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Perspectives | Expert Voices in Health & Health Care One of the most neglected social determinants of health is access to adequate transportation. While housing, education, social inequality (as refl ected by the Gini coeffi cient), and income are widely recognized as important factors of well-being, it is striking that the public health discourse on transportation has overwhelmingly emphasized the negative aspects [1]. These include crashes, injury, mortality, pollution, lack of exercise, and noise. A worthy public health emphasis on active mobility through walking and cycling may have also overshadowed the central role of transportation as driver or passenger in an automobile for the majority of the US population who do not have access to eff ective public transportation or who have compromised personal mobility. Recent evidence points to the negative consequences of restricted personal vehicle transportation on an individual’s independence, emotional and social well-being, and life expectancy. The public health bias towards the negative aspects of transportation issues, particularly driving, has led to observed disengagement of physicians and other clinicians in assessing and promoting medical fi tness to drive and a failure to consider the transportation needs of patients when accessing health care services [2]. For those clinicians who do address fi tness to drive, few supports exist. At the federal level, a standard for fi tness to drive exists only for commercial drivers (Federal Motor Carrier Safety Administration 49 CFR Part 391). At the state level, regulations vary regarding medical standards for fi tness to drive and requirements for mandatory reporting of impairment. Seventeen states lack medical advisory boards to guide these regulations, and thirteen states lack internal medical units to review medical evaluations and/or need for re-examination of referred drivers [23]. States without such medical support systems rely on individual physician opinion about fi tness to drive and driving impairment despite a general lack of physician knowledge of medical fi tness-to-drive guidelines [3]. It is not surprising, therefore, that there has been little dialogue between the fi eld of health care and the main disciplines involved in transportation, such as transportation planners and engineers. However, the beginnings of a rapprochement between the fi elds has begun, through an emerging focus on the impact of disease and disabilities on transportation mobility and driving safety. This emerging scientifi c foundation should replace stereotypes, opinions, and anecdotes, and should guide evidence-based transportation counseling for older drivers, young drivers, and those with medical conditions and disabilities. Ensuring that individuals have equitable access to transportation is vital to ensuring well-being across the life span. Therefore, there is a need for a balanced perspective that can appropriately weigh actual safety risks against the real health consequences of restricting mobility, and a partnership between the fi elds of health care and transportation could facilitate this balance. More sophisticated, individualized approaches and modeling are becoming available and could allow for “personalized prevention” that optimizes outcomes not only for older adults but also across the life span.

Transportation Equity, Health, and Aging: A Novel Approach to Healthy Longevity with Benefits Across the Life Span