Health 2020: transport and health: sector brief on transport

Synergy between sectors: working together for better transport and health outcomes The Health 2020 policy framework has been adopted by all Member States of the WHO European Region in order to address Europe’s great social and health challenges, calling upon the health sector to reach out to, and work with, all the various sectors and parties in the continuous work of improving people’s health and well-being. Investing in transport plays an important role in determining health throughout the life-course. The transport sector is crucial to opportunities for participation in society, sustainable development, preventing injuries and disease and promoting health as well as the quality and liveability of the envi- ronment. By working together, health and transport can contribute significantly to in- dividuals, communities and societies, reduce inequalities and support human develop- ment and high-quality, liveable environ- ments, not only improving good health and well-being but also enhancing sustainable transport and fostering healthy and resilient communities and economies. The transport sector can help create healthi- er people and communities by: • ensuring availability and access to jobs and key services, education and leisure; • creating living environments that are both safe and supportive and support the well-being of communities and individuals; • providing healthier and sustainable trans- port options that reduce pollution, noise and congestion while supporting active lifestyles and road safety and improving air quality; • encouraging social inclusion by address- ing environmental health inequalities, preventing alienation and solitude and reducing crime and violence; • supporting individuals and economies through new jobs and professions linked to new transport policy options and improving the quality and liveability of environments; and • working with the health sector to em- power communities and strengthen their capacity to participate in decisions affect- ing their environment and their health. Summary Health 2020: Transport and health May 2015 Sector brief on Transport 5 Social progress is best mea- sured by objective indicators of health, health equity and well-being, and this includes the conditions in which people are born, live and work. 1 Health and wellbeing are public goods and assets for human development that contribute to strong, dynamic and creative societies. 2 Health and well-being are best achieved if the whole of government works together, and Health 2020 promotes whole- of-government and whole-of- society approaches. 3 Health and well-being can be improved and health inequalities reduced, through the right policies and working with other sectors. 4 Different countries, cities and communities are at different starting-points; each is unique and can pursue common goals through different pathways. Key messages The goal of Health 2020 is to significantly improve the health and well-being of populations, reduce health inequalities, strengthen public health and ensure people-centred health systems that are universal, equitable, sustainable and of high quality. Health 2020: Transport2 In 2012, all 53 Member States in the European Region adopted Health 2020, the new common European health policy framework, and committed themselves to developing integrative policies that engage with all sectors in addressing the social and economic determinants of health and well-being. Promoting healthy, inclusive and sustainable transport options can play a key role in this process and further contribute to improving human health. The transport sec- tor plays an important role in people’s lives, including providing access to jobs, services, education and leisure; supporting economic growth; and through its capacity to affect their environment and their health. In today’s Europe, cars, heavy good vehicles and motorcycles are the main means of road transport. The rapid growth of road transport has affected health and envi- ronment through congestion, car crashes, air pollution and noise. It has contributed to sedentary lifestyles, especially in urban areas, and to emissions of greenhouse gases. Many of these risk factors are linked to respiratory diseases, high blood pressure, obesity, cardiovascular diseases, type 2 diabetes, cancer and mental health problems. Making our cities safe for walking and cycling as well as adequate, accessible and affordable public transport will improve health and tackle inequalities in mobility in the population. Working together, we have the power to intervene to address avoidable negative effects, to compensate for unequal situations and to ensure that those who are among the most vulnerable receive the extra attention they need. Strengthening the link between health and transport policy World Health Organization 3 All Member States of the WHO European Region have agreed to monitor progress against six common targets: 1. Reduce premature mortality in the European Region by 2020 2. Increase life expectancy in the European Region 3. Reduce health inequalities in the European Region 4. Enhance the wellbeing of the European Region population 5. Ensure universal health coverage and the right to the highest attainable level of health 6. Set national goals and targets related to health in Member States. What makes societies prosper and flourish can also make people healthy, and policies that recognize this have more impact. Building awareness and capacity to make health objectives part of society’s overall socioec- onomic and human development is essential. All policy fields, including health, need to reform their ways of working and use new forms and approaches to policy at the global, national and local levels. The goal of Health 2020 is to significantly improve the health and well-being of populations, reduce health inequalities, strengthen public health and ensure people-centred health systems that are uni- versal, equitable, sustainable and of high quality. Health 2020: a framework for action Health 2020: Transport4 Strengthening the link between transport and health It is well understood that transport is an important determinant and lever for health and health equity. Meeting the needs of today’s societies for transport influenc- es health in many ways, and sustainable transport practices are key for protecting and promoting human health. For example, a lack of