Transport and health on World Health Day
Transport is inextricably linked to both our physical and mental health, yet transport policies almost invariably focus on economic outcomes and carbon reduction. To mark World Health Day, we spoke to Dr Aagash Vadera, a GP and part of the Create Streets Network, to discover a health professional’s take on transport.
How frequently are you seeing patients who are negatively being impacted by our current transport system?
Every day! If your movement within the world is at the behest of our transport system, then it is easy to see why poor transport leads directly to social isolation, lack of engagement within the community and inability to access local services such as the GP. In some areas that I work, this happens on a daily basis, where infrequent or unreliable bus routes mean that a patient is unable come to the surgery at a given time.
It’s important to remember that cars are expensive, and not everybody has access to one. If we make access to essential services car dependent, it is the poorest in society that will suffer the most. Once a week I help out at a nearby food bank where we provide up to four quite heavy bags of food, toiletries and essentials to those in need. I wonder how many people are not able to get to the food bank due to the transport system.
Aside from the impacts of air pollution from transport, what other impacts can poor transport have on people’s health and wellbeing?
The impacts are wide-reaching and profound. They reverberate across geography, generation and socio-economic class.
Poor transport untethers people from their communities. This means difficulty accessing 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.
Noise pollution should be spoken about in the same breath as air pollution – such are it’s causes and negative effects on our health. Noise from traffic has been well established to increase the risk of cardiovascular disease (heart attacks, strokes), blood pressure, stress levels, poor sleep and for children cause hearing damage and speech disturbance.
Poor transport also entrenches regional inequality, disconnecting people from better homes and better jobs.
The biggest impact, however, is what we’re NOT doing. We are losing the battle against inactivity. We move 20 per cent less than we did in the 1960s. The wider cost of obesity to the economy is estimated to be £100 billion a year, look at this figure in relation to the NHS health budget (more than half). A fifth of our children leave primary school with obesity. This is setting them up for a life of chronic ill health.
Transport has a key role to play in countering this trend. Our current transport system bakes in sedentary living, yet active travel (including at the start and end of each public transport trip) 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. The upsides dwarf the downsides more than any other intervention we have. We should be leaning into this with all our force. The chance to reduce the risk of almost every chronic disease, cancer, dementia and obesity. The massive uplifts to mental health and psychological wellbeing, without touching tablets. The huge boosts to immune, bone, muscle, cognitive, cardiovascular, respiratory health. Better school outcomes for children, better workplace performance for adults. The list goes on!
Do you think the impact of poor transport on people’s health and wellbeing is recognised by government?
Yes and no. Yes in the sense that the data is there: the research is done, the reports written, the recommendations laid out.
No in the sense that there is still an element of ‘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.
Do you think the government has historically done enough to address the health impacts of poor transport?
The various clean air initiatives are good, as are active neighbourhoods, and the general direction of travel regarding active travel.
However, dedicated capital investment into active travel infrastructure is negligible. We have some of the lowest levels of cycling, walking and wheeling in Europe. Based on this alone, there is more to be done.
How do you think tackling the health impacts of transport can help deliver on one of the Government’s five missions: Build an NHS fit for the future?
The key words are ‘fit’ and ‘future’.
Our ageing population is a massive (current and future) pressure on NHS services and budgets. It is not just that we are growing older, but that we are doing so with more ill health. Preventative, population-based healthcare is what we need to stay fitter and healthier for longer. If our current trends for chronic disease, cancer and obesity continue for another generation, our health and social care system will collapse.
What as a GP, do you think would be single best policy/intervention to address the health impacts of transport?
The main health impacts from transport are the negative effects of air/noise pollution and the positive effects of physical activity through active travel. It’s about maximising the good and mitigating the bad. Broadly speaking this means driving less and walking/cycling more, both as standalone trips and to/from public transport.
During the ten minutes I have with a patient, I can, at best, appeal to the willpower of the individual in front of me, to try and instigate some health-related behavioural change. This is good, necessary work but misses the fact that we are conditioned and constrained by our environment. The popular line that we are a ‘country of motorists’ has it exactly backwards: we are a country of roads, and this leads, inevitably, to driving as default.
Alongside the expansion of [public transport and active travel] infrastructure, we need to tell better stories about active travel, get our leaders on board, and defuse any cultural warfare to find (the ample) common ground. This involves painting a vision of the future of transport – one that is ambitious, proactive and has cross-sector benefits – so that everyone, from motorists to cyclists, children to the elderly, economists to environmentalists, can sing from the same hymn sheet.
During the pandemic, we saw the power of a well-coordinated public health campaign. Citizens dutifully ‘protected the NHS’ by complying with various lockdown measures. We need a similar mobilisation of the public health apparatus towards increasing our physical activity through walking and cycling – again to protect the future of the NHS.
Dr Aagash Vadera is an NHS GP interested in the power of urban design and transport planning to transform our health. He worked with Create Streets on the Move Free report.
