Abstract
Like most English-speaking car dominated countries around the world, the transport system of Aotearoa New Zealand has developed in a way that systematically ignored the negative health and wellbeing effects of how we get around. This system has also largely ignored how health and wellbeing effects are distributed across society and what this might mean for existing and future inequities. Despite a recent shift to consider broader health, wellbeing and sustainability implications in transport policy in Aotearoa, there are still substantial gaps in our knowledge about how transport influences health, wellbeing, and equity, and how these influences could be addressed through transport policy and practice.
The aim of this thesis was to gain a better understanding of the influences of transport policy on wellbeing, health and equity in Aotearoa. I addressed this aim through three main research questions: (1) How can concepts of wellbeing be applied to transport policy in a way that helps create a more sustainable and equitable transport system that contributes to achieving wellbeing? (2) To what extent does the current transport system have an impact on health and health equity in Aotearoa? (3) What can be learnt from a case study of a typical intervention to encourage healthier and more sustainable transport?
I used a range of methods from different disciplines to give a broader understanding of how transport researchers and policymakers might equitably tackle the varying, but intertwined, wellbeing and health challenges transport contributes to. These methods included microsimulation modelling, structural equation modelling and regressions to explore relationships between population health and health inequities, transport and individual behaviour change.
By undertaking a narrative review of the transport justice and equity literature I adapted a conceptual framework of wellbeing and distributive justice for transport policy. This framework, based on the Capabilities Approach, gave a clearer picture of the positive and negative impacts of transport on people’s health and wellbeing and highlighted the inequitable distribution of these effects across society. It also provided theory-based guidance on actions to improve transport justice that can readily be integrated into existing policy institutions.
Through the health impacts modelling study, I found that if the negative health impacts of the current transport system were removed, at least 1.28 (95% UI: 1.11 – 1.5) million Health Adjusted Life Years and $7.7 (95% UI: 10.2 – 5.6) billion would be saved over the lifetime of the 2011 NZ population. Māori would gain more healthy years per capita than non-Māori, resulting in small but important reductions (2-3%) in the present gaps in life expectancy. These potential health gains were similar to those that would be gained from the eradication of tobacco or obesity.
Finally, focusing on an existing active travel intervention in two provincial cities in Aotearoa, I used structural equation modelling and regression analyses to apply an alternative approach to transport policy and practice developed earlier in the thesis. I found that a commonly used behaviour change theory (the Theory of Planned Behaviour) could identify some psychological factors that might explain how this successful intervention increased active travel overall. However, it was not able to explain the observed changes in walking and cycling seen over the three-year study period. The theory was also not able to explain any of the differences seen by gender or ethnicity. This suggested that alternative behaviour change theories might help to more appropriately evaluate transport interventions to improve health, wellbeing and inequities.
Overall, the transport system and transport policy have potentially wide-ranging impacts on wellbeing, outside the traditional areas of transport policy. It is evident that the current transport system in Aotearoa has substantial negative health impacts on society and this health burden is disproportionately borne by Māori. To address these health, wellbeing and inequity issues, we need to carefully consider the theories and assumptions underpinning how we design and evaluate these interventions and ensure we design policy and evaluation programmes with equity in mind from the start.