Effect of increasing active travel in urban England and Wales on costs to the National Health Service

Astell–Burt

Journal of Transport & Health

2017

AimsInvestments to promote public transport utilisation are being championed to achieve sustainable development, but the potential co-benefits for mental health are comparatively under-researched. We hypothesised that frequent users of public transport would be more likely to have better mental health (possibly due to increased levels of physical activity), but among the more frequent users, less favourable perceptions of public transport infrastructure (PPTI) could have a negative influence on mental health. MethodsMultilevel linear and logistic regressions were fitted on 30,214 participants in the UK Household Longitudinal Study with lagged PPTI and confounder measures at baseline and indicators of active travel and mental health (General Health Questionnaire (GHQ), SF-12 Mental Component Scale (MCS) and the Warwick Edinburgh Mental Well Being Scale (WEMWBS)) at follow-up. ResultsCompared to participants expressing poor PPTI, those who felt it was excellent were 1.29 (95%CI 1.15, 1.45) times more likely to be frequent users of public transport and 1.53 (95% CI 1.33, 1.76) times more likely to choose to walk or cycle journeys of less than two to three miles. Frequent use of public transport was found to be consistently associated with better mental health for GHQ caseness (OR 0.85, 95%CI 0.79, 0.91), MCS (coefficient 0.45, 95%CI 0.23, 0.66), and WEMWBS (coefficient 0.30, 95%CI 0.19, 0.40). Among frequent users of public transport, participants expressing poor PPTI were 1.46 (95%CI 1.11, 1.93) times more likely to report poorer mental health according to the GHQ caseness indicator, compared to frequent users that PLOS ONE | https://doi.org/10.1371/journal.pone

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Perceived Public Transport Infrastructure Modifies the Association Between Public Transport Use and Mental Health: Multilevel Analyses from the United Kingdom

Astell–Burt

Journal of Transport & Health

2017

Mitig Adapt Strateg Glob Change

“…System-wide effects need to be also considered, as an intervention in a particular sector may reverberate across the entire economy. For example, increasing active travel (walking and cycling) instead of using private cars has been shown to reduce costs to the healthcare services (and improve fiscal sustainability prospects) by reducing prevalence of some chronic diseases (Jarrett et al 2012). Investment therefore in transport infrastructure to promote active travel and reduce emissions can lead to cost savings and benefits elsewhere, such as the health sector.…”

Section: A Brief Review Of Methodological Approaches To Climate Policmentioning

confidence: 99%

Advancing methodological thinking and practice for development-compatible climate policy planning

Scrieciu

Belton

Chalabi

et al. 2014

Self Cite

This version is available at https://strathprints.strath.ac.uk/45742/ Strathprints is designed to allow users to access the research output of the University of Strathclyde. Unless otherwise explicitly stated on the manuscript, Copyright © and Moral Rights for the papers on this site are retained by the individual authors and/or other copyright owners. Please check the manuscript for details of any other licences that may have been applied. You may not engage in further distribution of the material for any profitmaking activities or any commercial gain. You may freely distribute both the url (https://strathprints.strath.ac.uk/) and the content of this paper for research or private study, educational, or not-for-profit purposes without prior permission or charge.Any correspondence concerning this service should be sent to the Strathprints administrator: strathprints@strath.ac.ukThe Strathprints institutional repository (https://strathprints.strath.ac.uk) is a digital archive of University of Strathclyde research outputs. It has been developed to disseminate open access research outputs, expose data about those outputs, and enable the management and persistent access to Strathclyde's intellectual output. Authors accepted manuscript. Published as:Scriecu, S., Belton, V., Chalabi, Z., Mechler, R., Puig, D. (2014) There are growing calls for identifying climate mitigation and adaptation policypackages that would also support human development objectives at the national and regional levels. The literature on climate policy analysis and impact assessment continues to be driven by standard economics with its body of competitive general equilibrium optimization models and cost-benefit analysis techniques of aggregation and monetization. However, its recommendations for climate action are often based on highly restrictive underlying assumptions, which have been increasingly criticized for being too prescriptive, not adequately capturing salient observed socioeconomic realities, and not acknowledging pluralism in values.The main aim of this paper is to put forward a new methodological approach that seeks to address these deficiencies. A generic but comprehensive framework eliciting mitigationadaptation-development interactions, accounting for institutional barriers, and drawing on a combination of an emerging body of new climate economics and multi-criteria decision analysis is suggested. We purport that, by using this framework, multi-dimensional impacts and multistakeholder interests could be better represented when planning climate policy actions. We also argue that analytical tools drawing on economic thinking which embraces interdisciplinary analysis and deep uncertainty and avoids the fallacy of unique optimal solutions, may deliver more effective strategies for pushing economies onto the transformational pathways required.

