Health Disparities, Transportation Equity and Complete Streets: a Case Study of a Policy Development Process through the Lens of Critical Race Theory

Abstract

Historic disinvestment in transportation infrastructure is directly related to adverse social conditions underlying health disparities in low-income communities of color. Complete Streets policies offer a strategy to address inequities and subsequent public health outcomes. This case study examines the potential for an equity-focused policy process to address systemic barriers and identify potential measures to track progress toward equity outcomes. Critical race theory provided the analytical framework to examine grant reports, task force notes, community workshop/outreach activities, digital stories, and stakeholder interviews. Analysis showed that transportation inequities are entrenched in historically rooted disparities that are perpetuated in ongoing decision-making processes. Intentional efforts to incorporate equity into discussions with community members and representatives contributed to explicit equity language being included in the final policy. The potential to achieve equity outcomes will depend upon policy implementation. Concrete strategies to engage community members and focus city decision-making practices on marginalized and disenfranchised communities are identified.

Introduction

Transportation systems are a focal point for addressing health disparities at the intersection of planning and public health. Complete Streets (CS) policies represent a growing response to traditional roadway design that moves large numbers of cars as efficiently as possible, rather than balancing the needs of pedestrians and cyclists. At this juncture, researchers and practitioners are interested in walking behavior and other active travel modes, as well as the public spaces that may facilitate or deter whether these behaviors are safe, comfortable, and dignified. CS policies have the potential to address inherent inequities in transportation planning to the benefit of vulnerable populations, including racial/ethnic groups, low-income communities, youth, the disabled and the elderly. However, cycling and pedestrian improvement efforts may overlook the reality of those living in poverty and ultimately risk triggering gentrification. Almost 20 years since the proliferation of CS policies, it is a useful time to conduct an equity analysis of this policy approach at the nexus of public health and planning efforts.

In 2016, a public streets advocacy organization in Tucson, Arizona received funding to engage members from vulnerable communities in a CS policy development process that would address historically rooted transportation inequities in the city. Two years later, Mayor and Council approved the policy. Examination of the policy process offers an opportunity to document the potential for a CS policy to address transportation equity, as well as consider how to identify and measure progress. The incontrovertible link between transportation infrastructure and health disparities is illustrated by the disproportionate number of pedestrian crashes in low-income and historically underrepresented neighborhoods [1], a burden compounded by evidence that underrepresented ethnic and uninsured individuals are more likely to die from their injuries [2]. Low-income and people of color are least likely to benefit from public spending on transportation, resulting in diminished education and employment opportunities and disparate access to goods and services [3, 4]. Underrepresented racial/ethnic and low-income neighborhoods have markedly less access to recreational areas with negative implications for physical and mental health [5, 6].

Addressing Health Disparities with Complete Streets

To the extent that streets are the means through which individuals travel from one place to another, the CS concept recognizes a general right to mobility. The National Complete Streets Coalition defines CS as an approach that views roadways as one component of a broader multimodal system that seeks to accommodate varying uses and needs across different contexts [7], and encourages the inclusion of community characteristics, destinations, and esthetics in envisioning a street [8]. The diffusion of CS policies is impressive. As of 2014, approximately 25% of towns and cities had a policy [9], an expansion that may have been spurred by a steady increase in pedestrian fatalities across the nation [7]. Evaluation of CS on desired outcomes lags behind, however, and more specifically on identification of appropriate outcomes and measures in relation to health equity, traffic fatalities, and increased safety [10, 11].

The potential for CS to address transportation equity certainly lies in the intentionality of the effort from the policy development process through its implementation and measurement. Several communities have developed ways to engage their communities in the policy process [12, 13], but provide few examples of efforts to explicitly integrate racial equity into the planning process or determine whether application of an equity lens can ultimately address historical discrimination in transportation planning and infrastructure.

