Explore how the way in which transport systems are organised can play a role in improving health and addressing health inequalities
Why transport matters for health
How transport systems are organised can play a role in improving health and addressing health inequalities. Transport can affect health directly, in terms of air pollution or active travel. It can also affect health indirectly through its relationship with the wider determinants of health, such as providing access to public services and an individual’s place of work.
Explore the different ways in which transport can affect health outcomes below.
Increasing physical activity and minimising time spent sitting down helps to maintain a healthy weight and reduces the risk of cardiovascular disease, type 2 diabetes, cancer and depression. The NHS recommends that adults should do at least 150 minutes of moderate activity, or 75 minutes of vigorous activity, each week. Walking and cycling as part of one’s travel routine – whether for an entire journey or to access public transport – can help meet these targets. There will be little benefit, however, if this means of exercise merely displaces the time for physical activity, or if the activity is not prolonged or intense enough to affect health outcomes.
Road transport accounts for 35% of nitrogen oxide and 12% of particulate matter emissions. These include PM10 particles (particles with a diameter of 10 micrometres or less) and PM2.5 particles (particles with a diameter of 2.5 micrometres or less), both of which are small enough to penetrate the respiratory system. Outdoor air pollution is associated with premature mortality and increased risk of hospital admissions from respiratory disease, lung cancer and cardiovascular illness. In the UK, the mortality burden of long-term exposure to air pollution is equivalent to 28,000–36,000 deaths each year.
The health impact of noise is well documented too, with unwanted sound associated with higher levels of stress, anxiety, sleep deprivation, high blood pressure and cardiovascular disease. Noise pollution can also result in cognitive impairment in children.
More in-depth analysis on air and noise pollution will be published separately as part of our upcoming releases to the evidence hub.
Road collisions are a major cause of preventable death, serious physical injury and psychological trauma. In 2019, collisions in the UK caused almost 154,000 casualties and killed 1,748 people. Collisions are also distributed unequally across society, with children and young adults in the most deprived areas experiencing a higher risk of injury and death than those in the least deprived areas.
Some theories offered to explain this include higher exposure (fewer residents in cars), less adult supervision for children and less understanding of the issues around road safety. Other evidence for this inequality has been found in a study noting links between lone parenthood, smaller domestic garden areas, and higher junction density in deprived areas.
A review of transport-related interventions found beneficial impacts from campaigns to increase helmet use for cyclists and to promote the use of child car seats and seat belts. Traffic-calming measures and legislation against drink driving were also found to be effective.
A transport system that is easily accessible, reliable and affordable contributes to life satisfaction and wellbeing in many ways. It enables access to friends and family, as well as health-supporting facilities, such as schools, colleges, parks, libraries and – more directly – health care centres. For example, a study in the North West of England found that increased distance from accident and emergency departments was associated with lower usage, whereas increased distance from GP practices was associated with higher attendance to accident and emergency departments.
Transport also provides access to work, which itself has an important impact on health.
Transport systems could be exclusionary for seven potential reasons, and these include a combination of personal and system-level factors:
- physical (such as disability-unfriendly transport)
- geographic (absence of transport services in an area)
- facilities (distance between residence and amenities)
- economic (inability to afford transport)
- time-based (inability to schedule transport due to caring responsibilities)
- fear-based (safety concerns over transport use)
- space-based (certain groups prevented access to public spaces, such as gated communities or first class lounges).
Social exclusion is a particular problem for those with low incomes and those who live in rural or other areas with limited public transport. Higher income groups are more likely to have cars and can travel more easily. An evaluation of four public transport schemes in deprived areas found that these schemes have positive knock-on effects for employment and the use of health services.
Research shows that people who rate public transport as ‘good’ are almost three times more likely than those who rate it as ‘poor’ to be able to access public services, such as health care, food shops or education.
The effect of the coronavirus (COVID-19) pandemic has had a far-reaching impact across society. As well as the direct impact on health, the economic and social consequences from policy measures to control the pandemic have had a significant impact on mental and physical health.
Travel is one area that has been seriously affected by the pandemic, with lockdown measures restricting non-essential travel and the use of public transport. These measures have interacted with other determinants, particularly employment, to create a new inequality – between those who can work from home and those who are still required to travel to their workplace.
Changes to commuting patterns
During the national lockdowns and the regional tier system of restrictions, public health advice encouraged those who are able to work from home to do so. At the same time, social distancing requirements have meant a reduced capacity on public transport, given the concerns over infection risks. These changes affect health in several ways.
Some groups are still required to travel to their workplace, such as key workers or those who cannot practically work from home. For those without private transport, this has meant travelling on public transport (and facing a potentially higher risk of infection) or commuting by walking, cycling or running. The three latter options may not be practical over certain commuting distances. Having to travel to work has emerged as a potential inequality, as those able to work from home are more frequently in higher-paid professional occupations.
There is also the potential for worse health outcomes for those working from home. Commuting often comprises a large proportion of a person’s physical activity for the working population. Overall trends indicate that this drop in physically active commuting as a result of working at home has been balanced out by an increase in non-commuting physical activity, but this may mask variations between groups.
Infection risk from public transport
Evidence on infection risk for those travelling by public transport is not conclusive. In line with restrictions elsewhere in society, public transport has been subject to social distancing measures.
A Scientific Advisory Group for Emergencies (SAGE) review found that the ‘overall weight of evidence is towards an increased risk’ of COVID-19 transmission. Other studies have found that the risk is dependent on proximity to infected individuals and the duration of proximity. For example, a study by the Institute of Health Equity found that the elevated risk of mortality from COVID-19 among bus drivers was due, in part, to higher levels of exposure to infection.