Transport and health Lessons from integrating health into transport strategies

1. Transport and health Lessons from integrating health into transport strategies Carlos Dora World Health Organization Geneva

2. Many health impacts from transport: NOISE INJURIES PHYSICAL INACTIVITY AIR POLLUTION PSYCHOSOCIAL EFFECTS

3. e.g. Air Pollution leads to heart and lung disease and premature deaths • And to increases in hospital admissions, and asthma attacks • To loss of millions of working days • Children living near busy roads with heavy/diesel vehicle traffic have higher risks of respiratory problems. • No safe level of AP (Particulates) • Every 10 µg/m3 decrease in PM2,5 leads to 3,4% decrease in mortality • Health impacts are larger in lower socioeconomic groups (cumulative exposures)

4. e.g. 60% of world population does very little physical activity Greater health benefits among least active Dose-response physical activity and health, in B Martin et al, 2004

5. 30 minutes a day of Physical Activityis enough to reduce: • By 50 % the risk of developing coronary hearth disease, • By 50% the risk of developing non-insulin-dependent diabetes and obesity. • By 30 % the risk of developing hypertension. • The risk of colon /breast cancer (e.g. Shanghai 50% reduction in colon cancer). • Helping to maintain bone mass and protecting against osteoporosis. • Improving balance, co-ordination, mobility, strength and endurance. • Increasing self-esteem, reducing levels of mild to moderate hypertension and promoting overall psychological well-being.

6. e.g. Traffic Deaths: 1,2 million/yearTraffic Injuries over 40 million/year Source: Peden et al (2004)

7. Traffic linked to neighbourhood social support Busy streets are less convivial, more anonymous

8. A large proportion of the Global Burden of Disease is attributed to urban transport 15% - Underweight Tobacco Unsafe sex Alcohol Overweight 5% - Water, sanitation and hygiene (5.5%) Indoor air (3.7 %) Percent of total burden (within region) Transport (3.3%) Physical inactivity Zinc deficiency Tobacco Alcohol Occupational injuries Occupational risks Overweight 1% - Unsafe sex Ambient air Lead Ambient air Climate change Water, sanitation and hygiene Lead Developing countries (high mortality) Developed countries

9. Traffic policies may have many benefits to health and environment – Scarce documentation! • Traffic delays inside the charging zone average 30% lower than before • Pedal cycle movements have increased by about 20 % • Bus and coach movements have increased by over 20% • Van and lorry movements have reduced by about 10 % • Powered two-wheeler movements have increased by 10-15% • 8% reduction in personal injury accidents in the charging zone during charging hours compared to the same period last year. • 6% fewer pedestrians were involved in accidents, • (Based on the first 6 months of provisional data since charging began) London congestion charge Source: Congestion Charging: Update on scheme impacts and operations. February 2004 (www.tfl.gov.uk/tfl/downloads/pdf/congestion-charging/cc-12monthson.pdf) The congestion charge is a £5 daily charge for driving or parking a vehicle on public roads within the congestion charging zone between 07:00 and 18:30, Monday to Friday, excluding weekends and public holidays.

10. Bogota: urban space to public transport and pedestrians – reduction in traffic injuries and air pollution ? political success ? before... ... after

11. Narrow solutions: limited results. e.g. Continuing Traffic Growth Has Cancelled Out Pollution Savings from Cleaner and More Efficient Vehicles • Cars are becoming heavier and more powerful. • Trips are becoming increasingly long. • Total kilometers traveled by road continues to grow EC: Transport in Figures, 2000

12. Integrated transport policies have great health gain potential - • Transport Demand Management via: • Economic measures • Changes in individual travel behaviours • Compact land use to reduce need to travel • Maintain high walking and cycling • Support public transport

13. Filling the information gap: Develop tools that help economist to include health in their analyses e.g. the Nordic Council work to include health effects in cost-benefit analyses of infrastructure for cyclists shows that this can be a very profitable investment Net benefit/cost ratio

14. Developing tools for the assessment of health impacts from transport:e.g. WHO HEARTS model Exposure (GIS based) Health effects (based on dose/response curves) • The tools developed consist of two modules (TEX & HIT) to provide two sets of health-related indicators: • exposure measurements: TEX operates within ArcGIS and for population groups defined by the users according to different features. TEX calculates the exposure of predefined groups along the scenario duration (from 1 hour to 1 year) of considered case study. • health effects: HIT calculates attributable mortality or morbidity, relative risk, disease-adjusted life-years, for different age / social groups related to air pollution; output for noise and crashes are also available.

