The health impacts of transport planning and policy

1. The Health Impacts of Traffic-related Exposures in Urban
Areas: Understanding Real Effects, Underlying Driving
Forces and Co-producing Future Directions
Haneen Khreis, 2nd International Conference on
Transport and Health, San Jose, 13-15 June, 2016
Session: Collaboration for a Healthy Change in Transport Planning, Advocacy, and Policy

2. Acknowledgements
Karyn Warsow, Health Policy
Management and Leadership
Ersilia Verlinghieri, public
participation in transport planning
Alvaro Guzman, power in
transport planning
Luc Pellecuer, Incorporation of Environmental
Impacts into engineering
Antonio Ferreira, Governance
and Transport Policies
Ian Jones, Urban and Transport
planning
Eva Heinen, Active travel behavior David Rojas-Rueda, Epidemiology and
public health
Natalie Mueller, Public health Paul Schepers, Traffic safety Karen Lucas, Transport and
social analysis
Mark Nieuwenhuijsen, Epidemiology and
public health

3. Background
■ The world is witnessing its largest
surge of urban growth in history
■ e.g. 75% of the European
population live in urban areas
■ Urbanization being shaped by step
changes in transport connectivity
and related land-use practices
■ Transport often envisioned as a
driver for urban development and
a contributor to economic returns
■ But has negative impacts on the
health of a population
exacerbated in urban areas
Rydin et al. 2012

4. Background
■ Each year, > 1.3 million deaths and 78 million
injuries warranting medical care result from motor
vehicle crashes
■ Air pollution and decreases in physical activity
associated with annual estimates of 7 million and
2.1 million global deaths, respectively
■ Current land-use planning and policy patterns are
reinforcing excessive use of motorized transport
modes
■ Health impacts are disproportionately distributed,
contributing further to gross inequalities in health

5. Background
■ Sustainable transport infrastructure/modes
effective in promoting active travel; increasing
physical activity and reducing exposures
■ Can reduce health inequalities through
modifying some of the pathways by which low
socioeconomic position can lead to diseases
■ This evidence reinforces the need to develop
and implement effective policies that define and
address health consequences

6. Rationale
– A clear scoping of traffic-related
health impacts (in urban areas)…
– Understanding and discussing the
underlying driving forces behind
where we are now…
– Is there a need for a new health-
aware perspective in the
transport/development agenda?
– Examples of good practice and
lessons learned from case studies
– Consider stakeholders involved and
make recommendations
Where are we now?
How did we get here?
Where do we want to go?
What will guide us?
How will we get there?

7. ■ Initial meeting at the 1st International Conference of
Transport and Health 2015 – London
■ Bring together expertise in transport engineering, transport
and urban planning, research and strategic management,
epidemiology and health impact assessment
■ Built on/led to recent reviews on this topic by some authors
■ Arrange meetings amongst the authors. Full collaboration
has been made possible through the use of online tools
such as Google Docs and emails
■ Organize (4) workshops around the key synergies between
transport and health
■ Concepts presented were developed further and discussed
amongst the authors, and others attending
■  this paper emerged from a collective rather than a
solitary exercise
Methods

8. Where are we now?
Adverse health
impacts associated
with traffic
Motor vehicle
crashes
Physical inactivity
Air pollution
exposure
Noise exposure
Temperature
(rises) exposure
Green space
reduction
exposure

9. Motor vehicle crashes
■ One of the earliest recognized traffic-related health
issues (obvious effects…)
■ Vulnerable populations and road users including the
elderly, children, the economically disadvantaged and
pedestrians and cyclists are the most impacted
■ Half of the world’s road traffic deaths occur amongst
motorcyclists, pedestrians and cyclists, with 31% of
deaths amongst car occupants (rest is unspecified)
■ Low-income and middle-income countries account for
over 90% of the world’s roads fatalities despite having
48% of the world’s registered vehicles
■ Have received more policy attention partly due to the
attention to crash severity and loss of life
■ Incidence rates for active travel depend on the number
of active travellers resulting in a rapid decline in MVC
when the number of these users increase

