The connection between public transit and health is clear. Research shows that transit helps increase physical activity, lowers levels of disease related to environmental factors, and results in greater pedestrian and vehicular safety. But transit can also perpetuate inequity. In many communities, for example, expansion of public transit improves quality of life for white, upwardly mobile, car-less millennials and suburban commuters, but simultaneously displaces low-income communities, as areas around new transit stations are gentrified with higher-end mixed-use developments.

Innovations in Health Equity

This special supplement examines the organizations and programs that are addressing social inequalities in housing, transportation, work, and other parts of society that create disparate health outcomes.

An initiative in Denver called Mile High Connects (MHC) is showing how to counter the displacement. In 2004, Denver voters approved FasTracks, a $7.8 billion transit expansion, adding 122 miles of new light rail, 18 miles of bus rapid transit, and enhanced regional bus service to the region. Construction is currently under way on the multi-decade project, with four new rail and bus rapid transit lines opening in 2016 alone. Bolstered by early support from the Ford Foundation, local nonprofits and funders came together to take advantage of a historic opportunity and formed MHC in 2011. MHC is a cross-sector collaborative of nonprofits, foundations, businesses, and government leaders in the Denver region that makes an explicit connection between public transit and health equity.

MHC’s goal is to ensure that Denver’s transit build-out benefits low-income communities and communities of color by connecting them to affordable housing, healthy environments, high-quality education, and well-paying jobs. MHC serves as a backbone organization, influencing local and regional policies, leveraging and deploying resources, and helping residents of low-income communities and communities of color engage directly in decision making that affects their lives.

MHC’s first public act was to create the Denver Regional Equity Atlas. The document starkly contrasted the relationship between new transit lines and issues of importance to the region’s low-income communities, including the location of affordable housing, job centers, health-care institutions, and high- and low-performing schools, and how they were connected (or not) to the new tax-funded transit lines. Now an online interactive tool used by both community residents and decision makers, the Equity Atlas demonstrates that areas with lower incomes and higher concentrations of people of color have less access to healthy food, walkable blocks, and health centers, as well as significantly higher numbers of households that are burdened with relatively high housing and transportation costs. Over time, the tool has become important not only to document current disparities, but also to show population-level outcomes across the region.

Initially, MHC’s work was based on the premise that ensuring that people could live near and use transit would have a positive impact on families’ budgets. But MHC soon learned that for many, the cost of transit itself was unaffordable. Residents were making choices between fares and meals, medicine, and other basic necessities. When low-income people have access to affordable public transit, they are better able to access health clinics and hospitals, grocery stores, and recreation centers, an important health resource in communities where outdoor exercise is not always possible or safe. But transit without affordability wasn’t going to have the intended effect. Transit affordability thus became a central theme, galvanizing hundreds of community members and more than 100 nonprofit, public sector, and business partners.

MHC also learned that physical access to transit was a crucial barrier for many neighborhoods, where low levels of infrastructure investment had been endemic for years. Crumbling or missing sidewalks, poor lighting, inadequate drainage, and other obstacles made it difficult for residents to get to transit stops. In some communities, reaching the closest bus service required walking up to a mile. In other neighborhoods, bus routes that took riders to places like human service agencies or hospitals were being eliminated as light rail service expanded.

Linking Public Transit and Social Determinants of Health

The Housing + Transportation Affordability Index has been an important resource informing MHC’s early efforts. As housing costs rise in newly developing areas, affordable housing gets pushed outward to less dense suburban communities that often have fewer services and less transit. Transportation costs increase for those same households, and they arrive at a tipping point where any savings they achieve because of affordable housing are offset by increased transportation costs. Knowing that households that use mass transit can save up to $10,000 a year, MHC seeks to ensure that low-income communities and communities of color benefit from the expanding transit system by preserving and building affordable and workforce housing in close proximity to transit stations, as well creating opportunities for new nonprofit services and businesses that will provide good jobs for local residents.

Under the leadership of Enterprise Community Partners, nine local partners worked together to create the Denver Transit Oriented Development Fund, which paved the way, almost literally, for this effort. The fund used public, philanthropic, and financial institution capital to purchase land near future transit stations to maintain the affordability of housing and community facilities as station areas were developed. These MHC partners preserved and created more than 600 units of affordable housing in the first three years of the fund’s existence, and the fund has grown to a regional scale, added new investors, and increased the number of qualified borrowers.