15. SAMU : agent-based modelling of pedestrians/cars interactions and resulting accidents Source : Banos, Godara, Lassarre, 2005

16. “A man who, beyond the age of 26, finds himself on a bus can count himself as a failure” Contributing to change in social norms: • A European Parliament Resolutionadopted on 28 February 2002 • Stronger integration of health considerations into transport policies, including by carrying out health impact assessment of major transport projects.”

17. Challenge: using the lessons/experience elsewhere: 105 million people moved to cities in China between 2000 and 2005 • Advice on national & urban Healthy Transport Policies /Strategies • Difficult to communicate the benefits of bicycles! • Need insight into communication of local healthy transport solutions Co-benefits of climate change adaptation strategies and policies • Research with countries and cities – preparedness plans

18. WHO will begin at home: healthy transportto work for staff health and climate change reduction • Transport to work is a major source of health & wellbeing risks, but also offers opportunities for healthy activity • Survey identified lack of infrastructure for cycling and public transport for over half the staff who want to adopt those modes • Interest from nearby International agencies (UN, ILO, Red Cross etc.)

19. More Healthy Transport among WHO staff can: • Enhance staff wellbeing via: • Injury prevention • Air pollution reductions • Improved Physical activity • Improved Mental health • Improve the carbon footprint from WHO HQ staff travel to work • Give the good example on transport & health to health agencies (ministries, clinics, hospitals) and other international agencies

20. On balance the Benefits of Cycling & Walking are much greater than Risks from injuries • But a successful strategy to promote C&W has to include injury prevention measures • Effective preventive measures are available

21. Step 1: Understanding staff needs and feasible Sustainable Transport alternatives for HQ • Describe staff commuting patterns & barriers to sustainable transport and needs (staff survey). • Identify incentives for, cycling, car pooling, and use of public transport. • Identify ways to promote equity in parking at work, with special attention for those with special needs (area of residence, need to drop children at school, physical disability…) • Agree ways to monitor the impacts of the ST intervention (through staff's mode of transport, through medical services etc.) and readjust it as needed.

22. Step 2: Develop and disseminate Information & Advocacy materials on: • Accessible sustainable transport alternatives for WHO HQ staff • The benefits of sustainable transportation for personal health, (briefings done in collaboration with injury prevention, physical activity, air pollution units) • The role of health systems can play in achieving health through promotion of sustainable transport modes (eg. hospital transport programmes)

23. Sustainable transportation alternatives Cycling Public transport Car Pooling Cycles lanes & maps Building facilities (showers, changing rooms, parking) Repairing your bike Bus & train network info (timetables, connections) Reduced prices for monthly subscriptions Examples of sustainable transportation alternatives Real time info system

24. Step 3: Promotion and Events • World Health Day – 7 April 2008 at WHO HQ • Short-term events at WHO HQ promoting ST staff: • on cycling and walking • on public transport • on connection with neighbouring France • Engage a few senior staff as role models on ST to work • Event with senior staff and Geneva/Swiss authorities on health and transport

25. Good practice examples of sustainable transport practices in the workplace exist, right here in Geneva! • Rolex SA (Plan-les-Ouates): car sharing, shuttle services • Geneva International Airport: 45% of eco-mobility in 2020 • Télévision Suisse Romande: development and promotion of soft mobility between the different TSR's sites (cycling path,…) Source: Mobilidée

26. There are also good practice examples of ST within health sector institutions • Switzerland: with Swiss Bicycle Advocacy Association • District hospital of Lucerne (KSL): 3500 staff. Created a working group of 6 people, in charge of promoting and following up the use of the bike. • District hospital of Schaffhouse (KSSH): 850 staff. Parking space problems, staff using the car for short trips, taking away parking space from patients and visitors. Action: financial support/incentives for staff to use the bike or Public Transport instead of car, including costs of eventual taxi if needed. Source: igvelo • Nottingham City Hospital: • Provided bicycle locks, cycle racks, bicycle leasing scheme, ensuring public transport connections.

27. Detailed example: Grenoble ST-Microelectronic • 60% staff live in the surroundings • Traffic jam on the site at peak hours • 80% of single car use 40% energy used on the site is for staff transportation • Problems • Measures • Development of public transportation (free shuttles site - railway station, financial participation) 2. Development of green transportation (creation of cycle lanes around site, disposal of safety cycle kit, disposal of taxi and/or bus if any problem, promotion of greener fuel for company vehicles) 3. Development of proximity services (post office, kiosk, bicycle repair professionals on site, fast food services, free anti-pollution control) 4. Action on short business travel (increase of gas-driven professional vehicles, disposal of vehicles for staff, coordination of business travel, car-sharing development for professional travel between the sites)  In 4 years, increase from 20% to 51% of alternative transportation