10. Motor vehicle crashes
“I'm listening to a live streaming of the
US Department of Transportation 50th
Anniversary ceremony. The overwhelming
theme is automotive safety. t is ingrained
in the culture not specific to people. This
perspective requires a cultural shift at
the policy level, which is happening
slowly in the US ”
“Perhaps mention safety concerns
were raised soon after ww2. At least
in NL in the ’60 and ’70. As a
consequence there cars were
banned and it was one of the
reasons to stimulate bicycling”

11. Physical inactivity
■ The biggest public health problem of the 21st century
■ 2.1 million global deaths/year attributable
■ Physically inactive people have a 20% to 30% increased
risk of all-cause premature mortality
■ Increased physical activity associated with a reduction in
risk of chronic diseases e.g. cardiovascular disease,
dementia, Alzheimer's and Parkinson's disease, type-2
diabetes, breast cancer, colon cancer depression and
anxiety symptomatology
■ Emerging evidence for a role in delaying cognitive
decline/improving brain health
■ Positive effect on pulmonary function, which can have a
role in reducing the negative health effects of traffic-
related air pollution

12. Active travel and physical activity
■ 20% to 50% of population do not meet physical activity
guidelines
■ Active travel could provide means to build physical
activity into daily routines
■ Active travel associated with higher levels of objective
and self-reported physical activity
■ Countries with higher levels of active travel have lower
obesity levels suggesting
■ Providing for active travel will boost its levels, although
the effects of new infrastructure may not be
immediate
■ Available resources for physical activity participation
including parks and walking and biking trails vary by
neighbourhood socioeconomic status with the pattern
of fewer options for the more deprived

13. Traffic-related
air pollution
■ In urban areas, ambient air pollution is
dominated by motor vehicles traffic
■ Associated with all-cause mortality,
childhood asthma incidence,
cardiovascular disease incidence,
cardiovascular mortality and morbidity,
cerebrovascular mortality and
morbidity, decreased lung function in
children, infant mortality, lung cancer,
low birth weight, pregnancy-induced
hypertensive disorders, preterm birth,
respiratory infections, and respiratory
mortality and morbidity
■ Contributing to an estimated 370,000
premature deaths and on average a 9
month reduction in life expectancy in
Europe
■ Source models not widely available
■ TRAP disproportionately distributed
amongst socio-economic and
vulnerable groups e.g. low-income
groups and minorities, as their schools
and residences are often located in
high traffic exposure areas

14. Traffic-related noise
■ Ambient noise are associated with the road
network, junctions, traffic flow, speed and load
■ Health effects of traffic-related noise are
increasingly being recognized as attributable to a
large burden of disease that may be comparable
to that of air pollution
■ One million healthy life years are lost every year
from traffic-related noise in the western part of
Europe alone
■ Ambient noise has been associated with all-
cause mortality, cardiovascular mortality and
morbidity, annoyance and sleep disturbance,
adverse reproductive outcomes, cognitive
problems in children, diabetes type-2, high blood
pressure in children, mental health and well-
being problems and stroke
■ Cardiovascular effects by ambient noise have
been shown independent of air pollution
exposures
■ Low-income individuals and visible minorities
tend to be located in the areas most polluted by
road traffic noise

15. Urban Heat Islands
and Greenhouse
Gases
■ High density urban settlements
and roads heat absorbing
concrete and asphalt structures
dominate the landscape = heat
island effect
■ Traffic also release anthropogenic
heat by way of tailpipe emissions
(black carbon, carbon dioxide,
methane, nitrous oxide) and can
amplify urban temperatures
■ High ambient temperatures have
been associated with all-cause
mortality, cardiorespiratory
morbidity, children’s mortality and
hospitalization, heat stress,
hospital admissions, increased
health service use for chronic
diseases, including respiratory
diseases, hypertension and
diabetes, preterm birth, reduced
lung function in children and MVC

