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Part 3 of 3

Interview by Gary Gunderson

Phillip Summers began working in community development in 2001, teaching health and physical education in Belize. He holds a Master of Public Health from UNC-Chapel Hill. Phillip is interested in social justice, racial reconciliation, and active living by design. He has more than 30 co-authored publications from community-based participatory research with immigrant farmworkers and construction workers.  While doing community engaged research public transportation captured his imagination and passion for creating systems that enable health. He lives with his family in Winston Salem, NC, and worked as a bus driver for the public transportation system.

Link to Phillip Summers’ Blindspot.city HERE!

Gary Gunderson: This is Gary Gunderson. I’m interviewing Phillip Summers, who is a dear colleague from Wake Forest Medical Center. He’s been a researcher in public health science research career, a remarkable research career really focusing on people who, whether they’re farm workers or people in tough neighborhoods in Winston-Salem or people who basically live in our blind spot.

The name of Phillip’s blog is Blind Spot and it’s perfectly named. He opens our eyes to what we could see if we knew where to look and knew why we should care. And we’re going to do two podcasts, both of which actually are based on Phillip’s most remarkable past year in which he followed the thread of his intellectual curiosity out of his research job and out the door across the sidewalk and not on to a bus, but in the driver’s seat of a bus.

He’s worked as a bus driver in Winston-Salem, a small town in the mid-South but you can see a lot from that seat. In the first podcast we’re going to talk about what Phillip’s seen from the bus driver’s seat, including the lives of other people who drive the buses and those who ride the buses. What do we need to see through your eyes about that?

In the second podcast we’re going to flip in a different direction and ask the question, so what? So, I’m not planning on driving a bus, I ride a bus sometimes, more likely Amtrak than a local bus. But what would be your counsel for those of us who are not going to replicate your life but need to gain from what you’ve done with your life to help us see the implications for our life and work from what you’ve learned in this past year? So, we’ll do that in two chunks and go from there. So, let’s just start basic, what the heck were you thinking? How did you end up behind the wheel of a bus?

Phillip Summers: Well, in an academic setting you do spend a lot of time thinking about community-level interventions. And as I was thinking about social determinants of health, I realized that there was a high yield, high impact on expanding transit service. This came through two or three years of policy advocacy around expanding public transportation locally. So, public transportation was a timely issue in Winston-Salem because we were going through redesigning of our routes, we had the opportunity to get greater funding because we had a major thoroughfare close and the state was going to give us extra funding.

A lot of the stakeholders that we engaged with asked the school of medicine to work on public transit policy. So, in those two years, I learned a lot about what it meant from an academic perspective but I also saw some of the harsh realities, or I would say I was grieved by how hard it was to work with the transit authority. The American Public Health Association came up with an interesting guide that talked about how public health professionals can work with transit planners and people in transit because it has such real implications on the daily life of people in your community.

And it just captured my imagination and I said, “What if I had more transportation expertise, and what if I understood better from the lived experience of a bus driver how to recommend intervention, how to make salient critiques about policy change?” That could really be grounded in reality. So, that’s what I endeavored to do is to try to learn firsthand.

Gunderson: So, normal bus drivers don’t talk like that. A sentence like you just said is why they say, “Oh, you’re a specialist in busology.”

Summers: I do love that story.

Gunderson: Tell me about entering literally the family of bus drivers. That’s got to be a tough, tough ground.

Summers: Well, you mentioned that busology, and I love that story. A classmate picked up early on as I was a little bit of an egg-head in training. He said, “Philip, you’re a busologist. You know all things about buses.” And what was so funny about that is how do you take this public health, or systems level approach, down to the micro level of now you have to drive these routes? And I certainly had caught a lot of funny looks.

And then a lot of passengers would come onto the bus and take a double take and say, “Oh, you’re not our normal driver or you don’t fit the mold.” And unfortunately, when we have so much, I’m going to use the word structural vulnerability but that might not be right. It might just be blatant segregation, but we have a very racialized transit authority, both in the composition of who the drivers are, the minorities, and in the ridership also, people of minority.

And so, it was jarring as someone who is well-educated to be the minority in that work culture. So, I learned a lot about how to work in a context as a minority.

Gunderson: Did they let you in? What do they need to see? I’m just wondering a little bit about the personal world. What I’m really asking is I guess the credibility of your presence, were you actually part of the bus driver community?

Summers: Well, yes and no. It’s now January, I stopped driving in December. And even just today a driver was at my house asking for help and we conference-called in with another driver. And so, it felt really rewarding to make some of those connections and feel like, “Hey Phillip, you have something to offer and we want to ask your help.” So, that would be the yes part. And then the no part would be, I never felt that comfortable. I mean, there was cultural things that would keep you at arm’s length.

And I guess back to the yes side, they were just so pleased to have someone show up and do the shifts. I think what’s so demanding about transit is you have a schedule and you’re obligated to keep it and there’s no, “Oh, I’m sick.” Somebody has to be behind the wheel of that bus. And so, they were happy that I was well and that my word is my word.

Gunderson: How many hours did you drive?

Summers: Well, on some long weeks it would be as many as 55 hours a week. And the schedule is extreme because we start as early as 5:30 in the morning and we run till about 12:30 at night. Because as a driver, you have to get the bus ready, you have to get it in service. So, if a stated service starts at 6:00 AM and stops at midnight, you have some work on the tail ends of that. So, it is a very demanding industry to work in.

Gunderson: How much do you get paid?

Summers: As a first year driver, I was making $15.20 an hour, I think. Over the course of the year I made about $26,000 take home pay.

Gunderson: How much does a bus weight?

Summers: Oh, wow. I should know that.

Gunderson: I’m just thinking, but I mean they’re really big and the streets are not big and you’re not that big.

Summers: It was daunting. I mean, I often found myself praying a lot about, “Oh, I don’t want to hit anyone or I don’t want to cause evil with this bus.” So, that would be the scary side. And then the funny side would be, sometimes I’d be driving around town and maybe make a hard right turn in a narrow space and look up and then I would have a friend cheering for me. I mean, that only happened on one or two times. But a bus can be very interactive. I was enamored with the public nature of public transit.

