transport and health. determinants of health source: dahlgren and whitehead

Transport and Health

Determinants of health

Source: Dahlgren and Whitehead

The links

• Physical activity• Road injuries• Air pollution• Access

• Inequalities

Physical activity

• Physical activity not only contributes to wellbeing, but is also essential for good health (Chief Medical Officer)

• Adults who are physically active have 20–30% reduced risk of premature death and up to 50% reduced risk of: • Coronary heart disease • Stroke• Diabetes• Some cancers

Physical activity

• Achieve a minimum of 30 minutes moderate activity on at least five days of the week

• Moderate activity includes brisk walking, cycling• 65% of men and 76% of women don’t get enough physical

activity• Around 58% of trips by car or van are under five miles (30

minutes by bike)• Nearly 25% are under two miles (30 minutes brisk walk).

The ‘need’ – cycling 1952 - 2005

Road injuries

• Around 3,500 people are killed and 250,000 injured in Great Britain annually on the roads.

Air pollution

• Air pollution from particulate matter is linked to 8,100 premature deaths annually, and sulphur dioxide to 3,500.

Access

• Access to work, education, healthcare and food is more difficult for those without a car.

Access

Work: two out of five jobseekers say lack of transport is a barrier to getting a job

Learning: nearly half of 16–18-year-old students say they find their transport costs hard to meet

Health: over a 12 month period, 1.4 million people miss, turn down or choose not to seek medical help because of transport problems

Food shopping: 16% of people without cars find access to supermarkets difficult, compared with 6% of people with car

Inequalities

• Exposure to air pollution is greater for those living in areas of deprivation.

• Children from social class V are five times more likely than those from social class I to be killed as pedestrians.

NHS action

• Introducing patient and staff travel plans • Implementing physical activity strategies in conjunction

with cycling/walking strategies • Providing resources for local transport programmes • Contributing to local accessibility planning and improving

transport access to NHS sites • Assessing the health impact of local transport plans.

NICE guidance

• Physical activity and the environment• Road injuries in children aged under 15

Physical activity and the environment

To produce guidance for the Highways Agency, local authorities, the NHS, the independent sector and others, on the promotion and creation of built or natural physical environments that are conducive to and support increased

levels of physical activity among local communities, to meet the physical activity recommendations of the Chief

Medical Officer of England

Process

• The PDG• The evidence• Developing draft recommendations• Consulting on the draft recommendations• The final guidance

• The future

• Role of stakeholders

The evidence

• Five reviews of interventions: • Transport•Built environment•Urban planning•Natural environment• Policy

The evidence – some difficulties

• Measurement issues• Public health ‘ideal’• Interventions for different priorities

The evidence

Total of over 94,000 hits – plus various websites trawled…

• Plus review level correlates – environment and physical activity

• Plus economic reviews and modelling

The guidance

• Recommendations

• Considerations

• Research recommendations

• Implementation

Considerations

• The aim is to help people to incorporate activity into their daily lives

• By considering evidence about changes that may support this

• In the past, priority often given to sedentary transport and activities

• Many organisations own, manage and influence land used by public

Considerations

• Promoting PA needs several factors and environmental change is only one

• But can’t get people to be active when the environment is one which discourages them

Considerations – economics issues

• Differences between e.g. transport economics and health economics

• How to apportion costs of an intervention to health outcomes

• Extra costs of interventions

Final recommendations

• Strategies, policies and plans (1)• Transport (2)• Public open space (1)• Buildings (2)• Schools (1)

Recommendation 1 Strategies, policies and plans

• Involve community and experts

• Ensure planning applications prioritise physical activity as part of daily life. Ensure local facilities are accessible on foot, bike etc

• Assess the likely impacts and make results publicly available

Recommendation 2 Transport

Ensure pedestrians and cyclists are given the highest priority when developing or maintaining streets and roads. (This includes people whose mobility is impaired.)

Reproduced by kind permission of J Bewley/Sustrans

Recommendation 2 (continued) Transport

Use one or more of the following methods:

• re-allocate road space to support physically active modes of transport

• restrict motor vehicle access• introduce road-user charging schemes• introduce traffic-calming schemes to restrict vehicle

speeds• create safe routes to schools

Recommendation 3 Transport

Plan and provide a comprehensive network of routes for walking and cycling

Offering convenient, safe and attractive access to workplaces, homes, schools and other public facilities. (The latter includes shops, play and green areas and social destinations.)

Built and maintained to a high standard.

Road injuries in children aged under 15• Just starting…