Desmond O’Neill: On transport as a contributor to economic, social, and personal wellbeing

Desmond O'NeillTransport is the invisible glue that holds our lives together, an under recognised contributor to economic, social, and personal wellbeing. Unfortunately, in public health terms, our profession has allowed itself to focus almost exclusively on the downsides of transport. The chapter on transport in Marmot and Wilkinson’s otherwise excellent Social Determinants of Health makes for grim reading—accidents, pollution, and the impact of cars on exercise, and no mention on how lack of access to transport is associated with impaired health and social inclusion, an emerging research issue.

My current responsibilities include the development of traffic medicine in Ireland and my latest CPD activity was to attend the Transportation Research Board (TRB) annual meeting. This is one of the largest transportation research conferences in the world, held every January in Washington DC since 1920. Spread over three large hotels, delegates from around the world can sample an extraordinary selection of presentations. The topics range from road safety through to bridge and airport construction, and over the years there has been a slow but sure increase in medical input to complement transport engineering and planning.

This emerges particularly in a very strong human factors component, from the use of sophisticated in-car information technology, through medical fitness to drive, to access to transportation for those with disability. The subject matters are promoted by various subcommittees, and the TRB is generous in its openness for those from other countries to join, and indeed sometimes to chair these committees.

The range of topics for medical fitness to drive was broad, but had perhaps been overly confined under the heading of older drivers, except for drugs and alcohol. A hotly debated issue was that of how medical fitness to drive issues were channeled in very different ways by doctors, police, courts, and driver licencing agencies, and the meeting is quite a unique space where all players meet in one room. It is also clear that many jurisdictions struggle with illicit drug taking, and no clear consensus arose from the session.

The new edition of the Canadian medical fitness to drive guidelines was launched during the meeting, and Quebec has been prominent in setting the pace for evidence based guidelines. In terms of illness, and particularly multi-morbidity, they have chosen a strong policy of assessing by function rather than disease label, with ready recourse to relatively brief on-road testing if a concern is raised.

A particularly interesting programme for safety for older drivers (and one which might have interesting application for the rest of us as well) is the CarFit programme, adapting the safety measures to the individual person, such as the head rest, and seating position. The American Occupational Therapists Association has been very active, and launched a very useful manual for assessment of drivers with illness and functional limitations across the life span.

One of the most important new forums is that of linking public health and transportation: surprising as it may seem, the many disciplines in transport have had poor linkage with public health, up to now generally only related to crashes and accidents. However, it is clear that many other aspects are important, from pollution, through to exercise, to access to transportation as an aspect of social inclusion and wellbeing. The speakers at the meeting included cancer epidemiologists, environmental scientists, and transit planners, and I have been asked to be a representative of medical fitness to drive/older driver committee on this public health and transportation group.

But perhaps medical fitness to drive issues may change, and even fade in prominence, in a tantalising glimpse into the future of driverless cars delivered by a representative of a consortium developing the background guidelines and technology for this radical change. Fuelled as much by congestion as by safety, many elements of the system are being put in place, and trials ongoing in many parts of the USA. However, it will be some time before these are rolled out more widely, so traffic medicine will be required for some time to come.

The meeting is recommended for all those who wish to gain insights into the interface between health and transport. In addition, the setting is attractive. Washington in January is uncrowded, and the conference is set in the bohemian surroundings of Dupont Circle, including Kramerbooks and Afterwords, a wonderful bookshop/café which is open all night at weekends, and the gem like Phillips Collection, its attractive galleries rich in American and European art. Its Sunday afternoon chamber concerts also tend to dovetail nicely with the Human Factors workshops, a further transport of delight.

Desmond O’Neill is a consultant physician in geriatric and stroke medicine in Dublin, and is a member of the external advisory panel of the age friendly university initiative.