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