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At first glance, you might not think that cuts to public transportation might affect someone’s health. But Devilla Ervin understands the impact firsthand. The 23-year-old lives in West Oakland and a few years ago worked the graveyard shift at McDonald’s.

“I got off work at 4 a.m. and there was no bus service,” he describes. “And so I was walking in my community of West Oakland, with shootings and violence, 45 minutes to an hour to get home.”

Yet, in addition to the threat of violence, Ervin also described a sense of social isolation that he’s felt as a result of recent cuts to bus service in his area.

“It’s not good for physical and mental health,” he says. “It wasn’t good for my spiritual health too, because I couldn’t get to church. A lot of the bus cuts were around International Boulevard where my church is.”

Access to public transportation is what policy types call a “social determinant of health” or SDOH. Health is about much more than health care, than simply seeing a doctor.

Now, in a new study, the Alameda County Public Health Department documents the link Ervin has experienced between health and access to reliable public transportation.

In the report, Getting on Board for Health, health department representatives surveyed transit-dependent riders in Alameda County. The Bay Area as a whole has experienced an 8 percent cut to bus service between 2006 and 2011.

“We found among the transit dependent riders we surveyed, more than 8 in 10 say they have more difficulty getting to their jobs, social activities, school or doctors office,” says study co-author Rebecca Flournoy. “And we know this is problem from public health” studies (for example, this one).

Flournoy, the deputy director for planning policy and health equity at the Alameda County Public Health Department says the health impacts include cumulative effects of stress and social isolation, as well as missed doctors care.

And Devilla Ervin is not alone. There are about 2 million Bay Area residents who do not have a car and are transit dependent.

The survey included 477 transit-dependent riders in Alameda County. Nearly two-thirds reported longer wait times as a result of service cuts, one-third said they had longer commutes, and about one in ten said they didn’t see friends or family as frequently. About 6 percent — mostly seniors and people with disabilities — reported less access to health care appointments.

Sheela Gunn-Cushman, a member of the Disability Action Network of Hayward, is blind and relies on buses to get around. She says there’s a clear link for her between health and transit.

“When the buses don’t run, neither do we. That means we can’t work, play, socialize things like that. And we can’t get jobs and keep jobs and and go to doctors appointments and be human,” says Gunn-Cushman.

“A lot of these residents really build their daily lives around where, when and if public transportation is available,” says study co-author Flournoy.

While other transportation studies have explored public transit health impacts in terms of physical activity, traffic safety, and air quality this is one of the first of its kind to focus on health benefits from improving transportation access.

The county health agency released the report now in hopes of influencing the draft Plan Bay Area which will go before the Metropolitan Transportation Commission (MTC) for a vote in July. The long-term plan helps determine the allocation of $289 billion in regional transportation spending over the next 27 years.

One option for the MTC’s plan includes maintaining public transportation funding at current levels. The Alameda report advocates for a different option called the “Equity, Environment and Jobs” alternative. This approach would invest more funding into services, including bus transit around the region.

American children are less likely to live to age 5 than children in other high-income countries. (Photo: Comstock)

If one big thing you want out of life is to live a long time in good health, the U.S. is not doing a good job, says a major report from the National Research Council and the Institute of Medicine, entitled “Shorter Lives, Poorer Health.”

There’s no explaining it away. A panel of physicians and researchers from around the country found a health disadvantage at all ages — from birth to 75 — when compared against people in 16 other “high income” countries.

The breadth and scale of this report is something: 405 pages of analysis across diseases, ages and incomes groups.

Even well-off Americans, “those who have health insurance, college educations, higher incomes and healthy behaviors,” according to the press release, seem to be in worse health than their counterparts in the other well-off countries.

Dr. Steven Woolf, chair of the panel that wrote the report, said they were “struck by the gravity” of what they learned. “Americans are dying and suffering at rates that we know are unnecessary because people in other high-income countries are living longer lives and enjoying better health. What concerns our panel is why, for decades, we have been slipping behind.”

Pretty sobering.

This study builds on a 2011 report that looked at people over 50, but that report largely blamed past smoking history and obesity for the shorter longevity of older Americans. Today’s news broadens to include younger Americans, news which is a “tragedy” according to Woolf. “I don’t think most parents know that, on average, infants, children, and adolescents in the U.S. die younger and have greater rates of illness and injury than youth in other countries.” (The report includes a depressing interactive chart that compares the U.S. to other countries by disease.)

UCSF’s Dr. Paula Braveman was on the panel and repeatedly used the word “shocked” in an interview today to discuss the findings. Still, she said there were a couple bright spots. The U.S. does better on cancer and stroke mortality, but “the rule is we’re worse on everything,” she told me.

