For every 1,000 babies born in the U.S., about six die before they turn one. In South Linden, a poor, predominantly black neighborhood in Columbus, Ohio, that number is close to 24.
That’s a staggering rate of children never reaching their first birthdays. Premature births and low birth weights are the leading culprits, according to a 2014 report by the Greater Columbus Infant Mortality Task Force. Babies sleeping unsafely is another common cause of death.
Linden’s astonishing concentration of infant death is a canary in a coal mine, underscoring a host of racial and environmental factors that are putting babies, women and their pregnancies at serious risk. And the neighborhood isn’t alone; it and seven others around Columbus—Franklinton, Hilltop, Morse/161, Near East, Near South, Northeast, and Southeast—are home to some 22 percent of all infant deaths throughout Franklin County, despite making up just nine percent of the population.
“Where you find sick and dying babies, you will find moms who are not doing well; you will find neighborhoods that are not doing well,” Mark Chaffin, the director of Research in Developmental and Behavioral Pediatrics at the University of Oklahoma Health Sciences Center, told the Columbus Dispatch in 2014.
Poverty, poor nutrition, barriers to education, jobs, and health care, and chronic stress: These factors worsen pregnancy outcomes for women of all races. And in the Columbus area, they disproportionately affect black women. (Some researchers have even linked the stress of a lifetime of racism to poor pregnancy outcomes for black women.) In South Linden, which borders the I-71 north of downtown Columbus, close to half of the population lives below the poverty line, and about as many have less than a high-school education. Crime is high. It’s a federal “food desert.” That’s a lot stacked against healthy pregnancies.
The city of Columbus has begun to seriously address its infant mortality problem, working with the state of Ohio, Franklin County, and local health providers to dispatch community health workers into hard-hit neighborhoods. They help register women for health insurance and educate them about pre- and post-natal care, nutrition, and safe sleep habits. (A similar model has helped Baltimore reduce its high infant mortality rate.) Private businesses have partnered with the city to host job fairs and skills-training opportunities.
But lately, the city is rallying particularly hard to improve a service that touches on many other social determinants of health: transportation.
Public transit: Connecting families to resources
Columbus is a sprawling, car-oriented city, says Erika Clark Jones, the director of community strategies at CelebrateOne, the organization appointed by the city to carry out the recommendations of the city task force. “For women who don’t have access to cars, getting to doctors, jobs, school, and all the other support systems they need to say healthy can be a real issue,” she says.
In Linden, it’s not so much that transit doesn’t exist. Five bus lines serve the area, and the neighborhood has two entrances onto I-71. The community has some of the highest rates of ridership in the area, due to the relatively high number of people without a car.
But there are big gaps between the bus lines that travel along the neighborhood’s major thoroughfares. To get to bus stops—which are often no more than telephone poles with a sign—residents have to walk along crumbling sidewalks or even in the street, passing abandoned homes and few storefronts. And once they’re on board, travel is slow. What would be a 12-minute car drive to a major hospital takes close to an hour on the bus. All of this can be pretty discouraging and isolating, especially when you’re carrying an extra 30 pounds in baby weight.
That’s part of the reason that Columbus is routing its new BRT system, CMAX, right through Linden. Starting in September 2016, buses are expected to arrive every 10 minutes at core stations, and the system is projected to cut travel times by 20 percent. There’s a big hope that faster, more frequent bus service—with amenities like WiFi, covered stations, and real-time bus arrival information—will plant seeds for economic development and amenities like farmers’ markets and grocers in Linden. But before all of that, it’s designed to increase access to employment centers like the Polaris neighborhood to the north and downtown to the south, with two major hospitals in between.
A smarter, healthier Columbus
Expanding transit access to women of childbearing age is also a central focus of the city’s bid to win the Smart Cities Challenge, the U.S. Department of Transportation’s $50 million grant program that asks cities to use technology to improve transportation networks. In March, Columbus was announced as one of seven finalists for the Smart Cities Challenge, alongside Austin, San Francisco, Pittsburgh, Denver, Portland and Kansas City.
Crucially, Columbus wants to offer universal transit cards, which riders could use to pay for public transit as well as taxis, ride-hailing and car-sharing options. Kiosks would be installed at key locations, which would allow riders with (or without) credit cards or smartphones to add funds, call rides, and access real-time transit information. The city may also subsidize trips by private service providers like Uber and Car2Go. (A report released this week by the Center for American Progress highlighted this approach as a boon for low-income riders.) This could go a long way to address gaps in first mile/last mile connections, which can be a huge hurdle to low-income citizens getting the services they need.
“There are lots of resources in our suburbs that are hard for residents in the inner city to access,” says Patrice Brady, a senior planner with the city of Columbus who works closely with CelebrateOne. One example is a major hospital in Dublin, a northwest suburb. “There’s not frequent service to get there, and even once you get to the end of the line, how do you get to the OB-GYN?” she says. “If there were a Car2Go, or a way to access Uber, that would help me as a pregnant woman.”
The main point, Brady and Clark Jones say, is to give residents options—including the option to access care and jobs within their own neighborhoods. “We want to do everything we can to bring prenatal and pediatric care to all underserved communities,” says Clark Jones. “But if transportation options are also limiting choices, then that’s what we want to address.”
Transportation is only one tool with which to stem the terrible trend of infant mortality. And measuring its direct impact on the health of moms and babies won’t be easy. But the need is clear. There’s a push for public transit happening across Columbus, which despite rapid population growth remains the largest city in the U.S. without any kind of passenger rail (nope, not even Amtrak). Increased bus options, pedestrian bridges, bike-sharing, and ride-hailing services are slowly transforming the downtown core. Now it’s time to extend services to the Columbus citizens who need it most.
“For us, transportation isn’t just getting from A to B,” says Rory McGuiness, who spearheaded Columbus’ Smart Cities Challenge application as the city’s deputy development director. “It’s the central way for our citizens to get to greater ladders of opportunity, to economic activity, to the middle class.” And, hopefully, to more first birthdays.