Monday, June 14, 2010

Public Health & Transportation: There's a Connection

[Third in my occasional series of postings about how health reform legislation is changing the landscape for coordinated public and human services transportation.]

Title IV of the Patient Protection and Affordable Care Act (PPACA) addresses public health and disease prevention. Although the legislation's expansion of Medicaid will have a larger dollar impact on transit services, this is the one section of the "health reform" legislation that specifies a role for the U.S. Dept. of Transportation in helping the federal government create a healthier America.

The Secretary of Transportation already has gone on record as a champion of his department’s role in helping promote healthier communities. He has said so in many speeches, in his “FastLane” blog (take particular note of his posts on May 11, April 20 and April 6, 2010) and in other venues. He is a champion of this cause, but he is not alone in seeing that transportation investments and partnerships can do much to help achieve healthy outcomes in terms of physical fitness, obesity prevention, access to preventive health services, health improvements resulting from better access to fresh and nutritious food, and decreased incidence of chronic health conditions as a result of transportation-related environmental improvements in our air, soil and water.

Drawing on decades of research results from the Centers for Disease Control and Prevention (CDC) and other agencies, Title IV of PPACA addresses strategies to create healthier communities and improve public health outcomes.

The Secretary of Transportation is named to a 12-member council, chaired by the Surgeon General, that is to provide coordination and leadership to support prevention, wellness and health promotion and to help create and support the infrastructure that results in a healthier America. On June 10, 2010, Pres. Obama signed an executive order that officially brought this National Prevention, Health Promotion and Public Health Council into existence.

This council is charged with creating a National Prevention and Health Promotion Strategy, along with other reports and recommendations for improving the overall health status of Americans and their public health.

Prevention & Health: Putting Money on the Table

Reports and strategies, such as those to be pursued by this council, are important, but policy and federal investment are at least as important. Under PPACA, there is a $15 billion program of mandatory spending to provide a national investment in prevention, wellness and health promotion.

This prevention and wellness program is expected to build on a $640 million “Communities Putting Prevention to Work” program established under the American Recovery and Reinvestment Act (ARRA, or the "stimulus bill"). In that program, numerous projects have been launched by states and community-based organizations in efforts to increase physical activity, improve nutrition, decrease rates of childhood and adult obesity, and decrease smoking prevalence. As one illustration of this, the “active living” program established at Section 4201 of PPACA repeatedly cites “infrastructure improvements” as eligible uses of its appropriated funds, and the statute clearly includes transportation among that infrastructure.

Studies published by the Centers for Disease Control and Prevention (CDC) and others have shown that investments in public transportation correlate with positive health outcomes, and directly relate to this program’s goals of increased physical activity, reduced obesity, and improved access to nutrition. Under the ARRA program, administered by CDC, numerous projects that support active living and community design have been launched, including the inclusion of health outcomes in the transportation planning processes undertaken statewide in North Carolina and Rhode Island, to name but two examples.

This facet of emphasis on wellness and community health promotion is new under PPACA. It is an opportunity for the Department of Transportation to work with its partners to show that transportation activities, ranging from support of bicycle and pedestrian projects, to the support of enhanced public transit services, to the multidisciplinary planning and delivery of services envisioned under the DOT-HUD-EPA Partnership for Sustainable Communities, all play central roles in promoting and supporting a healthy America.

The Dept. of Transportation has acknowledged its role in this dimension of PPACA and health outcomes in its draft Strategic Plan. While many of the programmatic results from that plan are awaiting legislative authorizations, the DOT and its partners in the Coordinating Council on Access and Mobility (most of whom also are members of the newly established National Prevention, Health Promotion and Public Health Council) should begin discussing and coordinating likely federal strategies that promote transportation’s role in disease prevention and health promotion. This opportunity must not be wasted as a channel through which DOT, its federal partners and its non-governmental partners are able to promote outreach efforts, community partnerships, federally funded innovation, and other steps that produce demonstrable improvements in public health and nutrition access and outcomes.

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