transport%20and%20health%20resources%20 %20department%20of%20health

Transport and Health ResourceDelivering Healthy Local Transport Plans

DH InfoRmaTIon ReaDeR BoX

Policy HR/Workforce Management Planning Clinical

Estates Commissioning IM&T Finance SocialCare/PartnershipWorking

Document purpose Forinformation

Gateway reference 15079

Title TransportandHealthResource:DeliveringHealthyLocal TransportPlans

author DHandDfT

Publication date 20January2011

Target audience PCTCEs,SHACEs,DirectorsofPH,LocalAuthority CEs,DirectorsofAdultSSs,PCTChairs,NHSTrust BoardChairs

Circulation list

Description Theresourceprovidestransportandhealthevidence andtoolstosupportthedevelopmentofLocalTranport Plansround3andtheirassessmentthroughthe StrategicEnvironmentalAssessmentprocess.

Cross reference DraftGuidanceonHealthinStrategicEnvironmental Assessment2007

Superseded documents

action required N/A

Timing N/A

Contact details PublicHealthStrategyandSocialMarketing Room580DSkiptonHouse 80LondonRoad SE15LH 02079723762

for recipient use

Transport and Health ResourceDelivering Healthy Local Transport Plans

January 2011

Written by: Checked by: authorised by:

Name: AndrewBuroni LauraJones DanielSmyth DanielSmyth

JobTitle: Senior Consultant

Senior Consultant

SeniorDirector SeniorDirector

Date:

Signature:

Revision number

Date of Issue Status Reason for Revision

1 09/03/10 Draft1 TechnicalReview

2 15/03/10 Draft2 TechnicalReview

3 24/03/10 Draft3 DoH&DfTReview

4 31/03/10 Draft4 DoHReview

5 6/05/10 Draft5 CLGcomments

6 02/06/10 Final FinalCLGandDoH comments

RPS Planning & Development Ltd 6-7LoversWalk Brighton EastSussex BN16AH

Tel 01273546800 fax 01273546801 [email protected]

ThepreparationofthisreportbyRPShasbeenundertakenwithinthetermsofthe Briefusingallreasonableskillandcare.RPSacceptsnoresponsibilityfordata providedbyotherbodiesandnolegalliabilityarisingfromtheusebyother personsofdataoropinionscontainedinthisreport.

foreword

TheTransportandHealthresourcewasjointlycommissionedbytheDepartment ofHealth(DH)andDepartmentforTransport(DfT)tosupportthedevelopment anddeliveryofhealthconsciousLocalTransportPlansthroughoutEngland.

LocalTransportPlans(LTPs)arerequiredtobeassessedthroughStrategic EnvironmentalAssessment(SEA)(EuropeanDirective2001/42/EC)asanintegral partofdeveloping,appraisingandlater,deliveringLTPs.Addressinghumanhealth isakeyrequirementoftheSEAdirective,andhealthimpactsarealsocoveredin thestatutorydutytoassessfortheImpactonEquality,whichwillneedtobe carriedoutforallLTPs.

Thisresourceisforinformationandrelatestoexistingpolicy.Itisintendedforuse byTransportPlannersfordevelopingtheirplans,PublicHealthDepartmentsthat canadviseonlocalhealthissues,andSEApractitionersassessingtheplanand informingitspreparation.Itcontainseasilyaccessibleevidenceonthefullrangeof thehealthimpactsoftransportmodessothattheinformationcanbeincorporated intotheevidencebaseforlocaltransportplansandtheirassessmenttoensure healthissuesareeffectivelycoveredthroughouttheprocess.

Theresource:

suggestshowandwhentousethefourkeyelementsoftheresource (TransportandHealthScreeningTool,summaryoftheTransportandhealth evidencebase,suggestedassessmentmethodsandtheTransportandHealth BibliographyMatrix)inChapter1;

showshowthedifferentelementsinformthefivestagesinSEAinChapter2;

providesaquickreferencescreeningtoollinkinghealthoutcomeswith transportmodeChapter3;

givesasummaryofthetransportandhealthevidenceinChapter4with supplementaryinformationinAppendixA;

suggestsapproachestousingSEAandhealthimpactassessment(HIA)in Chapter5;

providesinformationonkeyhealthpathwaysandhowtheycanbeaddressed intransportplanninginChapter6;

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TransportandHealthResource

suggestskeyperformanceindicatorsformonitoringhumanhealthimpactsin Chapter7;and

setsoutsuggestedtransportmitigationandcommunitysupportinitiativesin Chapter8.

The benefits of more health conscious transport planning include:

measurestoimprovehealthinvariablyhelpreducecongestion,improveair quality;increaseaccessibility;reduceillnessrelatedabsenteeismatwork;and reduceriskofinjury;

lowlevelsofphysicalactivitythroughcaruseinplaceofactivetravelmodes contributestotheburdenofchronicdiseasethroughhigherlevelsofheart disease,stroke,cancers,diabetesandotherillnessesincludingthoseresulting fromobesity;

walkingandcyclingaretheeasiestwaysformostpeopletoincreasetheir physicalactivitylevels.Useofpublictransportcanalsoincreasephysical activityduetouseofactivetraveltoreachpublictransportinterchanges;

adultswhocycleregularlyhavealongerlifeexpectancythanthosewhodont;

atschoolageactivetravelisoneofthemaincontributorstoachievingthe ChiefMedicalOfficersrecommendationsforphysicalactivityandmaintaining ahealthyweight;

reducingmotortrafficspeedsinurbanareastolessthan30mphdirectly reducescasualtiesandincreasesopportunitiesforactivetravel;and

Infrastructuremeasurestobenefittheactivetravelmodesresultinanaverage ofa13:1BenefittoCostRatio(1).

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Contents

1. How and when to use the Transport and Health Resource ........................... 5

2. The Strategic environmental assessment Process and Interface with the

Transport and Health Resource ..................................................................... 7

3. Transport and Health Screening Tool ......................................................... 14

4. Transport and Health evidence Base ........................................................... 19TransportModes........................................................................................ 19

Walking................................................................................................. 19 Cycling.................................................................................................. 20 PublicTransport..................................................................................... 22 PrivateTransport.................................................................................... 23 FreightTransport.................................................................................... 24 CivilAviation.......................................................................................... 24

Transportopportunitiesthatinfluencehealth............................................. 25 HealthInequalitiesandTransport............................................................ 26 Lifestyle................................................................................................. 27 Access,AccessibilityandCommunitySeverance...................................... 28 EconomicHealth..................................................................................... 29 Safety.................................................................................................... 30 PhysicalStrainandInjury........................................................................ 30 Crime..................................................................................................... 31 CongestionandStress............................................................................ 31 AirQuality............................................................................................. 32 Noise..................................................................................................... 32 TransportBehaviourandEnvironmentalandHealthConsequence.......... 34

5. Suggested Strategic Level assessment methods ........................................ 36StrategicEnvironmentalAssessment............................................................ 36 HealthImpactAssessment......................................................................... 37

6. assessment by Human Health effects ........................................................ 41DemographyandPeople............................................................................. 41 Lifestyle(physicalactivityandinactivity)..................................................... 41 Access,AccessibilityandCommunitySeverance.......................................... 44

EconomicHealth..................................................................................... 45 Crime...................................................................................................... 46 RiskofbeingKilledorSeriouslyInjured(KSI)fromCollision.................... 46

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AirQuality.................................................................................................. 48 ParticulateMatter................................................................................... 48 NitrogenDioxide.................................................................................... 50 SulphurDioxide...................................................................................... 51 Ozone.................................................................................................... 52 Evaluationofhealtheffectsofairquality................................................ 53

Noise.......................................................................................................... 55 Evaluationofenviromentalnoise............................................................ 56

Hypertension.............................................................................................. 57 Annoyance............................................................................................. 60 SleepDisturbance................................................................................... 61 MentalHealthEffects............................................................................. 61 ChildrensLearning................................................................................. 62

7. Delivering Local Transport Plans: Key Performance Indicators.................... 63MonitoringProgrammeandKeyPerformanceIndicators............................ 63

8. Suggested Transport mitigation and Community Support Initiatives ......... 67TransportMode.......................................................................................... 67

ActiveTransport...................................................................................... 67

References........................................................................................................... 72

Tables and appendices

Tables

Table 2.1: LTP, Sea Interface with the Transport and Health.................................. 9

Table 5.1: Recommended HIa appraisal format and Criteria .............................. 40

Table 6.1: Guideline Values for Community noise in Specific environments....... 58

Table 6.2: Percentage of Highly annoyed People................................................ 61

Table 7.1: Suggested Health KPIs........................................................................ 64

appendices

appendix a: Supplementary Transport and Health evidence Base....................... 81

appendix B: Transport and Health Bibliography matrix .................................... 122

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1. How and when to use the Transport and Health Resource

1.1 Thisresourceisintendedtoaidintheinitialdevelopmentoftransport plans,supportandinformtheirassessmentthroughtheStrategic EnvironmentalAssessment(SEA)processandhelpdeliverLocalTransport Plan(LTP)strategicobjectivesinlinewiththeLTP3Guidance.Thissection establisheshowandwhentousetheresourcebyintroducingthekey content,anditsinterfacewiththeSEAprocess.

Transport and Health Screening Tool

1.2 TheTransportandHealthScreeningToolinSection3.1,isamatrix designedtostructureandrefinethedetailedliteraturereviewinforming thedevelopmentofthetransportandhealthevidencebase.Itprovidesa meansfortransportplanners,theirpartnersinotherLocalAuthority departmentsandSEApractitionerstorapidlyscreenthekeyhealth pathwaysandpotentialhealthoutcomesassociatedwithspecifictransport modes.ItcanbeappliedtoinformanumberoftasksinStageAofthe SEAprocess,including:

informingthescreeningandscopingofhumanhealthissuestobe addressedwithinSEA;

asameanstonavigatetoareasofinterestinthetransportandhealth evidencebase;and

asameanstoinformanddevelopalocalhumanhealthbaselinesection andmonitoringprogramme.

1.3 Thetransportandhealthscreeningtoolcanbefurtherappliedtoinform StagesD&EoftheSEAprocess,byhighlightingparticularlyvulnerable groupstoengagewithandthedevelopmentofanappropriatehealth monitoringprogramme.

Transport and Health evidence Base

1.4 TheTransportandHealthEvidenceBasehasbeencompiledfromawide rangeofsystematicreviewsontransportandhealthintheUK,withinthe specificcontextoftheLTP3Guidance.Giventherangeofhealthpathways associatedwithtransport,andtherequirementtofocusuponhealth protectionaswellashealthandwellbeing,thereviewwasfurther

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supplementedthroughasynthesisofavailableliteratureheldbythe DepartmentofHealthandtheDepartmentforTransport.

