Notes on Accessibility and Chronic Pain

I’m surrounded by people who have various chronic pain disorders. I’m not sure why this is; people with disabilities tend to be marginalized and made invisible, and this is especially true for disabilities other than what’s become the universal symbol for the community, the wheelchair. I speculate that queer communities make chronic pain more visible because they normalize talking about one’s body, and this way people casually tell me about their Ehlers-Danlos Syndrome (EDS), their chronic fatigue, their sciatica, their epilepsy, their motion sickness, their sensory issues, their car crash injuries. Not all of the people I’ve spoken to about this in the last five years are queer, but a hefty proportion are, likely a majority, and the rest tend to be public transit advocates who are sensitive to this issue. This makes it not a perfect ethnography, but I do think the combination of talking to experts and members of the lay public is good at showing some of what transit planners have unfortunately so far overlooked.

The issue of chronic pain

Public accommodations for disabled people look at a few classes of disabilities. Wheelchair users are the best-known and form the universal symbol for the group, to the point that the name of the program in Britain is “step-free access”; it makes sense since elevator installation on subways is the most expensive retrofit required, but is not the only issue. Two additional important classes are blind and deaf people; for their benefits, systems install tactile pavements on platforms and arrange things so that station announcements are both visible from the train and clearly audible.

However, chronic pain syndromes are not on the list of disabilities to be so covered by design standards. The assumption is that invisible disabilities do not really exist; one person suffering from both EDS and complications from a debilitating car crash told me that they considered walking around with a cane, not because they needed it, but because otherwise people would assume they were able-bodied and freely run into them and not accommodate their need for a seat at public facilities.

Compounding this issue is the matter of spoons. Spoons are, in the disability community, an analog of hit points or mana pool in RPGs, an abstracted level of energy that is drained by routine activities, such as household chores, work, having a difficult conversation with a romantic partner, or dealing with medical care. In addition to having a more limited pool of spoons, people with disabilities also have to deal with a medical care system that is often adversarial and hostile; doctors flat out disbelieve patients’ pain, especially when they are women or racial minorities, which issue has been publicized more broadly with post-viral fatigue for long covid. The upshot of spoons is that people with disabilities can expend a spoon and act in ways that do not appear different from the behavior of able-bodied people, such as boarding a bus with poor ride quality, but they can’t do so consistently, and accessibility standards should acknowledge this and figure out how to minimize spoon consumption.

The issue of long covid makes accommodations for people with chronic pain an especially pertinent issue. Corona is not the first infection to lead to long-term ill effects, but because it is so much more virulent than the flu and the cold, it affects many more people, including many middle-class people who are used to getting what they need from the medical system to obtain a diagnosis. A hefty fraction of the population has been made permanently disabled, outside corona fortresses like Taiwan, and this means that going forward, access for this class of people will be a serious public issue.

Disability and harassment

People with disabilities do not expect the general public or any authority to be sympathetic to them or their needs. Twitter is full of threads giving people advice about how to deal with hostile doctors, and both in public and in private, people who require regular medical care think little of the medical establishment; I suspect one of the connections with queerness is that trans people tend to have a similar negative experience.

This lack of sympathy includes outright harassment. It’s lesser-known than sexual harassment, but it follows a similar pattern: one asshole makes derisive or threatening remarks, and the general public stands by. In some cases, the public may want to be helpful but not know how and thereby make things worse: one of my interviewees spoke of a friend who has seizures and is afraid to take public transport because if they have an episode on a bus then people might try to help them in the wrong way such as sticking a spoon in their mouth, which could lead to broken teeth.

The people I’ve interviewed who mentioned harassment or public hostility to me, including women and men, did not propose the same mechanisms as women who are afraid of sexual harassment. Women who worry about sexual harassment tend to complain about a general fear of crime, mentioning problems like poor lighting, obstructed sight lines, and loitering, and positives like nearby retail and safety in numbers. I have not heard the same from the disabled people I’ve spoken to. To the extent there’s a specific ask, it’s better public awareness and training, in common with people with other disabilities (wheelchair users object to strangers touching their wheelchairs without permission).

