Transportation's Role in a Pandemic of Inequality
There will be many painful lessons to learn from this pandemic, not the least of which is that it pays to be white. Minorities have borne the brunt of COVID-19 related burdens. Deaths from the virus are three times higher for Black and Hispanic Americans compared to Caucasians. Indigenous Americans fare even worse.
Spiraling healthcare costs are a frequent scapegoat. Communities of color often lack health insurance and can’t afford pricey medical treatments that proactively manage illness. Lowering healthcare costs will — we are told — reduce racial disparities in health. I doubt it. Lower prices may nudge America’s poor towards using health services but the ability to do so ultimately hinges on getting around.
Every year, more than three million Americans miss or delay non-emergency medical care due to inadequate transportation access. Existing mobility options are — for many struggling Americans — less than ideal. Owning a car is pricey. Riding the bus takes too long (assuming it shows up at all).
When buses do show up, they don't always get people where they need to be. Take Washington, D.C. The nation's capital ranks near the top for its public transit system. But top marks can be deceiving. Metrorail, buses and regional commuter trains often offer wealthier neighborhoods and suburbs easier access to urban cores than what's available to lower-income neighborhoods in the District. When poor communities are serviced, commuting times are longer making it more harder to access clinics, pharmacies and hospitals.
The result is a worsening of existing health inequalities. That socioeconomic disparities in health persist even in countries that offer universal health coverage should come as no surprise. Free scans, screenings and shots do little to improve the health of poor people when those people can’t get to the doctor’s office in the first place.
Medicaid should offer relief. The government-backed plan assures users, “rides to and from providers when necessary” and tens of millions of low-income Americans take the government up on that offer annually. But funding shortfalls, financial mismanagement and poor service reliability make the program less than ideal. Medicaid is for many, the poster child of government inefficiency, not prowess.
Which brings us to COVID19 vaccine distribution. President Joe Biden has promised 100 million COVID vaccinations in his first 100 days. That’s nice. It would be nicer if we knew how the poor are expected to reach vaccine clinics. The White House should be commended for pursuing the, “effective, equitable distribution of treatments and vaccines — because development isn’t enough if they aren’t effectively distributed.” But administration officials should be rebuked for providing little clarity on how ‘equitable distribution’ will be achieved.
Reports abound of some clinics being set up far away from impoverished communities. If this persists, expect communities of color to be left behind during the vaccine rollout.
To truly get the COVID-19 pandemic under control, America needs a bold transportation plan. A national conversation about addressing inequality, inequity and disparity is a fruitless endeavor if transportation barriers are ignored. We need to find ways to make mobility more affordable, more convenient, and yes, more sustainable for society’s most vulnerable. Inaction risks – as Transportation Secretary Pete Buttigieg recently noted — reinforcing, “racial and economic inequality by dividing or isolating neighborhoods.”
COVID-19 isn’t the first pandemic to expose structural inequalities in society. When the Spanish flu hit, it was the working poor — not the rich — that were first infected and ultimately, most affected. A century later, history has repeated itself. We are admittedly too late to reverse course for this pandemic. However, with the right policies, we can be ready for the next one.
Ashley Nunes is the R Street Institute's Director of Competition Policy and research fellow at Harvard University.
