Transport impacts our health in the most fundamental ways. It affects the air that we breathe and determines whether we can access basic healthcare. The simplest forms of exercise – like walking – can be rendered joyful or miserable by transport policy.
Air and noise pollution from traffic, a reduction in physical activity caused by increased use of motorised vehicles, coupled with the impact of a lack of access to transport – reduced access to health services, loneliness, lack of social interaction – all mean that our transport system has far reaching consequences for our health and wellbeing.
Air pollution
Air pollution is probably the most well-known of transport’s harmful side effects and one that is thankfully recognised and is being addressed. Cleaner fuels and efforts to reduce both the number of vehicles and keep the dirtiest out of urban centres is starting to have an impact on improving air quality, but there’s still a long way to go. The government’s plan to reinstate the 2030 ban on sales of all new petrol and diesel cars is welcome news, but with reports that sales of hybrid vehicles could continue until 2035, it will still be decades until all new cars are zero emission.
Of course, it’s not just private cars that are contributing to dirty air, road freight is a major source of air pollution, particularly in urban areas. ‘Last-mile’ home deliveries –the journeys between your local depot and front door – increase congestion and pollute the air where people live. In London, freight represents 15% of total vehicle miles travelled and this looks set to increase.
The government has a role to play in helping businesses make the switch to less polluting delivery modes as Dr Natasha Feiner, policy and influencing manager at Impact on Urban Health, and part of the Health Effects of Air Pollution programme, explains:
“There are two key areas where the government could be effective in helping reduce pollution from freight and improving health. More financial support, with interest-free or fixed low-interest loans and a tiered business rates relief system, would help incentivise businesses to track and reduce polluting emissions. And new regulations would provide businesses with a level playing field and more certainty for long-term investment in sustainable technologies.”
The previous government set a target to grow rail freight by 75% by 2050, which should help remove some lorries from motorways and A roads, but as we only currently move less than 10% of freight by rail, we have a long way to go before we see a significant shift away from road freight as the default mode for transporting goods.
Changes to national planning policy via the National Planning Policy Framework (NPPF) also have the potential to support a shift to more sustainable movement of goods, as Dr Feiner explains: “It’s been positive to see the new government consulting on changes to how transport and freight is planned via the NPPF. This could support new delivery infrastructure, like pick-up and drop-off points, that would significantly improve how freight operates in urban centres.
“Making it easier for people to choose an ‘active last mile’ – meaning a person would have the option to walk or cycle to pick up or drop off a parcel – can help to reduce air pollution from delivery vans in residential areas. Currently, not enough people live near pick-up and drop-off points, but the ‘vision-led’ approach to transport proposed in the NPPF could change this.”
Car dependency
“Poor transport untethers people from their communities,” says GP Dr Aagash Vadera. “It makes it more difficult to access local amenities, essential services and support networks and results in a less cohesive community. The effects are not just in lower subjective wellbeing: social isolation and loneliness is as serious a risk factor as obesity and smoking for chronic disease, mental health and dementia.”
As a society, our reliance on cars as the main form of transport has led to the marginalisation of certain groups of people for whom car ownership is either impossible, impractical or unaffordable. Creating a society where car ownership is key to being an active member of the community is contributing to poor physical and mental health and, in turn, to accessing the health services that people need to get better.
Two thirds (66%) of people in England can’t reach their nearest hospital by public transport in under 30 minutes. For those in urban towns and cities, the average minimum journey time is around 40 minutes but for those in rural villages, it’s almost double. For context, car drivers can reach their nearest hospital in just 20 minutes on average (1).
Missed appointments cost the NHS more than £216m in 2023, and in 2021/2022, 7.8 million appointments were missed with one in 10 people citing travel as the main reason (2). As a GP, missed appointments is something Dr Vadera deals with on a daily basis.
“In some areas that I work, patients are missing appointments because they are reliant on public transport and unreliable or infrequent buses often mean they are unable to come to the surgery at a given time. Once a week I help out at a nearby food bank. I wonder how many people are not able to get to the food bank, which is only open for two hours a week, due to poor transport. If we make access to essential services car dependent, it is undoubtedly the poorest in society that will suffer the most.”
Our sedentary lifestyle
Physical activity levels are around 20% less than they were in the 1960s and our increasingly sedentary lifestyles are having serious consequences for our health and wellbeing. Half of women and a third of men in England today are not active enough to stay healthy and estimates suggest that by 2030 we will be 35% less active than we were in the 1960s (3).
The drop in our physical activity levels coincides with the increase in car ownership. At the start of the 1960s there was roughly one car for every 10 people. Today, there is one car for every two people (4). Motorways, cheaper cars, better car design and the idea of cars as status symbols all helped propel the car from a luxury item to a household necessity.
NHS data shows that 26% of adults are living with obesity in the UK and a fifth of our children leave primary school obese. Obesity is the second biggest preventable cause of cancer. The cost to the economy is estimated to be £98bn (5), so tackling the obesity crisis is one of the most urgent issues facing the country.
Transport can play a major role in reducing obesity according to Dr Vadera: “Our current transport system bakes in sedentary living. Active travel reverses this: it makes movement an intrinsic part of our day to day lives, thereby unlocking the monumental benefits of increased physical activity. From a health perspective, no intervention comes close to exercise. It is the magic pill.”
Anandita Pattnaik from UK Health Alliance, agrees: “Promoting active travel alongside public transport and reducing private car use can greatly enhance public health. Increased physical activity helps combat obesity and lowers the risk of type two diabetes, heart disease, stroke, hypertension, breast and colorectal cancers, and other obesity-related conditions. Research shows that increasing active transport from a median of four minutes to 22 minutes daily can reduce the risk of diabetes and cardiovascular diseases by 14%.”
In 2021, walking, wheeling, and cycling led to 14.6 million fewer cars on the road, reduced greenhouse gas emissions by 2.5 million tonnes and prevented 138,000 serious long-term health conditions. Active travel also offers benefits such as improved productivity and less strain on healthcare services by reducing the impact of air pollution, physical inactivity, social isolation and improving mental wellbeing.
Pattnaik believes that transport has a major role to play in improving our health: “The most useful transport policy from a public health perspective would be to reduce motorised road traffic and increase investment in high-quality infrastructure to support and encourage walking, wheeling, cycling, and the use of public and shared community transport.”
Transport policies almost invariably focus on economic outcomes and carbon reduction, but they must also address our health and wellbeing. Dr Vadera agrees: “There is still too much ‘thinking in silos’. The benefits of better transport cut across so many sectors, that we do it a disservice by not recognising this.
“Education, employment, economy, environment, ecology, physical health, mental health, community cohesion, housing, high streets, regional inequality – all stand to gain. We need to start talking about it like this, and that is not something I have seen or heard from any government.”
[References]
- https://www.gov.uk/government/statistics/journey-time-statistics-england-2019/journey-time-statistics-england-2019
- https://www.england.nhs.uk/2023/01/nhs-drive-to-reduce-no-shows-to-help-tackle-long-waits-for-care
- Ng SW, Popkin B (2012) Time Use and Physical Activity: a shift away from movement across the globe. Obesity Review 13(8):659-80
- www.waterstones.com/book/british-car-advertising-of-the-1960s/heon-stevenson/9781476667898
- https://institute.global/insights/public-services/unhealthy-numbers-the-rising-cost-of-obesity-in-the-uk
This article was authored by Campaign for Better Transport, a transport charity working throughout England and Wales. For more information, visit bettertransport.org.uk
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