transport and health · 2018-09-28 · car ownership rate per capita is also increasing ehi...
TRANSCRIPT
TRANSPORT AND HEALTH
How transport affects the health of
New Zealanders
Kylie Mason
Presentation to the Transport Knowledge Hub
22 February 2018
Outline
1. How does transport affect health?
2. EHI transport indicators: What is the data telling us?
3. What is the overall health impact of road transport in NZ?
How does
transport
affect health?
• Notes
How does
transport
affect health?
Traffic crashes
Air
pollution
Noise pollution
Road safety for
vulnerable road usersActive transport
Climate change
Barriers due
to lack of
transport
Public transport
Traffic crashes
• Cause many deaths, injuries, disability
• In NZ, a few hundred people die each year in traffic crashes
• Cyclists, pedestrians and motorcyclists are more vulnerable
road users
HOW TRANSPORT AFFECTS HEALTH
Air pollution from motor vehicles
HOW TRANSPORT AFFECTS HEALTH
• Particulate matter (PM10, PM2.5)
• Nitrogen oxides (NOx)
• Carbon monoxide (CO)
• Sulphur oxides (SOx)
• Carbon dioxide (CO2)
• Ozone (ground-level)
• Volatile organic compounds (VOCs)
• Hydrocarbons (HC)
• Polycyclic aromatic hydrocarbons (PAHs), eg
benzo(a)pyrene (BaP)
Transport is a key source of air pollution
HOW TRANSPORT AFFECTS HEALTH
Health effects from air pollution
Health effects mainly from:
particulate matter (PM2.5, PM10),
but also NO2, CO, others
Health effects include:
• Premature death
• Lung (respiratory) diseases
• Heart (cardiovascular) disease
• Some cancers
Air pollution: All cars and roads are not equal
HOW TRANSPORT AFFECTS HEALTH
• Diesel vehicles produce
• more particulate matter (PM)
• but less CO, hydrocarbons
• Diesel exhaust fumes cause
lung cancer
• Busy roads have higher air pollution levels
• Higher health risk within 300–500m of state highways
Noise pollution
Source: Hammer MS, Swinburn TK, Neitzel RL. 2014. Environmental noise pollution in the United States: developing an effective
public health response. Environ Health Perspect 122:115–119.
Physical activity – active and public transport
• Produces no air/noise pollution, greenhouse gases
• Physical activity reduces the risk of many health
issues:
HOW TRANSPORT AFFECTS HEALTH
Cancer
Cardiovascular
disease
Obesity
Mental health
Diabetes
Bone density
Low physical activity – the health burden
• An estimated 1435 deaths were attributable to low
physical activity in New Zealand in 2015
HOW TRANSPORT AFFECTS HEALTH
Note: DALY = disability-adjusted life year, and is the sum of years of life lost (YLL) and years lived in disability/ill-health (YLD)
Source: Global Burden of Disease Study 2015
Other health impacts from transport
Lack of transport
• Barriers to accessing services and goods, eg
• Healthcare services
• Shops and healthy food
• Social isolation and loneliness
• Associated with increased mortality, depression,
high blood pressure, dementia
Greenhouse gas emissions from transport sector
• 20% of NZ’s total GHG emissions
HOW TRANSPORT AFFECTS HEALTH
Environmental Health Indicators
for transport:
What is the data telling us?
What is an environmental health indicator?
EHI TRANSPORT INDICATORS
• Describes the link between the environment and human
health
• Provides information for action
EHI transport indicators
• Number of motor vehicles
• Active transport to and from school
• Main mode of transport to work on Census day
• Household travel time by mode of transport
• Unmet need for GP services due to a lack of transport
• Road traffic injury deaths
• Road traffic injury hospitalisations
EHI TRANSPORT INDICATORS
The number of motor vehicles is increasing
EHI TRANSPORT INDICATORS
0
500,000
1,000,000
1,500,000
2,000,000
2,500,000
3,000,000
3,500,000
4,000,000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Number of vehicles
Year
New Zealand's vehicle fleet, 2000-2016
Other
Bus
Trucks
Motorcycles
Lightcommercial
Lightpassenger
Source: Ministry of Transport
Car ownership rate per capita is also increasing
EHI TRANSPORT INDICATORS
In 2014,
New Zealand
had the
highest car
ownership rate
per capita
in the OECD
0
100
200
300
400
500
600
700
800
2000 2002 2004 2006 2008 2010 2012 2014 2016 2018
Number of light vehicles per 1000
people
Year
Light vehicles per 1,000 population, New Zealand, 2001-2016
Diesel vehicle numbers continue to climb
EHI TRANSPORT INDICATORS
Light diesel vehicles
Diesel trucks
Diesel buses0
100,000
200,000
300,000
400,000
500,000
600,000
700,000
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
20
10
20
11
20
12
20
13
20
14
20
15
20
16
Number of diesel vehicles
Year
Diesel vehicles in New Zealand, 2000-2016
Children’s mode of transport to school
EHI TRANSPORT INDICATORS
