Mr. Bridges, open this gate. Mr. Bridges, tear down this wall!

In 1987, President Ronald Reagan stood by the Brandenburg Gate in West Berlin and called on Gorbachev, the leader of the Soviet Union, to take down the wall cutting off Berlin’s east and west halves.

A photo of a photo which also includes a photo. The black and white bit is the Brandenburg Gate at the end of World War Two. The colour bit is what the gate looks like today.

In 2017, I’m calling on the Minister of Transport, Simon Bridges, to take action. I could have called this post “let’s get rid of mandatory helmet laws in New Zealand” (and I’m not sure comparing Simon Bridges to Gorbachev, or me to Reagan, does either of us any favours), but let’s roll with it for now – at least it gives the post titles some variation.*

Back in September/ October 2016, I took a holiday to Europe, visiting Germany (Munich and Berlin) for the first time.

Germany is the country that gave the world Mercedes, Volkswagen, BMW, Audi and Porsche. It’s the country famous for its no-speed-limit autobahns, which I remember being told about in reverent tones growing up – probably one of my strongest wired-in memories to do with Germany.

Germany today has a very different zeitgeist. I was struck by the popularity of cycling in both cities (and also by the great quality, well used public transport, but that’s a story for another day). I found the contrasts so striking that I started writing this post while I was still in Berlin, and I’ve stuck with the title that came into my head then. Because if Germany, this famous automotive country, can make cycling so popular then New Zealand can do the same. Because in Munich, Berlin, and every other great cycling city around the world, hardly anyone wears helmets.

People on bikes by the East Side Gallery, one of the few remaining remnants of the Berlin Wall and decorated with street art.

Berlin today is ranked as one of the top cycling cities in the world, #12 in the Copenhagenize index. Munich is now outside the top 20 of that index, but still regarded as a very cycle-friendly city. There are bikes everywhere in Berlin, at least in the more tourist-friendly inner parts of the city. There’s a widely available bike share scheme, run by DB Bahn (who also run the public transport).

100 metres from where I stayed in Berlin, there was a cycle school – a little cycling track, mocked up with miniature street signs, cycle lanes and different turning scenarios. In Berlin, all primary-school children take a cycling safety course.

People on bikes in Berlin

People on bikes in Munich (where helmets seemed a bit more common than Berlin)

Cycling in New Zealand

New Zealand, of course, has more vehicles per capita than almost every other country in the world (712 vehicles per 1,000 people; Germany has 572). Germans make the cars, but they don’t drive them anywhere near as much as Kiwis do. Cycling in New Zealand has become a fringe, marginalised activity, although this is getting better. Cycling rates have dropped precipitously since the 1980s – they’re now climbing again, but off a very low base. With cycling, there’s safety in numbers. The lack of cyclists in New Zealand means that drivers aren’t looking out for them, so our accident and fatality rates for cycling are well above those of European countries, despite our policy of mandatory helmets.

New Zealand’s government has been quite forward-thinking on cycling in the last couple of years, launching the Urban Cycleways Programme and also spending more on cycling out of the National Land Transport Fund (of course, it’s still a tiny percentage of the overall fund). The cycleways programme was an inspired piece of policy: it provided some funding, but also leveraged this as a way to encourage councils to invest in cycleways. Costs now get split between the Urban Cycleways Fund, the NLTF, and the local council.

I think it’s quite appropriate that the cycleways programme uses funding from outside the general transport funding sector. Looking at the costs and benefits from cycling, the biggest benefits are actually health-related, and nothing to do with transport. Ideally this could be recognised by funding some cycling initiatives out of the health budget, but at least they’re coming from outside of transport.

Of course, if we make helmets optional, we’ll get much better value out of these cycleway investments – there will be more people cycling and using them. Plus, there’s much less need for helmets on cycleways – serious cycling accidents are overwhelmingly caused by collisions with cars and other vehicles, not falling off the bike.

Cycling and Health

The direct costs of cycling are pretty straightforward – it’s the amount being spent on infrastructure, whether it’s cycleways or token splashes of paint on the roads. As for indirect costs (externalities), cycling arguably has less than any other travel mode. Cyclists aren’t hurting anybody.

The benefits are a bit more complex. Like public transport, cycling helps to mitigate congestion – so car users benefit from having faster, more reliable travel times. Cycling also reduces greenhouse gas emissions.

Then there are the health benefits of cycling. Quoting from a 2014 paper which modelled potential cycling investment in Auckland (emphasis added):

Our findings suggest that the most effective approach would involve physical segregation on arterial roads (with intersection treatments) and low speed, bicycle-friendly local streets.