16. Green infrastructure
■ Associated with a number of beneficial health effects,
including decreased premature mortality, reduced
cardiovascular disease, higher birth weight, improved
mental health, improved sleep patterns, recovery from
illness, reduced children's behavioural problems, reduced
incidence of childhood asthma, increased social contacts
■ Other beneficial effects on cognitive development, physical
activity and obesity
■ Possible mechanisms for health benefits are due to
increased physical activity, more space to enable social
interaction, psychological restoration and stress reduction,
and mitigation of environmental exposures including air
pollution, noise and heat
■ Distribution of (access to) green spaces can be differential
by socioeconomic status in favour with those with resources
to move to greener areas
■ Amount of green space is often limited in cities
■ Varies considerably between and within cities, European
cities average around 18.6% green space
■ Transport and utilities use significant amounts of land
which could arguably be or be used for green infrastructure

17. Results
– A clear scoping of traffic-related
health impacts (in urban areas)…
– Understanding and discussing the
underlying driving forces behind
where we are now…
– Is there a need for a new health-
aware perspective in the
transport/development agenda?
– Examples of good practice and
lessons learned from case studies
– Consider stakeholders involved and
make recommendations
Where are we now?
How did we get here?
Where do we want to go?
What will guide us?
How will we get there?

18. How did we get here?
■ A significant burden of disease associated with
transport practices
■ Suggest that transport design, planning and policy are
operating separate from health at some level
– Trends of development,
– (lack of) Public policies
– Public’s perceptions and awareness,
– The state of the transport investment appraisal
– and the influence of powerful actors in leading to
the current state and maintaining it

19. Rapid and car-centred urbanization
■ Advanced a car-centred planning approach
dominated urban and transport planning since
post-Second World War
■ The car has become socially, culturally,
economically, politically, ethically and
environmentally ingrained in westernised
countries
■ The very nature of urbanization enhances
exposure to heat, air pollution, and radiation via
street canyons, heat island effects, depleting
green space
■ Given the global trends towards a more
urbanised world population, impacts are
forecasted to continue and intensify
■ The car has become socially, culturally,
economically, politically, ethically and
environmentally ingrained in westernised
meaningful public transport system and a
gradual abandonment of these urbanised areas
■ Reinforces policy focus on ‘economic centres of
agglomeration’
■ Fosters a self-reinforcing cycle of car
dependence by creating a system of ‘auto-
mobility’
■ Auto -mobility systems
– increased the fraction of the exposed
population living and working in close
proximity to highways and roads
– decreased physical activity
– and reduced the feasibility and
convenience of active travel and of public
transport provision
■ The very nature of urbanization enhances

20. Rapid and car-centred urbanization
■ Car-centred urbanisation increases the physical
separation of activities and the need for
motorized transport
■ Increased spatial separation of activities lowers
urbanised population densities, and results in
lower commuter numbers needed to support a
meaningful public transport system and a
gradual abandonment of these urbanised areas
■ Reinforces policy focus on ‘economic centres of
agglomeration’
■ Fosters a self-reinforcing cycle of car
dependence by creating a system of ‘auto-
mobility’

21. Rapid and car-centred urbanization
■ Auto -mobility systems
– Increased the fraction of the exposed
population living and working in close
proximity to highways and roads
– Decreased physical activity
– Increased the need and convenience for
motorized transport
– and reduced the feasibility and
convenience of active travel and of public
transport provision

22. “The transport sector is susceptible
to long term effect on design
decisions. Urban form does not
change as rapidly (or even at all) as
building or roads are built or
demolished, for example many roman
road still exist in the landscape or still
serve as roads”
In regard to transport policy measures : “Why
land use policy measures seem to receive the
least attention whilst they could be most
effective?” – “I agree with you! Is true, there are
the most effective because there are the cause
of the cause. But at the same time is the harder
to be changed from a politician perspective, is a
change of model. But is the most important and
effective intervention”

