‘BC ON THE MOVE’ in a Healthier Direction

Submission to the Ministry of Transportation and Infrastructure

CONSIDERING HEALTH IN THE PROVINCE’S TEN-YEAR TRANSPORTATION PLAN

The BC Healthy Living Alliance appreciates the opportunity to provide input into provincial planning that will determine the direction of transportation investments and policy over the next ten years.

As well as being fundamental to our economy, transportation is an important determinant of health.[i] Transportation systems and planning have an enormous impact on the shape, form and air quality of communities as well as citizens’ travel choices, safety and social connectivity. At the individual level, transportation choices impact on one’s ability to access health promoting services including essentials such as grocery stores, schools, recreation facilities, health care, employment and social supports.

A strong Transportation Demand Management (TDM) approach including active transportation and transit can mitigate or reduce the impact of air pollution and physical inactivity. These are significant risk factors for the most common, preventable and costly chronic diseases in BC, including diabetes, cancer and heart and respiratory diseases. To put these costs in context, 34% of the BC population with chronic diseases consumes approximately 80% of the combined Medical Services Plan, PharmaCare and acute care budgets. This makes preventable chronic diseases a major cost driver of the healthcare budget, which is projected to account for 42 per cent of government expenses by 2016-17.[ii]

This submission outlines BC Healthy Living Alliance’s recommendations to get ‘BC on the Move’ in a healthier direction, with:

  • Safer Roads and Cleaner Air for All;
  • An Active Transportation Strategy and Fund to Build the BC Network;
  • Expanded Public Transit;
  • Increased Transportation Options in Small Towns and Rural Communities; and
  • Rigorous Assessment of the Health Impact of Transportation Policies and Projects.

 

Safer Roads and Cleaner Air for All

Roads connect people with services and goods within BC and beyond. It is important that the road network is well-maintained for safety and to meet the needs of our citizens and economy. Our highways and roads need to be designed, and in many places retrofitted, so that they facilitate a range of transportation options and accommodate multiple users.

According to the BC Government’s website on Climate Action, “Emissions from the transportation sector have grown 42% since 1990 and made up 37% of BC’s total GHG emissions in 2005. Within the sector, 60% of these emissions came from road vehicles, and most of the road vehicle emissions came from light passenger vehicles.”[iii] To shift the trajectory of transportation sector emissions downward, a significant investment is required in transportation demand management to reduce reliance on the single occupant vehicle and increase the mode share of transit and active transportation.

The impact of expanded road capacity on local air quality should also be considered within this plan. Exposure to air pollution is a recognized risk factor for asthma, chronic obstructive pulmonary disease, cancer and increased risk for cardiovascular events.[iv], [v] Some recent studies indicate that air pollution is associated with increased risk for type 2 diabetes.[vi], [vii]

“Air pollution has both acute and chronic effects on human health, affecting a number of different systems and organs. It ranges from minor upper respiratory irritation to chronic respiratory and heart disease, lung cancer, acute respiratory infections in children and chronic bronchitis in adults, aggravating pre-existing heart and lung disease, or asthmatic attacks. In addition, short and long-term exposures have also been linked with premature mortality and reduced life expectancy.”[viii]

In British Columbia, the Canadian Medical Association report No Breathing Room: National Illness Costs of Air Pollution predicted that air pollution would cause in that year:

  • 306 acute premature deaths;
  • 1,158 hospital admissions; and
  • 8,763 emergency department visits. vii

In 2012, the International Agency for Research on Cancer (IARC), a part of the World Health Organization, classified Diesel Particulate Matter (DPM) as a Class 1 human carcinogen based on evidence that it is a cause of lung cancer.[ix] However, decreases in concentrations of particulate matter have been shown to increase life expectancy even when controlling for socioeconomic and demographic variables.iii “Reductions in air pollution accounted for as much as 15% of the overall increase in life expectancy in the study areas.”[x]

From 2007 to 2010 BCHLA worked with 24 local governments and 15 Aboriginal communities on the ‘Built Environment and Active Transportation (BEAT)’ initiative and from that experience, we know that highways act as real barriers to walking and cycling. It can be very challenging for local governments to implement measures that would enhance the pedestrian and cycling environment but more responsiveness, flexibility and overall support from the Ministry of Transportation and Infrastructure (MOTI) would make a measurable difference.