Trains, buses, and automobiles

Most of my interviewees have said that they prefer trains to buses, often strongly. Trains have better ride quality; buses are rickety and make them feel more fatigued, motion sick, or in outright pain. Some did not mention mode choice either way; I don’t recall any who explicitly said they are indifferent between bus and rail transit. The better ride quality of trains must be viewed as a key factor behind the rail bias, the observation that at equal speed and other amenities, trains get around 40% more ridership than buses.

Other opinions are variable. Some have said that even trains induce fatigue, and as a result, they drive everywhere; others have explicitly said the otherwise and prefer trains to cars on ride quality and motion sickness grounds. Bikes are less clear – the German chronic pain podcaster I talked to said that she has difficulty riding bikes but public transit is fine, and the Americans I’ve talked to did not say much about bikes, but then American cities are in general not nearly as bike-friendly as Berlin.

The magnitude of the bus effect varies by person, type of bus, and system. Reasons people have cited for avoiding buses include sudden acceleration and deceleration cycles, uncomfortable seats, insufficient straps to hold on, brake squeal, old buses in general, the noise and rattling of the diesel engine, and the experience of waiting at a bus stop on the street with nowhere to sit. Trolleybuses, lacking a diesel engine, are better according to some but not all people I have spoken to. One person emphasized that driving on the same arterial road used by a bus was much better than riding the bus, singling out Denver for its poor ride quality in comparison with the better buses of Sydney.

Trains vary in quality too. One interviewee complained that the ride quality on the Washington Metro deteriorated after the system switched from automatic (albeit not driverless) operation with smooth acceleration and braking to manual driving, leading to motion sickness.

One thing I did not hear commonly despite asking multiple times was complaints about walking. To the contrary, one source, familiar with modern transit planning conventions, explicitly said they’re fine with walking longer to consolidated stops, and another would walk longer distances to the subway to avoid the bus. But one planner, Allan Rosen who has proposed many bus reforms in New York, has argued in public that his sciatica makes walking longer to the bus stop more difficult.

The need for seats

It’s understood that in public accommodations, the disabled, elderly, and pregnant should have first priority for seats. Signs and PSAs remind passengers on trains and buses to get up if they see such a person, designating priority seats near the doors; there are also strong social norms about getting up for elderly people (my mother taught me this when I started riding the bus alone, at age 10).

This is compounded for people with invisible disabilities. Passengers will not spontaneously get up for someone who is in physical pain. When I would get sick enough that my legs hurt, I had no expectation of being able to get people to give me a seat, and had to seize what I could on Vancouver buses. This is one of the reasons as mentioned above one of my sources considered walking with a cane, which they otherwise did not need.

The implication is that seats must be available. Every bus stop must have a bench and shelter on a system that expects people who are not desperately poor to ride public transport. Train stations and other public facilities must have ample seating space for the general public as well; the hostile architecture trend of eliminating seating in order to repel homeless people must cease.

On vehicles, the seating-standing space tradeoff is murkier. Trains that cram many seats into the same space at the expense of standing space end up cramped. Moreover, for the people I’ve interviewed, a short period of standing typical of urban rail trips, of perhaps 10 minutes or even 20, is tolerable, even at the expense of some spoon expenditure.

Motion sickness

There is ample literature studying motion sickness on various forms of transport, public and private. Examples include Dobie et al cited in Persson, and Cohen et al, regarding trains; Griffin-Turner 1 and 2 regarding buses; and Li-Reda-Butz and Ittner-Mühlbacher-Weisswange regarding car drivers and passengers with further implications to buses.

One of my sources also told me of getting vertigo on the long escalators of the deepest stations of the Washington Metro, those on the Red Line as it transitions from running under hilly terrain to ducking under Rock Creek.

In general, motion sickness levels show great heterogeneity. Backward-facing seats, which the literature implies are less comfortable and which get a 5% discount on Korean high-speed trains, are no trouble for those sources who I asked directly, and yet they are unusually bad for me, an otherwise able-bodied person. Much depends on exact characteristics of acceleration, smoothness of ride, and road quality.

Sensory issues

A pair of people who I interviewed together told me about sensory issues. Those are even worse-known than physical chronic pain, and have implications for system design that are at odds with current norms. The issue is that of lighting quality: lighting that is too harsh or unnatural can induce migraines and repel passengers. The Denver system, already bad for its physical ride quality, also has such harsh white light at stations and on vehicles.

Sensory issues are especially delicate, as the worst cases can induce seizures, and people who get seizures are an important constituency for public transportation as many cannot drive for fear they might be incapacitated while on the road and cause an accident.

