Synergies between Urban Transport and Public Health Dr Carlos Dora  Coordinator Interventions for Healthy Environments Dep...
This presentation covers <ul><li>The links between urban transport and public health  </li></ul><ul><li>Which transport po...
The links between Transport and Health  <ul><li>Urban air pollution -> 1.2 million deaths  </li></ul><ul><li>Physical inac...
T-Related Air Pollution leads to heart and lung disease and premature deaths <ul><li>Increases in hospital admissions, and...
Better air quality improves health The health benefits of a ban of coal sales i n  Dublin Clancy et al 2002
Reduction in fine PM and mortality:  extended follow up of Harvard six Cities Study Period 1: 1974-89 (mean PM2.5: 1980-85...
30 minutes of  physical activity a day  is enough to reduce: <ul><li>By 50% the  r isk of heart disease (CHD) </li></ul><u...
60% of world population does very little physical activity Most health gains from getting the inactive to move Greater hea...
Traffic Noise is a major cause of annoyance; Interferes With Memory, Attention and Ability to Deal With Analytical Problem...
<ul><li>Psychological Barriers  - How people feel about moving through an area: </li></ul>Community Severance <ul><li>Perc...
Traffic Deaths:  1,2 million/year Traffic Injuries over 40 million/year Source: Peden et al (2004) 0-4 5-14 15-29 30-44 45...
Children pay a High Price <ul><li>They are at higher risk of being involved  traffic injuries . </li></ul><ul><li>Play unh...
Need to prevent main global cause death - Chronic diseases <ul><li>Cardiovascular disease, mainly heart disease, stroke </...
Transport can be a 'facilitator' or a  'burden' on health  <ul><li>Transport systems offer vital  access  to health-essent...
Hanoi, 1993 Hanoi, 2001 Hanoi, 2002 More vehicles = more road space/construction for vehicles = greater air pollution, noi...
The vicious cycle: Increased traffic injury risks  Parents drive their children to school by car Traffic increases Streets...
Busy road environment puts pedestrians and cyclists at risk Source: Pucher and Dijkstra, Promoting safe walking and cyclin...
Narrow solutions: limited results.  <ul><li>e.g. Continuing Traffic Growth Has Cancelled Out Pollution Savings from Cleane...
Diesel & clean diesel <ul><li>Adopted often because it produces less CO2 </li></ul><ul><li>Produces more particles (PM10, ...
Large global investments being made in new transport systems <ul><li>...but with little measurement of their real health i...
For instance, investments in transit, cycling and pedestrian infrastructures are not well tracked World Bank lending by mode
Transport policies with excellent health performance: Walking, Cycling, Public Transport/ Rapid Transit
Modal split: more active & public transport, less car use, improve health determinants Review of  studies on urban travel ...
Investment in infrastructure for public and active transport, & for limiting car travel, improve health determinants  Revi...
Driving policy change towards adopting healthy urban transport – facilitating a transition <ul><li>Governance – how govern...
Diffusion of governance – who do we need to engage with? Governance.com: democracy in the information age, E.C. Kamarck & ...
What information is relevant to those groups?  Technical solutions are needed, but not sufficient to enable change  <ul><l...
To ensure sound economic decisions <ul><li>The Market for transport fails to deliver socially optimal patterns as  </li></...
To ensure policy making draws on existing knowledge and best practice   <ul><li>Difficulty in accessing information  on th...
To protect vulnerable groups <ul><li>Children are vulnerable to injuries, air pollution and noise, their cognitive and phy...
To promote health equity <ul><li>Exposure to health risks depends on mode of transport used  </li></ul><ul><li>Need to ens...
Health 'co-benefits' can pave the transition from  a grey (oil-based) to &quot;green&quot; economy  <ul><li>Green Urbanism...
Health in the 'Green Economy' analyses <ul><li>Identifies green growth policies (described in IPCC) that are better for he...
IPCC analyses have not covered co-benefits  from green and climate friendly policies – Transport <ul><li>Findings: Current...
Role for BRT and Integrated systems: Knowledge on impacts of policies that can support  transition <ul><li>Generation of k...
