In Columbus, Ohio, too many moms aren't getting to watch their kids grow up. Better mobility might be part of the fix. Jessica Rinaldi/Reuters

Last year, Columbus, Ohio, won a $50 million grant for high-tech transportation innovation, with a promise to help its most vulnerable families. Now some worry their needs are fading into the background.

COLUMBUS, OH.— Katrina Lewis could feel impatience radiating off the bus as she struggled to collapse the stroller. That was the rule on Columbus transit, the driver said, even with small children in tow.

That meant extracting her newborn and two-year-old from the big doublewide baby carrier as the four-year-old stood next to her. All the passengers seemed to stare as Lewis bent over the bulky stroller, baby gripped in one arm, crying. Her bad hip ached under the strain. She thought she heard someone on the back of the bus shout her name: Come on, Katrina!

That’s it, Lewis thought. “I could not handle it that day,” says the 37-year-old. She picked up the stroller, backed off the bus, and hauled her family, on foot, nearly a mile to the primary care center where the children had doctor’s appointments that day. They were nearly half an hour late. “I should tell y’all to go home,” Lewis remembers the receptionist telling her. Hours later, after they’d walked back home, she collapsed on the couch from the exhaustion.

Columbus, like so many American cities, is a hard place to raise children when you’re poor. Transportation—and the lack of it—is a big reason why. The city’s bus network is sparse, and there’s no passenger rail of any kind. A bus ride can turn a 20-minute drive into a two-hour chore. Getting around is best done by car, if you can afford to keep one on the road.  

This isn’t just an irritation: It is a serious health problem, particularly for children and mothers. In Lewis’ neighborhood of South Linden, infants are dying at more than four times the national rate. When families struggle this hard to make it to the doctor, prenatal conditions and congenital anomalies—which are responsible for about 14 percent of all infant deaths in Franklin County—can go undetected. Essential follow-ups get lost.

And there’s another factor linking poor mobility with poor health. Juggling kids, jobs, and errands on shoddy transit causes daily anxiety and stress, along with other environmental frictions like unstable housing and crime. The stress can increase a mom’s chances of preterm delivery—by far the most common infant killer in Columbus.

In June 2016, the city scored a $50 million jackpot promising to transform Columbus’ mobility landscape, beating 77 other cities for the Smart City Challenge. Funded by the U.S. Department of Transportation and Vulcan Inc., the competition called on leaders of mid-sized metros to use new technologies to improve mobility around the city and its quality of life. Part of the winning Columbus proposal was a vision of connecting low-income South Linden residents with better means of accessing medical care, jobs, and education. This was a novel model—a transit revamp aimed at saving lives, not just commute time. A central aim: reduce infant mortality by 40 percent by 2020, the city’s existing goal.

Today, a year and a half later, there’s money sitting in the bank, and the outlines of Smart Columbus are taking shape. The big question: Will vulnerable moms get the lift they need?

***

To answer that, let’s begin on Cleveland Avenue, the diagonal north-south spine that connects South Linden to downtown Columbus and wealthy neighborhoods to the north. Block after block of vacant homes and businesses line the street; grocery stores, clinics, and auto shops have vanished to decades of disinvestment, population decline, and foreclosure. “It’s mostly boarded up everything and anything,” says Twinkle Schottke, the director of Moms2B, a support program for women at risk of unhealthy pregnancies, as we drive past.

The neighborhood looks like it could belong in any number of post-industrial, Rust Belt metros. But Columbus is actually booming: It’s the fastest-growing metro in the Midwest, with a prestigious anchor university and an array of corporate headquarters drawing 10,000 new residents annually. In the past 15 years, the city has carefully seeded hundreds of millions in private investment and public tax dollars to remake downtrodden urban neighborhoods into alluring residences for newcomers.

Abandonment in South Linden. (Laura Bliss/CityLab)

By the city’s own admission, those opportunities haven’t reached poor, predominantly black neighborhoods like South Linden. Here, unemployment is triple the rest of Columbus, and incarceration rates are more than six times higher. There are more single mother households here than in 99 percent of all U.S. neighborhoods, yet there are no OB-GYN clinics. With a median household income of about $21,000, relatively few households own cars.

“When you have kids of two or three different ages, it’s everyone going everywhere except to the same place. It’s getting to daycare, to schools, and then going to work,” says Sharonda Avant, a 25-year-old mother of four.

