Transport is a health issue

Dr Harry RutterSouth East Public Health

Observatorywww.sepho.org.uk

Health impacts on:

Individuals

Communities Environment

Individuals

• Physical activity

• Injuries• Environment• Access

Average distance travelled per year

Miles per person per year 99/01

% change from 89-91 to

99/01

Walking 189 -20

Bicycle 39 -6

Car 5,354 11

Source: DfT Great Britain data http://www.transtat.dft.gov.uk/tables/tsgb02/1/download/10202.xls

Passenger transport by mode 1952-2000 (Great Britain)

0

100

200

300

400

500

600

700

1956 1961 1966 1971 1976 1981 1986 1991 1996 2000

Year

Bill

ion p

asse

nger kilo

metr

es

Car

Rail

Bike

Source: http://www.transtat.dft.gov.uk/tables/tsgb01/9/90101.htm

Journeys to school by mode and age group: 1985/86 to 1995/97

Source: DfT Personal Travel Factsheet 2 - June 1999 http://www.transtat.dft.gov.uk/facts/nts/pt2_99/school99.htm

Sedentary lifestyle

• In SE ~50% exercise < once a month

• Increasing obesity– 20% of adults in England– Has trebled in last 20 years– Shortens life by average of 9 years– £0.5 billion direct costs to NHS– £2.0 billion impact on economy

Sources: HSRU Healthy Lifestyles Survey and Tackling Obesity in England, National Audit Office, 2001

Cars and obesity

• 14% of Chinese households acquired a car between 1989 and 1997

• Men who acquired a car– gained ~2kg– doubled their risk of obesity

Source: Bell et al, Obesity Research 2002; 10: 277-83

Cardiovascular mortality

• 236,000 deaths a year from cardiovascular disease in UK – 39% of deaths– 36% of premature deaths in men,

28% in women– 58% higher mortality in male

manual thanmale non-manual workers

Source British Heart Foundation Statistics Database 2002 - http://www.dphpc.ox.ac.uk/bhfhprg/stats/2000/2002/mortality.html

Health benefits of physical activity• Heart disease• High blood pressure• Stroke• Cancer• Diabetes• Mental health and well-being• Cognitive function / independence

Physical activity and mortality• >36% CHD deaths are attributable

to sedentary lifestyle1

• 14% of UK CHD deaths could be avoided by stepping up a level2

• 28% reduction in mortality3

• Adds one to two+ years of healthy life4

• Dose-response relationshipSources: 1) McPherson et al. Coronary heart disease: Estimating the impact of changes in risk factors. National Heart Forum, 2002

2) Britton et al, Monitoring the progress of the 2010 target for coronary heart disease mortality, National Heart Forum 2000

3) Andersen et al. All-cause mortality associated with physical activity during leisure time, work, sports, and cycling to work.

Archives of Internal Medicine 2000, 160, 1621-1628. 4) Paffenbarger et al. Physical activity, all-cause mortality, and longevity of college alumni. NEJM

1986;314:605-13

Traffic injuries in UK

• In 2001 there were:– 3,450 deaths– 40,560 killed or seriously injured– 313,000 injuries

• Cyclists– 136 deaths (3.9% of total)– One death per 29,000,000 km cycled

Sources http://www.transtat.dft.gov.uk/tables/tsgb02/4/download/41502.xls and http://www.transtat.dft.gov.uk/tables/tsgb02/4/download/40702.xls

Mortality: CHD v. traffic injury

(UK 2001)124000

107 750 27 98 1665 7620

20000

40000

60000

80000

100000

120000

140000

CHD Childpedestrians

Adultpedestrians

Childcyclists

Adultcyclists

Car driversand

passengers

Other roadusers

Sources: http://www.dphpc.ox.ac.uk/bhfhprg/stats/2000/2002/mortality.html & http://www.transtat.dft.gov.uk/tables/tsgb02/4/download/41502.xls

0.00

0.20

0.40

0.60

0.80

1.00

<20 20-40 40-60 60-80 80-100 100-120 120-140

Minutes/day of cycling

Rel

ativ

e risk

of dea

th

Reduction in relative risk of death for cyclists cycling at 10mph 5 days a week

Source: Paffenbarger et al. Physical activity, all-cause mortality, and longevity of college alumni. N Engl J Med 1986;314:605-13

Risk of injury per million kilometres (EU data)

Age Drivers Cyclists

12-14 - 16.8

15-17 - 18.2

18-24 33.5 7.7

25-29 17.0 8.2

30-39 9.7 7.0

40-49 9.7 9.2

50-59 5.9 17.2

60-64 10.4 32.1

>64 39.9 79.1

Total 20.8 21.0

Source: Cycling: the way ahead for towns and cities. EU 1998

Health cost / benefit of cycling• At least 20:1 life years gained:lost• Costs of sedentary lifestyle much

harder to visualise than cycling death or injury - risk communication issues

• Cycling is safer than driving

Source: Hillman, M. Cycling and the Promotion of Health. Policy Studies 1993, 14, 49-58