Critical Race Theory

Originating in the field of legal studies, CRT was initially used to critique education reform efforts that sought to accomodate rather than confront racial hierarchy. Adapted for a public health paradigm [14], CRT insists upon a contextual and historical analysis of current conditions and recognition of the central role that racism continues to play in how advantages are distributed in society [15]. The application of CRT constructs of race consciousness and structural determinism focused this case study on examination of how historical processes that created inequity in transportation infrastructure are self-perpetuated [16, 17]. The central question is whether by directly addressing equity, the CS policy process can begin to unravel inherently racist processes and define and measure new approaches. Importantly, CRT places the experiential knowledge of communities of color at the center of understanding and eliminating racial oppression. CRT is thus compatible with a case study approach, which allows for multiple perspectives and inclusive research methodologies, such as narratives and storytelling, to link theories about race to practice.

Methods

Case studies describe a specific event or complex phenomenon through a variety of perspectives within social, cultural, and historical contexts [18, 19]. By investigating equity within a policy process, we examine implications of the national recommendation to incorporate equity language into CS policies. The overall purposes of the case study are to inform future efforts in CS policy development and provide a basis for future research on equity outcomes.

Case Study Background

Tucson is one of the poorest and most economically segregated cities in the U.S., with about 15% of the population living in areas of concentrated poverty and 23% of the population living in poverty [20]. About 43% of the population is Hispanic/Latino (mostly Mexican American), 5% Black, and 3.5% Native American [20]. Tucson is consistently ranked among the least safe cities for pedestrians [21] and fatality rates are higher in Tucson’s lower-income census blocks than in higher-income areas [22]. Some of this disparity may be due to a history of disinvestment in the city’s lower-income and predominantly Hispanic/Latino areas. Adding a layer of complexity, much of the traditional Mexican American parts of Central Tucson were cleared through urban renewal programs in the 1960s, leaving a legacy of distrust that 60 years later is brought into community discussions about city planning and transportation investments [23, 24]. Many displaced families moved to neighborhoods that experienced ongoing disinvestment and industrial contamination. During this period, Tucson’s urban form adapted to the automobile in patterns determined by the arterial road network that favored wide streets and high speeds. More recently, these forces culminated in the escalation of pedestrian deaths, with low-income and underrepresented racial/ethnic residents at greatest risk. CS policy development in Tucson, therefore, has had to address both physical and socioeconomic conditions associated with transportation safety.

CS policy development began in the fall of 2017, when an advocacy organization received funding to engage community members in developing a CS policy for Tucson. The advocacy organization convened a group (the ‘Brain Trust’), made up of individuals who had a history of working with underserved communities, to discuss the intersectionality of transportation infrastructure and challenges facing low-income communities of color. The advocacy organization hired consultants who helped them define both the policy development process and the community engagement activities. Together, they worked with the Tucson Department of Transportation (TDOT) to convene the CS Task Force, a strategy designed to bring multiple perspectives to policy development.

Data Collection

The case study is bounded by the formal initiation of the policy development process in October 2017, through city council approval in January 2019. Data sources include grant progress reports, the CS Task Force activity notes, community workshop notes, community member digital stories, community responses to pop-up engagement activities, and media coverage [25] (Table 1). We also analyzed the five iterations of the draft CS policy as they reflected the incorporation of community perspectives. We conducted case study interviews to fill in experiential gaps in data and to explore perspectives on the potential for the policy to address equity. The institutional human subjects review board exempted the case study as not human subjects’ research.

Table 1.

Case study data sources

Data source	Data format	Equity-focused activity	Perspective
1. Grant reports	4 progress narratives	Describe and reflect upon intentional efforts to engage marginalized perspectives in developing policy	Advocacy organization
2. CS Task Force	Meeting and small group activity notes and drawings from 7 meetings.	Use appreciative inquiry in pairs and small groups to draw on diverse areas of equity “expertise” in refining policy elements.	Community organizations, city staff, community members
3. Digital stories	Transcripts from 8 stories	Use storytelling to elevate the transportation experience of a diverse group of community members.	Community members (youth, parents, people with disabilities, bus riders)
4. Community workshops	Meeting and small group activity notes from 16 workshops	Use appreciative inquiry to contribute diverse community perspectives to definition of complete streets.	Community members
5. Pop-up engagements	Survey data from four events	Record transportation priorities among vulnerable users at transit center, library, food bank, and restaurant.	Community members
6. Newspapers, magazines	21 print and online news stories	Build community awareness and common language around transportation and CS.	Media
7. Policy iterations	6 documents	Use an iterative process to incorporate equity into written policy document.	City elected officials and staff, community organizations
8. Case study interviews	25 interview transcriptions	Fill in experiential gaps in the case study and capture diverse perspectives on CS, equity, and CRT (for case study only).	City elected officials and staff, community organizations, community members

