François Gagnon: Workshop on Transportation Policies and Health Inequalities (2011), Tools & Resources panel presentation from Building Healthy Communities: Bringing Health & Wellness to the Community Planning Table conference.
Q&A
1) Would air quality improve if there were fewer stop lights at intersections and we moved to roundabouts? Wouldn’t there be less idling?
I partly answered this question at the conference. I will not add more, given that we are currently writing a document that will further address many questions concerning roundabouts based on evaluation studies. If you want to receive it when it comes out, you can either subscribe to our newsletter or check our website regularly – this one is most probably going to be published this spring.
2) Do you have an opinion (agree or disagree) on metered parking near essential services (e.g., hospital emergency rooms)?
I can only offer some personal thoughts on this as it is not in the mandate of my organization to develop normative positions on specific policies. It should be clear I’m speaking for myself here.
As the issue has appeared in the newspapers recently, it is relatively true that parking fees can act as some form of barrier for people who live in lower income brackets. I say relatively because the average annual cost of a car is somewhere around 8000 or 9000$ (at least here in Qc), so parking fees, however high they can be, can only amount to a relatively minor portion of total costs of a car over a given year. Maybe then we could more appropriately call it ‘an additional barrier’ to the access of hospitals by car, the first and probably most important being the almost imperative for too many to own or have access to a car itself. That said, it remains true that parking fees at healthcare facilities should not be a barrier, of course. So health care managers at all levels should find ways to make sure that this does not happen. There are a few options that exist to that end.
First, they could think of ways that their users who have low incomes (imagine a cut-off point) don’t have to pay those fees, for example by being reimbursed upon presentation of income proof. Second, and to bring the discussion in another direction, maybe this is a debate that can be a starting point for figuring out ways to give access to hospitals by other means than the car. While it is certainly true that some people’s sickness or disability plainly makes it such that they cannot travel otherwise to receive healthcare services, it is certainly not the case for every patient. So providing access by other means of transport to existing facilities is a good way to avoid this effect for the people who can. And I could add it is not that difficult to do, even in relatively low density areas. People tend to think of mass transit and large buses when they think of public transport, but small buses (10-15 people) or even collective taxis can be more appropriate to serve low volumes of people. On the same theme, health care management in general in Canada (I don’t know about the precise situation in Newfoundland and Labrador) in recent decades has also had a tendency to close the smaller healthcare facilities that were knotted in the local fabric of collectivities. These made it possible for patients to access many services very close to their homes through other means of transportation than the car. The corollary has been to open ‘big box’ type of hospitals on the fringes of cities and towns. It is possible that it has brought some efficiency gains for the system, but this has created pressure on people to motorize the way they move around – and this especially true since this has happened in retail, education and other more or less daily services. Maybe it is time to revisit these trends in hospital planning and decentralize the most commonly used services. i.e. the non-specialized ones.
3) In NL, we travel throughout the province mostly by car. There is a intraprovincial bus service but no train service. You can fly between major centres. From your perspective, are there inequalities related to this reality?
This is not at all a NL phenomenon – Canada as a whole is amongst world ‘leaders’ (if not in first place)for volumes of kms travelled by motorized vehicles! But to answer your question without writing a book, I will limit my answer to car-oriented transportation systems and inequalities in health outcomes. In this regard, I tend to classify them in two categories. This is a general account, how it plays out specifically in NL, I cannot say precisely.
(1) Emphasis on the car as the dominant mode of transportation creates health inequalities because it creates difficulties of access to resources that are related to health outcomes, for eg. employment opportunities, food and health care services. This happens in two main ways. First, people who do not have higher incomes have to mobilize financial resources for cars (it was estimated to cost between 8000 and 9000$ per year to own an average car in Quebec last year) that they cannot use for food, housing, etc. Second, where the car is the predominant mode of transportation you can often find ‘food deserts,’ which means some people who don’t have a car have a difficult time accessing food outlets. I would also add employment and health care service deserts but those terms have never been coined to my knowledge. This is so because the ‘long event’ of the car becoming the dominant mode of transportation has come in parallel with the transformation of our spaces (both the design and the localization of roads, hospitals, schools, retail facilities etc.) around it.