I mean, you get to interact with people. It really was refreshing. After having spent a lot of time in an office setting where I would maybe interact with a few close colleagues to being right there as a public service out in front, never knowing who you’re going to meet or what they would say.

And so, I learned a lot about myself, learned a lot about how to keep my head in a situation that can be trying. I mean, because certainly passengers can come on disgruntled, and I think they have every right to be because our service, is it once an hour predominantly? We have a very old bus stock so it can be less than reliable. I think every human faces pressures to get to places on time. Everyone values their mobility, but if you don’t have the autonomy over your own mobility, like via a car and you’re beholden to a transit authority that I would say is underappreciated in the form of old buses and the lack of service, you are getting ground up under the wheels of a system that really doesn’t care about your mobility.

Gunderson: It keeps you poor instead of helps you out.

Summers: One of the stories that someone said was, as we were talking about a route, he said, “Yeah, riding the bus is like having a part-time job that doesn’t pay.” And I thought, “That’s so poetic.” You’re spending six or seven or eight hours a week just in transit that you’re not compensated for that time. Now, on the plus side, transit advocates will say, “Well, you can read a book and you can use that time well.”

And I do think that’s true, but I think to the extent that we can expand service, and increase frequencies, and make it reduce people’s time in transit, it would be that much more valuable in a community where we suffer from issues with economic mobility. And economic mobility is this idea of people who are poor get trapped in poverty. And I think that transit is one of those systems that really does constrain their opportunities.

Gunderson: In Winston-Salem, I mean, the statistics are that if you’re born poor in Winston, you’re overwhelmingly likely to die poor. And you met a lot of people who were somewhere in that life. They’re generally not kids, but when you see a bus go by now a route you’ve driven, who do you think of and wondering, “I wonder what’s going on in their life now?” Tell me a little bit about the faces and lives of people who you’ve met.

Summers: Well, this is also a microcosm of things that are playing out on a global scale. You can read and understand that a lot of people, there’s a gulf between people who are in the intellectual economy and people who are in the service industry. And so, the service industry people will ride the bus for two or three hours a time. I had a passenger tell me, he worked across town, he said, “They don’t even realize it takes me two-and-a-half hours to get there and they put me on the schedule for three hours.” I sometimes spend more time getting to work than I’m working and it doesn’t often make sense.”

And so, there’s a big gulf between who is riding and what their lives are like and then who is driving. I don’t know that that answered your question. I think the quick answer to when I see the bus now, I look to see who the driver is and just wonder how they’re doing and if I still know them because primarily I’m worried about transit riders. I left being a bus driver very concerned about the well-being of bus drivers. They work very long hours. They often don’t have time to eat nutritiously or get good rest. And so, that was very eye-opening to realize how much occupational strain they’re under.

Gunderson: I mean, they’re public servants.

Summers: They are. I was a bus rider before I became a driver and I often wondered why are the drivers sorely? Why are they not very gregarious? Maybe I’m over the top, just kind of a Labrador Retriever and love to see people. But I realized that when you work 10 hours straight, your ability to have the poise or outgoing personality is just drained by the simple desire to want to catch a break.

I think things like privatization of bus systems… I mean, privatization is a big global word about how governmental services are outsourced to contain costs. Certainly we fall under that category here in Winston-Salem. We have a service contract for our buses, I think makes it even harder to engage with policymakers who are really very removed from the inner workings of the bus to make the type change that would improve the life of drivers and then in turn riders.

So, there’s really, I think the bigger foci needs to be the ridership base because they can collectively have more political clout to make demands about how service should be run.

Gunderson: So, tell me about, how much opportunity did you have as a bus driver actually to talk with people to carry on a conversation? I’m just thinking you’re careening around the city streets of Winston-Salem up and down around corners and hills and were you able to actually have conversation? Did you come to know people that you actually talked with?

Summers: Absolutely. Now granted, I’m not a typical driver, I went in with a research question, so I had a little more incentive to try to get some of their stories and I know how to do open-ended interviews. So I’d ask a lot of leading questions and I’d always be very happy with how much it tumbled out. I was doing it from my own curiosity and my own interest.

I also learned that the drivers know a lot of their passengers, the ones who are, we’ll just say a typical driver because they’re along familiar lines. I mean, they get dependent passes where some of their own family can ride for free. I think one of the things that shocked me, related to this point of getting to know people is, think about how many times you get in your car in a day. You get in your car, in and out of your car two or three times a day. Well, if you’re transit-dependent and you’re getting off and on maybe the same bus two or three times a day, so you have a lot of interaction with the drivers. And as the drivers stay on the same routes, they really start to look out for people and care for people. So, I do think it’s such an important social fabric, a way for communities to get together.

There were some buses that were in the eastern part of our city that had higher ridership where it was a joy to hear people interact with each other. So, not only did I make the effort to get to know people, I would also eavesdrop as they were interacting and talking about football or asking about their neighbors. It was really a rich public space.

Gunderson: So, two questions. Did you ever pull up at a bus stop and look at someone standing there and feel fear? And the second question, did you ever let anybody off your bus and be afraid for them?

Summers: Yes to both those. Those are really good questions, Gary. I’ll answer the second one first. Luckily it was a warmer spring night, but it was the end. So, it was 11:30, I’m going to make one more half run and then I’m going to take the bus back to the depot at midnight. And there’s a woman asking a bunch of questions. There was two different buses close by. You could tell she was trying to decide which one to get on.

She finally comes over to my bus and gets on and confides in me, “You look nice and there was fewer people on your bus and so I thought I could trust you. I need your guidance on where I should get off to sleep for the night. I’m new to town and I’m scared about sleeping out tonight. I don’t know where a safe place would be. Would you be willing to give me a pointer?”

I’m gobsmacked at that point because I didn’t know exactly what to tell her, but I’m driving out and thinking through it with her and eventually find a church to let her off at thinking, “This might be a large enough campus and it might be safe enough.” But it definitely left a mark on me, very concerned about her well-being because she was a female that, and frankly reminded me of my aunt.

