Can Innovative Transportation Options Help Narrow Health Disparities And Increase Clinical Trial Diversity?

Once reliant solely on buses and subway systems, our nation’s seniors may soon have new choices on how to navigate their communities, including to their doctor’s appointments. In March, the National Hispanic Council on Aging (NHCOA ) released a poll indicating that Hispanic older adults felt that affordable and safe driverless cars could improve the lives of themselves and their family members. Although approximately 70% of senior surveyed live within an area with mass transit, they still felt that driverless cars could provide significant value, highlighting an opportunity for innovative transportation options to address the needs of a population that will reach 20 million by 2060.

This poll comes at a critical juncture as our transportation landscape continues to shift towards ride-sharing and health disparities persist among older Latinos and African Americans. Zhai Yun Tan reports in an August 2016 article in The Atlantic that hospitals nationwide are now starting to partner with ride-sharing services such as Lyft and Uber to help patients get to their appointments on time. In some cases, these rides are even being paid for by Medicaid and other insurance plans. According to a 2013 Journal of Community Health review by Samina Syed, Ben Gerber, and Lisa Sharp, patients with lower socioeconomic status, particularly those lacking a vehicle, report higher barriers to accessing health care and are more likely to miss their appointments. These ride partnerships could help fill in the gaps for patients who struggle to make it to appointments; although many hospitals provide transportation services, these typically need to be planned in advanced and may not offer a direct route to the hospital.

In addition to providing quick and reliable rides for routine medical care, ride-sharing services may also help improve access to medical research opportunities for communities of color that often cite transportation as a barrier to participation. Despite a higher prevalence for diseases like Alzheimer’s, Latinos and African Americans are chronically underrepresented in clinical research for life saving drugs. According to the FDA Office of Women’s Health , Latinos make up less than one percent of clinical trial participants despite making up 17 percent of the U.S. population. However, polling data has demonstrated that Latinos and African Americans are willing to participate in these trials. A recent poll from the Global Alzheimer’s Platform Foundation found that 39% of Americans said they would consider taking part in an Alzheimer’s clinical trial, including 34% who are African American, 41% who are Hispanic. This diversity gap has real consequences for public health and both the FDA and NIH agree that minority inclusion in medical research is vital to ensuring drug safety and spurring medical innovation.

Yet transportation is a persistent issue. The Eliminating Disparities in Clinical Trials Project (EDICT ) named unreliable transportation among the key socioeconomic obstacles working class individuals face when participating in medical research. Ride-sharing, and eventually driverless cars, could offer new avenues for addressing these transportation issues.

Data released by Uber reveals that ride-sharing services are uniquely positioned to serve diverse communities. A March 2014 Uber study concluded that in Chicago, four in ten rides begins or ends in an underserved neighborhood, and the average wait time and likelihood that a ride will be completed has no relationship with the median neighborhood income. Further, ride-sharing company Lyft recently partnered with Axovant Sciences to provide transportation to seniors enrolled in an Alzheimer’s clinical trial in California. If successful, this novel partnership model should be further explored with minority communities in mind.

While promising, these services have their own set of challenges that must be addressed. For example, advocates have noted that ride-hailing services have mixed success serving individuals with disabilities. Additionally, these services rely heavily on electronic payments and smart phones, which can be a barrier for individuals of lower socioeconomic status. Despite these challenges, innovative transportation options have the potential to improve mobility while increasing access to care and treatment for many communities.

Ride-sharing may not be a panacea for eliminating health disparities or for the exclusion of minorities in clinical research, but it is an example of a fresh approach that could help bridge the divide today while larger fixes are developed. As our population ages and diseases like Alzheimer’s become more prevalent, demand for these types of innovative solutions will only grow. 

Jason Resendez , executive director of the LatinosAgainstAlzheimer’s Network and Coalition - a network of UsAgainstAlzheimer’s - with contributions by Beth Moretzsky , The George Washington University.