We estimate that these changes would bring large benefits to public health over the coming decades, in the tens of dollars for every dollar spent on infrastructure. The greatest benefits accrue from reduced all-cause mortality due to population-level physical inactivity.

Overall, the authors estimated that a $630 million investment in cycleways and “self-explaining roads” (traffic calming etc) would get cycling mode share to 40% by 2051, and give benefits of more than $13 billion, with a benefit:cost ratio of 24:1. Pretty good really. And we’ve found so far that the benefit:cost ratios for cycleways, at least the ones getting funded by the Urban Cycleways Programme, are often an order of magnitude higher than what we get for roads.

So, riding a bike is good for fitness and keeps you healthier for longer. At the New Zealand level, if more people cycled we’d have a healthier population, with lower mortality.

The next step: making helmets optional

Now, let’s have the conversation around helmet laws. Looking at the international picture: New Zealand’s compulsory helmet laws make us an international outlier. The evidence on their effectiveness has been mixed at best. Yes, helmets can reduce the severity of head injuries; but they’re also a barrier to cycling uptake.

We don’t know for sure in New Zealand, because the research hasn’t been done. But here’s my personal view. If we got rid of the law that says you have to wear a helmet while cycling, we’d have more people on bikes. This means car drivers will pay more attention to them, and drive more carefully. As such, it’s not clear whether the rate of serious head injuries (and in the worst case, deaths) would rise or fall. It depends on which effect dominates – cyclists being less likely to wear helmets so getting more severely injured, or drivers being more alert around cyclists. I wouldn’t be surprised if the latter effect wins out.

But here’s the thing – even if the latter effect doesn’t win out, it’s probably still a good idea to get rid of the law. Because there are all the other benefits from cycling to consider too – a healthier, fitter population, plus the congestion and emissions benefits. Those benefits are likely to be much greater than any ‘net’ cost from having more cyclists injured.

We’ve got an unusual split of powers in New Zealand:

  • The Accident Compensation Corporation (ACC) funds the costs of accident injuries. Every time a car slams into a cyclist, it’s ACC who pays for it. Understandably, ACC is all about doing things that reduce the risk and severity of injury (helmets can help with the latter, and don’t help and may even hurt the former). As noted above, it’s not clear whether making helmets optional would be better or worse for this.
  • The Ministry of Health handles the remainder of the public health system. They should be very interested in things which boost the general state of health among New Zealanders, such as cycling.
  • The police are responsible for enforcing the helmet law. It’s positive to see that cops aren’t fining cyclists as often as they used to, but ultimately they’re still giving out fines because that’s what the law says.

ACC and the Ministry of Health are more or less separate, with separate departments and different Ministers. The police are also separate, of course. These different organisations may have differing views on cycling and helmets, given their different responsibilities. We need a consensus-builder (a Gorbachev or perhaps a Bridges?) to bring the parties together and make, the right decision to give the best outcome for society.

Mr Bridges, it’s time to open this gate, and let the cyclists through. In order to get the most from the Urban Cycleways Programme, to encourage cycling as an everyday activity, and to unlock the health benefits, we need to get rid of the helmet law and make helmets optional.

* It also seems kind of unnecessary to have gates, walls and Bridges all mentioned in the title, but such is life

Mid-week reading: Cycle connectivity, metro connectivity, walkability

This is mid-week reading – a feature I’m writing while trying to get on top of work and back on a regular blogging schedule.

This week’s theme is connectivity. Transport networks are powerful tools for connecting people – or separating them. When designed well and managed safely, they can allow people to reach opportunities. But when designed poorly, they can create severance and isolate people from each other.

Unfortunately, once infrastructure’s been put in place, it’s extremely persistent. A non-connective street network will stay in place more or less indefinitely. There are relatively few opportunities to change that.

However, the clever folks at Bike Auckland recently highlighted a new opportunity to overcome severance through the design of the Tamaki Drive to Glen Innes cycleway. In their first post on the topic, they highlighted the abundance of connections offered by the Northwestern Cycleway:

This is a tale of two paths. We begin out west, on a stretch of the Northwestern Cycleway. This is a ‘road of national significance’ for people on bikes – a commuter path from the far west into town. But at the local level, it also makes all sorts of handy journeys possible for people like Penny and her family, who use the path to access school, daycare, and work.

Motorway-style routes have a seductive A to B directness, whether they’re for cars or bikes, but what makes them truly useful, as Penny’s family’s story shows, is the exits – the on- and off-ramps, if you will.

