There is sufficient evidence that interventions to improve access to transportation improve social outcomes pertaining to engaging in active transportation and accessing social and economic opportunities.
The findings below synthesize the results of the studies on interventions to improve access to transportation across three domains of measurement:
Lack of reliable transportation remains a significant challenge in the United States (U.S.). In 2022, approximately 5.7% of adults reported not having dependable transportation for daily needs, with higher rates among women, younger adults, and those with lower income or education levels[1].
While lack of transportation to and from medical appointments and services is a real risk to healthcare access and adherence[2],[3], broader transportation limitations also increase social and behavioral risks to health[4]. An estimated two-thirds of U.S. adults are overweight or obese, with almost a quarter reporting that they do not engage in any physical activity outside of their jobs[5]. The lack of safe, affordable options for active travel like walking or biking to jobs, shops, or services contributes to health inequities. Access to multi-modal transportation options can lower the risk of chronic disease, reduce traffic injuries, and generate public health savings through cleaner air and improved mobility[6]. These benefits are particularly important in low-income and underserved communities[7], where access to reliable transportation is often limited.
Transportation access is a driver of health, though population-level interventions are rarely reimbursed through health systems. Unlike Non-Emergency Medical Transportation, which is tied to accessing clinical care[8], general transportation interventions operate at the population level and are rarely reimbursed through government and employer-sponsored coverage. Instead, they are typically funded through local government programs, housing authorities, or transportation agencies aiming to improve access to healthcare and life’s necessities.
Common strategies include subsidized transit passes, prepaid travel cards, discounted or free access to shared micromobility (such as bikes and scooters), and infrastructure improvements that expand mobility for people earning lower wages[9]. These strategies may be embedded in affordable housing initiatives, city mobility programs, or climate adaptation efforts. While not framed as health interventions, they support well-being by expanding access to services, promoting physical activity, promoting clean air, reducing traffic injuries, reducing social isolation, improving opportunities for social mobility, and bridging health equity gaps[10]. Available evidence in the literature indicates that such interventions can increase trip frequency, reduce car dependence, improve air quality, and enhance access to employment, education, and other key resources[11],[12].
People with disabilities.
A traveler’s cheque voucher program, a voucher model of rural transportation that took place in 10 community programs in 10 states.
Descriptive study. 588 adults with disabilities participated in the program.
Social: The rides were used primarily for employment and employment preparation, with 171 individuals securing either part‐time or full‐time employment through the program.
Affordable housing residents in the city of Portland, Oregon.
A transportation incentive program for affordable housing residents. Transportation incentives were provided for participants with lower incomes, including a U.S. $308 prepaid Visa card (the cost of an annual reduced fare transit pass) that could be applied to public transit or other transportation services, a free bike share membership, and access to discounted rates on several services.
Descriptive study. N = 278.
Social: The financial support from this program encouraged some participants to use new mobility services (including Uber/Lyft, bike share, and e-scooter) that they had never used before. The program increased access for participants, helping them make more trips and, for some, get to places they otherwise could not have gone. Further, transportation fairs, where participants could learn about services and talk to providers, promoted both mode sign-up and mode usage, particularly for new mobility services and a reduced fare transit program.
Adults.
Behavioral and/or structural interventions to reduce the use of motorized transport for journeys made by adults.
Systematic review and meta-analysis. 15 full-text articles were included.
Social: Meta-analyses reveal no significant effect on reduction of frequency of car use or on increasing the proportion of journeys by alternative, more active modes of transport. There is insufficient data on alternative outcomes, such as distance and duration, which may have important health implications.
Equity seeking groups with a focus on race, ethnicity, and socioeconomic status.
Transportation interventions focused on promoting walking, cycling, and public transit.
Scoping review of peer-reviewed literature. 10 studies were included.
Health: Eight of the ten included studies found that the intervention had an overall positive impact on health outcomes. When compared across indicators of participant race, ethnicity, or socioeconomic status, nine found either no significant difference or a favorable impact of the intervention on the health outcome for the disadvantaged groups studied.
Urban populations.
Transportation interventions with a focus on bicycle lanes, bus rapid transit systems, and aerial trams.
Systematic review. 39 studies were included.
Social: In empirical studies, bicycle lane interventions were associated with increases in physical activity and active transport.
System-based simulation studies showed that economic incentives designed to disincentivize car use and policies designed to improve the public transportation system can have positive impacts on active travel time and bus share.
