Stephen Rees's blog

Thoughts about the relationships between transport and the urban area it serves

Posts Tagged ‘health services

Equity, Opportunity and Good Health

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A free public lecture from SFU Continuing Studies and The City Program

How Transportation Affects the Essential Qualities of Life In Metro Vancouver
Thursday, 30 April 2015 7:30 PM at SFU Segal School of Business

Transportation connects us to our community, our place of work and our friends and family. The way transportation infrastructure is designed and the modes of transportation that we have access to impact our lifestyle and our health.
The lecture reviewed some of the evidence from other jurisdictions, but focused primarily on the findings from the My Health My Community project that surveyed 28,000 Metro Vancouver residents in 2013/14.
While there are clear dividends in health for active transportation users, current transit infrastructure does not equally benefit all communities in Metro Vancouver. Access to transportation widens opportunity and is a significant equity issue in Metro Vancouver.

This lecture was in collaboration with the 2015 ITE QUAD Conference, May 1-2 at the Pan Pacific Hotel, Vancouver.

It is fortunate that the text and illustrations that were used for this lecture are all available on line. I noticed that several people were trying to photograph the illustrations used, but that turns out to unnecessary too.

The talk was preceded by a presentation by Dale Bracewell, the Manager of Active Transportation at the City of Vancouver. He started by stating that Vancouver now designs its active transportation projects to meet the needs of all ages and abilities. The overarching goals are set by Transportation 2040 but that includes the interim goal of 50% of trips by walk, cycle and transit by 2020. The City has set itself objectives in the fields of Economy, People and Environment. The active transportation program fits within the People category and the Healthy City Strategy, which has a four year Action Plan. Walking and cycling are now the fastest growing transportation mode which reflects Vancouver’s high Walk Score. A panel survey is conducted annually with the City’s Health Partners.

Walking has increased by 19% while the collision rate has fallen by 20%. The collision data also needs to be seen within the context of the City’s Vision Zero. Cycling has increased by 41% while collisions have fallen by 17%. It is clear that the safety in numbers effect is working. Vancouver has installed a series of automated bike counters. He had a set of graphics which I have yet to find but the data is available as a large pdf spreadsheet.

This is the counter at Science World which now has the biggest count – even greater than the Burrard Bridge

Bike Counter

The counters show cycle use growing between 7 and 15% over the last year. The Lion’s Gate Bridge now equals Hornby and Dunsmuir, even before the new safety measures for cyclists have been introduced.

hornby-beforeafter

Hornby Street still moves as many vehicle now as it did before, simply because the  two way separated bike lane replaced on street parking. There are still 14,000 cars a day, but cycle traffic has increased 50% to 2,700 per day. At the same time there are 5,000 people on the sidewalk, with pedestrians showing a clear preference for the side with the cyclists rather than the parked cars. The street is now moving more people overall.

He also added a plug for an upcoming conference in Vancouver next year pro walk pro bike pro place  September 12 – 15, 2016

Dr. Jat Sandhu is the regional director of the public health surveillance unit at the Vancouver Coastal Health Authority. He stressed that his remarks are his own personal views.

He started by contrasting the experience of driving a car in congested traffic on the Sea to Sky Highway with that of riding a bike on a path next to the North Arm of the Fraser River – the stress of the former versus the relaxation of the latter. He grew up in Hong Kong and described his boyhood commute to school from Stanley to Kowloon: and one and half hour combination of buses and ferry to cover the same distance as the Canada Line from Richmond Brighouse to Waterfront.

He cited the work of Larry Frank at UBC who has published the all embracing literature review on health and transportation, looking at physical activity, air quality, mental health, injuries and equity. “Urban Sprawl and Public Health”. He also pointed to USC study of the Los Angeles to Culver City Exposition LRT which reduced daily vehicle travel by households of between 10 to 12 miles a day which a 30% reduction of CO2 emissions.

It is known that daily physical activity helps maintain a healthy weight, reduces the risk of chronic disease and grants a 40% reduction in the risk of premature mortality.  Yet only 40% of the population meet the recommended activity levels. Obesity is now overtaking smoking in the mortality race. Physical inactivity is a large part of the problem as shown by a study of commute time against obesity in Atlanta GA (Am J Prev Med 2004). He also pointed to the lack of transit equity citing the Next Stop Health study in Toronto.

The My Health My Community survey covers the entire area covered by Fraser Health and Vancouver Coastal Health. What makes Canadians sick? 50% of the time “your life”.

The study asked respondents 90 questions about their socio-economic status, health, lifestyle, healthcare access, built environment and community.