Of course, the Western Springs/ Kingsland stretch of the NW cycleway is especially rich in access points, a legacy of how SH16 was sliced through the heart of the original connected neighbourhood. Take the 2.5km stretch from St Lukes Rd to the Waima St over bridge that leads to Penny’s school. There are by a rough count 14 connections to local streets. One every 180m or so!

And the relative paucity of connections proposed for a key section of the new Tamaki to GI cycleway:

From our first engagement with this project in November 2014, we’ve seen this path as not just a utilitarian urban access route for long distance commuters, but an iconic destination and local treasure in its own right. We’ve consistently made the case for linking the cycleway to existing recreational paths and nearby streets, so as to make local journeys possible and to integrate the path into the neighborhoods it passes through. (We’re also battling tirelessly for better cycle facilities on the roads that will bring people to the cycleway).

In other words, this path will not only link Glen Innes to downtown, but will also allow for smart local trips like Penny’s family’s rides – if it comes well-supplied with local connections.

Wait a minute. Did we say ‘if’? 

Yup.

Because there’s a chance that Stage 2, which is the 2.5km stretch between St Johns Rd and the Orakei Boardwalk, may yet make it through construction with no side connections (only the future possibility of them).

In Bike Auckland’s second post, they explored the impact of adding even a single local connection:

But do you really have a feel for what difference just a single additional side access could make – and how many more people could get to the path easily and safely if one was built?

Well, we wanted to get an idea, so we did an experiment. We used an Open Street Map, with the new Stage 2 section of the path added in red – and we estimated the catchment first with, and then without a key additional side path.

We started from Meadowbank Train Station, which is a good local marker because everyone knows where it is.

Then we went out 2km, and then 3km, following all the branching paths and local roads (major caveat – not all routes on the map are cycle-friendly), to see just how far that took us.

The results are in the animation. See how one short side path of 150m opens up a new catchment that’s within a 3km ride or walk of the station?

BikeAKL_Tamaki_GI_Catchment_BluePath_Animated

Interesting results. It’s a bit hard to tell from the map, but that looks like it’d bring another 100 homes or so within reach of the station (not to mention the cycleway).

On a much bigger scale, Henry Grabar reports (in The Atlantic) about Paris’s new Metro plan, which is aimed to “tie Paris back together”. The city has a long history of overcoming problems that manifest in its urban form through investments in altering that urban form, knitting it together in different ways:

Here begins the most ambitious new subway project in the Western world. The extension of Line 14 is but the first leg of the Grand Paris Express, a $25 billion expansion of the century-old Paris Métro. By the time the project is completed in 2030, the system will have gained four lines, 68 stations, and more than 120 miles of track. Planners estimate that the build-out will boost the entire network’s ridership by almost 40 percent.

The goals: Reduce the smog-choked region’s car traffic. Link business districts, airports, and universities. Ease social ills by knitting together the French capital’s isolated and troubled banlieues, much as the initial Métro construction did for the outlying districts of Paris proper at the dawn of the 20th century…

Benoît Quessard, an urban planner for the local government, told me that he sees the expansion as not merely “an economic wager but also a social one.” In this sense, it will test an old Parisian belief about the Métro conferring, beyond convenience, a kind of citizenship on its riders. In 1904, four years after the first line opened, the writer Jules Romains predicted that the system would be a “living, fluid cement that will succeed in holding men together.”

Incidentally, when I read about the banlieues, I always think of Guillaume Apollinaire’s wonderful poem Zone, a drunken-dreamlike walk through the downscale outer districts of early-20th century Paris, before the Metro put them on the map:

Some refugees stay in furnished rooms
In the rue des Rosiers or the rue des Écouffes in the slums
I have seen them at night walking
Like pieces on a chessboard they rarely move
Especially the Jews whose wives wear wigs
And sit quietly in the back of the shop

The last article of the week is from Grant Schofield, a professor of public health at AUT, who summarises his new research on the impact of urban form on physical activity:

Living in an activity-friendly neighbourhood could mean people take up to 90 minutes more exercise per week, according to a study published in The Lancet today. With physical inactivity responsible for over 5 million deaths per year, the authors say that creating healthier cities is an important part of the public health response to the global disease burden of physical inactivity.

The study included 6822 adults aged 18-66 from 14 cities in 10 countries from the International Physical activity and Environment Network (IPEN) [1]. The cities or regions included were Ghent (Belgium), Curitiba (Brazil), Bogota (Colombia), Olomouc (Czech Republic), Aarhus (Denmark), Hong Kong (China), Cuernavaca (Mexico), North Shore, Waitakere, Wellington and Christchurch (New Zealand), Stoke-on-Trent (UK), Seattle and Baltimore (USA).