adequate physical activity is esti- mated to be associated with about 900 000 deaths per year in the European Region, where about 20–30% of adults are estimat- ed to be obese. Walking and cycling could help integrate physical activity into daily life, and urban transport patterns would make this feasible. Walking and cycling are easily available to almost everybody, can effectively replace short car trips and can be more readily integrated into people’s busy schedules as part of daily lives. Road traffic injuries are the leading cause of death among people 5–29 years old and often result in severe disability which may be life-long. The World Bank 2014 report Transport for health states that “injuries and pollution from vehicles contribute to six of the top 10 causes of death globally” and that “road injuries have substantial impact on maternal and child health”. Of people dying in road traffic in the Europe- an Region, 43% are vulnerable road users (27% pedestrians, 12% users of motorized Synergy between sectors: transport policy as a tool to benefit health two- or three-wheelers and 4% cyclists) and 50% are car occupants. Unsafe road envi- ronments are a deterrent to people using physically active forms of transport as well as public transport. Road transport is also a significant source of outdoor air pollution. Exposure to ambient particulate matter, of which transport is a major source, particularly in urban areas, is estimated to cause an average loss of 9 months of life expectancy and 482 000 premature deaths per year in the European Region. According to the report “Economic cost of the health impact of air pollution in Europe: Clean air, health and wealth”, 2015, the economic cost of these health effects is valued at more than US$ 1.2 trillion per year. Promoting sustainable development by reducing air pollution and greenhouse-gas emissions from transport while improving energy efficiency and shifting towards a low-carbon economy would also indirectly contribute to addressing climate change–re- lated health outcomes. Providing transport infrastructure and sys- tems that enable all parts of society to par- ticipate in transport activities and therefore strengthening social inclusion would reduce inequalities. Focusing on high-risk groups, including children, older people, poor people and people with reduced mobility, would reduce health inequality effects from transport, including their greater exposure to unsafe roads. Walking and cycling are particularly practicable for groups excluded from other forms of physical activity for economic, social or cultural reasons and therefore hold untapped potential to reduce health gaps related to physical inactivity. Safer road infrastructure and vehicle design and using comprehensive legislation, enforcement and education to change road user behaviour, are instrumental to achiev- ing safety on the roads. Integrating health and transport concerns can bring mutual benefits, including re- ducing congestion and emissions, moving towards a low-carbon and more energy-ef- ficient economy and increased physical ac- tivity levels and consequently better health for all. Additional societal benefits could be expected from opportunities for new jobs and professions linked to new transport pol- icy options as well as from improvements in the quality and liveability of the urban envi- ronment for every child, woman and man – preventing alienation and solitude, reducing crime and boosting local economies. World Health Organization 5 How can transport policy make a differ- ence to health? Health 2020 provides a platform for such joint working between the transport and health sectors. Working together, we have the power to intervene to address some of today’s greatest health challenges, including health inequalities and social exclusion, and to support sustainable development while ensuring that individuals and communities are able to fulfil their highest potential. In turn, intersectoral collaboration promotes and supports transport goals by reducing congestion and emissions and moving towards low-carbon and energy-efficient economies. Synergy between sectors: collaboration to promote sustainable development and health KEY AREAS TO EXPLORE TOGETHER INCLUDE: • how health and transport can align poli- cies that benefit both sectors and serve the whole community; • how to pursue mutual benefits such as reduced congestion, improved road safety and increase sustainable transport options; • how the health and transport sectors can work together in times of economic or external pressures using existing policy platforms such as the Transport, Health and Environment Pan-European Pro- gramme with specific commitments to fulfil a vision of green and healthy mobility and transport for all; and • how to optimize outcomes in health and health equity by strengthening the part- nerships between the health, transport and urban and spatial planning sectors. • Invest in environment- and health-friendly transport and clean fuels. • Support transport and subsidy policies that reduce emissions of transport-related green- house gases, air pollutants and noise • Promote community-led, local needs–responsive action conducive to healthy, inclusive and safe modes of transport, such as walking, cycling and public transport • Strengthen monitoring and reporting on healthy and safe modes of transport • Create framework conditions that empower local authorities to act on sustainable and healthy transport • Internalize all societal effects and costs from unhealthy and unsustainable transport prac- tices to promote sustainable, health-friendly transport with concrete market incentives • Directly link local communities (including in rural areas) with health and social infrastructure How can the sectors work together? Health 2020: Transport6 How can health make a difference to the transport sector? Collaboration to improve the well- being of people and communities THE CHALLENGE Transport affects the environment and human health both locally and remotely People’s health and environmental condi- tions are deteriorating through the increase in motorized transport in cities. Poor people, homeless people, children and older people are disproportionately affected, leading to increasing health inequalities Complex health and environmental chal- lenges require coherence across policies and new partnerships • Evaluate the health implications of transport policies, both in terms