Transport is a public health issue.
It enables access to the goods,
services and activities that people
need to live and maintain their
health; yet it may also have adverse
impacts on the health of individuals
and populations. These impacts may differ in
different groups of the population, so transport
may contribute to inequalities in health.
Transport and health
Some of the impacts of individuals’ transport
decisions may impact on their own health,
for example, by enabling access to essential
services or by encouraging sedentary lifestyles.
There are also impacts on the wider population,
for example, by increasing pollution or exposing
other road users to the risk of crashes and
injuries. These issues need to be considered
when assessing the health impacts of any
proposed transport development or policy.
There is now a large body of literature on
transport and health and this has recently been
reviewed in a document from the Scottish Health
Impact Assessment Network (1). Some of the
main impacts are described below.
Physical activity and obesity
Levels of obesity are rising and Scotland has
one of the highest rates of obesity in the world.
In Lothian 62% of men and 54% of women are
now overweight or obese (2). This is associated
with a heavy burden of morbidity and mortality.
The causes of this trend include increasingly
sedentary lifestyles and decreasing physical
activity levels. Much of this is related to increased
car use replacing more active forms of travel
(3, 4). Regular physical activity has other health
benefits including reduced risk of osteoporosis,
some cancers, type 2 diabetes and improved
mental health. The current chief medical officer’s
recommendation for adults is to accumulate
30 minutes of moderate activity, such as brisk
walking, at least 5 days a week (5). Most of
the people who achieve this target do so by
incorporating physical activity into their daily
lives, for example, by regular active travel to work.
Cars are a sedentary form of transport.
Using public transport usually involves walking
to and from bus or train stops, which may help
sedentary people become more active (6).
Walking and cycling are active forms of travel
and people who walk or cycle for 30 minutes
a day will achieve the minimum recommended
activity level for health benefits.
Injuries and deaths
In Scotland in 2006, 314 people were killed
and 2,625 were seriously injured following
road crashes. Of these, 61 of the people
killed and 684 of those seriously injured were
pedestrians. There were 10 cyclists killed and
131 seriously injured (7). There is evidence
that in places where cycling is more common
the risk of a cyclist being involved in a crash is
lower (8, 9). The numbers and rates of injury or
death from rail, air, bus, ferry and tram crashes
are small (10).
Road transport causes emissions of several
pollutants that have been associated with
adverse health outcomes (11, 12). The most
significant of these is fine particulate matter
(PM). Road transport is responsible for 30% of
the emissions of PM2.5, which are fine particles
2.5 microns in diameter (13). Increases in
air pollution are associated with increases in
cardiovascular disease and worsening of preexisting
asthma and other respiratory diseases
(14, 15). For many pollutants, concentrations in
vehicles are higher than background or general
roadside concentrations (16). Observational
studies have shown reductions in respiratory
and cardiovascular mortality and respiratory
admissions following interventions to reduce
transport related air pollution (17, 18).
Transport noise, for example, from busy road
intersections or airports, has been associated
with annoyance and loss of sleep (19, 20).
Motorised transport accounts for 22% of CO2
emissions in the UK (21). This contributes to
climate change, which may bring devastating
health and social impacts (22).
Although transport may be popularly regarded
as a source of stress, for example road rage or
commuter stress, there is little evidence on the
extent of this as a public health issue (23).
Fear about personal safety may deter
people from using public transport, cycling or
walking (24, 25).
Busy transport routes may be associated with
community severance, whereby local communities
have reduced access to local amenities and
disrupted social networks (26).
Although most of the above impacts suggest
that car use may be bad for one’s health, there
is evidence that car ownership is associated
with better physical and mental health even after
controlling for socio-economic status (27, 28).
This may be because cars are required to access
essential services and health promoting amenities,
or because cars are seen as a status symbol and
People without access to a car may be
unable to access employment, amenities or
medical care (29). Disadvantaged groups also
disproportionately bear the adverse impacts
of transport. For example, speeding is more
common in less affluent areas (30) and the
pedestrian death rate for children in social class
5 is four times higher than children in social
class 1 (31). Impacts of any transport proposal
differ for different groups. For example, people
living near a new route bear different impacts
from those who live further away but use that
route. Transport needs for people in urban and
rural areas are different (32).
