Clean Transportation Is the Public Health Investment My Patients Need

In his first address to a joint session of Congress, President Joe Biden laid out his vision for a recovery from the COVID-19 pandemic, including a comprehensive plan to build back better by investing $2 trillion in our country’s aging infrastructure. In his speech, he pushed for a rapid transition to clean energy to create good-paying jobs, improve public health and meet the climate crisis head-on. Biden’s American Jobs Plan would also accelerate clean transportation with targeted investments in public transport and vehicle electrification. As a pediatrician, I know these measures are more than an economic stimulus: They are necessary public health interventions that will dramatically reduce the dangerous pollution that harms children.

Many people in this country live in communities where air pollution makes the simple act of breathing dangerous. Researchers estimate between 90,000 and 360,000 deaths every year in the United States are related to air pollution. We breathe in particulate pollution (PM2.5) that comes from the more than 276 million cars and trucks on the road, and it enters our bloodstream, causing a host of health problems including cardiovascular problems, diabetes, asthma and premature births.

Children are particularly vulnerable because they spend more time outside and breathe faster compared to adults, exposing them to more pollution. In the short term, higher particulate pollution levels result in more emergency room visits for asthma and increased lung infections in children. Early and ongoing exposure to air pollution can cause long-term health problems, putting children at higher risk for developing asthma, hypertension, obesity, type 2 diabetes and high cholesterol. Medical experts are also discovering how air pollution might affect us down to our very genes – increasing our risk for asthma in ways that can be passed down from parent to child.

This risk is not distributed evenly throughout our population. Transportation planners historically routed highways through Black and brown communities, cutting them off from opportunity and burdening them with the long-lasting effects of high levels of vehicle pollution. West Oakland, in the Bay Area where I live, was a thriving community until it was encircled by freeways to transport people into San Francisco from predominantly white suburbs. The freeways cemented decades of divestment and led to the Bay Area’s highest diesel pollution rates.

To protect our health, we must end our reliance on dirty gas and diesel and transition to electric vehicles. Creating a clean transportation system would be a major public health intervention, but research shows it’s also cost-effective. A new study found transitioning to all-electric new cars and trucks by 2035 could save consumers $2.7 trillion by 2050, an average of $1,000 per household, while creating 2 million jobs. Another study found electric freight trucks could be 50 percent cheaper than diesel by 2030, generating billions in savings. There’s really no reason not to make this transition and that’s why California, New York and Washington state, along with 15 other countries, have all committed to phasing out the gas car.

Ending our reliance on polluting vehicles is vital, but we must also invest in walkable, bikeable communities and accessible public transportation for all. It’s no surprise people living in walkable neighborhoods are physically and mentally healthier. And more equitable public transit options would create economic opportunity: Researchers at Harvard have found access to transportation is crucial to escaping poverty, and in many places, not having a car can mean walking miles to get to work.

The American Jobs Plan will invest in America’s aging infrastructure and bolster the economy, while improving air quality across the country. The plan would invest billions in transportation electrification and double federal spending for public transportation. It also includes a plan to advance environmental justice by reconnecting neighborhoods cut off by the federal highway system. But the president must also direct the Environmental Protection Agency to set much stronger national fuel economy and tailpipe emissions standards for all vehicle classes and commit to phasing out the archaic, gas-powered car.

As a hospital-based pediatrician, so much of what I do involves helping kids breathe. Whether it’s a premature infant whose walnut-sized lungs are too small to inflate without help or an older child with asthma who needs medication to open his or her airways, getting kids to the point of taking effortless breaths should feel rewarding. But I would much rather they lived in a world where they didn’t need my help to breathe at all. As Congress considers Biden’s infrastructure package, they must remember my tiny patients and the millions of children and others who struggle to breathe — and invest in an equitable, zero-emissions transportation system.


Dr. Lisa Patel is a clinical assistant professor in the Department of Pediatrics at Stanford University and formerly an environmental scientist with the Environmental Protection Agency. The views presented here are her own and not those of her employer.

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