Desmond O’Neill: Wheelbarrows, transport, and health

desmond_oneillThere is an old joke about a man who goes through a customs post with a wheelbarrow of sand every day. The increasingly frustrated customs officers make intensive searches of the contents, but never find any contraband. After many years, all are retired and meet by chance in a pub. When prevailed upon to reveal what he had been smuggling, he volunteers that it was wheelbarrows.

This story evokes parallels in many aspects of healthcare, whereby a focus on the tangible and the traditional can distract attention from the often less well defined, but bigger issue.

With older people, for example, the search for single organ disease can blind unattuned clinicians to the more important issue of functional loss and multi-morbidity.

In traffic medicine, a focus on the very real problems of injury, pollution, and lack of exercise can divert attention away from the less dramatic but equally important consideration of adequate access to transport as a mediator of health and wellbeing.

Up until recently, apart from special interest sections of the US Transportation Board, there have been few opportunities for academics and professionals in both public health and transportation to tease out the complex inter-relationships between health and transport.

The inaugural International Conference on Transport and Health in London this month was a big step forward in filling this gap. Promoted with verve by Jenny Mindell (UCL and founder-editor of the Journal of Transport and Health) and Karyn Warsow (of a non-governmental organisation, Transportation Public Health Link), the conference was successful in bringing together the many players involved.

If a theme could be seen to unify the very broad range of disciplines involved, it was that of livability—from good urban design; embracing and enhancing multi-modality of transport (particularly walking, cycling, and public transport); consultation with end users; to the use of emerging technologies, such as e-bikes and transport apps on mobile phones.

The range of projects and techniques were innovative, from using manipulated photographs to tease out the most desirable cycling streetscapes, to a prospective study of physical activity in the new housing spaces created from the Olympic Village in London.

A global perspective was notable, with a magisterial talk by Dinesh Mohan teasing out how the experiences of low income countries stress test perceived wisdom on promoting traffic safety, and in particular the need for a body of traffic medicine and road safety academic expertise locally to implement meaningful change. Equally impressive was a project to establish the foundation for age and disability friendly road safety policies in Sri Lanka.

The importance of transport access to health was highlighted in a number of papers: for example, the only determinant associated with mental health problems in an Italian study of the built environment was transport accessibility, and a UK study showed that utilisation of health services largely depends on mobility levels.

However, much work needs to be done to promote this aspect of transport and health. The standard Health Impact Assessment model for transport for the UK misses out on transport inequalities, and this was notable in other presentations on health impacts during the conference.

A part of this seems to relate to an ambivalent if not negative view of the car by many in this subject area. Just as one transport planner, while talking about consultation with end users, stated that a desk in an office is not the best place to plan transport for others, so too a privileged academic position in a large city with good public transport and increasing cycle access may not also be the best place to visualise the broader picture, particularly for those in rural and suburban areas, and those with disability.

Not only is the car recognised as a valuable means of extending independent living for older people in the community, but the condition which stops them from using the car usually also hinders them from using most forms of public transport, and effective alternative transportation is generally by way of someone else’s car.

I personally regard any minute spent behind the wheel of a car as one stolen from my life, and use public transport and cycling whenever I can, but I’m aware that this pattern exists in addition to access to a car when and where I need it. Indeed, it is notable that the Netherlands, whose €31 billion fiscal advantage from cycling was vaunted at the conference, has one of the highest rates of car ownership in the world.

So, while all societies will benefit from better urban and infrastructure planning, improved walking and cycling access, and more efficient public transport, it seems clear that these should be seen as complementary to the car in its various and evolving guises (including short term rental, Uber, and driverless) and the trick is to encourage multi-modality of transport as a lifelong strategy.

For an evolving, academic underpinning of these important issues, next year’s conference in San Jose, California, should be equally rewarding—and a perfect opportunity to sample its evolving cycling and pedestrian network!

Desmond (Des) O’Neill is a geriatrician and cultural gerontologist in Dublin. 

Competing interests: None declared.