Need for healthy transport indicators to inform policy change <ul><li>Evaluation of baseline across diverse settings.  </l...
Healthy transport indicators can… <ul><li>Provide policymakers with arguments for a more &quot;virtuous&quot; policy cycle...
Healthy transport indicators – capturing key “nodes” of interaction
Pathways of health impact <ul><li>Transport interventions </li></ul><ul><li>Economic </li></ul><ul><li>Regulatory </li></u...
Current transport indicators measure how well transport systems move vehicles Kilometres of paved road per square kilometr...
Transport indicators that  might  better link to health are missing from the puzzle  Kilometres of separated cycle lanes/t...
Examples: Healthy transport indicators should track four measurable domains of impacts  Measure  access/physical activity ...
Access  (Domain 1: examples)   ACCESS/Equity  Target POPULATION HEALTH HAZARD/ RESOURCE INDICATOR (examples) DATA/ METHOD ...
Physical activity  (Domain 2: examples)  PHYSICAL ACTIVITY Target POPULATION HAZARD /Resource INDICATOR (examples) DATA AN...
Health indicators for urban transport should be...  <ul><li>Already available or measurable with sparse resources </li></u...
Getting the right data for building healthy transport indicators <ul><li>Requires coordinated action by all partners: </li...
Researchers: keep in mind that simple surveys can yield rich data  People on heavily- trafficked streets reported fewer ne...
‘ Healthy transport’ indicators can inform:  <ul><li>a.  Monitoring, reporting, verification (MRV) systems;  e.g. for deve...
a. Monitoring, reporting and verification <ul><li>MRV may become increasingly important for transport systems to financing...
b. Health and environment impact assessment of specific projects <ul><li>Key transport indicators can be integrated with/a...
c. Modeling/mapping  <ul><li>Modeling can offer more detailed pictures at different scales  </li></ul><ul><li>Integrated r...
HEARTS: Florence case study noise Lnight level differences in receptors (coloured dots) between 2010 and 2003 scenarios A ...
Simulating time-activity patterns: exposure to benzene in a polluted Italian urban area
d.  Economic assessment  <ul><li>Systematic collection of relatively few, robust indicators can support health-economic as...
<ul><li>BRT's impact on health likely extends well beyond the commuter corridor. </li></ul><ul><li>Measuring the long-term...
5 .  Towards global, harmonized  'healthy transport' indicators
What IS a 'healthy'   transport indicator? Proposed definitions <ul><li>Any single (or group) of statistical values that t...
Choosing the best data as an indicator <ul><li>Only a few indicators can be measured routinely; they should reflect: </li>...
Next steps: <ul><li>A partnership between key cities and WHO, harnessing WHO's broad experience on transport, environment ...
WHO is ready to travel with you Photo credits: www.stillpictures.com ;  www.hardrainproject.com ;  www.bigstock.com
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Synergies between urban transport and public health

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Synergies between urban transport and public health

  1. 1. Synergies between Urban Transport and Public Health Dr Carlos Dora Coordinator Interventions for Healthy Environments Department of Public Health and the Environment PUBLIC HEALTH AND ENVIRONMENT
  2. 2. This presentation covers <ul><li>The links between urban transport and public health </li></ul><ul><li>Which transport policies are good and which are bad for health </li></ul><ul><li>Driving policy change towards adopting healthy urban transport </li></ul><ul><li>The role of BRT and integrated systems in facilitating a transition </li></ul>
  3. 3. The links between Transport and Health <ul><li>Urban air pollution -> 1.2 million deaths </li></ul><ul><li>Physical inactivity -> 3.2 million deaths </li></ul><ul><li>Traffic injuries -> 1.3 million deaths </li></ul><ul><li>Traffic noise -> stress, heart disease, analytical impairment </li></ul><ul><li>Climate change -> over 150 000 deaths </li></ul><ul><li>Access to vital goods and services, social networks/equity/cohesion -> profound and under-reported. </li></ul>Every year:
