Background In the context of city operations and management, smart generally implies“…turning to technology to better connect our communities, improving citizen services”, and, more importantly, finding more intelligent ways to manage city resources and assets. It is a common notion that a city transportation system is a critical asset that must be intelligently managed to enable a better quality of life. It is less clear, however, that a city transportation system is in fact a public health tool and enabler. A transportation system, though, is not just the physical system it is; it is the integration of several activities some of which involve physical assets while other involve policies, standards and norms, that take place over long time span and involve significant resources including technology. Catering for public health should be an integral part of the smart city movement and thinking. Methods The paper first examines the different activities involved in putting together a transportation system, namely: Planning, Design, construction, Operations (management), Maintenance, and, in some cases, Decommissioning (henceforth PDCOMD), and then maps those activities to known public health outcomes. The paper notes that certain activities of the transport system development process are more suited to serve public health than others. For one, transportation system planning is fundamental to ensuring suitable integration of public health in the early stages of putting the transport system together. The operations activity is equally critical but historically—and to this day-- seldom viewed or used as the public health tool it is. Results This paper shows that “smart” as in integration of information and communication technology to improve efficiency of the transportation system may or may not serve public health; public health considerations in some cases require the calming/slowing down and spatial shifting-- thus the appearance of inefficiency-- of certain elements of the transportation system. Alternatively, the notion of efficiency as applied to transportation systems may need to be modified to explicitly incorporate aspects of public health. Conclusions The now trendy notion that information sensing, connectivity, and computation form the backbone of smart cities is questioned. The paper presents an alternate framework where public health is made integral to the notion of smart cities through explicit consideration and integration in key transportation system activities. Adopting an encompassing definition of “health” and “healthy” is vital. Among the many transport system activities, the paper identifies two, planning and operating, where public health consideration is particularly consequential.