The transportation report on Metro Vancouver released last week is the first of a series of reports from this data, intended to inform the discussion of the transportation plebiscite in this region. It draws from the survey responses from residents of the region – which is a subset of the survey mostly conducted on line, but with supplementary paper surveys to ensure adequate coverage of ethnic minorities. It covers only those over 18 years of age. Its target was a 2% sample which may seem small but is much better than the 0.5% sample of the typical transportation survey. Census data to neighborhood level was used to ensure a representative sample. It was a one year process, and results have been weighted to correct for age, gender, education and geography. Of 34,000 respondents, 28,000 live in Metro Vancouver: 80% of those make daily trips for work or education.

55% car driver or passenger

29% transit

10% walk

4% bike

2% other

Only Vancouver, New Westminster, Burnaby and the City of North Vancouver have over the Metro Vancouver average for active transportation modes.

Page 1 Key Messages Graphic

Page 1 Mode of Commute Graphic

I think the two maps are perhaps the most useful representations I have seen especially since they also map the Mayors’ Council’s proposals. What I think would be immensely more useful is a map of the non-active modes with the road projects that have been built in this region in the last ten years or so. While Dr Sandhu points to the goodness of fit of the proposals to correct some of the grosser transit inequities of this region, I think a map of “motordom” showing how the widening of Highway #1 (ongoing) the increase of traffic speeds on the Sea to SkyHighway, the impact of the South Fraser Perimeter road and the increase of capacity along Highway #10 through South Surrey, as well as all the various interchange improvements financed by development (200 St and Highway #1 for instance) as well as the Golden Ears Bridge and the new bridge over the CP yards in Port Coquitlam vastly overshadow anything that might happen as a result of the Mayor’s plan. I do not have the technical competence to produce such a map overlay myself, but I do hope one of you does.

By the way, the originals of these maps are huge: click on them to enlarge and see the details.

Page 4 Active Transport MAP

Page 5 Car use MAP2

Among some of the other results he quoted:

The median commute time is 30 minutes: for car users it is 25 minutes and for transit 45 minutes. He said that reducing travel time for transit users should be a target, though absent the data on distance I am not sure that actually tells us much. To some extent, people choose how long they are willing to travel – and for some, such as West Coast Express users – the travel time will be viewed in a positive light. However, as a selling point for the Yes side in the plebiscite “Less time in your car, more time in your community” works well.

The determinants of transit use include age: the two biggest groups are 18 to 29 and those over 70. In both cases there is often a financial incentive for transit use (UPass, concession fares). 14% of transit users have a chronic health condition which he said points to the need for more HandyDART, which is included in the plan. There is a 50% higher transit usage by ethnic minorities – except for South Asians – with the highest usage among recent immigrants  – who of course are not eligible to vote. Neither, come to that is Dr Sandhu. Only 75% of respondents are Canadian citizens. Transit use decreases with increases in income.

He also produced a graph showing municipalities by commute mode and the incidence of obesity. He said the correlation coefficient (r²) was 0.99 [which as far as I am concerned is unheard of].

He also showed the WalkScore map of the region – which I wish I could find on line. The web page I link to is not exactly what I was looking for!

The current transit infrastructure does not equitably benefit all communities. This is a social justice issue as it impacts access to education and employment. The proposed investments will be positive in this regard. The greatest health legacy of the Olympic Games was [not the creation of his position] the Canada Line. Metro Vancouver is 4th in transit use in North America, only behind the very much larger populations of New York, Montreal and Toronto. We have a relatively small population of 2.5 million and thus “do not have the same tax base”.

Q & A

1.  A question about the aboriginal use of transit which seemed to be explained by lower income and the availability

2.  Some people use different modes for the same trip on different days: walking or cycling in good weather for instance. Or more than one mode during one trip. The reply was that the choice of mode had been “collapsed down” and respondents were asked to pick their primary mode

3.  A technical discussion of the sample compared to household survey which replaced the long form censu  s

4. A question about income which produced the response that the City of Vancouver saw similar levels of active transportation across the city, but immigrants were more economically active than the population in general – a reflection of federal immigration policies.

5. Do people realize how walkable their neighborhood really is? Don’t we need more education?

The study helps the Health Authorities feed information into the OCP and community partners, as well as their interactions with nonprofits and school boards

6. “I have not heard the word Translink used. Is there going to be more bus service?”

7. Eric Doherty pointed out that just increasing bus service shows diminishing returns without a greater commitment to bus priority. He also mentioned feelings of superiority when he rode on a bus to the ferry and passed all those car users stuck in congestion.

I responded that bus priority measures are one of the most cost effective ways of improving the attractiveness of transit, but requires a level of enforcement not so far seen here.