She’s sitting in a circle of ten other women at a recent Moms2B meeting. For the most part, these sessions cover healthy eating, safe sleeping advice, and behaviors that can put pregnancies at risk of unhealthy outcomes, such as smoking and drug use. But today, partly for my benefit and partly because it’s a huge source of stress, the moms are talking about how much trouble they have getting around.

“I missed eleven appointments in the past year because of transportation,” Avant says. Other mothers murmur in agreement.

Many of the moms are insured by Medicaid, which means they can arrange for non-emergency medical transportation vans to take them to health appointments and Moms2B sessions. But the system doesn’t work well: Drivers show up late or hours early. They don’t bring car seats or the extra space that was promised for kids. Sometimes they don’t come back for the return trip. Lewis shares a story from another Moms2B session in October, when it took her an hour and multiple phone calls to get a van dispatcher to finally admit no one was coming to bring her home.

“They always forget us,” Lewis remembers telling a Moms2B counselor, who eventually ordered a taxi. Schottke estimates her organization spends $1,500 a month buying cab rides for her participants. “I just hate to think that this is the reason they don’t show up again next week,” she tells me.

Columbus’ infant mortality crisis is one of the worst in the country. For every 1,000 babies that are born in Franklin County every year, nearly nine die before they turn one, compared to about six nationwide. Just eight neighborhoods, including South Linden, are responsible for nearly half of those deaths. The racial disparity is stark, with almost three times as many black babies dying as white ones. There are a web of contributing factors: smoking, poor nutrition, unsafe sleep habits, and a host of environmental determinants, including a lack of transportation to care. Nearly 23 percent of women who make prenatal appointments at Columbus’ free clinics do not show up.

Apart from unimaginable trauma and grief for families, infant mortality harms society in the coldest terms. According to data provided by Moms2B, a premature or low-birth weight infant costs Ohio taxpayers roughly $38,000 in her first year of life, compared to $4,000 annually for a healthy baby.

For years, infant mortality was a disturbing open secret in this city. But Columbus made it a focus of its Smart City Challenge bid. Working with data and guidance from CelebrateOne, the infant mortality task force the city established in 2014, officials called out South Linden as a high-stakes neighborhood that could benefit from transit investment to help residents get to jobs, education, and healthcare. Mayor Andrew Ginther promised in 2016 to use transportation to “change the life trajectory of those underserved neighborhoods.” The proposal was lauded for its strong social bent. Media coverage, including my own, followed suit.

The neighborhood was not the sole focus of the proposal, and infant mortality was one of many challenges the city hoped to address. To reduce congestion, increase job access, and improve traffic safety, officials also pitched a suite of futuristic projects to be deployed across the city, including self-driving shuttles, bike- and car-sharing hubs, “smart” traffic signals that communicate with vehicles, and electric vehicle chargers.

Yet for researchers, advocates, and residents, the grant looked like a rare opportunity for South Linden to benefit. The proposal described how the grant would support the Central Ohio Transit Authority’s existing plans to run new rapid buses down Cleveland Avenue at speeds 20 percent faster than the current service. It discussed sidewalk kiosks that could be used to add funds with cash or credit, call cars, and study timetables, and universal transit cards that could pay for any form of transit. Linden was also mentioned as a possible site for autonomous vehicles to serve as “first and last mile” connections.

And most promisingly for women like Lewis, the city said it would study mobility challenges specifically in South Linden, and work with private and public partners to offer something better.

Barb Bennett, left, president/COO of Vulcan Inc, and U.S. Transportation Secretary Anthony Foxx, center, present the Smart City Challenge award to Columbus, Ohio Mayor Andrew Ginther in 2016. (Jay LaPrete/AP Images for Vulcan, Inc.)

But as Columbus makes its bid for a tech-powered transformation, Jason Reece fears that the equity goals could fade into the background. Reece is a professor of urban planning at the Ohio State University whose research helped inform some of the grant planning, and who has studied health inequities in South Linden in depth.

If Columbus wants to lift up vulnerable families through transportation, he says, it needs to invest in programs aimed narrowly at vulnerable families. “Technology doesn’t necessarily trickle down to serve those folks who are most in need,” he says. “You have to put the people you’re going to focus on in the forefront.”

