Section IV What should be done? What is a healthy transport system?........................................................................................1 Outline of Section IV................................................................................................................1 References..............................................................................................................................2 What is a healthy transport system? Transport promotes health by enabling access to places and people and providing exercise. However, it also damages health by, for example, injuries, pollution, noise, congestion, stress, and severance of communities by roads. The damage affects both people who are travelling and others in society, as outlined in Section II. The health effects of transport are unequally distributed in society with disadvantaged people experiencing the least benefit and the most disbenefit. For example, cars provide great mobility for their users, but do most health damage to those without cars. Present patterns of transport do not meet existing, and cannot meet projected, transport needs. Furthermore there is growing evidence that increasing dependence on the private motor vehicle is neither a cost effective, nor an environmentally sustainable, way of meeting these needs. The aim of a healthy transport policy should be to maximise access to facilities for everyone at minimum cost; these costs, including health costs, should not be unfairly distributed throughout society. Therefore a healthy transport policy must: • encourage walking and cycling, which are healthy exercise, do not impose danger on others, and do not generate pollutants. • reduce the dangers faced – or perceived - by pedestrians and cyclists. This requires road designs that reduce speed of motor traffic, the provision of cycle and pedestrian facilities and, most importantly, changes in driver attitudes. • ensure that people without cars are able to get about independently. The savings to health and welfare services provided by improved accessibility more than offset any subsidies paid to improve public transport. 1 • seek to reduce pollution levels resulting from car use and seek to reduce injuries from motor traffic, which may require reduction in traffic levels and car use generally. Outline of Section IV Section IV presents the views of the Transport and Health Study Group on what needs to be done to achieve a healthy transport system, drawing on the evidence that has been presented in Section II. Chapter 13, Reducing social exclusion , considers how transport could be provided to meet the needs of those with disabilities, impairments and encumbrances and those who are excluded due to poverty, gender, age, or geography. IV-1 Chapter 14, Promoting walking and cycling , summarises strategies to increase physically active transport. Chapter 15, Revitalising public transport , discusses how public transport can be improved to be the default mode when walking or cycling are not possible. Chapter 16, Rethinking streets , considers how the built environment needs to be changed in future to reduce car use and make streets better places for residents, pedestrians, and cyclists. Chapter 17, Driving less but driving better , recommends strategies to reduce the use of motorized road vehicles and also to improve the standard of driving when these are used. Chapter 18, Preventing injuries, considers what can be done to reduce injuries to travellers, particularly those using roads and especially those caused by collision with a motorised vehicle. Chapter 19, The roles of the NHS, considers the importance of the NHS influencing societal norms both in its role as the biggest employer in Europe and through the close link between NHS departments of public health and local government. Chapter 20, Other strategies for a healthy transport system , makes further recommendations that cut across the areas discussed earlier in Section III. Chapter 21 makes recommendations, with Chapter 22 concluding the report. As with Sections I, II and III, references are listed at the end of each chapter. References 1 Nicholl JP, Freeman MR, Williams BT. Effects of subsidising bus travel on the occurrence of road traffic casualties. Journal of Epidemiology & Community Health. 1987; 41 :50-4. IV-2 13 Reducing social exclusion Anne Frye, Stephen Watkins, Rachel Aldred, Stuart Murray, Jennifer Cohen 13.1 Extending social inclusion.......................................................................................13-1 13.1.1 Principles for inclusion ....................................................................................13-2 13.1.2 Reducing social exclusion through public transport provision..........................13-3 13.1.3 Active travel ....................................................................................................13-3 13.2 Rural disadvantage.................................................................................................13-3 13.3 Poverty ...................................................................................................................13-4 13.4 Women...................................................................................................................13-4 13.5 Older people...........................................................................................................13-4 13.6 Disabilities and Encumbrances...............................................................................13-6 13.6.1 Mobility vehicles..............................................................................................13-7 13.6.2 Public transport for those with disabilities or encumbrances ...........................13-7 13.7 References.............................................................................................................13-9 13.1 Extending social inclusion Social inequalities in the use of transport, the adverse effects of transport, and the effects of transport policies were described in chapter 9. In 2000, the UK government described four ways in which people can be excluded by transport from participation in society: • Spatially (they cannot reach there are all) • Temporally (they cannot reach there in time) • Financially (they cannot afford to travel there) • Personally (they do not have the mental or physical abilities to use the available means of travel). 1 Social inclusion is the removal of the causes of social exclusion, which is a combination of circumstances (such as low income, unemployment, poor housing, poor skills and poor health) which prevent people from participating fully in society. Usually those who are socially excluded have two or more of these characteristics, for example unemployed teenagers and low-income people living in rural areas. Extending social inclusion entails removing barriers and facilitating access. The Social Exclusion Unit defined accessibility as ‘at reasonable cost, in reasonable time, and with reasonable ease’. 2 The ‘New Approach to Appraisal’ (NATA),an appraisal framework for transport projects and proposals in the UK, includes accessibility as one of the five strands (see section 12.10 for information about WebTAG for appraisal methods). Social inclusion involves many issues that have nothing to do with transport, including politics, poverty and the nature of society. However, better transport can help to overcome many problems associated with social exclusion by enabling people to reach opportunities that can help them earn money, improve their health, and enjoy a rich social life, all of which can help 13-1 make people to feel more included. Hence, it is increasingly being recognised that transport policy should take into account explicitly the needs of those who are socially excluded. There are a number of reasons why social inclusion should be increased, including increasing equity, increasing the potential of the whole of society, and reducing the risk of friction between groups in society. A number of barriers to social inclusion can be identified in transport: • Fear, e.g. fear of mugging; • Confusing layouts, e.g. shared spaces for visually impaired people • Lack of confidence, e.g. in using buses; • Information barriers, e.g. inability to understand bus timetables because of learning or language difficulties; incomplete knowledge of transport options available • Social/cultural barriers, e.g. women not being allowed to drive; • Physical barriers, e.g. high steps onto buses, absence of dropped kerbs • Financial barriers, e.g. unaffordable fares. There are a variety of ways in which the barriers to increased social inclusion be overcome, for example: • Continue to increase the accessibility of transport services (low floor buses, driver training, and so on); • Recognise that those who are currently excluded are potential customers and sources of revenue; • Develop ways of increasing the confidence of potential travellers; • Consult those who do not use public transport now to find out what needs to be done to help them; • Develop new ways of providing information; • Encourage co-operation between agencies that provide facilities; • Be imaginative: novel fare schemes, clever marketing, better information, and so on. However, there is currently no comprehensive way to ensure that transport policies do take social inclusion into account. This issue is being addressed in a research project being carried out in the Centre for Transport Studies at University College London as part of the work programme of