“…158 Here, there are mixed implications. We identified no strong evidence for the anticipated negative effects on distances walked, given that the scheme appeared to generate new trips, which involved some walking, and some replacement of more 'passive' car travel.…”

Section: Active Travel: Implications For Physical Exercisementioning

confidence: 99%

On the buses: a mixed-method evaluation of the impact of free bus travel for young people on the public health

Green

Steinbach

Jones

et al. 2014

Public Health Research

Self Cite

BackgroundIn September 2005 London introduced a policy granting young people aged < 17 years access to free bus and tram travel. A year later this policy was extended to people aged < 18 years in education, work or training. This intervention was part of a broader environmental strategy in London to reduce private car use, but its primary aim was to decrease ‘transport exclusion’, and ensure that access to goods, services, education and training opportunities were not denied to some young people because of transport poverty. However, there were also likely to be positive and negative health implications, which were difficult to assess in the absence of a robust evidence base on the impact of transport policies on health and well-being.ObjectivesTo evaluate the impact of free bus travel for young people in London on the public health. Specifically, to provide empirical evidence for the impact of this ‘natural experiment’ on health outcomes and behaviours (e.g. injuries, active travel) for young people; explore the effects on the determinants of health; identify the effects on older citizens of increased access to bus travel for young people and to identify whether or not the intervention represented value for money.DesignQuasi-experimental design, using secondary analysis of routine data, primary qualitative data and literature reviews.SettingLondon, UK.ParticipantsYoung people aged 12–17 years and older citizens aged ≥ 60 years.InterventionThe introduction of free bus travel for those aged < 17 years living in London in 2005, extended to those aged < 18 years in 2006.Main outcome measuresQuantitative: number of journeys to school or work; frequency and distance of active travel (i.e. walking and/or cycling), bus travel, car travel; incidence of road traffic injuries and assaults and socioeconomic gradients in travel patterns. Qualitative: how free bus travel affected young people and older citizens’ travel and well-being.MethodsQuantitative component: change-on-change analysis comparing pre–post change in the target age group (12–17 years) against that seen in ‘non-exposed’ groups [for travel mode, road traffic injury (RTI) and assaults]. Qualitative component: interviews analysed using both deductive and inductive methods. Economic evaluation: cost–benefit analysis (CBA).Data sourcesLondon Area Transport Survey (LATS) and London Travel Demand Survey (LTDS) (travel mode); STATS19 Road Accident data set (RTI); Hospital Episode Statistics (HES) (assaults); interviews with young people and older citizens; and cost data from providers and literature reviews.ResultsThe introduction of free bus travel for young people was associated with higher use of bus travel by adults and young people [31% increase, 95% confidence interval (CI) 19% to 42%; and 26% increase, 95% CI 13% to 41%, respectively], especially for short journeys, and lower car distances relative to adults (relative change 0.73, 95% CI 0.55 to 0.94); no significant overall reduction in ‘active travel’ [reduction in number of walking trips but no evidence of change in distance walked (relative change 0.99, 95% CI 0.92 to 1.07)]; significant reduction in cycling relative to adults (but from a very low base); a reduction in road traffic injuries for car occupants (relative change 0.89, 95% CI 0.84 to 0.95) and cyclists (relative change 0.60, 95% CI 0.55 to 0.66), but not pedestrians; an overall modest increase in journeys to work or school (relative change 1.09, 95% CI 1.06 to 1.14); equivocal evidence of impact on socioeconomic gradients in travel behaviour and no evidence of adverse impact on travel of older people aged > 60 years. An increase in assaults largely preceded the scheme. Qualitative data suggested that the scheme increased opportunities for independent travel, social inclusion, and a sense of belonging and that it ‘normalised’ bus travel. The monetised benefits of the scheme substantially outweighed the costs, providing what the Department for Transport (DfT) considers ‘high’ value for money.ConclusionThe free bus travel scheme for young people appears to have encouraged their greater use of bus transport for short trips without significant impact on their overall active travel. There was qualitative evidence for benefits on social determinants of health, such as normalisation of bus travel, greater social inclusion and opportunities for independent travel. In the context of a good bus service, universal free bus travel for young people appears to be a cost-effective contributor to social inclusion and, potentially, to increasing sustainable transport in the long term. Further research is needed on the effects of both active and other travel modes on the determinants of health; the factors that influence maintenance of travel mode change; travel as ‘social practice’; the impact of driving license changes on injury rates for young adults and the value of a statistical life for young people.FundingThe National Institute for Health Research Public Health Research programme.