IPATH Policy Statement
On 13 February 2025, President Trump took the initiative to create the Make America Health Again Commission (Section 3). MAHA represents a multi-disciplinary team with the responsibility of tackling the nations chronic disease epidemic. IPATH applauds this effort and suggests that a representative from the field of transportation be added.
The policy brief below was sent to the following US leaders on 17 February 2025, in response to the development of the MAHA Commission:
On 13 February 2025, President Trump took the initiative to create the Make America Health Again Commission (Section 3). MAHA represents a multi-disciplinary team with the responsibility of tackling the nations chronic disease epidemic. IPATH applauds this effort and suggests that a representative from the field of transportation be added.
The policy brief below was sent to the following US leaders on 17 February 2025, in response to the development of the MAHA Commission:
- Donald J Trump, US President
- Robert F. Kennedy, Secretary Department of Health Human Services
- Sean Duffy, Secretary of Transportation
- Michael Johnson, US House Speaker
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Memorandum
To: Robert F. Kennedy Jr., Secretary of Health and Human Services
From: International Professional Association for Transport & Health (IPATH) https://www.ipathinc.org/ and Transportation Public Health Link (TPH Link)
RE: Make America Healthy Again (MAHA): An integrated approach to the US chronic disease epidemic based on the sociopolitical, economic and environmental elements of transportation sustainability
Date: 17 February 2025
Overview
Chronic health conditions such as heart disease, cancer, and diabetes are the leading cause of illness, death, and disability in the United States amounting to $4.5 trillion in annual health care costs. It is estimated that six in 10 Americans have at least one chronic disease, and four in 10 have two or more chronic health conditions. Ironically, many chronic diseases are caused by lifestyle choices such as smoking, poor nutrition, physical inactivity, and excessive alcohol use.
The synergy of risk and protective factors involved in the development of chronic disease accounts for the psychological/behavioral, social and biological contexts over time beginning with preconception and extending through to old age. The emphasis is on individual choice and how choice sets in motion one's life trajectory and social well-being.
Transportation serves a critical role in this trajectory by connecting citizens to the activities required to thrive and develop healthy lifestyles. The choice of transportation modality is dependent upon place of residence (urban, suburban or rural) in which an individual may choose to walk, ride a bicycle; use public transit, rail; ride share services, or drive a motor vehicle. These choices are influenced by the availability of transportation alternatives within a community, perceived personal and budgetary constraints, attitude (cultural influences), habit and educational information. As such human utility and the interplay of life stressors manifest in the body as chronic disease. Further, community level stressors such as persistent poverty, unemployment, substandard housing, lack of affordable housing, or no housing (homelessness), lack of transportation, increasing rates of crime, violence and threats of personal harm whether real or perceived are all known to exert cumulative adverse health effects that result in chronic disease.
These stressors are also known to have a negative impact on patients who are readmitted to the acute care hospital setting and/or emergency department (ED) for chronic illness exacerbation. Missed clinic visits and frequent ED admissions place additional strain on an overburdened healthcare system through increased service utilization and increased overall healthcare costs. However, it also negatively impacts patient-perceived health outcomes, (e.g., functional status and quality of life) and patient satisfaction.
Taking all of this into account, it is obvious that transportation is critical to the upstream factors associated with the Social Determinant of Health (SDOH) and the adverse effects of social disadvantage, risk exposure, and social inequities that play a causal role in poor health outcomes (downstream SDOH). This is particularly true for chronically ill patients living in rural communities that lack the financial resources to provide reliable public transportation. Many of these rural patients are older with physical and/or psychological disabilities. They tend to have limited access to specialized care due to geography (i.e., services are located at regional healthcare facilities as opposed to availability within the local community), an inability to drive, live in poverty, experience safety concerns, and often feel a loss of freedom (for those with disabilities), which ultimately impacts health equity.
Disinvestment and budget cuts to public transportation have created a fragmented system and exposed the health inequities within rural and urban communities. There is an unmet need to provide alternate transportation options to the most vulnerable segments of the citizenry to promote access to healthcare, nutritious foods, education, employment and other activities of daily living. This represents an opportunity to improve overall community health and reduce health disparities that manifest as chronic disease.