Speed

• Injuries• Noise• Pollution• Land use

Speeds on non-urban roads• Cars

– On motorways and dual carriageways >50% exceed 70 mph

• HGVs– On dual carriageways 88%

exceed50 mph limit

2001 data - Source: http://www.transtat.dft.gov.uk/tables/2002/vsgb/vsgb.htm

Speeds on urban roads

• Cars– On 30mph roads

• 2/3 exceed 30 mph• 1/3 exceed 35 mph

• HGVs– On 30 mph roads

• 55% exceed 30mph

2001 data - Source: http://www.transtat.dft.gov.uk/tables/2002/vsgb/vsgb.htm

Access

• To health services (SEU report)• To employment• To goods and services• To friends and relatives

Communities

• Social networks• Community severance• Health inequalities

Health inequalities

• Children / Elderly / Poor / Marginalised

• SE gradients for car and bike ownership

• SE gradient for activity levels• Children in lowest SE group 5x more

likely to die as pedestrians than in highest

Sources: Abdalla I, Barker D, Raeside R. Road accident characteristics and socio-economic deprivation. Traff. Engin. Control 1997;38:672-6 andhttp://www.socialexclusionunit.gov.uk/transport/transport.htm

Environment

• Emissions• Greenhouse gases• Noise• Visual• Land take• Construction and maintenance• Energy

Transport and air pollution (GB data)

• 70% of CO emissions• 48% of all nitrogen oxide

emissions• 22% of particulates

Source: http://www.transtat.dft.gov.uk/tables/2002/tt/section8/section8.htm#8.6

Diesel and petrol engines

• Diesel produces NOx and particulates

• Petrol produces NOx, CO and VOCs

• Both produce carcinogens such as PAH, benzene and 1,3-butadiene

• Catalysts don’t help much for short journeys (ie most journeys in urban areas) as they need to warm up to work

Source: http://www.doh.gov.uk/comeap/statementsreports/diesel.htm

Mortality due to air pollution• Over 8,000 deaths/year from PM10

• 3,500 deaths from SO2

• Others from CO and NOx

Sources: http://www.doh.gov.uk/comeap/statementsreports/airpol7.htm and http://www.doh.gov.uk/comeap/statementsreports/transport.htm

Don’t forget other modes

• Air• Rail• Sea• Inland waterways• Freight – especially by road and air

Aviation

• Climate change• Air pollution• Noise• Surface access• Inequalities• Communicable diseases and wider health

protection• Global public health issues

Road freight

• 576 killed in crashes involving a heavy goods vehicle in 1998

• 60 were occupants of the HGV• 20% of fatalities were cyclists or

pedestrians

http://www.transtat.dft.gov.uk/facts/accident/hgv/hgv98.htm

Commuting mode by Government Office Region, 2001

0

10

20

30

40

50

60

70

80

90

100

SouthEast

WestMidlands

East ofEngland

EastMidlands

SouthWest

NorthWest

Yorkshireand theHumber

NorthEast

London

Per

cent

age

Walk

Bicycle

Rail

Bus, coach

Motorcycle

Car, van, minibus

Source: http://www.transtat.dft.gov.uk/tables/tsgb02/1/download/10702.xls

Regional expenditure on roads by Government Office Region

-

100.0

200.0

300.0

400.0

500.0

600.0

700.0

800.0

SouthEast

NorthWest

London WestMidlands

Yorkshireand theHumber

Eastern SouthWest

EastMidlands

NorthEast

£ m

illions

Local Roads

Motorways and trunk roads

Source: http://www.transtat.dft.gov.uk/tables/tsgb02/1/download/11902.xls

Role of the NHS

• Service provider• Employer• Consumer• Citizen

Healthy Travel Plans

• Requirement of the NHS Environmental Strategy

• Requirement of the DH Controls Assurance Risk Management process

• Requirement of the NSF for CHD

Benefits to employers

• Healthier employees• Fitter and more productive

workforce• Less demand for car parking• Sets a good example• Achieves policy requirements• Increases efficiency

Benefits to individuals

• Get healthier• Feel healthier• Send healthy message• Save money

Benefits to public health

• Healthier population• Reduced inequalities• Fewer injuries• Social and community benefits• Environmental benefits

What can we in public health do?• Awareness• Knowledge• Skills• Partnership• Action

Conclusions

• Transport is a health issue• Personal, social and environmental

costs of motorised transport• Health, social and environmental

benefits of active transport• Role for public health in

partnership with colleagues in other sectors