Data Analysis

Data were uploaded into NVivo 12 software in the form of documents, spreadsheets, and images and categorized by type of data source and the perspective represented (e.g., city, community). To finalize the codebook and establish interrater consistency, two researchers coded a selection of the data and refined definitions of the CRT constructs as they related to transportation equity. We included ‘equity’ and ‘community engagement’ as concepts that were intrinsic to case study objectives. We individually coded one-third of the data and double-coded the remaining one-third to ensure that we maintained consistency. We collectively reviewed the data coded under each node against the codebook definition, and recoded as necessary. Upon completion of the coding process, we examined expressions of the CRT constructs from community, advocacy, and city perspectives. Using the CRT constructs that were the most salient in our analysis, we modeled various pathways through which a focus on equity might be achieved. Table 2 outlines the CRT constructs that were most relevant to our modeling process and their definitions within the context of transportation equity.

Table 2.

Coding framework

Coding construct	Definition of coding terms	Case study application
Equity [26]	The absence of avoidable, unfair, or remediable differences among groups of people…. defined socially, economically, demographically or geographically or by other means of stratification.	Any references using the word equity as it relates to transportation.
Centering in the margins [14]	Emphasizing the perspectives of marginalized groups, particularly viable, non-mainstream perspectives in order to “enrich mainstream understandings of problems and reduce the possibility of developing perspective imbalances.”	Descriptions of efforts to focus discussions of transportation policy on priorities of marginalized populations, i.e., decision-making processes, policy language, capacity building.
Voice [14]	Prioritizing the perspectives of marginalized persons; privileging the experiential knowledge of outsiders within. Recognizing that although racialization divides groups according to socially assigned race, experiences of and responses to marginalization are not uniform.	Descriptions of strategies (digital stories, CS workshops) or community-driven efforts to include and privilege marginalized perspectives or the perspectives themselves.
Race consciousness [14]	A deep awareness of one’s racial position and racial stratification processes versus operating in colorblind contexts.	References to explicit expressions of race and ethnicity as it relates to transportation.
Social location [14]	An individual/group’s position within a social hierarchy (e.g., privileged vs. marginalized, minority vs. majority) [which] informs the perspectives from which one views a problem; recognition that all individuals possess experiential knowledge informed by social locations.	References to characteristics of people who are left out of policy process; for CS consider the role of the physical location such as neighborhood in defining the social location.
Historical context [14]	Constructs and measures should be context-specific because racism functions differently depending on the place, population, time, and context.	References to Tucson’s transportation history.
Structural determinism [14]	The fundamental role of macro-level forces in driving and sustaining inequities across time and contexts and the tendency of dominant group members/institutions to make decisions that preserve existing power hierarchies.	References to practices that place groups at a disadvantage, i.e., funding priorities, hiring practices, authority over information.
Community engagement [22]	The process of working collaboratively with and through groups of people affiliated by geographic proximity, special interest, or similar situations to address issues affecting the well-being of those people to bring about changes that will improve the health of the community and its members.	References to actions taken by decision-makers and advocates to encourage involvement in the decision-making process by members of the community impacted by the decisions.

Results

Our analysis centered first on the concept of equity as the focal point of the CS case study, and subsequently on each of the CRT constructs and their relationship to equity, with the inclusion of community engagement as a key strategy (Table 3).

Table 3.

Expressions of CRT constructs in the Complete Streets Policy Process.

