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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).

Air pollution

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).

Other impacts

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).

Health inequalities

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 raise self-esteem.

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 wellbeing (33).

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.

key points

  • 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.