Chapter2,supportsstagesAandBoftheSEAprocessbyprovidinga concisediscussionastotheparticularhealthissuesandopportunities associatedwithtransportmodesandtheirdisproportionatedistribution withincommunitiesandvulnerablegroups.Supplementaryinformation isinAppendixA,andsupportsStagesC,DandEoftheSEAprocess. TransportplannersandpartnersfromthehealthsectorandSEA practitionerscanapplythetexttosupportthedevelopmentofspecific humanhealthsectionswithinSEAEnvironmentalReports,informthe assessmentoftransportoptionsandapplyitduringconsultationexercises toinformandaddresslocalhealthconcerns.

Recommended assessment methods

Chapter3presentsassessmentmethodsthatcanbeappliedatthe strategicleveltodeterminethedistribution,magnitude,likelihoodand significanceofpotentialhealthoutcomes.Thepurposeofthissectionis toinformstageBoftheSEAprocessbyestablishingmethodsthatcanbe appliedtoinformtheassessmentoftransportoptions,andtosignpostto existingmethodsthatareinherentlydesignedtoaddresshumanhealth. AsdemonstratedinTable3.1,Chapter3providestransportplanners, publichealthspecialistsandSEApractitionerswithameanstomore effectivelydrawfrom,andwhereappropriatesupplement,assessment methods,offeringamoreconsistentandcosteffectiveapproachtohuman healthandequalityimpactassessmentonLTPs.Itisnothoweverintended tosuggestthatquantitativepredictionscanbemadeofthehealtheffects ofplans.

Transport and Health Bibliography matrix

1.5 Thematrixliststheevidencebibliographyusedinthisdocumentand indicatesthehealthimpactseachonecoversbythemodeoftransport. Thisisaquickmethodofsignpostingkeyhealthliteraturebytransport modeandsupportstagesA,B,CandDoftheSEAprocess.andwillalsoaid injustifyinganddefendingstrategicdecision-making.

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2. The Strategic environmental assessment Process and Interface with the Transport and Health Resource

2.1 TheEuropeanDirectiveonStrategicEnvironmentalAssessment(SEA) createsaformalprocessforpredictingandevaluatingtheenvironmental effectsofplansorprogrammes(2).

2.2 TheformerOfficeoftheDeputyPrimeMinister,nowtheDepartmentfor CommunitiesandLocalGovernment(CLG),publishedthePractical Guide to the Strategic Environmental Assessment Directive 2005 whichshouldbe referredtoforinformationonmeetingtherequirementsoftheSEA Directive:http://www.communities.gov.uk/publications/ planningandbuilding/practicalguidesea

2.3 TheSEADirectiverequiresconsiderationofthelikelysignificanteffectsofa planorprogrammeonhumanhealth.ResponsibleAuthoritiesmayfindit helpfultodrawonthemethodsofhealthimpactassessment(HIA)when consideringhowaplanorprogrammemightaffectpeopleshealth,and howpositiveeffectscouldbeenhancedandnegativeeffectsreduced.

Article 5 and Annex I of European Directive 2001/42/EC

This specifies that an Environmental Report should be written that includes an assessment of the likely significant effects on the environment, including on issues such as biodiversity, population, human health,fauna, flora, soil, water, air, climatic factors, material assets, cultural heritage including architectural and archaeological heritage, landscape and the interrelationship between the above factors.

2.4 TheDepartmentofHealthrecommendsthatthedefinitionofhealthused istheoneusedbytheWorldHealthOrganization(WHO).

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity(3)

2.5 ThiscoversthefullrangeofpotentialhealthimpactsasshowninFigure 2.1.Itappliestoabroadenvironmentalandsocio-economicmodelof healththatcanbeappliedtoassesshowplansandprogrammeswill influencekeydeterminantsofhealthandwellbeing.

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2.6 ThoughconsiderationofhealthwithinanSEAofferstheopportunityto considerissuesofhealthandtransportmoreformally,itisnottheonly mechanismforbringingaboutgreaterhealthgainassociatedwithtransport plans.Ratheritshouldbeviewedasoneofrangeoftools,includingHIA, thatcansupporteffectivejointworkingacrosstransportandhealthsectors onabroaderandongoingbasis.

2.7 ForfurtherexplanationofthecoverageofhumanhealthinSEAreferto theDepartmentofHealthsDraft Guidance on Health in SEA2007:

http://www.dh.gov.uk/en/Consultations/Closedconsultations/DH_073261

figure 21 Population Health and the environment

Macroeconomy,politics

globalforces

Otherneighbourhoods

otherregions Thedeterminantsof healthandwellbeing inourneighbourhoods

Clim

atechange

GLOBAL ECOSYSTEM

Biodiversity

Air, water, land

NaturalHabitats

NATURAL

ENVIRONMENT

Buildings, places

BUILTENVIRONMENT

Streets, routesWorking, shopping,mov

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ACTIVITIES

Living, playing, learningWealth

creation

LOCAL E

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Markets

Socialcapital

COMMUNITY

Netw

orks Diet,physical a

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IFESTYLE work/lifebalance

PEOPLE

Age,sex& hereditary factors

Source:HughBartonandMarcusGrant(2006),drawingonWhiteheadandDahlgren (1991)andBarton(2005).UnitedKingdomPublicHealthAssociation(UKPHA)Strategic InterestGroupandtheWHOHealthyCitiesProgramme.

2.8 Table2.1presentsthefivekeystagesoftheSEAprocess,assetoutinthe PracticalGuide,andhowandwhenthisresourcecanbeappliedtosupport boththeLTPandSEAprocess.

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TheStrategicEnvironmentalA

ssessmentProcessandInterfacew

iththeTransportandHealthR

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Table 2.1: LTP, Sea Interface with the Transport and Health

LTP Process Sea Process Interface with Transport and Health Resource

Stages Task Tool and Location within Document Description

Chapter 3 Chapter 4 and appendix a

Chapter 5 appendix B

Transport and Health Screening

Tool




Determinethe scopeofthe LTP(strategy and Implementation Plan)clarifying goals; specifyingthe problemsor challengesthe authoritywants tosolve

StageA:Setting thecontextand objectives, establishingthe baselineand decidingonthe scope

Identifyingother relevantplans, programmesand environmental protection objectives

Byhighlightingthepotentialhealthpathwaysandoutcomes associatedwithspecifictransportmodes,itispossibletoaidinthe identificationofwiderplans,programmesandenvironmental objectivesthatmayfurtherinfluenceorcompoundhealthand inequality.

Collectbaseline information

Byprovidingasummaryoftheavailabletransportandhealth evidencebaseandcataloguingthekeyhealthpathwaysandpotential healthoutcomesassociatedwithspecifictransportmodes,itis possibletoinformthedevelopmentofbespokeevidence,andthe developmentofmorefocusedandeffectivehealthbaseline consistentlythroughouttheUK.

Furthermore,knowingthespecificdatarequirementsforassessment methodsatanearlystagewill:

fostermoreeffectiveengagementwithrepresentativesfromhealth andhealthcareorganisations;

reduceunnecessaryrepetitionofeffortinthecollectionofbaseline statistics(bydesigningthehealthbaselinesectiontoinformthe assessmentstageandbetransferabletothemonitoringstage);and

supportthedevelopmentofappropriatehealthindicators.

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Tool




Identify environmental problems

Byhighlightingthekeyhealthoutcomes(bothadverseandbeneficial) ofspecifictransportmodesandtheirpotentialunevendistribution withincommunities,willaidintheidentificationofissuesand opportunitiesatanearlystageofbespokeLTPs.

Theidentificationofvulnerablecommunitygroupsalsoprovidesa meanstofurtherrefineconsultationprogrammeswithlocal communities,vulnerablegroupsandkeyhealthstakeholders.

Furthermore,theidentificationofpotentialmitigationandcommunity supportinitiativeswillfurtheraidinestablishingthedistribution, likelihoodandsignificanceofsuchhealthoutcomesatanearlystage

DevelopingSEA objectives

Byestablishingthepotentialhealthoutcomes(bothadverseand beneficial)associatedwithspecifictransportmodes,andthemethods availabletoassessthem,itisnotonlypossibletoinformthe developmentofmorehealthfocusedSEAobjectives,butalsoindicate astohowthebroaderSEAobjectivesareimplicitlygearedtoaddress health.

Consultingon thescopeofSEA

Byestablishingthekeyhealthpathwaysassociatedwithaspecific transportmode,andhowthosepathwayscanbeunevenlydistributed throughoutapopulation,providesameanstotargetengagement programmesmoreeffectively.

Furthermore,theapplicationofthetransportandhealthevidence basewill:

facilitatemoreinformeddiscussionwithlocalcommunitiesandkey healthstakeholders;

highlighthowcommunityhealthhasbeenanimplicitconsideration fromtheonsetoftheproject;and

provideameanstoaddresscommunityhealthconcernsrapidly, robustlyandwithconfidence.

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esource





Transport Transport Recommended Transport and Health and Health assessment and Health Screening evidence methods Bibliography

Tool Base matrix

Generating optionsforthe strategyand implementation plantoresolve these challenges; appraisingthe optionsand predictingtheir effects

Selecting preferred optionsforthe strategyand implementation planand

StageB: Developingand refining alternativesand assessingeffects

Testingtheplan orprogramme objectivesagainst theSEA objectives

Theevidencebaseandsupportingtoolsprovideabasistointegrating healthandequalityimpactassessmentintoplannedSEAworkstreams consistentlythroughouttheUK.

Knowledgeofthepotentialhealthoutcomesofaspecifictransport mode,andhowtoassessthemcanbeappliedto:

supportanditerativelyassessthepotentialhealthinfluenceof transportoptions;

informandsupportthejustificationfortheappraisalofmultiple options;

mitigatepotentialrisks,andsupportthedeliveryoftransport objectivesthroughcommunitysupport;and

indicatehowenvironmentalmonitoringandindicatorsaregeared towardstheprotectionofhealth,andrationalisethedevelopment ofappropriatehealthspecificKPI.

Developing strategic alternatives

Predictingthe effectsofthe planor programme, including alternatives

Evaluatingthe effectsofthe

deciding planor Inaddition,sucharesourcecanalsobeappliedtodefiningmore priorities programme, specificandcosteffectivescopeofworkwhencommissioning

including technicalassessments. alternatives

Mitigating adverseeffects

Proposing measuresto monitorthe environmental effectsofthe planor programme implementation

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TransportandHealthR

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Tool




Productionof draftLTP

Consultation ondraftLTP

Productionof finalLTP

Adoptionof LTP

StageC: Preparingthe Environmental Report

The Environmental Reportisakey outputofthe SEA,presenting informationon theeffectsofthe draftplanor programme, issuedfor consultation

Theresourceprovidesafoundingplatformfordevelopingthehealth andequalityaspectsoftheEnvironmentalReport,itsconsultationand theassessmentofanyfurtherrevision.

