National Institutefor Public Healthand the Environment

Assessing health in mobility measuresErna van BalenNational Institute for Public Health and the Environment (RIVM)ECOMM, 13-15 May 2009

National Institutefor Public Healthand the Environment

‘Health in MM is too complicated’

‘Health effects are not based on evidence’

‘MM is mainly aimed at reducing traffic flows’

National Institutefor Public Healthand the Environment

Health and mobility

National Institutefor Public Healthand the Environment

Transport-related health effects: some key figures EU

127,000 deaths and 2.4 127,000 deaths and 2.4 million injuries/yearmillion injuries/year

Air pollution from road Air pollution from road transport: 8.6 months transport: 8.6 months shorter life-expectancyshorter life-expectancy

Physical inactivity : Physical inactivity : 600,000 deaths/year600,000 deaths/year

More than 30% of the More than 30% of the EU15 population EU15 population exposed to noise levels > exposed to noise levels > 55 dB(A) 55 dB(A)

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General framework for health impact assessment (HIA)

Selection of healthendpoints

Assessment ofpopulation exposure

Identification ofexposure-effect relations

Estimation of thenumber of cases

Calculation of diseaseburden

Population density,modelled ormeasuredexposure levels

Meta-analysis, pooled analysisepidemiologicalstudies

Prevalence,incidence data,demographics

INPUT

HIA-PROCESS

INPUT

Severity weights, duration

Price tags:health costs percase, life year,

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Example: Traffic-related burden of disease: Example: Traffic-related burden of disease: before and after reduction of speed limitbefore and after reduction of speed limit (10 (10 hotspots motorways)hotspots motorways)

0

100

200

300

400

500

600

700

800

900

Before After Before After Before After

Road traffic noise Traffic-related airpollution

Traffic accidents

DA

LY

s (

abso

lute

)

Source: Kempen et al, 2008

National Institutefor Public Healthand the Environment

Methods

• Selection of cases from ELTIS with impact on health

• Screening for availability of before-after measurements

• 3 assessors to reach agreement

• Direct health impacts and indirect health impacts

• Assessment of effects and assigning scores

• Assessment of other implementation issues

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Some examples (1)

• Travel plan for Addenbrooke’s hospital campus: promotion of car sharing, improving cycling infrastructure, staff-discounted bus tickets staff car use from 74% to 38%, bus travel from 4% to 25%, cycling from 17% to 26%

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Some examples (2)

• I WALK Club: competition for children to walk to school instead of being driven walking to school from 50% to 68%

National Institutefor Public Healthand the Environment

Some examples (3)

• Cycle Plan San Sebastian: better facilities for cyclists (parking spaces, bicycle paths), campaigns and regulation

bicycle use tripled within 6 years

National Institutefor Public Healthand the Environment

National Institutefor Public Healthand the Environment

Key messages

Health in MM is not complicated, but a positive side-effect of mobility interventions

Other effects have an impact on health

MM can be aimed at achieving health benefits

National Institutefor Public Healthand the Environment

And further…

• See www.healthytransport.com for inspiring examples, evidence briefings and info on ‘what works’. In development: please let us know your comments!

• Join the international Health Impact Assessment conference 14-16 October 2009 in Rotterdam, The Netherlands. Theme: ‘on the move’ www.hia09.nl

• This work was conducted in the framework of THE PEP (Transport, Health and Environment: Pan-European Program) www.thepep.org, coordinated by WHO/UNece

• Thanks to financial support from the Dutch ministries of transport, environment & spatial planning and public health

Thank you for your attention!

National Institutefor Public Healthand the Environment

Options for policy: where can health benefit be achieved?

Intervention Road traffic accidents

Air pollution Noise Physical inactivity

CO2

Emission reduction: particle filters

Emission reduction: tyres

Technology: energy-efficient

Cleaner fuels

Speed limit reduction

+/-

Effective public transport

+/- +/-

Infrastructure

Promoting walking/cycling