The research team mapped out the neighbourhood features from the areas around the participants’ homes, such as residential density, number of street intersections, public transport stops, number of parks, mixed land use, and nearest public transport points. Physical activity was measured by using accelerometers worn around participants’ waists for a minimum of four days, recording movement every minute.

On average, participants across all 14 cities did 37 minutes per day moderate to vigorous physical activity – equivalent to brisk walking or more. Baltimore had the lowest average rate of activity (29.2 min per day) and Wellington had the highest (50.1 min per day).

The four neighbourhood features which were most strongly associated with increased physical activity were high residential density, number of intersections, number of public transport stops, and number of parks within walking distance. The researchers controlled for factors including age, sex, education, marital and employment status and whether neighbourhoods were classed as high or low income. The activity-friendly characteristics applied across cities, suggesting they are important design principles that can be applied internationally.

Just a brief comment on this last point. One legitimate question about these findings is, basically: what’s stopping people from choosing to live in healthier places if there are benefits to doing so? (Or, in economese, what’s the market failure, exactly?)

The answer is that decisions about the built environment aren’t made by individuals. People don’t always have a free choice. Road networks are centrally planned, and the planners may not necessarily have good information about people’s actual needs and desires.

Similarly, housing choices and neighbourhood design has been extensively regulated, with the result that there may be an undersupply of walkable, accessible neighbourhoods in the city.

A bit more choice could be good for us!

Guest Post: Transport is a public health issue

This is a guest post from Donna Wynd

As a social scientist, I often look at transport ‘solutions’ and find my eyes rolling to the back of my head. Transport is a sector dominated by men who are, predominantly, trained to see transport as an engineering or technology problem. Engineers in particular are trained to solve problems: toasters, particle colliders, milking machines are all solutions to specific problems. Traffic flow is no more or less a problem than reheating lasagne.

Engineering solutions tend to focus on the here and now whereas the social and environmental impact of transport networks and infrastructure stretch across space and time: they influence behaviour, and our interactions with others, yet there seems to be little recognition of this. Much of my work ultimately involves public health issues such as housing, education, and social assistance. Transport, linking as it does so many disciplines, is clearly another of them.

In other words, transport is not just about relieving commuter congestion; it is about our ability to access work, services and leisure, our physical and mental health, our physical environment, and the relationship between all these things. As such, transport has significant public health consequences beyond widening a stretch of road. In Auckland, there are two aspects of this that seem to be particularly relevant, and I will focus on those: our obesity epidemic, and the demographic changes Auckland will experience over the next 50 years.

Obesity

Obesity is something we all have an opinion on but is not well understood, even by many health professionals. In part, this is because the causes and effects of overweight/obesity are numerous and complex. Are people obese because they because they eat the wrong type of food, don’t exercise, are poor, or have unfortunate genes? All of the above.

However, the evidence points to a strong correlation between obesity and car dependence (there’s a cute graphic here).

Suburbs with services that are difficult to get to other than by car tend to have heavier populations. We know from our own experience in Auckland that such suburbs are often very hostile for cyclists and pedestrians. We also know the picture is further confused by the strong correlation between low-income and living in outer suburbs with few transport amenities other than roads. Inner-city areas with good public transport tend to have leaner, wealthier inhabitants. In part this is because transport choices are incorporated into real estate prices, thus setting up a cycle whereby low-income families are forced into more distant (from the central city) suburbs.

In general, it is also easier for residents of suburbs closer to the central city to cycle or walk to work. By contrast, almost no one who lives in the Mangere-Otara suburban belt, and who works at Highbrook or the airport walks or cycles to their jobs. A lack of protected cycle ways and high speed limits on local arterials put the frighteners on most would-be cycle commuters. Yet it is the residents of these suburbs that have the highest rates of obesity in the country and correspondingly high rates of associated diseases, especially diabetes. Plus, these areas are perfect for cycling because they are flat.

One of the tragedies of our transport system is that it doesn’t have any incentive to engage with other sectors to reduce car dependence and improve public health (indeed, it could be argued that transport planners have a vested interest in maintaining car dependence). However, while Auckland Council is blackmailing the public into supporting motorway tolls in order to fund the completion of the $207 million Auckland regional cycleway, obesity is costing our health sector millions. A 2012 paper by Boyd Swinburn and his colleagues estimates that obesity cost over $620 million in direct costs to the health sector in 2006 alone (we’ve gotten fatter since then), plus a further $98-225 million in lost productivity. Then there were the non-monetary costs including disability, and loss of quality of life. In addition there are the welfare costs associated with people unable to work because of diabetes, heart disease, the impact of strokes, the list goes on and on. People with obesity-related disability often also need subsidised housing. Given these enormous public and personal costs, putting off building decent cycling and pedestrian infrastructure (including improved access to public transport) is more than poor transport planning: it is a dereliction of duty.