StageD: Consultingon thedraftplanor programmeand the Environmental report

Consultingthe publicand Consultation Bodiesonthe draftplanor programmeand the Environmental report

Assessing significant changes

Makingdecisions andproviding information

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Tool




Reviewing implementation ofLTP

StageE: Monitoringthe significanteffects ofimplementing theplanor programmeon theenvironment

Developingaims andmethodsfor monitoring

Aspreviouslydiscussed,theresourceprovidesafoundingplatformfor developinganappropriatemonitoringprogrammeincluding appropriatehealthindicators,butalsoprovidesabasistosignposting howenvironmentalindicatorsareinherentlygearedtowardsthe protectionofhealth.

Respondingto adverseeffects

Source:TableModifiedfromAPracticalGuidetotheSEADirective(OfficeoftheDeputyPrimeMinister)andGuidanceonLocalTransportPlansfromthe DepartmentofTransport(AnnexF)




esource

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3. Transport and Health Screening Tool

3.1 Thetransportandhealthscreeningtoolprovides,transportplanners,health professionalsandSEApractitionerswitharapidmeansofidentifying potentialhealthpathwaysassociatedwithtransportmodes,informingboth theinitialstagesoftheLTPprocessandstagesAandBoftheSEAprocess assetoutinFigure2.1.

3.2 Touseit,selecttheappropriatetransportmodecolumnandscrolldownto establishthekeyhealthopportunitiesandissuesassociatedwiththat transportmode.Thisinformationcanbeappliedasaprimarymeansto establishpotentialhumanhealthissuesoragapanalysistoensurehuman healthhasbeensufficientlyaddressed.Itcanalsobeappliedtonavigateto keyinformationwithinthesummaryofthetransportandhealthevidence baseinChapter4,orthemoredetailedevidencebasewithinAppendixA. Thescreeningtoolhelpsdevelopanevidencebasetailoredtothe developmentofLTPs.

3.3 Byindicatingthepotentialhealthoutcomesassociatedwithtransport modes(bothadverseandbeneficial),thescreeningtoolalsoprovides, transportplanners,healthprofessionalsandSEApractitionerswiththe meanstoinformthedevelopmentofappropriatehumanhealthstrategic objectives,appraisalcriteriaandselectappropriateassessmentmethods fromChapter5(RecommendedAssessmentMethods).

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figure 3.1: Transport and Health Screening Tool

TransportandHealthScreeningTool

Determinant of Health Health Pathway Potential Health outcome Transport mode

active Transport Private Transport Public Transport

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HeaLTH oPPoRTUnITIeS

Lifestyle Increasein physicalactivity

Cardiovascularbenefits(preventionandrecovery) Respiratorybenefits Obesitymanagement Diabetes(type2)minimisation&management Improvementinlifeexpectancy Reducedstresslevels(mentalhealth) Improvedemotionalwellbeing Strengthenbones/muscles/joints Reducedcancerprevalence(sometypes) Reducedcosttohealthcareandsociety

economic Health Reduced transportcosts andincreased disposable income

Relativelyimprovedsocio-economichealthandcoping skills

Improvedpedestrianisationofstreetsandincreased patronage/viabilityofcommunityresources,amenities andfacilitiesleadingtohealthyandmorevibrant communities

Supportinga Deliveringbothgoodsandcustomerstoservices, sustainableand vibranteconomy

amenitiesandresourcescriticaltomaintainingand promotingahealthyvibrantpopulation

Increased access to Improvedsocial Generallyimprovedsocial,mentalandphysicalhealth social networks and cohesionand destinations interaction

Crimeprevention Designoutcrimeandtheperceptionofcrimethrough improvedandmorefrequentuseofsurroundingareas/ communityfacilities 15

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Improvedurban environment

Generallyimprovedsocial,mentalandphysicalhealth

Improvedair quality

Improvedcardiovascularandrespiratoryhealth Reductionincardiovascularandrespiratoryhospital admissions Reductioninallcausemortalityrateandimprovedlife expectancy

Roadsafety Improvedroadsafetyandreductioninthenumberof killedandseriouslyinjured

Contributeto Potentialhealthbenefitatthelocal,nationalandglobal reducingtheUK level greenhousegas emissions Improvednoise environment

Reductioninannoyanceandassociatedstressand anxiety Reductioninsleepdisturbance Improvedmentalhealthandcognitivefunction

Reduced Improvedurbanenvironmentwithimplicationsfor congestion improvedaccessandaccessibility,reducedcommunity

severance,reducednoiseandairpollutionexposure withphysical,mentalandsocialhealthbenefits

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TransportandHealthScreeningTool



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HeaLTH ISSUeS

Lifestyle Reduced opportunityfor physicalactivity

Increasedcardiovasculardiseaseriskandprevalence

Increasedriskofoverweightandobesityprevalence IncreasedriskofDiabetes(type2)prevalence Generalreductioninstressmanagementandcoping skills Increasedriskofosteoporosisprevalenceandincreased riskandseverityfromslips,tripsandfallswithinthe olderpopulation Increasedriskofcancerprevalence(sometypes) Increaseinallcausemortalityandreductioninlife expectancy Increasedcosttohealthcareandsociety

Physicalstrain Riskofinjuryfromincreasedlevelsofphysicalactivity

Community severance

Reducedaccessandaccessibilitytosocialnetworks, amenitiesandfacilitieswithasubsequentimpactupon generalsocial,mentalandphysicalhealth

economic Health Costoftransport totheindividual

Relativereductioninsocio-economichealthandcoping skills

Localeconomy andviable localamenities, facilitiesand socialareas

Lessactivemodesoftransportreducethelevelof footfallwithincommunitiesandcanadverselyreduce theleveloflocalspendingthatinturnreducesthe viabilityoflocallevelservicesandamenities,with social,mentalandphysicalhealthimpacts.Thishasa tendencytoimpactuponspecificcommunitygroups inparticular(olderpeople,theinfirmandsocio-economicallydisadvantaged)withfeweralternatives

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environmental Issues Riskofcollision Riskofseriousandfatalinjuries Increased generationto vehicleemissions

Increasedriskandprevalenceofcardiovascularand respiratorydisease

Increaseincardiovascularandrespiratoryhospital admissions

Increaseinallcausemortalityrateandreducedlife expectancy

Noise&Vibration Increaseinannoyanceandassociatedstressand anxiety

Sleepdisturbance

Reducedmentalhealthcognitivefunction

Increased Congestion

Increasedcommuterstressandanxiety

Community Reducedaccesstosocialnetworks,amenitiesand Severance facilitieswithsubsequentimpactstosocial,mentaland

physicalhealth Personalcrime &security(and perception)

Reducedopportunitytoincreasecommunitypatronage ofstreetsandpreventopportunisticcrime/improve perceptionsofcrimeinfluencingsocialbehaviour, communityuseandultimatelyphysical,mentalasocial health.Ofparticularconcerntoolderpeopleandthe infirmwithfeweralternatives Poorperceptionsofsafetyatmodalinterchanges limitingtransportoptionsandinfluencingsocial,mental andphysicalhealth

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4. Transport and Health evidence Base

4.1 Thetransportandhealthevidencebasehasbeencompiledfollowinga systematicreviewofthehealtheffectsfromkeytransportmodes, supplementedthroughasynthesisofavailableliteratureheldbythe DepartmentofHealth,theDepartmentforTransport(DfT)andVoluntary SectorOrganisations(e.g.Sustrans).Thisisasummaryoftheavailable evidencebase,andissupportedbyamorein-depthdiscussionwithin AppendixA.

4.2 Nosinglemodeoftransportissolelygoodorsolelybadforhealth,and localstrategieshavetoprovideabalancetocatertocommunity,retailand developmentneedsinordertofacilitatehealthy,vibrant,sustainableand cohesivecommunities.Forthisreason,thischapterhasbeenstructuredto provideabriefdiscussionofthepotentialhealthissuesandopportunities associatedwiththeindividualtransportmodes(andtheirpotential disproportionateinfluenceuponvulnerablecommunitygroups),followed byafinaldiscussionastothepotentialhealthpathwaysandoutcomes.

Transport modes

Walking

4.3 Evidencesuggeststhatincreasinglevelsofwalkingasakeymodeoflocal transportnotonlypromotesgoodhealthandwellbeing,butalsoaidsin significantlyreducingtheprevalenceandtreatmentcostsforawiderange ofkeyphysicalhealthissuesintheUK.Includinglevelsofobesity,type2 diabetes,cardiovasculardisease,cancer,osteoporosisandwillultimately aidinreducingallcausemortality.Inaddition,walkingalsopromotessocial inclusion,canreducecrimeandperceptionsofcrime(morepeoplewalking andwatchingoverneighbourhoodscandiscourageopportunisticcrimeand anti-socialbehaviour),hasnodirectenvironmentalimpactandistypically opentoallageandsocio-economicgroups(4)(5).

4.4 Potentialhealthrisksarelargelyassociatedwiththepotentialriskof collisionwithroadvehicles.Despiteadeclineinchildmortalityfromroad trafficcollisions,evidencesuggeststhatchildreningeneralandchildren fromsomeminorityethnicbackgroundsandindisadvantagedareasin particular,aremoreatriskfromroadtrafficcollisions.

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4.5 Barrierstoimprovinglevelsofwalkingwithinapopulationarelargely environmentalandbehavioural.Environmentalbarriersmayinclude physicalbarriersreducingaccessandaccessibility,thequalityoftheurban environmentinfluencingtheneedordesiretowalkoveralternative options,andpedestriansafety.Thelocationanddesignofcommon destinationsegemploymentandeducationsites,retailparksorleisure centrescanmakepeoplefavourthecar.

4.6 Behaviouralbarriersaremorecomplex,varyingbetweenthecommuter type(i.e.officerun,schoolrunetc),agegroupsandrelativesocio-economicstatus,andmayinclude:

generalsedentarybehaviourandpoorknowledgeastothe convenience,economicandsocial,mentalandphysicalhealthbenefits ofwalking;

alackof,orperceivedlackofsupportinginfrastructure(e.g.public toilets,reststops,sheltersetc);

crimeandperceptionsofcrime;and

safetyandpoorperceptionsofsafety(bothfromroadvehiclecollisions andthequalityoftheurbanenvironment).