23. Mass Motorization and
Ethical Positions Towards
Human Life
■ Increasing the number of vehicles and infrastructure
priorities
■ Manifested most clearly in the substantial deaths due to
MVC, and less clearly in the rise of chronic diseases related
to traffic exposure and practices over the same periods
that car traffic undergone large changes
■ Systems approach; such as the Vision Zero initiated by
Sweden and Sustainable Safety in the Netherlands 
based on an ethical position in which it is unacceptable to
have people seriously injured or killed on the network
■ Transport infrastructure design is inherently conceived to
drastically reduce crash risk
■ This clarity in policy and guidance may have led to a
substantive influence for human life in the transport design
agenda

24. The Car Lobby
■ Acknowledge car industry as a powerful and diffuse
force in advocating for mass motorization through
marketing strategies to increase uptake and
maintenance of driving
■ Opposing measures that may reduce car use, e.g.
fuel duty increases, reduction in parking supply,
proposals for car-free zones, improvements in traffic
safety and delayed EU emissions regulations
■ Little public support for measures to rectify the
impact
■ The car industry with its economic reach to provide
jobs including manufacturing, dealerships, hire
companies, parking garages, motoring organizations,
oil and gas companies, construction and engineering
firms, insurance industry and others, make it difficult
to regulate
■ It is moving into new markets in low and middle-
income countries

25. Public Policy Favouring Car Mobility
“For national and local policy makers, I suggest the following ranking of priorities in
transport policy: (1) stimulate the economy by facilitating the smooth flow of goods and
people, (2) ensure social equity by facilitating access to mobility for disadvantaged
groups (especially via public transport), and (3) addressing negative externalities in the
following order of importance: (a) congestion, because it has negative social and
economic implications, (b) local ‘quality of life’ problems such as air pollution, parking
and spatial problems, (c) safety (traffic deaths and injuries), and (d) environmental
sustainability such as climate change. This externality ranking explains why most
transport policy programs address congestion (via congestion charging, dynamic traffic
management, and demand management)” (Geels 2012)

26. Public Policy Favouring Car Mobility
■ Historic strong association between economic development and an increase in the demand
for transportation and number of road vehicles
■ Infrastructure banks and governmental agencies have funded road construction for several
decades
■ Motorized mobility remains a criterion for measuring country-level economic success
■ Economic investment in roads is seen as an important determinant of economic growth
■ Traffic optimization and travel time savings remain the lead principles in transport planning
■ Technical-orientation in practice (mainly an engineering and economic focus) underestimate
the negative externalities of transport infrastructure decisions
■ Even solutions supposedly aimed at alleviating car use such as transit and bus rapid transit
are directly measured by travel time savings
■ Road investment strategies continue to support motor vehicle travel, thereby attracting more
cars whereas considerably less is allocated to active and public transport modes or mobility
management strategies

28. 100 major schemes funded by £15.2
billion of public money

29. The State of the Practice of Transport
Appraisal ■ Cost Benefit Analysis (CBA) is the most commonly used
instrument to determine whether a certain transport project
is to be preferred over another
■ A project that has the highest positive monetary value, or
the highest benefit to cost ratio is the preferred project by
decision-makers
■ Monetized items include (changes in) travel times,
consumer surplus, (changes in) employment, business
activity and earnings, MVC, casualties, carbon and air
quality emissions and noise impacts

30. The State of the Practice of Transport
Appraisal
■ But many inherent limitations:
– CBA accept transport users’ willingness-to-pay as an appropriate indicator factored in the
calculations
– CBA are embedded in an econometric ontology that associates lower economic benefits and costs
to events taking place in the future due to economic depreciation rates. As a result, short-term
economic benefits (e.g. higher accessibility to jobs, lower travel costs) are likely to be overvalued
when measured against more complex and distant costs such as long-term environmental and
health impacts
– CBA assumes the outputs of transport planning models in the calculations
– It is acceptable to consider the time savings for existing travellers that use the services of a new
transport project as benefits. It also establishes that it is valid to sum time savings to the time
spent by travellers that were induced to travel by the new project (induced demand)
– CBA logic assumes that time savings are a benefit when time spent travelling can be positively
valued by transport users, especially those using transit and active travel modes
– Impacts on morbidity are not addressed