I’m not suggesting that completing the cycle network and making our pedestrian facilities more accessible and attractive will solve our obesity problems. But it will help, and in a way that is cost-effective, friendly, and will help reduce our greenhouse gas emissions.

Demographic change

Overlaid onto the obesity tidal wave is the upcoming grey tsunami. New Zealand is an ageing society, something that importing younger workers will not reverse.

Older people have different transport needs to younger persons. Within 20 years it is likely that many of the current roadbuilding fraternity will be ruing the lack of alternative transport choices in Auckland as their mobility wanes. Older people don’t like driving as much, and as we age our ability to drive is reduced. Accordingly, an older, non-working, population has greater need for disability-friendly public transport, and local facilities that are easily accessible by foot. Or, if you’re my Mum, you’ll start biking to the shops to get the bread and milk when you’re in your 70s.

This means planners should be thinking about a population with higher rates of disability and a greater need for non-car transport options now. Unfortunately, the Auckland Plan, although purporting to look 30 years down the track, largely assumes today’s needs and priorities will be those in a generation’s time. The emphasis is on roading and congestion rather than the implementation of an accessible, multi-modal transport network.

Why is this a public health problem? Because the elderly still need to get to services, especially medical services, and lack of transport is a contributor to social isolation and exclusion. The 2003 report by the Social Exclusion Unit in the UK noted that “transport problems can be a significant barrier to social inclusion”, and that this may lead to a cycle of exclusion and undermine the wellbeing of communities. In addition, we know that low-income communities have a disproportionately high rate of pedestrian casualties (particularly among the young and elderly). The report notes that “the social costs of poor transport were not given any real weight in transport project appraisal. So the distribution of transport funding has tended to benefit those on higher incomes,” an observation that holds true in Auckland [emphasis in original].

The World Health Organisation notes that as a reflection of power relations, social exclusion makes it difficult for people to meet their basic needs, ignores their human rights, and undermines social cohesion. It also has a physical impact, notably through stress mechanisms that can have negative impacts on people’s health. Given the enormous costs to the health system of an ageing population, it is in all our interests to minimise the risk of injury and social isolation arising from poor transport planning. And for those with a political bent, it should not need stating that change will come one way or another because old people vote.

As with obesity, transport planners alone cannot deal with the problems of an ageing population. But a recognition of demographics should inform planning and decision-making.
Other public health issues associated with transport include the extraction and transport of fossil fuels, and public safety. Incorporating a public health perspective into our transport planning processes will pay off economically, environmentally and socially. In short, focussing on health and mobility should be the primary focus of transport planning.

Motorways and health

An article in the herald earlier this week highlighted some of the health issues we see have with motorways.

People who live beside Auckland’s Southern Motorway are subjected to air pollution at nearly double the level of those 130m further away, research shows.

The researchers suggest looking at preventing people from living within 20m of motorways and building more walls to separate the roadways from homes, children’s facilities and businesses.

Fixed and bicycle-mounted measuring instruments, used in autumn and winter in Otahuhu, detected pollution levels that peaked beside the motorway from 7am to 9am, coinciding with the morning commuter rush.

The researchers, from Canterbury University’s geography department and the National Institute of Water and Atmospheric Research, found similarly high levels of pollution along Princess St, which feeds the motorway, and several other areas of high traffic volume.

Potentially of most concern is their finding of a morning peak of around 140,000 “ultrafine” particles of pollution per cubic centimetre of air.

These particles, a 10,000th of a millimetre in diameter, can penetrate deep into the lungs. Particulate air pollution is associated with lung disease and heart problems.

What this really shows is one of the key issues of having such a reliance on urban motorways. It also makes me wonder what it would do to the business cases of projects if we had also considered the health impacts and the mitigation needed to address those impacts. The article says some researchers are now suggesting we need a 100m buffer to motorways, the costs of doing that would be astronomical from both a financial and land use perspective.

Some will of course point out that electric cars will solve these problems and while it may to a large extent, as Peter has pointed out in the past, uptake of electric vehicles has been glacially slow and there is no sign of that changing any time soon.

