Health at center of transport and mobility

Last week, I delivered the keynote address at the 30th conference of the Transportation Science Society of the Philippines (TSSP), a community of practitioners and academics dedicated to advancing the country’s transportation system.

As the first medical doctor to address this annual convention, I spoke of the complex challenges at the nexus of human health and the environment in the future of transport, which need sustained collaboration between disciplines, professions, and sectors.

“Transport is not an end in itself,” stated Dr. Sheilah Napalang, TSSP president and professor at the University of the Philippines’ School of Urban and Regional Planning. Indeed, we use private cars or public vehicles to report to work, go shopping, access health care, and so on. As means to various ends, transport systems are usually measured in terms of accessibility, affordability, convenience, and more recently, environmental sustainability.

As a physician addressing the transport community, I posed to them a challenge: How about measuring the success of transport in terms of health? There is broad consensus that health is an outcome and indicator of a prosperous and sustainable society; it is even at the heart of the United Nations Sustainable Development Goals. So, if the transport sector were to look at health as part of its business, which areas of health should it consider?

A 2021 paper written by Glazener and colleagues identified 14 pathways that link transport with human health. Four pathways are deemed beneficial to health: green spaces; physical activity; access, and mobility independence (i.e., allowing the elderly and people with disabilities to move without extra help). The other 10 are detrimental to health: contamination (due to chemicals); social exclusion; noise pollution; urban heat island (i.e., worsening heat in cities); road travel injuries; air pollution; community severance (i.e., how infrastructure such as highways divide communities); electromagnetic fields; mental stress, and greenhouse gases, which drive climate change. From noxious gases that commuters inhale during a jeepney ride, to the unbearable heat they must endure while waiting in a Metro Rail Transit station, these pathways are very palpable in our transport system.

Moving forward, health professionals and researchers must collaborate closely with transportation scientists and urban planners in monitoring the health impacts of bad transport design, and the health benefits of good transport reform.

Meanwhile, let me add other considerations. First is how transport is vital for resilience against health crises such as pandemics. During COVID-19, transport restrictions limited people’s access to essential services like groceries, schools, and workplaces. Even health workers were stranded during the initial days of the pandemic. Thankfully, a former vice president had the vision to create a totally new transport system, ensuring that frontliners reached hospitals and treatment centers.

Moreover, mobility restrictions made people engage in less physical activity, which contributed to the rise in chronic conditions such as obesity. Some studies even suggested that these pandemic “side effects” may even be greater in magnitude than direct COVID-19 infections.

The other aspect that should not be forgotten is the health and well-being of people working in the transport sector, such as jeepney drivers and traffic enforcers who were considered “essential workers” during the pandemic. But does this designation translate to adequate care and support for their well-being? For instance, during the conference, it was revealed that pedicab drivers earn way less than the minimum wage, not surprising, but utterly unacceptable.

Ensuring the well-being of our transport workers—physical and mental, but also social and economic—must be part of our health-centered approach to transport policy. Ultimately, at the transport-health interface, equity must be embraced as an underpinning principle. Case in point is the country’s ongoing transition toward electric vehicles, which are promoted for both health and environmental reasons. There must be a “just transition” to ensure that drivers receive enough support, while commuters can afford these major changes.

Thankfully, in centering health in transport policy, we are not starting from scratch. I laud the Department of Health for being proactive in engaging the transport and urban mobility community as part of its health promotion agenda. The challenge is to translate these national efforts into local implementation in cities and municipalities.

After hearing good practices and exciting plans—from cities like Iloilo and Davao—I left the conference with optimism and hope.

—————–

Renzo R. Guinto, M.D. Dr.PH., is associate professor at the SingHealth Duke-NUS Global Health Institute based at the National University of Singapore.