By Professor Melody Smith, Te Kura Neehi, School of Nursing, Waipapa Taumata Rau, University of Auckland, Tāmaki Makaurau; and Dr Kirsty Wild, School of Population Health, Waipapa Taumata Rau, University of Auckland, Tāmaki Makaurau
With the newly released Draft Government Policy Statement on Land Transport 2024–34 has come a range of commentaries and submissions from experts in their field. A key area that is not well articulated or acknowledged in the current policy statement is the importance of active transport infrastructure.
The conversation generated by the Draft Government Policy Statement on Land Transport 2024–34 (GPS) highlights the wide-reaching impact of transport infrastructure, with experts across diverse fields demonstrating the integral role that transport plays across a gamut of outcomes – from supporting our economy, to promoting planetary health. Though not well-articulated or acknowledged in the GPS, facilitating active transport modes – walking and wheeling (e.g., biking, scootering, using a wheelchair, etc.) – is fundamental to a successful transport system, and is integral to human health.
Why is this important?
Infrastructure that enables people to walk and wheel more (and thus use motorised transport less) has a significant impact on individual and population health. For example, this can be through increased physical activity, connections with others, and a reduction in vehicle-related air pollution (Glazener et al., 2021). Conversely, transport infrastructure that prioritises motorised transport can cause significant harm through increased risk of injury, reduced access to services, community severance, increased exposure to noise and air pollution, and stress. It is worth noting that these benefits and harms are not spread evenly across the population. Some groups, such as Māori, older people and more socio‑economically deprived people, gain fewer benefits from the system, suffer more of the adverse consequences, and contribute least to the harms of the system (as they drive less). Disabled children, young people and adults experience disproportionate barriers to mobility in the transport system, resulting in significant lost opportunities to participate in everyday life (Bozovic et al., 2024; Smith et al., 2021).
Just taking physical activity as an example, using active transport modes is critical to enabling New Zealanders to meet daily recommendations for physical activity. Walking is currently the primary form of exercise for adults (50 per cent of adults report walking), and young people (35 per cent) (Sport New Zealand Ihi Aotearoa, 2023); and people who use active transport modes accumulate significantly more physical activity than those who travel by car (Martin et al., 2016; Sahlqvist et al., 2012; Wilson et al.).
Physical activity is essential for health across the life span (Bull et al., 2020); it is associated with a 30 per cent reduction in all-cause mortality, a 40 per cent reduction in cognitive decline, a 35 per cent reduction in risk for type 2 diabetes, a 33 per cent reduction in hypertension, a 48 per cent reduction in depression, a 66 per cent reduction in bone fracture risk, a 20 per cent reduction in breast cancer risk, a 25 per cent reduction in coronary heart disease and stroke, and a 19 per cent reduction in colorectal cancer (US Department of Health and Human Services, 2018). Currently, less than half of New Zealand adults and adolescents are getting enough exercise to stay healthy, and approximately 40 per cent of children are not sufficiently active for health (Ministry of Health, 2023).
The primary reasons given for lack of exercise are a lack of time, and lack of access to spaces for exercise (Sport New Zealand Ihi Aotearoa, 2023). In this context, initiatives to support active transport are likely to be especially effective because this is a low-cost opportunity for exercise that children and adults can fit into existing time budgets. New Zealand research shows that many people want to get around actively, but are deterred by the environment they live in: three-quarters of urban-dwelling adults report that they would cycle if the roads were safer (Waka Kotahi New Zealand Transport Agency, 2022), and unsafe transport environments are consistently identified as the key barrier to children’s active transport (Smith, Amann, et al., 2019). Despite the strong desire of children to walk and bike to school, rates of active transport to school are low and declining (Smith, Ikeda, et al., 2019). Overall, approximately one-third of children and young people get to school actively, with only 12 per cent of adolescents getting to school actively (Wilson et al., 2023).