Driving and sprawl are killing you

An article in the New York Times a few months ago summarised quite nicely recent research into connections between transport modes and health outcomes:

Millions of Americans like her pay dearly for their dependence on automobiles, losing hours a day that would be better spent exercising, socializing with family and friends, preparing home-cooked meals or simply getting enough sleep. The resulting costs to both physical and mental health are hardly trivial.

Suburban sprawl “has taken a huge toll on our health,” wrote Ms. Gallagher, an editor at Fortune magazine. “Research has been piling up that establishes a link between the spread of sprawl and the rise of obesity in our country. Researchers have also found that people get less exercise as the distances among where we live, work, shop and socialize increase.

Obviously there’s nothing really new in the fact that obesity creates significant health problems and that our car dependent lifestyles have created a culture where people have to go out of their way to exercise – and therefore many just don’t get around to it. What’s perhaps most interesting though is just how related obesity rates and other health problems appear to be with our urban form and our transport choices:

“In places where people walk more, obesity rates are much lower,” she noted. “New Yorkers, perhaps the ultimate walkers, weigh six or seven pounds less on average than suburban Americans.”

A recent study of 4,297 Texans compared their health with the distances they commuted to and from work.It showed that as these distances increased, physical activity and cardiovascular fitness dropped, and blood pressure, body weight, waist circumference and metabolic risks rose.

The report, published last year in The American Journal of Preventive Medicine by Christine M. Hoehner and colleagues from the Washington University School of Medicine in St. Louis and the Cooper Institute in Dallas, provided causal evidence for earlier findings that linked the time spent driving to an increased risk of cardiovascular death. The study examined the effects of a lengthy commute on health over the course of seven years. It revealed that driving more than 10 miles one way, to and from work, five days a week was associated with an increased risk of developing high blood sugar and high cholesterol. The researchers also linked long driving commutes to a greater risk of depression, anxiety and social isolation, all of which can impair the quality and length of life.

It’s not just in the US, similar results come from a Swedish study:

 A Swedish study has confirmed the international reach of these effects. Erika Sandow, a social geographer at Umea University, found that people who commuted more than 30 miles a day were more likely to have high blood pressure, stress and heart disease. In a second study, Dr. Sandow found that women who lived more than 31 miles from work tended to die sooner than those who lived closer to their jobs. Regardless of how one gets to work, having a job far from home can undermine health. Another Swedish study, directed by Erik Hansson of Lund University, surveyed more than 21,000 people ages 18 to 65 and found that the longer they commuted by car, subway or bus, the more health complaints they had. Lengthy commutes were associated with greater degrees of exhaustion, stress, lack of sleep and days missed from work.

Fortunately it’s not all bad news though. The trends we’re seeing with fewer young people getting driver’s licenses than earlier generations, contributing to the general decline in per capita driving over the past 7 or so years offer some hope to researchers that perhaps we’re finally “turning a corner” on many of these trends:

In her book, Ms. Gallagher happily recounts some important countervailing trends: more young families are electing to live in cities; fewer 17-year-olds are getting driver’s licenses; people are driving fewer miles; and bike sharing is on the rise. More homes and communities are being planned or reconfigured to shorten commutes, reduce car dependence and facilitate positive interactions with other people.

Dr. Richard Jackson, the chair of environmental health sciences at the University of California, Los Angeles, says demographic shifts are fueling an interest in livable cities. Members of Generation Y tend to prefer mixed-use, walkable neighborhoods and short commutes, he said, and childless couples and baby boomers who no longer drive often favor urban settings.

While there is still a long way to go before the majority of Americans live in communities that foster good health, more urban planners are now doing health-impact assessments and working closely with architects, with the aim of designing healthier communities less dependent on motorized vehicles for transportation.

Now, about that Unitary Plan that enables a huge amount of sprawl and the Integrated Transport Programme loaded up with poor value roading projects.

Public transport’s health benefits

Todd Littman of the Victorian Transport Policy Institute has released a fascinating study into the health benefits of public transport. Here’s a brief summary of the study and its findings:

This report investigates ways that public transportation affects human health, and ways to incorporate these impacts into transport policy and planning decisions. This research indicates that public transit improvements and more transit oriented development can provide large but often overlooked health benefits. People who live or work in communities with high quality public transportation tend to drive significantly less and rely more on alternative modes (walking, cycling and public transit) than they would in more automobile-oriented areas. This reduces traffic crashes and pollution emissions, increases physical fitness and mental health, and provides access to medical care and healthy food.

These impacts are significant in magnitude compared with other planning objectives, but are often overlooked or undervalued in conventional transport planning. Various methods can be used to quantify and monetize (measure in monetary units) these health impacts. This analysis indicates that improving public transit can be one of the most cost effective ways to achieve public health objectives, and public health improvements are among the largest benefits provided by high quality public transit and transit-oriented development.

