“Everything in life is somewhere else—and you get there in a
car.” -- E.B. White
“Twentieth-century urban America didn’t belong to the skyscraper;
it belonged to the car. Transportation
technologies have always determined urban form.”
– Edward Glaeser,
Triumph of the City (2011)
The following are factors that diminish quality of life as
listed in the Pennsylvania Advance Health Care Directive. The lead question is this: “When you think
about the following scenarios, what would be considered an unacceptable quality
of life?”
Not being able to drive a car
Not being able to get out of bed
Not being able to leave the house or move
around and interact with people (e.g., a coma state)
Not being able to have meaningful relationships or recognize family or friends
Not being able to think for myself or make my own decisions
In other words, not being able to drive is incompatible with quality of life: If I can’t drive, living is no longer worthwhile. Losing the driving license is the lead-in to a dependent life. And for Americans, loss of independent mobility equates to a severely compromised state of being.
The way people move around, and for what reasons, has much
to say about opportunity. How that opportunity
is recognized and acted upon, in turn, provides clues about what cultural
values are, how they act as deep motives, and how change is seen - as enhancing
or blocking the top operating values. The
ability to drive is considered the gateway to many opportunities, and
especially to the ability to hold a job—even with remote work as an option.
In the US, staying put is not regarded as advantageous to
individual development. We all know that
to progress, go to a decent school, build a career, get a family started, meet
partners and leverage relationships, use marriage as a driver of social
capital, we have to seek out new places.
Our country was founded on these tenets as Europe looked west to the new
world to realize freedoms not to be found in locked-in Old World centers.
License to move
The driver’s license is a rite of passage in the US, marking
the start of true independence away from the family and obligations to parents. Independence is the American measure of
mental and physical well-being, and also, in a seeming contradiction, the basis
for social health and upward mobility.
Independence is a signal of intelligence and social viability through
mobility, and the car provides that most effectively.
What about public transit?
Five percent or less of the American public use commuter trains and
buses; even Washington D.C.’s excellent Metro system has just a 10% ridership. High usage correlates with population
density, as in Japan, Hong Kong, New York City, and much of Europe. Edward
Glaeser estimates that commutes by public transit are twice that of cars, 48
minutes against 24 minutes, which is why 86% of US commuters opt for the
time-saving route. He gauges the best
commute as the brief walk of 15 minutes, less than a mile (Triumph of the
City, p. 13). The time burden is
independent of actual distance: “The problem with public transportation is the
time involved in getting to the bus or subway stop, waiting to be picked up,
and then getting from the final stop to one’s ultimate destination” (179).
In between is the hybrid of semi-private car services such
as Uber and Lyft and vans powered by smart phones at rates closer to taxis than
buses. For most middle-class
Americans—and 95% call ourselves middle-class—the price of public transit is
not the ticket but the stress of riding with below-middle classes than we’d like
to see around us. In Honolulu, with one
of the leading bus systems island-wide, class-mixing is less an issue in the nation’s
most diverse state with more equal incomes, but tourists still favor car
rentals. Wills Eye Hospital, in its
literature on “Preparing for Hospital Discharge,” warns that “Public transport
is not an acceptable form of transportation home from the hospital.” You need access to a private car and driver
just to return home from your treatment.
Mass transit leaves the rider dependent on schedules and
stop locations, going against the autonomy principle that one should be able to
go wherever and whenever they want, one of our leading cultural core
values. The need to live by someone
else’s schedule, often requiring transfers to other parts of the routing, takes
a toll on the rider’s time, and this is the core of the problem. Even waiting in traffic is seen as an
acceptable exchange for the ability to travel point to point once the blockage
clears. It is the main advantage of an
Uber ride.
Since Ford’s Model A, cars took off, making the ability to
travel long distances the hallmark of the free life. The driver’s license is the turning point for
adolescents into independence and autonomy.
Car ownership makes independence possible. One car per family of two employed adults is
considered a disabled system, just waiting to finance the second car. Losing that license is the start-point of
life’s end, giving up independence to rely on the wheels of others. For these nondrivers, a city’s dependence on
cars is the leading factor for livability.
Los Angles is famous as its own car culture, because of the far-spread
geography, but Florida is just as car-centric, as are Seattle and Washington, DC.,
and even the sprawling Las Vegas strip.
Quality of life
In summary, the Pennsylvania’s Advance Health Care Directive (above) features a listing of quality-of-life factors (quality of life being a
major measure of wellness in medicine).
Each factor is to be checked only if it is a deal-breaker in end-of-life
quality so that the Power of Attorney can see what the patient has determined he/she
can’t tolerate. The list includes: “Not
being able to move around and interact with people (such as in a coma)”; “Not
being able to think for myself or make my own decisions”; “Living in a nursing
home”; “Living in constant severe pain,” or--wait for it-- “Not being able to
drive a car.”
This is in line with other measures of life quality. The Americans with Disabilities Act (ADA)
qualifies inability to drive for medical reasons as a disability if it limits performing a major life activity, such as working or engaging in
daily tasks. For a broad class of jobs
(including driving itself), driving is a major life activity. The largest class of male workers are those employed
in driving activities.
The car question is the only item on the list of 13 that is
not a medical issue, including “Not being able to live on my own.” And, in deference to the American bias toward
independence, “being able to live on my own” is the last right the aging
population is willing to give up, the strong bias being independence, as in "aging in place." In many cultures, this would be a highly
unwanted state of things--being unable to live with relatives would be the
non-starter. For Americans, NOT living
alone and not driving to and from that home are the deal-breakers. But before independent living, independent
driving takes first place in defining quality of life. Even teens of driving age can create a world
of their own away from the family home.
In a world increasingly urban and densely populated, and in
the face of climate change, the power of the automobile to dictate mobility and
housing options is coming under increasing pressure to resolve the issues of cultural values: autonomy and independence. Already these issues are showing high costs
to society as well as the individual.
What eventual solutions can be devised to resolve the pragmatic costs that
threaten our embedded beliefs?
* Images from KODA, Pennsylvania Advance Health Care
Directive (2024)