REACTION

Gordon Price was really impressed by the cycling data. There’s nothing like a few good figures to destroy some long held misbeliefs.

The health study simply confirms what we have long known, but seem reluctant to act on. My own views on this were set out in a post in published earlier this year. I want to acknowledge the recent promotion of that post on Twitter by Brent Toderian which has had a very significant impact on my WordPress statistics.

The talk was in a larger room than usual, and was linked to the ITE Quad conference, but was poorly attended. The discussion was really rather muted.

The Need for Improved HandyDART Service

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Once upon a time I worked for Translink and the HandyDART file seemed to reside almost permanently on my desk. If I can recall any one summarizing emotion about that it would be intense frustration. The problems then were only too apparent, and the willingness to do anything about them was almost non-existent. I would like to be able to say that since I left more able minds were employed and things got better. But they haven’t: they have got a great deal worse. And mostly because everyone involved in the decision making process prefers to ignore demographics.

The story makes the front page of today’s Vancouver Sun, but my own resolution to not link to paywalled sites can be maintained since there is also coverage at the Vancouver Media Co-op. And my friend Eric Doherty, who is the author of the report, has made the whole thing available on line at his own web site as a pdf. I recommend that you read the whole thing.

The points made by the report are telling. The need to use Handy DART rises steeply with age, and the population “over 70 in Metro Vancouver has increased by two and a half times that of the general population” in the last five years. This is nothing new – the same effect can be observed over a much longer period. But during that time HandyDART service has not been increased. Indeed it has been cut, in part due to a misguided belief on the part of the former Translink Commissioner Martin Crilly that taxis would be cheaper. He formed that opinion after hiring his old friend and former colleague Glen Leicester – who was previously Translink’s Vice-President of Planning who presided over the years of inaction on the same issues when he was my boss. He now operates as Shirocca Consulting of North Vancouver and his usual methodology is very selective comparison with other Canadian cities using CUTA data.

The headline statistic is the rapid increase in the number of trip refusals – 4,900 times in 2008, 13,400 times in 2010 and 37,700 times in 2012 – obtained by an FoI request. It is also pointed out in the report that trip refusals actually understate the problem. “Trip denials do not show the full extent of unmet demand people won’t attempt to book trips they know will be denied.”  That’s actually a tweet I made which slightly edits what Eric wrote to fit the Twitter 140 character limit.

Privatising the service did not help at all. Previously Translink contracted with a number of smaller operators – mostly societies run by people with disabilities, with one company on the North Shore which must have had one of the most quixotic mission statements as it could not have ever turned a profit. At no time in the years I was involved was there any suggestion that this arrangement was especially problematic, although the re-organisation and concentration of health services by the province was making the need for cross-boundary trips increasingly problematic.

I do not understand why an American based for profit organization needed to be brought in – and they have not performed well. And – just in the interest of full disclosure – MVT in the US is run by Kevin Klika who was once a brother-in-law of mine.

Once of the real changes I have noticed in recent months is that the Health Authorities have at long last woken up to the health impacts of our dysfunctional transportation system. They have sent representatives to at least two of the recent pubic meetings about the future of transit in the region. Perhaps this is being driven by the work of Larry Frank at UBC. But the concern expressed so far has been restricted to the general health of the population at large (see yesterday’s post for Larry’s take on that) and none at all about how the geographic concentration of outpatient services has put such a strain on the sector of the population that needs it most. It needs to be understood that when you are over 70, you are much less likely to be in employment or full time education, so the only trips you can qualify for on HandyDART are those of a medical nature. That must be borne in mind too when you look at trip refusal rates.

The failure of Translink to meet the essential needs of the most vulnerable sector of society is egregious, but in large measure it can be laid at the refusal of the Health Authorities to work cooperatively with Translink. Their view seemed to be that transporting patients was not any of their concern. As long as it could be downloaded onto the patient then their own statistics and financial data would look better. They were, after all, only following the example of other service providers – such as retailers. By choosing to build bigger facilities, and seeking “economies of scale” more of the distribution/collection problem could be downloaded to customers. IKEA, for instance, not only expects you to travel a long way to its stores, it expects you to take care of delivery and final assembly – unlike most other furniture retailers. Of course, Health Authorities do not face much competition – so the pressure has simply been from politicians who only think that public services ought to be run like businesses.

HardyDART is much more a social service than a business and its shameful neglect of its responsibilities has to laid at the feet of these same politicians. And, I am sorry to say, at those of a number of senior officials only too willing to do their bidding and not stand up for their mandate.

Written by Stephen Rees

November 20, 2013 at 11:43 am