Guest Post: Transport is a public health issue

This is a guest post from Donna Wynd

As a social scientist, I often look at transport ‘solutions’ and find my eyes rolling to the back of my head. Transport is a sector dominated by men who are, predominantly, trained to see transport as an engineering or technology problem. Engineers in particular are trained to solve problems: toasters, particle colliders, milking machines are all solutions to specific problems. Traffic flow is no more or less a problem than reheating lasagne.

Engineering solutions tend to focus on the here and now whereas the social and environmental impact of transport networks and infrastructure stretch across space and time: they influence behaviour, and our interactions with others, yet there seems to be little recognition of this. Much of my work ultimately involves public health issues such as housing, education, and social assistance. Transport, linking as it does so many disciplines, is clearly another of them.

In other words, transport is not just about relieving commuter congestion; it is about our ability to access work, services and leisure, our physical and mental health, our physical environment, and the relationship between all these things. As such, transport has significant public health consequences beyond widening a stretch of road. In Auckland, there are two aspects of this that seem to be particularly relevant, and I will focus on those: our obesity epidemic, and the demographic changes Auckland will experience over the next 50 years.

Obesity

Obesity is something we all have an opinion on but is not well understood, even by many health professionals. In part, this is because the causes and effects of overweight/obesity are numerous and complex. Are people obese because they because they eat the wrong type of food, don’t exercise, are poor, or have unfortunate genes? All of the above.

However, the evidence points to a strong correlation between obesity and car dependence (there’s a cute graphic here).

Suburbs with services that are difficult to get to other than by car tend to have heavier populations. We know from our own experience in Auckland that such suburbs are often very hostile for cyclists and pedestrians. We also know the picture is further confused by the strong correlation between low-income and living in outer suburbs with few transport amenities other than roads. Inner-city areas with good public transport tend to have leaner, wealthier inhabitants. In part this is because transport choices are incorporated into real estate prices, thus setting up a cycle whereby low-income families are forced into more distant (from the central city) suburbs.

In general, it is also easier for residents of suburbs closer to the central city to cycle or walk to work. By contrast, almost no one who lives in the Mangere-Otara suburban belt, and who works at Highbrook or the airport walks or cycles to their jobs. A lack of protected cycle ways and high speed limits on local arterials put the frighteners on most would-be cycle commuters. Yet it is the residents of these suburbs that have the highest rates of obesity in the country and correspondingly high rates of associated diseases, especially diabetes. Plus, these areas are perfect for cycling because they are flat.

One of the tragedies of our transport system is that it doesn’t have any incentive to engage with other sectors to reduce car dependence and improve public health (indeed, it could be argued that transport planners have a vested interest in maintaining car dependence). However, while Auckland Council is blackmailing the public into supporting motorway tolls in order to fund the completion of the $207 million Auckland regional cycleway, obesity is costing our health sector millions. A 2012 paper by Boyd Swinburn and his colleagues estimates that obesity cost over $620 million in direct costs to the health sector in 2006 alone (we’ve gotten fatter since then), plus a further $98-225 million in lost productivity. Then there were the non-monetary costs including disability, and loss of quality of life. In addition there are the welfare costs associated with people unable to work because of diabetes, heart disease, the impact of strokes, the list goes on and on. People with obesity-related disability often also need subsidised housing. Given these enormous public and personal costs, putting off building decent cycling and pedestrian infrastructure (including improved access to public transport) is more than poor transport planning: it is a dereliction of duty.

I’m not suggesting that completing the cycle network and making our pedestrian facilities more accessible and attractive will solve our obesity problems. But it will help, and in a way that is cost-effective, friendly, and will help reduce our greenhouse gas emissions.

Demographic change

Overlaid onto the obesity tidal wave is the upcoming grey tsunami. New Zealand is an ageing society, something that importing younger workers will not reverse.

Older people have different transport needs to younger persons. Within 20 years it is likely that many of the current roadbuilding fraternity will be ruing the lack of alternative transport choices in Auckland as their mobility wanes. Older people don’t like driving as much, and as we age our ability to drive is reduced. Accordingly, an older, non-working, population has greater need for disability-friendly public transport, and local facilities that are easily accessible by foot. Or, if you’re my Mum, you’ll start biking to the shops to get the bread and milk when you’re in your 70s.

This means planners should be thinking about a population with higher rates of disability and a greater need for non-car transport options now. Unfortunately, the Auckland Plan, although purporting to look 30 years down the track, largely assumes today’s needs and priorities will be those in a generation’s time. The emphasis is on roading and congestion rather than the implementation of an accessible, multi-modal transport network.

Why is this a public health problem? Because the elderly still need to get to services, especially medical services, and lack of transport is a contributor to social isolation and exclusion. The 2003 report by the Social Exclusion Unit in the UK noted that “transport problems can be a significant barrier to social inclusion”, and that this may lead to a cycle of exclusion and undermine the wellbeing of communities. In addition, we know that low-income communities have a disproportionately high rate of pedestrian casualties (particularly among the young and elderly). The report notes that “the social costs of poor transport were not given any real weight in transport project appraisal. So the distribution of transport funding has tended to benefit those on higher incomes,” an observation that holds true in Auckland [emphasis in original].

The World Health Organisation notes that as a reflection of power relations, social exclusion makes it difficult for people to meet their basic needs, ignores their human rights, and undermines social cohesion. It also has a physical impact, notably through stress mechanisms that can have negative impacts on people’s health. Given the enormous costs to the health system of an ageing population, it is in all our interests to minimise the risk of injury and social isolation arising from poor transport planning. And for those with a political bent, it should not need stating that change will come one way or another because old people vote.

As with obesity, transport planners alone cannot deal with the problems of an ageing population. But a recognition of demographics should inform planning and decision-making.
Other public health issues associated with transport include the extraction and transport of fossil fuels, and public safety. Incorporating a public health perspective into our transport planning processes will pay off economically, environmentally and socially. In short, focussing on health and mobility should be the primary focus of transport planning.

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