Recommendations:

  • MOTI should ensure that new transportation infrastructure projects align with the Ministry of Environment’s air quality and climate change targets.
  • Develop an Inspection/Maintenance (I/M) program for heavy-duty vehicles to reduce emissions.
  • Include an ongoing program with funding for auditing, planning and upgrading cycling and walking facilities on provincial roads and bridges.
  • Improve the MOTI’s process for working with local governments to lower speeds, place safety-related signage and improve cycling and pedestrian environments and crossings on highways within communities.
  • Implement the British Columbia Road Safety Strategy 2015 which would make significant progress towards the goal of zero fatalities.

 

An Active Transportation Strategy and Fund to Build the BC Network

Active transportation including walking, cycling, wheeling and any human-powered form of transport is increasingly popular in urban centres but also in mid-sized and smaller towns. Looking forward, infrastructure that facilitates active transportation will become increasingly important to meet the needs and demands of an aging population and the millennial generation who are ”less likely to learn to drive, own cars or drive as much as earlier generations”.[xi]

Many local governments have invested in active transportation facilities but need more financial support to build complete networks that will get residents more physically active. Smaller communities are especially challenged due to a small tax base and limited budgets. The Canadian Fitness and Lifestyle Research Institute found in a survey of Canadian Municipalities that “three in five communities report that an increase in the amount of walking, bicycling and multi‐purpose trails was the most pressing infrastructure need in their community to increase physical activity levels among citizens.”[xii]

Community planning and infrastructure exerts a powerful influence over citizen’s access to healthy foods and ability to be physically active in their daily routines. “Research is increasingly demonstrating links between the built environment and eating and physical activity behaviours.” [xiii]

BC research found that adults are 2.5 times more likely to engage in active transportation when living in compact and well connected neighbourhoods. They are also more likely to get the recommended amounts of daily physical activity.[xiv] Furthermore, studies show that neighbourhoods that support active transportation are associated with reduced risk for obesity and reduced air pollution. One study found “a 5% increase in walkability to be associated with a per capita 32.1% increase in time spent in physically active travel, a 0.23-point reduction in body mass index, 6.5% fewer vehicle miles traveled, 5.6% fewer grams of oxides of nitrogen (NOx) emitted, and 5.5% fewer grams of volatile organic compounds (VOC) emitted.”

The BC Ministry of Health’s ‘Healthy Families BC Policy Framework’ identifies seven evidence-based “best investments” for physical activity, which includes “transport policies and systems that prioritize walking, cycling and public transport.” This builds on a report by the Provincial Health Services Authority finding that “there is a growing consensus among public health experts that supporting more physically active modes of transportation and better access to recreational opportunities offer the most effective ways to increase activity levels across the population, particularly among people who are overweight and/or inactive.”[xv]

British Columbia needs an Active Transportation Strategy that will align policy and funding to support the development of local infrastructure within a larger provincial network. Other jurisdictions have adopted comprehensive cycling or active transportation plans such as neighbouring states, Washington, Oregon and Idaho. In Canada, Quebec has their well-known provincial network, the ‘Route Verte’ in addition to provincial bicycle policy and a new complementary Sustainable Mobility Strategy. Ontario has a new cycling strategy #CycleON that includes a 20-year vision with aspirational goals to make Ontario an internationally recognized destination for cycling. Nova Scotia’s Provincial Active Transportation Task Team was formed in 2010 with representatives from nine government departments and is now close to completing their first provincial policy framework for active transportation.

Building an active transportation network that meets the needs of British Columbians beyond the next ten years will require a significant increase in infrastructure funding. For example, high quality cycling facilities that are attractive to a significant portion of the population such as bicycle paths and separated bicycle lanes can cost from $1 million to $4 million per km (1/6 the cost of one km of road network for motorized vehicles).xvi

The Netherlands, considered a global leader in cycling provides funding at $40/person/year and other jurisdictions have made similar investments: Winnipeg $32/person/year; Brisbane $51/person/year; London $27/person/year.[xvi]  To compete with other leading jurisdictions, BC should be investing between $88M and $175M in active transportation per year over the next ten years.

