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National Institutefor Public Healthand the Environment
Assessing health in mobility measuresErna van BalenNational Institute for Public Health and the Environment (RIVM)ECOMM, 13-15 May 2009
National Institutefor Public Healthand the Environment
‘Health in MM is too complicated’
‘Health effects are not based on evidence’
‘MM is mainly aimed at reducing traffic flows’
National Institutefor Public Healthand the Environment
Health and mobility
National Institutefor Public Healthand the Environment
Transport-related health effects: some key figures EU
127,000 deaths and 2.4 127,000 deaths and 2.4 million injuries/yearmillion injuries/year
Air pollution from road Air pollution from road transport: 8.6 months transport: 8.6 months shorter life-expectancyshorter life-expectancy
Physical inactivity : Physical inactivity : 600,000 deaths/year600,000 deaths/year
More than 30% of the More than 30% of the EU15 population EU15 population exposed to noise levels > exposed to noise levels > 55 dB(A) 55 dB(A)
National Institutefor Public Healthand the Environment
General framework for health impact assessment (HIA)
Selection of healthendpoints
Assessment ofpopulation exposure
Identification ofexposure-effect relations
Estimation of thenumber of cases
Calculation of diseaseburden
Population density,modelled ormeasuredexposure levels
Meta-analysis, pooled analysisepidemiologicalstudies
Prevalence,incidence data,demographics
INPUT
HIA-PROCESS
INPUT
Severity weights, duration
Price tags:health costs percase, life year,
National Institutefor Public Healthand the Environment
Example: Traffic-related burden of disease: Example: Traffic-related burden of disease: before and after reduction of speed limitbefore and after reduction of speed limit (10 (10 hotspots motorways)hotspots motorways)
0
100
200
300
400
500
600
700
800
900
Before After Before After Before After
Road traffic noise Traffic-related airpollution
Traffic accidents
DA
LY
s (
abso
lute
)
Source: Kempen et al, 2008
National Institutefor Public Healthand the Environment
Methods
• Selection of cases from ELTIS with impact on health
• Screening for availability of before-after measurements
• 3 assessors to reach agreement
• Direct health impacts and indirect health impacts
• Assessment of effects and assigning scores
• Assessment of other implementation issues
National Institutefor Public Healthand the Environment
Some examples (1)
• Travel plan for Addenbrooke’s hospital campus: promotion of car sharing, improving cycling infrastructure, staff-discounted bus tickets staff car use from 74% to 38%, bus travel from 4% to 25%, cycling from 17% to 26%
National Institutefor Public Healthand the Environment
Some examples (2)
• I WALK Club: competition for children to walk to school instead of being driven walking to school from 50% to 68%
National Institutefor Public Healthand the Environment
Some examples (3)
• Cycle Plan San Sebastian: better facilities for cyclists (parking spaces, bicycle paths), campaigns and regulation
bicycle use tripled within 6 years
National Institutefor Public Healthand the Environment
National Institutefor Public Healthand the Environment
Key messages
Health in MM is not complicated, but a positive side-effect of mobility interventions
Other effects have an impact on health
MM can be aimed at achieving health benefits
National Institutefor Public Healthand the Environment
And further…
• See www.healthytransport.com for inspiring examples, evidence briefings and info on ‘what works’. In development: please let us know your comments!
• Join the international Health Impact Assessment conference 14-16 October 2009 in Rotterdam, The Netherlands. Theme: ‘on the move’ www.hia09.nl
• This work was conducted in the framework of THE PEP (Transport, Health and Environment: Pan-European Program) www.thepep.org, coordinated by WHO/UNece
• Thanks to financial support from the Dutch ministries of transport, environment & spatial planning and public health
Thank you for your attention!
National Institutefor Public Healthand the Environment
Options for policy: where can health benefit be achieved?
Intervention Road traffic accidents
Air pollution Noise Physical inactivity
CO2
Emission reduction: particle filters
Emission reduction: tyres
Technology: energy-efficient
Cleaner fuels
Speed limit reduction
+/-
Effective public transport
+/- +/-
Infrastructure
Promoting walking/cycling