Low physical activity in New Zealanders was directly attributable to 920 deaths in 2019 and more than 11,000 years of life lost (Institute for Health Metrics and Evaluation, 2024). Costs to the health system of insufficient activity are significant – estimated at $530 million annually. Conversely, significant cost savings are gained through increasing walking and cycling; costings for New Zealand show savings of $9.90 per kilometre for each new walker, and $4.90 per kilometre for each new cyclist (Waka Kotahi New Zealand Transport Agency, 2023). Importantly, these figures do not take into account the mental health benefits of physical activity and the associated reduced cost to our healthcare system, so are likely to be even higher than this.
Infrastructural interventions that support walking and cycling are also cost effective. For example, the 20-year health economic benefit from London’s Mini-Hollands program was calculated at £1.056 million ($2.172 million), from a program cost of ~£100 million ($205 million), equating to a benefit-to-cost ratio (BCR) of 11:1 (Aldred et al., 2024). Moreover, the most effective interventions were low-traffic neighbourhoods, which provide a 20-year per-person physical activity related benefit of £4800, compared to a per-person cost of up to £112 (BCR 43:1) (Aldred et al., 2024).
What is needed?
To keep the population healthy, it is essential that all New Zealanders are able to actively get around safely in their neighbourhoods and communities. Active transport is one of the mostimportantopportunities available to New Zealanders to increase their physical activity, and an essential tool to help improve population health.Footpath and cycle lane availability, connectivity, width and quality are all important – as are provision of safe places to cross, traffic-calming infrastructure, and slower speeds around key locations (e.g., schools). Examples from New Zealand show that infrastructure that prioritises active modes of transport and slowing cars results in significant speed reductions (Hosking et al., 2023). Raised crossings significantly reduce harm and risk of injury to pedestrians (Blewden et al., 2020), and facilitate access and mobility, especially for people with mobility restrictions – including older people, people with a disability, and people using prams (Witten et al., 2022).
What do we have to lose?
Everyone loses when we restrict people’s ability to get out and about actively. For example:
Air pollution in New Zealand causes thousands of early and avoidable deaths each year, and the most common source is tailpipe emissions from motor vehicles. The transport sector is responsible for approximately 80 per cent of harmful air pollution in New Zealand. More than 90 per cent of people living in Auckland are exposed to air quality below international standards, and it is estimated that exposure to traffic-related air pollution in the city is responsible for about 900 premature deaths each year (Kuschel et al., 2022).
Long-term exposure to air pollution leads to health conditions and diseases, such as asthma and bronchitis, heart disease and stroke, and diabetes.
The social cost of poor air quality is about $15.6 billion annually for the whole of New Zealand.
Police records show that between 2017 and 2021, there were 249 deaths and 2938 serious injuries (i.e., injuries that required overnight hospitalisation or longer) due to crashes on Auckland roads (Waka Kotahi, 2023). This is considered an under-report of the total amount of deaths and serious injuries, with the actual figure estimated to be around 13 times higher (Viastrada, 2021). In addition to the tragic loss of life and harm this causes, these crashes also have major costs to society. It is estimated that deaths and serious injuries will cost the New Zealand health system $1.2 billion (2011 NZD) over the lifetime of those alive in 2011 (Randel et al., 2022). The social cost of crashes is estimated to be $12.5 million for each death and $660,100 for each serious crash (Ministry of Transport, 2023).
The harmful effects of transport contribute seriously to the unnecessary and unfair health gap between Māori and non-Māori (Randal et al., 2022).
It is unsurprising, then, that the World Health Organization provides a clear direction for the future of transport infrastructure with its statement: ‘National transport policies set the agenda and priorities that determine investment in mobility systems, and should therefore prioritise walking and cycling, and public transport, as safe and accessible travel modes for everyone.’
Ultimately, for a healthier New Zealand, our transport infrastructure must fulfil its role to facilitate safe and healthy transport for all.
Note: This editorial includes content from a submission on the Draft Government Policy Statement on Land Transport 2024–34 (tinyurl.com/gpslt2024), written by 22 authors, including Professor Smith and Dr Wild.
References
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