Implications for Funding

MHC’s work is opening up new opportunities for philanthropy to think differently about resources and funding structures. We are studying how capital might be most effectively leveraged and invested at a large scale to support the Denver region’s transit buildout and related community development. It’s clear that tracking large-scale public investments opens up opportunities to try new or scale-proven strategies to achieve health equity. We are also seeing early success in combining philanthropic investment with private sector impact investment capital to achieve greater impact in the built environment and community development efforts.

Creative thinking about philanthropic capital is also encouraging public sector innovation. For example, as MHC continues to explore the essential question of transit affordability, it is developing a low-income pass for riders in partnership with the Denver region’s transit agency. Implementation is a core challenge because of the lost revenue to the transit agency as a result of subsidized fares. To help close the gap over the next five years, MHC is crafting a strategy layering transit agency investment with philanthropic and private funds. Through this strategy, we anticipate building the case and political support for a sustainable public revenue source.

The Benefits and Challenges of Cross-Sector Partnerships

MHC believes that systems will change to benefit low-income communities and communities of color only if members of those communities and their allies work in partnership with grass-tops leaders—and if these partners share decision-making authority. MHC’s decision-making table today includes 17 core nonprofit, philanthropic, and business partners, and the collaborative has built relationships with nearly 300 additional partners.

This broad approach means that sometimes the work takes more time than we would like it to. But it’s important to ensure that everyone’s perspective is heard. Partners must devote time, attention, and effort to build trust among those who do not normally work together, as well as work to ensure that collaborative partners share language and values. Effective cross-sector partnerships must learn to live with, and even embrace, the constant creative tension that comes from the mix of cultures, backgrounds, and professional and personal experiences that members bring to the group. One of MHC’s central tenets is that unless everyone is feeling at least a little uneasy about at least one of the collaborative’s strategies, MHC is probably not doing its job.

This creative tension can lead to successful outcomes. MHC has forged strong cross-sector relationships that have led to the preservation and restoration of lifeline bus service routes in low-income communities, significant movement toward a regional low-income fare program, creation of economic opportunity strategies linking good-quality jobs and transit, and the development of new policy priorities focused on affordable housing in proximity to transit.

Public investment in large-scale transit projects can lead to dramatic improvements in the most important factors determining the long-term health of families and communities. By enabling families to live close to transit, these investments increase access to good jobs, housing, schools, and health care. Cross-sector collaboratives that engage low-income communities and communities of color with funders, nonprofits, and private and public sector decision makers have the ability to ensure that public transit fosters healthy and equitable neighborhoods for all.

Transit Equity Profiles

Here’s just one example of the tangible progress MHC has seen. Guadalupe lives in a neighborhood only a few miles from Denver’s thriving downtown, but back in 2010, you would not have known it from the neighborhood amenities. Her neighborhood was a food desert; she had to take a 50-minute ride on two buses to get to the nearest grocery store. Though she knows that fresh food is important, she often found herself exhausted at the end of the workday, shopping at a nearby convenience store for groceries. By 2014, however, MHC’s partners created a new mixed-use development in Guadalupe’s neighborhood that added affordable housing near a transit stop and spurred the addition of more community-serving amenities, including a library, a child-care center, and a culturally appropriate fresh-food market.

Manolo’s experience provides another example. Manolo is a single father of three children who works two custodial jobs to support his family. Over the past year, he has seen development begin around a rail station near his home that will be opening in 2016. Rent prices are increasing, and he is seeing some of his neighbors forced to move. Manolo feels lucky that he lives in a building owned by a nonprofit that keeps the rents low enough for him to afford. He says he does not know what he would do otherwise and would worry that his kids would have to change schools and leave friends, as he has seen happen to many of his neighbors. “I want to be here for all the change. I want to be able to be a part of the neighborhood when it’s good, not just when it’s bad.”

Maria’s experience illustrates progress, but also underscores the fact that there are still great challenges to overcome. Maria has lived her whole life in a neighborhood on the city’s west side and is now raising her own children there. She works full-time at a fast-food restaurant and used to have to walk more than a mile to get to the nearest bus route to work. Two years ago, she began working with some neighbors to get the transit agency to put a bus route put back into their neighborhood. When the group took a victory ride on the day the route opened, she described it as one of her proudest moments. But Maria still worries that the bus fares are too high for her and other neighbors to afford. At a recent meeting where more than 60 community residents testified, Maria had tears in her eyes. She said, “It is beautiful to see us all speaking with one voice. Hopefully they will listen and give us a pass based on our income, not thinking everyone can pay the same.”

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Read more stories by Dace West.