Transcript Transport and health Lessons from integrating health into transport strategies Carlos Dora

Transport and health
Lessons from integrating health into
transport strategies
Carlos Dora
World Health Organization
Geneva
Many health impacts from transport:
NOISE
INJURIES
PHYSICAL
INACTIVITY
AIR
POLLUTION
PSYCHOSOCIAL
EFFECTS
e.g. Air Pollution leads to heart and
lung disease and premature deaths

And to increases in hospital
admissions, and asthma attacks

To loss of millions of working days

Children living near busy roads
with heavy/diesel vehicle traffic
have higher risks of respiratory
problems.

No safe level of AP (Particulates)

Every 10 µg/m3 decrease in
PM2,5 leads to 3,4% decrease in
mortality

Health impacts are larger in lower
socioeconomic groups
(cumulative exposures)
e.g. 60% of world population does very
little physical activity
A = inactive
B = active
C = trained
Health
Benefits
A
B
C
low
high
Physical activity level
Dose-response physical activity and
health, in B Martin et al, 2004
Greater health
benefits among
least active
30 minutes a day of Physical Activity
is enough to reduce:

By 50 % the risk of developing
coronary hearth disease,

By 50% the risk of developing noninsulin-dependent diabetes and
obesity.

By 30 % the risk of developing
hypertension.

The risk of colon /breast cancer (e.g.
Shanghai 50% reduction in colon
cancer).

Helping to maintain bone mass and
protecting against osteoporosis.
e.g. Traffic Deaths: 1,2 million/year
Traffic Injuries over 40 million/year
Share by age groups
0-4
5-14
15-29
30-44
45-59
60+
0%
10%
male female
Source: Peden et al (2004)
20%
30%
40%
Traffic linked to neighbourhood social support
Busy streets are less convivial, more anonymous
A large proportion of the Global Burden of Disease is
attributed to urban transport
Percent of total burden
(within region)
15%
-
5% -
1% -
Underweight
Unsafe sex
Tobacco
Alcohol
Overweight
Water, sanitation and hygiene (5.5%)
Indoor air (3.7 %)
Zinc deficiency
Transport (3.3%) Physical
inactivity
Tobacco
Alcohol
Occupational
Occupational risks
Overweight
injuries
Unsafe sex
Ambient
AmbientLead Climate
Water, sanitation and
air
air
change
Lead
hygiene
Developing
countries
(high mortality)
Developed
countries
Traffic policies may have many benefits to
health and environment – Scarce
documentation!
London congestion charge

Traffic delays inside the charging zone average 30%
lower than before

Pedal cycle movements have
increased by about 20 %

Bus and coach movements have increased by over 20%
Van and lorry movements have reduced by about 10 %
Powered two-wheeler movements have increased by
10-15%



8% reduction in personal injury
accidents in the charging zone
during charging hours
compared to the same period
last year.

6% fewer pedestrians were involved in accidents,
(Based on the first 6 months of provisional data since
charging began)
Source: Congestion Charging: Update on scheme impacts and operations. February 2004
(www.tfl.gov.uk/tfl/downloads/pdf/congestion-charging/cc-12monthson.pdf)
The congestion charge is a £5 daily charge for driving or parking a
vehicle on public roads within the congestion charging zone
between 07:00 and 18:30, Monday to Friday, excluding
weekends and public holidays.

