Health impact assessment of increasing public transport and cycling use in Barcelona: A morbidity and burden of disease approach

Abstract

Background: Transportation is a major source of air pollutant emissions and car use, promotes physical inactivity and sedentary lifestyle which are associated with obesity, cardiovascular disease, diabetes, cancer, and other diseases. Both physical inactivity and air pollution have been classified as two of the 20 leading risk factors of burden of disease worldwide in 2010. Aims: Quantify the health impacts on morbidity and burden of disease of reduced car trips and increased public transport and cycling trips. Methods: A health impact assessment study of morbidity of replacing short and long duration car trips with bicycle and public transport trips in the Barcelona metropolitan area (1.6 million inhabitants) was performed. Through 8 different scenarios, the number of cases of disease or injuries related with particulate matter air pollution < 2.5 mm (PM2.5), physical activity and traffic incidents in travelers was estimated. An air dispersion model was used for estimating PM2.5 exposure and cases of disease related to PM2.5 in the general population. To estimate the burden of disease in travelers and the general population of these scenarios, a disability adjusted life years (DALYs) approach was applied. Results: A 40% reduction in long-duration car trips substituted by public transport and cycling trips resulted in annual reductions of 127 cases of diabetes, 44 of cardiovascular diseases, 30 of dementia, 16 minor injuries, 11 of breast cancer and 3 of colon cancer, which resulted in a reduction of 302 DALYs per year in travelers. The reduction in PM2.5 exposure in the general population associated with the 40% reduction of long-duration car trips resulted in annual reductions of 7 cases of low birth weight, 6 of preterm birth, 1 of cardiovascular disease and 1 of lower respiratory tract infection. Conclusions: Transport policies to reduce car trips and increase public transport and cycling trips can produce important health benefits in terms of burden of disease.