The figure shows the causal pathway by which transport affects health. Structural Fund spending for transport can influence different parts of this pathway. Possible approaches and actions for Structural Funds to improve health gains are shown in the blue box.

Click on any topic in the boxes to learn more.


Understanding the policy context

This provides an overview of the main policy and legislation items that need to be considered in order to comply with the ex-ante conditionalities for spending of Structural Funds on transport, while particularly focusing on health-relevant aspects of:

  • The Commission’s 2011 White Paper on Transport – Roadmap to a Single European Transport Area – Towards a competitive and resource efficient transport system

  • EU Air Quality regulations

  • The EU Environmental Noise Directive (2002/49/EC) and other legislation to control noise from specific equipment and products


Developing projects

The causal pathway for transport shows that sustainable, smart transport systems are important contributors to good overall public health. Projects in the transport sector can maximise this contribution.

The Approaches to Consider page shows a few good practice examples of projects that illustrate the potential impacts of transport on health gains.


Developing Operational Programmes

There are a number of ways in which Structural Funds investment in the transport sector can affect public health. These include:

  • Safety enhancements in transport networks

  • Promotion of public transport use

  • Promotion of transport intermodality

  • Noise control

  • Improvement of connectivity and access to key services

  • Construction of bicycle paths and bicycle-friendly infrastructure

The Approaches to Consider page provides examples of some of the linkages between health and transport that can be considered within the Operational Programmes, and links to good examples from case studies and actual programme documents.


Investment in transport infrastructure

The European Environment Agency state that infrastructure development is important to enhance market integration, improve trade and foster development in order to strengthen regional cohesion in Europe.

To increase the capacity of transport infrastructure, the European Commission set itself the objective of offering users high-quality and safe infrastructure that includes all transport modes and allowing for optimal use of existing capacities by either creating new or upgrading existing infrastructure.

Spending on transport infrastructure increased over the decade to 2008 for the 20 Member States included in the EEA-32 analysis, both in absolute terms and as a proportion of GDP.

Road infrastructure continues to receive the majority of investment, and although other modes of transport (rail, sea and air) have increased their share of investment overall in the last decade, the most recent five years have seen a return to increasing proportions of investment in road infrastructure.

The EU-12 Member States have seen proportionally much greater rises in the level of transport investment than the EU-15 Member States in all modes except sea transport infrastructure.

Overall investment in transport infrastructure grew by almost 3% in 2007-2008 for the EEA-32 Member States included in the analysis, despite a general economic recession and reduction in transport activity in that year.

From (European Environment Agency, 2011e)


Passenger transport demand

Demand for passenger transport helps to understand the size and the environmental impact of the transport sector.

In turn it explains trends in transport’s impact on the environment.

Demand for passenger transport explains the modes of transport that are used and the relative success of the policy measures that the EU and/or each country are implementing to reduce demand or to influence modal choice.

In the last decade, bus demand grew by 8% in the EEA-32. This was driven mainly by EU-15 Member States, with an increase of 10%, contrasted by a 4% drop in demand from the EU-12 (possibly in part due to competition with passenger car travel as car ownership levels increase). Romania, however, bucks this trend amongst the new EU Member States, with continued strong growth in demand (14% in 2007/08). This compares to an overall rise of just 0.4% in the EU-15, and a negligible decrease (less than 0.1%) in the EU-12 in 2008.

Demand for rail passenger transport increased by 3.5% in the EEA-32 between 2007 and 2008, and 19% in the last decade. However, there was a marked contrast in trend between the EU-15 and EU-12, with the former growing by nearly 30% in the ten years to 2008, and the latter shrinking by around 20%.