Proof lies in other cities that have looked to tech as a salve for social problems. Philadelphia’s attempt to train 500,000 low-literacy workers via smartphone was deemed “empty rhetoric.” Pittsburgh recently declared itself an “inclusive innovation” city, with the aim to diversify its tech workforce, but a lack of rigor has failed to move that dial very far, as my colleague Brentin Mock recently reported. Meanwhile, in boomtowns like Seattle and San Jose, high-tech prosperity has been accompanied by displacement and affordable housing challenges.

Since it won the grant competition in June 2016, Columbus has worked with private partners to leverage the $50 million winnings to raise additional capital. By now, it has nearly $500 million in its Smart City bank—with the goal of reaching $1 billion.

The city has taken some baby steps towards its social promise. This summer, Columbus asked Sidewalk Labs, the urban innovation subsidiary of Alphabet, to develop a way to streamline the Medicaid shuttle service. After a handful of focus groups with Moms2B participants, Sidewalk Labs produced a recommendation: Build a cellphone-based platform that would allow moms to communicate via SMS with medical care providers and shuttle drivers when they needed rides to the doctor, and automatically arrange pick-ups through traditional van contractors or newer ride-hailing services like Uber or Lyft.

Maybe that’s not as sexy as a fleet of robot cars, but an easy-to-access blend of paratransit and ride-hailing seems like the kind of real-world solution that would serve women like Lewis pretty well. “I don’t know why all the [Medicaid] vans can’t already work that way all the time,” she says.

Sidewalk Labs’ vision suggests that they could, if the resources were available, and at some point, it seems they were planning to try. Corinna Li, who leads mobility research at Sidewalk Labs, says the intention for Columbus was to do a pilot in Linden.

Schottke, who helped coordinate the focus groups, says she couldn’t wait to see something tested. “I know people like to roll out grand plans,” she says. “But my moms need help now.”

For now, however, receiving Sidewalk Labs’ recommendation is as far as the city plans to go, says Brandi Braun, Columbus’ deputy innovation director. There is no plan for a pilot. None of the Smart City ideas have a start date, says Braun; no specific investments are finalized. She says that city is still working through project management guidelines and other preliminary tasks. She also notes that the state is looking into its own “smart” revamp for the Medicaid vans, and the city wants to avoid redundancy.

But when I ask her if new and expectant moms in Linden were truly a target population of the grant, as so much of the publicity of Columbus’ victory implied, Braun hesitates. None of the Smart City projects were ever going to singlehandedly solve for infant mortality, she says. That health crisis and the families most affected by it “are one piece of the puzzle,” she says. Broader-based investments—such as the bus upgrade along Cleveland Avenue that’s set for 2018, and universal fare cards that Braun says will eventually move forward—are supposed to indirectly serve this population.

Perhaps they will. Such area-wide mobility upgrades could assist residents in disinvested parts of Columbus simply by making it easier for them to get to the richer ones. “There are lots of resources in our suburbs that are hard for residents in the inner city to access,” Patrice Brady, a senior planner at CelebrateOne, the infant mortality task force, told me when I first reported on Columbus’ Smart City plans last year. “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? If there were a Car2Go, or a way to access Uber, that would help me as a pregnant woman.”

But Reece worries that such benefits might not materialize so easily. “We need to be hyper-focused on the needs [of this population],” he says. “This is the piece I’m going to be keeping my eye on: Are we really doing what we said we’d be doing? Are these efforts really serving people on the ground?”

***

Others in Columbus see a bait-and-switch afoot. Jonathan Beard, a longtime community developer at the Columbus Compact Corporation, says that the city has a history of using social equity as a guise for redevelopment projects that push out existing citizens. He points to a host of unkept promises in the historically black and now-gentrifying King-Lincoln district, and the recent demolition of a public housing project that had been a point of pride for Columbus’ black community and listed on the National Register of Historic Places.

In Beard’s view, the Smart City proposal could be an urban renewal scheme in the worst sense of the term: South Linden’s position between booming downtown Columbus and wealthier suburbs to the north could make it an strategic target for investments destined more for gentrifiers. “Columbus is all about real estate,” he says. “They move black folk around this city like you move a pawn around the chess board.”

Braun affirms that South Linden was selected because of its immense social challenges, as well as its proximity to COTA’s new bus rapid transit line. And Brady adds that the city's work on infant mortality, and on closing its racial gap, goes beyond the Smart City grant: CelebrateOne trains community health workers and runs educational campaigns.