The province is fortunate to have and should take advantage of the expertise that exists within British Columbia’s academic institutions and among practicing planners, engineers and community advocates. Indeed, Vancouver has been recognized internationally for growth of walking and cycling trips and will be the host city for Pro Walk / Pro Bike / Pro Place in in 2016 with the theme of “Better Health through Active Transportation.” This would be an ideal forum for the province to consult with experts from across North America and to profile BC’s next steps in developing an active transportation strategy.

Recommendations:

  • Align the ‘BC on the Move’ plan with the Ministry of Health’s ‘Healthy Families BC Policy Framework’ and ‘Physical Activity Strategy’
  • Commit to a comprehensive ‘Active Transportation Strategy’ for people to walk, bike or roll, aligning policy and funding to support the development of local infrastructure within a larger provincial network.
  • Allocate between $88M and $175M in active transportation per year over the next ten years. Prioritize investments in:
    • Walking and rolling facilities which include enhancements such as traffic-calming and safe street crossings, benches, lighting and way-finding as these are important to meet the needs of those in wheelchairs as well as the growing demands of an aging population.
    • Triple ‘A’ (all ages and abilities) cycling facilities which have been shown to motivate higher numbers of people to travel by bike (including seniors and women with children), while also reducing risk of injury for all users.[xvii],[xviii]
    • Active School Travel Planning – including education and programming as well as street design and end-use facilities for healthy, active children.

 

Expanded Public Transit

Public transportation is a basic amenity that provides multiple benefits for all but is particularly necessary for those who do not own or are not able to drive their own vehicle. This includes people on limited incomes, those with physical impairments or disabilities, youth and some seniors. Transportation systems relate directly with the built environment and how our communities are planned.

The health benefits of public transportation accrue from increases in physical activity and accessibility, and reductions in injuries, localized air pollution and greenhouse gas emissions that contribute to climate change.

Studies estimate that the average transit rider walks between 1 – 1.3km per day and are more than three times more likely to meet the minimum guidelines for daily physical activity.[xix] Increased accessibility through public transit provides a greater quality of life for people regardless of income or physical ability. It is a significant factor in determining rates of labour force attachment. One study found that low skilled workers were 30% more likely to have a job and to be working more than 30 hours per week when their community was served by public transit.xii Other studies have found that transit investments can positively affect access to healthcare in rural communities and among immigrant communities.xii

Recommendations:

  • Provide funding and policy support for the BC Transit Strategic Plan 2030 to meet their goal of doubling transit ridership by 2020.
    • Support municipalities and regional districts’ ‘Transit Future Plans’ that will grow transit system capacity sufficiently to attract new ridership and serve community needs while maintaining affordability.
  • Provide funding and policy support for TransLink’s Regional Transportation Strategy (2013) to meet the targets for the mode share of walking, cycling and transit use as set out in Transport 2040.
  • Improve handyDART service over time to meet demand and to expand accessibility to evenings, Sundays and holidays.
  • Support transit authorities and local governments to fund transit infrastructure and service improvements through alternative funding mechanisms – such as vehicle levies, road pricing (including tolling), local fuel and parking taxes and expansion of community/group passes (such as the U-Pass).
  • Support and encourage transit-oriented development.

Increased Transportation Options in Small Towns and Rural Communities

People living in rural communities generally need to “travel longer distances, and often on more dangerous roads, for work, shopping and other reasons. Not surprisingly, injuries and death due to traffic accidents are much more common in rural areas.”[xx]

The lack of public transportation services to rural and remote residents in BC is seen widely in those areas as a barrier to healthy living overall including being able to access healthy foods. According to the Canadian Institute for Health Information, “access to prevention, early detection, treatment or support services… make good health status even more difficult to achieve in rural or remote areas…”xx This leads to worsened health outcomes and health research confirms that these are more pronounced in rural residents.xx

There is a dearth of public transportation options that serve smaller rural and remote communities and more connections are needed into regional centres and between regional hubs. Low population densities make frequent public transit a challenge to deliver, however, innovative approaches such as a dial-a-ride, shuttle vans and ride-sharing are potential solutions.

Recommendations:

  • Establish a task force to explore innovative public transportation systems that can serve rural and remote populations including those with mobility challenges.
  • Explore with the health authorities ways to improve transportation to health services including prevention, primary, treatment and tertiary services for rural and remote residents who are unable to afford transportation.
  • Provide funding and policy support for innovative approaches to increase mobility in rural and remote communities.
  • Consider fare adjustments for ferry dependent communities as outlined in the UBCM paper, ‘Boatswains to the Bollards: A Socioeconomic Impact Analysis of BC Ferries’.