Passenger car transport accounted for a large proportion of inland passenger transport among the EEA-32. Nine of the EEA-32 Member States meet over 85% of their passenger transport demand by car, and 20 have a car share of over 80%. Cars clearly remain the dominant mode of passenger transport amongst Europeans.  Lithuania has the highest share of passenger car transport in the EEA-32, at just over 90%. Lithuania has also experienced the largest growth in passenger car demand of any Member State, nearly 200% in the last decade. This means that, despite relatively modest changes in other modes, it has the largest 10-year growth in passenger demand of any Member State. This is accompanied by one of the strongest increases in GDP over the same period. These trends suggest that rapid growth in the economy may have led to an increased demand for, and ability to afford, transport that is most easily met in the short term by the private car.

From (European Environment Agency, 2011d)

[Ed note: Figures for walking and cycling?]


Regional economy

An underlying cause of demand for passenger transport is the level of income. Across the EU there is a tendency for households to spend a roughly equivalent share of disposable income on transport as income changes. Additional income therefore means additional travel budget (European Environment Agency, 2011d).

In 2009, private households in the EU27 spent € 890 billion or roughly 13.2 % of their total consumption on transport-related items.

·         close to one third of this sum (around € 272 billion) was used to purchase vehicles;

·         slightly more than half (€ 453 billion) was spent on the operation of personal transport equipment (e.g. to buy fuel for the car); and

·         the rest (€ 165 billion) was spent for transport services (e.g. bus, train, plane tickets).

From (European Commission, 2011: 19)

The split between different types of passenger transport – also known as modal split - is important as transport modes perform differently, for example with regard to:

·         resource consumption;

·         greenhouse gas emissions;

·         pollutant and noise emissions;

·         land consumption; and

·         crashes etc.

The DPSEEA pathway shows that each of these factors has implications for health and wellbeing.


Relative location of homes, schools, services

The share of public transport, and the intensity with which it is used, generally increases as the density of urban areas increases.

Public transport providers will recoup a higher proportion of their costs through passenger fees when travel demand and activities are concentrated in the same area.

In high concentration areas, public transport,as well as walking and cycling, can offer accessibility as great as, and possibly greater, than cars. This partly relates to congestion on urban roads and limited parking space. As a result, car ownership generally decreases with increasing population density.

Urban form also changes when urban planning is based on the requirements of car drivers: for example, there has been a considerable increase in the number of supermarkets and superstores in the EU during the last couple of decades (Eurostat & European Commission, 2011a: 8). Basic services, such as shops, tend to retreat from the residential areas when access to services and activities becomes dependent on the car. Working places and shopping areas get located on brownfield areas, or on greenfield areas at the edges of urban areas. These offer more (parking) space and lower ground prices and are designed to meet the needs of car drivers (European Environment Agency, 2003).


Age and quality of vehicle fleet

Increasingly tight regulations have resulted in the gradual introduction of more fuel-efficient, less polluting, less noisy and generally safer road vehicles.

The average age of the vehicle fleet is therefore an indirect indication of the environmental performance of road transport.

The overall objective is to record the improvement of the fleet composition whereby older, more polluting vehicles are replaced with newer, cleaner ones.

From (European Environment Agency, 2011a)


Emissions of air pollutants from vehicles

The combustion of fossil fuels for transportation produces a complex mixture of pollutants comprising literally thousands of chemical constituents.

The transport sector is responsible large share of urban air pollution as well as noise nuisance. Combustion processes in vehicle engines produce gases as well as particles, either as primary emissions (such as diesel soot) or as secondary particles via atmospheric transformation (such as sulphate particles formed from the burning of fuel containing sulphur). Fine particles are small enough to be inhaled into the lung.

In spite of the growth in transport across Europe, related emissions of harmful substances such as carbon monoxide, unburned hydrocarbons, particulates and nitrous oxides are decreasing as stricter EU emission standards are imposed for cars and trucks.There has been a significant reduction in road transport emissions since 1990 across Europe.

Nonetheless, air quality problems persist (see air quality under state) even though vehicles have become cleaner. One reason is that the increase in the number of vehicles is off-setting the technological and fuel quality improvements. Another is that emissions in real driving conditions tend to be higher than emissions under test conditions.

While road vehicles are the most important transport-related source of air pollutants, ships, inland vessels, diesel trains and airplanes can also contribute to poor air quality.

