Essential Evidence on a page: No 59 Global Perspective - Urban populations, transport and health inequalities

Dr Adrian Davis

Top line: By providing better accessibility to all, sustainable transport can have direct benefits in terms of poverty reduction. Healthier transport can spread the health and environment costs and benefits of transport more evenly across the population sectors.

Over the next 30 years, most of the world’s population growth will occur in cities and towns of developing countries.1 This trend is an indicator of the growing importance of urban environments to public health. Particularly in Asia, vibrant economic growth has lead to an increase in industrialisation, urbanisation and motor vehicle use.2 In Africa urbanization is also very rapid. For example, the population of Dar es Salaam is doubling every 12 years.3

Regarding premature deaths and ill-health, urban dwellers face a range of burgeoning environmental hazards, many due to patterns of unplanned and unsustainable styles of transport development. The inherent health risks of these patterns for developing cities are very significant and growing, but have not yet been fully recognised by planners and policymakers.4 To cite a few, the impacts of which have already occurred in UK cities: ƒ

  • Urban air pollution, much generated by vehicles, kills some 800,000 people annually. ƒ
  • Road traffic injuries are responsible for another estimated 1.2 million deaths. ƒ
  • Motorisation is a driving force in sedentary lifestyles and lower levels of routine physical activity – trends associated with diseases causing 1.9 million deaths annually.5 The substitution of active to sedentary travel is also accelerating obesity levels.
  • Transport patterns exacerbate poverty and inequalities, when large gaps develop between the quality of private motorised transport and the quality of public transport and non-motorised transport, which are most accessible to poorer communities.
  • Motorisation is a driving force shaping cities and communities, affecting patterns of physical movement, and fundamental social interactions and health and well-being.

Poor people are most vulnerable to environmental pollution– since they often live in areas of very high motor traffic volumes, more exposed as pedestrians or cyclists to injury risk; and most economically damaged by urban transport that emphasises private modes:

“As average incomes grow and car ownership increases, the patronage, financial viability, and eventually quality and quantity of public transport diminishes. Motorisation, which is permitted by the growth process, may thus also make some poor people even poorer. In particular, in the absence of efficient congestion pricing for road use, piecemeal investment to eliminate bottlenecks will almost certainly benefit the relatively wealthy at the expense of the poor.”6

1 World Urbanization Prospects: 2004 The 2003 Revision. United Nations Department of Economic and Social Affairs, Population Division: New York.

2 Health Effects of Outdoor Air Pollution in Developing Countries of Asia; A Literature Review, 2004 Boston, MA. Health Effects Institute, April. (Accessed 24th June, 2010 : http:

3 de Jong, R. 2002 The Environmental Impact of Cities” Habitat Debate. UN-Habitat – United Nations Human Settlements Programme, 8 (2), June, p. 5.

4 Montgomery, M., et al., (eds) 2004 Cities Transformed: Demographic Change and its Implications in the Developing World. ed. N.R.C. Panel on Urban Population Dynamics. Earthscan: London. p. 529.

5 WHO, 2004. Global strategy on diet, physical activity and health. Gevena: WHO.

6 Cities on the Move: A World Bank Urban Transport Strategy Review. 2002The World Bank, Washington, D.C. (Exec Summary accessed 24th June 2010:

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