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The Gold Standard — Transportation: A Vehicle for Mental Health

By Michelle Gold
Network, Summer 2008

Transportation affects mental health. Access to goods, services, recreation and the workplace is the purpose of transportation, and uncontrolled or poorly designed land use results in barriers to access and poorer mental health. The cost of transportation can also prevent people from getting to the places, goods and services they need to be healthy.

There is consistent evidence that the design of roadways impacts mental health by influencing community cohesion, sense of belonging and social support.

Urban sprawl — low-density, car-dependent suburbs on the outskirts of metropolitan areas — typically results in residents spending a significant amount of time commuting. Long hours in traffic have been found to generate feelings of distress and frustration, back pain and high rates of heart disease, arthritis and asthma. Lengthy commutes and traffic congestion affect blood pressure and mood, increase workplace absenteeism, reduce time for community participation, and lessen overall life satisfaction.1

There is also evidence that the design of roadways impacts mental health by influencing community cohesion, sense of belonging and social support. Excessive vehicle traffic in neighbourhoods reduces resident interaction, thereby lowering opportunities for social support. Traffic noise has been shown to induce sleeplessness, irritability and depression. The disruptive effects of wide, fast moving or congested roadways have been referred to as a “community severance effect.”2 In one study, residents in high-traffic streets were more likely to withdraw from the street — drawing blinds, closing windows and walking less. However, residents in low-traffic streets were more likely to interact with others in their neighbourhood, and had three times as many friends and twice as many acquaintances.

Mental health is also affected by “locational disadvantage.” Because of geographic location, certain populations have limited access to goods, services, education, jobs, and social and recreational opportunities. This is a major challenge in northern, remote and rural communities, whose populations have poorer health on average than people living in urban areas.3,4 The distance factor, compounded by insufficient transportation options, has been found to increase social isolation and reduce utilization of non-acute health care in rural populations.5

To lessen this impact, organizations in many Ontario communities operate specialized transportation programs that take people to a variety of supportive resources, including community mental health services. This is particularly important in rural and remote areas that lack public transportation. Such programs, often utilizing a bus or other multi-person vehicle, may also have a vocational component, providing client-drivers with training and paid work experience. Yet while either operated by volunteers or primarily financed through local grants or targeted fundraising activities, the programs appear to be necessary short-term fixes, rather than long-term transportation strategies.

In 1986, the World Health Organization met in Ottawa and declared “supportive environments” to be one of five key strategies to promote health. The resulting Ottawa Charter for Health Promotion recommended the built environment be monitored to ensure “positive benefit to the health of the public.”6 With this in mind, it is encouraging to note that transportation planning is beginning to shift from a narrow focus on mobility — the movement of people and goods, generally only resulting in highway and public transit development — to accessibility-based analysis.7Accessibility-based transportation planning broadens the lens by looking at ways to improve options for reaching desired goods, services and activities. With this approach, walking, cycling, telecommunication and land use planning are all considered.

Accessibility-based planning recognizes three aspects of land use design that influence transportation and have implications for mental and physical health: density, land use mix and connectivity.8 Density refers to the concentration of structures and activities within an area, which determines the distance to one’s destination. High density land use has the potential to support alternative, more active modes of transportation, such as walking and cycling. This contributes to a sense of community and promotes physical activity that enhances health. Mixed-use zoning supports integrated blends of residential, commercial, cultural, recreational and civic structures. Connectivity is the degree to which transportation networks, including streets, railways, walking and cycling routes, interconnect. Good connections create more accessible destinations and travel routes that are attractive, vibrant and safe. Higher density, mixed-use zoning, supported by good connectivity, increases access to desired destinations. It also expands options, lessens travel time and lowers transportation costs.

And affordability of transportation directly affects people’s access to goods, services and activities, such as health care, education, work and recreation. Improving affordability can generate significant economic, social and health benefits for people with low incomes, as reducing transportation costs is equivalent to an increase in income. It is essential to maximize the availability and affordability of transportation options to support access, taking into account people’s needs and abilities.

Some communities have already found effective ways to do so. In Ottawa, the Community Pass Pilot Program discounted the cost of a public transit pass for people receiving income support through the Ontario Disability Support Program,9 including people with a mental health disability. Beyond decreased financial pressures, the majority of users reported significant increases in mobility and sense of well-being. Having affordable public transit increased the number of activities people participated in outside the home, including visiting family and friends, going to medical and dental appointments, and attending cultural events and clubs or groups. Three-quarters of participants reported an increase in independence and improved feelings of self-worth, and about half described improvements in their mental health.

Transportation is clearly a determinant of health. We all need to be able to get to the places, goods, services and people that sustain our physical and mental well-being. If we are to lessen the negative impacts of poorly designed and insufficient transportation systems, land use planning must incorporate elements of design into the built environment that enhance accessibility and affordability. Our health is depending on it.

Michelle Gold is senior director of policy and programs at CMHA Ontario.


References

  1. Howard Frumkin, “Urban Sprawl and Public Health,” Public Health Reports 117 (2002): 201-217, www.publichealthreports.org/.
  2. Carlos Dora and Margaret Phillips, “Transport, Environment and Health” (World Health Organization Regional Publications, European Series no. 89, 2000),www.euro.who.int.
  3. Fran Baum and Catherine Palmer, “Opportunity Structures: Urban Landscape, Social Capital and Health Promotion in Australia,” Health Promotion International 17, no. 4 (2002): 351-361, heapro.oxfordjournals.org.
  4. 4 David Hay, Judi Varga-Toth and Emily Hines, “Frontline Health Care in Canada: Innovations in Delivering Services to Vulnerable Populations” (Ottawa: Canadian Policy Research Networks, Research Report F63, 2006),http://www.cprn.com.
  5. Thomas Arcury et al., “The Effects of Geography and Spatial Behavior on Health Care Utilization among the Residents of a Rural Region,” Health Services Research 40, no. 1 (2005): 135-155, http://www.blackwell-synergy.com.
  6. World Health Organization, “Ottawa Charter for Health Promotion” (First International Conference on Health Promotion, 1986),http://www.who.int.
  7. Todd Litman, “Evaluating Accessibility for Transportation Planning” (Victoria, B.C.: Victoria Transport Policy Institute, 2008), http://www.vtpi.org.
  8. Lawrence Frank, Sarah Kavage and Todd Litman, “Promoting Public Health through Smart Growth: Building Health Communities through Transportation and Land Use Policies and Practices” (Vancouver, B.C.: Smart Growth BC, 2006), http://www.vtpi.org.
  9. Acacia Consulting and Research, “Community Pass Customer Survey Project: An Evaluation of Ottawa’s Transit Services Community Pass Pilot Program” (City of Ottawa Transit Services Division and the Transportation Committee of People with disABILITIES, November 2006).

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