Construct	Community members	Advocacy Stakeholders	City staff and elected officials
Equity	“At first, I did not know what it was... and that was the same for other people... and even if we showed them the definition, what does that mean still? Making safe streets for people that really need them- and that’s not equity even.” (Community member)	“The other thing that always came up was shade; it is inhumane to have bus shelters in a city this hot without a better concept of shade and better shade canopy overall.” (Advocacy outreach)	“Prioritizing the areas that need it the most, that is a goal of this in my head. By prioritizing those areas that need it the most, we will be addressing equity. But I think it is tricky with development or improvements. The issue is gentrification and the impact of that.” (City staff)
Centering in the margins	“You cannot just pay one person ….some real investment, hiring young people from the neighborhood schools to be neighborhood ambassadors, they need jobs, families need income, but they are the best people to carry out the work, and then there is love for what the city creates.” (Community member)	“The people we are most concerned about with safety and access are least likely to come to a neighborhood meeting... The people in the room have time, money or a grave threat to their interest.” (CS Task Force member)	“Elected officials are in a better position to bring awareness to who is in a conversation and who is disenfranchised or what would inherently eliminate people from participating. For people on the inside it is harder to speak in those terms.” (Elected official)
Voice	“We never imagined how difficult it would be to walk there. In some places there were not ramps and it was difficult to push the stroller. In other places there was no sidewalk or they were too narrow. There were obstacles and we had to go in the street to avoid them. The cars passed us at high speed, putting our lives at risk.” (Digital story)	“Hearing those voices and sharing those stories at different events we would facilitate; being able to use those stories as a jumping off point to say what are complete streets? What do they look like?” (Advocate) “Youth of color (were missing), I am the youngest one at the task force meetings, and where are they? At the dialogues and the pop-ups it was parents and older folks.” (CS Task Force member)	“One of the things that is intriguing to me is the idea that the people that use our transportation systems have a voice, to see if they see any difference. How do you make a connection and how do you ask them in an effective way.” (Elected official)
Race consciousness	“I think race plays a big role on everything. We like to say its economic, but who is poor? Here it is Hispanics, it is targeted against minorities, I wish they would engage minorities…The amazing bike structures will be for who? Not for us.” (Community member)	“It’s hard not to notice in a room talking about equity to not see that a healthy proportion of the room is white.” (CS Task Force member)	“There is still a big rift in the community along white and Hispanic divide – those things are really hard to overcome.” (City staff)
Social location	“Finally, I saw the bus, so I started walking toward the bus stop, 'cause you know, I was hiding under the shade. And when I looked up, the bus had not stopped! The bus driver turned, made eye contact, but never stopped. Now, all I wanted to do was to ask her a question. ‘Why didn't you stop?’” (Digital story)	“I’m always aware of it, because many times at meetings I’m one of the few women of color in the room. Being cognizant and understanding my perspective is different than others in the room. Knowing my life experience which shaped my world view is so different than a lot of other people's that come from different backgrounds.” (Advocate)	“Often the communities and neighborhoods that are poorer aren’t listened to as much or have as big of a voice as neighborhoods with wealthier socioeconomic structure.” (City staff)
Historical context	“I think that the trust, how many times have communities just been abandoned and things taken away from them, and they're like, 'oh they are going to do this for me, oh yeah right'…” (Community member)	“They very directly asked, ‘What exactly do we get out of this?’ My sense is that originated from a feeling that they have lent their voice to things before but perhaps have been forgotten in the implementation” (Advocacy outreach)	“Coming back as an adult becoming aware of the history of Tucson and how it is thought of in the community. The redevelopment in the 70s created- I picked it up immediately, the anger by those who felt betrayed by the city.” (City staff)
Structural determinism	“I do think there is something to be said about having more diverse people in decision making positions and working in our city government, things will start to shift. Because I do not think they will otherwise.” (Community member) “Let us be honest, we all know developers and auto industry had a lot to do with how Tucson was developed, so anything going against that, regardless of how good it is, is change, and change is pain…I’m sure there will be resistance in places.” (Community member)	“There is no one that looks like me making decisions. I feel intimidated going up and talking during a call to the audience, and I’m an educated person. Think about someone who may not speak English, does not have the fluency to talk about what their issues even are- in a place where 40–45% are Hispanic/Latino.” (Advocate)	“My fear is that the CS policy could fall victim to the same structural determinism that transportation projects always fall victim to, unequal investments in different parts of town because of flawed selection processes. For example, in the CS policy, there is mention of bicycle boulevards and high capacity transit corridors which are often more equitably planned than they are executed.” (City staff)
Community engagement	“Giving them (community members) the decision-making power to be involved in how the CS project would benefit their community rather than just make it more bike friendly and contribute to gentrification and displacement.” (Community member)	“Part of the goal has been to demonstrate a different community engagement model to help inform future engagement efforts in implementing the Complete Streets policy so that city departments are more inclusive and equitable in their outreach.” (CS Task Force facilitator)	“The structure of the Coordinating Council shall be guided by the following principles: follows best practices in collaborative decision making; includes representation from key stakeholder groups; brings accountability to the implementation of this CS Policy; empowers community…and is facilitated by a neutral, professional facilitator.” (Final CS Policy)