  4. 4. T-Related Air Pollution leads to heart and lung disease and premature deaths <ul><li>Increases in hospital admissions, and asthma attacks </li></ul><ul><li>To loss of millions of working days </li></ul><ul><li>Children living near busy roads with heavy/diesel vehicle traffic have higher risks of respiratory problems. </li></ul><ul><li>Every 10 µg/m 3 decrease in PM2,5 leads to 3,4% decrease in mortality </li></ul><ul><li>Health impacts are larger in lower socioeconomic groups (cumulative exposures) </li></ul>
  5. 5. Better air quality improves health The health benefits of a ban of coal sales i n Dublin Clancy et al 2002
  6. 6. Reduction in fine PM and mortality: extended follow up of Harvard six Cities Study Period 1: 1974-89 (mean PM2.5: 1980-85) Period 2: 1990-98 Laden et al. AJRCCM 2006
  7. 7. 30 minutes of physical activity a day is enough to reduce: <ul><li>By 50% the r isk of heart disease (CHD) </li></ul><ul><li>By 50% the risk of diabetes (NID-D) </li></ul><ul><li>By 50% the risk of obesity </li></ul><ul><li>By 30% the risk of hypertension </li></ul><ul><li>The risk of colon and breast cancer (50% reduction in colon cancer in Shanghai study) </li></ul><ul><li>Help maintain bone mass and protect against osteoporosis </li></ul><ul><li>Improve balance, coordination, mobility, strength and endurance </li></ul><ul><li>Increase self-esteem, reducing levels of mild to moderate hypertension. </li></ul>
  8. 8. 60% of world population does very little physical activity Most health gains from getting the inactive to move Greater health benefits among least active Dose-response physical activity and health, B Martin et al, 2004 Active transport is PA with a practical purpose No need to go to the Gym
  9. 9. Traffic Noise is a major cause of annoyance; Interferes With Memory, Attention and Ability to Deal With Analytical Problems <ul><li>Emerging and consistent evidence for impact on hypertension and cardiovascular disease </li></ul><ul><li>Children chronically exposed to loud noise show: </li></ul><ul><li>impaired acquisition of reading skills, </li></ul><ul><li>attention and problem-solving ability. </li></ul><ul><li>Road traffic is the major source of exposure to noise. </li></ul>
  10. 10. <ul><li>Psychological Barriers - How people feel about moving through an area: </li></ul>Community Severance <ul><li>Perceived danger </li></ul><ul><li>Traffic noise </li></ul><ul><li>Can combine to produce: </li></ul><ul><li>Trip Suppression </li></ul><ul><li>Traffic pollution </li></ul>
  11. 11. Traffic Deaths: 1,2 million/year Traffic Injuries over 40 million/year Source: Peden et al (2004) 0-4 5-14 15-29 30-44 45-59 60+ Male Female Share by age group
  12. 12. Children pay a High Price <ul><li>They are at higher risk of being involved traffic injuries . </li></ul><ul><li>Play unhindered by street traffic = double social contacts </li></ul><ul><li>Restrictions to walk and cycle hinder the development of their independence . </li></ul><ul><li>Lack of physical activity leads to obesity . </li></ul>Obesity in children BMJ, 2001; 322:24-6
  13. 13. Need to prevent main global cause death - Chronic diseases <ul><li>Cardiovascular disease, mainly heart disease, stroke </li></ul><ul><li>Cancer </li></ul><ul><li>Chronic respiratory diseases </li></ul><ul><li>Diabetes </li></ul>
  14. 14. Transport can be a 'facilitator' or a 'burden' on health <ul><li>Transport systems offer vital access to health-essential goods, services, education and employment – and to physical activity and social networks. </li></ul><ul><li>Poorly designed transport systems create a health burden directly (injury risks) and indirectly (equity, access, social cohesion, etc.). </li></ul><ul><li>Conventional transport indicators fail to capture the full range of positive & negative health impacts </li></ul>
  15. 15. Hanoi, 1993 Hanoi, 2001 Hanoi, 2002 More vehicles = more road space/construction for vehicles = greater air pollution, noise and physical activity risks
  16. 16. The vicious cycle: Increased traffic injury risks Parents drive their children to school by car Traffic increases Streets are even more dangerous More children are physically inactive and obese