Considering the enormous amount of money spent on the health system in New Zealand (over $13 billion each year), looking at effective ways in which to improve health can potentially be extremely cost-effective. Add to that all the lost productivity from people dying earlier, or people being less healthy and productive and we’re talking seriously big numbers here.

Some of the connections between transport and health are obvious. The more we drive the more at risk we are of dying in a car accident. The converse to that is, because public transport is generally extremely safe, the more we use public transport per capita, the lower likelihood we will have of dying in traffic accidents. Statistics from US cities play out this correlation fairly well: There are also links between greater use of public transport, walking and cycling, and lower rates of obesity. This is once again reasonably obvious – as all public transport users are also pedestrians: while cycling is likely to keep you fit and therefore healthier in that sense:

Research also suggests that obesity rates tend to be inversely related to use of alternative modes (walking, cycling and public transit), as indicated in Figure 12. Rundle, et al. (2007) found that New York City residents’ Body Mass Index (BMI) ratings tend to decline significantly with greater subway and bus stop density, higher population density, and more mixed land use in their neighborhood.

Smart growth community design provides health benefits, particularly for children by encouraging physical activity (The American Academy of Paediatrics 2009). Residents of smart growth, multi-modal communities tend to walk more and have lower rates of obesity and hypertension than in sprawled areas (Ewing, et al. 2003). Frank, et al. (2010) found that residents of more neighborhoods with more and better transit service tend to walk significantly more and drive significantly less than residents of more automobile dependent neighborhoods. Research by Sturm (2005) found that, accounting for demographic factors such as age, race/ethnicity, education and income, the frequency of self-reported chronic medical conditions such as asthma, diabetes, hypertension and cancer increased with sprawl (Sturm 2005). Overall, 1,260 chronic medical conditions are reported per 1,000 residents; each 50-point change toward less sprawled location is associated with 96 fewer conditions. For example, shifting from automobile-oriented San Bernardino, California to transit-oriented Boston, Massachusetts would reduce 200 chronic medical conditions per 1,000 residents, a 16% reduction.

Another interesting link between public transport and better walking or cycling conditions is that a good public transport system makes it possible to remove many cars from city street, narrow down roads of pedstrianise them completely: which has huge benefits for walking and cycling. But critically, at the same time the good quality public transport will enable the city to keep functioning. It allows the best of both worlds.

I seriously do see the day when the Ministry of Health funds cycleways.

Transport, urban form and health

The Public Health Advisory Committee (PHAC) has released a very interesting study into the linkages between urban environments and wellbeing, entitled Healthy Places, Healthy Lives: urban environments and wellbeing. During my university studies I did quite a lot of research into what we call “Health Geography” – looking at how different environments affect different health outcomes. There are obvious linkages, like if you live in a polluted area or on a damp house then chances are you’ll have poorer health on average than someone elsewhere, but other areas of linkages are a bit more complex, and interesting. Particularly when we look at analysing the links between urban form and health outcomes.

Here’s an interesting extract from the PHAC’s study:

In high-income countries such as New Zealand, advances in engineering during the past 50 years have reduced physical activity in daily urban life. People drive to work, school or the shops, work is more sedentary than it was for people in previous generations, and recreation is also increasingly passive. Many of New Zealand’s urban areas, built over the past 50 years in response to population growth, were planned around these advances in engineering. Such neighbourhoods often have poorly connected street networks (for example, cul-de-sacs rather than grid-like streets) and low-density housing that is beyond walking distance to shops, workplaces and public transport.

International and New Zealand research suggests that the way we have been designing and planning our cities over recent decades is leading to some unintended negative consequences for health. Planned primarily around cars, these neighbourhoods are not conducive to physical activity for either recreation or active transport. In the resulting environments, there are fewer opportunities for social interaction, more motor vehicle emissions contributing to poorer air quality, and greater risk of road traffic injuries.

There’s certainly nothing here that we didn’t know already, but what this report does is put a few numbers on these effects:

  • Physical inactivity accounts for almost 10 percent of New Zealand’s 20 leading causes of death. It is a contributor to obesity and type 2 diabetes, which together cost the health system over $500 million per year.
  • The social cost of pedestrian injuries and fatalities is estimated to be $290 million per year (based on 1996–1999 averages). The social cost of all road traffic injuries was estimated to be $3.7 billion in 2008.
  • Air pollution accounts for over 3 percent of New Zealand’s 20 leading causes of death. Motor vehicle pollution, which is more common in urban areas, causes an estimated 500 deaths per year, an extra 540 cases of bronchitis, and an extra 250 hospital admissions for acute respiratory and cardiac conditions in New Zealand in adults over 30 years. Vehicle emissions can cause or exacerbate respiratory and cardiac illness, which costs the health system and economy an estimated $415 million per year.

