Transport is a health issue Dr Harry Rutter South East Public Health Observatory .
Transcript of Transport is a health issue Dr Harry Rutter South East Public Health Observatory .
Transport is a health issue
Dr Harry RutterSouth East Public Health
Observatorywww.sepho.org.uk
Health impacts on:
Individuals
Communities Environment
Individuals
• Physical activity
• Injuries• Environment• Access
Average distance travelled per year
Miles per person per year 99/01
% change from 89-91 to
99/01
Walking 189 -20
Bicycle 39 -6
Car 5,354 11
Source: DfT Great Britain data http://www.transtat.dft.gov.uk/tables/tsgb02/1/download/10202.xls
Passenger transport by mode 1952-2000 (Great Britain)
0
100
200
300
400
500
600
700
1956 1961 1966 1971 1976 1981 1986 1991 1996 2000
Year
Bill
ion p
asse
nger kilo
metr
es
Car
Rail
Bike
Source: http://www.transtat.dft.gov.uk/tables/tsgb01/9/90101.htm
Journeys to school by mode and age group: 1985/86 to 1995/97
Source: DfT Personal Travel Factsheet 2 - June 1999 http://www.transtat.dft.gov.uk/facts/nts/pt2_99/school99.htm
Sedentary lifestyle
• In SE ~50% exercise < once a month
• Increasing obesity– 20% of adults in England– Has trebled in last 20 years– Shortens life by average of 9 years– £0.5 billion direct costs to NHS– £2.0 billion impact on economy
Sources: HSRU Healthy Lifestyles Survey and Tackling Obesity in England, National Audit Office, 2001
Cars and obesity
• 14% of Chinese households acquired a car between 1989 and 1997
• Men who acquired a car– gained ~2kg– doubled their risk of obesity
Source: Bell et al, Obesity Research 2002; 10: 277-83
Cardiovascular mortality
• 236,000 deaths a year from cardiovascular disease in UK – 39% of deaths– 36% of premature deaths in men,
28% in women– 58% higher mortality in male
manual thanmale non-manual workers
Source British Heart Foundation Statistics Database 2002 - http://www.dphpc.ox.ac.uk/bhfhprg/stats/2000/2002/mortality.html
Health benefits of physical activity• Heart disease• High blood pressure• Stroke• Cancer• Diabetes• Mental health and well-being• Cognitive function / independence
Physical activity and mortality• >36% CHD deaths are attributable
to sedentary lifestyle1
• 14% of UK CHD deaths could be avoided by stepping up a level2
• 28% reduction in mortality3
• Adds one to two+ years of healthy life4
• Dose-response relationshipSources: 1) McPherson et al. Coronary heart disease: Estimating the impact of changes in risk factors. National Heart Forum, 2002
2) Britton et al, Monitoring the progress of the 2010 target for coronary heart disease mortality, National Heart Forum 2000
3) Andersen et al. All-cause mortality associated with physical activity during leisure time, work, sports, and cycling to work.
Archives of Internal Medicine 2000, 160, 1621-1628. 4) Paffenbarger et al. Physical activity, all-cause mortality, and longevity of college alumni. NEJM
1986;314:605-13
Traffic injuries in UK
• In 2001 there were:– 3,450 deaths– 40,560 killed or seriously injured– 313,000 injuries
• Cyclists– 136 deaths (3.9% of total)– One death per 29,000,000 km cycled
Sources http://www.transtat.dft.gov.uk/tables/tsgb02/4/download/41502.xls and http://www.transtat.dft.gov.uk/tables/tsgb02/4/download/40702.xls
Mortality: CHD v. traffic injury
(UK 2001)124000
107 750 27 98 1665 7620
20000
40000
60000
80000
100000
120000
140000
CHD Childpedestrians
Adultpedestrians
Childcyclists
Adultcyclists
Car driversand
passengers
Other roadusers
Sources: http://www.dphpc.ox.ac.uk/bhfhprg/stats/2000/2002/mortality.html & http://www.transtat.dft.gov.uk/tables/tsgb02/4/download/41502.xls
0.00
0.20
0.40
0.60
0.80
1.00
<20 20-40 40-60 60-80 80-100 100-120 120-140
Minutes/day of cycling
Rel
ativ
e risk
of dea
th
Reduction in relative risk of death for cyclists cycling at 10mph 5 days a week
Source: Paffenbarger et al. Physical activity, all-cause mortality, and longevity of college alumni. N Engl J Med 1986;314:605-13
Risk of injury per million kilometres (EU data)
Age Drivers Cyclists
12-14 - 16.8
15-17 - 18.2
18-24 33.5 7.7
25-29 17.0 8.2
30-39 9.7 7.0
40-49 9.7 9.2
50-59 5.9 17.2
60-64 10.4 32.1
>64 39.9 79.1
Total 20.8 21.0
Source: Cycling: the way ahead for towns and cities. EU 1998
Health cost / benefit of cycling• At least 20:1 life years gained:lost• Costs of sedentary lifestyle much
