Transport and Health

1
Transport and Health
2
Determinants of health

• Source Dahlgren and Whitehead

3
The links

• Physical activity
• Road injuries
• Air pollution
• Access
• Inequalities

4
Physical activity

• Physical activity not only contributes to
  wellbeing, but is also essential for good health
  (Chief Medical Officer)
• Adults who are physically active have 2030
  reduced risk of premature death and up to 50
  reduced risk of
• Coronary heart disease
• Stroke
• Diabetes
• Some cancers

5
Physical activity

• Achieve a minimum of 30 minutes moderate activity
  on at least five days of the week
• Moderate activity includes brisk walking, cycling
• 65 of men and 76 of women dont get enough
  physical activity
• Around 58 of trips by car or van are under five
  miles (30 minutes by bike)
• Nearly 25 are under two miles (30 minutes brisk
  walk).

6
The need cycling 1952 - 2005
7
Road injuries

• Around 3,500 people are killed and 250,000
  injured in Great Britain annually on the roads.

8
Air pollution

• Air pollution from particulate matter is linked
  to 8,100 premature deaths annually, and sulphur
  dioxide to 3,500.

9
Access

• Access to work, education, healthcare and food is
  more difficult for those without a car.

10
Access

• Work two out of five jobseekers say lack of
  transport is a barrier to getting a job
• Learning nearly half of 1618-year-old students
  say they find their transport costs hard to meet
• Health over a 12 month period, 1.4 million
  people miss, turn down or choose not to seek
  medical help because of transport problems
• Food shopping 16 of people without cars find
  access to supermarkets difficult, compared with
  6 of people with car

11
Inequalities

• Exposure to air pollution is greater for those
  living in areas of deprivation.
• Children from social class V are five times more
  likely than those from social class I to be
  killed as pedestrians.

12
NHS action

• Introducing patient and staff travel plans
• Implementing physical activity strategies in
  conjunction with cycling/walking strategies
• Providing resources for local transport
  programmes
• Contributing to local accessibility planning and
  improving transport access to NHS sites
• Assessing the health impact of local transport
  plans.

13
NICE guidance

• Physical activity and the environment
• Road injuries in children aged under 15

14
Physical activity and the environment

• To produce guidance for the Highways Agency,
  local authorities, the NHS, the independent
  sector and others, on the promotion and creation
  of built or natural physical environments that
  are conducive to and support increased levels of
  physical activity among local communities, to
  meet the physical activity recommendations of the
  Chief Medical Officer of England

15
Process

• The PDG
• The evidence
• Developing draft recommendations
• Consulting on the draft recommendations
• The final guidance
• The future
• Role of stakeholders

16
The evidence

• Five reviews of interventions
• Transport
• Built environment
• Urban planning
• Natural environment
• Policy

17
The evidence some difficulties

• Measurement issues
• Public health ideal
• Interventions for different priorities

18
The evidence

• Total of over 94,000 hits plus various websites
  trawled
• Plus review level correlates environment and
  physical activity
• Plus economic reviews and modelling

19
The guidance

• Recommendations
• Considerations
• Research recommendations
• Implementation

20
Considerations

• The aim is to help people to incorporate activity
  into their daily lives
• By considering evidence about changes that may
  support this
• In the past, priority often given to sedentary
  transport and activities
• Many organisations own, manage and influence land
  used by public

21
Considerations

• Promoting PA needs several factors and
  environmental change is only one
• But cant get people to be active when the
  environment is one which discourages them

22
Considerations economics issues

• Differences between e.g. transport economics and
  health economics
• How to apportion costs of an intervention to
  health outcomes
• Extra costs of interventions

23
Final recommendations

• Strategies, policies and plans (1)
• Transport (2)
• Public open space (1)
• Buildings (2)
• Schools (1)

24
Recommendation 1 Strategies, policies and plans

• Involve community and experts
• Ensure planning applications prioritise physical
  activity as part of daily life. Ensure local
  facilities are accessible on foot, bike etc
• Assess the likely impacts and make results
  publicly available

25
Recommendation 2 Transport

• Ensure pedestrians and cyclists are given the
  highest priority when developing or maintaining
  streets and roads. (This includes people whose
  mobility is impaired.)

Reproduced by kind permission of J
Bewley/Sustrans
26
Recommendation 2 (continued) Transport

• Use one or more of the following methods
• re-allocate road space to support physically
  active modes of transport
• restrict motor vehicle access
• introduce road-user charging schemes
• introduce traffic-calming schemes to restrict
  vehicle speeds
• create safe routes to schools

27
Recommendation 3 Transport

• Plan and provide a comprehensive network of
  routes for walking and cycling
• Offering convenient, safe and attractive access
  to workplaces, homes, schools and other public
  facilities. (The latter includes shops, play and
  green areas and social destinations.)
• Built and maintained to a high standard.

28
Road injuries in children aged under 15

• Just starting