Transport and health Lessons from integrating health into transport strategies
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Transcript of Transport and health Lessons from integrating health into transport strategies
Transport and health Transport and health Lessons from integrating health Lessons from integrating health
into transport strategiesinto transport strategies
Carlos DoraCarlos DoraWorld Health OrganizationWorld Health Organization
GenevaGeneva
Many health impacts from Many health impacts from transport:transport:
INJURIESNOISE
AIR POLLUTION
PHYSICAL INACTIVITY
PSYCHOSOCIALEFFECTS
e.g. Air Pollution leads to heart e.g. Air Pollution leads to heart and lung disease and and lung disease and
premature deathspremature deaths And to increases in hospital And to increases in hospital
admissions, and asthma attacksadmissions, and asthma attacks To loss of millions of working days To loss of millions of working days Children living near busy roads Children living near busy roads
with heavy/diesel vehicle traffic with heavy/diesel vehicle traffic have higher risks of respiratory have higher risks of respiratory problems.problems.
No safe level of AP (Particulates)No safe level of AP (Particulates) Every 10 Every 10 µg/mµg/m3 3 decrease in PM2,5 decrease in PM2,5
leads to 3,4% decrease in mortalityleads to 3,4% decrease in mortality Health impacts are larger in lower Health impacts are larger in lower
socioeconomic groups (cumulative socioeconomic groups (cumulative exposures)exposures)
e.g. 60% of world population does e.g. 60% of world population does very little physical activityvery little physical activity
Health Benefits
A B C
Physical activity level
low high
A = inactiveB = activeC = trained
Dose-response physical activity and health, in B Martin et al,
2004
Dose-response physical activity and health, in B Martin et al,
2004
Greater health Greater health benefits among benefits among
least activeleast active
Greater health Greater health benefits among benefits among
least activeleast active
30 minutes a day of Physical 30 minutes a day of Physical ActivityActivity
is enough to reduce:is enough to reduce:
By 50 % the risk of developing coronary hearth disease, By 50 % the risk of developing coronary hearth disease, By 50% the risk of developing non-insulin-dependent By 50% the risk of developing non-insulin-dependent
diabetes and obesity.diabetes and obesity. By 30 % the risk of developing hypertension. By 30 % the risk of developing hypertension. The risk of colon /breast cancer (e.g. Shanghai 50% The risk of colon /breast cancer (e.g. Shanghai 50%
reduction in colon cancer)reduction in colon cancer).. Helping to maintain bone mass and protecting against Helping to maintain bone mass and protecting against
osteoporosis.osteoporosis.
Improving balance, co-ordination, mobility, strength and Improving balance, co-ordination, mobility, strength and endurance.endurance.
Increasing self-esteem, reducing levels of mild to moderate Increasing self-esteem, reducing levels of mild to moderate hypertension and promoting overall psychological well-hypertension and promoting overall psychological well-being.being.
e.g. Traffic Deaths: 1,2 e.g. Traffic Deaths: 1,2 million/yearmillion/year
Traffic Injuries over 40 million/yearTraffic Injuries over 40 million/yearShare by age groups
0% 10% 20% 30% 40%
60+
45-59
30-44
15-29
5-14
0-4
male female
Source: Peden et al (2004)Source: Peden et al (2004)
Traffic linked to neighbourhood social supportTraffic linked to neighbourhood social support
Busy streets are less convivial, more anonymousBusy streets are less convivial, more anonymous
Per
ce
nt
of
tota
l b
urd
en
(w
ithin
reg
ion
)
1% -
5% - Water, sanitation and hygiene (5.5%)
Lead
Underweight
Indoor air (3.7 %)
Ambient air
Occupational injuries
Developing countries
(high mortality)
Developed countries
Occupational risks
Alcohol Tobacco
Overweight
Lead
Unsafe sex
Tobacco
Climate change
Alcohol
Ambient air
Water, sanitation and hygiene
Overweight Unsafe sex
Physical inactivityZinc deficiency
15% -
A large proportion of the Global Burden of Disease is attributed to urban transport
Transport (3.3%)
Traffic policies may have many benefits Traffic policies may have many benefits to health and environment – Scarce to health and environment – Scarce
documentation!documentation!
