Dear reader,

This EPOMM e-update puts the question “Mobility and health: Where do they meet?“ into the spotlight. It focuses on overall policies, strategies, guidelines and recommendations rather than on specific initiatives, for example on walking or cycling, as these have been covered by previous editions of the EPOMM e-update An upcoming e-update will deal with how Mobility Management contributes to road safety.

Author: Fred Dotter, Mobiel 21 on behalf of EPOMM

Air pollution is the biggest environmental risk to public health

Travel, especially by private car, has increased at an incredible rate over the last fifty years. It has brought unprecedented levels of mobility, independence and opportunities that have changed our way of life.

But it has also created new health and social problems. How we travel - the individual choices we make, the mode of transport we use, where we go and how often - and governmental policies that influence these choices have important implications for health.

At the same time, it has been shown that the decline in physical activity caused by using more environmentally destructive transport modes, and the fragmentation of urban neighbourhoods caused by heavy traffic and road infrastructure, pose additional health risks. These health impacts affect society as a whole, and they tend to fall disproportionately on certain groups of the population, often the most vulnerable. It is now widely recognised that the health risks posed by motorised transport are more diverse and complex than previously thought. Even so, the magnitude of these risks may still be underestimated.

According to a research by the European Environment Agency, exposure to air pollution caused about 400,000 premature deaths in the European Union in 2016. Air quality in Europe — 2019 finds that although Europe’s air is getting cleaner, persistent pollution, especially in cities, is still damaging people’s health. In this report, the researchers concluded that almost all Europeans living in cities remain exposed to air pollution levels that exceed the health-based air quality guidelines set by the World Health Organization.

Transport can be harmful to our health, but it doesn’t need to be

The promotion of cycling and walking for everyday physical activity not only promotes health but can also have positive effects on the environment.

The publication Health economic assessment tool (HEAT) for walking and for cycling. Methods and user guide on physical activity, air pollution, injuries and carbon impact assessments, published by the World Health Organization in 2017, is of key interest to professionals at both national and local levels. HEAT summarises the tools and guidance developed to facilitate this shift.

Already back in 2014, the WHO published the manual Developing national action plans on transport, health and environment. A step-by-step manual for policy-makers and planners, which was developed to guide a national transport, health and environment action plan (NTHEAP) as a key mechanism for developing sustainable and healthy transport in a country. It provides a comprehensive and intersectoral way to plan and take action on transport, environment and health at the national level.

More than ever, we need to be aware of the crucial connection between transport, health and the environment. THE PEP, the Transport, Health and Environment Pan-European Programme – makes the link. It aims at making progress towards the achievement of transport patterns that are sustainable for health and the environment by focusing work at the Pan-European level on those priorities where further work of the international community is most needed and could make the biggest impact. THE PEP streamlines and consolidates the WHO and UNECE activities on transport, environment and health. It seeks a more effective use of resources and better co-ordination of efforts at the national and international levels.

Researching health impacts and urban mobility

There are many successful examples of integrated strategic transport and mobility planning that can achieve broader social, economic and environmental objectives. Such projects should be used as an evidence base to make economic assessments that go beyond traditional methods. Cost savings can be achieved across several local authorities or national departments. A more coordinated approach with strong leadership will be needed to exploit opportunities to improve urban infrastructure and address complex problems such as health.

The publication Health + Mobility, A design protocol for mobilising healthy living offers an approach to using city data to understand local health and transport problems and opportunities.

The report, which is the result of a collaboration between Arup, BRE, University College London and AREA Research / Perkins + Will, aims to help decision-makers to create better mobility infrastructure by better understanding the impact of mobility infrastructure on well-being in their cities. It examines the relationship between physical and mental health and the availability of active and non-active means of transport for everyday travel.

By reviewing recent studies, literature and methodologies, the authors have developed a framework that structures the relationship between mobility infrastructure and health. The framework supports the design protocol to help cities promote and support health and well-being.

A question of time and interpretation … and willingness

It was only two years ago that the EU environment and transport ministers met in Graz, Austria, to encourage the European Commission to adopt a strategic holistic policy approach. This included a comprehensive strategy to move towards clean, safe, accessible and affordable mobility, and also to strengthen innovation, competitiveness and social inclusion in Europe. This resulted in the so-called Graz Declaration "Starting a new era: clean, safe and affordable mobility for Europe", where active mobility to promote health and sustainability was one of the areas highlighted for future action. More concretely, the declaration emphasised the need to:

• Acknowledge active human-powered mobility as an equal mode of transport and as an integral part of an intermodal mobility chain.
• Develop a European strategic and supportive framework to promote active mobility aimed at increasing the latter's share in transport.
• Integrate active mobility in the current and future European funding and financing schemes to enable the extension and improvement of infrastructure for active mobility.
• Provide support with European instruments for the development and implementation of plans, programmes and projects in the Member States on active mobility, including by promoting consistent data collection, information sharing and the dissemination of best practice.
• Include the health benefits of active mobility in infrastructure and transport projects and policies.
• Scale up EU-wide and national awareness-raising efforts on the multiple benefits of active mobility for health, for liveable, safe and attractive urban environments, and for local and regional economic attractiveness.
• Provide support for initiatives aimed at promoting behavioural change and the creation of safe environments such as cyclable and walkable streets to broadly enable active mobility for citizens.