Communityengagementisthereforeimportanttogaininganappreciation oflocalcommunitycircumstance,andidentifyingandaddressingbarriers towalkingandassociatedhealthbenefituptakeduringthedevelopment andassessmentofbespoketransportplans.

Cycling

4.7 Similartowalking,evidencesuggeststhatencouragingamodalshift towardscyclingnotonlyoffsetsthehealthrisksfromothertransport modes,butagainpromotesgoodhealthandwellbeing,andaidsin significantlyreducingtheprevalenceandtreatmentcostsforawiderange ofkeyUKhealthissues.EconomicmodellingcommissionedbyCycling Englandhascalculatedtheeconomicvalueofcycling.Thisestimatedthata 20%increaseincyclingby2015wouldresultindecreasedmortality valuedat107million.PotentialsavingstotheNHSareestimatedat 52millionduetoreducedillness,withafurther87millionsavedby employersthroughreducingabsencesfromwork(6).Followingtheinitial cost,cyclingpresentsarelativelycheap,healthytransportmodewithno directenvironmentalimpactandistypicallyopentoarangeofcommuter types(officeworkers,schoolrunetc)andageandsocio-economicgroups.

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TransportandHealthEvidenceBase

4.8 Thekeyhealthrisksareagainlargelyassociatedwithariskofcollisionwith otherroadusers.Thetotalnumberofpedalcyclistskilledorseriously injuredhasrisenyearonyearsince2004,however,therateoffataland seriouscasualtiespermiletravelledhasnotchangedsignificantly, suggestingmuchofthisincreaseistheresultofincreasednumbersof cyclists.Thereissomeevidencethatincreasingthenumbersofcyclists decreasestheriskofcasualties,knownasthesafetyinnumbers hypothesis.Howeverthiseffectisunlikelytobe100%,soanyincreasein numbersincyclistsmaystillbeassociatedwithanincreasednumberof cyclingcasualties,thoughtheproportionofcyclistsaffectedwould decrease.Onestudyhassuggestedthatascyclingdoubles,theriskof accidentperkilometretravelledbycyclistsdecreasesby34%(7).Theprecise mechanismsassociatedwiththesafetyinnumberseffectisunclear, howeverthefollowingpossibilitieshavebeenproposed:

Greaterexpectationofotherroadusersthattheymayencountera cyclistandhencehavingvisualsearchstrategiestoactivelylookfor them;

Increasedtendencyforcardriverstohaveexperienceascyclistssuch thatthereismoreawarenessofpossiblecyclistvulnerability;and

Betterplanningofhighwayandsafetyinfrastructuretoprovidefor increasedlevelsofcycling(7).

4.9 Keybarrierstocyclingareassociatedwiththeperceptionofdanger, concernsaboutfitness,unrealisticassumptionsaboutrelativespeedofcar versuscyclejourneys,initialcost,convenience,thesecurestorageof bicycles(bothathomeanddestinations)andtheopportunityformodal interchangewithotherformsoftransportandperceptionsaboutsafety. Criticalmass,wherecyclingbecomesnormalisedmaybeamajorfactorin overcomingmanyofthesebarriers.

4.10 Unlikewalking,cyclingincursadditionalcoststotheindividualforthe bicycle,safetyandsecurityequipment(helmet,highvisibilityequipment andlocks)andclothing.Suchcostsarerelativetotheindividual,and primarilyaffectsthoseonlowerincomes.However,cycleownership generallyismuchhigherthancycleuse,soaffordabilityisnottheonly barriertoparticipation.

4.11 Cyclingrequirestheabilitytostorebicyclessafelyathomesandatthe desireddestination.Unfortunately,notallhomesareableorinthecase ofrentedaccommodationinparticular,allowedtostorebicyclesindoors

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(firesafety),andaswithdestinations,mayfurtherlackappropriatestorage facilitiesoutside.Poorstoragecanresultintheft,vandalismorpremature deteriorationofbicycles,limitingthelevelandviabilityofcyclingasa modeofdailytransport.Formanycyclists,thelackofsecurestorage facilitiesatdestinations,isakeybarrierlimitingthechoiceofcyclingover othertransportmodes.

4.12 Cyclingalsolendsitselfwelltoimprovedpublictransportmodal interchange,providingameanstooffsetroadvehicletripstotrainandbus stations.Incircumstanceswherebicyclescanalsobetransported,cycling canprovideadditionalinterchange,therebyfurtherpromotingamodal shifttocyclingandincurringadditionalhealthbenefits.However,barriers limitingsuchadditionalmodalinterchangeinclude:

alackofstoragefacilitiesonpublictransporttherebyremovingany opportunityforfurthermodalinterchange;

additionalcarriagecosts;and

abanonbicyclecarriageduringpeaktransporthours.

4.13 Suchbarrierscoupledwithalackofsecurestoragecansignificantlyreduce theconvenience,costeffectivenessandviabilityofcyclingasatransport mode.Addressingsuchbarrierswillsupporttheuptakeofcyclingasakey modeoftransportandforrecreationalpurposes.

Public Transport

4.14 ThevariouspublictransportmodesintheUKprovideacrucial,safeand overlappingtransportnetworkwithinbothurbanandruralareas,catering toawiderangeofcommuter,ageandsocio-economicgroupneeds.Public transporttypicallyencouragesenvironmentalandhealthconscious transportbehaviour,byreducingoverallvehiclemovementsandassociated healthrisks.Furthermore,thereistypicallyahigherleveloftransfer betweenpublictransportandmoreactiveformsoftransport,whereon average,walkingtoandfrompublictransportcancontributetowards66% oftherecommendeddailylevelofmoderatephysicalactivitynecessaryto promotegoodhealth(8)(9)(10).

4.15 Thekeyhealthissuesassociatedwithpublictransportaresimilartothatof privatevehicleuseandcanincludethegenerationoflocallevelemissions toair,noise,riskofcommunityseveranceandriskofaccidentandinjury.

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4.16 Thechoiceofpublictransportisrelativetotheindividualandvaries accordingtogeneralavailability,thecommuterneed,thedistancetobe travelled,speedandtosomeextenttheoverallconvenienceandqualityof thetrip(i.e.proximitytohomeanddestination)(11).Publictransportmay notalwaysproveaviable,costeffective,orconvenientoption,particularly inruralareasorforparticularcommuterrequirements(carriageof belongingsorgoods,linkingmultiplejourneyrequirementsetc).

4.17 Keybarrierstotheuptakeofpublictransportandassociatedhealth benefitscanvarywithinspecificageandsocio-economicgroups,andcan includeactualandperceivedconcernsofcomfort,speed,reliability, convenienceandtosomeextentcost.Althoughsomeformsofpublic transportmaybelessaccessibletosocio-economicallydisadvantaged groups(particularlyduringpeaktimes),theoverlappingnatureofpublic transporttypicallyprovidesalternatives,yetmayprovelessconvenient.

4.18 Evidencefurthersuggeststhataddressingbarrierstomodalinterchange betweenactiveandpublictransportmodesiscritical,wherebothmenand womenfromawiderangeofagegroupsindicateconcernsofsecurityand safetywhenwaitingattrainandbusstations.

4.19 Improvementstothequalityandsafetyofintermodalareas(busandtrain stations),informationsystems(realtimedisplayboards)andaddressing commonpoorperceptionsofpublictransportarethereforekeywhen planningandsupportingthedeliveryofeffectivetransportsystems.

Private Transport

4.20 Theownershipanduseofprivatevehicleshasbroughtenormousfreedom andconveniencetoawiderangeofsocio-economicgroupsandcommuter types.Suchconveniencehasenabledustakemorecontroloverourlives, providinggreateraccesstoamenities,facilities,housing,education, employment,recreationandsocialnetworkswhenwewantthem.

4.21 However,suchconveniencehasnotbeenwithoutcosts.Theproliferation ofprivatevehicleownership,andtheiruseoverdistancesthatcouldbe typicallytakenviamoreactiveformsoftransporthascontributedtowards amoresedentarylifestyleintheUK,whichevidencesuggestsislinkedto increasinglevelsofobesity,type2diabetes,cardiovasculardiseaseand cancer.GiventheincreasingageingpopulationintheUK,suchissuesare likelytocontinuetogrow,withsignificantimpactsonthequalityoflife andthecostoftreatmenttotheNHSandsociety.

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4.22 Privatevehicletripsarealsoamajorsourceofnoiseandairpollutionin urbanareas(anddisadvantagedcommunitiesinparticular),creatinga rangeofenvironmentalbarriersleadingtocommunityseveranceandarea keycontributortotheUKstotalgreenhousegasemissions.Therateof fatalandseriousroadtrafficcollisionsfromprivatevehiclescontinuesto decline.Howevercasualtyratesarenotevenlydistributed,withthoseaged between16and29yearsofagehavingthehighestratesofdeathor seriousinjury(12)

4.23 Suchconveniencehasfurtherinfluencedspatialplanning,whereownership anduseofprivatevehicleshasincreasedthedistanceswearepreparedto travelforeverydaytasks(i.e.outoftownshopping,employment,schools etc).Suchplanninghaspositivelyreinforcedtherequirementforprivate vehicleownership,withlong-termimplicationstothehealthandwellbeing ofcommunitiesthroughouttheUK.

4.24 However,thatisnottosayprivatevehicleownershipdoesnothavea placeinaneffectiveandsustainableLTPs,butthattheissuesmustbe managedtopreventriskandthewideningofinequalitywithin communities.Suchmanagementrequiresamorejoinedupapproachto spatialplanning,transportandhealth.

freight Transport

4.25 Freightprovidesacrucialcomponentintheconstructionanddeliveryof sustainableandvibrantcommunities,but,istypicallypoorlyperceivedby thegeneralpublicandassociatedwithriskofroadtrafficaccidents, emissions,congestionandcommunityseverance.Althoughmeasureshave beentakenattheGovernmentleveltoreducethenumberof environmentalrisksandimproveefficiency,reliabilityandcostoffreight transport.Furtherconsiderationoffreightinlocaltransportplanningcan beappliedtoreducecumulativeimpactswithothercommutertypes(i.e.to avoidemploymentandtheschoolrun)andvulnerablemodesoftransport (i.e.cyclistsandpedestrians).Suchconsiderationwillaidindeliveringmore environmentalandhealthconscioustransportbehaviour.

Civil aviation

4.26 CivilAviationhasbeenincludedwithintheevidencebasereviewasithasa numberoffactorswhichcaninfluenceresidentcommunitiesandadjoining modestransport.However,thestrategicframeworkforthedevelopment ofairportcapacityintheUnitedKingdomoverthenext30yearshasbeen setoutbytheAviationWhitePaper(13),takingastrategicviewofwhere

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airportdevelopmentmaybeneeded,balancingthebenefitsofnew airportsagainsttheimpactstheycanhave.Assuch,Localtransport authoritiesarenotrequiredtodeveloporperformSEAoncivilaviation projects.