Source: Congestion Charging: Update on scheme impacts and operations. February 2004Source: Congestion Charging: Update on scheme impacts and operations. February 2004
((www.tfl.gov.uk/tfl/downloads/pdf/congestion-charging/cc-12monthson.pdfwww.tfl.gov.uk/tfl/downloads/pdf/congestion-charging/cc-12monthson.pdf))
The congestion charge is a £5 daily charge for driving or parking a The congestion charge is a £5 daily charge for driving or parking a vehicle on public roads within the congestion charging zone vehicle on public roads within the congestion charging zone between 07:00 and 18:30, Monday to Friday, excluding between 07:00 and 18:30, Monday to Friday, excluding weekends and public holidays.weekends and public holidays.
Traffic delays inside the charging zone average 30% Traffic delays inside the charging zone average 30% lower than before lower than before
Pedal cycle movements have Pedal cycle movements have increased by about 20 %increased by about 20 %
Bus and coach movements have increased by over 20% Bus and coach movements have increased by over 20% Van and lorry movements have reduced by about 10 %Van and lorry movements have reduced by about 10 % Powered two-wheeler movements have increased by Powered two-wheeler movements have increased by
10-15%10-15%
8% reduction in personal injury 8% reduction in personal injury accidentsaccidents in the charging zone in the charging zone during charging hours during charging hours compared to the same period compared to the same period last year. last year.
6% fewer pedestrians were involved in accidents, 6% fewer pedestrians were involved in accidents, (Based on the first 6 months of provisional data since (Based on the first 6 months of provisional data since
charging began)charging began)
London congestion chargeLondon congestion charge
Bogota: urban space to public transport Bogota: urban space to public transport and pedestrians – reduction in traffic and pedestrians – reduction in traffic injuries and air pollution ? political injuries and air pollution ? political
success ?success ?
before... ... after
Narrow solutions: limited Narrow solutions: limited results. results. e.g. Continuing Traffic e.g. Continuing Traffic
Growth Has Cancelled Out Pollution Growth Has Cancelled Out Pollution Savings from Cleaner and More Savings from Cleaner and More
Efficient VehiclesEfficient Vehicles
Cars are becoming Cars are becoming heavier and more heavier and more powerful.powerful.
Trips are becoming Trips are becoming increasingly longincreasingly long..
Total kilometers Total kilometers traveled by road traveled by road continues to growcontinues to grow
EC: Transport in Figures, 2000
Integrated transport policies have Integrated transport policies have great health gain potential -great health gain potential -
Transport Demand Transport Demand Management viaManagement via: :
– Economic measures Economic measures
– Changes in individual Changes in individual travel behaviours travel behaviours
– Compact land use to Compact land use to reduce need to travelreduce need to travel
Maintain high walking Maintain high walking and cyclingand cycling
Support public Support public transporttransport
0
2
4
6
8
10
12
14
16
Hokksund Hamar Trondheim
e.g. the Nordic Council work to include health effects in cost-benefit e.g. the Nordic Council work to include health effects in cost-benefit analyses of infrastructure for cyclists shows that this can be a very analyses of infrastructure for cyclists shows that this can be a very
profitable investmentprofitable investment
Net benefit/cost ratio
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Hokksund Hamar Trondheim
Other Benefits
Health
Filling the information gap: Develop tools that Filling the information gap: Develop tools that help economist to include health in their help economist to include health in their
analysesanalyses
Exposure(GIS based)
Health effects(based on dose/response curves)
The tools developed consist of two modules (TEX & HIT) to provide two sets of health-related indicators:
• exposure measurements: TEX operates within ArcGIS and for population groups defined by the users according to different features. TEX calculates the exposure of predefined groups along the scenario duration (from 1 hour to 1 year) of considered case study.
• health effects: HIT calculates attributable mortality or morbidity, relative risk, disease-adjusted life-years, for different age / social groups related to air pollution; output for noise and crashes are also available.
Developing tools for the assessment Developing tools for the assessment of health impacts from transport:of health impacts from transport:
e.g. WHO HEARTS modele.g. WHO HEARTS model
SAMU : agent-based modelling of SAMU : agent-based modelling of pedestrians/cars interactions and pedestrians/cars interactions and
resulting accidentsresulting accidents
Source : Banos, Godara, Lassarre, 2005
Contributing to change in social normsContributing to change in social norms::
“A man who, beyond the age of 26, finds himself on a bus can count himself as a failure”
A European Parliament A European Parliament ResolutionResolution
adopted on 28 February adopted on 28 February 20022002
Stronger integration of health considerations into transport policies, including by carrying out health impact assessment of major transport projects.”