  17. 17. Busy road environment puts pedestrians and cyclists at risk Source: Pucher and Dijkstra, Promoting safe walking and cycling to improve public health: Lessons from the Netherlands and Germany, Am J Public Health, 2003: 93:1509-16. Holland Germany US Walking share of urban trips 18% 22% 6% Biking share of urban trips 28% 12% 1% Pedestrian fatality rate (deaths/100M km) 2.5 4.4 14.0 Bicyclist fatality rate (deaths/100M km) 2.0 3.2 7.2
  18. 18. Narrow solutions: limited results. <ul><li>e.g. Continuing Traffic Growth Has Cancelled Out Pollution Savings from Cleaner and More Efficient Vehicles </li></ul><ul><li>Cars are becoming heavier and more powerful. </li></ul><ul><li>Trips are becoming increasingly long . </li></ul><ul><li>Total kilometers traveled by road continues to grow </li></ul>EC: Transport in Figures, 2000
  19. 19. Diesel & clean diesel <ul><li>Adopted often because it produces less CO2 </li></ul><ul><li>Produces more particles (PM10, PM 2,5) per unit travelled </li></ul><ul><li>Shift to diesel in Europe could explain lack of decline in PM10 in last decade </li></ul><ul><li>Health impacts of air pollution have not changed either in the last decade </li></ul>
  20. 20. Large global investments being made in new transport systems <ul><li>...but with little measurement of their real health impact on most of the world's population </li></ul>
  21. 21. For instance, investments in transit, cycling and pedestrian infrastructures are not well tracked World Bank lending by mode
  22. 22. Transport policies with excellent health performance: Walking, Cycling, Public Transport/ Rapid Transit
  23. 23. Modal split: more active & public transport, less car use, improve health determinants Review of studies on urban travel mode, physical activity and health – WHO/Health in Green Economy (forthcoming)
  24. 24. Investment in infrastructure for public and active transport, & for limiting car travel, improve health determinants Review of studies on infrastructure investment, physical activity and health – WHO/Health in Green Economy (forthcoming)
  25. 25. Driving policy change towards adopting healthy urban transport – facilitating a transition <ul><li>Governance – how governments, social organizations interact, how they relate to citizens and how decisions are taken in a complex globalized world (Institute of Governance, Ottawa, Policy Brief 2003) </li></ul><ul><li>New types of: </li></ul><ul><li>Leadership </li></ul><ul><li>Engagement </li></ul><ul><li>Accountability and transparency </li></ul>
  26. 26. Diffusion of governance – who do we need to engage with? Governance.com: democracy in the information age, E.C. Kamarck & J.S. Nye Jr. (eds) 2002 Local groups Local government Local businesses Subnational level National non-profits State National corporations National level NGOs Intergovernmental organizations Transnational corporations Supranational level Third sector Public sector Private sector
  27. 27. What information is relevant to those groups? Technical solutions are needed, but not sufficient to enable change <ul><li>Economically sound? </li></ul><ul><li>Fair? does it improve equity? </li></ul><ul><li>Long term implications – does it protect children? </li></ul><ul><li>Does it respond to aspirations of different groups in society? </li></ul><ul><li>Does it respond to society's greatest concerns? e.g. Climate Change, Green Economy </li></ul>
  28. 28. To ensure sound economic decisions <ul><li>The Market for transport fails to deliver socially optimal patterns as </li></ul><ul><ul><li>Transport Costs are not all paid for the user, and the costs borne by others (external costs) are substantial. </li></ul></ul><ul><ul><li>The overall use of transport, particularly more polluting modes, is then higher than socially optimal </li></ul></ul><ul><ul><li>The right investments and prices (for pollution, accidents etc.) would correct these distortions </li></ul></ul><ul><li>The end result is cost to all society that are not seen by the individual: </li></ul><ul><li>absenteeism to work and costs to businesses, </li></ul><ul><li>increasingly high health care costs of chronic diseases, </li></ul>
