Your mode of transport to work determines your health: How public transport affects public health.

The traffic situation in Trinidad & Tobago (T&T) can be horrendous at times. Over the pass many years, we would have seen infrastructure improvements, like the San Fernando interchange and the Grand Bazar interchange, that may have helped alleviate the traffic situation somewhat. However, with a public that aspires towards investments that may be perceived as a mark of achievement or upward social mobility, like owning one’s on car, the car sales industry remains a lucrative industry and results in more and more cars for private use on the road ways. Such an ideology seem to have existed after the end of World War I, when the appearance of the automobile led to changes that culminated with the phased closure of the railway April 1953 and on 28 December 1968 the complete closure of the Trinidad Government Railways. Oh, what a tangled web we wove that has culminated in our current traffic woes and all other problems that has stemmed from it. The escalating rates new cars on the road has seen drawbacks in the many initiatives we have embarked on in the past to alleviate the traffic situation. My goes back to Robert Mougabe, former president of Zimbabwe who asked the question, ‘We need to teach our generation that a car is not a symbol of success and walking doesn't mean poverty?’ But, is this just a question of morals, ethics, virtue and philosophy? Over time we have realized that every part of our daily lives are intertwined very intricately and are more concordant than they are mutually exclusive. This has brought us to think in a whole new perspective and realized that our priorities are not where they should be, especially from a policy level. On this topic of the mode of transport, would it be completely outrageous to think that this could be directly associated with public health? 

 

Is it obvious, if not to the common man, to our administration, that Public Transport is one of the social determinants of health or a socio-economic factor that directly affects a population’s health? With regard to current trends in T&T, it may not seem so, as the sales of private vehicles continue to rise despite the investment into our transportation sector within the context of public transport. Using public transport increases physical activity and helps reduce the chance of obesity and other health problems related to sedentary lifestyles. Active travel, particularly walking and cycling, has been recommended because of the health benefits associated with increased physical activity. How people travel affects physical and mental health, including cancer, cardiovascular disease, vehicle crashes, and diabetes, four major causes of death.

Promoting physical activity is an established health promotion priority, and is as important stopping smoking and reducing high blood pressure. It is well documented that population patterns of physical activity are influenced by the physical and built environments with features of the built environment such as mixed land use, well-connected street networks and high residential density positively associated with higher levels of physical activity. The beginning or end of a public transport trip usually involves some walking to the next destination. This active travel component of a public transport trip could provide an important opportunity for physical activity and may be missed in some assessments of physical activity. Studies in Australia have shown that a range of 8–33 minutes of additional physical activity is associated with public transport use.  Studies have also concurred that people who use public transport are five times more physical active. 

 

The incident rate of cars being on our road ways has gotten so high that a car per citizen is a becoming a stark reality. Apart from promoting a sedentary lifestyle, driving one’s own car also has its drawbacks. Given the fact that there are increased car on the roads that has resulted in increased traffic, this has increased the transit time from home to work and back considerably. In addition to adding more stress to the motorist, the motorist spends most of their time alone in his car for hours without human interaction. More so since using cell phones is outlawed while driving. Long hours in traffic means reduced time spent with colleagues at work and the family at home. This essentially leads to social exclusion, another important socio-economic factor that is deleterious to health, especially mental health. Studies have shown that if there is a reliable and cost effective public transport system, with more people using such a system there will be opportunities for social interaction while in transit which would fosters good mental health among members of the population that use the public transport system.

We all know that the increase consumption of fossil fuels, due to more vehicles being on the road, leads to more carbon emissions, global warming and climate change. This is even compounded by the increase in transit time due to the horrendous traffic on the roadways. But, in addition to this, air and noise pollution from transport cause a wide range of health problems, with road transport and diesel vehicles in particular the biggest contributors.  The World Health Organization (WHO) recently warned of health-threatening air pollution levels in major cities around the world. Just days into 2016, several European cities including London and Paris were affected by pollution episodes.  There is clear and increasing evidence of the health impacts that exposure to a whole range of air pollutants can have. Although only episodes of high pollution might be making the newspaper headlines, long-term and continued exposure to even low concentrations of air pollutants is much more harmful to human health. Similarly, noise pollution threatens human health and wellbeing, with road traffic again the most widespread contributor. Individual air pollutants can cause a variety of health impacts. Nitrogen oxides, particulate matter, sulphur oxides, carbon monoxide, and various heavy metals such as cadmium, lead and mercury are all emitted from the exhausts of vehicles. In addition, precursor chemicals in exhausts may react in the atmosphere giving rise to the formation of ozone. Finally, particulate matter and heavy metals are also released into the air as a result of tyre and brake abrasion and, once they have been deposited on the pavement may be ‘re-suspended’ in the air by passing cars. Exposure to these pollutants can have very specific health impacts, but in general, the organs, nervous system and blood are affected, causing or aggravating ailments such as lung disease — leading to respiratory problems — heart attacks, asthma, anxiety, dizziness and fatigue. Noise also has significant health impacts. Exposure during the night can cause sleep disturbance, leading to adverse health effects. Long-term exposure during an average day period can result in increased blood pressure and cardiovascular disease among other illnesses.

 

A deeply concerning scenario is the incidents of car accidents and lives tragically lost in them. Fatal road accidents indeed are a significant cause of death in T&T that could be preventable. The implementation of the breathalyzer seems not to have had the curbing effect that was intended. In the big cities of Europe and the USA, studies have shown that such incidence of fatal road accidents are prevented due to the availability of a reliable, efficient and affordable public transport system. Thus, it makes sense that the Ministry of Works and Transport is an important stakeholder where the public’s health is concerned. By having the power to make decisions regarding transportation policy, the Ministry can play a key role in reducing the incidence and prevalence obesity, diabetes, hypertension, cardiac disease, cancer, mental illness, respiratory diseases and road fatalities. A top official at the Ministry after being interviewed, revealed that the Ministry is thinking along the lines of policy to improve transportation by focusing on public transportation. Currently, the Ministry is doing destination studies and other transport studies as a preliminary needs assessment to determine the areas that need improvement and the priority in which they should be dealt. There is the consideration of the introduction of a High Occupancy Vehicle Lane to be used by buses and taxies to free up traffic flow. Much like the San Fernando to Port-Of-Spain ferry service has served to reduce the amount of private cars on the road, the Ministry is formulating policy to have improved bus services, ride sharing, car pooling and park and ride facilities to encourage use of the public transport system. Thus, the ultimate goal should be to have a reliable, efficient, effective and affordable public transport service. After this is established, there should be consideration of a toll system to enter major towns and cities. Parking meters and only paid parking should be introduced in these places in an attempt to discourage usage of private vehicles and encourage use of the public transport system. Such initiatives will go a long way in improving public health and by extension productivity to achieve the United Nation’s millennium and achieving sustainable development.      

 

 

Dr Visham Bhimull 

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