A European Parliament A European Parliament ResolutionResolution
adopted on 28 February adopted on 28 February 20022002
Stronger integration of health considerations into transport policies, including by carrying out health impact assessment of major transport projects.”
Challenge: using the Challenge: using the lessons/experience elsewhere:lessons/experience elsewhere:
105 million people moved to cities in 105 million people moved to cities in China between 2000 and 2005China between 2000 and 2005
Advice on national & urban Healthy Transport Advice on national & urban Healthy Transport Policies /StrategiesPolicies /Strategies
Difficult to communicate the benefits of bicycles!Difficult to communicate the benefits of bicycles! Need insight into communication of local healthy Need insight into communication of local healthy
transport solutions transport solutions
Co-benefits of climate change adaptation Co-benefits of climate change adaptation strategies and policiesstrategies and policies
Research with countries and cities – preparedness Research with countries and cities – preparedness plans plans
WHO will begin at home: healthy transportWHO will begin at home: healthy transportto work for staff health and climate change to work for staff health and climate change
reductionreduction
Transport to work is a major source of health & wellbeing Transport to work is a major source of health & wellbeing risks, but also offers opportunities for healthy activity risks, but also offers opportunities for healthy activity
Survey identified lack of infrastructure for cycling and public Survey identified lack of infrastructure for cycling and public transport for over half the staff who want to adopt those transport for over half the staff who want to adopt those modesmodes
Interest from nearby International agencies (UN, ILO, Red Interest from nearby International agencies (UN, ILO, Red Cross etc.) Cross etc.)
More Healthy Transport among More Healthy Transport among WHO staff can: WHO staff can:
1.1. Enhance staff wellbeing via:Enhance staff wellbeing via:• Injury prevention Injury prevention • Air pollution reductionsAir pollution reductions• Improved Physical activityImproved Physical activity• Improved Mental healthImproved Mental health
2.2. Improve the carbon footprint from WHO HQ staff travel to Improve the carbon footprint from WHO HQ staff travel to workwork
3.3. Give the good example on transport & health to health Give the good example on transport & health to health agencies (ministries, clinics, hospitals) and other agencies (ministries, clinics, hospitals) and other international agenciesinternational agencies
On balance the Benefits of Cycling & On balance the Benefits of Cycling & Walking are much greater than Risks from Walking are much greater than Risks from
injuriesinjuries
But a successful strategy to promote C&W has to But a successful strategy to promote C&W has to include injury prevention measuresinclude injury prevention measures
Effective preventive measures are availableEffective preventive measures are available
Step 1: Understanding staff needs Step 1: Understanding staff needs and feasible Sustainable and feasible Sustainable
Transport alternatives for HQ Transport alternatives for HQ Describe staff commuting patterns & barriers to sustainable Describe staff commuting patterns & barriers to sustainable
transport and needs (staff survey).transport and needs (staff survey). Identify incentives for, cycling, car pooling, and use of Identify incentives for, cycling, car pooling, and use of
public transport.public transport. Identify ways to promote equity in parking at work, with Identify ways to promote equity in parking at work, with
special attention for those with special needs (area of special attention for those with special needs (area of residence, need to drop children at school, physical residence, need to drop children at school, physical disability…)disability…)
Agree ways to monitor the impacts of the ST intervention Agree ways to monitor the impacts of the ST intervention (through staff's mode of transport, through medical (through staff's mode of transport, through medical services etc.) and readjust it as needed.services etc.) and readjust it as needed.
Step 2: Develop and disseminate Step 2: Develop and disseminate Information & Advocacy materials on:Information & Advocacy materials on:
1.1. Accessible sustainable transport alternatives for WHO HQ staffAccessible sustainable transport alternatives for WHO HQ staff2.2. The benefits of sustainable transportation for personal health, The benefits of sustainable transportation for personal health,
(briefings done in collaboration with injury prevention, physical (briefings done in collaboration with injury prevention, physical activity, air pollution units)activity, air pollution units)
3.3. The role of health systems can play in achieving health through The role of health systems can play in achieving health through promotion of sustainable transport modes (eg. hospital transport promotion of sustainable transport modes (eg. hospital transport programmes)programmes)
Sustainable transportation alternativesSustainable transportation alternatives
CyclingCycling Public Public transporttransport Car PoolingCar Pooling
Cycles lanes Cycles lanes &&
mapsmaps
Repairing Repairing your bikeyour bike
Building Building facilities facilities
(showers,(showers,changingchangingrooms, rooms,
parking) parking)
Bus & trainBus & trainnetworknetwork
info info (timetables,(timetables,connections)connections)
ReducedReducedprices forprices formonthlymonthly
subscriptionssubscriptions
Examples of sustainable Examples of sustainable transportation alternativestransportation alternatives
RealRealtime infotime infosystemsystem
Step 3: Promotion and EventsStep 3: Promotion and Events
World Health Day – 7 April 2008 at WHO HQWorld Health Day – 7 April 2008 at WHO HQ Short-term events at WHO HQ promoting ST staff:Short-term events at WHO HQ promoting ST staff:
– on cycling and walkingon cycling and walking– on public transporton public transport– on connection with neighbouring Franceon connection with neighbouring France
Engage a few senior staff as role models on ST to work Engage a few senior staff as role models on ST to work Event with senior staff and Geneva/Swiss authorities on Event with senior staff and Geneva/Swiss authorities on
health and transport health and transport
Good practice examples of sustainable Good practice examples of sustainable transport practices in the workplace exist, transport practices in the workplace exist,
right here in Geneva! right here in Geneva!