I think as researchers, oftentimes we see numbers and sometimes they have a hard time seeing faces. So, they became a lot of faces where it wasn’t abstract. It was like, “Oh, what about that lady, how did her night end up?” There are other sadder stories that I’m not going to go into where I did, in hindsight, find out it didn’t end up well for young ladies, and the police were involved. And so, those were the scary things.

I think you asked, “Was I ever scared?” Yes. I guess you want a little vignette on that. I’d be glad to give it. So again, I had to get off the night runs because I am totally a morning person. And so, I did both these stories from when I was on nights and I did not do a good job of driving around the streets at night. So, it was at midnight, I’m on a route in eastern part of the town. I come up to this stop that’s out in front of this assisted-living place. There’s a man, older, African-American gentleman, but he’s only in his hospital gown. He has some bags and he’s very agitated and he says, “I’m getting out of this place. I need to get out of here. I need to go to the hospital.”

And I’m thinking, “Oh Lord, what do I say? How do I handle this?” Because the first thing he says is, “I don’t have bus fare.” And so, I used that as I think through my options as, “Well, because you don’t have fare. Because I’m getting ready to close, I can’t really take you someplace where you could connect to ultimately get to your destination. So, if it was maybe an hour sooner and you could take my bus downtown and then take a bus across town. This is an important health disparity, most of the concentrated poverty is on one side of town and all the health resources are on other sides. So you’re going to have to transfer. So what I’m telling you is it’s midnight, there’s no more transfers, the buses are about to stop.”

And here’s this gentleman in a very vulnerable position and he’s telling me he’s a veteran, and I’m thinking, I’m a little intimidated because I want to get it right. I want to get it right for him. I want to get it right for me. And I say, “Well, because you don’t have the fare and because I think you probably are safer here going back and making amends in your assisted-living.”

In hindsight you could say he was trying to spring out of his assisted-living place at midnight. I said, “Why don’t you stay here and you don’t have the fare and I’m just going to suggest that you stay.” And that’s ended up what happening in a process that later and everyone’s like, “Duh, of course you did the right thing. He should’ve stayed there.” But in the moment it’s just a little scary because you think, “This guy is asking to go to a hospital, maybe that’s really what should happen.”

And maybe as you’re listening, you’re like, “Well duh, call the ambulance.” But when you’re in mobility, you want to help people get where they’re going. And so, you’re always trying to figure out, did I help that person?

Gunderson: So, you’re not a social worker, but you’re socially smart and intuitive. We’ve talked on and off throughout the year, I’ve been so struck by your eyes that see through a filter of compassion for other people that many people would look at and it wouldn’t remind them of their aunt. They would just see a strange person who’s not at all like them and very different.

First of all, I want to start to move toward the next podcast, about the so what part, but I’m really, really struck. I feel like I have to open a little bit of space. You came into this partly as a researcher but also as a person with compassion. Your compassion is formed from faith.

So, I’m curious a little bit. A lot of people who listen to these podcasts are like that. We have professional jobs and a set of credentials and a day’s work that we’re supposed to do, that’s professional. But we’re also people of faith, and I’m curious a little bit. Speak out of that side of how you’ve perhaps been changed.

Summers: Well, blindspot.city is my blog and the header there was, trying to follow the call to love my neighbor as myself. I did not just wake up one morning and say, “I’m going to become a bus driver because it would be cool.” It more was after almost 10 years of riding, and being around the bus, and having befriend people, my eyes were just open to what their needs were.

It was through the coalition building and through the academic work, I have a master’s in public health. It’s actually in public health leadership, so we would study things like servant leadership. What does it really mean to take the lower seat to try to serve a population? So, those were some ideals that I think I was trying to follow as I was driving a bus. I think what I learned from that is that you can be incredibly rich, the learning about yourself, the learning about your community.

I fall back to this language of faith of like, if you really are following what you feel is a calling, you’ll be met with opportunity and presence and joy and peace. I sang with a bunch of people on the bus, I would pray with people on the bus. I got to know people and see them. And I think really what we all want are open hearts and open eyes. And so, when I was right at that intersection of using all my skills as a public health thinker and doing that service, it was really incredibly rewarding.

Gunderson: I actually think that’s a good place to stop and shift to the next podcast, which is, so what? What are those of us listening to your story with enormous credibility, you speak out of intellectual credibility, and a faith credibility, and a human compassion that’s very, very compelling and invitational. Next podcast, I want to talk about what you would have us carry from this experience. What do you want in my life because of what you’ve done in your life and talk about that?

Summers: Well, certainly I need to make sure I thank you for this space to talk about it. I think because it was so rewarding, it feels like there’s so many stories to tell. So thank you for creating the time.

 

 

 

 

SECOND PODCAST

 

Gary Gunderson: So it’s Gary Gunderson talking conversationally with Phillip Summers who is most recently famous as our favorite bus driver in the city, a researcher and colleague and a person of faith who helps us see all this through eyes that about what matters most.

The first podcast we talk about what was to drive and what it was to be one of a group of drivers, what it was to be in a conversation like a human being with people who were riding the bus. I want to turn sharply towards the, so what part of this. You are a public health researcher, you are trained and by temperament and intellect a master of the severe arts of resource allocation, of evaluation, of looking with a critical eye at the pattern, not just individual stories, but the patterns in our city.

And so, in your mind, as we have followed this story over the past year with you, I’ve come to understand in a deeper way that the public health system is like the water system. It’s part of the connectional tissue of how a community, how a public actually lives and finds their way through life. So, how is a bus like a water system? Let’s unpack that metaphor a little bit.

Phillip Summers: Yeah. So, I was at the American Public Health Association meetings in Atlanta, I guess that was maybe three years ago. And they had a plenary on how transportation is a critical lifeline service in any city. And it definitely got me thinking, we think water is critical. We can’t live without it. And I’m thinking, “Well, your mobility has everything to do with your opportunity. Your physical ability to move around helps you access healthy foods, get to education, get to healthcare, get to work, see family, go to church.” These are all things as social creatures that are really important.

What I learned about driving a bus is that it’s like most hard or complex problems. There’s the technical side, which is simply, does the bus run? And then there’s the soft side of, do people know how the system works? And that soft side has a lot of parts to it, which would be, do the policy makers who are making decisions know how it works and how their decisions impact the real day-to-day lives of people who are transit-dependent? Transit dependence, this idea of, you don’t have a car, you’re relying on the bus to do all these critical functions I just mentioned, to go to work, eat.