Strengthening Federal Response through Collaborative Workforce Development
Based on a systematic problem-solving approach that accounts for the synergy between the social (health), political, economic and environmental elements of sustainability it is vital to support the inclusion of a cross-disciplinary and multi-sector team of professionals in the design, planning and development of proposed and rehabilitated transportation infrastructure projects. In this way, appropriate quantitative and qualitative research, performance metrics, and strategic management methods can be implemented to effectively evaluate the health impacts of a proposed transportation project that places PEOPLE FIRST in the decision-making process. Until recently, traditional perspectives of the built environment as it relates to the transportation infrastructure and its direct impact on public health has received cursory attention by policy advisors.
This systematic workforce development approach includes planning and development, continuous process improvement, impact evaluation, data analyses, and outreach and education to drive the process. As funding streams continue to shrink and the demand for accountability and improvements in operational efficiencies increase, it will be imperative for transportation to partner with nontraditional entities, in particular, Health and Human Services to devise strategic goals, transparency, and innovative ideas that meet the health and transportation needs of the US population.
Resolving the Problem
Transportation is a vital component to community sustainability in terms of accessing health care, housing, nutritious foods, education, employment, leisure activities, and social networks. Thus, activity patterns, personal decisions, behavioral rules and the travel environment influence a person’s travel behavior with respect to the multidimensional nature of choice and the impacts of developing chronic disease. The nation needs to develop innovative solutions that focus on transportation insecurity in its most vulnerable citizens.
A proper analysis of chronic disease should be based on a systems approach that considers the synergy of risk and protective factors as opposed to a single exposure such as surface transportation. A comprehensive assessment is required of the sociopolitical, environmental and economic impacts, while promoting community cohesion and participatory representation. Based on a multi-dimensional integrative problem-solving approach, this process has the flexibility to account for individual determinants of health acting at different levels resulting in an upstream perspective to understand the impact of a proposed facility on quality of life in the affected community.
The inclusion of health state (i.e. asthma, cardiovascular disease, obesity, diabetes, etc.) into a build and no build scenario of a transportation project and its alternatives will provide important health estimates to overall community impact. Even when accounting for the uncertainty and inconsistencies of publicly available data (i.e. secondary reporting) this level of analysis by a trained expert demonstrates an estimate of cumulative impact and provides decision makers with better information. Expanding the team to include public health professionals comparable to an epidemiologist and economist provides the skill set needed to evaluate population demography and conduct combined cost-benefit/cost effective analysis. Resource limited communities would have the option of utilizing publicly available quantitative and qualitative tools. For example, Community Analyst and Streetwyze are public health epidemiological based tools used to evaluate demographic, health, economic, education, and business data variables, combined with instant reports and interactive color- coded maps to provide characteristics of area geographic context such as congressional district, block groups, census tracts, or zip codes.
Cross-Disciplinary and Multi-Sector Workforce Collaboration
Changing the trajectory of the chronic disease epidemic in the United States will require mutual collaboration, communication and commitment between all stakeholders; transportation firms-consultation and design, transportation/urban planners, federal/state Department of Transportation (DOT), local Metropolitan Planning Organizations (MPO), health/risk assessor, public health advocates and practitioners, communications specialists and the PUBLIC. Although there is a potential for disagreement, a cross-disciplinary and multi-sector team of this nature has the advantage of observing a problem from many different perspectives. To this end, innovative solutions to potential problems are mapped out (risk management and mitigation), concerns are addressed, and re-engineered policies are built into an existing political framework, ensuring long-term sustainability through improved community livability, health outcomes, quality of life, and reduced healthcare costs.
Improving the Nation’s Chronic Disease Epidemic
Given the state of the nation's inefficient and inequitable transportation infrastructure, poor health outcomes, and public demand for accountability of taxpayer dollars, conditions are ideal to implement such a change. It is time for the federal government to be proactive instead of reactionary when it comes to the health and wellbeing of all the nation’s people.
The International Professional Association for Transport & Health (IPATH) along with our social and spatial epidemiology real time data team, Streetwyze and Social Innovation, Universal Opportunity Labs (SOUL Labs) and professional consultant, Transportation Public Health Link (TPH Link), are uniquely positioned in the transportation and health sectors to assist Mr. Kennedy to achieve the goal of tackling the Nation’s chronic disease epidemic through a cross-disciplinary and multi-sector collaborative group of academic researchers and professional practice personnel and resources.