31. The State of the Practice of Transport
Appraisal
“Would it be the solution to conduct
an overall appraisal/evaluation of a
plan/intervention. Not just health or
economic benefits, but as wide as
possible? I guess that is the main
problem at the moment that
evaluations/appraisals are mostly
done by domain”

32. Results from transport practitioners
Economic Growth
Travel Time Savings
Cost Effectiveness
Land-use
Accessibility
Noise Reductions
Equality
Providing for Cars
Efficiency
SafetySustainability Policy Integration
Connectivity
Economic Growth
Travel Time Savings
Cost Effectiveness
Accessibility
Carbon ReductionsNoise Reductions
Equality
Providing for Cars
Efficiency
Safety Policy Integration
Connectivity
Sustainability
AirQuality

33. Public Perceptions and Awareness
■ Historically, societal acceptance and preference toward private
car ownership was celebrated as a process of democratization
fulfilling individual desires of flexibility and self-determination
■ It also symbolized the idea of freedom and independence as
well as, power, superiority, and social status
■ Behind public perceptions are driving forces of this
development such as “the leading industrial sectors and the
iconic firms within 20th-century capitalism (Ford, GM, Rolls-
Royce, Mercedes, Toyota, VW and so on), and the industry from
which the definitive social science concepts of Fordism and
Post-Fordism have emerged.” (Urry 2004)
■ These forces are behind a persistent car-mobility paradigm
making car dependence a phenomenon that operates societally
■ Cultural norms reinforced by public policy and institutions that,
although should represent the public interest and are oriented
around sustainability tend to exercise power to protect special
interests

34. ■ Health impacts of transport were not widely recognized until the 1990s
■ Lack of public awareness of these impacts, even those which have been receiving
increasing media coverage such as air pollution; reinforce the lack of political
commitment and initiative to address these problems

35. Results
– A clear scoping of traffic-related
health impacts (in urban areas)…
– Understanding and discussing the
underlying driving forces behind
where we are now…
– Is there a need for a new health-
aware perspective in the
transport/development agenda?
– Examples of good practice and
lessons learned from case studies
– Consider stakeholders involved and
make recommendations
Where are we now?
How did we get here?
Where do we want to go?
What will guide us?
How will we get there?

37. Where do we want to go?
■ Mitigating or preventing adverse health impacts will have a long run benefit to
society in terms of overall well-being, productivity, economic prosperity, reduction in
healthcare costs  societal investments rather than societal costs
■ An integrated cross-disciplinary planning effort to move away from a car-based
society to high quality and equitable public and active travel systems
■ More importance to health in the development and transport agenda
■ Knowledge transfer and collaboration in research, policy, and practice will play a
fundamental role in promoting healthy transport practices

38. Results
– A clear scoping of traffic-related
health impacts (in urban areas)…
– Understanding and discussing the
underlying driving forces behind
where we are now…
– Is there a need for a new health-
aware perspective in the
transport/development agenda?
– Examples of good practice and
lessons learned from case studies
– Consider stakeholders involved and
make recommendations
Where are we now?
How did we get here?
Where do we want to go?
What will guide us?
How will we get there?