The language of universal design

The trend within accessibility advocacy is toward universal design and fostering independence. To that end, wheelchair users are promulgating norms in which it is prohibited to touch a stranger’s wheelchair without consent. Gap standards incorporate this norm by mandating such narrow gaps between train or bus and platform that a wheelchair user can safely traverse it without requiring someone else to push them. For the same reason, there is some agitation by wheelchair users in the United States against local regulations that require drivers to strap them in when they board a bus, such as those of New York City Transit, robbing them of their independent mobility.

Likewise, the trend is toward universal design, rather than special accommodations. Nobody wants to be judged for demanding special treatment or delaying other passengers; my sources, all either middle-class or aspiring to that status, have never once mentioned paratransit as an option. In this mentality, elevators are a lifeline for people in wheelchairs but are also useful for able-bodied people with strollers or heavy luggage, tactile pavements help prevent accidents, and clear audiovisual announcements help able-bodied passengers who are not alert during the trip and are especially helpful for people who don’t speak the language. And far from an obscure radicalism, the practice of universal design was first explained to me by Laura Brelsford, assistant general manager of accessibility at the MBTA.

Accommodating people with EDS, motion sickness, sciatica, or especially in the coming generation long covid is likewise a matter of universal design. Better ride quality on buses and trains means that I have a better user experience and (through precise computer control) faster trips while people who are more sensitive to motion sickness can ride at all without vomiting. Railstituting buses with trams where appropriate likewise has wide-reaching benefits, accruing again the most to people with chronic fatigue, and the same is true of the intermediate option of using trolleybuses or IMC. Bus shelter has very high impact relative to its cost, and this again especially benefits people who can’t stand for 10 minutes waiting for a bus.

All of these design issues are difficult to quantify. This makes them invisible to the manager who asks for metrics and data for everything as an excuse for inaction, as invisible as the chronic pain sufferers who they most benefit. But they are real, and from a broad enough view, their impact on the use and health of a public transport network is large.


  1. R. W. Rynerson

    Most Denver buses are Gilligs of types widely used in the U.S. Gillig knows how to build a bus that meets federal requirements and is often the winning bidder. In retirement I make a few, but lengthy, trips and haven’t noticed anything that could be causing vibration except for the broken up pavement. The worst riding quality is on arterials where parking has been banned in order to get an extra lane or two, so buses are running in the gutter.

    I’m not sure where the excessive white light problem occurs. RTD in Denver has structures, like Union Station and many rail or bus platforms. The customer affected by it should contact their elected transit board member with some examples. That’s the sort of issue that they like to handle. In 29 years with the Denver system the only complaints about lighting that I can recall were demands for more of it, demands for less of it in the dark sky mountains, and requests for daylight in the underground bus stations. All three of those have been adopted in one project or another.

  2. Matthew Hutton

    I really don’t understand why one would go to the doctor with a problem that is entirely imaginary – so I’d expect most of the problems they face are real to be honest.

    • Matthew Hutton

      (This is why doctors are ridiculous when they don’t believe peoples symptoms)

      • Jacob Manaker

        I really don’t understand why one would go to the doctor with a problem that is entirely imaginary

        It’s a well-known trope that American students will make up a headache or other minor ailment to get out of class for a while. Of course, students are trapped at school in a way that many workers are not trapped in their jobs — I think most “sick day” policies are excuse-free (still in graduate school, so not 100% sure). But then Scott Alexander wrote about patients who need a special medical professional’s note just to bring their own chair in to work at an office job. When patients present with concocted maladies to launder a request through the bureaucracy, will they trust the doctor enough to reveal the truth before they get the signature? I wouldn’t be so sure.

        (This is why doctors are ridiculous when they don’t believe peoples symptoms)

        Actually, I can empathize with that pretty well. It’s a slippery slope from “these symptoms don’t match what I learned in training, so this is either psychosomatic or something medical science has studied little, if at all” to “this is possibly psychosomatic, so there’s nothing I can do that’s guaranteed to work, just gotta take it seriously and hope that’s enough” to “this is probably psychosomatic, so my biochemistry-infused training is useless” to “this is psychosomatic, and I’m not a psychiatrist, so it’s not my job.” Misguided? Yes. Banally evil? Maybe. Ridiculous? I think not.

