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The Spatial Trap Exploring Equitable Access to Public Transit As a Social Determinant of Health

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The Spatial Trap Exploring Equitable Access to Public Transit As a Social Determinant of Health The Spatial Trap Exploring Equitable Access To Public Transit As A Social Determinant Of Health By Ron Wray October, 2013 The Wellesley Institute engages in research, policy and community mobilization to advance population health. Acknowledgments The Wellesley Institute would like to thank the hard work of all of our external reviewers. Copies of this report can be downloaded from www.wellesleyinstitute.com. The Spatial Trap | Policy Paper © Wellesley Institute 2013 10 Alcorn Ave, Suite 300 Toronto, ON, Canada M4V 3B2 416.972.1010 [email protected] TABLE OF CONTENTS Introduction .................................................................................................................................................2 How do we currently think about transportation and public transit? ........................................................3 The economic policy frame ...................................................................................................................3 Bringing health in: a population health policy frame ..........................................................................4 Choice riders and other priorities: who gets missed? ..........................................................................4 Towards a health equity policy frame ...................................................................................................5 Public Transit and the spatial trap ..............................................................................................................8 Employment ..........................................................................................................................................9 Access to goods and services ...............................................................................................................11 Social networks/social capital .............................................................................................................13 Implications of the spatial trap ...........................................................................................................13 Wrapping health equity evidence in context: Toronto transportation & demographics .........................14 Implementing the Big Move in Toronto .............................................................................................15 Changing demographics of mobility and work in Toronto/shifting spatial traps ............................16 Transit affordability ............................................................................................................................20 Conclusion – framing equitable public transit as a social determinant of health ...................................20 Framing public transit as a health equity issue ..................................................................................21 Asking the right questions: health equity impact assessment...........................................................21 Answering the right questions: health equity transit metrics, data and targets ...............................22 Who pays for equitable public transit? ...............................................................................................23 Concluding remarks ............................................................................................................................23 References ..................................................................................................................................................24 EXECUTIVE SUMMARY The Spatial Trap: Exploring Equitable Access To Public Transit As A Social Determinant Of Health With The Big Move, Ontario’s regional transportation authority, Metrolinx, unveiled a bold vision to transform how people in Toronto and the Greater Toronto Area (GTA) move about their daily lives. Not only will the transformation improve the efficiency of our roadways and transit lines through the reduction of traffic congestion, it will represent a significant investment in improving the health of all residents by decreasing harmful pollution and greenhouse emissions and increasing healthier forms of commuting such as transit, cycling and walking. And yet, in many respects, the vision is two dimensional. With a focus on what are called “choice riders” – moving upper and middle class persons from private vehicles for their commute to public transit options (there is a gap in priorities). Less evident in the planning and debate are the social needs of those with limited or no options: those who rely on public transit, or worse, cannot afford even that. Without affordable, available and accessible public transit, more marginalized residents such as single mothers, people with low income and recent immigrants are faced with restricted mobility, and this further limits their economic opportunity and access to other determinants of health such as healthy food and recreation. In essence, we need to complete the public transit picture with the introduction of a further dimension: health equity. The purpose of this paper, then, is to shape the ongoing debate and how we think about public transit in Toronto – a future in which public transit represents a vital form of re-connecting individuals and communities caught in a spatial trap of social exclusion. The report reviews the international evidence on how public transit can enhance mobility and potentially improve the health and well-being of the most socially excluded, and considers the evidence on the existence of spatial traps in Toronto. In conclusion, the report identifies the elements of a health equity transit frame to pose the essential questions on equity and fairness that should be asked of each local, city or regional transit proposal. The Three Policy Frames Of Public Transit Traditionally, transportation and public transit planning has been bound within the confines of one policy frame, economics. From this frame, the functional objectives of planning are clear and specific: how can we move the most people and goods within the city and region in a time and cost efficient manner. While obviously essential to the productivity and competitiveness of the local economy from which many of us benefit, this policy frame too often ignored equally large questions about other aspects of health and well-being. Over the last three decades, population health research and advocacy have drawn attention to the need to address harmful externalities of transportation (e.g., air pollution, injuries/accidents) and the health promotion potential of increasing physical activity through active transportation (OMA, 2005; Toronto Public Health, 2007, 2011) Slowly over time, there has been a convergence of these two policy frames with mutually beneficial focus on expanding public transit options that reduce the use of private vehicles, thereby simultaneously decreasing traffic congestion and health harming externalities. EXECUTIVE SUMMARY | THE SPATIAL TRAP More recently, transportation and public transit research has drawn attention to another dimension of economic well-being and population health – social exclusion (Lucas, 2012). That is, the recognition that in a modern geographically dispersed society, acquiring health promoting social determinants such as decent work and healthy food is inextricably tied to mobility (Cass, Shove & Urry, 2005; Kenyon, 2003; Urry, 2002). However, for many, mobility is dependent on public transit. When such transit is not readily available, accessible, or flexibile, those dependent on transit face a form of social exclusion that can reduce employment opportunities and earnings (Blumenberg & Ong, 2001; Cervero, Onesimo & Landis, 2002; Plaut, 2006; Preston, McLafferty and Liu, 1998; Van Ham, Multer & Hooimeijer, 2001; Van Ham, 2001). Even grocery shopping or dropping off a child a day care can becomes an arduous trip, if not impossible, venture (Blomenberg and Ong, 2001; Grieco, 2003; Health Development Agency, 2005; Kenyon, 2003). In essence, the lack of accessible and timely public transit creates a spatial trap of limited life chances – a silent architect of health inequities. Alternatively, the availability of public transit can re-connect the socially excluded to economic opportunity, essential goods and services and other preconditions of good health. Public Transit And The Spatial Trap: Reviewing The Evidence The exclusionary force of inequitable transit and the spatial trap has been observed in countless studies over five decades in a wide variety of developed countries including the Canada, the U.S., the U.K., Australia and others. Accordingly, a robust body of evidence exists outlining the links between the lack of public transit and reduced economic opportunity and social mobility: 1. Employment: The physical mobility to move from one place to another for different purposes is linked to our ability to achieve economic and social mobility, with spatial flexibility intrinsically linked to employment and earnings (Preston, McLafferty and Liu, 1998; Van Ham, Multer & Hooimeijer, 2001; Van Ham, 2001). It is not surprising that low income populations frequently cited transportation as a key barrier to jobs or better paying work. Studies have empirically observed a relationship between the high cost of travel and rates of unemployment and low earnings (Blumenberg & Ong, 2001; Selod & Zenou, 2007; Van Ham, Multer & Hooimeijer, 2001). There is a strong association between proximity to a transit stop and employment and this that is further affected
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