(see EEA's transport pages:


Psychological pressure

Aggressive behaviour on the road is common and appears to be increasing (World Health Organization Regional Office for Europe, 2000: 26). Studies report that

·         25% of young drivers aged 17–25 would chase another driver if they had been offended; and

·         60% of study participants behaved aggressively while driving.

The car has been described as an instrument of dominance, with the road as an arena for competition and control. The car also symbolizes power and provides some protection, which makes drivers less restrained.


Ambient air quality

Transport is responsible for emissions to air (see pressures).

All and any emissions to air have an effect on health. Air quality standards and objectives are set at levels that are deemed to be acceptable for human health and the environment - however, Europe's requirements have been revised periodically as policy makers take on board new evidence about the health impacts of poor air quality.

Air pollutants arise from the combustion of fossil fuels for transportation, power generation, and other human activities. Together they produce a complex mixture of pollutants comprising literally thousands of chemical constituents. The precise characteristics of the mixture in a given locale depend on the relative contributions of the different sources of pollution, such as vehicular traffic and power generation, and on the effects of the local geoclimatic factors.

However, all mixtures contain certain primary gaseous pollutants, such as sulphur dioxide (SO2), nitrogen oxides (NOX) and carbon monoxide (CO) that are emitted directly from combustion sources, as well as secondary pollutants, such as ozone (O3), that are formed in the atmosphere from directly-emitted pollutants. Particulates (particulate matter, PM) are both primary and secondary pollutants; research in recent decades has highlighted the health impacts of fine particulates (under 10 and especially under 2.5 micrometers), which more easily pass into the body.

Although emissions from transport vehicles have decreased (see pressures), this does not appear to have a statistically significant influence on the air quality in urban agglomerations. In part, the increase in the number of vehicles is off-setting the technological and fuel quality improvements.

From (European Environment Agency, 2011b)


Cycling infrastructure

The underpinning principle of planning and designing high quality infrastructure is that measures for pedestrians and cyclists should offer ‘positive provision’. It should be clear to the user that measures for pedestrians and cyclists reduce delay or diversion and improve safety (Department for Transport, 2008: 9).

The bicycle, whether owned, borrowed or hired, can contribute to greater use of public transport. The bicycle extends the radius around the station, bus stop or home within which the traveller can reach a stop or vice versa without a car within minutes (Dimitriadis, 2007: para 3.16).


Extent of road network

Accessibility of goods and passengers shapes a region’s ability to compete economically.

Nonetheless, accessibility can be achieved by means of transport other than road, such as air or rail, and in particular by an effective integration among transport systems. Indeed, regions with a high GDP do not necessarily have a high motorway density. From (Eurostat & European Commission, 2011c)

The EU 27 comprises (European Commission & DG Energy and Transport, 2011):

·         5,000,000 km of paved roads, out of which 65,100 km are motorways;

·         212,800 km of rail lines, out of which 110.458 km electrified; and

·         42,709 km of navigable inland waterways.

In general, the density of the motorway network is closely correlated with population density and, thus, with the degree of urbanisation.

The most dense motorways are found in the Netherlands, Belgium, the western regions of  Germany and the United Kingdom. At the country level, the Netherlands has the highest motorway infrastructure density with 77 km/1 000 km², followed by Belgium (58 km/1 000 km²) and Luxembourg (57 km/1 000 km²). Trailing some distance behind Luxembourg, Germany comes fourth with 35 km/1 000 km², followed by Slovenia, Cyprus and Spain. The countries with the lowest motorway density are Romania (1 km/1 000 km²) and Estonia, Finland and Poland (2 km/1 000 km²). Bulgaria, Sweden, Lithuania, Ireland, Slovakia and the Czech Republic also all have motorway densities below 10 km/1 000 km².

Within countries, the highest motorway density is found around European capitals and other big cities, in large industrial conurbations and around major seaports. Historically, the motorway infrastructure in these specific regions was a product of regional development rather than the driving force behind it.