Adults in the general population.
Interventions with positive (carrot) or negative (stick) aspects for changing population-level travel behavior. Transportation access interventions included subsidized carpooling, subsidized or free public transit tickets, new, extended or improved public transport lines, subsidized or free bikes, financial rewards for active travel, etc.
Systematic review and meta-analysis. 102 reports describing 121 interventions met the inclusion criteria.
Social: Results for carrot interventions were less consistent than for stick or combined interventions. For driving outcomes, interventions with stick strategies (standardized mean difference [SMD] –0.17, 95% CI –0.36 to 0.02) and combined carrot-and-stick strategies (–0.13, –0.47 to 0.20) had point estimates of greater magnitude than those for interventions with carrot strategies (–0.10, –0.23 to 0.03).
For active travel outcomes, combined carrot-and-stick strategies had a higher point estimate (0.33, –0.01 to 0.68) compared with carrot interventions (0.08, –0.05 to 0.21).
Functions thought to change behavior using financial means were effective at decreasing driving behavior, whereas those improving access, safety, and space were effective for increasing active travel outcomes.
[1] Ng AE, Adjaye-Gbewonyo D, Dahlhamer J. Lack of reliable transportation for daily living among adults: United States, 2022. NCHS Data Brief, no 490. Hyattsville, MD: National Center for Health Statistics. 2024. DOI: https://dx.doi.org/10.15620/cdc:135611
[2] Bettelheim A. Over 1 in 5 skip health care due to transportation barriers. Axios. 2023 Apr 28. Available from: https://www.axios.com/2023/04/28/over-skip-health-care-transportation-barriers
[3] Ufere NN, Lago-Hernandez C, Alejandro-Soto A, Walker T, Li L, Schoener K, Keegan E, Gonzalez C, Bethea E, Singh S, El-Jawahri A. Health care–related transportation insecurity is associated with adverse health outcomes among adults with chronic liver disease. Hepatology communications. 2024 Jan 1;8(1):e0358.
[4] Atherton E, Schweninger E, Edmunds M. Transportation: A Community Driver of Health. American Public Health Association, AcademyHealth, Kaiser Permanente. 2021.
[5] U.S. Department of Transportation. Active Transportation and Health. Washington (DC): U.S. Department of Transportation. 2024. Available from: https://www.transportation.gov/mission/health/active-transportation-and-health
[6] Millard-Ball A, Reginald M, Yusuf Y, Bian C. Global health and climate benefits from walking and cycling infrastructure. Proceedings of the National Academy of Sciences. 2025 Jun 17;122(24):e2422334122.
[7] Heaps W, Abramsohn E, Skillen E. Public Transportation in the U.S.: A Driver of Health and Equity. Princeton (NJ): Robert Wood Johnson Foundation; 2021 Jul 1. Available from: https://www.rwjf.org/en/insights/our-research/2021/07/public-transportation-in-the-us-a-driver-of-health-and-equity.html
[8] American Hospital Association; Health Research & Educational Trust. Social Determinants of Health Series: Transportation and the Role of Hospitals. Chicago (IL): American Hospital Association; 2017 Nov 15. Available from: https://www.aha.org/system/files/hpoe/Reports-HPOE/2017/sdoh-transportation-role-of-hospitals.pdf
[9] Hewitt E. A Free‑Transit Prescription for Healthier Communities. Reasons to be Cheerful; 2025 Jan 24. Available from: https://reasonstobecheerful.world/free-transit-healthier-communities/
[10] Sadeghvaziri E, Javid R, Jeihani M. Active transportation for underrepresented populations in the United States: a systematic review of literature. Transportation research record. 2024 Jun;2678(6):403-14.
[11] Stankov I, Garcia LM, Mascolli MA, Montes F, Meisel JD, Gouveia N, Sarmiento OL, Rodriguez DA, Hammond RA, Caiaffa WT, Roux AV. A systematic review of empirical and simulation studies evaluating the health impact of transportation interventions. Environmental research. 2020 Jul 1;186:109519.
[12] Xiao C, Van Sluijs E, Ogilvie D, Patterson R, Panter J. Shifting towards healthier transport: carrots or sticks? Systematic review and meta-analysis of population-level interventions. The lancet planetary health. 2022 Nov 1;6(11):e858-69.