        • Matthew Hutton

          Yeah but making up that you have a headache to stay home is different from going to the doctors with your fake headache.

      • Tiercelet

        Doctors are, indeed, ridiculous, but they’re trained to be so, in a number of ways.

        First, historically, they’ve largely been taught that they have to express confidence and certainty in order to uphold the authority of their profession. This is only reinforced by training methods that involve challenging people on the spot and ridiculing those who can’t at least offer some sort of answer. Admitting “I don’t know about that” is unthinkable. Similarly, doctors are vastly distrustful of informed patients–to the point that people are often advised to hide how much they know about their conditions, lest the doctor be offended or refuse to deal with them.

        Second, doctors (in the US at least) are massively oversold on the risks of pain medications. They’ve come to view any pain issues as “drug-seeking” (and/or someone “illegitimately” trying to “get on disability so they can have it easy”) so those complaints are automatically discounted–doubly so when the patient visibly differs from the doctor (and thus fails to evoke subconscious sympathy).

        Third, medical instruction is still largely centered on a normative Healthy Thin White Male Adult Patient. Medical conditions look different in different people, but the literature fails to recognize this, and doctors historically haven’t been taught to worry about it anyway. So they don’t recognize disease presentation, which kicks in the “I know everything already, this person doesn’t fit, ergo this person is wrong” reflex, and they discount the patient’s reporting.

        That’s just the surface…

  3. Ernest Tufft

    Buses are clearly more of hassle for being slower, stuck in traffic worse than an automobile. Trains are generally more comfortable. Both trains and busses have boarding issues that make it difficult for disabled and senior citizens. I experience recently, quite a waste of time at urban bus stop as driver struggled to provide hydraulic wheelchair access platform, for which veteran disabled fellow and long line of passengers patiently waited. At the stations though are the most challenging labyrinth of staircases, broke down escalators and elevators. I’m surprised that train stations don’t get rebuilt to eliminate staircases and escalators, replacing them with ramps, so that everyone, wheelchairs, cyclists and scooters can board quickly and efficiently, without searching around for elevator.

    • df1982

      Interestingly Melbourne’s entire suburban railway network (with the exception of one station) was built in the 19th century with step-free access ramps. It helps that it was mostly built through areas that at the time were sparsely inhabited, and with generally flat terrain, but it shows what could have been done if the awareness had been there more globally. Unfortunately the ramps don’t meet modern day accessibility standards because the inclines are generally too steep, but most wheelchair users should still be able to use them (getting from the platform to the train is a different story, and generally the gap is big enough that the driver is required to assist in boarding).

        • Ernest Tufft

          The circuitous problem is mostly one of space. The engineers were required to build ramp, so they did! Ramps are no less time consuming than the long corridors and turnstile entrances. Engineers just need to be given more sidewalk space and take away a lane of auto traffic.

      • Ernest Tufft

        Yes, the ramps have to be graded for wheel chairs. The platform problem can be fixed with add-on hydraulic extensions on train cars, I think. The space issue for adding ramp isn’t really so hard, even in places like NYC. Simply take away a car lane from street 🙂

      • Ernest Tufft

        Stairs are extremely dangerous, and I’m surprised urban transit hasn’t scrambled to eliminate them, as they would that cliff leading into death trap rail space.

  4. James Scantlebury

    Transit agencies have come a long way with regard to accessibility, especially when embedding the principles of Universal Design into their processes, but there’s still a long way to go.
    I think your point about the comfort of trains/trams compared to buses is a great one – I think the point also applies to others who have a challenging time on transit, such as the elderly, pregnant people or parents with small children.

    I did a little research into London recently. Initially very far behind comparator cities – Washington DC was installing lifts in the 1970s, and the Underground and Fire Brigade did not permit wheelchairs in the deep Underground for ‘safety reasons’ until the 1990s. In the early 1990s, disability protestors (Disabled People’s Direct Action Network) blocked traffic and handcuffed themselves to buses to protest for better accessible transport and disabled rights. And by 2005 – thanks to Ken Livingstone and Peter Hendy – London was the first major city to have an all low floor bus fleet. The transit fans kicked up a huge fuss at the time about the retirement of the iconic, open platform Routemaster – but in hindsight, the decision to retire them in favour of low floor buses was outstanding.

