A Population Approach to Transportation Planning: Reducing Exposure to Motor-Vehicles

Transportation planning and public health have important historical roots. To address common challenges, including road traffic fatalities, integration of theories and methods from both disciplines is required. This paper presents an overview of Geoffrey Rose's strategy of preventive medicine applied to road traffic fatalities. One of the basic principles of Rose's strategy is that a large number of people exposed to a small risk can generate more cases than a small number exposed to a high risk. Thus, interventions should address the large number of people exposed to the fundamental causes of diseases. Exposure to moving vehicles could be considered a fundamental cause of road traffic deaths and injuries. A global reduction in the amount of kilometers driven would result in a reduction of the likelihood of collisions for all road users. Public health and transportation research must critically appraise their practice and engage in informed dialogue with the objective of improving mobility and productivity while simultaneously reducing the public health burden of road deaths and injuries. 1. Introduction Transportation planning and public health have important historical connections [1]. In the early 20th century transportation planning and public health held similar objectives. In 1909 Marsh wrote, “city planning is the adaptation of a city to its proper function. This conception can be indefinitely expanded but its significance will be appreciated if we admit that no city is more healthy than the highest death rate in any ward or block and that no city is more beautiful than its most unsightly tenement (p.27)” [2]. Since the early 20th century, the relationship between transportation planning and public health has waxed and waned [1, 3]. There is growing recognition that integration of theories and methods from each discipline is beneficial for advancing research and practice [4]. Of particular relevance to both transportation planning and public health are injuries due to traffic collisions. Worldwide, traffic collisions are one of the leading causes of death among youth and young adults [5]. A number of intervention strategies including black spot analyses are used in transportation planning to reduce road fatalities. There is ongoing debate in the transportation planning literature that this type of intervention may have limited effectiveness in reducing road fatalities [6–8]. New approaches are needed to reduce the burden of road traffic fatalities. Given the need to reconnect transportation planning and public health, this paper will present