From (Eurostat & European Commission, 2011c)



Noise is normally defined as 'unwanted sound'. A more precise definition could be: noise is audible sound that causes disturbance, impairment or health damage (European Environment Agency, 2010b: 5).

In 1999, WHO published its Guidelines for community noise (World Health Organization, 1999). These consolidate scientific knowledge on the health impacts of community noise and provide guidance to environmental health authorities and professionals who work to protect people from the harmful effects of noise in non-industrial environments.

Environmental noise, also known as noise pollution, is among the most frequent sources of complaint regarding environmental issues in Europe, especially in densely populated urban areas and residential areas near highways, railways and airports. In comparison to other pollutants, the control of environmental noise has been hampered by insufficient knowledge of its effects on humans and of exposure–response relationships, as well as a lack of defined criteria (World Health Organization Regional Office for Europe & JRC European Commission, 2011: 99).



Quality of public transport

The quality of public transport is clearly important in influencing people’s mode of travel and achieving other aims. For example:

·      People who use public transport have higher levels of physical activity.

·      Public transport can reduce the volume of traffic; if so, the road environment will be more conducive to active transportation (walking, cycling, public transport), resulting in less air pollution, less greenhouse gas emissions and fewer road traffic injuries.

The Second European Quality of Life Survey reports that perceptions of the quality of public transport are slightly more positive in the EU15 countries, with respondents in Austria, Finland and Luxembourg giving the highest rating for public transport.

Among the NMS12 (New Member States), the ratings for the quality of public transport in Estonia and Lithuania are on a par with the EU15 countries. A low rating in Cyprus reflects the lack of public transport infrastructure in that country.

Perceptions of the quality of public transport differ between rural and urban areas. In most countries, the public transport system is perceived more favourably by those living in urban areas, particularly in the EU15 (on average 0.6 points higher).

In a few of the NMS12, such as Bulgaria and Romania, people in rural areas rated the quality of public transport more positively than those in urban areas.

From (Anderson et al., 2009: 54)



Children cannot estimate speed and risks and are often too small to see cars and their drivers so as to avoid them. Thus children are at elevated risk in road traffic, typically unable to cope with high traffic environments until about 10 years of age.

From (Task Force on Road Safety of the Working Party on Accidents and Injuries, 2005: 8).


Distances travelled

The distance travelled by passenger transport can be expressed as passenger-kilometres. This is estimated by multiplying the number of unlinked passenger trips by the average length of their trip. Across the EU-27 these have risen steadily from 1990 to 2009 and there has been a considerable increase for the EU-12. .

Passenger kilometres for passenger cars

From (European Commission, 2011: 44)

Despite this increase in passenger-kilometres many journeys are short: cars are the dominant mode of travel for distances over 1.6 km. More than 30% of trips made in cars in Europe cover distances of less than 3 km and 50% less than 5 km. These distances can be covered within 15–20 minutes by bicycle or within 30–50 minutes by brisk walking, providing the recommended amount of daily physical activity.

Journeys by other modes are also short: typically under 2 kilometres (km) for walking and under 8 km for cycling.









Change 2008/2009




























In England, for example, about 25% of journeys are shorter than 1.6 km in length, and 80% of these are travelled on foot.

From (World Health Organization Regional Office for Europe, 2002: 6)

As a consequence, the role of physically active forms of transport such as cycling and walking has decreased dramatically.


Drunk driving

Drinking and driving increases both the risk of a crash and the likelihood that death or a serious injury will result.

The risk of involvement in a crash increases significantly above a blood alcohol concentration (BAC) of 0.04g/dl.

From (World Health Organization, 2009: 21)


Duration of road exposure

Exposure to roads is increasing across the population as road networks grow and car ownership increases. This applies to the whole population: car drivers and passengers but also to people who do not own cars and to pedestrians as well as drivers and passengers. Transport workers typically report long working days and long weeks.

Spatial planning that encourages greater use of cars leads to higher volumes of motorized traffic, and in turn, greater risks to pedestrians.