Equity

The outreach and facilitation materials and the notes from these activities demonstrated that equity was a point of reference throughout the policy development process. The CS workshops generated definitions of equity as inclusivity across generations and populations, as well as economic and geographic equality for individuals and neighbors in prioritizing complete streets. In the CS Task Force, the facilitators sought to treat equity as “a discipline”; they viewed the Brain Trust and the task force members as “custodians of both the process and equity as an outcome.” To do this, they used specific facilitation techniques designed to model equitable communication that provided various pathways for input and valued the contributions of every individual. This approach contributed to broad agreement among the task force members that their goal was to create an equity-focused policy, however, case study conversations revealed lack of a common equity definition.

While stakeholders agreed that racial equity was a major focus of the policy, some suggested that it might be strategic to sidestep addressing race or even equity directly. They suggested defining equity as an “equivalent experience” across travel modes, with the assumption that this approach would capture underlying reasons behind racial differences including “homes without personal vehicles, transit riders and people without cars.” One city staff felt that speaking directly about equity was potentially controversial and/or ineffective. Further, city staff and elected officials described the political need to demonstrate “fairness” in resource distribution across each city ward taking precedent over addressing equity. Underlying disconnects between elected officials and city staff also created an obstacle to furthering equity-based initiatives. It was therefore important to take on controversial issues, including “data on deaths [presented] during the presentations to the city council and voicing the experiences of community members.”

Historical Context

City stakeholders were aware of the lingering impact of historic events in Tucson that contributed to ongoing mistrust of the city. Community stakeholders were more cognizant of specific historic events, describing the subsequent contamination of the south side neighborhoods they had moved to after being displaced from downtown. Community stakeholders also referred more broadly to ongoing “unconscious ways that the city has disinvested in our communities.”

Structural Determinism

Respondents across the city, community, and advocacy domains recognized contributions to structural determinism as historically rooted and difficult to change. Current decision-making practices were also seen as preventing the city from effectively addressing structural inequities, such as funding pedestrian and cycling improvements based on ‘existing use’ and favoring privileged communities in transit upgrades. City stakeholders recognized the need for the city to “overcome the internal structures of our organization” that maintained power structures and inhibited community engagement.

Race Consciousness

Explicit expressions of race were limited to the interviews, in which we asked respondents to reflect on the role of racial discrimination in transportation equity. Community respondents disagreed over the preeminence of race and class in transportation inequities, but were explicit about the need to be race conscious, or more specifically, community conscious. Task force members did not discuss or address race explicitly during the process, but were aware that those who worked directly on the CS policy were primarily white.

Task force and city stakeholders expressed a general belief that terms such as ‘vulnerable’, ‘disenfranchised’, and ‘marginalized communities’ in the policy could be effective in addressing racism. The final version of the policy included the term ‘communities of color’ in describing the focus of community engagement efforts and stipulated the inclusion of community members on the Coordinating Committee, a body described in the policy as providing oversight in policy implementation and accountability. Community members, however, expressed some uncertainty that infrastructure improvements would benefit communities of color and concern that if improvements did occur they would cause gentrification.

“I think race plays a big role in everything. We like to say its economic, but who is poor? Here it is Hispanics, it is targeted against minorities, I wish they would engage minorities…The amazing bike structures will be for who? Not for us.” (Community member)

Social Location

Physical and social location were intertwined with references to those on the ‘Southside’ as being neglected by the city, living in poverty, or being vulnerable to gentrification. Geographic and social location were also related in terms of perceived preferences in transportation infrastructure, with respondents contrasting downtown residents as desiring CS infrastructure versus the priorities of affluent white neighborhoods or those who lived in the suburbs. We found that race consciousness, social location, and voice were linked inextricably. Not only did stakeholders feel that people of color were either purposefully excluded or ‘tokenized’ at the decision-making table, they also described social location as an implicit barrier to equitable participation at that table.