    There’s still a strong disability advocacy community in the UK – Transport for All focuses on accessible transport, but also accessible public realm + streets (dropped kerbs, shared space etc). They recently won a big legal battle about parents with pushchairs/strollers occupying the wheelchair space on a bus and refusing to move. Still work to do – a viral tweet just this week about a guy yelling at a guide dog on an escalator because he wanted to get past…

    Alon – have you heard anything about the benefits/disbenefits of transit agencies using in-house, but separate advisory groups – TTC has ACAT (Advisory Committee on Accessible Transit), TfL has IDAG (Independent Disability Advisory Group) etc.

    Another separate point – some cities offer disabled people the use of subsidised taxis/cabs to get around – I was really surprised to learn that the London taxi fleet has been accessible since 2000, I thought it was much more recent than that! (As of 2021, Private Hire Vehicles – Uber etc – just 0.7% of them in London are accessible..)

    • Borners

      London cabs are special branded deluxe guild of taxi drivers with state privileges and really awesome kit.

      Though making the Tube accessible is just going to cost a bob. Probably still worth doing, convince the public to eat the cost by tying ventilation shafts to lifts sorry “elevators”. But that requires a TfL that can build cheaply which we don’t have.

      • Richard Gadsden

        TfL is (or was before the pandemic-induced bankruptcy) slowly and expensively making the Tube accessible to wheelchairs.
        Whenever they rebuild a station, they make it fully accessible, and they would sometimes do a rebuild just to make one accessible.

    • Nathanael

      London’s change was absolutely amazing. I visited in the late 1990s, right in the middle of it, with my hobbling-on-two-canes grandmother. It was quite obvious that it had been one of the worst, most disabled-hostile cities in the world, and it was becoming one of the most disabled-friendly ones very quickly. The London taxicab changeover was very fast. NYC is still bellyaching over making taxicabs accessible two decades later.

      The Tube, which is genuinely difficult to make accessible (sharply curved platforms on steep slopes, buried deep under historic buildings!) has actually been making far more progress than the NYC Subway, which is trivial to make accessible by comparison.

      One thing about London is that they took quite seriously their obligation to work around built-environment restrictions. People really would volunteer to assist people however the people wanted assistance. They don’t *do* that in NY.

  5. wiesmann

    One take on accessibility which I found interesting is the presentation from Microsoft ( which has an interesting matrix, with on one axis the disability, and on the other the various instances of that disability: permanent, temporary, occupational. People tend to focus on the first instance (permanent). If you look at the problem that way, the set of people who benefit from accessibility improvements is pretty large. For wheelchair accessibility, a pram, heavy luggage or a shopping cart is an occupational form of the disability.

    As far as sea-sickness it’s certainly a thing for me, if I read something aboard an RABDe 500, I get sea-sick, so I tended to schedule my routes to avoid these.

  6. Reedman Bassoon

    A comment about invisible handicaps:
    I know a local handyman who had a stroke at age 49 and spent two years recovering (unmarried, had to move back in with his mom). He tried working for a big box home improvement retailer, but couldn’t do it, and is on permanent disability (Social Security Disability Insurance plus Medicare). The stroke caused diabetes to appear and he had to have a gastric bypass to control his neuropathy. He drives an SUV and qualifies for a license plate with a wheelchair on it (not just a handicapped placard on his rear view mirror).

    He gets a lot of negative feedback from people when he parks in handicapped parking spaces because he doesn’t look feeble. When his meds are “balanced”, his blood pressure is nominal, and he’s rested, he can get around OK.

    1) The California DMV has issued 2.9 million handicapped placards. (i.e. about 1 in 5 registered vehicles, about 1 in 8 licensed drivers)
    2) San Francisco has a population of 870,000, and has issued 60,000 placards (about 1 placard for each of 14 men/women/children)
    3) San Francisco has 29 Residential Parking Permit Districts. A handicap placard means you don’t need any RPP to park there.

  7. Marc

    For the first time in my life I’m dealing with precisely the transit issues described above. I live and work in the SF Bay area, with a daily pre-pandemic commute from Oakland to Stanford via AC Transit and Caltrain. Roughly three weeks ago I had two unexpected full-on vertigo attacks in the space of a few days. Diagnosis is BPPV, a chronic, mostly benign, often mis-diagnosed condition that will likely pop up now and then. Just getting the proper diagnosis was difficult, I’ve run into people who spent decades trying to figure out what was happening, only to find out that there is a simple 1 minute movement test that will diagnose it, if a doctor knows to try it.

