“How come this virus is making me so sick?”
As a doctor taking care of COVID-19 patients, I get this question a lot. I’m trained to describe the biological pathways of this virus to them. But I also know that for some of my patients, most of whom are people of color, immigrants, and under-resourced, that part of the answer may be that society didn’t care enough to keep their air clean.
It is a devastating explanation, but Attorney General Maura Healey’s recent report, done in collaboration with Boston University School of Public Health, makes clear that communities of color with historically disproportionate levels of air pollution are the places hit hardest by the coronavirus in Massachusetts. And initial findings from a Harvard study have shown that even a small increase in exposure to particulate matter 2.5 (PM 2.5), a common but dangerous form of air pollution, is associated with increased death rates for people infected with the coronavirus. Structural racism lies at the root of this health injustice.
One of the best prescriptions I could write for my patients is a clean, equitable, and sustainable transportation system. Transforming our dirty transportation system has long been an urgent public health issue. Air pollution has always made us sick; it increases the risk of heart attacks, childhood asthma exacerbations, strokes, and premature death. But COVID-19 puts an even greater impetus on us to end the use of internal combustion engines and fossil fuels.
A focus on transportation is appropriate. A recent Union of Concerned Scientists study revealed that communities of color breathe in, on average, 66 percent more PM 2.5 air pollution from vehicles than white residents in the Northeast and mid-Atlantic region. In addition to air pollution, our transportation system contributes to the climate crisis. In 2019, cars, trucks, and buses were the number one source of carbon dioxide emissions both locally and nationwide. The warming planet will result in increased days of dangerous heat and higher rates of serious infectious diseases such as West Nile virus in Massachusetts.
Meanwhile, the Trump administration is working to roll back vehicle fuel efficiency rule, a move that will increase air pollution and could drive carbon dioxide emissions up by 1,055 million to 1,317 million metric tons, according to a study by the Rhodium Group. This is cruel; it will cause people to die unnecessarily.
Regions can chart a different path. One tool at its disposal is the Transportation Climate Initiative, a regional policy proposal from Washington, D.C. to New England that can help drive down vehicular emissions and invest as much as $68 billion across the region to build a modern transportation system that decreases pollution. Many details still need clarity. The final form of TCI must invest in public transportation, improve environmental justice, and decrease emissions with urgency. But TCI’s framework is smart, to persuade a vast region to create an enforceable, measurable, target-based emissions reduction plan.
A bright spot during the COVID-19 crisis has been the leadership and collaboration of governors in the Northeastern and mid-Atlantic region. The same is needed to transform the region’s transportation system. In the midst of the economic devastation brought by COVID-19, TCI is an effective framework to rebuild the economy with good-paying clean energy jobs while decreasing pollution and greenhouse gas emissions. Done right, this initiative will help the nation move away from the internal combustion engine and create critical investments for the public transit system and electrified transportation system. It can help the economy, improve health equity, and save lives.
My oath as a doctor is to first do no harm. But our transportation system does active harm to my patients by polluting the air and destabilizing the climate. We need to stop describing the big problems of our time, and instead act with conviction to solve them. I want to be able to tell my patients that Massachusetts did everything it could to keep their air clean and their families healthy. TCI is an important regional policy that will move us one step closer to that reality.
Dr. Gaurab Basu is co-director of the Center for Health Equity Education & Advocacy at Cambridge Health Alliance and an instructor at the Department of Global Health & Social Medicine at Harvard Medical School.