SECTOR RESIDENCIAL EN ESPAÑA

Transport investments and transport policy are an integral part of present day urban planning activities aimed at increasing the economic productivity of urban areas, while lessening the external costs generated by the transport network. Both transport

investments and transport policy are capable of reducing health costs of transport by decreasing the level of travel demand, fuel consumption, traffic congestion, and emissions. In reality, major transport investments are based on transport policy decisions and include the expansion of existing, and construction of new transport infrastructure - bus rapid transit (BRT), train networks, subways and metro-rails, light rails, airports, ports, freight and road networks. However, in addition to public transport investments, transport policy covers a diverse range of areas such as traffic demand management, vehicle standards and use, fuel standards and taxes, safety and surveillance, access and equity issues, user pay based road network (toll management), community support activities, land use and housing.

Major transport investments made in public transport infrastructure, particularly bus rapid transit (BRT), light rail and railways (metro, surface and elevated rails), are observed to reduce important transport externalities like congestion, emissions and accidents (and thus related health costs) (Baum-Snow and Kahn 2000, Lee 2003, Molina and Molina 2004, Vergara and Haeussling 2007). For example, a BRT investment in Bogota, Colombia is estimated to have reduced 93 percent of traffic fatalities and 40 percent of local air pollutants in addition to a reduction of 14.6 million metric tons carbon-di-oxide (CO2) emissions during the first 30 years of its operation (Lee 2003). Furthermore, in the USA it is estimated that an average motor vehicle trip per passenger kilometre of travel generates about double the amount of CO2 emissions as produced by commuter-rail (ABA 2007).

Decisions on transport investments and transport policies are also closely associated with policies on land use and urban planning. For example, compact urban planning is observed to improve the environment by reducing urban sprawl and thereby transport emissions - such as, the multi-city empirical study by Lyons et al.

2003, based on 84 cities selected from various countries. This finding is supported by another ex post evaluation study conducted on a 30 year old development in the Netherlands (Geurs and van Wee 2006). This study concluded that compact urban development policies reduced a range of externalities like urban sprawl, car use, emissions, and noise levels.

In addition, active transportation has been promoted as an alternative policy measure to private driving, as it is found to be associated with substantial health benefits through increased physical activity (Garrard 2009, NSW PCAL 2011, Hitchcock & Vedrenne 2014, Mueller et al. 2015). Active transportation includes travel by foot, bicycle and other non-motorised means (e.g. foot-powered scooters) and travel by foot within a trip chain for public transport users. A study showed that policies encouraging the use of both energy efficient motor vehicles and increased active transport would almost double the impact on greenhouse gas emissions, while curbing adverse health effects by increasing physical activity (Giles- Corti et al. 2010).

Another study by New South Wales (NSW) Premier’s Council Of Active Living (PCAL) proposed a Walking Strategy for encouraging active travel based on a methodology for health benefits that incorporated measures of morbidity as well as mortality and estimated a consequent set of parameters that can be applied in cost– benefit analyses (NSW PCAL 2010). This methodology and associated parameters were developed by a study to estimate the economic benefits of shift from short car trips to walking (PwC 2010). Applying the methodology of this paper, health benefits of a 1% annual switch to walking were estimated at $134 million and $214 million over five and ten years respectively (PwC 2011). In contrast, a systematic review of 24 studies from 12 countries found very little robust evidence of the effectiveness of

active transport interventions for reducing obesity, despite active transportation having a positive impact on health outcomes (Saunders et al. 2013).

However, a study commissioned by the Queensland Government in 2011 estimated economic benefits for a typical off-road path in an inner urban area and found that for every 1000 pedestrians per day, economic benefits of around $7 million were generated per kilometre of walking path, and for every 1000 cyclists per day the benefits were around $15 million per kilometre of cycling path (DIRD 2013). Similarly, another study suggested a framework and parameter values to capture these health benefits for the Australian population with a weighted benefit of $1.68 per km (range $1.23–$2.50) for walking and a $1.12 per km (range $0.82–$1.67) for cycling that included both mortality and morbidity health effects generated by physical activity (Mulley et al. 2013). In practice though, health costs and/or health benefits of major transport investments are not directly measured for the Australian economy, in spite of having estimates on various externalities of transport investments and policies, which include health costs implicitly (traffic accidents, emissions, car use, noise pollution, urban sprawl etc.).

Despite having demonstrated health benefits, active transportation that supports walkability can also result in higher levels of air pollution exposure for the people living or working in busy urban settings. Similarly, transport measures lowering air pollution levels may not support active transportation. Thus, a given set of transport strategies aimed at reducing adverse health effects can actually generate conflicting health outcomes. To address this issue, transport strategy induced health benefits should be estimated for the target population as a whole considering existing population health status and factors influencing population health, where net health gain from a given set of transport improvements can be derived.

The lack of (or limited) attention to estimating health impacts of transport investment strategies and transport policies is likely to be influenced by a range of issues on methods of measuring and valuing population health effects, which are:

 qualitative vs quantitative methods;

 analysis at the macro (group) or micro (individual) level; and

 synergy with other assessment approaches to health effects.