39. What will guide us?
■ Example of good practice emerging from a collaborative
and open-ended project bringing together expertise in
health, environmental sciences, air pollution, transport
planning, economics, practice and advocacy and policy
making
■ HEAT aims at making the health benefits of regular cycling
and walking visible to transport and urban planners
■ Whilst addressing the importance of CBA in transport
design and planning decisions
■ The tool offers economic estimates of health benefits of
walking and cycling by estimating the economic value of
reduced mortality that results from specified amounts of
walking or cycling in a defined population
■ Been used in research, policy making recommendations,
advocacy and in practice
■ Was recommended in the official toolbox for transport
investment appraisal (WebTAG) in England and in the
Action Plan for Improving the health of Londoners by
Transport for London

40. What will guide us?
■ iConnect study aimed at measuring and evaluating the
changes in travel, physical activity and carbon emissions
related to Sustrans' Connect2 programme
■ Connect2 an ambitious UK-wide project that transformed
local travel in more than 80 communities creating new
crossings and bridges to overcome barriers increasing
physical activity
■ Initial funding for this programme came from a non-
transport source, the UK Big Lottery Fund (£50 million),
in which public vote demonstrating the huge amount of
public support for this programme was essential
■ This funding was used to unlock other sources of funding
necessary to complete the programme at an overall value
of £175 million

41. What will guide us?
■ Bradford Metropolitan District Council recently undertaken
a low emission zone feasibility study
■ Involved stakeholders, researchers and practitioners from
different disciplines including transport planning,
environmental sciences, public health and health
economics alongside collaboration with other city councils
in the West Yorkshire
■ The relative impact of several transport interventions
scenarios beyond the ‘business as usual’ case were
modelled
■ The impact that these scenarios may have on projected
air quality concentrations, health of the local population
and the costs and benefits associated with each
intervention measure were calculated and presented
■ Was used to provide strong evidence in support of two
funding bids at an approximate value of £1 million that
aim at improving air quality in the region

42. Results
– A clear scoping of traffic-related
health impacts (in urban areas)…
– Understanding and discussing the
underlying driving forces behind
where we are now…
– Is there a need for a new health-
aware perspective in the
transport/development agenda?
– Examples of good practice and
lessons learned from case studies
– Consider stakeholders involved and
make recommendations
Where are we now?
How did we get here?
Where do we want to go?
What will guide us?
How will we get there?

43. What action
and from who?
■ No “one size fits all” approach and policy
transfer is a highly politicised process
justifying preferred solutions
■ Technological improvements are not it!
Counter-productive in instances such as
the failure of the massive technology
change from petrol towards to mitigate
climate change
■ Public transport and active travel
provision and behavioural and societal
transformations are needed
■ Active involvement and collaboration of
engineers, planners, economists,
epidemiologists, and medical providers to
ensure health is at the top of the list of
competing priorities

44. How will we get there?
■ Transport Engineers and Planners
■ Try and bridge the gap between design, planning,
economics and health
– Bring the health agenda to the table
– Consider the health impacts of engineering and
planning decisions as more explicit outcomes of the
transport design and appraisal process
– Expand transport planning curriculums beyond the
functional quality of infrastructure
– Engage more with the public
– Consider health through transport design as an
additional objective
– Adopt tools and methods that would enable
assessing health impacts of transport design and
planning (e.g. Health Impact Assessment tools

45. How will we get there?
■ Health practioners
– Improve understanding of the urban and transport planning agenda
– Play a proactive role to include health as a transport project objective
– Advocate for effective policies that encourage active travel and reduce car use
– Partner with urban and transport planners from the start of design and
planning process to ensure that health is a recognized objective
– Support transport engineers and planners in conducting health impact
assessments for possible transport scenarios
– Develop innovative and usable health economic assessment tools to be added
to existing or novel transport design and planning tools

46. How will we get there?
■ Researchers
– Start appraising tools that are being used in transport planning to provide a holistic
point of view in regards to impacts on health
– Advocate for co-production and cross-disciplinary work
– Increasing the outreach and communication between the research community and
transport practitioners, local governmental entities and the public constituency
– Epidemiologists and health researchers can contribute to resolving open scientific
issues and improving the evidence base for health impact assessment
– Follow-up to how policy guidance/recommendations will be interpreted or altered
– Increase public outreach and awareness of health impacts of transport choices
and practices