harder to visualise than cycling death or injury - risk communication issues
• Cycling is safer than driving
Source: Hillman, M. Cycling and the Promotion of Health. Policy Studies 1993, 14, 49-58
Speed
• Injuries• Noise• Pollution• Land use
Speeds on non-urban roads• Cars
– On motorways and dual carriageways >50% exceed 70 mph
• HGVs– On dual carriageways 88%
exceed50 mph limit
2001 data - Source: http://www.transtat.dft.gov.uk/tables/2002/vsgb/vsgb.htm
Speeds on urban roads
• Cars– On 30mph roads
• 2/3 exceed 30 mph• 1/3 exceed 35 mph
• HGVs– On 30 mph roads
• 55% exceed 30mph
2001 data - Source: http://www.transtat.dft.gov.uk/tables/2002/vsgb/vsgb.htm
Access
• To health services (SEU report)• To employment• To goods and services• To friends and relatives
Communities
• Social networks• Community severance• Health inequalities
Health inequalities
• Children / Elderly / Poor / Marginalised
• SE gradients for car and bike ownership
• SE gradient for activity levels• Children in lowest SE group 5x more
likely to die as pedestrians than in highest
Sources: Abdalla I, Barker D, Raeside R. Road accident characteristics and socio-economic deprivation. Traff. Engin. Control 1997;38:672-6 andhttp://www.socialexclusionunit.gov.uk/transport/transport.htm
Environment
• Emissions• Greenhouse gases• Noise• Visual• Land take• Construction and maintenance• Energy
Transport and air pollution (GB data)
• 70% of CO emissions• 48% of all nitrogen oxide
emissions• 22% of particulates
Source: http://www.transtat.dft.gov.uk/tables/2002/tt/section8/section8.htm#8.6
Diesel and petrol engines
• Diesel produces NOx and particulates
• Petrol produces NOx, CO and VOCs
• Both produce carcinogens such as PAH, benzene and 1,3-butadiene
• Catalysts don’t help much for short journeys (ie most journeys in urban areas) as they need to warm up to work
Source: http://www.doh.gov.uk/comeap/statementsreports/diesel.htm
Mortality due to air pollution• Over 8,000 deaths/year from PM10
• 3,500 deaths from SO2
• Others from CO and NOx
Sources: http://www.doh.gov.uk/comeap/statementsreports/airpol7.htm and http://www.doh.gov.uk/comeap/statementsreports/transport.htm
Don’t forget other modes
• Air• Rail• Sea• Inland waterways• Freight – especially by road and air
Aviation
• Climate change• Air pollution• Noise• Surface access• Inequalities• Communicable diseases and wider health
protection• Global public health issues
Road freight
• 576 killed in crashes involving a heavy goods vehicle in 1998
• 60 were occupants of the HGV• 20% of fatalities were cyclists or
pedestrians
http://www.transtat.dft.gov.uk/facts/accident/hgv/hgv98.htm
Commuting mode by Government Office Region, 2001
0
10
20
30
40
50
60
70
80
90
100
SouthEast
WestMidlands
East ofEngland
EastMidlands
SouthWest
NorthWest
Yorkshireand theHumber
NorthEast
London
Per
cent
age
Walk
Bicycle
Rail
Bus, coach
Motorcycle
Car, van, minibus
Source: http://www.transtat.dft.gov.uk/tables/tsgb02/1/download/10702.xls
Regional expenditure on roads by Government Office Region
-
100.0
200.0
300.0
400.0
500.0
600.0
700.0
800.0
SouthEast
NorthWest
London WestMidlands
Yorkshireand theHumber
Eastern SouthWest
EastMidlands
NorthEast
£ m
illions
Local Roads
Motorways and trunk roads
Source: http://www.transtat.dft.gov.uk/tables/tsgb02/1/download/11902.xls
Role of the NHS
• Service provider• Employer• Consumer• Citizen
Healthy Travel Plans
• Requirement of the NHS Environmental Strategy
• Requirement of the DH Controls Assurance Risk Management process
• Requirement of the NSF for CHD
Benefits to employers
• Healthier employees• Fitter and more productive
workforce• Less demand for car parking• Sets a good example• Achieves policy requirements• Increases efficiency
Benefits to individuals
• Get healthier• Feel healthier• Send healthy message• Save money
Benefits to public health
• Healthier population• Reduced inequalities• Fewer injuries• Social and community benefits• Environmental benefits
What can we in public health do?• Awareness• Knowledge• Skills• Partnership• Action
Conclusions
• Transport is a health issue• Personal, social and environmental
costs of motorised transport• Health, social and environmental
benefits of active transport• Role for public health in
partnership with colleagues in other sectors