States Invest in Public Health and Safety Through Transportation Policy

January 09, 2026 | Clint Grant

The design and management of transportation systems are inextricably linked to public health, influencing everything from the air we breathe to our physical activity levels. However, this critical relationship is under immense strain. Transportation and public health have historically operated in siloes, yet communities are facing marked increases in traffic-related serious injury or death and increasing rates of chronic disease. While these may seem like disparate issues, addressing the crises in both road safety and community well-being requires a unified response.

State policy is moving beyond traditional, crash-focused interventions to a systems-based approach, redefining transportation infrastructure as a foundational investment in public health. By adopting frameworks like Health in All Policies, states are integrating health considerations into urban planning to address health related outcomes. Recent federal initiatives have also moved beyond traditional interventions toward comprehensive, systems-based approaches that address the underlying conditions contributing to traffic fatalities and serious injuries (e.g., Safe Streets and Roads for All; National Roadway Safety Strategy; Better Utilizing Investments to Leverage Development grant program). These changes help drive transportation policy solutions that protect everyone.

State Role and Policy Opportunities

States play a key role in advancing the integration of transportation and public health. Recent efforts have focused on protecting vulnerable road users — pedestrians, cyclists, children, and older adults — who face disproportionate risk due to limited physical protection and reduced visibility while on the roadway. Jurisdictions can utilize a number of mechanisms to enhance partnership between public health agencies, transportation departments, community representatives, and policymakers, including:

• Collaborative data collection and health impact assessments.
• Evidence-based funding prioritization that supports safe and sustainable mobility.
• Adoption of safe systems principles in street design standards.
• Targeted investments that address disparities affecting vulnerable road users and underserved communities.

One example of collaboration is underway in New Jersey, which enacted A1476 in 2025 to establish the New Jersey Target Zero Commission. Led by the New Jersey Department of Transportation with members from the state health department and human services agency — among others — the commission is tasked with enhancing road safety interventions to eliminate all traffic fatalities and serious injuries by 2040. An action plan and strategies to support these goals through roadway design, speed management, and education is due in January 2026. New York (S 3071) and Minnesota (SF 2687) also considered bills to establish formal pathways for transportation policy collaboration this session, with New York exploring a task force focused on school transportation safety and Minnesota proposing a work group focused on strategies for safe school bus stop locations.

States are also considering other efforts to improve transportation safety for children and other vulnerable road users, and around schools. In 2025, California enacted at least two bills focused on pedestrian safety. AB 382 will eventually lower the speed limit in school zones down to 20 miles per hour, while SB 671 will require the use of adaptive pedestrian signals at certain locations to improve safety and accessibility for pedestrians who are blind or who have low vision. Hawaii took both legislative and executive actions to promote its transportation policy goals, aimed at protecting pedestrians — including children — and reducing fatalities. Last year, the legislature enacted SB 1195 to limit parking within 20 feet of crosswalks and intersections, known as intersection daylighting, noting that illegal parking in these areas is dangerous for pedestrians, including children walking to school. Fines collected from violators are earmarked for the state’s safe routes to school special fund. Also enacted in 2025, HB 1231 allows the state to collect additional funds for its safe routes to school program through a new $5 surcharge on motor vehicle registrations. Finally, Governor Josh Green issued an executive order in September 2025 acknowledging the increase in traffic fatalities and the need for appropriate integration of emerging transportation methods like e-bikes. The order directs the state Department of Transportation to issue rules regarding e-bikes and encourages the state Department of Education to develop policies that limit the use of high-speed or otherwise non-conforming e-bikes on public school campuses.

Health Benefits of Accessible Active and Public Transportation

Policies that support active transportation — like walking and biking — and public transportation infrastructure can also serve to improve population health outcomes in multiple ways. For example:

• Expanding transit and safe active transportation networks decreases motor vehicle miles traveled and directly contributes to fewer traffic crashes and fatalities.
• Transit-supportive design increases physical activity levels, with transit users engaging in roughly 30% more daily activity than non-users.
• Lower vehicular traffic reduces air pollution and greenhouse gas emissions, strengthening respiratory and cardiovascular health.
• Neighborhoods with sidewalk infrastructure significantly increase residents’ likelihood — by nearly half — of achieving 30 minutes of daily physical activity.
• Reliable, affordable transportation strengthens connections to employment, health care, and social engagement, supporting mental and emotional well-being.

Despite strong evidence linking transportation systems to health, the United States faces barriers to achieving safe and fair mobility. Decades of car-centric investment have left many low-income and rural communities without reliable transit or active transportation networks, reinforcing mobility disparities and limiting access to safe, health-promoting options. These gaps are especially pronounced in rural areas, where deteriorating roads, scarce sidewalks, and limited non-car options disproportionately affect older adults and people with disabilities, further restricting safe travel to health care, food, and social connection. While recent reporting highlights that pedestrian fatalities fell for the second year in a row, the total remains disturbingly high and nearly 20% higher than in 2016. These persistent safety concerns deter people from walking, biking, or taking transit even where infrastructure exists. Together, these conditions sustain car dependence, increase preventable injuries, and contribute to sedentary lifestyles and chronic disease.

ASTHO will continue to monitor policies that address transportation as a core component of public health and provide any necessary updates.