Main mode of transport to work on Census day
EHI TRANSPORT INDICATORS
Source: Census 2013
Unmet GP need due to a lack of transport
EHI TRANSPORT INDICATORS
• Affected 148,000 New Zealanders in 2016/17 (~3%)
• More than 7% of Māori and Pacific adults affected
1.1 0.6 3.1 2.8 4.81.0 1.8 2.8 3.5 7.20
1
2
3
4
5
6
7
8
9
1 (least deprived) 2 3 4 5 (most deprived)
Percent (%)
NZDep2013 quintile
Unmet GP need due to a lack of transport, by
socioeconomic deprivation (NZDep2013), 2016/17
Children Adults
Source: New Zealand Health Survey
Traffic crash deaths: An increasing road toll since 2013
EHI TRANSPORT INDICATORS
Source: Ministry of Transport
0
100
200
300
400
500
600
700
800
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
20
10
20
11
20
12
20
13
20
14
20
15
20
16
20
17
Number of deaths
Year
Annual road toll in New Zealand, by transport mode, 1990-2017
Total
Vehicle occupant
Motorcyclist
Pedestrian
Cyclist
379
deaths
Age group patterns in mortality rates vary by mode of transport
EHI TRANSPORT INDICATORS
1.50.4 0.1
13.5
1.3 1.30.2
5.6
1.60.6
0.1
5.0
1.10.6 0.3
8.4
0.5
2.1
0.4
0
2
4
6
8
10
12
14
16
Vehicle occupant injury Motorcyclist injury Pedestrian injury Cyclist injury
Age
-sp
ecif
ic r
ate
per
10
0,0
00
Mode of transport
Road traffic injury deaths, by age group and mode of transport, 2005-2014
0–14 years 15–24 years 25–44 years 45–64 years 65+ years
*
Traffic injury death rate is higher for Māori than non-Māori
EHI TRANSPORT INDICATORS
12.41.2
1.7
0.24.80.9 0.6 0.2
0
2
4
6
8
10
12
14
Vehicle occupantinjury
Motorcyclist injury Pedestrian injury Cyclist injury
Age-standardised rate per 100,000
Mode of transport
Road traffic injury deaths, by Māori/non-Māori and mode of transport, 2005–2014
Māori Non-Māori
Highest rate of traffic injury deaths in most deprived areas
EHI TRANSPORT INDICATORS
3.3
0.6 0.60.1
3.6
0.80.6
0.1
4.4
1.1
0.50.2
5.2
1.20.8
0.1
7.7
1.0 1.0
0.2
0
1
2
3
4
5
6
7
8
9
10
Vehicle occupant injury Motorcyclist injury Pedestrian injury Cyclist injury
Age
-sta
ndar
dise
d ra
te p
er 1
00,0
00
Mode of transport
Road traffic injury deaths, by NZDep2013 quintiles and mode of transport, 2010-2014
NZDep Q1 (least deprived) Q2 Q3 Q4 Q5 (most deprived)
Motorcyclists at more risk of death, per time spent travelling
EHI TRANSPORT INDICATORS
Transport injury hospitalisations increased from 2014 to 2016
EHI TRANSPORT INDICATORS
0
20
40
60
80
100
120
2000 2002 2004 2006 2008 2010 2012 2014 2016
Age-standardised rate per 100,000
Year
Road traffic injury hospitalisations by mode of transport, 2001–2016
Total
Vehicle occupant injury
Motorcyclist injury
Pedestrian injury
Cyclist injury
Higher hospitalisation rates outside of major towns and cities
EHI TRANSPORT INDICATORS
35
159
4
63
24
7 6
83
26
72
67
29
61
0
10
20
30
40
50
60
70
80
90
100
Vehicle occupant injury Motorcyclist injury Pedestrian injury Cyclist injury
Age
-sta
nd
ard
ised
ra
te p
er 1
00
,00
0
Mode of transport
Road traffic injury hospitalisation rate, by urban/rural classification, 2014-16
Main urban area Secondary urban area Minor urban area Rural
Regional differences in transport injury hospitalisation rate
EHI TRANSPORT INDICATORS
154 72 71 73 95 99 108 145 92 90 72 60 48 55 91 74 108 63 71 64 770
20
40
60
80
100
120
140
160
180
200
No
rth
lan
d
Wai
tem
ata
Au
ckla
nd
Co
un
ties
Man
uka
u
Wai
kato
Lake
s
Ba
y o
f P
len
ty
Tai
raw
hit
i
Ha
wke
s B
ay
Tar
anak
i
Mid
Cen
tra
l
Wh
ang
anu
i
Cap
ital
an
d C
oas
t
Hu
tt
Wai
rara
pa
Nel
son
Mar
lbo
rou
gh
Wes
t C
oa
st
Can
terb
ury
Sou
th C
ante
rbu
ry
Sou
ther
n
New
Ze
ala
nd
Age-standardised rate per 100,000
District Health Board
Road traffic injury hospitalisation rate, by District Health Board, 2016
District Health Boards New Zealand
Children’s road traffic injuries (0-14 years)
EHI TRANSPORT INDICATORS
29 32 27 18 29 24 30 21 22 15 10 14 7 130
5
10
15
20
25
30
35
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
20
10
20
11
20
12
20
13
20
14
Number of deaths
Year
0
1
2
3
4
5
2000 2002 2004 2006 2008 2010 2012 2014
Crude rate
per 100,000
Year (3-year moving average)
Children’s traffic injury deaths (among children aged 0-14 years), 2001-2014, numbers and crude rate per 100,000
Unequal impacts seen for children as well
EHI TRANSPORT INDICATORS
Children’s traffic injury deaths by ethnic group (2009-2014) and NZDep2013 quintiles (2010-14), (crude rate per 100,000)
1.0 0.7 1.0 1.1 2.70
1
2
3
4
1 (least
deprived)
2 3 4 5 (most
deprived)
Crude rate per 100,000
NZDep2013 quintile
3.2 1.1 0.9 0.9 1.50
1
2
3
4
5
Māori Pacific Asian European/Other Total
Crude rate per 100,000
Ethnic group (prioritised)
By ethnic group By NZDep2013 quintiles
What is the
overall health impact
of road transport
in New Zealand?