  29. 29. To ensure policy making draws on existing knowledge and best practice <ul><li>Difficulty in accessing information on the health impacts of transport interventions </li></ul><ul><li>Myths about what is good practice are repeated and reinforced </li></ul><ul><li>Scientific evidence is scattered, and often not translated regarding its implications for policy </li></ul>
  30. 30. To protect vulnerable groups <ul><li>Children are vulnerable to injuries, air pollution and noise, their cognitive and physical development require exploration of the neighbourhood and outdoor activity. </li></ul><ul><li>Children and other vulnerable groups are exposed to risks from traffic but enjoy few benefits from it. </li></ul><ul><li>These groups often do not have a voice to influence decisions. Evidence should make their case heard </li></ul>
  31. 31. To promote health equity <ul><li>Exposure to health risks depends on mode of transport used </li></ul><ul><li>Need to ensure safety of people using all modes </li></ul><ul><li>Pedestrians and cyclists do not cause pollution, contribute to reducing traffic congestion, will use health services less and be more assiduous to work, but are exposed to health risks caused by motor vehicle users (injuries, pollution) </li></ul><ul><li>Policies that reduce the health risks of the poor help reduce poverty </li></ul><ul><li>Healthy mobility for the poor also improves health by increasing access to jobs, education and health services </li></ul>
  32. 32. Health 'co-benefits' can pave the transition from a grey (oil-based) to &quot;green&quot; economy <ul><li>Green Urbanism – land use plans, public transport and walking and cycling lead to: </li></ul><ul><li>Less obesity, traffic injuries, cardiovascular & respiratory diseases </li></ul><ul><li>More access to goods and services for all – less inequity – human security </li></ul><ul><li>Access to healthier, varied, lower-fat diets – more sustainable food production </li></ul><ul><li>Energy security – less dependence on oil </li></ul>
  33. 33. Health in the 'Green Economy' analyses <ul><li>Identifies green growth policies (described in IPCC) that are better for health in: </li></ul><ul><li>Transport </li></ul><ul><li>Housing </li></ul><ul><li>Household energy </li></ul><ul><li>Food/agriculture policies </li></ul><ul><li>'Greening' the health sector </li></ul>
  34. 34. IPCC analyses have not covered co-benefits from green and climate friendly policies – Transport <ul><li>Findings: Current IPCC reviewed policies emphasize improved vehicle fuels and engines. </li></ul><ul><li>They miss major health and mitigation co-benefit opportunities from cycling/walking/transit and public transport & compact urban land use. </li></ul><ul><li>Not in the analyses – out of consideration for policies and incentives </li></ul><ul><li>This will be revised in the next IPCC report </li></ul>
  35. 35. Role for BRT and Integrated systems: Knowledge on impacts of policies that can support transition <ul><li>Generation of knowledge that is meaningful to stakeholder groups: </li></ul><ul><ul><li>User groups </li></ul></ul><ul><ul><li>Funding sources </li></ul></ul><ul><ul><li>Local government </li></ul></ul><ul><ul><li>Businesses </li></ul></ul><ul><li>A vision on how health and wellbeing can be achieved through urban transport </li></ul>
  36. 36. Need for healthy transport indicators to inform policy change <ul><li>Evaluation of baseline across diverse settings. </li></ul><ul><li>Assess costs of business as usual </li></ul><ul><li>Estimate health impacts of policies projects before major new investments are made. </li></ul><ul><li>Prioritize investments in transport (maintenance and infrastructure). </li></ul><ul><li>Evaluate efficiency of implemented interventions. </li></ul><ul><li>Evaluate progress. </li></ul>
  37. 37. Healthy transport indicators can… <ul><li>Provide policymakers with arguments for a more &quot;virtuous&quot; policy cycle leading to: </li></ul><ul><li>Less cardiovascular and respiratory diseases from air pollution </li></ul><ul><li>More opportunities for physical activity </li></ul><ul><li>Safer movement by pedestrians/cyclists </li></ul><ul><li>Greater access for the majority of people – who do not own or regularly use a motor vehicle, including: (most women, children, elderly & middle income as well as poor). </li></ul>