    Driving is pretty much out of the question until this particular round is over with. I’ve been using buses to do local trips, and am just starting the commute to work twice per week. I’m still unsteady on my feet, so I have to walk like I’m slightly drunk. The main problem is the potential for “drop attacks”. The two major attacks I had would have resulted in a prompt fall with possible further injury, had I not been sitting or lying in bed. If I fall and injure myself in my own neighborhood someone would likely notice. My fear is that if it happens elsewhere (particularly as I walk over a mile between the Transbay and Caltrain terminals in SF), I assume people would do what they normally do if they see a 60-something black guy lying on the sidewalk, step around or over me and keep going. The main mobility problem with I have with buses and trains that lack level boarding is the step down to the ground, my brain still doesn’t have the right cues as to where my feet are, so it now always ends up being a barely controlled stumble.

    Other problems I’ve encountered include the fact that the number of buses to SF was slashed during the pandemic, and remains that way, making timely connections to Caltrain difficult. During the pandemic, Caltrain literally removed every bench in and around the 4th and King terminal to keep homeless folks away. A missed connection outside of commute hours would require standing for up to an hour, which is quite fatiguing at this point.

    I could adjust my commute to use BART and transfer at Millbrae, resulting in a longer commute time, but less walking. The transfer between BART and Caltrain there is also difficult for anyone with mobility issues, due to the long escalators/stairs and frequently broken elevators required by the overhead mezzanine. And, of course, the schedules have never really been integrated, many times I’ve reached the Caltrain or BART platform just as a train is leaving the station, wait for the next one is anywhere from 15 to 60 minutes.

    I’ll get through this, but I can really feel for anyone who has more persistent mobility, pain, or balance issues.

  8. Phake Nick

    1. I have to condemn this type of bus seats which give me pain to use even as a normal person as it force one’s neck bend forward
    2. It is interesting how bus companies, in push for “accessibility”, decided to remove seats from their bus compartments, to allow multiple wheelchairs be parked together inside a single bus, and result in many more passengers having to stand in the bus compartment in the journey. (Or could be simply a for-profit move to allow more passengers be fit into each individual buses)
    3. Personally, while I consider myself able-bodies and not necessary to use priority seats most of the time, once in a while I would feel extremely dizzy and could definitely use some seats for rest, but whenever I attempt so, I would worry about perception from people surrounding that would they try to ask me off the seat because I’m visually someone young and not crippled

  9. Nathanael

    Good summary. My partner has mobility impairments and chronic pain, I have chronic pain, sensory hypersensitivities and mild mobility impairments, practically everyone I know has SOMETHING going on, and I’m just going to say that you covered the outline pretty well — this is exacly the same picture I would have given.

    One thing that has to be watched out for which has shown up in Philadelphia is putting in very, very long ramps (six switchback ramps) instead of elevators. (In addition to elevators is fine.) While very long ramps are is managable for power wheelchair users, they’re pretty terrible for anyone who is ambulatory but has difficulty with long distances.

    • Nathanael

      Since I’m far more ambulatory than my partner, at events in general I’m often the one who is going to offices, banging on doors, and getting employees out to provide seats. Also I scout the no-stairs routes, and I’m the one taking the stairs to wake up employees to get them to unblock the ramp routes. On transit, I’m the one telling other people to clear the seat for my invisibly-disabled partner. In cars, I’m the one calling the cops to get the cars without placards towed out of the handicapped spaces.

      Not everyone has an advocate like my partner does. People shouldn’t have to have an advocate just to get these basics. But they do.

    • Alon Levy

      Yeah, in Boston this is called path of travel, and there are strict rules on making sure this doesn’t happen; the maximum permitted path is IIRC 400 m, but that’s from the street, so up-and-down ramps for getting to Blue Line stations that are at-grade behind the street are avoided in favor of elevators.

