Caroline Shaw

Objective: Transport is a major determinant of population and planetary health, causing significant and ongoing harm. The scale and pace of policy action to create a healthy, low‐carbon transport system is inadequate. Using a commercial determinants of health framework may offer a useful approach to understand the lack of action to reduce this harm. Methods: We examined the diaries of the Aotearoa New Zealand ministers of transport for 5 years to look at the interest groups they met with. Interest groups (IGs) were classified firstly into commercial, non‐commercial or iwi/hapū (the Crown's Indigenous treaty partners) and, secondly, by the focus of the group. Findings: Over the 5‐year period, there were five ministers and associate ministers who encountered 974 transport‐related IGs during 880 meetings. Most of these IGs (74%) were commercial (18% business associations and 56% firms). Health and safety organisations represented 3.6% of total encounters (health alone was 0.7%). The most common IG focus was air travel. Conclusions and Implications for Health Promotion: Commercial IGs were heterogeneous, but they had opportunities to influence ministers of transport at three times the rate of non‐commercial IGs. Efforts are needed to understand the absence of health IGs in these meetings and to increase the involvement of health in transport policy. Measures to increase transparency around corporate political activity are needed.

Background Electrification of the light vehicle fleet is a core component of decarbonisation policy globally. As transport is an important determinant of health, this process will likely impact a range of pathways to population health, outside of averted climate change. Methods A transport-health multistate lifetable model for Aotearoa/New Zealand was used to model changes in the vehicle fleet and transport behaviour patterns that could be expected as part of electrification in Aotearoa/New Zealand. These changes are related to the new energy source and the costs of driving. The potential health, equity, health system cost and environmental impacts of this transition were modelled through the pathways of physical activity, injury and air pollution (tailpipe and non-tailpipe). Results Compared with a scenario of 2018 vehicles and travel patterns projected forward, under the electrification scenario modelled by 2050, there would be a 21% increase in per capita kilometres travelled by car, a loss of 270 health adjusted life years (95% uncertainty interval (UI) −1000 to 500) and health system costs incurred of NZ$44 million 2018 dollars (95% UI NZ$−12 to NZ$110). While health impacts from air pollution decreased, in the electrification scenario road injury increased and there was a net health loss. Increasing the cost of driving, through distance-based charging, attenuated the negative health impacts. Conclusions These results suggest that the electrification of the light vehicle fleet has mixed health impacts. Researchers and policy-makers should take a cautious approach to claims that light fleet electrification will have co-benefits for population health and health equity.

The transport system influences health, including the onset of new cancers, in both positive and negative ways. Transport affects the frequency of cancer via access to healthcare, employment and other goods and services of society; physical (in)activity; exposure to transport‐related pollution and climate change. In addition, avoidable transport health impacts overload the health system that delivers cancer care. The current transport system in Aotearoa/New Zealand is the result of policy choices made in the last 50–70 years which have privileged the private motor vehicle. We discuss examples of local work to support a healthier transport system, including action research with government partners creating infrastructure to support healthy travel, health professional advocacy in transport policy processes and involvement in coronial processes and a subsequent government advisory group. These, and other attempts at change, have had limited impact because of the elements that hold the current system in place; the weak regulatory architecture and institutions, commercial influences on policy and funding arrangements. Creating a healthy, cancer‐preventing transport system requires not just focus on specific policy changes but reform of the policy making apparatus to ensure healthy people and planet are at the centre of decision making.

Background: Health co-benefits are a key potential advantage of transport decarbonisation policy. However, health impacts will occur in the context of existing transport-health inequities and decarbonisation policies will themselves impact inequities. Methods: We modelled the health, health system and environmental impacts of the ‘Behaviour’ and ‘Technology’ pathways developed by the New Zealand Climate Change Commission. Household transport related health impacts were modelled through the pathways of physical activity, air pollution (PM _2·5 and NO ₂ ) and injury for the New Zealand population from 2018 to 2050. We modelled impacts for Māori (the Indigenous Peoples of Aotearoa) and non-Māori. Findings: Both pathways show improvements in population health, reductions in health system costs and reduced lifecycle greenhouse gas emissions compared to baseline, although health gains were substantially larger in the Behaviour pathway. Health gains were 20-30% larger for Māori than non-Māori in both pathways, although more healthy life years were gained by Māori in the Behaviour pathway. For those aged 0-4 in 2018, healthy life expectancy differences between Māori and non-Māori reduced by 0·5% in the Behaviour pathway. Healthy life years gained by Māori and non-Māori altered substantially depending on assumptions about the equity of the implemented pathway. Interpretation: Decarbonising transport may reduce health and healthy life expectancy inequities between Māori and non-Māori if policies supporting decarbonisation are implemented equitably. Pathways that increase physical activity will have a much larger impact on population health than those which rely on low emission vehicles. Funding: Health Research Council of New Zealand (20/151) and University of Otago.

Background: Surveillance of domain-specific physical activity (PA) helps to target interventions to promote PA. We examined the sociodemographic correlates of domain-specific PA in New Zealand adults. Methods: A nationally representative sample of 13,887 adults completed the International PA Questionnaire–long form in 2019/20. Three measures of total and domain-specific (leisure, travel, home, and work) PA were calculated: (1) weekly participation, (2) mean weekly metabolic energy equivalent minutes (MET-min), and (3) median weekly MET-min among those who undertook PA. Results were weighted to the New Zealand adult population. Results: The average contribution of domain-specific activity to total PA was 37.5% for work activities (participation = 43.6%; median participating MET-min = 2790), 31.9% for home activities (participation = 82.2%; median participating MET-min = 1185), 19.4% for leisure activities (participation = 64.7%; median participating MET-min = 933), and 11.2% for travel activities (participation = 64.0%; median MET-min among participants = 495). Women accumulated more home PA and less work PA than men. Total PA was higher in middle-aged adults, with diverse patterns by age within domains. Māori accumulated less leisure PA than New Zealand Europeans but higher total PA. Asian groups reported lower PA across all domains. Higher area deprivation was negatively associated with leisure PA. Sociodemographic patterns varied by measure. For example, gender was not associated with total PA participation, but men accumulated higher MET-min when taking part in PA than women. Conclusions: Inequalities in PA varied by domain and sociodemographic group. These results should be used to inform interventions to improve PA.