Transportation is defined as the movement of people or goods from one place to another. In the context of health, transportation addresses access to public transportation and facets such as public transportation affordability, efficiency and availability. It also covers availability of a private automobile for use by an individual or household. 

The transportation system in the United States is a complex network of roadways, sidewalks, trails, tracks and airports that move people, goods and services. In 2017, over 76 percent of Americans commuted to work alone while 9 percent carpooled, representing 85 percent of Americans driving to work. Additionally, 5.0 percent opted for public transit, 2.7 percent reporting they walked and only 0.5 percent biked to work (1). This dependence on driving is associated with 40,000 traffic-related deaths annually in the United States. Beyond traffic-related injuries and fatalities, the health costs associated with air pollution and physical inactivity from car-dominant transportation modes results in hundreds of billions of dollars of expenses each year. For example, each additional hour spent in traffic per day is associated with a 6 percent increase in the likelihood of obesity, while walking a mile per day is associated with a 5 percent reduction in obesity risk (2). 

Our nation is reliant on motorized transportation with 80 percent of federal transportation funds currently earmarked for road and bridge construction, therefore leaving less funding for more active transportation options such as public transit, walking and bicycling (2).

Percent of the workforce (those 16 years and older and employed) and their means of commuting to work, Jefferson County, Colorado, and United States (2018)

Source: US Census, ACS (2018) - 1 year estimates, Table: S0801

Health Disparities and Inequities

The limited funding available to make roads more bicycle- and pedestrian-friendly can create barriers for residents to engage in healthier and more active transportation. Many neighborhoods lack adequate and well-connected sidewalks, safe street crossings, adequate street lighting or transit services. Improving these neighborhood conditions can support residents in engaging in more active transportation options. Limitations in funding, existing infrastructure and street design impact the ability of local municipalities to improve the infrastructure, such as adding sidewalks. While the solution may seem straightforward, it is often more complicated and requires collaboration between multiple government agencies such as public works, planning and public health.

1.3% of workers in Jefferson County do not have access to a vehicle.

- US Census, American Community Survey data, 2018 1-year estimates, Table: S0801

Neighborhoods that focus on encouraging easy access to transit and providing greater opportunities for biking and walking are associated with healthier populations overall (2).

In the past, federal highway funding decisions were made without input from residents of urban neighborhoods and communities of color, which have been disproportionately affected — and at times displaced — by highway construction. These same communities have also faced a lack of investment in active transportation options, like walking, biking, rollerblading and more. Consequently, these areas now have higher concentrations of air pollution, asthma, pedestrian fatalities and obesity (3).

Older adults are also increasingly facing substantial challenges in securing reliable sources of transportation when they are no longer able to drive independently. Public transit operators are required under the Americans with Disabilities Act to provide on-demand paratransit services to those who cannot access conventional transit. However, these services are only required to be available for individuals with serious disabilities, only offered in three-quarter mile wide areas that run parallel to existing bus routes and only run during hours that buses usually operate (4). 

Implications and Data for Jefferson County

Community Health Needs Assessment Focus Group Findings

Road safety was a significant concern that emerged across focus groups in mountain and suburban communities. Participants related concerns with some roads being unsafe for bicyclists and pedestrians due to lack of adequate infrastructure such as connected sidewalks, bike lanes, and safe street crossings. In the mountain communities, it was noted that trucks crowd the road, making it especially perilous for bicyclists. In addition, participants expressed a desire for better street lighting in their neighborhoods as well as separate bicycle and pedestrian paths to enhance the safety of traveling by foot and by bicycle. Considering these concerns, future projects should consider appropriate bicycle and pedestrian infrastructure to accommodate these modes of transportation. Click here to learn more about active living.

Another concern that emerged around bicycle and pedestrian transportation was the need for improved signage. Participants stated that for older adults and those with impaired vision, the lettering on existing signs is often too small to be seen easily.

Travel time to work, by percent of the employed population commuting selected time intervals, and the mean time the employed population travels to work, Jefferson County, Colorado, and United States (2018)

Source: US Census, ACS 2018 - 1 year estimates, Table: S0801

Those commuting to work in Jefferson County have a higher average travel time (28.2 minutes) than those in other parts of Colorado (25.9 minutes) and the United States (27.1 minutes). The majority (38.6 percent) of Jefferson County's commuting residents have a 30- to 59-minute commute.

Community Health Needs Assessment Key Informant Findings

Partners working with low-income Hispanic and Latino families expressed that they often have barriers to accessing private transportation or are reliant on inefficient public transportation, which can be an issue for getting to their jobs or their kids to doctors’ appointments. Local organizations working with these individuals and families note that these persons often only have one car or are reliant on public transit, which can be inefficient depending on their location.

Non-emergency medical transportation needs for Medicaid recipients was a significant barrier reported by informants working with this group, affecting the ability of many vulnerable recipients to access timely appointments for doctor visits, medication refills or even grabbing groceries. Medicaid recipients are also in need of more efficient third-party transportation options since current providers are not able to meet all of their needs, as stated by several informants.

Older adults on fixed incomes and those reliant on third-party transportation due to medical issues have substantial transportation barriers, especially those in mountain communities. Informants serving this population stated that they are at capacity and that more resources are needed to meet the rising demand for these types of services.

Given that access to efficient public transit, private transportation and third-party transportation for medical reasons has been noted by community partners as a barrier to accessing timely and needed health care for their clients, key informants suggested greater regional coordination on these types of transportation.

Additionally, many informants had road safety concerns for the homeless and other individuals that are reliant on biking as their primary form of transportation.


Reference List

1. Tomer, A. (2017, October 7). America’s commuting choices: 5 major takeaways from 2016 census data. Retrieved from:

2. Robert Wood Johnson Foundation. (2012). How does transportation impact health? [Issue Brief]. Retrieved from:

3. Leadership Conference Education Fund. (2011, April).The Road to Health Care Parity: Transportation policy and access to health care. Retrieved from:

4. Rosenbloom, S. Urban Institute (2013, May). Roadblocks ahead for seniors who don’t drive [Issue Brief]. Retrieved from:


Data Sources

US Census, ACS: American Community Survey - American Factfinder (Table: S0801):

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Published on July 17, 2018

Updates on January 28, 2020