The following three sub-sections briefly discuss each of these three methodology issues.

2.3.1 Quantitative versus Qualitative Methods

In the estimation of health impacts of transport, most studies have adopted quantitative methods over qualitative approaches (Schiefelbusch 2010), as decision makers are generally more interested in knowing the costs and benefits in terms of dollar values. However, health impacts are not always measurable in terms of monetary units, as individual health status is often ranked by the researchers in primary health surveys, instead of assigning any dollar values – for example, mental health (pain, grief, satisfaction etc.) contributing to individual’s income or labour productivity. In addition, there exists an issue regarding the monetary valuation of social impacts in particular – visual impacts of roads and traffic, community perceptions on access to transport and value of life, individual’s locational preference for jobs, education or recreations.

All of these factors are important elements of health impacts investigations, but are in reality “less tangible aspects that cannot be expressed in quantitative

terms” (page 145, Wright and Curtis 2002).

In order to take account of these tangible health effects of transport, experts suggest qualitative analysis comprising of discussion with focus groups and in-depth

interviews (Bayley et al. 2004). In contrast, for the assessments and valuation of other important health impacts of transport - air pollution, noise exposure and accidents – epidemiological and socio-economic databases exist, which facilitate detail quantitative analysis.

2.3.2 Suitability of Macro or Micro Level Analysis

Researchers face a big question regarding the level of analysis when health impacts of transportation are quantified and valued in dollar terms. The debate is whether the valuation of the identified health impact(s) should be for a group (macro - nation or community) or for a representative individual (micro). For example, studies have noted the popularity and suitability of neighbourhood surveys in the evaluation of the social effects of transportation projects (Forkenbrock et al. 2001). The neighbourhood surveys are recognised as particularly useful for including social impacts relating to community cohesion and forced relocation. However, other researchers find these surveys useful only for identifying a certain type of social impacts, such as trip diversion and delay, and road safety (James et al. 2005).

Another debate exists over the transferability of the health impacts results between neighbourhoods of different geographical sizes. That is, whether robust results derived for health impacts assessments in larger geographical areas can be applied to smaller areas, which essentially indicates a high possibility of bias in impact analysis findings for smaller areas. This is an important issue for estimating health impacts in local areas. However, current practice supports using scenario planning to incorporate health impacts locally (Nguyen et al. 2014, Low Choy et al. 2012, Bierbooms et al. 2011, NSW-DEC 2006). Under uncertainty, scenario planning is used as a tool, where the process of constructing scenarios assists

researchers to analyse across sectors and stakeholders to incorporate available knowledge into a local health impacts analysis.

However, from a policy point of view, health impacts valuation at a macro level is more useful as public policies are always targeted at a population group, industry or region. Moreover, transport policy formulation and implementation and decision-making on major transport investments are very expensive in terms of both time value and resource values, with significant implications to the public fund. Therefore, for the effective use of the public fund, it is imperative that policy makers consider health costs of any major transport investments and transport policy at a macro level, which could reflect the potential health benefits of the overall target group. For example, some transport externalities (air pollution, noise exposure, traffic accidents, greenhouse gas emissions, physical inactivity) have wide-ranging impacts on particular population groups or communities, as the nature and extent of health impacts differ across these groups. For example, estimates of health inequalities across 932 local regions in Australia showed the existence of a wide population health gaps for a range of chronic health conditions (see section 6.3, Figures 6.6 and 6.7).

2.3.3 Synergy with Other Approaches

The literature review revealed that social and other impacts associated with transport (such as environmental, health and economic) have often overlapped (Parkhurst and Shergold 2009), leading to a set of concerns regarding the use of methodological approaches in valuing these impacts (Marcovich and Lucas 2011). For example, the Health Impact Assessment (HIA) has emerged as a new approach with the in-built flexibility of integrating different methodologies in evaluating transport infrastructure and policies (Gorman et al. 2003, McCarthy et al. 2010,

Mindell et al. 2004, Thomson et al. 2008). However, some researchers have noted multiple variations of this HIA approach in practice with a concern that HIAs may simply be ‘repackaging’ social impact and other forms of assessment in a ‘health wrapping’ (Forsyth et al. 2010).

Another set of approaches have focused on the monetary valuation of the social impacts of transport programs or externalities (Monzón and Guerrero 2004, BTRE 2005, Preston and Wall 2008, BTRE 2009). Here, social impacts are considered to be a ‘social cost’, and assessed like other monetary costs associated with transport projects or programs.

However, monetary valuation approaches can be incorporated into the HIA approach to derive the health costs of not only transport related health effects, but also the health costs of other non-health policies in the area of social welfare, housing, urban planning, community development or support programs. This wider adaptability and flexibility of the HIA approach has been utilised in the current thesis to develop an economic approach for estimating health impacts of major transport investments and transport policy in Australia.