utilitarian necessity instead of an experience to be lived. You merely travel through your environment instead of appreciating and existing within it.

Research finds that those who walk to most aspects of their life live happier, healthier lives. A 31,000 participant study out of Obesity found that participants who lived in areas that were walkable were more likely to engage in higher rates of physical activity and on average have lower BMIs than those that lived in car-dependent neighborhoods https://onlinelibrary.wiley.com/doi/10.1002/oby.23634. The HHS has even caught onto this, with the US Surgeon General releasing a 2015 memo titled “Step It Up” encouraging municipal leaders to focus on walkability and micromobility in a bid to boost health outcomes. https://www.hhs.gov/sites/default/files/call-to-action-walking-and-walkable-communites.pdf

The Impact of Cars in Urban Spaces

It is no secret that privately owned vehicles are the most inefficient route of transit. The vast majority of Americans commuting via car do so alone - with a staggering 69 percent of people commuting everyday by themselves in their private automobiles. A single bus can comfortably replace up to 40-50 cars, while a moderately-sized subway train can replace into the 100s of cars.

New York City is a prime example of private vehicles competing for the same space as pedestrians resulting in dangerous health effects. The Bronx - one of the more residential boroughs of NYC - is also home to the Cross-Bronx Expressway, a major commuting route into NYC from north New Jersey and the commuter suburbs to the north of NYC. The Bronx has the highest rates of childhood asthma in the United States. Research found that asthma rates rise significantly for pedatric patients growing up near the Cross-Bronx Expressway. The pediatric asthma rate for The Bronx overall is a staggering “17 percent, almost three times the national average” https://citylimits.org/2024/06/18/opinion-let-the-bronx-breathe-address-the-cross-bronx-expressways-impact-on-asthma/#:~:text=Research%20has%20shown%20that%20growing,and%20more%20frequent%20asthma%20attacks.. The Cross-Bronx Expressway also has some of the worst congestion in the United States, maximizing the amount of time that carbon-based pollutants are pumped into the residential areas adjacent to it. These children are essentially growing up constantly exposed to excessively high levels of pollution as a result of heavy private automobile use and high congestion.

The Gowanus Expressway, a Robert Moses project from the 1930s, is another major NYC highway. The Gowanus runs from the southwest tip of Brooklyn and allows traffic from Staten Island and New Jersey off the Verrazano Bridge into the rest of the city. A staggering 200,000 vehicles drive over it each and every day - and in the process, bathe the surrounding neighborhoods of Sunset Park, Red Hook, Park Slope, and South Slope in their carbon-based pollutants. A 2012 study found significantly higher rates of asthma and inflammatory lung disease specifically in residents that lived closer to the Gowanus Expressway.

The above graphic, sourced from NYC Department of Health, shows the rate of asthma-related emergency department visits for each neighborhood and borough in NYC. It is no surprise that the areas with the largest, most dense highways show higher rates of asthma hospitalizations. The exact path of the Gowanus is outlined in dark blue in Brooklyn, indicating higher rates of asthma hospitalizations. The Bronx, the home of the Cross-Bronx Expressway, is also deep blue. Less car-dependent sections of the city such as the more proximal, residential parts of Queens and Manhattan proper show lower rates of asthma hospitalizations. These are also coincidentally the areas of the city with less highway infrastructure and less automobile congestion. The financial zone at the southern tip of Manhattan showed the highest rates of asthma-related hospitalizations out of the whole borough. Coincidentally, this is an area with a high amount of automobile traffic due to commuters heading into the financial district.

The Impact of Congestion on Emergency Responses

Congestion by private vehicles also plays a role in response and transport times for emergency vehicles. Despite urban areas having more emergency resources on average, there are significant delays for emergency vehicles due to traffic. We will examine the statistics of response times out of London, a major city that is at least somewhat comparable to the major metropolitans of the US, for this discussion. The London Fire Brigade found a significant delay in response time of approximately 40 seconds during times of high traffic congestion https://www.transportxtra.com/publications/local-transport-today/news/71126/excess-traffic-to-blame-for-delays-to-emergency-services-study-finds/.

New York City also found a significant increase in response times over time as congestion throughout the city worsens https://abc7ny.com/post/how-will-congestion-pricing-impact-emergency-response-times/14969990/. 911 callers in the congestion zone south of 60th street will have to deal with up to a minute longer response time on average versus other areas of the city with less traffic https://abc7ny.com/post/how-will-congestion-pricing-impact-emergency-response-times/14969990/.

More Reading

https://therapidtransient.wordpress.com/2021/02/06/off-the-rails-comparing-the-capacity-of-trains-buses-cars-and-more/