Transport opportunities that influence health

4.27 Thekeyandrepeatingmessagefromtheavailableevidencebaseisthat transporthastheopportunitytosignificantlyinfluencethehealthand wellbeingofcommunitiesby:

improvingaccessandaccessibilitytoincome,employment,housing, education,services,amenities,facilitiesandsocialnetworkscrucialto maintainingahealthyvibrantandcohesivecommunity;

influencingthequalityoftheurbanenvironment(airquality,noise, severanceandriskofcollision)withsocial,mentalandphysicalhealth outcomes;and

influencinglifestyleandbehaviourwithopportunitiestoeitherprevent orcompoundmanyoftheUKskeyeconomic,social,mentaland physicalhealthissues(andassociatedhealthcarecosts).

4.28 ThedevelopmentofmorehealthconsciousLTPsisthereforenotonly criticaltofacilitatingdailytasksanddrivingsustainableemployment,retail andmanufacturingsectorsbutoverlapswiththedeliveryofLocal DevelopmentFramework(LDF)objectives,strategichealthcareplanning andcommunitysupportinitiatives.

4.29 Researchindicatesthatthekeyhealthpathwaysassociatedwiththe varioustransportmodesareoverlapping,varybetweenthecommutertype andresidentcommunitygroupsandthedistribution,magnitude,likelihood andsignificanceofpotentialhealthoutcomesarefurtherinfluencedby relativesocio-economicstatusandagestructure.Suchcomplexinteractions cannotbeaddressedthroughagenericevidencebase,howeveran appreciationofthefollowingkeyhealthpathways,andtheirinteraction withspecificcommunitygroupswillaidinthedevelopmentanddelivery ofbespoke,healthconsciousLTPs.

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4.30 Asdiscussedbelow,thekeyhealthpathwaysassociatedwithtransport include:

lifestyle;

access,accessibilityandcommunityseverance;

economichealth;

safety(riskoftrips,strainandcollision);

crime;

congestionandstress;

airquality;

noise.

Health Inequalities & Transport

4.31 FairSociety,HealthyLives,TheMarmotReview(14)ofhealthinequalities identifiedaseriesofrecommendationstotacklethehealthinequalitiesthat persistwithinEngland.TheReviewfoundthatthereremainsasocial gradientinhealththelowerapersonssocialposition,theworsehisor herhealth.

4.32 TheReviewaimedtoidentifythecausesofthecausesofthese inequalitiesandconcludedthathealthinequalitiesresultfromsocial inequalities.Asaresult,actiononhealthinequalitiesrequiresactionacross allthesocialdeterminantsofhealthandtransportwillhavearoletoplay.

4.33 Transportenablesaccesstowork,education,socialnetworksandservices thatcanimprovepeoplesopportunities.However,therelationshipbetween transportandhealtharemultiple,complexandsocio-economically patterned,forexamplethereisaclearsocialgradientinaccesstoworkand services,withgreaterfreedomtotravel,linkedtoincreasedcarownership, asincomeincreases.

4.34 Theimpactoftransportonhealthinequalitiesismostsignificantwhen lookingatdeathsfromroadinjuries.Childreninthe10%mostdeprived wardsinEnglandarefourtimesmorelikelytobehitbyacarthanchildren inthe10%leastdeprivedwards.

4.35 Thereviewrecommendsthattoreducethesteepnessofthesocialgradient inhealth,actionstotacklesocialinequalitiesmustbeuniversal,butwitha

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scaleandintensitythatisproportionatetothelevelofdisadvantage. Aconceptthereviewtermsproportionateuniversalism.Thereforethe Reviewrecommendsthatpoliciesseekingtoincreaseactivetravelshould considertheirimpactonhealthinequalities,andworktotarget communitiesprogressivelyacrossthesocialgradient.

4.36 Thereportsupportsamovetowardsanincreaseinactivetravelandpublic transportuse,bothasawayofdirectlyincreasinglevelsofphysicalactivity andinturnimprovinghealth,butalsobecauseofitsroleindeveloping moresustainablecommunities.

4.37 Inrecognitionoftransportsroleinimprovingaccess,anditsroleasakey factorinmakingcommunitiesmoresustainabletransportplannersandSEA practitionersmaywanttoengageplanning,housing,environmentaland healthsystemsintheLTPandSEAprocessinordertoaddressthesocial determinantsofhealtheffectively.

4.38 Thereviewconcludedthatimprovingactivetravelacrossthesocial gradientrequiresincentivestoincreaselevelsofactivetravelaswellas initiativestoimprovesafetyandencourageactivetravel.Interventions needtobothimproveroadsafetyandimproveparentalandpeer support(15).

4.39 Thereisalsoevidencethattherearepotentialhealthbenefitsandhealth inequalitybenefitsfromenablingincreaseduseforpublictransport.

4.40 TheReviewalsofoundevidencethatwhere20mphzoneshavebeen introducedinjurieshavedecreasedby40%withcyclistinjuriesfallingby 17%andpedestrianinjuriesbyathird.Thereviewconcludesthatif appropriatelytargetedsuchzonescouldhelpachievearelativereductionin inequalitiesinroadinjuriesanddeaths(16).

Lifestyle

4.41 Transportchoiceandbehaviourcansignificantlyinfluencelevelsofphysical activityorinactivity,withsubsequentlong-termconsequencesforphysical, mentalandsocialhealthandwellbeingthroughouttheUK.LTPsgeared towardsincreasingtheappealanduseofactiveandpublicmodesof transportwillcontributeinincreasinglevelsofphysicalactivitywith subsequentreductionsintheprevalenceofobesity,type2diabetes, coronaryheartdisease/strokeandsometypesofcancer.Evidencefurther suggeststhatincreasedwalkabilitywithinabuiltenvironmentcan

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improveperceptionsofriskandpersonalsafety,furtherencouraging walkingandsocialnetworkswithinparticularlyvulnerablegroups,including olderpeopleandtheinfirm(17).

4.42 ConsideringtheincreasingageingpopulationintheUK,thepromotionof activetransportwillfurtheraidinreducingtheprevalenceandmanaging thesymptomsofosteoporosis,lowerratesofall-causemortalityandaidin facilitatingimprovementsinhealthandwellbeingforallageandsocio-economicgroups.Morehealthconscioustransportplanningcantherefore haveaprofoundinfluenceuponlifestyle,thequalityoflifeandreduce healthcarecostsandthecosttosociety.

4.43 Strategiesintendedtoimprovephysicalactivityhowever,shouldnot adverselyimpactuponstrategiesgearedtowardsimprovingaccessand accessibilityorriskwideningpocketsofsocio-economicandhealth inequality.Toclarify,somecommutertypesandcommunitygroupneeds cannotalwaysbeaccommodatedthroughactiveandpublictransport.LTPs shouldthereforeseektoencourageamodalshiftawayfromprivate vehicleusethatwouldbebetterservedthroughactiveandpublictransport modes(i.e.theschoolrun,employmentetc).

access, accessibility and Community Severance

4.44 Improvedaccessandaccessibilityistheprincipleaimoftransportplanning, providingandimprovingaccesstoawiderangeofactivitiesandamenities criticaltomaintaininggoodsocial,economic,mentalandphysicalhealth, andimprovethelevelofcontroloverandqualityoflife.Theoverlapping natureofactive,publicandprivatetransportmodesprovidesameansto catertoallcommutertypesandneeds.However,withtheincreasein modalchoicetowardsprivatevehicleuse,theveryprocessintendedto improveaccessandaccessibilityisinvariablyimpingingonaccessand accessibility,withadisproportionateimpactuponcommunitiessubjectto relativedisadvatage.

4.45 Toclarify,theincreasedmodalpreferenceforprivatevehiclessignificantly contributestowardscurrentcapacityandcongestionissues,cancreate environmentalandperceivedbarriers,resultingincommunityseverance, andhasinfluencedthenatureofspatialplanningwhichincreasesthe distancesthemajorityofthepopulationarepreparedtotravelonadaily basis(i.e.schools,employmentoutoftownshoppingcentresetc).Thiscan notonlyreducelevelsofaccessandaccessibilitytothosewithlimited accesstomotorisedmodesoftransportation,buttheincreasedmodal

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preferenceforprivatevehiclescanfurthercompoundsuchimpactsby reducingpatronage,viabilityandfrequencyofpublictransportmodesin suburbareas,andreducestheviabilityofsmall,locallevelretailfacilities andamenities.

4.46 Incontrast,evidencesuggeststhatwellplannedurbanareasthatpromote highqualitytransportnetworks,andprioritiseactiveandpublictransport modesfacilitateimprovementsinlifestyle,increasephysicalactivity,reduce crimeandperceptionsofcrime,improvesocialnetworksandoffsetthe risksassociatedwithprivatevehicleuse(11)(17)(18)(19)(20).Increasedfootfall withincommunitiesalsopresentsanopportunitytoincreaseinduced spending,withsubsequentopportunitiestosupportlocalregenerationand thedevelopmentandviabilityoflocalcommunityfacilitiesandamenities.

4.47 ThedevelopmentofLTPscannotthereforeworkinisolation,andmustbe designedtocomplementandsupportthedeliveryofLDFobjectivesand addresspocketsofsocio-economicandhealthinequality.

economic Health

4.48 Incomeandemploymentarekeydeterminantsofhealthinfluencinga widerrangeofhealthdeterminants,includingaccessandaccessibilityto facilities,amenitiesandsocialnetworks,thelocationandqualityof housing,levelsofeducationandrelativecopingskillsandcanfurther influencelifestyleandrisktakingbehaviour.Theassociationisstatistically significantwherepocketsofsocio-economicdeprivationcorrelatewith higherburdensofpoorhealth,lowerlevelsoflifeexpectancyandhigher treatmentcosts.

4.49 Althougheconomichealthislargelyaddressedatthestrategiclevel throughspatialplanninginLDFs,LTPsplayacriticalrollinthedeliveryof LDFobjectivesandcanfurtheraddresslocalcircumstanceandsensitivity, andsupporttheremovalofbarrierstoincomeandemployment, contributingtowardsthereductionofsocio-economicandhealth inequality.

4.50 Vulnerablecommunitygroupsincludethoseexperiencingrelative disadvantage.Itisimportanttonotehowever,thatalthoughsuch communitiesexperiencebothimpactsandbenefitsfromimproved transportaccesstoincomeandemployment.Widerinitiativesarerequired toimprovetherelativeskillsbasetofullyuptakesuchopportunitiesand preventthewideningoflocalinequality.