Acknowledgment and Contact
Karyn M. Warsow, MSc., MPH, DrPH(c)
Founder/Chief Executive Officer
International Professional Association for Transport & Health (IPATH)
Transportation Public Health Link (TPH Link)
4947 Hallenius Road
Gaylord, Michigan 49735
[email protected]
231.546.3462
To: Robert F. Kennedy Jr., Secretary of Health and Human Services
From: International Professional Association for Transport & Health (IPATH) https://www.ipathinc.org/ and Transportation Public Health Link (TPH Link)
RE: Make America Healthy Again (MAHA): An integrated approach to the US chronic disease epidemic based on the sociopolitical, economic and environmental elements of transportation sustainability
Date: 17 February 2025
Overview
Chronic health conditions such as heart disease, cancer, and diabetes are the leading cause of illness, death, and disability in the United States amounting to $4.5 trillion in annual health care costs. It is estimated that six in 10 Americans have at least one chronic disease, and four in 10 have two or more chronic health conditions. Ironically, many chronic diseases are caused by lifestyle choices such as smoking, poor nutrition, physical inactivity, and excessive alcohol use.
The synergy of risk and protective factors involved in the development of chronic disease accounts for the psychological/behavioral, social and biological contexts over time beginning with preconception and extending through to old age. The emphasis is on individual choice and how choice sets in motion one's life trajectory and social well-being.
Transportation serves a critical role in this trajectory by connecting citizens to the activities required to thrive and develop healthy lifestyles. The choice of transportation modality is dependent upon place of residence (urban, suburban or rural) in which an individual may choose to walk, ride a bicycle; use public transit, rail; ride share services, or drive a motor vehicle. These choices are influenced by the availability of transportation alternatives within a community, perceived personal and budgetary constraints, attitude (cultural influences), habit and educational information. As such human utility and the interplay of life stressors manifest in the body as chronic disease. Further, community level stressors such as persistent poverty, unemployment, substandard housing, lack of affordable housing, or no housing (homelessness), lack of transportation, increasing rates of crime, violence and threats of personal harm whether real or perceived are all known to exert cumulative adverse health effects that result in chronic disease.
These stressors are also known to have a negative impact on patients who are readmitted to the acute care hospital setting and/or emergency department (ED) for chronic illness exacerbation. Missed clinic visits and frequent ED admissions place additional strain on an overburdened healthcare system through increased service utilization and increased overall healthcare costs. However, it also negatively impacts patient-perceived health outcomes, (e.g., functional status and quality of life) and patient satisfaction.
Taking all of this into account, it is obvious that transportation is critical to the upstream factors associated with the Social Determinant of Health (SDOH) and the adverse effects of social disadvantage, risk exposure, and social inequities that play a causal role in poor health outcomes (downstream SDOH). This is particularly true for chronically ill patients living in rural communities that lack the financial resources to provide reliable public transportation. Many of these rural patients are older with physical and/or psychological disabilities. They tend to have limited access to specialized care due to geography (i.e., services are located at regional healthcare facilities as opposed to availability within the local community), an inability to drive, live in poverty, experience safety concerns, and often feel a loss of freedom (for those with disabilities), which ultimately impacts health equity.
Disinvestment and budget cuts to public transportation have created a fragmented system and exposed the health inequities within rural and urban communities. There is an unmet need to provide alternate transportation options to the most vulnerable segments of the citizenry to promote access to healthcare, nutritious foods, education, employment and other activities of daily living. This represents an opportunity to improve overall community health and reduce health disparities that manifest as chronic disease.
Strengthening Federal Response through Collaborative Workforce Development
Based on a systematic problem-solving approach that accounts for the synergy between the social (health), political, economic and environmental elements of sustainability it is vital to support the inclusion of a cross-disciplinary and multi-sector team of professionals in the design, planning and development of proposed and rehabilitated transportation infrastructure projects. In this way, appropriate quantitative and qualitative research, performance metrics, and strategic management methods can be implemented to effectively evaluate the health impacts of a proposed transportation project that places PEOPLE FIRST in the decision-making process. Until recently, traditional perspectives of the built environment as it relates to the transportation infrastructure and its direct impact on public health has received cursory attention by policy advisors.
