Getting There: Transportation as the Cost of Access to Work, Care, and Food

The distance between a household and what it needs

A job is only a job you can get to. A clinic is only useful if you can reach it on the day of the appointment. Healthy food is only an option if the store is within reach and the trip is affordable. For a great many households, the binding constraint on work, health, and nutrition is not the thing itself but the distance to it and the cost of crossing that distance. This primer is about transportation as access, and about why the price and availability of getting around quietly determines whether the rest of a community's resources are actually within reach.

The lens here is access to the essentials of a healthy life. Mobility shapes whether people can hold a job, keep a medical appointment, and feed their families well, which makes it a determinant of health and stability in its own right, not merely a convenience.

What the evidence shows

The connection between transportation and opportunity is well documented. Access to transportation reduces barriers to employment, education, health care, and child care, and research shows a clear negative relationship between distance from transit and employment: the farther people live from a transit access point, the harder it is to find and keep work. Lower-income workers, and disproportionately Black and Latino workers, often face a triple burden, longer commutes, higher costs, and fewer jobs within a reasonable trip, because affordable housing and job centers sit far apart and the transit between them is thin.

The same constraint shapes health and food directly. Studies of low-income people managing chronic conditions find transportation to be a recurring barrier to care, with long waits, high costs, and unreliable options causing missed appointments and interrupted treatment. The inability to pay a fare has measurable downstream effects: poorer access to food, missed medical visits, even job loss and frayed social ties. And transportation is woven into food security, with high transportation costs and limited transit named in community after community as among the biggest barriers to reaching healthy food, overlapping with the same places that carry high rates of chronic disease.

Cost is the lever

What makes this tractable is that much of the barrier is about cost, and cost is something policy can move. The clearest evidence comes from fare reduction. Where transit systems have lowered or eliminated fares, the effect on access is direct: in several regions, making bus service free or deeply discounted opened up reliable trips to work, school, and job centers for people for whom the fare itself had been the obstacle. Reduced-fare and income-based fare programs exist precisely because the fare is, for many riders, the difference between reaching an opportunity and missing it.

There is an honest complication worth naming. Remote work, sometimes offered as a way around the transportation barrier, mostly is not one for the households that need it most, because remote-friendly jobs cluster in higher-wage professional sectors rather than the in-person, lower-wage work that low-income workers more often hold. The answer is not to wish the trips away but to make them affordable and available: reliable transit, fare assistance, demand-responsive service where fixed routes do not reach, and, where appropriate, help with car access in places transit cannot realistically serve.

What this means for community infrastructure

Treating transportation as access changes how a community evaluates it. The measure is not only miles of route or number of buses but whether residents can actually afford to reach the work, care, and food they need, and whether they can keep reaching them reliably over time. That favors durable arrangements, sustained fare assistance, transit planned around where people actually need to go, demand-responsive options for underserved areas, over one-time projects that look impressive but do not lower the daily cost of getting there.

This is the Foundation's concern applied to the literal distance between people and their opportunities. A community where getting to work, the doctor, and the grocery store is affordable and reliable has removed one of the quietest and most consequential barriers to health and stability. Build mobility as durable, affordable access, designed around residents' real destinations, and the rest of a community's resources finally come within reach. Leave it to chance, and a job, a clinic, and a full refrigerator can all sit just out of reach for want of a way to get there.

References

1. Urban Institute, Upward Mobility Initiative. Transportation access. Access to transportation reduces barriers to employment, education, health care, and child care; negative relationship between distance from transit and employment. https://upward-mobility.urban.org/framework/neighborhoods/transportation

2. Regional Plan Association. Reduced Fares. Inability to pay fares linked to poor food access, missed healthcare appointments, job loss, and broken social connections; income-based fare programs. https://rpa.org/work/reports/reduced-fares

3. Urban Institute. Four Ways to Address Food Insecurity through Transportation Improvements (2025). High transportation costs and limited transit named in every community studied as top barriers to food, jobs, health care, and education. https://www.urban.org/urban-wire/four-ways-address-food-insecurity-through-transportation-improvements

4. Overcoming Transportation Barriers for Low-Income Individuals with Chronic Conditions. Healthcare (2025). Transportation as a social determinant with direct impacts on healthcare access for chronic-condition patients. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12652909/

5. Richmond Fed, District Digest. Transportation Access as a Barrier to Work (2025). Free and reduced-fare transit pilots expanding access to jobs and education; remote work concentrated in higher-wage sectors. https://www.richmondfed.org/publications/research/econ_focus/2023/q4_district_digest

6. CDC, Preventing Chronic Disease. Public Transit Supports for Food Access (2025). Overlap of transit and food access disparities with chronic disease; demand-responsive transit to food retail. https://www.cdc.gov/pcd/issues/2025/24_0458.htm