Bogota: urban space to public transport and
pedestrians – reduction in traffic injuries and air
pollution ? political success ?
before...
... after
Narrow solutions: limited results.
e.g. Continuing Traffic Growth Has Cancelled
Out Pollution Savings from Cleaner and More
Efficient Vehicles
 Cars
are becoming
heavier and more
powerful.
 Trips are becoming
increasingly long.
 Total kilometers
traveled by road
continues to grow
EC: Transport in Figures, 2000
Integrated transport policies have great
health gain potential  Transport
Demand
Management via:
– Economic measures
– Changes in individual
travel behaviours
– Compact land use to
reduce need to travel
 Maintain
high walking
and cycling
 Support public
transport
Filling the information gap: Develop tools that help
economist to include health in their analyses
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 profitable
investment
100%
16
90%
14
80%
12
70%
10
60%
Other Benefits
50%
Health
40%
8
Net
benefit/cost
ratio
6
30%
4
20%
10%
2
0%
0
Hokksund
Hamar
Trondheim
Hokksund
Hamar
Trondheim
Developing tools for the assessment of
health impacts from transport:
e.g. WHO HEARTS model
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.
SAMU : agent-based modelling of
pedestrians/cars interactions and resulting
accidents
Source : Banos, Godara, Lassarre, 2005
Contributing 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
Resolution
adopted on 28 February
2002
Stronger integration of health
considerations into transport
policies, including by carrying
out health impact assessment
of major transport projects.”
Challenge: using the
lessons/experience elsewhere:
105 million people moved to cities in
China between 2000 and 2005
 Advice
on national & urban Healthy Transport
Policies /Strategies
 Difficult to communicate the benefits of bicycles!
 Need insight into communication of local healthy
transport solutions
Co-benefits of climate change adaptation
strategies and policies
 Research
plans
with countries and cities – preparedness
WHO will begin at home: healthy transport
to work for staff health and climate change
reduction
 Transport
to work is a major source of health & wellbeing
risks, but also offers opportunities for healthy activity
 Survey identified lack of infrastructure for cycling and public
transport for over half the staff who want to adopt those
modes
 Interest from nearby International agencies (UN, ILO, Red
Cross etc.)
More Healthy Transport among
WHO staff can:
1.
Enhance staff wellbeing via:
•
•
•
•
2.
3.
Injury prevention
Air pollution reductions
Improved Physical activity
Improved Mental health
Improve the carbon footprint from WHO HQ staff travel to
work
Give the good example on transport & health to health
agencies (ministries, clinics, hospitals) and other
international agencies
On balance the Benefits of Cycling &
Walking are much greater than Risks from
injuries
 But
a successful strategy to promote C&W has to
include injury prevention measures
 Effective preventive measures are available
Step 1: Understanding staff needs
and feasible Sustainable
Transport alternatives for HQ




Describe staff commuting patterns & barriers to sustainable
transport and needs (staff survey).
Identify incentives for, cycling, car pooling, and use of
public transport.
Identify ways to promote equity in parking at work, with
special attention for those with special needs (area of
residence, need to drop children at school, physical
disability…)
Agree ways to monitor the impacts of the ST intervention
(through staff's mode of transport, through medical
services etc.) and readjust it as needed.
Step 2: Develop and disseminate
Information & Advocacy materials on:
1. Accessible sustainable transport alternatives for WHO HQ staff
2. The benefits of sustainable transportation for personal health,
(briefings done in collaboration with injury prevention, physical
activity, air pollution units)
3. The role of health systems can play in achieving health through
promotion of sustainable transport modes (eg. hospital transport
programmes)
Examples of sustainable
transportation alternatives
Sustainable transportation alternatives
Public
transport
Cycling
Cycles lanes
&
maps
Repairing
your bike
Building
facilities
(showers,
changing
rooms,
parking)
Reduced
prices for
monthly
subscriptions
Car Pooling
Bus & train
network
info
(timetables,
connections)
Real
time info
system
Step 3: Promotion and Events


World Health Day – 7 April 2008 at WHO HQ
Short-term events at WHO HQ promoting ST staff:
–
–
–


on cycling and walking
on public transport
on connection with neighbouring France
Engage a few senior staff as role models on ST to work
Event with senior staff and Geneva/Swiss authorities on
health and transport
Good practice examples of sustainable
transport practices in the workplace exist,
right here in Geneva!
– Rolex SA (Plan-les-Ouates): car sharing, shuttle services
– Geneva International Airport: 45% of eco-mobility in 2020
– Télévision Suisse Romande: development and promotion of soft mobility
between the different TSR's sites (cycling path,…)
Source: Mobilidée
There are also good practice examples of
ST within health sector institutions
Switzerland: with Swiss Bicycle Advocacy Association
District
hospital of Lucerne (KSL): 3500 staff. Created a working group of 6
people, in charge of promoting and following up the use of the bike.
– District hospital of Schaffhouse (KSSH): 850 staff. Parking space problems, staff using the
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,
including costs of eventual taxi if needed.
Source: igvelo
Nottingham City Hospital:
– Provided bicycle locks, cycle racks, bicycle leasing scheme, ensuring public transport
connections.
Detailed example: Grenoble STMicroelectronic
– Problems
• 60% staff live in the surroundings
• Traffic jam on the site at peak hours
– Measures
40% energy used on the site
is for staff transportation
• 80% of single car use
1. 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,
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
services, free anti-pollution control)
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
the sites)
 In 4 years, increase from 20% to 51% of alternative transportation
60%
51%
50%
45%
40%
40%
35%
30%
20%
2000
20%
2001
2002
2003
2004
2005