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Suggested Citation:"Chapter 4 - Health Causes and Impacts." National Academies of Sciences, Engineering, and Medicine. 2022. Racial Equity, Black America, and Public Transportation, Volume 1: A Review of Economic, Health, and Social Impacts. Washington, DC: The National Academies Press. doi: 10.17226/26710.
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Suggested Citation:"Chapter 4 - Health Causes and Impacts." National Academies of Sciences, Engineering, and Medicine. 2022. Racial Equity, Black America, and Public Transportation, Volume 1: A Review of Economic, Health, and Social Impacts. Washington, DC: The National Academies Press. doi: 10.17226/26710.
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Suggested Citation:"Chapter 4 - Health Causes and Impacts." National Academies of Sciences, Engineering, and Medicine. 2022. Racial Equity, Black America, and Public Transportation, Volume 1: A Review of Economic, Health, and Social Impacts. Washington, DC: The National Academies Press. doi: 10.17226/26710.
×
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Suggested Citation:"Chapter 4 - Health Causes and Impacts." National Academies of Sciences, Engineering, and Medicine. 2022. Racial Equity, Black America, and Public Transportation, Volume 1: A Review of Economic, Health, and Social Impacts. Washington, DC: The National Academies Press. doi: 10.17226/26710.
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16 While some have argued transportation practitioners should avoid focusing on broad sociological issues such as public health, impacts of historical and current transportation inequities are particularly egregious within the context of public health outcomes. For example, as Black people encounter and experience harm as a result of biases, discriminatory transportation, and land-use priorities, environmental racism continues to be a leading cause of chronic illness for Black people in the United States and is, in several ways, married to the racialized impacts of past and present transportation-infrastructure-development practices. The prevalence of health disparities in predominantly Black neighborhoods was underscored by the racialized impacts of the COVID-19 pandemic as public health experts found predisposition to infection was directly linked with the impacts of environmental racism. Commonplace notions of public health have historically failed to acknowledge, and have even disregarded, specific health contexts rele- vant to Black people, so public health outcomes across disciplines, such as transportation, reflect this erasure. Environmental Racism Creates Inequitable Health Impacts The environmental-justice movement was born in the 1980s as activists found white-led envi- ronmental groups and civil rights spaces failed to address the specific and disproportionate impacts of toxic land use on Black people (Gomez et al. 2011). A relevant definition of envi- ronmental justice in this work is “equitable distribution of environmental risks and benefits [and] fair and meaningful participation in decision-making; recognition of oppression and difference in affected communities; and the peoples’ capacity” (Light and De-Shalit 2003) to self-determine notions of resourcefulness and sustainability that supports thrivance as a spatial attribute. This definition acknowledges racism as a primary cause of environmental inequities—environmental racism. Use of the word racism is deliberate and denotes that Black communities are planned for, resourced, and invested in differently based on race and targeted, either explicitly or implicitly, for environmental and health hazards. Environmental racism is the path by which metropolitan planning organizations (MPOs), urban planning, and transportation planning as a form of public health governance has failed—and continues to fail the Black population in the United States. The policies, practices, and decisions made by local, state, and government officials related to the placement of toxic transportation facilities, highways, and other industrial land uses are rooted in and continue the legacy of anti-Black racism. C H A P T E R   4 Health Causes and Impacts Relevant References and Tools Brown, C. Arrested Mobility Podcast Series. https://arrestedmobility.com/. Glave, D. 2010. Rooted in the Earth: Reclaiming the African American Environmental Heritage. Moore, N. Y. 2016. The South Side: A Portrait of Chicago and American Segregation. Taylor, S. R. 2018. The Body Is Not an Apology: The Power of Radical Self-Love.