And then do the riders understand. So, we started working on transit policy as the routes were redesigned. Neighbors were having a hard time finding where new stops were, how the new routes worked, where the time systems were. So, there was a lot of disruption around what was public transit starting in 2017. And I drove during 2019 but I was working on the issues from the school of medicine side. Late 2016 is when we started really saying these changes are coming, they have real implications in the lives of people who are transit-dependent.

Transit dependent in the south is a shorthand way of saying the poor, the minority because unfortunately… or maybe said better, we have a real opportunity to intervene in public transit because it’s so important. We had the nation’s largest black-owned bus company because we have a legacy of industry and the growth where African-Americans were brought into our tobacco industries via a bus system that they created themselves. So, transit is very important in Winston-Salem. I think this year we’re going to hit about 2.4 million rides. To get to that number, you’re carrying substantial numbers of people every day.

Gunderson: So, but some routes more than other routes. Tell me about as a… I’ve seen your spreadsheets, I’ve looked at your spreads of data and those who are data-inclined would find the lens of clarity you brought to, how do you actually see what’s going on in the ridership of the system? Tell me a little bit about data.

Summers: You can get data aggregated at a couple of different levels. I would say if this podcast is dedicated to the, what do we do about it at your local level, finding out what your rides per route are. So, it happens that we have about 29 routes and on blindspot.city you can find a post that uses September of 2019 as an example of what a typical month of ridership would look like. And it breaks it down by route, by hour of service. And that gives you a ratio of rides per hour of service.

And that’s the fair metric to compare. Before I realized that we needed such a fair metric, I would look at just rides per route and that would mask the fact that some routes run late, or nights, or weekends and other ones had less service. And so, I had a feeling that there was blatant demand, that there would be more rides if there was more service. And so, having a fair metric helps you understand where you’re getting the most rides, where your most productive routes are and where you might have opportunity where some of that demand might be going forward. So, in the transit industry, those aren’t novel measures, but really trying to apply them to your local context as you’re trying to figure out resource allocation, where you’re trying to figure out where your transit riders are, what some of those prominent routes are.

Here in Winston, the United Way has a Place Matters initiative where they’re really trying to target certain neighborhoods because of the preponderance of distress in those areas. And so you could say, well, it turns out in Winston those are along major very, the route I’m thinking of has about 20 rides an hour, which is well above our average. I think our average is about 14 rides an hour. So maybe it was like 23 rides an hour in this impact zone.

But you could say there’s a lot of people riding the bus. This could be an opportunity to expand service there if that bus runs once an hour, if that bus had more frequency you might help further open up opportunity in this neighborhood that you’re trying to bring more resource and more opportunity. So, one place to start might be adding a second bus so that people could enjoy greater mobility.

Gunderson: So literally as a researcher, part of your counsel is, those of us who think of buses not so much as a way for me to get to work, although I’m on route 80, it’s a way for the people who need our services. So, if I run a hospital and we’re talking about my patients and some of my work colleagues, most likely those who are working in the service parts of the hospital. I need a metric to be able to understand what’s the current pattern of utilization of the routes that are most relevant to the parts of the city that I need to be most concerned a lot about.

A lot of our work at FaithHealth is very site-specific. So, early on in the conversation with you I realized, “Oh, the places where we’ve done community health assets mapping and where we’ve been very conscious about deploying FaithHealth connectors and supporters of health and different kinds of community health workers build the networks with the congregation. Those very streets are the ones you are driving across as a bus driver.

And so, the intersection… Well, I don’t know poodle noodle about how to evaluate what’s the right level of service, who’s paying for it? Should this route be lower and put the emphasis over here? I don’t have any way as a lay person to even look at that. That’s part of what you’re offering to us as a way where you can find that out. Somebody in the city either knows that or that data’s available in ways that can be analyzed by someone with your skillset to clarify, as a public health person, you need to be concerned about the pattern of utilization in these routes.

Summers: Certainly there’s going to be opportunity to look at routes specific in certain geographies. There’s also opportunity to understand at a higher scale or macro level how many rides the transit authority is giving. So, some of that stuff is made available in national transit database because most transit authorities get federal money, they have to give accounting of what their ridership is. So you can look at things like cost per ride.

From a hospital setting, sometimes people get confused about demand response. Demand response is not fixed route, I was a fixed route driver. A fixed route driver is someone you think about they’re driving a route and they have set time points and they hit them. And that schedule is published and you know when you can get off and on. Demand response is where, maybe you qualify because of some medical condition or you’re elderly and you can’t get to the bus stop and so then you ride… Somebody comes to your door, they call it door to door or demand response, and they take you directly to your doctor’s appointment.

It’s often much more expensive, but it is factored in to the total budget of what public transportation is offered. And it has an important level of ridership, particularly here locally, as public health thinkers, we know that our country is getting sicker and older, so there’s going to be more and more opportunity to work with mobility issues.

Gunderson: So our city, you mentioned the genesis of the need for more drivers came from tearing up the major thoroughfare through Winston-Salem, extremely disruptive of normal transportation. And so, expanded bus service was part of the adaptation. Well, now that road isn’t quite finished, but pretty close. We’re going to enter another crucial public policy moment in which there’s an opportunity highly likely to be in our blind spot about looking as a public policy community at the role of our bus systems, where the routes go, how much is enough, where the money is, how does the bus system compete in the same pot of money for other public health initiatives? How does this compete with immunization or opioid prevention services? So, as a public health person, how do you think about making it visible so that the limited pot of public resources includes the discussion about mobility?

Summers: Well, certainly I get excited talking about all the positives out of public transportation, environmental positives, less greenhouse gas emissions, physical activity benefits. Studies will show that you’re more likely to take more steps in a day if you’re a transit rider. On the accident prevention side, you’re in fewer automobile accidents. On the local economic stimulus side, there’s this idea of a walking economy. So when you’re a transit rider, you’re more likely to spend money at local stores and the money stays in the community.