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Safety

Risk of Collision

4.51 Themostobviousandimmediatehealthriskfromtransportistheriskof fatalandseriousinjuriesfromcollisionwithvehicles.Therateofserious andfatalcollisionshavecontinuedtodecreaseintheUK.Such improvementsinroadsafety,andtherelativedifferencesbetweenthe specifictransportmodesarethoughttobelargelyduetoimprovedvehicle safetyfeatures,improvedroadinfrastructure(e.g.junctionimprovements, moreandbetterpedestriancrossings)andimprovementsinroaduser behaviour(includingreduceddrinkinganddrivingandimprovedspeed limitcompliance).Despiteoverallimprovementsinroadsafetytherelative magnitudeandlikelihoodofriskvariesbetweenthevarioustransport modeswithmotorcyclists,pedestriansandbicyclistshavingKSIrates ordersofmagnitudehigherthanthoseofcarandpublictransport modes(21).

4.52 EvidencefurthersuggeststhatthereisadisproportionateriskofKSIinjuries tochildrenandchildrenfromsocio-economicdeprivedandminorityethnic communitiesinparticular.Suchriskisthoughttobeduetoacombination offactorsincluding,ahigherlikelihoodofsuchcommunitiesresidingin proximitytomainandbusyroads,lowerqualityurbanareaswithoutopen andgreenspaceforrecreation,andalowerappreciationastotherelative risks.

Trips and Slips

4.53 Thequalityoftheurbanenvironment(includingtheprovisionofsafe pavementsandcyclepaths)cansignificantlyinfluencetransportbehaviour andlevelsofphysicalactivity,whereevidencesuggeststhatolderpeople andtheinfirminparticular,aresensitivetopoorlymaintainedorpoorly designedpedestrianamenitiesofwhichcanformanenvironmentalor perceivedbarrier.Suchbarriersnotonlyreduceaccessandaccessibilityfor suchcommunitygroups,butcancompoundhealthissuesbylimiting opportunitiesforphysicalactivitythroughtransport.Suchbarriersneedto beaddressedtoavoidisolatingspecificagegroupsandwideninghealth burdenswithinthisagegroup.

Physical Strain and Injury

4.54 Thereislimitedevidencetosuggestthatincreasedphysicalactivityfrom activetransportorinterchangewithpublictransportpresentsasignificant riskfromphysicalstrainandassociatedinjury.Itisgenerallythecasethat

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individualsregardlessofageandsocio-economicstatusmanagesuchrisks tothemselvesbyimplementingapaceandjourneydistancethatis appropriatetothemandtheirspecificcommuterrequirement.

Crime

4.55 InthecontextofdevelopingandassessingLTPs,thekeyfocusoftransport crimeisonprevention,andaddressingbarrierstomoreenvironmentaland healthconscioustransportbehaviour.Evidencesuggeststhatakeybarrier limitinglevelsofactiveandpublictransportuse,isfearofpersonalsafety onroutesorwhilewaitingforinterchange.Researchindicatesthat althoughallmembersofsocietyexpresssuchconcern,crimeandfearof crimeislikelytohavethemostsignificantimpactuponolderpeopleand theinfirm,withsubsequentimpactsupontheiraccessandaccessibility, behaviour(i.e.avoidactiveandpublictransportafterdark)andlevelsof physicalactivity.

4.56 Evidencefurthersuggeststhatimprovingtheleveloffootfallandeyeson thestreetbecauseofincreasedactiveandpublictransportcanaidin reducingcrimeandimproveperceptionsofcrime,therebyfurtherreducing barrierstophysicalactivityandsocialcohesion.

Congestion and Stress

4.57 Aspopulationsincrease,sowillthefrequencyoftheirrelativetransport requirementsandsubsequentriskofcongestion.Thepotentialimpactto healthlargelyincludesthelocallevelenvironmentalimpactfroman increasednumberofstationaryandslowmovingroadvehicleswith subsequentlyhigherconcentrationsandlowerdispersionofvehicle emissionsandnoisealongthoseroutes.

4.58 Congestionleadingtodelayhasthepotentialtoincreasestresstoboththe commuterandthecommunitiesthataresubjecttotheenvironmental disruption.Congestionalsopresentsameanstofurthercompound environmentalandbehaviouralcommunityseverance,leadingtothe isolationofvulnerablecommunitygroups(olderpeopleandtheinfirm), andcanfurtherreducelevelsofphysicalactivityasakeytransportmode andrecreation(throughpoorperceptionsastothequalityandsafetyof theurbanenvironment).

4.59 LTPsthatmanageriskofcongestionwithinurbanareasthereforepresents anopportunitytoreducetransportemissionexposure(tocommutersand recipientcommunities),improveaccessandaccessibilityandaidin

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addressingtheinstanceofcommuterandcommunitystresswithmental andsocialhealthbenefits

air Quality

4.60 Researchintothepotentialhealtheffectsofemissionsisextensiveand providesstatisticallysignificantassociationsbetweenmanyclassicalair pollutants(e.g.ParticulateMatter,NitrogenDioxideandSulphurDioxide) andeffectsonlifeexpectancyandawiderangeofcardiovascularand respiratoryhealthoutcomes.Suchassociationsandthespecificmethodto assesstheirimpactonhealtharediscussedinmoredetailwithinChapter6.

4.61 TransportisaleadingsourceofemissionstoairintheUKandthe predominantexposuresourcewithinurbanareas.Atthestrategiclevel,the healtheffectofairpollutionistypicallyaddressedthroughairquality standardsandairqualitymanagementareassettoprotectenvironment andhealth.However,thedistribution,magnitudeandsignificanceof potentialhealthoutcomeisalsodependantuponlocalcommunity circumstanceandtheexistingburdenofpoorhealth.

4.62 Vulnerablecommunitygroupstypicallyincludeolderpeople,theinfirmand thosesubjecttorelativesocio-economicdeprivation.Inaddition, disadvantagedcommunitygroupsarealsomorelikelytobesubjectto higherambientconcentrationsofairpollution(throughresidingin proximitytomainroads,congestedareasandindustrialsourcesand thereforebeingsubjecttohigherconcentrationsofvehicleandindustrial emissions).Suchcommunitygroupsarealsolesslikelytohaveaccessto privatevehicles.Assuch,disadvantagedcommunitiestypicallybearthe bruntoftheenvironmentalandhealthconsequenceofprivatevehicleuse, aremoresensitivetosuchimpactsandarelesslikelytoaffordthe associatedconvenienceandhealthbenefits.Transportplanningtherefore hasaroletoplayinaddressingandreducingpocketsofhealthinequality throughouttheUK,andneedtoconsiderthedistributionofimpactsand benefitsuponlocalcommunitiesandtheirrelativesusceptibility.

noise

4.63 Similartoairquality,transportisapredominantnoiseexposuresource withinurbanareas,andisassociatedwitharangenon-auditoryhealth outcomes,including:

annoyance;

stressanxietyandmentalhealth;

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cardiovascularandphysiological;

cognitivefunctioninchildren;and

nighttimeeffects(sleepdisturbance).

4.64 Inaddition,totheadverseeffectthatexposuretonoisecancauseon qualityoflife,thereisemergingevidencethatlongtermexposuretosome typesoftransportnoisecancauseanincreasedriskofdirecthealtheffects

4.65 Thepotentialcausalpathwaythroughwhichnoisecanaffecthealthis showninFigure4.1.Thismechanismisthebasisofmanyofthe epidemiologicalstudiesonhealth.Asshownthepotentialclinical importanceofthediseasestatesincreasetowardsthelowerpartofthe diagram.

figure 41 The noise Health Pathway

NoiseExposure(soundlevel) High Moderate

DirectPathway IndirectPathway

Hearingloss

Annoyance

StressIndicators

Biologicalriskfactors

ManifestDisorders

Disturbanceofactivities, Sleep,communication

Cognitiveandemotional response

PhysiologicalStressreactions(unspecific) AutonomicNervousSystem(sympatheticnerve) Endocrinesystem(PituitaryGland,AdrenalGland)

BloodPressure CardiacOutput

BloodLipids BloodGlucose

BloodViscosity BloodClottingfactors

CardiovascularDisease Hypertension Arteriosclerosis IHD

Source:ExposureandEffectindicatorsofEnvironmentalnoise.Ising,Babischetal(1992)(108)

4.66 TheNoisePolicyStatementforEngland(NPSE)(22)includesthelongterm visionofnoisepolicytopromotegoodhealthandgoodqualityoflife throughtheeffectivemanagementofnoisewithinthecontextof Governmentpolicyonsustainabledevelopment.

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4.67 Agrowingliteraturehasdevelopedaroundthelinksbetweennoiseand healthmostrecentlyEnvironmentalNoiseandHealthintheUK:areport bytheAdHocExpertGrouponNoiseandHealth(23)andEstimating Dose-ResponseRelationshipsbetweenNoiseExposureandHealthinthe UK(24)Evidenceonthelinkbetweennoiseexposureandannoyanceis commonlyacceptedandapproachestoallowthemtobereflectedin analysisarecommonlyusedinappraisalsuchasWebTAG(25).

4.68 Evidenceonthelinkstootherhealthimpactssuchasacutemyocardial infarctions,sleepdisturbancesandhypertensionarelessdeveloped. However,giventheprevailingbalanceofevidenceitisrecommendedthat sucheffectsshouldbeconsideredinappraisal.

4.69 TheWorldHealthOrganisation(WHO)NightNoiseGuidelinesforEurope report(26)proposesevidencebasednighttimenoiseguidelines.Inthis recentlypublishedreviewtheWHOstatethatenvironmentalnoiseisa threattopublichealth,havingnegativeimpactsonhumanhealthandwell being.

4.70 TheDepartmentforEnvironment,FoodandRuralAffairs(Defra)has producedNoiseActionPlans(27),whichhavebeenpreparedunderthe EnvironmentalNoiseDirective(2002/49/EC).Localtransportauthorities havebeenadvisedtoconsiderthecontentoftheseplansand,where appropriate,integratethemwiththeirLTPstoensureacoordinatedand systematicapproachtothemanagementoftransportnoise.Aspartofthe LTPprocess,authoritiescouldexaminetheoptionsforaddressingnoise problemsandanyrisksthatpoliciesmighthaveonachievingtargetsand meetingtherequirementsoftheDirective.