Health Causes and Impacts 17   A confluence of factors sparked the environmental-justice movement, including the siting of a hazardous-waste landfill in Warren County, North Carolina, in 1982 and the backlash it provoked from the county’s largely Black residents (McGurty 2007). Despite direct action, the landfill was ultimately constructed. Two academic studies that followed provided evidence supporting the notion that hazardous-waste landfills were disproportionately sited in commu- nities where Black people lived. The U.S. General Accounting Office, now the U.S. Government Accountability Office, found that Black communities in the South hosted a disproportionately high number of hazardous-waste-disposal facilities (U.S. Government Accountability Office 1983). A later study conducted by the United Church of Christ Commission for Racial Justice found that race was the most important factor in determining where toxic-waste sites were located across the country (Chavis and Lee 1987). From these initial findings of environmental racism, a burgeoning interdisciplinary academic literature on environmental justice has emerged and expanded to encompass myriad hazards, demographics groups, increasingly sophisticated quantitative analysis, qualitative work, rigorous social theory, and robust engagement between academic researchers and social movements (Sze and London 2008). In general, the findings uncovered during the 1980s have held strong in the subsequent decades (Maantay 2007; Mohai et al. 2009). Research has consistently shown that Black people in the United States are burdened with health impacts resulting from environmental racism. Locally, the placement of toxic infrastructure in Black communities and other undesirable land uses affect air quality, which is a critical driver of morbidity and mortality. Proximity to high-traffic roadways affects nearby air quality, increases noise exposure, introduces visual intrusions, and increases crash risk in Black neighborhoods. Below, the research team summa- rizes key literature linking air quality and roadway proximity to disparate health outcomes for Black people in the United States. Toxic Industries Do Immediate Harm to Black Communities A 2017 report coauthored by the Clean Air Task Force and the National Association for the Advancement of Colored People examined the health impacts caused by oil and gas refineries to nearby Black communities (Fleischman and Franklin 2017). The study found that over one million Black people in the United States live in counties that face a cancer risk exceeding the EPA’s level of concern from toxins emitted by natural gas facilities. Areas near refineries show elevated levels of benzene, hydrogen sulfide, formaldehyde, ozone, and volatile organic com- pounds, which can cause cancer, birth defects, and chronic conditions like asthma. The report demonstrates that Black people are more likely to live in “fence-line” communities and also experience worse air quality. A prime example highlighted in the report is that of Port Arthur, located on the Gulf of Mexico near the Texas-Louisiana border. The population of West Port Arthur is predominantly Black, 95%, and has been unfairly burdened by the proximate place- ment of multiple oil refineries. As a result, cancer rates among Black residents of Jefferson County, where Port Arthur is located, are 15% higher. Additionally, residents of West Port Arthur were four times more likely than people residing approximately 100 miles upwind to suffer from heart and respiratory conditions; nervous system and skin, head, and muscle aches; and ear, nose, and throat problems (Fleischman and Franklin 2017). The increased risk of illness due to toxic environmental conditions coupled with another land-use challenge—access to medical care—contributes to exacerbated early death and quality-of-life challenges for Black people in the United States. Environmental racism goes beyond the oil and gas industry. Burby examined industrial pollution in Baton Rouge, Louisiana, and how this pollution affects Black neighborhoods (1999). Burby examined the distribution of industrial facilities and the state of Louisiana’s data in the

18 Racial Equity, Black America, and Public Transportation US EPA’s Toxics Release Inventory, which provides data on certain toxic chemicals emitted to the air or water or placed in some type of land disposal. He found that Black Baton Rougeans were generally located closer to industrial facilities, had over twice as many facilities located within 3 miles of their homes, and experienced releases of over twice as much toxic air pollution as that experienced in predominantly white neighborhoods. The author also found that proximity to facilities was associated with higher levels of self-reported poor health (Burby 1999). In general, Black people have been significantly more likely to be exposed to industrial hazards than white people, and that exposure has negative effects on health and neighborhood safety. These industrial hazards come from many types of industry and include the placement of trans- portation facilities, refineries, and other industries. Placement of these facilities impacts air and water quality, eventually impacting human health. In addition, “accidental” chemical releases were a growing concern for air quality, citing incidents at Chevron facilities in largely Black Richmond, California, in 2007 and 2012 and BP facilities in Texas City, Texas, with substantial Black populations, in 2010. Proximity to Highways and Main Roads Causes Generational Health Implications In addition to industrial facilities, highways themselves engender environmental racism. Often built to expedite travel of white people and high-wealth people to and through urban centers, at the expense of low-wealth and Black communities, highways generate noise and air pollution, create visual intrusions, and affect community cohesion. The magnitude of these impacts is affected by proximity to the highway. Black people are disproportionately repre- sented among those who live near heavily traveled roads. Rowangould estimated the number and distribution of people living near roads with greater than 25,000 average annual daily traffic (2013). Using census data, he found that 19.3% of the United States population lives near high- volume roads but that this number increases to 23.7% for Black people. Multiple studies have examined the health impacts of living near heavily traveled roads and demonstrated that these impacts are borne disproportionately by Black neighborhoods. Nationwide, asthma is twice as common among Black people as asthma is among whites and, while Black people make up 12% of the United States population, account for 24% of asthma-related deaths. Though not all of this disparity is attributable to transportation-related air-pollution exposure, other work has shown a strong and significant correlation between proximity to heavy automobile or truck traffic and increased difficulty breathing and higher asthma incidence (Sanchez et al. 2003). Similarly, multiple studies in New York City have shown that increased exposure to air pollution was associated with asthma in neighborhoods with majority racialized populations (Sanchez et al. 2003; Maantay 2007). Pollution-related morbidity is particularly prevalent in the Bronx. Maantay found that people living near toxic land uses were up to 66% more likely to be hospitalized for asthma and 30% more likely to experience barriers to accessing wealth (2007). Ryan et al. examined air pollution in Cincinnati and found that Black people were more likely to live near stop-and-go traffic, and Black children were twice as likely to experience wheezing when compared to their white counterparts (2005). Almost one quarter of Black infants exposed to stop-and-go traffic were wheezing before their first birthday (Ryan et al. 2005). Commuter- and Pedestrian-Focused Pathways Increased risks of injury and death from traffic crashes involving all modes is another example of the health impacts of transportation planning for Black people. Hamann et al. demonstrated a higher risk of hospitalizations for pedestrian-related injuries for Black people relative to residents