of pressures on health and sustainability and opportunities for health gains • Incorporate literacy in the link between transport policies and health into the education of health professionals • improve population-wide health literacy, emphasize health, social and environmental benefits of physical activity through active transport • Keep the evidence on the health implications of transport updated & develop resources and tools for supporting intersectoral dialogue THE RESPONSE NEEDED Through intersectoral collaboration and using tools such as health impact assessment, to understand the effects as well as develop and implement healthy-friend- ly transport policies. Involving a broader set of stake- holders contributes to the legitimacy and acceptability of such policies Strengthening the stewardship role of transport on the urban environment through an alliance with health agencies and health advocates. Fully considering health and well-being of all population groups in transport pol- icies, including vulnerable or marginalized groups, helps to preserve and enhance the quality of the environment, especially the urban environment. Greater investment in public transport and support for sustainable modes of transport benefits health and offers scope to reduce health and social inequities Working together across all levels of governance, in- cluding advocating for whole-of-government approach- es and collaboration with other sectors to integrate transport, health and environmental objectives into urban and spatial planning policies, including infrastruc- ture in rural areas. Working together to demonstrate the benefits of healthy and sustainable transport are not limited to environment and health but extend also to the economic, tourism and social sectors World Health Organization 7 The Health 2020 policy framework has a political mandate. It has been adopted by all European Member States and can be adapt- ed to the different settings and realities that make up the European Region. It describes how health and well-being can be advanced, sustained and measured through action that creates social cohesion, security, a good work–life balance, good health and good ed- ucation. It calls on the health sector to reach out to the many different actors within and outside government and provides inspiration and direction on addressing the complex health challenges of the 21st century. The framework confirms values, is informed by evidence and identifies strategic directions and essential actions. It builds on the expe- riences gained through previous Health for All policies and guides the actions of both Member States and the Regional Office. The available evidence on the health impli- cations of transport, via direct and indirect effects, provides a strong basis for develop- ing and implementing policies involving the transport sector that promote good health, support well-being, reduce inequalities and are good for transport and the environment too, contributing to sustainability. In the European Region, robust policy platforms provide a governance structure for the transport, health and environment sectors to work together. These include the Transport, Health and Environment Pan-Eu- ropean Programme, with specific commit- ments to fulfil a vision of green and healthy mobility and transport for sustainable livelihoods for all, and the European Envi- ronment and Health Process, which, among other things, strives to provide opportunities for children to be physically active while re- ducing the risks of injuries. These platforms and the tools that have been developed through them can be leveraged to foster the integration of transport and health. Scientific evidence on the connections between transport and health is continually being strengthened, but available knowl- edge already provides a strong basis for undertaking a meaningful dialogue across sectors, with the aim of taking advantage of transport’s large potential to contribute to health and well-being for everyone. The benefits of healthy and sustainable transport are not limited to environment and health but extend also to the eco- nomic, tourism and social sectors. Through intersectoral collaboration, win-win-win solutions can be developed and implement- ed, consolidating the benefits through a holistic approach. The goal of the United Nation’s Decade of Action for Road Safety 2011-2020 to halve road traffic deaths, will only be achieved through comprehensive intersectoral approaches and will bring health benefits to all generations across their life-course. Health 2020 sees the transport sector as a co-producer of health; a crucially important policy area for society, influencing key deter- minants of health; an employer of a work- force and key contributor to the low-carbon economy; a key influence on the immediate and wider physical and social environment; and a partner in striving for investment in government policies that are coherent in their policy goals. A health and well-being lens can help to address complex issues such as integrating health and transport concerns in urban and spatial planning, through participatory consultation processes. Using Health 2020 as a platform for joint work: a political mandate and evidence base LIFE-COURSE STAGE • Social protection for women, mothers- to-be and young families • Universal, high-quality and affordable early-years education and care system • Eradication of unsafe work and access to employment and high quality work • Coherent and effective intersectoral action to tackle inequalities at older ages WIDER SOCIETY • Improved social protection, according to need • Co-creation and partnership with those targeted, civil society and civic partners • Action to reduce social exclusion • Gender equity approach BROADER CONTEXT • Promoting equity through tax and trans- fer payments • Long-term planning through links with other policies SYSTEMS • Greater coherence across sectors • Comprehensive responses • Regular reporting and public scrutiny Reducing health inequalities To reduce health inequalities, addressing the following is a good start: WORLD HEALTH ORGANIZATION | REGIONAL OFFICE FOR EUROPE UN City, Marmorvej 51, DK-2100 Copenhagen Ø, Denmark Tel.: +45 45 33 70 00 Fax: +45 45 33 70 01 E-mail: contact@euro.who.int Website: www.euro.who.int Document number: WHO/EURO:2015-6166-45931-66211 © World Health Organization 2015. 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