  38. 38. Healthy transport indicators – capturing key “nodes” of interaction
  39. 39. Pathways of health impact <ul><li>Transport interventions </li></ul><ul><li>Economic </li></ul><ul><li>Regulatory </li></ul><ul><li>Infrastructure </li></ul><ul><li>Information </li></ul><ul><ul><li>Technology </li></ul></ul><ul><ul><li>Land use/ planning </li></ul></ul><ul><ul><li>Equity </li></ul></ul>Travel behaviour in system Geo-spatial features of transport system Environmental pollution – air, noise, water Traffic injuries Access Physical activity Health
  40. 40. Current transport indicators measure how well transport systems move vehicles Kilometres of paved road per square kilometre (a little bit of) public transport ridership Average speed of car/truck traffic flow Car/motorcycle ownership per 1000 (a little) urban air pollution
  41. 41. Transport indicators that might better link to health are missing from the puzzle Kilometres of separated cycle lanes/traffic calming – injuries Public transport service level/ travel share for NMT – access and equity Average urban PM10 – Cardiovascular/ respiratory disease HEALTH IMPACTS Sidewalk connectivity and safety – physical activity
  42. 42. Examples: Healthy transport indicators should track four measurable domains of impacts Measure access/physical activity - key health benefits of transport. Measure pollution and injury - key health risks of transport systems. Substantial epidemiological evidence exists about health outcomes in all four domains. <ul><li>Access/equity of access </li></ul><ul><li>Physical activity </li></ul><ul><li>Pollution (air, noise and water) </li></ul><ul><li>Traffic injury </li></ul>
  43. 43. Access (Domain 1: examples) ACCESS/Equity Target POPULATION HEALTH HAZARD/ RESOURCE INDICATOR (examples) DATA/ METHOD Neighborhood cohesion Neighborhood or other sub-area; Vulnerable groups, e.g. children, elderly, women, disabled Land use/transport barriers to access Inequity of safe movement/ exposure to emissions <ul><li>Neighborhood integrity index; arterial streets/dividing highways </li></ul><ul><li>% health-essential goods and services in walking distance. </li></ul><ul><li>Pedestrian environment quality index (PEQ) – level of service metric reflecting h azards per/km sidewalk. </li></ul><ul><li>No. of weekly social interactions in neighborhood </li></ul><ul><li>Mapping of health-essential goods and services within walking distance. </li></ul><ul><li>Mapping major street/highway barriers </li></ul><ul><li>Mapping hazards, e.g. lack of sidewalks/obstacles/unsafe crossings </li></ul><ul><li>Social mapping of acquaintances/friends </li></ul>Neighborhood connectivity Community or sub area; vulnerable groups, e.g. children, elderly, women, disabled Lack of access to essential services public transport networks <ul><li>% transit modal share </li></ul><ul><li>Daily travel time/distance </li></ul><ul><li>New BRT/cycle lanes vs. new road lanes </li></ul><ul><li>Kilometres of bike lanes/kilometres of roads </li></ul><ul><li>Household survey/model of travel behaviors </li></ul><ul><li>Travel surveys/model for specified destinations via transportation model </li></ul>Access to jobs; schools; parks/recreation/ green spaces Simulated or sample individual-level Absence or fragmentation of parks/ recreational areas. <ul><li>Volume/frequency of transit service </li></ul><ul><li>% group within 10 minute walk to park. </li></ul><ul><li>% group within 30 minute walk to work/school </li></ul><ul><li>m 2 /acres of green space per m 2 of built pace. </li></ul><ul><li>Surveys using land use maps </li></ul><ul><li>Mental mapping/use surveys </li></ul>
