13 August 2019
Transport or lack of it has an impact on all our lives and on public health.
Public Health professionals talk about the determinants of public health. The image below helps to illustrate the factors which affect health and who can influence it.
Transport and public health
Where you live, the air you breathe and the way we travel, all impact on public health.
- General Health and wellbeing
- Stress which could be caused by overcrowding, congestion and delays
- Injuries and fatalities on the transport network (road safety, cycle and pedestrian safety etc)
- Physical Activity
- Air Pollution
- Noise pollution
- Placemaking and community severance
- Climate Change
- Health inequalities
The Scottish Health and Inequality Impact Assessment Network (SHIIAN) report also talks about the elements of a healthy transport system. It states that the elements of a healthy transport system include: –
- Provide an inclusive system that enables all groups of people to have easy and affordable access to employment, services and amenities
- Ensure transport decisions consider and balance need with individual traveller and wider impacts on other travellers and communities
- Avoid being dominated by the needs of car users and give genuine priority to alternative modes including active modes and public transport. Transport decisions should not be based on an assumption that most people will travel by car
- Encourage promote and support active modes of travel wherever possible. The individual traveller gains health benefits from regular physical activity and the wider community is exposed to less air pollution, noise, severance and lower risk of injury to others
- Continue to improve safety, particularly for vulnerable road users. Mix of legislative, engineering and educations measures
- Land use policy and decisions on location of employment, services, amenities and retail in relation to each other and residential areas will affect how far people need to travel.
Nestrans currently works with partners including NHS Grampian, Scottish Ambulance Service, Community Transport Association, Aberdeen City Council, Aberdeenshire Council and Moray Council to deliver transport improvements that can improve both public health and access to healthcare. This work is set out in the Grampian Health and Transport Action Plan which is based around the two key themes of public health and access to health.
Aberdeen has three air quality management zones. These are locations where the air quality is monitored due to emissions breeching or being near the World Health Organisations safe levels. As such the Scottish Government has said that Aberdeen will be required to have a low emission zone (LEZ) by 2020. A LEZ is where restrictions on certain vehicles (that pollute the most emissions) will be restricted from entering a zone and penalty charges will be put in place. There is lots of evidence that show that poor quality can affect health, particularly those who are vulnerable or have existing health conditions. Transport is a key emitter of pollution and Aberdeen City Council is currently working to establish the most appropriate LEZ model for Aberdeen.
Alternative fuels and new vehicle technologies will have a role to play in improving air quality (and this is discussed in more detail in a separate discussion paper titled ‘ Alternative Fuels’) however, policies to simply switch to alternative fuels will not address issues such as congestion, placemaking, encouraging active travel and public transport accessibility and therefore a balance will need to be struck.
Active travel also plays a key role in public health as a means of integrating a more active lifestyle into everyday activities and the health benefits of walking and cycling are well-known. There are significant challenges however to provide an active travel network that meets the needs of all users. Issues relating to walking and cycling will be covered in more detail in a separate discussion paper.
Public transport also has a key role to play in public health, particularly in its role of connecting people with facilities, jobs and opportunities and reducing social isolation which can have a significant impact on public health. Where access to public transport is poor or where people experience physical or affordability barriers to using transport, this tends to fall disproportionately on those already experiencing poorer outcomes, reinforcing these barriers. This is an equality issue and, if addressed, an area where transport can help to improve wider outcomes for individuals and communities.
Access to health
If you are unable to drive or do not have access to a car then public transport is often the only option for travelling to health and social care appointments. Public transport may not however be an option if you live in a rural area or are unable to use normal transport.
Many people depend on family, friends or neighbours to help them get to health and social care appointments. Others rely on taxis, community transport and volunteer drivers. The Scottish Ambulance Service also provide a patient transfer service for those who are eligible. A particular challenge in the provision of transport to health services is the variations in eligibility criteria (both physical and geographical) across multiple transport providers and the challenges that community transport providers face in funding and providing services and attracting staff and volunteers to run them. Due to the nature of funding provision, many community transport providers are unable to plan any more than a year ahead which contributes to significant levels of uncertainty across the sector.
As part of the Grampian Health and Transport Action Plan Nestrans has helped to establish a Transport to Healthcare Information Centre (THinC) for the NHS Grampian area. This is an advice helpline which provides advice on travelling to health or social care appointments. Members of the public and health or social care professionals can call for practical and free transport advice on travelling to an appointment in the Grampian area.
The line is open from 9am until 4.30pm Monday to Friday and can provide information on bus services, train times, dial-a-bus services, taxi companies with wheelchair-accessible vehicles and community transport.
Not being able to easily access transport can lead to social isolation which has a significant impact on mental health and well-being. Being able to access community groups, lunch clubs, visiting friends and family can all be beneficial to keeping and improving mental and physical health but are often dependent on being able to access appropriate transport. There is a significant opportunity for transport to play a preventative role in addressing public health issues by removing some of the barriers that currently exist.
Questions for consideration
Although we welcome comments on the range of issues related to this topic, we have posed some key questions below for consideration in any response you may wish to make.
To submit your comments please complete the form below:
References / Further Information
Transport Poverty in Scotland, Sustrans, August 2016, https://www.sustrans.org.uk/sites/default/files/file_content_type/transport_poverty_in_scotland_report.pdf
All Aboard: Young People’s Views on Public Transport in Scotland, Scottish Youth Parliament, January 2019 https://www.syp.org.uk/public_transport_campaign