Health hazards connected to atypical working times, such as insomnia, long-term fatigue and digestive  problems, are common in transport and affect the health and well-being of workers (Schneider, Irastorza, & Copsey, 2011: 21).

On average, around 65% of road crashes happen in built-up areas, 30% outside built-up areas and around 4–5% on motorways.

The risk of dying in crashes occurring on motorways is two to three times higher than those on other roads, very often because of the higher speed driven on motorways.

Roads near houses and schools are high-risk areas for children: as a consequence their activity, including cycling and walking, is restricted. Parents report the fear of crashes and injuries as the main reason for escorting children to school. The areas of highest risks for vulnerable road users such as pedestrians and cyclists are minor roads and their intersections with arterial roads.

From (World Health Organization Regional Office for Europe, 2000: 16)

Hillman and colleagues raise questions about the long-term effect of the dominance of the car on the psychological and physical health of children (Hillman, Adams, & Whitelegg, 1990):

  • children’s mobility restricted through town-planning, road- and other safety information and, importantly, the priority given to motorists in law;
  • psychological development of children may be impaired by curtailment of sense of independence and personal mobility;
  • acquisition of personal autonomy, which is hampered by the ubiquity of the car, promotes esteem; and
  • children’s play territory has been reduced as roads and pavements become more and more dangerous.


Fatigue affects all road users. Driver fatigue has similar effects on drivers’ reactivity and alertness as alcohol consumption.

This has serious health implications for professional drivers who drive longer hours and greater distances than other road users: as many as 20% of serious crashes are reported to be caused by driver fatigue (Schneider, Irastorza, & Copsey, 2011: 25).

Up to 45% of crashes resulting in fatalities happen at night, although there is far less traffic at night compared with the day time. Regarding the total number of injured people, only 18% occurs at night.

If a crash occurs at night, the risk for serious injury is much higher.

From (Schneider, Irastorza, & Copsey, 2011: 21).


Inexperienced road users

Young drivers are over-represented in certain types of crash, including:

  • single-vehicle crashes;
  • loss-of-control crashes;
  • crashes involving excessive speed and/or alcohol use; and
  • crashes when the driver is tired at night and at weekends.

Crashes when seat belts are not worn and when passengers are young often involve young drivers. As such, adolescents tend to benefit most greatly from the introduction of effective road safety policies.

From (World Health Organization Regional Office for Europe, 2011b)



In 2001 the EEA reported that about 120 million people in the EU (more than 30 % of the total population at the time) were exposed to road traffic noise levels above 55 Ldn dB. More than 50 million people were exposed to noise levels above 65 Ldn dB.

The EEA reported that that 10 % of the EU population were estimated to be exposed to rail noise above 55 LAeq dB. The data on noise nuisance by aircraft are the most uncertain, but studies indicated that 10 % of the total EU population may be highly annoyed by air transport noise.

From (European Environment Agency, 2001: 1)



An increase in average speed is directly related both to the likelihood of a crash occurring and to the severity of the crash consequences.

A 5% increase in average speed leads to an approximately 10% increase in crashes that cause injuries, and a 20% increase in fatal crashes.

Pedestrians have a 90% chance of surviving a car crash at 30km/h or below, but less than a 50% chance of surviving impacts of 45km/h or above.

(World Health Organization, 2009: 18)

Allowing faster speeds on some roads appears to have a spillover effect elsewhere; the average speed of the entire road system increases, thereby further increasing the risk of accidents.

From (World Health Organization Regional Office for Europe, 2000: 16)


Effect of noise on health

If a certain population is exposed to substantial noise, many people notice it and develop adverse feelings towards it.

Within a part of this exposed population, stress reactions, sleep-stage changes and other biological and biophysical effects may occur.

These may in turn increase risk factors like blood pressure.

For a relatively small part of the population these factors may then develop into clinical symptoms like insomnia and cardiovascular diseases which, as a consequence, can even increase the death rate.