It feels like to me, the benefits of investing in transit go on and on when you’re clued into primary prevention. So, as you’re really worried about social determinants of health, it’s this idea of keeping people well and giving them plenty of opportunities to be well. We came to some of this work because we were studying bicycles and we wanted people to be more physically active.

And it turns out that in communities where people are more physically active, they have a very robust public transit system because what they’ve created is a lot of multimodal options. So, these are plenty of modes of transportation that involve walking. So we like to say that every bus trip is a walking trip. You had to walk to the bus stop, you’re going to walk further than a typical parking space.

So, there’s part of me that gets really jazzed up locally about the social justice implications. I mean, there’s certainly a civil rights history of working in transit, but then also looking forward to what do we want to be as a community in that community where people can be physically active, where they can enjoy the greenways and the sidewalks? And it turns out that having a robust transit system enables more of multimodal activity. So biking and walking.

Gunderson: Perfect. So, have you ever seen a city official on a bus? And what would you want them to see as a decision maker? So there’s policy setting, city council people, county council people, but I’m asking, have you ever seen the decision makers who are actually responsible for this?

Summers: Well, I think the closest I came is we, at the central library, we aired a film that’s on YouTube called Bus Stop Jobs. And I’m a producer of that film mainly because it was my idea. I said, “We need to help people see this problem.” And so, Bus Stop Jobs is a 10-minute long short documentary about the day in the life of a bus rider. And what I think it does so well is it talks about how central the bus is to the daily life of a young mother.

And then it also waves in the supportive relationship of the driver. So, if you want to understand what it means to riders and if you don’t want to get on a bus, you can easily take 10 minutes to watch this beautifully set film. And it really highlights that people are having to travel from resource constraints settings to our, our plush downtown and what does that mean in their life?

So, there’s plenty of city council members who are at that first premiere, at the central public, at the central library.

I know this past year I wasn’t part of it, but we had a fare-free day. It was the first time we ever had a day where they eliminated fares. They were trying to get people on board to understand, we have a policy brief that will hopefully be published soon in an article around expanding night and weekend service that just talks about the benefits of fare-free transit. It’s reducing barriers, I think. I think that fares are aggressive tax, so I was happy to hear several elected officials came out and rode on that fare-free day. It happened to be my day off and I was out of town. But I am still plugged into some of the city council members who I know it’s on their minds, but getting a greater groundswell of people saying, “This has real implication for our lives,” is the juncture we’re at now. So, having opportunity to talk about the public health importance of public transportation is important as we raise awareness to say, “It is like water which is critical.”

And so, as you are transit-dependent, policymakers, when they erode service, they’re really harming your ability to move forward. And so, we want to mitigate that harm. We want to advocate for expansion of service so that people have more opportunity to move about and learn, work, play, all the great things that our community has to offer.

Gunderson: I know you’re right now tuned in and are participating in a night shelter for the homeless. Do you ever see people there that you met as a bus driver?

Summers: Oh, absolutely. I mean, even last night one of the guests at the homeless shelter said, “Are you missing driving a bus?” And I had to laugh. I said, “Yeah, as a matter of fact, I am.” Unfortunately, there’s a lot more strife. And I think the experience of homelessness is so very harsh. My mom rode the bus with me and she said to me, “Oh, I don’t know how you see and witness this much suffering.”

And it’s like the bus was a cakewalk compared to the homeless shelter. But I want to change that narrative. In North Carolina, I happened to go to grad school at UNC Chapel Hill. It’s the state leading transit authority. It’s owned by the City of Chapel Hill. It gives over 6,000,000 rides a year. Its cost per ride is the lowest in the state. And that’s because a whole cross section of the population ride, from professors, to students, to the people who work in the service industries in the hospital.

And you see that the National Academies of Science has a great article on the benefits of fare-free transit. There are maybe 30 to 40 fare-free transit systems in the nation. Typically they’re in university-dominated settings or in resort towns where someone’s willing to foot the bill. Chapel Hill is on a hill and so parking’s limited, they’re really growing. So, they have every incentive to say, “We’ll cough up money to subsidize transit so that it’s fare-free and it gets a lot of people on board.

And what I long to see in Winston is to have more people on board so that the system is better, better for everyone to enjoy. I think right now because it’s privatized, because it’s currently in what I would consider a blind spot in this area where a lot of people don’t understand its importance, it doesn’t get the resources it needs. So it looks like aging buses, the buses show their age in the form of breaking down or maybe in mobility like handicap lifts that don’t work. Any number of things, windshield wipers that puts you out of service because they’re so old.

I would argue that there’s a disinvestment or a lack of investment that’s happened and we need to change that narrative. We need to spend real dollars on the amenities, be it the shelters, on the rolling stock, on the buses, or in service paying people to drive the route so that there’s plenty of frequencies so people can have a shorter commute times.

Gunderson: So quite literally, we’ve talked a little bit about this. I was surprised when you raised the issue of getting the universities in our town to jointly do some common planning about mobility of their own students, as that would be as a step towards what you’re just describing.

Summers: Absolutely. Yeah. Figuring out who really has a stake in this game, who has a vested interest? One of the interesting stories as we were doing community engagement was we had a city council member come to one of our meetings, we would try to cast a net and get as many people to this transit coalition as we could. And she said, “Well, you’re the medical center, you’re the ones who demanded Sunday service. I mean in the South, things used to not happen on Sunday.”

And so, this was 10 years ago that the medical center started saying, “We really need our employees and people need to be able to get here on Sundays. We don’t stop. Why does the transit center get to stop?” And anytime there’s more service, that’s a real cost, right? A cost for the diesel gas, a cost for the person driving the bus. And so, this elected official was making the point that it always feels like people are asking and asking and not contributing.

So, how do we realize what a good local investment is? Especially as we’re thinking about population health, if there are whole groups of people that were responsible for their well-being, what does an intervention that’s going to meet them where they are and help them do the things we’re asking them to do? I can remember early on riding the bus and thinking, “Man, these people are doing everything we’re asking them to do and they’re not getting ahead. They’re showing up at work at minimum wage jobs and the systems are stacked against them. So how can we find creative subsidies that enable them to have things that generate health in their lives.”

