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The relationship between transportation and public health has been a concern of policy and planning for decades, centering on air quality, safety, and physical activity. Despite improved understanding of transportation as an environmental determinant of health, we lack critical knowledge of how streets, traffic, and land use interact as social determinants of health. Streets are among the most important forms of public space in cities. As such, they display the material signs of social problems and neglect such as graffiti, drug and alcohol use, and squalor, which are known social pathways that affect health. This chapter provides a critical summary of how transportation and land use can be understood as a social pathway of health and health disparities. It illustrates this idea with the case of major arterial roads. Arterial roads are an explicit example of why social-ecological health impacts are increasingly a focus of transportation policy, particularly as cities and regions locate infill and transit-oriented development along high-traffic streets and highways.