The U.S. is famous for spending significantly more per capita on health care than any other country, ”about 90% higher than in many other countries that we would consider global competitors,” according to the Kaiser Family Foundation (see pg. 7). But the panel was unanimous, Braveman said, in its agreement that these health disparities go beyond the health care system itself.

Yes, the panel acknowledges obesity and other unhealthy behaviors as drivers of poor health. But they also point to a multitude of other factors, including the social determinants of health – things like high rates of poverty, income inequality and the (poor) quality of schools — as well as social policy that can contribute dramatically to poor health outcomes.

“I’m hoping this will shake people up enough that they will finally be willing to consider what we have to learn from other countries,” Braveman says. “I think coming to grips with the fact that we’re the bottom of the heap on health, I’m hoping that that will make people willing to take a look at what’s being done in other countries and what we can learn from that.”

Sorry, cigarettes are still terrible for you, but can a good school system lead to better health? (Raul Lieberwirth: Flickr)

Too often, we confuse health with health care. Health care comes from a doctor or hospital. But health comes from many places we don’t normally think of as health at all — things like good schools, safe neighborhoods and access to a variety of jobs. In other words, if you live in places without those things, you have a lower likelihood of enjoying good health.

Today, a new study from researchers at Stanford’s School of Medicine confirms that health disparities across the country have more to do with social factors than the color of your skin or where you live. In fact, the researchers say that some of these social factors even outweigh — gasp — the effect of cigarette smoking. (More on that later).

The study, Geographic and Racial Variation in Premature Mortality in the US, looked at counties across the United States and the likelihood of people living to age 70. Lead author Dr. Mark Cullen says this measure is a good alternative to looking at life expectancy, because it shifts attention to events that occur earlier in life. In particular, researchers found that educational opportunities, distribution of income and a mix of jobs accounted for better health outcomes across the population of a county. These “social determinants of health” as public health professionals call them, also explain health disparities between African-Americans and caucasians. “In most parts of the country,” Cullen says, “if African-Americans had the same advantages that their white counterparts had, almost ALL of the racial disparity would go away.”

The study is national in scope. Here in California, Cullen says that people who live along the coast up to about Mendocino enjoy the best health statistics. But head east to the Central Valley and the health outcomes are much worse.

“It’s not surprising,” Cullen says, “the dominant theme there is these are regions of relatively lower socioeconomic status, relatively lower levels of educational attainment. We’re not talking about individuals here, we’re talking about populations at the county level.”

Cullen stresses that all policy avenues lead back to health. “ALL policy is health policy,” he says, “which is to say that every time at the state level or the county level or the federal level, there’s a debate about expenditures on housing or job training or education, those frankly are health debates. One of the biggest consequences of either cutting out programs or strengthening programs are the health consequences to the population. You don’t see them in a day or a week, you see them over decades.”

One person who sees policy outcomes up close is KQED’s Community Correspondent Xan West. She writes for KQED’s blog ouRXperience from her neighborhood of West Oakland, which is primarily African-American, low income and high crime. Responding to questions about today’s study, she described not only West Oakland’s lack of jobs and school closures, but also its run down playgrounds.

“You see a lot of decrepit and broken down play structures, that kids would hurt themselves on,” she told me. “Neighborhoods are not safe for kids to be outside in West Oakland. It effects how much being outside, being a kid, being able to play is important to childhood, as well as .. important to obesity, important to hypertension. You see heightened rates of obesity in West Oakland and other inner city places and part of that is the inability of people to go outside and play.”

Dr. Anthony Iton, now at The California Endowment, served for six years as Health Officer of Alameda County. While there, he published research about Alameda County’s social determinants of health. He called today’s report a “great study.” Like Cullen, he countered the idea that simply being African-American doomed someone to poorer health. “That is one of the great misperceptions,” he told me. People need to understand “the difference between race and racism. Race doesn’t matter, racism does matter because it constrains people’s access to … high educational attainment, high income, high employment.”

And finally, what of cigarettes? By no means is anyone suggesting smoking is good for you, but Cullen’s research showed the power of these social determinants of health. “Some counties have higher rates of smoking,” he explained. “Some counties have higher rates of obesity. But it was dwarfed by the social environment that was already measured. In fact, when you added it into the equation, it added very little. Now that’s not to say that being obese or smoking is individually a good thing. But it turns out when you look at large swaths of the population, that the underlying factor of education and wealth and occupation and so forth dominate.”

Editor’s Note: The California Endowment is a funder of KQED.