I know you’re very interested, Gary, in these causes of life, and I’m convinced that increasing people’s mobility options is generative. It would support their ability to get connected to important resources, to get to work, to really enjoy the assets of the community more. And so, I think you hear people talking about access to care as if it’s abstract when really they’re often talking about the actual ride to the doctor’s appointment, the actual ride to see the teacher, or the actual ride to the grocery store.

I mean, I’m sad that a lot of our nice grocery stores are on the west part of the town. I would love to figure out how to incentivize Whole Foods to build a grocery store in my neighborhood because I like Whole Foods. But if we had better buses, the people from my side of town could instantly get to Whole Foods. Right?

Gunderson: How long would it take for you to ride a bus from your neighborhood on the Southeast to Whole Foods?

Summers: I would say, if you know how to time it right, minimum 45 minutes, because you’re going to catch your bus downtown and then transfer over to Whole Foods. So, it depends on where you are. If you’re a little farther south, you might have to catch three buses, and so then you’re talking about an hour and a half.

Gunderson: But then on an hourly frequency if you miss, this could be three hours pretty easily.

Summers: Oh, absolutely. I mean, that lack of frequency really constrains you because you can’t make a mistake. If you miss, the bus is not coming again for another hour. So, you have a lot of anxiety in the ridership around making connections, around not missing stops.

Gunderson: Because it’s life or death. They can lose a job.

Summers: Yeah. As a driver, I was certainly attuned to when people were trying to access healthcare. I mean, when you were giving people rides and mobility devices to healthcare and one lady got very upset when she said, “I’ve been sitting out here for an hour because the first bus that came by, the wheelchair lift didn’t work, and now I’m not sure they’re going to take me at my appointment because I’m so late.”

And so I’m trying to reassure her and deescalate the situation and get her on the bus. I get her close to the facility that happens to be one of our facilities. So, I start asking her, “Now, how do you plan to navigate that last little bit?” And this is where I make a suggestion and she politely listens, but then goes and ends up taking our mobility device right down the center of the street.

So, we are confronted with real mobility issues. People who are physically handicapped, people who are getting older, people who don’t have the economic ability to access a car. These are whole populations that are often very hard to take care of from a medical standpoint. So, how can you intervene on their social determinant of health? I’m sorry Gary, but I just can’t get transportation out of my heart and mind as a very proximal way to address whole populations and increase that one important aspect of their well-being.

Gunderson: So hospitals right now, I’ll speak very specifically to hospitals. Most in North Carolina we’re in the process of changing Medicaid quite dramatically partly in the name of engaging social determinants. Transportation is seen as one of the four critical social determinants that are included, but I’ve never heard in any Medicaid policy discussion, I’ve never heard in a hospital policy discussion about how we relate to Medicaid patients, the bus system. So, we’re busy entertaining transportation consultants who actually are talking about optimizing Uber and Lyft and these other on-demand services.

We’re talking about buying vans, this and that. But we overlook the plumbing like the water system. It’s like we’d be delivering bottled water by Amazon drone instead of fixing the actual common system. So, as a policy expert, what would be your brief counsel to hospital folk who are thinking about transportation as a social determinant for their own patients?

Summers: Well, because it is going to be situated in the community, we started with a community-engaged approach, really listening to what local stakeholders said and what the issues are. So, using that as the building block, you can start to address some of those local concerns. When we started that process, we were very enamored with the idea of fare-free transit because we saw how well it worked in other parts of North Carolina, but the ridership said, “Look, we really have to have nights and weekends service back.” So, that was the issue that we had to follow because we wanted to hold true to those values of community engagement.

That was on the policy and where we see some other promising next steps, Duke at the university level was really trying to get their students downtown. They wanted to connect some of their campus. They created what ended up being this wildly popular, fare-free route. So, the whole route that was connecting it ended up being called the Bull City Connector was a fare-free route.

Duke said, after about eight years of operating it, “Why do we have to keep paying for this? Isn’t this a city function?” And indeed the city and the ridership, it was so wildly popular. City said, “Yes, we’re going to backfill and start paying for that. So, I often hold that up as an example of maybe in hybrid. So you have Chapel Hill, that’s the whole system’s fare-free, their neighbor that’s a bigger city, they have at least one fare-free route.

Certainly we’ve tried to float some of those ideas here to say, “This key corridor that goes by a clinic that serves, it’s the largest Medicaid provider in the state, could the route that goes by that in our hospital be fare-free? So, trying to think creatively, trying to think of some of those policy options, I’m still a major proponent of. But working directly with the transit authority around what they identify the issues are, I think is a great place to start. Looking at the data about ridership is a great place to start.

Gunderson: So, let’s turn that. And there’s two more bases I want to touch on before we close this. And that’s the specific counsel to those of us who may work at a hospital or a public health setting who you’ve caught our attention with your life, and your data, and your story as public health issue. Where do we go to figure out who in our town is the dialogue partner? Who would likely to be my first conversation that can lead me into my local data if I don’t live in Winston-Salem?

If you live in Winston, you’re going to go find Phillip. Well, what if I don’t live in Winston-Salem, who in your network would be my first step into the data and the intelligence who can help me see my own public health system with the kind of ways you’re inviting us to do?

Summers: Right. Thank you for that question. I think public transportation feels very foreign to most people. We’ve often been so encouraged when we just get people to ride once, like the light bulb comes on and they see their fellow riders. So, the first place we like to start is saying, “Go ride the bus once,” I think as you and I have talked. And then we say, “And then ride it a second time and a third time.”

Maybe it’s just three times, but you’ll start to see patterns. I think in public health patterns are one of the things that we clue in on. So, everyone can take two hours out of their day to go ride maybe the bus from their house to their major medical center and just see what that experience is like.

It’s not often easy to interact with transit authorities, because I think I mentioned in the prior podcast how demanding it is to meet that obligation in that schedule. So, don’t be discouraged if they’re not prompt to return your calls. But as you dig into the issue by riding yourself and talking to other stakeholders, you will find natural champions who are often interested in active transportation, who are willing to help you.

We’re getting ready to publish a paper on coalition building, so this is the idea of getting more stakeholders together to talk about a problem that’s affecting your whole community, practically where you can find data is the National Transit Database. Because it is a public function, you can ask city managers for ridership information. Sometimes they’re slow in getting it to you, but you will eventually get it. So, you do have to be ready for maybe a slower process.

