We need to think about how we want to move, without being driven by commercial interests that do not take our health into account. Freedom is not having to get into an expensive car to go somewhere, freedom is having the choice of how to get around.
Recently, The Lancet published a series on commercial determinants of health. Commercial entities can have a positive impact on health and society, not least by creating products and services that are beneficial or even essential to health, but they can also have negative impacts. The Global Burden of Disease (GBD) 2019 study estimates that just four commercial products (tobacco, alcohol, ultra-processed foods and fossil fuels) are responsible for 19 million deaths worldwide each year (34% of the 56 million total deaths or 41% of the 42 million NCD deaths).
Business Needs over Health Protection
Transport brings great benefits to society, but can also cause harm, including harm to health, which can be significant because of decisions, for example by car manufacturers, to increase sales and profits. Pricing policies, marketing practices, industry lobbying, subsidies and government regulation all play an important role. Harm to health occurs when these commercial entities operationalise their power by engaging in practices and shaping norms that prioritise their organizational needs over the protection of health, the environment or social cohesion.
Well-funded industry lobbying is an important commercial determinant of health in the transport sector. The transport industry has significant influence over government policies that can affect health outcomes. For example, the transport industry can lobby for policies that prioritise private cars and related infrastructure over public transport and/or weaker emission controls, which can have negative health effects such as car-dominated cities, higher levels of air pollution and noise, heat island effects, fragmentation of communities, greater inequalities, less public space for people, less green space and less physical activity, with high associated health burdens, when much healthier and more sustainable alternatives, such as public and active transport, are available.
Los Angeles. Photo: Denys Nevozhai / Unsplash.
Buying 'Freedom' when Buying or Needing to Buy a Car?
The car is often portrayed as the ultimate expression of freedom - the freedom to drive wherever you can or want to go. Car advertising often portrays driving as glamorous, fun and liberating. This advertising can encourage car ownership and use even when it is not necessary. But to what extent is it true that we are buying 'freedom' when we buy or need to buy a car?
People do not simply buy a car, but enter a 'car ecosystem' that includes, for example, car manufacturers, energy producers, finance companies, insurance companies, road builders, advertising companies and governments
People do not simply buy a car, but enter a 'car ecosystem' that includes, for example, car manufacturers, energy producers, finance companies, insurance companies, road builders, advertising companies and governments. Each of these entities aims to maximise its activities and profits by trying to get as much of people's income as possible, even though it might be better for them to spend it on other, healthier alternatives.
Underestimating the Running Costs of a Car
A recent study in Germany showed that car ownership can easily consume 20% or more of a person's salary, depending on income and vehicle type. For the typical German mileage of 15,000 kilometres per year, the total lifetime cost of car ownership (50 years) ranges from €599,082 for an Opel Corsa to €956,798 for a Mercedes GLC. However, most people underestimate the running costs of a car. They also showed that there are high societal costs, amounting to between 29% and 41% of the total cost of a car through subsidies, etc. And this does not include the billions of euros in subsidies given to the fossil fuel industry every year.
A recent study in Germany showed that car ownership can easily consume 20% or more of a person's salary, depending on income and vehicle type
Gran Via de les les Corts Catalanes (Barcelona). Photo: Martí Petit / Barcelona City Council.
Cars Societal Costs: Air Pollution, Noise or Land Use
Societal costs vary widely between transport modes. A study in Munich assessed the external societal costs of different transport modes, including public transport, private motorised transport, shared services and active mobility. They covered several categories of external costs, namely air pollution, climate, noise, land use, congestion, accidents and barrier costs, as well as the health benefits of active mobility. The results showed that almost 80% of all external costs were caused by diesel and petrol cars. It recommended a massive increase in active mobility and public transport to reduce external costs.
Why do we need to subsidise this relatively unhealthy mode of transport and why we do not invest more in healthier and often cheaper alternatives such as public transport, walking and cycling?
These external costs are borne by society, not by car manufacturers or individual car users. This raises the question of why we need to subsidise this relatively unhealthy mode of transport and why we do not invest more in healthier and often cheaper alternatives such as public transport, walking and cycling.
Photo: Mariona Gil / Barcelona City Council.
A Car-Dependent Society
Unfortunately, many decades of transport planning and strong pro-car lobbying have left many people dependent on cars due to under-investment in alternatives such as public transport, walking and cycling infrastructure. We have created a car-dependent society with few alternatives, especially outside cities. Much transport planning is based on outdated cost-benefit analysis, where some of the greatest benefits come from 'travel cost savings' to justify new infrastructure for the car, with heavy lobbying from the 'car ecosystem'. More road building and infrastructure has resulted in people moving further away from places such as work, shops and schools, leading to more car use and greater car dependency.
Unfortunately, many decades of transport planning and strong pro-car lobbying have left many people dependent on cars due to under-investment in alternatives such as public transport, walking and cycling infrastructure. We have created a car-dependent society with few alternatives, especially outside cities
The average commute may have been 5 kilometres in the past, whereas today it is more than 30 kilometres. We have created greater distances between homes and e.g. schools, shops, cultural events and work, with greater opportunities for e.g. jobs. But only for those with cars, and at great cost. We need to reverse this with better urban planning that reduces the need to commute long distances.
The average commute may have been 5 kilometres in the past, whereas today it is more than 30 kilometres. We have created greater distances between homes and e.g. schools, shops, cultural events and work, with greater opportunities for e.g. jobs. But only for those with cars, and at great cost
Commercial activities such as the growth of online sales are also killing off local shops and the local economy, leaving neighbourhoods barren except for more delivery vehicles and the need to travel further if you want to visit a shop. Local shops are important for social cohesion and destinations to walk to and be more physically active.
A Case of Profits over Health
Meanwhile, car manufacturers are pushing to sell bigger, more expensive premium cars to increase profits, even though these cars take up more public space, are more dangerous to other road users and pollute more. They are also trying to delay new emissions legislation (EURO 7) for years, even though the costs are relatively small. Every year of delay in reducing emissions means more deaths and illness. It is clearly a case of profits over health. Getting a bigger slice of your salary.
But even when regulations are in place, commercial actors often fail to comply or find cost-saving, unethical ways around them, such as Volkswagen's now infamous diesel cheating. Emissions from diesel cars rigged to appear environmentally friendly may be responsible for 5,000 air pollution deaths a year in Europe alone.
How We Want to Get Around
We need to find a new sense of how we want to get around, without being driven by commercial interests that are not particularly healthy for us. Freedom is not having to get into an expensive car to go somewhere, freedom is having the choice of how to get around. Often that choice has been taken away by billions of dollars of investment in car infrastructure over many decades that are hard to reverse and have made us car-dependent and less healthy than we could be. It will take a long time to undo this, but fortunately many cities in Europe have already started. They are prioritising healthy urban and transport planning.
New innovative urban models such as the Paris 15-minute city, Barcelona's Super Block, London's low-traffic neighbourhoods and the carefree Vaugban neighbourhood in Freiburg, Germany, show that we can and should prioritise public and active transport over private car use, and health over profit margins. Unfortunately, there is (still) relatively little money to be made in healthy urban planning, "only" in preventing poor health and well-being.
We need a new way of thinking about urban and transport planning and health, breaking down existing silos and planning and retrofitting our cities to reduce the need for (long-distance) transport. We need to promote sustainable, liveable and healthy societies and cities, driven not only by invested commercial interests, but also by better health and well-being.