  10. Mikel

    Not generally applicable to urban transit, but — have you heard complaints about overpressure when entering/exiting tunnels at high speed? For instance, the few times I’ve taken HSR to Madrid from the north my ears have popped really hard when exiting the Guadarrama tunnel. For me it takes a few seconds to recover normal hearing but I can imagine it being problematic for people having e.g. vertigo issues who have to ride HSR often and/or on lines with many tunnels. (some trains have better pressurization than others though)

    • Alon Levy

      I have. Some HSR trains have better pressurization than others. The Shinkansen has excellent sealing, which is then used to build smaller tunnels with a higher blockage ratio (=ratio of the train’s frontal cross section area to that of the tunnel) without destroying people’s hearing. I think the TGV is good at this by European standards, but I don’t know how it compares with AVE trains.

      • Mikel

        Hm, Renfe has like a dozen different classes of HSR stock from four different manufacturers, and I’ve only ridden 3 of them, so I have to assume that they’re a mixed bag. I’ve mostly travelled on class 120 which sadly isn’t CAF’s finest work comfort-wise. The oldest and busiest lines (Madrid-Andalusia and Madrid-Catalonia) have very little tunneling though, so pressurization probably hasn’t been a big factor in purchases. We’ll see with the recently opened Madrid-Galicia line and the under-construction Basque Y, both of which have lots of tunnels.

        For what it’s worth, the trains here are 3.0 m wide (3.2 for the Avril) and the longest tunnels (Guadarrama and Pajares) have an interior diameter of 8.5 m. Padornelo and El Corno are 8.76; Abdalajís is 8.80. Is that wider than the typical diameter in Japan?

        • Andrew in Ezo

          Shinkansen tunnels are single-bore double track arrangement, ranging from 9.5m to 10m in diameter. The Seikan Tunnel has a diameter of 9.7m

    • Marc

      The latest generations of Japanese Shinkansen all have long carefully shaped noses designed to spread the pressure change over a longer period as they hit tunnels at 300+ km/h. This helps both inside the train and outside, as the “tunnel boom” is significantly reduced. European HSR sets still mostly have rather blunt noses.

  11. James S

    Excellent article. In many ways, we are going backwards, with less and less public seating, and in transit vehicles, seating getting worse and worse. I believe MBTA and WMATA have eliminated cushioned seating on their trains. The new NJT buses also no longer have cushioned seats. Just hard plastic.

    And of course theres the issue of restrooms. Many disabilities force the person to go to the bathroom more than “normal.” Transit agencies do not care.

    • Alon Levy

      Not just transit agencies… Berlin has a special system in which there are sanisettes all over the city, but unlike in Paris they require payment to go in, while the urinal in the back is free, because what’s gender equality.

  12. Richard Gadsden

    Some comments from a mixture of personal and friend experience:
    I have moderate mobility impairment and I find standing still for more than a few minutes very painful. This means not only standing on board a train/bus, but also while waiting, while queueing to buy a ticket, etc. Long queues at ticket barriers are a serious access problem for me. Walking moderate distances is fine, though (stairs require spoon use, though stairs with a rail to grip onto are much less bad, especially upstairs; down is harder for me than up).
    Also, I need an unusually large amount of legroom (I’m about 196cm tall and have a knee impairment where I can’t bend them at more than about a sixty degree angle for a long period of time without lots of pain). Many trains or buses there will be only one or two seats on the entire vehicle I can sit in, and if they are not marked as then priority seats, then I have serious problems. This also means that I can’t fly economy-class, which effectively prices me out of flying altogether.
    TfGM, my local transit authority, issues official “please offer me a seat” pin-badges that can be used by people with invisible disabilities. There is no gatekeeping for them, but people tend to assume that you don’t get things with an official logo on unless you are officially disabled (a status that does not actually exist in the UK).
    One thing I would mention from a friend: lighting that is too diffuse creates problems for people with some visual impairments, who rely on strong contrasts – the friend comments that they don’t have stereoscopic vision and rely on things like shadows for depth perception. Manchester Victoria station has a large open space with entirely diffuse lighting, and they are completely unable to navigate that space unassisted. This is clearly a conflicting access requirement with the opposition to overly harsh lighting. I don’t have a resolution to this.

  13. Ernest Tufft

    I get nervous and headachy from the urban din found in subway stations and trains, but standing on curbside waiting for a bus that’s delayed by traffic blowing past it bothers me more. The chronic pain of getting thru a jammed turnstile, down staircase, or climbing aboard the bus with a cart full of groceries is what I see most, with ocasional cyclist carrying bicycle down steep staircase.

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