(2) The predominance of the car has often been established to the detriment of other users of public ways and of other type of uses of the spaces bordering them (eg. residence, commerce, etc.). Evidence of inequalities ‘on the road’ abound, but a quote from a WHO report on impacts of transportation policies on health outcomes can sum up neatly the question in richer countries: «In high-income countries, deaths among car occupants continue to be predominant [in absolute numbers], but the risks per capita that vulnerable road users face are high[er]. (WHO,2004 p.3) Moreover, it should be noted the ‘vulnerable’ road users are also frequently ‘lower ses’ road users – poorer people have less access to cars, and therefore travel more often by bike or foot. As for impacts of motorized travel on other uses of spaces bordering streets and roads, they manifest themselves in many different ways. One of those obvious pertinent cases for NL might be the slow transformation of smaller municipalities’ main streets into regional roads. The speed and volume of cars (and trucks) on these has been increasing constantly, creating noisy environments for residents living on beside them. The same is true with the construction of highways in large cities, where highways have further often been located close to – if not literally in – lower SES neighbourhoods.
All this can be looked at in another way, i.e. one can argue for infrastructure benefiting easy and safe active and collective transportation for everyone because in a number of ways it can help mitigate social inequalities created by a car-oriented transportation system. The mayor of Bogota, in Columbia, has posited things this way, for example.
4) St. John’s has a very limited bus service & public transportation system which limits mobility of students, low income people, etc. Yet the city layout is not conductive to tram lines, subways, etc. What can we do to improve public transport?
In Curritiba (Brasil), a city of 2,2 M., 70% of commuters travel by collective transportation, yet there is no subway or tram. So you can create a very good system without resorting to higher-end and costlier technologies. The key principles of planning a strong collective transportation system are reliability, comfort and speed. These are not the inherent properties of subways or tramways. This can be created with buses (big or small), collective taxis and reserved lanes and other supportive infrastructure (such as comfortable bus boarding areas).
Opposition to this will often be based on costs arguments, but in general this is a fallacy because a car-oriented transportation system is by very far the most expensive one can imagine. On top of providing streets and roads (in general, the announced construction cost is around 20% of its life-cycle cost – so the lifespan cost of a 1B$ highway project, for example, is somewhere around 5B$), one has to factor in costs of parking (at origins and destinations – for every car you have to something like 5 or 6 parking spots that you need to build and maintain!) and tremendous tolls in health outcomes (from collisions, noise, air pollution, sedentarity, etc.)
5) How do you deal with the ideological value of each person owning his/her own car instead of using public transport?
A useful distinction to make is symbolic value and use-value. There are some people for whom the car is a social status symbol – and I would not waste my time trying to convince them! But I would argue that for most people the value of cars is derived from what it allows them to do (use-value). For these people, one has to ask what does it do for them? Well, currently cars are in many (if not most) situations the easiest, most comfortable and most reliable way to get to their daily activities. Dealing with this cannot be done through advertising campaigns. The organization of the transportation system and of the land use has to be reorganized so that travelling by car is not so disproportionately advantageous relative to public transportation to get to those daily activities. This is no easy task, but if it is to be done it will be one project at a time – whether this means building a collective transport network or organizing daily destinations (for work, health care, daycare or school, food access, etc) around this network. Getting to the point where we are at in terms of having collectivities organized around the car took us 60 years more or less, the other way around might take as much time if other things (like peak oil) don’t push us down that road faster.
6) In your experience in doing your workshops, what is the most common inquiry and what is the most common barrier you have seen/heard?
That is a very broad question! Dealing with inequalities -related to transportation policies or not – is always a difficult thing because many in our communities tend to think inequalities are exclusively the domain of individual will and so even the idea of having public policies that will have for objective to mitigate them is not obvious, to say the least. But for public health practitioners trying to push these agendas, one of the most evident barriers to me is a lack of capacity to propose transportation or transportation-related interventions (strategic or tactical) that will be acceptable to elected officials and professionals responsible for the different aspects of the built environment that influence the way people move.
7) Are there cities where free bus passes are provided to seniors?
I know of cities that have reduced fares for seniors and students and other types of users. Other cities, like Portland (Oregon), have decided that their public system would be free to everybody. But I am not aware of free passes programmes specifically for seniors.