I think having some transparency and information would help everyone understand the value proposition of transit more, but because it resides currently in a blind spot, you’re going to have to do a little bit of digging. But just knowing that it’s there will help you continue to look for it because they have to count the rides.

Gunderson: I’m guessing if I were assistant city manager and I got a email or phone call from someone wanting to know about data on bus ridership, it would help me enormously if I mentioned in the email, “I recently rode the 80 route and it raised some questions in my mind about access to healthcare.” That would probably get your email in a totally different category than the general email that they’re receiving.

Summers: Well, certainly it is a city function, so you will get attention from policymakers. I think what happens is, how do you amplify your voice? They’re getting demands and queries all the time. So, we have to think about the communities that we live in and what is the experience of people that is different than ours? And so, I’ve found myself being frustrated, asking people to be radical. And I came to the conclusion that I can’t expect anybody to be radical if I’m not.

And radical has this beautiful connotation of getting at the root of things, right? So, in public health, we want to go upstream as far as we can to get at the very root of problems to ameliorate suffering. And so, locally we have real issues with concentrated poverty and where are you going to start working on that?

I’ve been really fortunate to have colleagues at Winston-Salem State, they helped produce that movie on the Winston-Salem Urban League as an advocacy organization for African-Americans. These were part of a coalition. These were part of, in some ways, a great cloud of witnesses that encouraged me and spurred me on to say, “Go for it Phillip. We understand that you want to dive into this issue. You want to be able to speak about the value proposition of public transit.” In some ways maybe it’s a problem that’s in the racialized South. I’ve never driven transit in New York City, but we all have this idea that they have it figured out, right? They put in subways, they understand that they have a mass amount of people who need to move. So, there’s other things that I’m just now thinking of.

There’s websites now because you can query Google Maps. There’s websites that rank cities on their walkability. And one of the main functions is Google has an API that tells them what transit authorities are doing. And so, one of the things we advocated for was getting our transit authority in the Google API so people could do route planning. But you will see profiles of Winston-Salem and they’ll say, “We don’t have mass transit.”

And that was as many as two or three years ago when we weren’t in that Google API, so there was no way they could query it or there’s no way they could quantify it. So, in this era-

Gunderson: So are we now?

Summers: We are now. So in this era of big data, we weren’t playing in that big data game when our transit authority wasn’t in the brain that is Google and the API that somebody in some city can say, “I’m going to quantify the mobility options of everybody across the nation just by asking Google, ‘tell me the frequency of your buses. Tell me how you get from this major luxury apartment complex to that major employer.'”

So, there are things like that that you can easily find and you’ll see in news articles that people will cite that they talk about the mobility of a community. So, I would say we need to be a little more aspirational in seeing our numbers move up in those types of settings. Everyone loves to talk about big data, but they often don’t understand the measures or how it works. And I’m saying foundationally, if your transit authorities buses only run once an hour, you’re never going to get a great score from potential employers that you’re trying to attract.

We spend a lot of money on economic incentives and trying to draw our employers, and I think we often overlook the simple day-in day-out functions of if you had a robust public transit system, you would be investing in your community and then you would also get better scores on things like the mobility as you’re trying to pitch for Amazon to locate the headquarters there. That’s a joke, but at the same time, where do they end up? In the DC area. They have trains, they have buses, they were the first of the nations to do bike share.

So, I geek out about this because I really care about people moving around on bikes, walking on buses. And I’ve been watching the issue for a while, so I wasn’t that surprised when Amazon decided to be outside of DC. They knew where the power base is, but they also know where the amenities are, where they’re going to attract people.

Gunderson: People like to move around.

Summers: Right.

Gunderson: So, last thing. These podcasts are not the last word you get. There’s a writing piece. We’re essentially going back and probably by the time these podcasts are up, very shortly they’ll be alongside an e-book that lays out a number of other transportation strategies. But when we first published this, it was actually one of the most popular things Stakeholder has put on our website.

I expect it’s going to be even more compelling now because it’ll actually be informed by and have a wrap. Much of the conversations we’ve had on this podcast are the kinds of things we want to wrap around that written product that’ll help those of us listening to the podcast have an e-book that we can turn around and share with our colleagues and use to invite them in to the substance and intellect and heart of the subject of helping people move around and so that they can live their life.

I want to thank you in advance for finishing that work and helping to create the pathways into this subject for many of us. I want to repeat, it’s blindspot.city.

Summers: Yeah, that’s right. That’s the blog that I was writing on throughout the year. I drove for 47 weeks. And so, as I was having some of these aha moments about things like intersection design, how people are asked to navigate. To me, there’s so many ways that there’s public health implications of public transit, right? The built environment, how people walk across sidewalks, how people will run to catch the bus because they don’t want to miss it because it’s so infrequent.

So there’s just little nuggets like that that have been captured at blindspot.city. I’m looking forward to writing the e-book that will come alongside what Gary was mentioning, and Stakeholder Health are great examples of how churches have worked to help parishioners get to medical appointments. I mean, when you’re faced with a daunting diagnosis of cancer and you have to all of a sudden, maybe you live in a rural setting and you have to weekly figure out how to get to the comprehensive cancer center.

Something like a parishioner-driven volunteer base system I think is a wonderful idea. So, what I’m going to talk about is going to be about public transportation, but it’s certainly going to compliment some of those other just creative ideas as people are looking to solve issues of mobility in their community.

Gunderson: Pretty cool. So, is there a story you’d want to leave us with?

Summers: Well, the story starts with my dear neighbor, Maria. I moved to Waughtown in 2010, I was wanting to live in a Hispanic neighborhood because I was going to be doing research with farm workers at the school of medicine. And I saw it as a great way to continue to work in Spanish, to understand social determinants of health, to live in a culturally-rich setting. So we were living there and we had one car at the time, a young family, and I would ride the bus to work. I would bike, I’d ride the bus. And so, at the bus stop I met Maria, and Maria is still my friend. We would sing at the bus stop and we would get to know each other. And so much of how I experienced the bus is through Maria’s experience. And Maria is a dear friend, but she also, like most of us, has a couple of handicaps in her life that she is working through. I only knew that because she could pay 50 cents to ride the bus. And I thought, “What is that?”