Transport and sustainability
Sustainable transport has been seen as a key
part of sustainable development. But what is
sustainable transport? Definitions vary in scope,
ranging from transport systems that don’t use up
resources faster than they can be replenished,
to transport that has minimal impact on the
environment, to a much wider concept that
includes social, environmental and economic
Sustainable transport policies should aim to:
- Reduce traffic congestion;
- Minimise use of non-renewable resources;
- Reduce CO2 and other emissions; and
- Minimise impact of transport infrastructure on the landscape.
In practice, sustainable transport often means
prioritising modes of travel other than cars and
using measures to reduce car use. In addition,
if the wider concept of sustainable transport
is accepted, it should include a concern for
equity, social wellbeing and health. This means
transport policy should enhance mobility and
access for all groups in the population and
minimise adverse health impacts, especially
on already disadvantaged groups. It is often
suggested that there is an economic need to
develop road infrastructure despite potential
adverse social and environmental impacts. But
there is now a growing argument that economic,
environmental and social needs are not in
opposition. There is a strong economic case
for action to prevent the potential catastrophic
effects of climate change (34).
Policy and public responses
Scottish national policy is to develop more
sustainable transport systems. The white paper,
Scotland’s Transport Future, set a target that
70% of the transport budget should be spent on
improving the public transport infrastructure (35).
Scotland’s National Transport Strategy states that
‘sustainable development principles will form the
basis of our approach’ (36). Scottish Planning
Policy on Planning for Transport states that in
development plans priority should be given to
walking, cycling, then public transport and finally
motorised modes (37). This also recommends
green transport plans.
Although stated policy prioritises walking and
cycling, in practice car use is increasing steadily.
Since 1996, there has been a 13% increase in
the volume of car traffic, with 42% and 18% rises
respectively in the volume of light goods and heavy
goods vehicle traffic. In the last 10 years there has
been a 2% rise in the number of trips by car but
falls of 18% and 7% respectively in trips by walking
or bus. Between 1966 and 2001 the percentage of
working people who drove to work rose from 21%
to 68% whereas the percentage travelling by bus
dropped from 43% to 12%. 40% of adults drive
every day (7).
There is ample evidence that individuals
value car use and ownership and are unwilling to
sacrifice this for the ‘public good’. This is shown,
for example, by the ‘no’ vote for congestion
charging in Edinburgh (38) and widespread public
support for those protesting about increases in
fuel prices in 2000 (39). This suggests there may
be little public support for policies that seek to
reduce car use.
So what needs to be done?
There is a clear overlap between health and
sustainability concerns regarding transport. Both
would suggest a need to reduce car use and
replace it with more active, less polluting forms
of transport. A concern for health and health
inequalities would also suggest the need for action
to ensure disadvantaged groups have greater
access to essential services and amenities.
To address these issues requires priority to be
given to ‘sustainable’ forms of travel that are
also good for health. This means prioritising
walking, cycling and public transport. This needs
to apply to spatial planning policy as well as
transport policy, as many residential, leisure,
retail and industrial developments are now built to
accommodate and encourage car use.
Action needs to address public policy,
transport infrastructure and the behaviour of
individuals. For example, individualised travel
marketing, in which information is tailored to
people who are already motivated, can be
successful in increasing active travel (40).
Given the high value placed on car use and
ownership, perhaps the first step should be to
raise awareness of the environmental, health
and social costs of current transport patterns
and benefits of active travel. This may be a prerequisite
to gain support for policies designed to
change travel patterns.
- Any transport policy or development may bring health benefits to some but adverse impacts for others. This pattern of health impacts depends on the local context. Major proposals are required to be subjected to environmental assessment, but this will neither identify, nor address all the relevant impacts on heath and health inequalities.
- A health impact assessment should also be conducted on major transport plans and developments to ensure that all the issues discussed here are addressed.