Transport Behaviour and environmental and Health Consequence

4.71 Evidencesuggeststhatthechoiceoftransportandsubsequentinfluence ontheenvironmentandhealthisinpartdefinedbythecommutertype andneed,includingthedistancetobetravelled,thespeedinwhichthe journeycanbemade,carryingcapacityandthesecurityandrelativesafety ofthetransportmode.However,modalchoiceinvariablyreturnsto convenience,comfortandcontrol.Suchconveniencehasledtothe increaseinprivatevehicletrips,includingthoseoverrelativelyshort journeysthatwouldbebetterservedthroughactiveandpublictransport.

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4.72 Suchbehaviourisnotonlyunsustainablebutpresentssignificantlong-term healthimplicationstoallmembersofsociety.Giventhegrowing population,andtheincreasingolderpopulationinparticular,afailureto addresssedentarylifestylesthroughmoreactivetransportwillincur increasingcoststotheNHSandultimatelysociety,totreatpreventable diseasesandaddresscurrentsocialissues(communityseverance,crimeand fearofcrime,inequalityetc).

4.73 Nosingletransportmodeissolelygoodorsolelybad,andanetworkof transportmodesisnecessarytoensurealljourneytypesandcommunity needsareaddressed.HealthconsciousLTPsthereforeneedtowork alongsideLDFobjectivestosupportthestrategicdevelopmentofhealthy, sustainable,vibrantandcohesivecommunities,andencouragemore environmentalandhealthconscioustransportbehaviour.

4.74 Thisresourceprovidesanappropriatebalancebetweencontentand brevity,howeveritisrecognisedthatthedevelopmentofspecificLTPsand studiesmayrequireadditionalinformationonparticularelementsofthe availableevidencebase.Wherethisisthecase,pleasealsorefertothe BibliographyMatrixinAppendixB,signpostingtokeyliteratureand specificformsoftransport.

35

5. Suggested Strategic Level

assessment methods

5.1 LTPshavetheopportunitytodevelopplanstoreducecommunityand commuterhealthrisksandfacilitateenvironmentalandsocio-economic benefitstodeliverhealthy,vibrantandcohesivecommunities.However, thismessageisoftenlostinLTPs,wherethedistributionandsignificance ofpotentialhealthoutcomescanbelostwithintheenvironmentaland economicobjectivesusedtostructurethestrategiesandtheirappraisal criteria.

5.2 Inordertoclearlydemonstratehowhumanhealthandequalityhasbeen implicitlyaddressedfromtheonset,itisrecommendedthatLTPsprovidea briefsectiononestablishinghowhumanhealthiscoveredunderthe variousenvironmentalandeconomicheadings.IntheSEAitis recommendedthatthereisanoverarchingsectiononhumanhealthwhich coversoverarchingissuessuchashealthinequalitiesandreferstoother sectionswherehealthmayalsobecoveredsuchasunderairquality,water, soil.Suchanapproachwillaidinmoreeffectivelyaddressingcommunity andkeystakeholderconcerns,anddemonstratesamorecoordinated approachtotransport,planning,environmentandhealth.

Strategic environment assessment

5.3 TheSEADirectiverequiresconsiderationofthelikelysignificanteffectsofa planorprogrammeonhumanhealth.ResponsibleAuthoritiesmayfindit helpfultodrawonthemethodsofHIAwhenconsideringhowaplanor programmemightaffectpeopleshealth,andhowpositiveeffectscouldbe enhancedandnegativeeffectsreduced.

5.4 ThedevelopmentofSEAobjectiveswillbelocallydetermineddefinedby thereviewoflocalpolicy,plansandprogrammestoestablishlocaland regionalenvironmental,socio-culturalandhealthpriorities.Inorderto provideamorecoordinatedapproachtotransport,environmentand health,itissuggestedthatthereisageneralintroductionthatwould highlighthowtheSEAobjectivesaregearedtowardsprotectinghuman healthand/orelementsvitaltodeliveringahealthy,vibrantandcohesive community.Thiswillnotonlyclearlyestablishhowcommunityhealthand healthinequalityhasbeenaddressedthroughouttheSEA,butalsohelps addresscommoncommunityconcerns.

36

SuggestedStrategicLevelAssessmentMethods

5.5 Inadditiontothebroadenvironmental,culturalandsocio-economicfields, thereisaspecificrequirementtosetobjectivesthatappraisetheinfluence uponresidentpopulationsandmorespecifically,humanhealth.Itwillbe necessarytoestablishappropriatehealthfocusedobjectivestocoverthe humanhealthelementoftheSEAguidance.

5.6 AlthoughsuchSEAobjectiveswillbetailoredtolocalpolicyand circumstance,itisrecommendedthattheybroadlycoverriskprevention, healthpromotionandthepotentialdisproportionatedistributionofboth. Thenumberofobjectivesshouldberealisticandhumanhealthmaybe coveredunderseveral,butsomeexamplesinclude:

toreducethepotentialhealthriskstocommunitiesandcommuters;

tosupportandenhanceaccessandaccessibilitycrucialtomaintaininga healthyvibrantandcohesivecommunity;

toencouragehealthierlifestylesandpromotephysicalactivityasakey modeoftransportandrecreation;

tomanagetransportriskandsupportimprovementsinhealth throughoutthecommunity;

toaddresstherelativeneedsandsupporthealthimprovementsinall communityandagegroups;and

toclosethegapsinsocio-economicandhealthinequality.

Health Impact assessment

5.7 HealthImpactAssessment(HIA)canbebeneficialforinformingthehealth aspectsofSEAtoidentifyandinformhealthissuesinPlans.AseparateHIA wouldnotnecessarilyberequired,ifhealthhadbeenfullyintegratedinthe SEA,unlesstherewereveryimportanthealthimpactswhichneededmore detailedconsiderationthancanbegivenwithintheEnvironmentalReport.

37


figure 51: Health Impact assessment: approach for Local Transport Plans

Identify the changes these plans make to levels of daily physical activity, access to schools, work, health services, shops, leisure, and play opportunities

estimate the size and characteristics of the groups of people who benefit, or

lose out, or experience no change

establish to what extent inequalities in health are reduced or widened

Devise measures to avoid or reduce impacts on groups of people who lose out

5.8 ForeachLTPthereisarequirementtocarryoutanassessmentoftheplans impactonequalities,inlinewithequalitieslegislationandhumanrights legislation.

5.9 IfcoordinatedappropriatelythehumanhealthsectionoftheSEAmaybe abletoinformpartoftheassessmentoftheLTPsimpactonequality preventingunnecessaryrepetitionofeffort,consultationfatigueand associatedtimeandfinancialcostsduringthedevelopmentandappraisal ofLTPs.

5.10 Table5.1presentsarecommendedhumanhealthappraisalformatthat appliesthekeydeterminantsofhealthasthebasistotheappraisalcriteria. Theappraisalstructureincludes:

thepolicyreferencenumber,dateandname:providingapointof referencetotheiterativedevelopmentoftherelativetransportoptions (i.e.asoptionsarerefinedandre-appraised);

asummaryparagraphofthetransportoptionappraised:intendedto providethereadercontexttowhatisbeingappraised;

ahealthdeterminants/fieldcolumn:providingthebasistothe appraisalcriteria;

ahealthpathwaycolumn:providingcommentaryandtherationalto thepotentialhealthoutcome;

ahealthoutcomecolumn:definingthepotentialdirectionand significanceofhealthoutcome(i.e.adverse,beneficial+,unclear?or neutral0)duringconstructionandoperationofthetransportoption;

asensitivegroupcolumn:establishinganyparticularcommutertypeor communitygroupthatmaydemonstrateaparticularsusceptibilityto

38

SuggestedStrategicLevelAssessmentMethods

potentialoutcomes(bothadverseorbeneficial)toestablishpotential inequalityimpacts;and

anactionsandrecommendationscolumn:toaddresspotentialrisks, enhanceopportunitiestoimprovecommunityhealthandaddress inequality.

39

TransportandHealthR

esource

Table 5.1: Recommended HIa appraisal format and Criteria

Transport option Health

Determinant/field Health Pathway

Potential Health outcome Sensitive Communities/

Groups

Potential actions to minimise adverse impacts and inequality and enhance opportunities to improve health Construction operation

Reference option Transport option Summary Description code and name date

Demography HealthNeeds

Lifestyle

Services,amenities andleisure

Accessand Accessibility

Incomeand Employment

Education

CrimeandSafety

Housing

Transport

BuiltEnvironment

Natural Environment

Openspace

40

6. assessment by Human Health effects

6.1 Thischaptersetsoutsuggestedassessmentmethodsstructuredbythekey transporthealthpathwaysestablishedChapter4.Ithighlightshowkey transporthealthpathwaysareaddressedwithintransportplanning,and whereappropriate,aidsselectingandapplyingadditionalhealth assessmentmethodstoinformandsupportdecision-making.

6.2 Quantitativepredictionsoftheeffectsofplansbasedonthe epidemiologicalresearchandimpactformulaepresentedbelowarenot expectedaspartoflocalSEAs.Theyhavebeenpresentedheretoprovide greatercontexttotheinformationpresentedwithinthisdocumentandas aninsightintotheextentofanalysispossiblebasedontheavailable evidence.

Demography and People

6.3 Toobtaininformationaboutthelocaldemographyandhealthprofileof thepopulation,refertothefollowinglocalsourcesofinformation:

HealthProfiles http://www.apho.org.uk/default.aspx?RID=49802

JointStrategicNeedsassessment

http://www.dh.gov.uk/en/Managingyourorganisation/ JointStrategicNeedsAssessment/DH_086692

TheDirectorofPublicHealthsAnnualPublicHealthReport

Lifestyle (physical activity and inactivity)

6.4 TheWHOhasdevelopedguidancetoillustratetheprinciplesoutlinedin theWHOdocument:Methodologicalguidanceontheeconomicappraisal ofhealtheffectsrelatedtowalkingandcycling(82)andtoassistanyone whowishestoconductaneconomicappraisalofthehealtheffects specificallyrelatedtoincreasedlevelsofcycling.

6.5 Itisdesignedtocomplementexistingtoolsforeconomicappraisalsof transportinterventionswhichhavetraditionallytendedtofocusonother issuessuchasemissionsorcongestion.TheHealthEconomicAssessment

41


ToolforCycling(HEATforcycling)isavailabletodownloadasanExcel spreadsheetfromtheWHO.Thetoolwillproduceanestimateofthemean annualbenefit(percyclist;pertrip;andtotalannualbenefit)dueto reducedmortalityasaresultofcycling,andcouldbeappliedinanumber ofsituations,including:

whenplanningapieceofnewcycleinfrastructure.Itwillallowtheuser tomodeltheimpactofdifferentlevelsofcyclingandattachavalueto thehealthbenefitresultingfromanestimatedlevelofcyclingwhenthe newinfrastructureisinplace.Thiscanbecomparedtothecoststo produceabenefit:costratio(andhelpmakethecaseforinvestment),or asaninputintoamorecomprehensiveeconomicappraisal;

tovaluethemortalitybenefitsfromcurrentlevelsofcycling,suchasto aspecificworkplace,acrossacityorinacountry;and

toprovideinputintomorecomprehensiveeconomicappraisals,or prospectiveHIAs.Forexampletoestimatethemortalitybenefitsfrom achievingnationaltargetstoincreasecyclingortoillustratepotential costconsequencestobeexpectedincaseofadeclineofthecurrent levelsofcycling.