  44. 44. Physical activity (Domain 2: examples) PHYSICAL ACTIVITY Target POPULATION HAZARD /Resource INDICATOR (examples) DATA AND METHODS Active transport (use of cycling and walking as a travel mode) Pedestrians and cyclists - Lack or absence of networks for active travel - Lack of connectivity between active travel networks and public transport to key urban destinations <ul><li>Ratio of pedestrian/cycle network: road vehicle network </li></ul><ul><li>% of trips by public transport (which can be a proxy for active travel) </li></ul><ul><li>% of population that walks and cycles sufficient for fitness and health (15 minutes or more daily). </li></ul><ul><li>Life expectancy gain/loss attributed to routine physical activity/active transportation </li></ul>% pedestrian/cycle network/road vehicle network from regional travel model: Modal split surveys to include data on pedestrians/cycle travel Calculation of Disability-Adjusted Life Years from data meta-analysis Recreational cycling/walking For play, exercise social activity/social interaction Children; adult subgroup - Lack or absence of network - Safety, social, environmental pollution barriers to recreational mode use Pedestrian Environmental Quality Index (PEQ - Level of Service Metric); Bicycle environmental quality index (BEQ) Children’s travel mode to school % of children's playtime spent walking/cycling/moving outdoors % children obese % engaging in daily physical activity Standardized observational surveys of physical features/barriers to system use; Bicycle/pedestrian counts Travel diaries Standardized physical activity/ obesity surveys
  45. 45. Health indicators for urban transport should be... <ul><li>Already available or measurable with sparse resources </li></ul><ul><li>Specific to transport policies </li></ul><ul><li>Robust and relevant to different scales/contexts </li></ul><ul><li>Meaningful and motivating </li></ul><ul><li>Actionable – can be modified by changed transport policies. </li></ul>
  46. 46. Getting the right data for building healthy transport indicators <ul><li>Requires coordinated action by all partners: </li></ul><ul><li>MINISTRY OF TRANSPORT - modal split indicators - transit, walking, cycling. </li></ul><ul><li>DEVELOPMENT BANKS - investment indicators - transit, walking/cycling infrastructure. </li></ul><ul><li>CITY – indicators of traffic injuries involving pedestrians/cyclists. </li></ul><ul><li>AIR POLLUTION - key air quality indicators, e.g. PM 10 . </li></ul><ul><li>HEALTH SYSTEMS - incidence/costs of treatment for injury and pollution-related conditions. </li></ul><ul><li>NGOs/RESEARCHERS – Simple field surveys of spatial and human factors (e.g. bicycle count, pedestrian environment quality; social interactions), using standardized observational/reporting methods easily repeated over time, and in diverse locales. </li></ul>
  47. 47. Researchers: keep in mind that simple surveys can yield rich data People on heavily- trafficked streets reported fewer neighbourhood friendships - Appleyard, 1981
  48. 48. ‘ Healthy transport’ indicators can inform: <ul><li>a. Monitoring, reporting, verification (MRV) systems; e.g. for development financing, carbon credits, etc. </li></ul><ul><li>b. Health and environment impact assessment; e.g. mortality/morbidity impacts of a transport change. </li></ul><ul><li>c. Modeling/mapping health impacts, real-time or simulation, in data-scarce settings. </li></ul><ul><li>d. Economic assessment – e.g. comparison of transport indicators with data on insurance costs/ health expenditures for injuries/air pollution/obesity related diseases. </li></ul>
  49. 49. a. Monitoring, reporting and verification <ul><li>MRV may become increasingly important for transport systems to financing with carbon credits, etc. </li></ul><ul><li>Transport systems currently find it difficult to demonstrate their added value in CDM context. </li></ul><ul><li>Climate Investment Funds consider co-benefits </li></ul><ul><li>Integrating health indicators/measures could provide a point of “added value”. </li></ul>
  50. 50. b. Health and environment impact assessment of specific projects <ul><li>Key transport indicators can be integrated with/assessed against health indicators to assess impact of a transport project on population: </li></ul><ul><ul><li>Burden of disease (deaths, DALYs) from injuries, air pollution, physical activity </li></ul></ul><ul><ul><li>Modal split!!! </li></ul></ul><ul><ul><li>Investments in sustainable transport (cycling/walking, PT) </li></ul></ul><ul><ul><li>Health expenditures for treatment of injuries and pollution-related conditions </li></ul></ul><ul><ul><li>Insurance-related expenditures on accidents/injuries) </li></ul></ul>