From (European Environment Agency, 2010b: 5)

In 2011 the World Health Organization Regional Office for Europe reviewed scientific evidence supporting causal association of environmental noise. Tthe following outcomes were selected for inclusion:

·         cardiovascular disorders;

·         cognitive impairment;

·         sleep disturbance;

·         tinnitus; and

·         annoyance.

Figure : Severity of health effects of noise and number of people affected

From (World Health Organization Regional Office for Europe & JRC European Commission, 2011: 100)

The review also estimated that DALYs (Disability Adjusted Life Years) lost from environmental noise in the EU countries are 60 000 years for ischaemic heart disease, 45 000 years for cognitive impairment of children, 903 000 years for sleep disturbance, 21 000 years for tinnitus and 587 000 years for annoyance. [RF: per year?]

Taken together, the estimate of lost life years total between 1.0–1.6 million DALYs.

Sleep disturbance and annoyance related to road traffic noise constitute the main burdens of environmental noise in western Europe. [DS: what share?]

From (World Health Organization Regional Office for Europe & JRC European Commission, 2011: 101-102)


Effects of air pollution on respiratory health

The effects on respiratory health associated with air pollution range in outcome from death from respiratory diseases to reduced quality of life, include irreversible changes in physiological function.

In general, the frequency of occurrence of the health outcome is inversely related to its severity.

Thus, assessing total health impact solely in terms of the most severe, but less common, outcomes, such as mortality, will underestimate the total health burden of air pollution.

From (Cohen et al., 2004: 1378)


Figure: The relative frequencies of health events associated with exposure to air pollution





Children of lower socioeconomic class are at much greater risk of road traffic injury (RTI) than the more advantaged. Reducing this risk is particularly important because socioeconomic inequality is increasing in many countries.

Socially disadvantaged children are more likely to live in neighbourhoods with unsafe roads, high-speed traffic and few safe areas in which to play; their families find safety equipment less affordable and have less access to high-quality emergency trauma services.

From (World Health Organization Regional Office for Europe, 2008: 17).

Road traffic injuries show a steep socioeconomic gradient, for all ages, with those from disadvantaged backgrounds at higher risk than their more affluent counterparts.

As well as being at increased risk disadvantaged families are hardest hit by the financial pressure resulting from road traffic crashes.

Poor families are less likely to have the financial resources to pay the direct and indirect costs related to a road traffic crash.

Many families are driven deeper into poverty by the loss of family breadwinner, funeral costs, the expenses of prolonged medical care and rehabilitation, or through earnings lost while caring for someone who is injured or disabled.

From (World Health Organization, 2009: 4)



Rail, air, or sea transport incidents often receive considerable media coverage as they generally involve larger numbers of people and are infrequent events. Road crashes are less visible, accepted as normal or just ‘accidents’, despite the fact that Europe’s roads account for the vast majority of transport crashes, deaths and injuries and many are highly avoidable.

Road: Overall, the annual number of road fatalities in the EU is falling, despite the growth (prior to the economic and financial crisis) in passenger and freight transport, although there is considerable variation across Europe. In 2009 34,826 persons were killed in road crashes (fatalities within 30 days). This includes drivers, passengers, pedestrians, cyclists and other road users. This was 10.5% fewer than in 2007 (when 38,877 people lost their lives). In comparison with 2001, the number of road fatalities was lower by more than a third (35.9%) (European Commission, 2011: 99).

Nonetheless, the health burden of road traffic crashes is high. The number of people killed on Europe’s roads account for almost nine out of every ten deaths resulting from transport incidents in 2009. Road crashes remain the largest single cause of death among people under 45 years of age. The road fatality rate, expressed as the number of deaths per million inhabitants, averaged 78 across the EU-27 in 2008, although there were stark contrasts between Member States.

From (Eurostat & European Commission, 2011b: 10).

The risk of crashes varies, depending on the type of road, the traffic mix, the time of day and climatic conditions, and the speed and mass of vehicles involved.

From (World Health Organization Regional Office for Europe, 2000: 16)

Walking: The number of people killed in road crashes (see above) includes pedestrian fatalities: across the EU-27 the average of pedestrian fatalities as a percentage of all road fatalities was 19.5%.