It’s not inconceivable, nor illogical, to wonder whether the Ministry of Health should be funding the construction of cycleways around our major cities.

The study also looks at what overseas cities have done to make themselves “more healthy”:

Many of the world’s most notable cities have been planned to promote healthy, active and social living. Florence’s abundance of cafés encourages walking and social interaction. Copenhagen’s support for cycling paints a new picture of ‘commuter traffic’. New York City’s intricate public transport system efficiently carries millions of passengers every day, and its numerous public parks provide opportunities for recreation and social cohesion.

Some of these features have historic roots, as in Florence and New York City. Others involve a deliberate shift in their shape and form. In these cases, leaders have recognised that developing multiple transport modes, opportunities for walking and cycling, and mechanisms for social interaction bring ‘co-benefits’ in terms of the environment, tourism, business, health and society. The changes undertaken in Copenhagen and Portland, Oregon provide two examples of this kind of leadership.

In Denmark, cycling to work plummeted between 1950 and 1975. Then the 1970s oil crisis prompted the Government to invest in cycling and public transport infrastructure. Policies included establishing cycle lanes and paths, modified intersections, traffic signals that prioritised cyclists, and traffic calming measures. Private car use was discouraged through parking fees, taxes and tough driving tests. These changes have meant that one-third of Copenhagen residents now cycle to work, and there has been a 25 percent drop in cycle accidents. The Government is investing another US$16 billion in high-speed intercity trains, light rail and city bicycle lanes. The aim is to increase the proportion of Copenhagen commuters cycling to work to 50 percent by 2020.

In the 1970s Portland, Oregon was threatened with a deteriorating urban centre, degraded housing and poor air quality. Through both city and state leadership in urban planning, the Government prioritised urban regeneration, the expansion of public transport, walking and cycling infrastructure, and integrated urban development and transport planning. City authorities turned down a proposed bypass highway in favour of light-rail and public transport-oriented development when they realised that the latter would produce significantly fewer vehicle miles travelled and lower levels of congestion. These efforts have led to positive outcomes for health, the environment and the economic growth of the city. The city is rated as one of the most walkable and cycleable in the United States. Greenhouse gas emissions decreased by 13 percent per year from 1990 to 2003. Walking traffic led to more retail spending, and the regenerated city became a focal point for business, attracting skilled workers, residents and tourists.

The efforts of Copenhagen and Portland highlight the changes to cities that leadership and a focus on healthy urban design can achieve. Many urban areas are developing compact, liveable communities that reduce urban sprawl, increase transport options, create a sense of community and place, and preserve natural resources. Different sectors and traditions have converged to advocate for these changes in response to climate change, resource depletion, rising greenhouse gas emissions, obesity, excessive water use, water and air pollution, traffic congestion, and social isolation. They have found that these changes also create more foot traffic and retail spending and have lower public service and infrastructure costs per capita.

Public health leaders have been among those gathering evidence about urban form and advocating for such changes. The Healthy Cities movement of the World Health Organization (WHO) has focused increasingly on urban planning. The recent report produced by the WHO and the Commission on Social Determinants of Health highlights improved living conditions (including health-focused urban governance and planning) as one of three overarching recommendations to improve health equity.

A number of recommendations are made:

Looking at how we might structure a public transport network to better promote good health outcomes, I think one gain through “The Network Effect” that is not particularly well explored is that having a sparser, but higher quality, public transport network means that people are likely to, on average, walk more. If my bus stop is a 5 minute walk away, but the bus only comes every 20 minutes, chances are I’m going to spend 5 minutes walking to the bus stop and then at least 5-10 minutes waiting for the bus (I’ll make sure I get there early so I don’t miss it). On the other hand, if my bus stop is an 8 minute walk away, but the buses come every 5 minutes, then chances are I’m only going to be spending a couple of minutes waiting for my bus, more than making up the extra time spent walking. In other words, on average people will spend more time walking and less time waiting – which is probably a better health outcome without being a worse public transport outcome.

If you throw into the mix the ability to ride your bike to a public transport stop/station, and make it easy to do so (bike racks etc) then once again you’re tapping into health benefits as well as transport benefits. It makes me wonder whether health effects should be a negative in the cost-benefit analysis of motorways.