Delivering health gain and equity through ‘upstream' transport interventions

The problem:Public health interventions often involve under-recognised ‘trade-offs’: for instance in achieving health gain at the expense of equity goals; or (in the case of transport) reducing road injury at the expense of fostering ‘active travel’. 

Methods:  Case study analysis of transport interventions which have identifiable benefits for health and health equity. 

The case studies: We outline three examples from robust evaluations of UK transport policy which have identified ‘win-win’ public health benefits overall.  First, traffic speed reductions through the introduction of 20mph zones have successfully reduced pedestrian injury by around 40%, whilst mitigating widening injury inequality rates.  Second, free bus travel for young people in London, UK, has fostered social inclusion and independence, and helped ‘normalise’ public transit use whilst avoiding reductions in active travel for young people.  Third, the introduction of a cycle hire scheme has promising indications that it helps broaden the uptake of cycling in London across traditionally under-represented groups.  This paper identifies some essential conditions that plausibly enabled these interventions to maximise gain across diverse outcomes.  First, all three interventions are ‘up-stream’, in that they aimed to change the physical, social or economic environments in which travel happens, rather than directing action at individual behavior.  Second, all are ‘universal’ policies, rather than targeted at (for instance) low income groups, or at particular deprived neighborhoods.  Third, all entailed action by local administrations that have some autonomy over infrastructure.   

Conclusions: We conclude that public health planners working with those delivering local transport options can help deliver meaningful and sustained health gain, and that evaluating the wellbeing impacts of such interventions is important for advocating for healthy transport policy.