And so, if you have a documented medical case, you can get a break on your fare. And I noticed some days Maria wouldn’t pay 50 cents. And now I’m condensing 10 years of relationship with my dear friend because it was just a few months ago, I said, “Maria, sometimes you would pay 50 cents and sometimes you wouldn’t.” And she said, “Sometimes I don’t want people to know that I qualify to pay 50 cents.” I pressed her a little further and she said, “Well, I’ve been paying full fare recently because I lost my ID and I don’t know how to get another one to only pay 50 cents.

And I’m thinking, “I can help with that, Maria.” She’s worked a few days a week in the service industry job. Helping her save some money by paying less fare all of a sudden was a high priority in my way of thinking, so I helped her get her ID to, again, pay 50 cents. That’s one example. A second example of just helping Maria when we redesigned the routes in 2017, that means the stops were going to be in different places and the buses that she had been riding for years and knew how to ride had fundamentally changed because of some of her handicaps or some of the things that make it harder for her to move about in the world.

It took her a long time to figure out what new buses she needed to take. And what that looked like was family members taking her downtown so she wouldn’t have to connect with so many buses. As they got tired of doing that, it looked like me coaching her on where the stops were, or me walking with her to some of the stops. So, really just taking time and maybe not assuming that everyone’s going to get it so quickly. I mean, if we really want to understand health disparities, I mean, she’s a minority young woman. If we really want to understand racial reconciliation, I think it means taking the time to walk a mile in someone’s shoes and being willing to speak up for and say, “These policy decisions that might look good on paper have real imprint on people’s lives.”

It’s hard for me to talk about the bus without talking about Maria. And sometimes I think she gets a little squirmy when I tell her, “Oh, I had your picture up in a presentation.” But I think ultimately she laughs and is delighted that her story can be used, that her story can illustrate how she loves to ride the bus. I mean, ultimately I told you we would sing at the bus stop. She’s glad to get to go to her job. I mean, it affords her independence.

I could go on and on, Gary, about how I love to drive blind people because you’re affording them vision, how I’d love to drive elderly people who want to talk. I mean, if we’re really concerned in public health about community development, if we’re concerned about restoring social fabric, I really want to charge and challenge people, put some attention in public transit. Really understand what it’s doing and how it can improve that fabric and develop your community because I think we would fulfill our calling as public health professionals as we do that.

Gunderson: So, the last word goes to your kids or about your kids. The last slide when you presented this to Grand Rounds at the hospital, for our FaithHealth’s Grand Rounds, last slide was of your kids. Their eyes, they were so proud of their dad. How do they understand what you’ve done?

Summers: Well, that photo, thanks for bringing it up, was actually my very last day of driving and as providence would have it, there was a two hour delay that day. So, instead of having to be at school, they got a ride with me in the morning and we had designed to have a church may come and we were going to sing Christmas carols.

I told you, I’m just being honest, I sang a lot on the bus. I think there’s this idea that sometimes the manual labor jobs have more joy because you’re not going anywhere. You’re on that bus and it’s like, “How are you going to entertain yourself?” And so, it looked like a lot of singing. And if you want to hear a beautiful Dona Nobis Pacem, one of the passengers recorded it and it’s on the blog.

This is just an example of, Lord grant us peace. We’re singing for the peace and prosperity of our city. And so, my kids. It was Christmas time, I was getting ready to go into Christmas vacation. They knew it was my last day. Kids are really enamored with buses anyway. But that photo was taken specifically from, they had ridden around with me on a really popular route and saying, and the tears in people’s eyes. I mean, now that we have social media sometimes, at least I’ll just speak for myself. I love to see these flash mobs where people will show up in a mall and sing something beautiful and people will just pause. And art and beauty is just like crashed into their lives.

Now, I’m not saying we were that great of singers, but there’s something about singing jingle bells with kids to other kids where the people on the bus were fired up about it. And so, it was a really touching moment, that photo in particular. And I think my kids maybe knew I had a fancy job in a nice building before, but they weren’t really sure what I was doing. When they would see movies like Bus Stop Jobs—my son saw the movie Bus Stop Jobs, he’s a kindergartner—and then when that driver came over to our house and she was talking to me about issues and we were helping her fix her bicycle or something, he says to me, “Dad, I didn’t know you were friends with a movie star.” And so, it’s just that innocent look of really being clear about what you’re doing. We’re trying to help people get around, and so we’re trying to improve the bus and I think they got it. So, I think they were proud of me and certainly I enjoyed the time and I really am grateful for an opportunity to speak about its importance because I really do want to raise awareness about the public health importance of public transportation.

Gunderson: Well, I know your kids already knew it, but it was cool for me as a father and a grandfather to watch your kids be so proud of you for doing something that actually is bold and creative. And you are a thought leader. You’ve been a prophet and a leader. There are a lot of people who have followed your story and are very curious about it and I’m grateful you’ve taken time to share both the intellectual content of the importance of your learning as a public health leader, but as a personal colleague and friend, I want to thank you for what you’ve done in the last year and for what’s going to happen in the next years. Thank you for talking to us. You get the last word.

Summers: Oh well, I want to reciprocate with that gratitude. Gary will remember that I came to him right as I was leaving the medical center and instead of discouraged me, he instantly got what I was trying to do. And I think FaithHealth was working through a series called Being Brave and it just, I know it resonated with you. So, I appreciate the support that you’re giving me and the opportunity to tell these stories. I appreciate how you’ve continued to call people of faith to live a little differently, to really try to get at the root of the issue. That we do indeed need to be radical to get to those roots.

Gunderson: Thank you for reminding me that. That was actually our year of loving dangerously.

Summers: Oh dangerously, that’s what it was.

Gunderson: Dangerously, and that’s exactly when you walked in and I said, “Well, good grief. This is way off the map of what we were talking about.” But you actually led us onto the map of a city bus system and thank you for that. So Phillip, we look forward to the writing and I suspect we’ll be talking again. Thank you.

Summers:        Thank you.