The highest percentage was 36.3% in Romania and the lowest was 9.8% in the Netherlands (there was no data for Bulgaria and Lithuania).

From (European Commission, 2011: 99).

Rail: In 2009 34 passengers lost their lives in 2009. This figure does not include casualties among railway employees or other people run over by trains.

Air: In 2010, 2 people were killed on board an EU carrier which was flying over the EU territory.

From (European Commission, 2011: 97)



Obesity is defined as having a body mass index (weight in kg divided by height in meters-squared) over 30.

Obesity is a main avoidable risk factor for several life-threatening diseases, including heart disease, diabetes and joint problems.

Changes in body weight result from an imbalance between energy intake and use.

More than 30% of adults in Europe are not sufficiently active in their daily life, and levels of physical activity are continuing to decline. The World Health Organization recommend different levels of physical activity by age group (World Health Organization, 2011a;2011b;2011c).

Where data are available, as in the United Kingdom, obesity is increasing although calorie intake remains largely stable, and this may also apply to other European countries.

In most European countries, the prevalence of obesity is estimated to have increased by 10–40% percentage points [ed note: check percent or percentage points?] from the late 1980s to the late 1990s.

(World Health Organization Regional Office for Europe, 2002: 7)


Physical activity

Physical activity is probably one of public health’s “best buys”, having the following benefits:

·         a 50% reduction in the risk of developing coronary heart disease, non-insulin dependent diabetes and obesity;

·         a 30% reduction in the risk of developing hypertension;

·         a decline in blood pressure among hypertensive people;

·         helping to maintain bone mass and thus protecting against osteoporosis;

·         improving balance, coordination, mobility, strength and endurance;

·         increasing self-esteem, reducing levels of mild to moderate hypertension and promoting overall psychological wellbeing.

Both walking and cycling as regular activities can also contribute to controlling weight. This is especially important given the rising trends of obesity in the population and the need for people to take effective action to control their weight.

From (World Health Organization Regional Office for Europe, 2008: 7)


Psychological effects

The long-term psychological effects experienced by survivors of motor vehicle crashes are not monitored compared to physical injuries and deaths. Studies have found that, 18 months after a crash:

  • 14% of survivors have diagnosable post-traumatic stress disorder;
  • 25% have psychiatric problems one year after a crash; and
  • one third have clinically significant symptoms.

The psychological needs of the children involved in road traffic crashes are often unrecognized. Few children receive professional help. A study in the United Kingdom found that one in three children involved in road traffic crashes suffered from posttraumatic stress disorder when interviewed 22 and 79 days afterwards.

The development of the disorder was unrelated to the type of the crash or the nature and severity of the physical injuries. The child’s perception of the crash as life threatening was the most important determinant.

(World Health Organization Regional Office for Europe, 2000: 26)

Communities are also affected by motorised transit. The growth in the use of the car has affected social contact and opportunities for social support. New community developments may be located farther from shops, schools, and other essential services (see Relative location of homes, schools, services).

Such distance can reduce contact with, and ties to, immediate neighbours, resulting in greater risks of social isolation. Maintaining social contact and support is especially important for carers and parents with young children and for older people.

Roads can also divide and segregate communities, leading to social and health inequalities. A seminal study comparing three streets in an area of San Francisco illustrated how the volume and speed of traffic influences the way people use streets for non-traffic functions (Appleyard, 1981 cited in World Health Organization Regional Office for Europe, 2000: 27).

  • Residents on the street with the lightest traffic volume saw their environment as safe and had three times as many friends and acquaintances among their neighbours as those on the street with the heaviest traffic.
  • There was very little activity on the pavement of the street with the heaviest traffic. Heavy traffic influenced behaviour: in the short term people did not walk on the pavement as much and over a longer-term the hostile traffic environment affected the street’s residential make-up.

This study has since been repeated with similar results in Bristol, UK (Hart, 2008).