  51. 51. c. Modeling/mapping <ul><li>Modeling can offer more detailed pictures at different scales </li></ul><ul><li>Integrated risk modeling can integrate different data sets to project the results of alternative policy scenarios. </li></ul><ul><li>Integrated transport, spatial/exposure and epidemiological modelling can yield data on aggregate health impacts from changes in: air pollution exposures, traffic accidents and physical inactivity. </li></ul><ul><li>WHO's HEARTS (Health Effects and Risks of Transport Systems) is an example of a GIS-based model of transport impacts on: injuries, air pollution, and noise. ( www.euro.who.int/__data/assets/pdf_file/0013/91102/E88772.pdf ) </li></ul>
  52. 52. HEARTS: Florence case study noise Lnight level differences in receptors (coloured dots) between 2010 and 2003 scenarios A comparison of noise levels in 2010 vs 2003 scenario shows a marked reduction of Lnight levels
  53. 53. Simulating time-activity patterns: exposure to benzene in a polluted Italian urban area
  54. 54. d. Economic assessment <ul><li>Systematic collection of relatively few, robust indicators can support health-economic assessment tools, such as WHO's Health Impacts of Active Transport (HEAT).* </li></ul><ul><li>HEAT allows 'health' to speak in the language of financial stakeholders. </li></ul><ul><li>Economic valuation of impacts strengthen the health argument. </li></ul><ul><li>It can allow health actors to weigh in on debates such as : </li></ul><ul><ul><li>The health economic benefits of investments in cycling, pedestrian infrastructure </li></ul></ul><ul><ul><li>Congestion pricing; pay-as-you-drive; parking cash-out schemes, etc. </li></ul></ul><ul><li>* ( http://www.euro.who.int/__data/assets/pdf_file/0011/87482/E90948.pdf ) </li></ul>
  55. 55. <ul><li>BRT's impact on health likely extends well beyond the commuter corridor. </li></ul><ul><li>Measuring the long-term or broader impacts of BRT on health, other simple indicators to consider would be: </li></ul><ul><ul><li>Shift in modal split over time to more/less PT/walking/cycling in and beyond the BRT corridor. </li></ul></ul><ul><ul><li>Change in average PM10 levels in the neighbourhoods near the corridor, and city-wide. </li></ul></ul>Example: a systematic evaluation of BRT
  56. 56. 5 . Towards global, harmonized 'healthy transport' indicators
  57. 57. What IS a 'healthy' transport indicator? Proposed definitions <ul><li>Any single (or group) of statistical values that together give an indication of the system's functionality for health benefit. </li></ul><ul><li>A standardized measure of change/progress in the transport system that reflects impacts health: </li></ul><ul><ul><li>over time </li></ul></ul><ul><ul><li>in comparison to other groups/settings with similar characteristics. </li></ul></ul>
  58. 58. Choosing the best data as an indicator <ul><li>Only a few indicators can be measured routinely; they should reflect: </li></ul><ul><ul><li>Most robust evidence on health impacts – preferably in one or more “domains” </li></ul></ul><ul><ul><li>Potential for routine, continued use </li></ul></ul><ul><ul><li>Ease of collection in data-sparse settings </li></ul></ul><ul><ul><li>Ease of integration into health-oriented modelling/burden of disease assessment . </li></ul></ul>
  59. 59. Next steps: <ul><li>A partnership between key cities and WHO, harnessing WHO's broad experience on transport, environment & health and the cities experience and opportunities for documenting transport policies impacts, and communicating with stakeholders. </li></ul><ul><li>Pilot test set of indicators, communication of results locally, engagement with stakeholders on transport and health </li></ul><ul><li>Review and agree on a core set of indicators that can be used evaluate investments and report back on health, climate change and other benefits: </li></ul><ul><li>Global communication strategy on healthy transport as a way to facilitate transition towards more human and green models of urban development </li></ul>
  60. 60. WHO is ready to travel with you Photo credits: www.stillpictures.com ; www.hardrainproject.com ; www.bigstock.com

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