Assessment of the Health Impact of Transportation Policies and Projects

As transportation planning and projects have a considerable impact on the health of citizens, it would be prudent for the BC government to assess the risks and respond pro-actively.

Health Impact Assessment (HIA) is a process designed to inform decision-makers about the potential health implications of a given policy, program or project. This allows decision-makers to weigh the health consequences in their deliberations which can lead to changes which can enhance health improvements or mitigate potentially negative health outcomes.

HIAs are a flexible tool as they are essentially a set of questions. The approach or techniques used to answer those questions can be scaled to fit the complexity of health considerations and the scope and timelines of the policy, program, project or initiative.

Evaluations of health impact assessment as a tool have shown that they can be effective at providing decision-makers with material to make a more informed decision.[xxi] This is particularly relevant in areas outside of the traditional domain of healthcare including development sectors such as energy, agriculture, industry and transport.

Researchers have found many instances where the HIA led to measures which mitigated negative health impacts or where modifications were made which either shifted the benefits to include more of the general population or to an underserved population.iv As the costs of negative health outcomes are carried by government, it is logical to reduce potential negative health outcomes from both a financial and ethical standpoint.

Recommendations:

  • The Ministry of Transportation should work with the Ministry of Health, BC CDC and local health authorities to incorporate HIAs into transportation projects.
  • Where transportation projects require an Environmental Impact Assessment, health professionals from MOTI, BC CDC and health authorities can provide valuable information to increase the quality of the health assessment, quantify risks and offer evidence-based proposals for mitigating health risks.

 

Transportation and Healthcare Costs

Chronic diseases, such as asthma, diabetes, cancer, heart and respiratory diseases are costly to our healthcare system and the provincial budget. Overall, the 34% of British Columbians diagnosed with chronic conditions consume approximately 80% of the combined Medical Services Plan, PharmaCare and acute care budgets.[xxii]

Excess weight costs $612M and inactivity costs $335M in direct healthcare costs.[xxiii] British Columbians who live in our poorest communities are between 24% and 91% more likely to die early from cancer (24%), respiratory diseases (53%), circulatory diseases (65%) and diabetes (91%).[xxiv] Yet much of the disease burden could be avoided since many chronic diseases are preventable, including approximately 50% of cancer and type-2 diabetes as well as 80% of premature heart disease and stroke.ii

The return on investing in transportation demand management strategies includes both the potential for long-term savings that come from a physically active population with reduced risk for chronic disease, but also immediate savings from injury prevention. Transit in Canada has a much lower fatality rate than other modes of transportation.xii UBC Study found that 1000 passenger miles taken by transit instead of in a vehicle saves $0.051 in healthcare complications.xii

 

Who We Are

Established in 2003, BCHLA represents the largest health promotion team in BC history. Our Vision is “a healthy British Columbia” and our Mission is: “To improve the health of British Columbians through leadership and collaboration to address the risk factors and health inequities that contribute significantly to chronic disease.”

Submitted by BCHLA:

Voting members:
Scott McDonald, BCHLA Chair and CEO, BC Lung Association
BC Pediatric Society
BC Recreation and Parks Association
Canadian Cancer Society, BC and Yukon Division
Canadian Diabetes Association, Pacific
Dietitians of Canada, BC Region
Heart and Stroke Foundation of Canada, BC & Yukon
Public Health Association of BC

Non-voting members:
First Nations Health Authority
Fraser Health Authority
Health Officers Council of BC
Interior Health Authority
Island Health
Ministry of Health
Northern Health Authority
Provincial Health Services Authority
Vancouver Coastal Health Authority

[i] Douglas M, Thomson H, Jepson R, Hurley F, Higgins M, Muirie J, Gorman D (eds) Health Impact Assessment of Transport Initiatives: A Guide, NHS Health Scotland Edinburgh 2007

[ii] British Columbia Provincial Health Officer. (2010). Investing in Prevention: Improving Health and Creating Sustainability. The Provincial Health Officer’s Special Report

[iii] BC Climate Action Toolkit http://www.toolkit.bc.ca/solution/transportation

[iv] Circulation. 2004; 109: 2655-2671 doi: 10.1161/​01.CIR.0000128587.30041.C8

[v] Am. J. Respir. Crit. Care Med. March 1, 1995 vol. 151 no. 3 669-674

[vi] Krämer, U. et al. Traffic-Related Air Pollution and Incident Type 2 Diabetes: Results from the SALIA Cohort Study. Environ Health Perspect. 2010 September; 118(9): 1273–1279

[vii] Brook RD, Jerrett M, Brook JR, Bard RL, Finkelstein MM.