– Rolex SA Rolex SA (Plan-les-Ouates): car sharing, shuttle services(Plan-les-Ouates): car sharing, shuttle services– Geneva International AirportGeneva International Airport: 45% of eco-mobility in 2020 : 45% of eco-mobility in 2020 – Télévision Suisse RomandeTélévision Suisse Romande: development and promotion of soft mobility : development and promotion of soft mobility
between the different TSR's sites (cycling path,…) between the different TSR's sites (cycling path,…)
Source: Mobilidée Source: Mobilidée
There are also good practice examples of There are also good practice examples of ST within health sector institutionsST within health sector institutions
Switzerland: with Swiss Bicycle Advocacy Association Switzerland: with Swiss Bicycle Advocacy Association
District hospital of Lucerne (KSL)District hospital of Lucerne (KSL): 3500 staff. Created a working group of 6 : 3500 staff. Created a working group of 6 people, in charge of promoting and following up the use of the bike.people, in charge of promoting and following up the use of the bike.
– District hospital of Schaffhouse (KSSH)District hospital of Schaffhouse (KSSH): 850 staff. Parking space problems, staff using the : 850 staff. Parking space problems, staff using the car for short trips, taking away parking space from patients and visitors. Action: car for short trips, taking away parking space from patients and visitors. Action: financial support/incentives for staff to use the bike or Public Transport instead of car, financial support/incentives for staff to use the bike or Public Transport instead of car, including costs of eventual taxi if needed.including costs of eventual taxi if needed.
Source: Source: igveloigvelo
Nottingham City Hospital:Nottingham City Hospital:– Provided bicycle locks, cycle racks, bicycle leasing scheme, ensuring public transport Provided bicycle locks, cycle racks, bicycle leasing scheme, ensuring public transport
connections.connections.
Detailed example: Grenoble ST-Detailed example: Grenoble ST-MicroelectronicMicroelectronic
– ProblemsProblems
– MeasuresMeasures1.1. Development of public transportation (free shuttles site - railway station, financial participation)Development of public transportation (free shuttles site - railway station, financial participation)
2. Development of green transportation (creation of cycle lanes around site, disposal of safety cycle kit, 2. Development of green transportation (creation of cycle lanes around site, disposal of safety cycle kit, disposal of taxi and/or bus if any problem, promotion of greener fuel for company vehicles)disposal of taxi and/or bus if any problem, promotion of greener fuel for company vehicles)
3. Development of proximity services (post office, kiosk, bicycle repair professionals on site, fast food 3. Development of proximity services (post office, kiosk, bicycle repair professionals on site, fast food services, free anti-pollution control)services, free anti-pollution control)
4. Action on short business travel (increase of gas-driven professional vehicles, disposal of vehicles for 4. Action on short business travel (increase of gas-driven professional vehicles, disposal of vehicles for staff, coordination of business travel, car-sharing development for professional travel between staff, coordination of business travel, car-sharing development for professional travel between the sites) the sites)
In 4 years, increase from 20% to 51% of alternative transportationIn 4 years, increase from 20% to 51% of alternative transportation
• 60% staff live in the surroundings60% staff live in the surroundings
• Traffic jam on the site at peak hoursTraffic jam on the site at peak hours
• 80% of single car use80% of single car use
40% energy used on the site 40% energy used on the site is for staff transportationis for staff transportation
20%
35%
51%
45%40%
20%
30%
40%
50%
60%
2000 2001 2002 2003 2004 2005