“I’m always aware of it because many times at meetings I’m one of the few women of color in the room…being cognizant and understanding my perspective is different than others in the room. Knowing my life experience which shaped my world view is so different than a lot of other people’s that come from different backgrounds.” (Advocate)

Thus, while awareness of the difference in experience and perspective was inescapable for a person of color, white participants were either unaware of social location or did not know how to address it.

Voice

The advocacy organization utilized various strategies to facilitate community members telling their stories both before and during the policy process. Approaches included digital storytelling workshops, community dialogue workshops, and pop-up engagement events in which staff discussed transportation decisions with community members in places where they were already congregating. In many cases, trained community members with connections to certain groups convened and facilitated the activities. These efforts gave expression to the experience of mobility, such as threats to physical safety, the lack of independence afforded to youth, and the indignity of the transit experience. Sensitized to these issues, the facilitators used those perspectives to center task force conversations.

The digital stories documented various themes related to the danger associated with mobility. One story described the harrowing experience of a mother inviting her daughter and grandson for a walk with a stroller before realizing the risks she had taken in navigating city traffic.

“We never imagined how difficult it would be to walk there. In some places, there were no ramps and it was difficult to push the stroller. In other places, there was no sidewalk or they were too narrow. There were obstacles and we had to go into the street to avoid them. The cars passed us at high speed putting our lives at risk.” (Digital story)

Young and older, disabled and able-bodied community members described dissatisfaction with their transit experiences. While the specifics varied, dignity, or lack of it, was an overall theme in these stories. An older woman described spending endless time in the desert sun at bus stops with no awnings, the heat of the benches forcing her to stand, surrounded by bees in the garbage cans and ants on the pavement. A student experienced being physically sick after waiting in the sun next to the garbage for a bus that was late and subsequently broke down turning an already 2-hour trip into four. A young adult described her powerless rage as she tried to chase down a bus that failed to stop for her. The advocates articulated the importance of reciprocity in engaging community members, or striking a balance between providing spaces for community members to ‘elevate their own voice’ and simply ‘extracting information.’ Direct engagement of individuals from marginalized communities in the task force was an ongoing challenge.

Centering in the Margins

Our analysis demonstrated that the entire policy development process was an effort to center in the margins, or focus discussion and decision-making practices on the priorities of marginalized and disenfranchised communities. We documented strategies in the Brain Trust, the CS Task Force, the facilitation tools, community outreach efforts, and the policy iterations. An ongoing concern for those on the task force was that they were not the people who are most impacted, but rather “representatives for the process,” and that “having a person with a lived experience is the richest and most meaningful form of engagement.” The task force sought to remedy this going forward by recommending specific policy language that prioritized the needs of marginalized communities. The policy also advanced efforts to center in the margins through application of a project prioritization tool by which CS funding would benefit residents most likely to rely on low-cost mobility options, including neighborhoods with higher concentrations of low-income and people of color. Other recommendations included ensuring that these community members were included in the Coordinating Council, supporting community coalition-building, hiring community members as experts in “identifying the problems they face and articulating solutions to those problems,” as well as establishing a city equity ombudsman or staff position and rebalancing transportation funding.

Community Engagement

We coded references across a spectrum of engagement strategies, from informing communities about plans and decisions, consulting with communities about plans but with no commitment to incorporating their input, involving communities more directly in processes but maintaining decision-making power, and giving community members a role in decision-making processes [27]. City engagement practices, specifically open meetings, were viewed by individuals inside and outside the city as ineffective. City stakeholders acknowledged that “we don’t do meaningful authentic public engagement” and “it is rare that a community involvement process truly honors our communities or values their input.” They recognized that existing practices attract “the usual players” and not necessarily the people most affected by or vulnerable to changes in city policy. City stakeholders were aware of the perception that “the city doesn’t listen to people” and that, historically, “public feedback was viewed as annoying and squeaky, and not helpful.” Advocacy stakeholders described the CS policy development process as an effort to “demonstrate a different community engagement model to inform future engagement efforts so that city departments are more inclusive and equitable in their outreach.” City officials also described it as “a grassroots effort that wasn’t just the city coming up with the policy,” and expressed the hope that it would inform future city practice “in terms of hearing from the more representative body across the city, particularly of areas that have not been as historically engaged or had the opportunity to be engaged.” The structure, composition, and guiding principles of the Coordinating Council outlined in the final Complete Streets policy provided a potential model of future collaborative community engagement.