[viii] Environmental Pollution Volume 151, Issue 2, January 2008, Pages 362-367
Proceedings of the 4th International Workshop on Biomonitoring of Atmospheric Pollution (With Emphasis on Trace Elements)

[ix] BC Lung Association. BC State of the Air Report 2014 http://www.bc.lung.ca/airquality/documents/StateOfTheAir2014WebLR.pdf

[x] Fine-Particulate Air Pollution and Life Expectancy in the United States C. Arden Pope, III, Ph.D., Majid Ezzati, Ph.D., and Douglas W. Dockery, Sc.D. N Engl J Med 2009; 360:376-386 January 22, 2009

[xi] Hopkins, D., Stephenson, J. Generation Y mobilities through the lens of energy cultures: a preliminary exploration of mobility cultures. Journal of Transport Geography. Volume 38, June 2014, Pages 88–91

[xii] Canadian Fitness and Lifestyle Research Institute (2004) A municipal perspective on opportunities for physical activity: Trends from 2000–2004. Available at http://www.cflri.ca/eng/statistics/surveys/capacity2004.php

[xiii] Healthy Eating Active Living Convergence Partnership. (2008). Strategies for Enhancing the Built Environment to Support Healthy Eating and Active Living.

[xiv] BC Recreation and Parks Association. (2009). Physical Activity and Transportation Benefits of Walkable Approaches to Community Design in British Columbia. Available at http://www.bcrpa.bc.ca/recreation_parks/active_communities/documents/BCRPA_Transportation_Study_2009.pdf

[xv] Provincial Health Services Authority. (2007). Creating a Healthier Built Environment in British Columbia

[xvi] British Columbia Cycling Coalition. PROVINCIAL CYCLING STRATEGY: Enriching Families, Connecting Communities (2013) http://d3n8a8pro7vhmx.cloudfront.net/bccyclingcoalition/legacy_url/187/BCCC-Cycling-Strategy-2013.pdf?1408764296

[xvii] Winters M, Davidson G, Kao DN, Teschke K. Motivators and deterrents of bicycling: Comparing influences on decisions to ride. Transportation 2011;38(1):153-68.

[xviii] Winters M, Babul, S et al. Safe Cycling: How Do Risk Perceptions Compare With Observed Risk? Can J Public Health 2012;103(Suppl. 3):S42-S47

[xix] Canadian Urban Transit Association. Economic Impact of Transit Investment in Canada: A National Survey.(2010) http://www.cutaactu.ca/en/public-transit/publicationsandresearch/resources/Final_CUTA-EconomicBenefitsofTransit-FinalReportESept2010.pdf

[xx] The Canadian Institute for Health Information. How Healthy Are Rural Canadians? An Assessment of Their Health Status and Health Determinants. September, 2006. http://www.phac-aspc.gc.ca/publicat/rural06/pdf/rural_canadians_2006_report_e.pd

[xxi] The Effectiveness of Health Impact Assessments: The Scope and Limitations of Supporting Decision-making in Europe (WHO, 2007) http://www.euro.who.int/__data/assets/pdf_file/0003/98283/E90794.pdf Accessed 12-07-11

[xxii] British Columbia. Office of the Provincial Health Officer. Investing in prevention: improving health and creating sustainability: the Provincial Health Officer’s special report., August, 2010 http://www.health.gov.bc.ca/library/publications/year/2010/Investing_in_prevention_improving_health_and_creating_sustainability.pdf

[xxiii] H. Krueger & Associates Inc. “The Economic Benefits of Risk Factor Reduction in British Columbia: Tobacco Smoking, Excess Weight and Physical Activity”, July 2013. www.krueger.ca

[xxiv] Tjepkema M, Wilkins, R, Long A, Cause-specific mortality by income adequacy in Canada: A 16-year follow-up study Health Reports 2013 Vol. 24 no.7 pp. 14-22