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I remember it like it was yesterday. I was teaching my beautiful youngest daughter to ride a bike. In addition to being adorable, she had a bit of a temper. After falling again and again, she became so frustrated with the bike that she bit the pedal in anger. Fortunately, this little tyrant grew into an exceedingly mature and empathetic college graduate with more emotional intelligence than I will ever have.

What this story still evokes in me is the very emotional nature of transportation. The ability to move around freely in a variety of situations is a deeply important need for humans. Transportation is also deeply and inextricably linked to health.

Transportation is acutely on our minds now because of the big increase in gas prices this summer. Many families are re-evaluating road trips, batching errands and carpooling. Sales of hybrid and electric vehicles increased significantly from 2020 to 2021. In June, The White House announced that companies were investing $700 billion “to boost U.S. manufacturing capacity for electric vehicle (EV) chargers.”

Transportation is clearly an important factor in our everyday lives, but we may fail to appreciate how critical it is to our health. When transportation is consistently unavailable or inaccessible, meeting basic needs becomes challenging or impossible. Read on to learn how efforts to transform transportation could change our health for the better.

More Options, New Opportunities

Since emerging roughly 10 years ago, ridesharing companies Uber and Lyft have created Uber Health and Lyft Healthcare to provide nonemergency rides to and from medical appointments. Health care systems can use these services to give providers the ability to schedule transportation for qualifying patients and pay for the ride, which is covered by some insurance companies. Nemours Children’s, for example, partners with Uber Health in the Delaware Valley to ensure that children don’t miss critical appointments.

Why would systems like Nemours and payers like Medicaid incorporate rideshares into the provision of health care?

Because rideshares help to ensure that patients are seen before their condition worsens, becoming more urgent and expensive to treat. In other words, tackling transportation challenges improves outcomes for patients — and improves the efficiency and efficacy of health care systems too.

As I have said many times before, health is about so much more than medical care — other factors, like nutrition, are essential to health. But what if you can’t get to the grocery store? Ridesharing may offer a solution here too. For example, through the Lyftup Grocery Access Program in Atlanta, Indianapolis and Baltimore, residents who live in food deserts can secure $2 rides to and from participating grocery stores. Even with gas prices as high as they are, doing one less MRI for advanced disease or preventing one unnecessary procedure can pay for an awful lot of rides.

In addition to transportation that takes you to grocery stores and doctor’s appointments, more and more communities are encouraging a mode of transportation that promotes health through its very use: bicycles (please don’t bite the pedals). As Jill Lepore notes in a recent issue of The New Yorker, “More people get places by bicycle than by any other means, unless you count walking, which is also good for you, and for the planet, but you can travel four times faster on a bicycle than on foot, using only a fifth the exertion.”

To encourage more travel by bicycle, cities from Boston to Missoula are expanding bike lanes, and communities are building networks of bike paths, like the East Coast Greenway. Though interest in bicycle infrastructure projects seems to be rising, the concept has been around for a while. In the 1930s, as cars became increasingly common, author E.B. White voiced his support for bike paths. “A great many people have now reached forty years of age in this country,” he noted, “ … and they are the ones who specially enjoy bicycling, the men being somewhat elated on discovering that they can still ride with no hands.”

Today, almost a century after White described the joy of riding with no hands, more Americans are discovering that they can ride a bike with little to no pedaling at all. An NBC News analysis found that e-bike rides jumped from 11% or 240,000 trips in May 2020 to 38% or 1.4 million trips in May 2021, according to data collected from 11 cities with e-bike ridesharing programs.

Even so, many Americans lack access to an e-bike ridesharing program, and e-bikes can be expensive to own and maintain. To encourage more e-bike ownership, local and state governments and the federal government are considering and implementing purchase incentives (like a proposed 30% refundable tax credit). In the meantime, cities like Los Angeles and Buffalo are establishing “e-bike libraries.” In partnership with the nonprofit Shared Mobility and stocked with e-bikes donated by Uber JUMP, these libraries allow members to borrow bikes at no cost for months at a time.

Though more expensive than their nonelectric predecessors, e-bikes are still significantly cheaper to own and maintain than cars. As the authors of a recent paper (PDF) on e-bike adoption explain, “The comparatively low ownership and operation cost of an e-bike is a potent argument for the potential for e-bikes to work as an equity-driving tool” as well as the potential to help cities reach ambitious transportation and environmental goals.

Fewer Premature Deaths, Billions in Savings, Greater Economic Resiliency

Transportation represents a significant barrier to care for many people, especially those in vulnerable groups like children. America could save billions of dollars by facilitating access to transportation options that allow individuals to visit the doctor, purchase nutritious food, and maybe even exercise in the process. But there’s another way that transportation matters to health. Vehicle emissions contribute to air pollution that negatively impacts our health. Nemours saw this first-hand when we discovered that idling school buses were related to a significant number of asthma-related visits to our ER.

Fortunately, a team led by Cornell University found greater adoption of electric vehicles, driverless cars, and ridesharing could prevent “5,500 premature deaths, with an annual savings of $58 billion” by 2050. According to their models, the states likely to experience the “largest decreases in premature mortality” include California, Texas, New York, Ohio and Florida.

The interdisciplinary team behind these promising numbers used sophisticated models to generate their estimates, but we also have “real-world” evidence from the COVID-19 crisis. Ridesharing provided a critical transportation option to essential workers during the pandemic, explained The World Economic Forum. The organization also noted that research shows adoption of “emerging mobility technologies like shared, electric and autonomous mobility (SEAM) over the next three decades could increase accessibility, social equity, and economic growth while reducing transport emissions by more than 80%.”

The Future Is Now...Almost

Movies and tv shows have depicted futures where we ride around in flying cars and take rockets on interplanetary vacations. We’re not there yet, but we are making progress — like the driverless shuttle patients and families can use when visiting Nemours Children’s Hospital, Florida in Orlando.

As I wait for my flying car, I’ll take some inspiration from E.B. White and see if I can still ride my bike with no hands — while wearing a helmet, of course!

About Dr. Moss

R. Lawrence Moss, MD, FACS, FAAP is president and CEO of Nemours Children’s Health. Dr. Moss will write monthly in this space about how children’s hospitals can address the social determinants of health and create the healthiest generations of children.