Afew years ago Christiana Sylvaine stopped driving. Diagnosed with narcolepsy, she’d had a few incidents behind the wheel that scared her. So she sold her car and turned instead to the two bus lines that ran within blocks of her home in Kansas City, Missouri. When Sylvaine boarded the bus, she never paid a fare. That’s because Kansas City’s public bus system stopped charging riders altogether in 2020, becoming the largest city in the U.S. to adopt a zero-fare policy. For Sylvaine, saving money on parking, gas and bus rides gave her more financial flexibility. And she believes that free use of the bus system had an impact on her health. When a health issue came up, she didn’t hesitate to seek medical care. In 2020, Kansas Citry became the largest city in the U.S. to adopt a zero-fare policy. Courtesy of Kansas City Area Transportation Authority “I was more inclined to not just brush it off or something like that, because I had access really easily to those bus services,” she says. The connection between transportation and health may not be obvious. But how people get around communities is interconnected with physical and mental wellbeing. Easy access to public transit is linked with direct health impacts, like increased levels of physical activity. Transportation also opens doors to other factors that contribute to health — as Sylvaine found with her health care appointments. “It’s the linkage between you and all of these other things that impact your health,” says Amanda Grimes, an associate professor of health sciences at the University of Missouri–Kansas City. “Access to food itself is a social determinant of health. But how do you get access to food? It usually takes transportation.” Across the U.S., 5.7 percent of adults don’t have access to reliable transportation to get around for their daily needs. One in five Americans who don’t have access to a car or public transportation have gone without necessary medical care.