47. How will we get there?
■ Policy makers
– Include long-term health impacts that are difficult to grasp or measure on the
short term
– Reallocate funding streams at the policy level to include health impact
assessment
– Expand CBA and similar appraisal methods
– Set operational goals and indicators in a transparent and non-sectorial manner
– Have strict legislation for integrated transport planning with land-use
– Clear policy and guidance to transport professionals to include health in the
development and transport agenda
“This is difficult to ask to people
who are already under pressure
to do their job as fast as
possible and whose boss does
not recognise the importance of
integrating health impact”

48. Changing perspectives?
■ “Economic investment in roads is seen as an important determinant of economic growth. It is
important to break this cycle and think about economic development rather than growth”
■ “It might be worth a quick thought experiment around what a health oriented approach to
transport planning might look like. Stated differently, from an engineer’s perspective,
accounting for black spots and reducing fatalities is health. From an urban designer
perspective, designing places for human interaction is health. From an urban planning
perspective (at least land use), separating land uses like residential from commercial or
industry (like pig slaughter houses) is health. As such, contemporary urban planning reflects
a variety of different perspectives and aims, which are often tied to specific pots of monies
and constrained and constituted via specific professional remit and duties”
■ “As my focus is more on design, I don’t think I’m the best person to contribute to the sections
about policy. In my role as policy advisor for the ministry I am of course involved in policy, but
this papers helps me realize how lucky road safety experts are”
■ “Neoliberalism and CBAs as wrong instruments at two levels: technical and fundamental”
■ “Yes CBAs are based on reducing travel time see article you sent me. While increasing travel
time may be beneficial in case of active transportation”

49. Conclusions
“Citing Frank and Engelke's 2001 literature review, the very first sentence in Northridge et
al. (2003) article is "While it has been stated before, it nonetheless bears repeating that the
connections between urban planning and public health are not new. Clearly, though such
connections are not new, they have been inadequate to generate consensus towards a more
sustainable, healthy and ethical urban and transport systems. There is probably several
articles you can point to which have sought to make similar points and cross disciplinary
boundaries. That being said, whereas such examples evidence Karen's point, I remain
unconvinced they evidence practice. There remains a gap between the academic and
professional circles. Again, this is not to pick on professionals or civil servants, who for the
most part do or at least strive to do a good job, but if things were different, you wouldn't
have a paper. They're aren't different, and thus, you still have valid points and a paper”

50. A few learning experiences
■ “The big questions will only be answered by cooperation of multiple disciplines”
■ “Transport and Health seem to have quite different histories, experiences and (vested)
interests and we need to develop a common narrative and close collaboration to tackle
the transport and health problems”
■ “Collaboratively writing this paper helps me to put my own discipline (road safety in my
case) in the broader context of health. For instance, some safety measures are helpful
for road safety only while other measures contribute to other health benefits as well.
This stimulates thinking”
■ “The one major lesson learnt is that although health has made significant advances in
demonstrating effects from car-oriented planning (which I was not aware of), such work
has yet to contribute to a more evidence-based approach to urban policy and practice”
■ “Collaborative efforts of both sectors are needed to provide healthy and sustainable
transport policies”
■ “…How to combine both interest in a sustainable manner will be the challenge of the
near future”

51. A few learning
experiences?
■ “It will take a lot of time and effort to develop
principles for designing the road system that are
helpful for all important health aspects. And
even more difficult (or impossible), principles
that work in different contexts. Having such
principles (e.g. the Sustainable Safety principles
in the Netherlands) were extremely helpful for
road safety policy. It would be great to have such
principles for transport and health in general. It
seems we have a long way to go to develop such
principles”
■ “What a pleasant surprise to realise we were so
many, with so different backgrounds, thinking
that health should be taken into account while
planning transport systems. Joining our forces is
definitely a promising avenue towards a more
integrated way of thinking transport issues”