This systematic workforce development approach includes planning and development, continuous process improvement, impact evaluation, data analyses, and outreach and education to drive the process. As funding streams continue to shrink and the demand for accountability and improvements in operational efficiencies increase, it will be imperative for transportation to partner with nontraditional entities, in particular, Health and Human Services to devise strategic goals, transparency, and innovative ideas that meet the health and transportation needs of the US population.
Resolving the Problem
Transportation is a vital component to community sustainability in terms of accessing health care, housing, nutritious foods, education, employment, leisure activities, and social networks. Thus, activity patterns, personal decisions, behavioral rules and the travel environment influence a person’s travel behavior with respect to the multidimensional nature of choice and the impacts of developing chronic disease. The nation needs to develop innovative solutions that focus on transportation insecurity in its most vulnerable citizens.
A proper analysis of chronic disease should be based on a systems approach that considers the synergy of risk and protective factors as opposed to a single exposure such as surface transportation. A comprehensive assessment is required of the sociopolitical, environmental and economic impacts, while promoting community cohesion and participatory representation. Based on a multi-dimensional integrative problem-solving approach, this process has the flexibility to account for individual determinants of health acting at different levels resulting in an upstream perspective to understand the impact of a proposed facility on quality of life in the affected community.
The inclusion of health state (i.e. asthma, cardiovascular disease, obesity, diabetes, etc.) into a build and no build scenario of a transportation project and its alternatives will provide important health estimates to overall community impact. Even when accounting for the uncertainty and inconsistencies of publicly available data (i.e. secondary reporting) this level of analysis by a trained expert demonstrates an estimate of cumulative impact and provides decision makers with better information. Expanding the team to include public health professionals comparable to an epidemiologist and economist provides the skill set needed to evaluate population demography and conduct combined cost-benefit/cost effective analysis. Resource limited communities would have the option of utilizing publicly available quantitative and qualitative tools. For example, Community Analyst and Streetwyze are public health epidemiological based tools used to evaluate demographic, health, economic, education, and business data variables, combined with instant reports and interactive color- coded maps to provide characteristics of area geographic context such as congressional district, block groups, census tracts, or zip codes.
Cross-Disciplinary and Multi-Sector Workforce Collaboration
Changing the trajectory of the chronic disease epidemic in the United States will require mutual collaboration, communication and commitment between all stakeholders; transportation firms-consultation and design, transportation/urban planners, federal/state Department of Transportation (DOT), local Metropolitan Planning Organizations (MPO), health/risk assessor, public health advocates and practitioners, communications specialists and the PUBLIC. Although there is a potential for disagreement, a cross-disciplinary and multi-sector team of this nature has the advantage of observing a problem from many different perspectives. To this end, innovative solutions to potential problems are mapped out (risk management and mitigation), concerns are addressed, and re-engineered policies are built into an existing political framework, ensuring long-term sustainability through improved community livability, health outcomes, quality of life, and reduced healthcare costs.
Improving the Nation’s Chronic Disease Epidemic
Given the state of the nation's inefficient and inequitable transportation infrastructure, poor health outcomes, and public demand for accountability of taxpayer dollars, conditions are ideal to implement such a change. It is time for the federal government to be proactive instead of reactionary when it comes to the health and wellbeing of all the nation’s people.
The International Professional Association for Transport & Health (IPATH) along with our social and spatial epidemiology real time data team, Streetwyze and Social Innovation, Universal Opportunity Labs (SOUL Labs) and professional consultant, Transportation Public Health Link (TPH Link), are uniquely positioned in the transportation and health sectors to assist Mr. Kennedy to achieve the goal of tackling the Nation’s chronic disease epidemic through a cross-disciplinary and multi-sector collaborative group of academic researchers and professional practice personnel and resources.
Acknowledgment and Contact
Karyn M. Warsow, MSc., MPH, DrPH(c)
Founder/Chief Executive Officer
International Professional Association for Transport & Health (IPATH)
Transportation Public Health Link (TPH Link)
4947 Hallenius Road
Gaylord, Michigan 49735
[email protected]
231.546.3462