It is ultimately left to the reader of this EPOMM e-update whether these points have been taken into account since then, or if there is sufficient progress towards reaching these.

Health and zero-emission mobility policy

During the Urban Mobility Days 2020, the dedicated session “Health and zero-emission mobility policy“ took into account that active modes of transport such as walking and cycling can help prevent these deaths and contribute to reduced emissions. To reinforce these measures, health issues must be embedded in mobility policy, in particular in Sustainable Urban Mobility Plans (SUMPs), which is still rarely the case.

Moderated by Fred Dotter, Mobiel 21, this session welcomed four excellent speakers to share ideas and initiatives dealing with health-mobility and its policy dimension.

1. Francesco Dionori (UNECE - United Nations Economic Commission for Europe) provided insights on the Transport, Health and Environment Pan-European Programme
2. Lucia Errandonea (Ideas for Change) focussed on the CitieS-Health Toolkit
3. Fabiana Palmero (City of Vic, Spain) informed about URBACT’s Healthy Cities Network
4. Francesco Iacorossi (Rome Mobility Agency) threw a spotlight, inter alia, on the CIVITAS Handshake project

The session recording can be found on the Eltis YouTube channel. In addition, presentations given during these sessions are available for download here

Linking transport and health in sustainable urban mobility planning

Health is more than just the absence of disease. It is arguably a foundation for life and living. While there are many aspects of Sustainable Urban Mobility Plans (SUMPs), improved health itself has historically not been seen as something to consciously consider as a transport or urban planner.

Yet, in fact there are many health benefits and problems that are closely linked to transport and therefore a SUMP can and must make these links and help to deliver improved public health. Carefully thought out transport planning can improve public health by reducing traffic speeds, by implementing better conditions for cyclists and pedestrians, or by measures to help pupils to walk or cycle to school and much more.

And this is one of the reasons why collaboration between transport planning and public health is essential, if we are to maximise the health benefits. It includes a strong focus on reducing the health inequalities, which plague European countries. The topic guide “Linking transport and health in SUMP - How health supports SUMP“, which has been developed in the framework of the Horizon 2020 project CIVITAS Prosperity, clearly defines public health and the public health impacts of transport. It explains how public health fits into the SUMP process and provides some examples of transport-related public health initiatives that have been taken in the context of mobility planning. The document is an excellent guide for the practitioner on public health impacts in transport and why the topic should be included in a SUMP.

UN Task Force to make ‎post-COVID-19 pandemic mobility more environmentally sound, healthy ‎and sustainable

The lockdown has triggered social, economic and cultural lifestyle changes, many of which have had a significant impact on mobility patterns. Active mobility has seen a strong resurgence, particularly through bicycle use, while public transport usage has fallen significantly. In parallel, more people are using their private cars as they provide an escape from the crowds.

As also mentioned in the EPOMM e-update Mobility Management in times of COVID-19, the effects on mobility patterns and habits have been varied and sometimes unpredictable. In addition, both the situation and its consequences are changing rapidly. However, the current crisis gives us an opportunity to reconsider the functioning of the transport sector.

To respond to these challenges and opportunities, UNECE Member States have joined forces to create a Task Force to develop a set of principles for green and healthy sustainable mobility, which is a key part of UNECE activities within the Sustainable Mobility and Smart Connectivity Nexus. The Task Force will be composed of representatives of Member States, international organisations, civil society, academia and other stakeholders. It will develop principles for an environmentally sound and healthy transport system based on sustainability and resilience and will explore long-term and strategic changes for the sector. The principles are planned to be proposed for endorsement by the Member States at the 5th High-level Meeting on Transport, Health and Environment, to be organised in 2021 in Vienna.

Conclusion

Transport is a critical factor affecting the health of individuals and the health of the community. The European Environment Agency considers that air pollution is the greatest risk to environmental health in Europe and was responsible for 400,000 premature deaths in Europe in 2016. Mobility itself can have adverse effects on the environment and on citizens’ health, due to traffic congestion, accidents, pollution and greenhouse gas emissions. However, huge health benefits can be achieved for the entire population if citizens switch from private cars to active transport and public transport.

The current health burden of transport policy is greater than it should be, given current knowledge of interventions and the availability of current technologies, many of which are simply not used. This is partly because the health consequences and costs associated with individual travel decisions and government policies affecting transport and mobility are not fully taken into account. For example, health professionals should be involved in carrying out health impact assessments and assessing health costs of transport projects and strategies, taking into account the values and priorities of the communities concerned.

Some points of synthesis:

• Transport policies have important implications for health due to their impact on air pollution, noise, injuries, climate change and their ability to create safe conditions for walking and cycling (or not).
• These health effects affect the majority of the population, not just transport users.
• Estimates of the health effects and costs of transport strategies do not take into account the health effects of increased walking and cycling and the cost savings for a population associated with increased walking and cycling.
• The health burden of transport is greater than expected, partly because users do not bear the full costs of the transport activities they undertake.
• There is a need to inform the public and policy makers about the health consequences of individual travel options and transport and land use policies.
• Health professionals play a key role in providing this information and in assessing the effects of transport policy on health.