Health Causes and Impacts 19   of Asian descent and white residents (2020). Black people and Indigenous people are also much more likely to be killed while walking compared to all other racial and ethnic groups (National Complete Streets Coalition and Smart Growth America 2021). Similarly, Black and Indigenous people experienced the highest growth rates in all traffic-related fatalities during 2020 (NHTSA 2021). These disparities in crash burden are a result of inadequate and unsafe infrastructure and a lack of safe and efficient travel choices stemming from transportation-planning priorities over time in predominantly Black neighborhoods. Pandemic-Era Transportation Policy and Planning Changes Have Disproportionately Affected Black Communities As COVID-19 spread across the United States, traffic and transit ridership plummeted. Transportation planners responded to these changes, often in ways that disproportionately affected Black people. One of the ways this was immediately felt was in heavy cuts to public transportation. Across entire systems, planners responded to the drop in ridership and revenue by cutting service of all types. Some of these services, such as commuter bus and rail systems of all types, saw dramatic declines in ridership. However, partly due to the Black riders that repre- sented nearly 40% of transit’s peak pandemic ridership, bus service remained relatively strong in many cities (Verma 2020). Commuters that had no choice but to commute via public transit during the pandemic were faced with longer waits, longer travel times, and crowded buses as they attempted to complete daily tasks (He et al. 2022). These negative effects of reduced service resulted in many Black workers struggling to juggle longer and less certain commute times with concerns about their health (Verma 2020). These cuts were even more detrimental for late-shift workers, who saw their options disappear (Puentes 2020). As the United States continues to recover from the pandemic, many transit agencies are making overtures to their lost ridership, especially those who used to ride commuter services such as express buses and commuter rail (Olander 2021; Yen and Weber 2021). In Los Angeles, San Francisco, Washington, DC, and many other cities across the nation, prepandemic bus service has not recovered (Klumpenhouwer et al. 2021); even as bus ridership continues to outpace train ridership, Black riders once again risk being further marginalized. The literature shows that while public transit services were cut and millions of Black people were suddenly struggling to find a means to complete daily tasks, white people, many at home, struggled with how to interact with public space during the pandemic. Former commuters, whose pre-COVID-19 travel and recreation behaviors included being in outdoor spaces, appropriated additional outdoor spaces near their homes during the pandemic. For example, roadways were transformed into walkways, parks became outdoor offices, and sidewalks became outdoor eateries. This moment was recognized by many transportation planners across the country, who quickly seized the “opportunity” presented by the pandemic to close streets to all but local traffic. Slow streets, or safe streets, as they began to be called, experienced a rise to prominence across the United States, and their advent brought about substantial consternation among many of the Black communities that lay in its wake (Bliss 2021). Perspectives revealed through the literature highlight the ways municipalities found the resources to quickly respond to the needs of their wealthy and white residents early in the COVID-19 pandemic, while Black residents sought answers to long-standing access and infrastructure-related issues that had not been addressed. These issues were compounded by the decades during which transportation planning and infrastructure development eroded quality of life in Black neighborhoods while prioritizing the preferences and multimodal needs of white riders.

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An overall objective of the transit community is to help develop an enhanced and more inclusive approach to public transportation planning and decision making. Public transportation planners have a critical role in addressing and correcting many of the problems caused by a 20th- and 21st-century transportation sector that severely impacted and, in some cases, destroyed Black communities in the building of today’s transportation systems and network.

The TRB Transit Cooperative Research Program's TCRP Research Report 236: Racial Equity, Black America, and Public Transportation, Volume 1: A Review of Economic, Health, and Social Impacts reviews the literature and summarizes common practices of the 20th and 21st centuries that had significant economic, health, and social impacts, and the racial gaps that emerged as a result of transportation inequities, deliberate actions, policies, and projects.

The objective of Volume 1 is to document the extent of the damage that has been done to Black communities as a result of transportation decisions and actions. Volume 2 will demonstrate a methodology to estimate how much it would cost to redress those damages. Volumes 3 and 4 will provide tools for elected and appointed officials and other stakeholder groups to engage effectively in the arena of transportation policy, planning, and funding at all levels of government.

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