Our approach – a ‘rapid assessment’
• Aims to answer the question: ‘How many deaths in NZ are
attributable to road transport?’.
• Estimated the health burden from:
• Motor vehicle traffic crashes
• Air pollution (PM10, NO2)
• Noise pollution
• Used an ‘environmental burden of disease’ method
• Used by the World Health Organization
• Co-authors of the study: Professor David Briggs and Professor
Barry Borman
HEALTH BURDEN OF ROAD TRANSPORT
Conceptual framework
• Research project in 2015
Briggs, D., Mason, K., Borman, B. (2016). Rapid Assessment of Environmental Health
Impacts for Policy Support: The Example of Road Transport in New Zealand. International
Journal of Environmental Research and Public Health,2016; 13(1): 61
Environmental burden of disease method
3. Calculate % of deaths attributable to exposure
(‘population attributable fraction’, PAF)
5. Calculate number of attributable deaths
HEALTH BURDEN OF ROAD TRANSPORT
1. Identify the
diseases caused
by each exposure
PM10: All-cause mortality
NO2: All-cause mortality
Road traffic noise:
ischaemic heart disease,
stroke, hypertensive
diseases
2. Identify % of NZ
population exposed
to each exposure
4. Get the number of
deaths for identified
diseases
Health burden of road transport in New Zealand
Road transport accounted for an estimated 650 deaths in 2012
Briggs, D., Mason, K., Borman, B. (2016). Rapid Assessment of Environmental Health Impacts for Policy Support: The Example
of Road Transport in New Zealand. International Journal of Environmental Research and Public Health,2016; 13(1): 61
HEALTH BURDEN OF ROAD TRANSPORT
650
308
218
65
59
0 200 400 600 800
Total
Road traffic crashes
Particulate matter (PM10)
Nitrogen dioxide exposure
Noise
Number of attributable deaths
19,244
13,974
3,426
1,023
821
0 5,000 10,000 15,000 20,000 25,000
Total
Road traffic crashes
Particulate matter (PM10)
Nitrogen dioxide exposure
Noise
Number of attributable years of life lost (YLL)
Comments from this study
Lack of exposure/monitoring data in New Zealand
• We estimated:
• population exposed to high nitrogen dioxide levels
• population exposed to road traffic noise
• Our study excluded exposure to ozone, VOC, CO
NZ results were comparable internationally
• But higher health loss from road traffic crashes
Showed importance of considering health impacts outside of
road crashes
HEALTH BURDEN OF ROAD TRANSPORT
Summary:
What does it all mean?
Key messages
• High reliance on cars in New Zealand
• Road transport has a substantial impact on health in NZ
• Traffic crashes, air pollution, noise pollution,
barriers to accessing services
• Unequal impacts of transport on health
• Motorcyclists, and to a lesser extent, cyclists
• Māori and Pacific peoples, people living in high
deprivation areas
• People living close to busy roads
SUMMARY
Key messages
Evidence supports encouraging more
use of active and public transport
• Move away from reliance on car use
and fossil fuels
Active and public transport have multiple benefits
• less air pollution, noise pollution, greenhouse gases
• more physical activity
improvement in the health and wellbeing of NZers
SUMMARY
To find out more
www.ehinz.ac.nz
www.ehinz.ac.nz
HealthSpace – an online mapping tool for exploring
regional health data
healthspace.ac.nz
HealthSpace example: Using active transport to work,
by territorial authority, 2013
healthspace.ac.nz
Thank-you for your time!
For more info,
visit our websites:
www.ehinz.ac.nz
healthspace.ac.nz
or email:
Kylie Mason [email protected]
EHI team [email protected]