Still, questions persist about the city’s approach. Jessica Roach, the executive director of R.O.O.T.T., a local reproductive justice organization, argues that Columbus is ignoring the bedrock reasons why transportation—as well as quality housing, education, and nutrition—are so much harder to access in black communities than in white ones. Helping moms get to prenatal health appointments is undoubtedly important, she says, but “until we start talking about racism as a risk factor, those infant mortality numbers are never going to drop.”

Lewis and her partner shop for groceries with a baby in tow. (Laura Bliss/CityLab)

Like so many neighborhoods in America, South Linden looks the way it does today due to a legacy of exclusion and disinvestment: Racial real-estate covenants and redlining kept homes and wealth out of the hands of black Columbus families in the first half of the 20th century. Entire blocks were razed to make way for an highway in the 1960s.

Racism guided those policies, and racism help build the environments now sickening black families. Medical science increasingly backs that argument up: Researchers now reject genetic explanations for the enormous disparities between white and black pregnancy outcomes, as well as the idea that race is simply a proxy for income—for even wealthy black women fare worse, health-wise, than white counterparts.

The clearest explanation is environmental stress. Some scientists have compared the levels of cortisol hormones found in some black American women to what it’s like to live with PTSD. Constant activation of the stress-response system “can disrupt almost all of the body’s processes,” increasing the risk for heart disease, obesity, diabetes, depression, and cognitive impairment, states the American Psychological Association. That stress also increases the odds of pregnancies that end in preterm births and low birth weights, the leading causes of infant mortality.

“In the broad discussion of these things, it’s really the social determinants of health that are driving things,” Greg Moody, the director of Ohio’s Office of Health Transformation, told the Plain-Dealer in 2015. “The actual clinical healthcare is a very small portion of what keeps a person or a family well.”

Low-income black women know that they’ve been dealt the worst hand in American society, says Roach. They have racism, sexism, and the effects of poverty to contend with. No wifi-equipped streetlight or self-driving car is going to solve that.

The city acknowledges this. But Roach says she’d like to see more women like Lewis guiding the conversation on public health issues like infant mortality. What distinguishes R.O.O.T.T., which trains doulas and leads anxiety-relief workshops, is its belief that the population that needs help also knows what’s best for themselves, Roach says. “At our organization, we start from a very simple place: Trust black women.”

***

Lewis tells me she wants the same things that everyone wants: a stable house, a steady job, and for her kids to be healthy and successful. That’s why she’s earning a degree in health information technology online, while her partner, Walt Johnson, works closing shifts at Wendy’s. She might eventually want her own car, she tells me, although she doesn’t drive. For now, she’d settle for a Lyft ride.

With Columbus sitting on a half-billion dollars pegged to transformative transportation, that doesn’t seem like a lot to ask. And yet, Lewis and so many Columbus moms are still struggling with the bus, and with those balky Medicaid shuttles. “Shouldn’t it be somebody’s job to make sure that everybody’s accommodated?” Lewis wonders.

Columbus won the Smart City Challenge because of its strong social promise, and its potential to be a blueprint for other cities seeking tech solutions to deeply human problems. It is not an easy charge. Faster bus service, as Columbus had already planned for, is a good start. But a true smart city commitment might start with Lewis’ suggestion: Make sure its most vulnerable residents can get around.

Counting on mobile phones and sensors to execute that promise may take more than grant money and good intentions. It would require more forthright engagement and targeted investments. Maybe then Columbus could have neighborhoods that fit its citizens—streets that connect instead of divide, services that relieve stress instead of creating it.

After the Moms2B meeting, I go grocery shopping with Lewis and Johnson. Into the shopping cart go bags of kale, hamburger meat, baby formula, cereal, and dozens of other items to feed the family. At the cashier, Lewis pays with a WIC card, four separate Kroger gift cards she received from Moms2Be, and finally, a $20 bill. She and Johnson carry eight bags of groceries outside to the corner, where they wait 20 minutes for the bus to come. There are no seats; they stand for the ride home.

A smart city sounds nice to Lewis. It also sounds far from where she lives. “My thing is, someone should get on the bus and ride with us,” she says, “and see what the struggles of everyday people are.”

This article is part of our project, “The Diagnosis,” which is supported by a grant from the Robert Wood Johnson Foundation.

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