Discussion

This case study of a CS policy development process underscores the necessity for public health critical race praxis in highlighting the role of racism in the creation and perpetuity of inequities, and more practically, in identifying concrete strategies to address them. Figure 1 is a graphic illustration of the analysis that articulates the relationships between the CRT constructs and potential strategies and pathways for achieving transportation equity, with eventual implications for addressing health disparities. According to the model, two strategies are central to the process. The first is a multi-faceted approach to community engagement that ensures both broad reach to as many people as possible, as well as more collaborative, intensive, and community-driven processes. The second is centering in the margins, or employing specific practices that focus discussion and decision-making on the priorities of marginalized and disenfranchised communities. Elevating the voice of community members is essential to both strategies, but doing so requires attention to social locations of privileged and marginalized identities that either facilitate or hinder participation in decision-making processes. Further, it is essential to acknowledge the role of race in this social hierarchy and its unique impact beyond those of class, education, or other identities that often are given more focus [28]. Finally, the model illustrates the importance of situating the development and implementation of policies with an awareness of historic and current structures that perpetuate inequity.

Fig. 1.

Achieving transportation equity through the lens of critical race theory

The techniques to engage communities and center in the margins outlined in the model are drawn from the case study analysis, either as efforts employed in the policy development process or recommended by study participants. For example, advocates consulted community members through outreach activities and more directly involved organizational representatives through the CS Task Force. The CS policy itself outlines strategies going forward that, if implemented, would result in collaboration with community members in project prioritization and implementation. This is significant, given that authentic community engagement is a relatively recent expectation for transportation departments [29]. The community engagement effort can be guided by a substantial and growing list of resources on ways to leverage public health engagement practices within the realm of transportation [30].

Efforts to center in the margins may be more challenging for mid-size cities that are strapped for resources and face myriad community voices that are not concerned with equity [31]. Several cities have expressed public commitment to the concept of equity, however [32], and attention to the CRT constructs in the transportation equity model can potentially transform city practices. While it could be argued that few of the recommendations are cost-neutral, a commitment to equity can be addressed through shifting in funding priorities rather than additional funding [33]. The need to recognize community expertise in hiring practices, for example, was strongly voiced by community members in our case study. City managers may feel that they do not have the resources to expand transportation staffing beyond traditional roles. In creating these positions, however, city managers can improve community trust and foster a mutually beneficial relationship fueled by a better-informed community and a better-connected city staff. In many cases, cities will require internal policy changes to expand hiring, training, and retention of diverse staff.

The case study raises difficult questions about the political viability of direct references to race consciousness and even of equity itself. City and community stakeholders suggested that use of these terms might impede progress because they are not well defined and are politically charged. The term ‘vulnerable populations’ is widely used in the final CS policy and may provide a practical solution to this dilemma. Frolich and Potvin (2008) suggest that using ‘vulnerable populations’ language moves public health interventions away from a focus on individual risk to address vulnerabilities rooted in the contextual realities of everyday life, including transportation [26]. In recognizing that solutions to the root causes of inequities lie outside the public health sector, addressing vulnerable populations also encourages public health practitioners to bring meaningful participatory practices to transportation and planning efforts [30, 34].

Community engagement in policy implementation also offers opportunities for cities to develop performance measures that are qualitative as well as quantitative, reflect community priorities, and consider access to and experience of transportation options [35]. Engaging community members in data collection processes offers unique perspectives on community priorities [23]. From a public health perspective, the focus on equity recognizes the potential for CS policies to improve the health of vulnerable and marginalized populations by addressing underlying issues of access and opportunity. Incorporating a racially focused equity lens in policy implementation and evaluation, while politically challenging, will be necessary to transform community engagement and decision-making practices and achieve measurable outcomes.

Compliance with Ethical Standards

Declaration of Interest

The authors have no financial or personal relationships to disclose.