6.6 Itisthereforegearedforstrategicdecisionmakingandisintendedtoaidin answeringthefollowingquestion:

If x people cycle y distance on most days, what is the value of the health benefits that occur as a result of the reduction in mortality due to their increased physical activity?

6.7 ThetoolisbasedontherelativeriskdatafromtheCopenhagenCentrefor ProspectivePopulationstudieswhichfoundarelativeriskofall-cause mortalityof0.72amongregularcommutercyclistsaged20-60years relativetothegeneralpopulation.Thestudycontrolledfortheusual socioeconomicvariables(age,sex,smokingetc.)aswellasforleisuretime physicalactivity.Italsotookaccountofapossibleactivitysubstitution:i.e. whetheranobservedincreaseinratesofcommutercyclingcouldbe compensatedbyareductionofleisuretimephysicalactivity.

6.8 Thetoolthenappliesthedataenteredbytheusertocalculatethetotal valueoftheeconomicsavingsduetoreductionsinall-causemortality amongthesecyclists.

42

AssessmentbyHumanHealthEffects

6.9 Keyinputsincludethetotalnumberofcycletripsperdayandthemean triplengthasaconsequenceoftheproposedtransportoption.Thetool thencalculatestheoverallvalueofthislevelofcycling,basedonanumber ofdefaultvalues.Thesehavebeenderivedfromtheliteratureandagreed aspartoftheexpertconsensusprocess,andshouldbeusedunlessmore relevantoraccuratedataareavailable.

6.10 Asdiscussedinmoredetailbelow,keyoutputsinclude:

maximumannualbenefit;

savingsperkmcycledperindividualcyclistperyear;

savingsperindividualcyclistperyear;

savingspertrip;

meanannualbenefit;

presentvalueofmeanannualbenefit.

6.11 Themaximumannualbenefitisthetotalvalueofreducedmortalitydueto thelevelofcyclingenteredbytheuser.Thisisamaximumvalue,asit assumesthatthemaximumpossiblebenefitstohealthwillhaveoccurred asaresultoftheenteredlevelofcycling.Inreality,thehealthbenefitsare likelytoaccrueovertime,andthisbuild-upperiodcanbeadjusted.

6.12 Themeanannualbenefitisthekeyoutputofthemodel.Itadjuststhe maximumannualbenefit(totalvalueoflivessavedduetothelevelof cyclingenteredbytheuser)bythreemainfactors:

anestimateofthetimeframeoverwhichbenefitsoccur.Thereis evidencetosuggestthatmortalityreductionsarelikelywithinfiveyears ofachangeinlevelofcyclingsothisisthedefaultvalue.

abuild-upperiodforuptakeincycling,whichallowstheusertovary theprojectionsinuptake(suchasforanewcyclepathwhichmaysee increasinguseovertime)andvariesforfullusageoccurringbetween 1and25years;and

Totaltimeperiod.Thisallowstheusertolookatdiscountedbenefits averagedoveraperiodofbetween1-25years.

6.13 Thepresentvalueofmeanannualbenefitadjuststheaboveoutputsto takethediminishingvalueofcostsandoutcomesovertimeintoaccount. Themodelsuggestsadiscountrateof5%butthiscanbevariedbyusers.

43


access, accessibility and Community Severance

6.14 LTPsareimplicitlygearedtoimproveaccessandaccessibilitytoarangeof facilitiesandamenitiesnecessarytomaintainandpromotegoodhealth. However,itisthecasethatincreasedaccessandaccessibilitytocommuters canresultinthecreationofenvironmentalbarriersatthecommunitylevel, leadingtocommunityseverance.LTPsthereforeneedtostrikethe appropriatebalanceofmeetingbothcommuterandcommunityneeds.

6.15 Theaccessibilityoftripdestinationsbyeachmodeoftravelwillinvariably affectthemodechoiceforeachtripandtheassociatedhealtheffectsof each.TheDfThaspreparedguidanceinassessingaccessibilitytokey opportunities(28)inordertoidentifyaccessibilityproblemsfacedbypeople fromdisadvantagedgroupsandareasthroughtheuseofCoreandLocal Indicators.

6.16 EachCoreIndicatorwillallowacomparisonbetweentheaccessibilityofa relevantpopulationforajourneypurposeandthosedeemedtobean appropriateproxyforpeopleatriskofsocialexclusion.Forexample,the proportionofa)householdsb)householdswithoutaccesstoacarwithin 15and30minutesofaGPbypublictransport.

6.17 TheCoreIndicatorsfocusonjourneytimestojobsandservicesbypublic transport,walkingandcycling(whereappropriate),however,accessibility problemsandsolutionsvarysignificantlybetweenlocalareasandtherefore journeytimemightnotalwaysbethemostappropriatemeasureoflocal accessibility.TheDfTthereforeencouragesLocalAuthoritiestodevelop performanceindicatorsbasedontheirlocalpriorities,suchasareas associatedwithparticularfundinginitiatives,ruralandregenerationareas.

6.18 Inparticular,theLocalIndicatorsprovidesLocalAuthoritieswiththetoolkit toassesstheaccessibilityforeachmodeforaspecifictransportoption.The potentialinfluenceoftransportoptionsfromaccessibilityshouldbebased qualitativelyusingtheLocalIndicatorsandtheeffectofeachmode assessedfromtheevidencebaseinChapter4.

6.19 Severanceistheperceiveddivisionthatcanoccurwithinacommunity whenitbecomesseparatedbyamajortrafficartery.Severanceisdifficult tomeasureandbyitssubjectivenatureislikelytovarybetweendifferent groupswithinasinglecommunity.

44


6.20 Inadditiontothevolume,compositionandspeedoftraffic,severanceis alsolikelytobeinfluencedbythegeometriccharacteristicsofaroad,the demandformovementacrossaroadandthevarietyoflandusesand extentofcommunitylocatedoneithersideofaroad.Allthesefactors shouldbeconsideredwhendeterminingthelikelyseveranceeffect.

6.21 Ingeneralterms,guidancepreparedbytheInstituteofEnvironmental ManagementAssessment(IEMA)(29)suggeststhata30%changeintraffic flowislikelytoproduceaslightchangeinseverance,withmoderate andsubstantialchangesoccurringat60%and90%respectively.The effectofseverancefromtransportoptionsshouldbeassessedqualitatively withreferencetotheIEMAguidanceandfromtheevidencebasein Chapter2andAppendixA.

economic Health

6.22 Employmentandincomearepotentiallythemostsignificantdeterminants oflong-termhealth,influencingarangeoffactorsincludingthequalityof housing,education,diet,lifestyle,copingskills,accesstoservicesandsocial networks.

6.23 Asaconsequence,poorersocio-economiccircumstancescaninfluence healththroughoutlife,wherecommunitiessubjecttosocio-economic deprivationaremorelikelytosufferfrommorbidity,injury,sufferfrom mentalanxiety,depressionandtendtosufferfromhigherratesof prematuredeaththanthoselessdisadvantaged(30)(31)(32)(33)(34).

6.24 Althoughquantitativemethodshavebeenestablishedtodemonstratethe healthbenefitofemploymentandincome,wherea10%riseinincome canreducetherelativeriskofmortalityby0.0035inmenand0.03in women,theintensivedatarequirements(i.e.theneedforinformationon therelativechangeofanindividualspayrange)limitsthisassessmenttoa qualitativeappraisal(34).

6.25 LTPsthatpromotethepotentialfor,andaccesstolong-term,stable, qualityemploymentwillcontributeinimprovingthehealthandwellbeing ofcommunities.Itisimportanttonotehoweverthatincreasing employmentandincomeopportunitiesalonewillnotmaximisehealth benefits.Increasedsupport,trainingandcommunityinvolvementis requiredinordertolinkanddevelopskillstoemploymentandreducethe riskofinequality

45


Crime

6.26 Thereiscurrentlyinsufficientevidencetoquantifythechangeincrimeand perceptionsofcrimefromchangesinthequalityoftheurbanenvironment, oramodalshifttowardsactiveandpublictransportmodes.However, thereissufficientevidencetosuggestthatsuchfeatureswillaidin addressingcommunitybarrierstophysicalandactivetransportmodes, improvelevelsofphysicalactivitythroughimprovedtransportand recreationandcontributeinfosteringmorecohesivecommunities.Assuch, thepotentialinfluenceoftransportoptionsshouldbeassessedqualitatively andsupportedbytheevidencebaseinChapter4.

Risk of being Killed or Seriously Injured (KSI) from Collision

6.27 Thecalculationofinjuriesasaresultofnewjourneysandincreasedtraffic flowsisnotanexactscienceandasaresult,localareasmayfinditmore appropriatetopresentqualitativeassessmentsofrisk.Asshownbelow, oneapproachforaquantativecalculationistocalculateanaccidentrate perjourney,basedonthegrossnationalstatistics.

AccordingtoUKDepartmentforTransportstatistics12,therewere 26,912peoplekilledorseriouslyinjuredonallGreatBritainroadsforall formsoftransportin2009.

Theannualnumberofvehiclejourneysortripsperpersonperannum canbeestimatedbythefollowingmethod;therearecurrently60 millionpeopleinGreatBritainandanaverageof973tripsperperson peryear,Takentogether,theresultisanestimated58.38billiontrips peryearinroadvehicles.

Therefore,theincidenceofaroaduser(includingpedestrians)being killedorseriouslyinjuredpertripcanbecalculatedbydividingthe numberofKSIbythenumberoftrips.

=(26,912/58,380,000,000)100,000=0.461KSIper100,000 journeys

Anestimateoftheextranumberofaccidentscanthenbecalculatedby applyingtherateofKSIperinjurytothenumberofnewtripsexpected.

Asimilarcalculationcanbemadetoestimatethenumberofcasualties perjourney.

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6.28 Theadvantageofthismethodisthatthenumberofaccidentscanbe calculatedwithoutadetailedknowledgeofroadtrafficmovementson particularroadtypesorthenumberofkilometrestravelled.Thismethod alsotakesintoaccounttheadditionalriskassoci

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