Public Transport and Health: Addressing Urban Mobility Challenges

Urban transport systems are the arteries of any city. When they work well, people move efficiently, economies thrive, and communities stay connected. But in most cities around the world, transport systems are under immense strain – leading to gridlocked roads, packed buses, polluted air, and declining public health. The relationship between how we move and how healthy we are is more direct than many realize. Let’s break down the key problems with urban transport, the health consequences they create, and the sustainable solutions that can turn things around.

Common problems with urban transport systems 🔗

Urban transport systems across the globe face a set of recurring challenges. These problems are interconnected – one issue feeds into another, creating a cycle that is difficult to break without deliberate intervention.

Traffic congestion 🔗

Traffic congestion is arguably the most visible and frustrating transport problem in cities. According to the INRIX 2024 Global Traffic Scorecard, Istanbul topped the list of the world’s most congested cities, with drivers losing 105 hours annually in traffic. New York City and Chicago each lost 102 hours, while London drivers lost about 101 hours per year. In the UK alone, congestion cost over £7.7 billion in 2024.

Congestion is particularly common in cities with populations exceeding one million. As noted by transport geographers, the rapid growth of motorization has increased demand for road infrastructure far beyond what cities can provide. More vehicles mean more road space is consumed – not just by moving traffic, but also by parked cars. In central business districts, drivers searching for parking can account for more than 10% of local traffic circulation.

The consequences go beyond wasted time. Congestion raises fuel consumption, increases tailpipe emissions, reduces economic productivity, and elevates stress among commuters.

Overcrowded public transport 🔗

Public transport systems in many cities struggle to balance supply with demand. During peak hours, buses, trains, and metro cars become dangerously overcrowded, creating discomfort and safety risks for passengers. During off-peak hours, these same systems often run underused, making them financially unsustainable.

This mismatch is a core challenge. Nearly every public transit system worldwide fails to generate enough revenue to cover its operating and capital costs. Underfunding leads to delayed maintenance, aging fleets, and unreliable services – which in turn push more people toward private cars, worsening congestion. Safety concerns, accessibility gaps for people with disabilities, and the lingering effects of the COVID-19 pandemic have further eroded ridership in many cities.

Lack of infrastructure for non-motorized travel 🔗

Walking and cycling are among the most efficient and healthy ways to travel short distances. Yet most cities have designed their streets primarily for motor vehicles. The result is a lack of safe, connected infrastructure for pedestrians and cyclists.

Heavy traffic makes walking and cycling dangerous. Roads without dedicated bike lanes, poor-quality footpaths, and a lack of clearly marked pedestrian crossings all discourage non-motorized travel. The World Health Organization (WHO) reports that road traffic injuries are among the top ten causes of death globally, resulting in approximately 1.35 million deaths each year. Between 20 and 50 million more people sustain non-fatal injuries annually. Pedestrians and cyclists are disproportionately affected.

Health risks from poor transport systems 🔗

The health effects of dysfunctional urban transport go far beyond occasional inconvenience. They are systemic, chronic, and disproportionately affect vulnerable populations – including children, the elderly, and lower-income communities.

Air pollution 🔗

Road transport is one of the biggest sources of urban air pollution. Vehicles emit a complex mixture of pollutants including particulate matter (PM2.5 and PM10), nitrogen oxides (NOx), carbon monoxide (CO), and volatile organic compounds (VOCs). These pollutants don’t just stay on the road – they spread through neighbourhoods, schools, and homes.

A 2024 systematic review published in PMC found a statistically significant association between traffic-related air pollution and a wide range of health problems, including cardiovascular disease, respiratory illness, and pulmonary conditions. The WHO estimates that ambient outdoor air pollution contributes to approximately 4.2 million premature deaths globally each year.

In cities like London, the health burden from diesel vehicle emissions alone has been significant. In 2015, on-road diesel vehicles contributed 46% of the transportation health burden in the London metropolitan area, with roughly 1,500 premature deaths linked to fine particulate matter and ozone from vehicle tailpipe emissions.

It is worth noting that even electric vehicles are not a complete solution to air pollution. While they eliminate tailpipe emissions, they still produce non-exhaust particulate matter from tyre and brake wear. In fact, due to the heavier weight of electric vehicles, some researchers have noted that non-exhaust sources may become an increasingly dominant contributor to urban air pollution as exhaust regulations tighten.

Noise pollution 🔗

Noise from road traffic is one of the most overlooked health hazards in cities. It goes beyond annoyance – chronic noise exposure has measurable effects on human health. The WHO has identified traffic noise as a risk factor for ischaemic heart disease, sleep disturbance, cognitive impairment in children, stress-related mental health conditions, and tinnitus.

According to WHO data, at least one million healthy life years are lost annually in high-income European countries due to traffic-related noise. Road traffic is the largest source of community noise in most cities, and noise levels tend to increase with higher traffic volumes and speeds. Children living near airports or busy roads are particularly vulnerable, experiencing delayed reading ages and elevated stress levels.

Physical inactivity 🔗

Car-dependent urban design discourages physical activity. When people rely on motor vehicles for nearly all their trips – including short ones that could be walked or cycled – they lose out on daily exercise that is essential for long-term health.

Research from the International Transport Forum (ITF/OECD) highlights that physical inactivity increases the risk of diabetes, heart disease, obesity, chronic kidney disease, cancer, and mental health disorders. People who are insufficiently active face a 20% to 30% higher risk of premature death compared to those who meet minimum activity guidelines. The WHO recommends at least 150 minutes of moderate physical activity per week – a target that active commuting through walking or cycling can help achieve.

Urban sprawl makes this problem worse. As cities expand outward without adequate public transport, people are forced into longer car-dependent commutes. This not only reduces physical activity but also increases isolation, reduces time for social engagement, and contributes to poorer mental health.

Sustainable transport solutions 🔗

The good news is that the link between transport and health cuts both ways. Just as poor transport systems damage health, well-designed sustainable transport can deliver significant health benefits. Here are the key solutions cities can pursue.

Green public transit 🔗

Investing in clean, efficient public transport is one of the most impactful steps a city can take. The World Resources Institute (WRI) reports that electric buses emit less than half the carbon of fossil fuel-burning private cars per passenger per kilometre. Quality public transport systems are also linked to fewer road fatalities – with less than a tenth of the casualty rate of car travel per kilometre.

Cities like San Francisco have demonstrated this clearly. The city’s Muni transit system, which runs largely on renewable fuels, accounts for only 2% of the city’s transportation-related emissions. London’s fleet of approximately 9,000 buses now operates with low or zero tailpipe emissions, contributing to notable reductions in nitrogen oxide levels across the city.

Research on Japan’s railway network expansion over 25 years found that railway development significantly reduced suspended particulate matter in surrounding areas. The improved air quality translated into health benefits valued between approximately USD 98 million and USD 162 million – roughly 1.4% of the total construction costs.

The financial case is also compelling. According to WRI, expanding public transport globally could lower the total cost of urban mobility by $5.3 trillion per year by 2050.

Cycling and pedestrian infrastructure 🔗

Building protected bike lanes, wider footpaths, and clearly defined pedestrian crossings is critical to making active travel safe and practical. The benefits of walking and cycling extend well beyond reduced emissions – they directly improve physical and mental health.

Copenhagen is a leading example. Nearly half of all commutes in the city are made by bicycle, supported by extensive dedicated cycling infrastructure. In Bogotá, Colombia, the combination of an extensive network of protected bike paths and targeted community programmes has made cycling a mainstream commuting option, including among populations that had previously been excluded.

The Environmental and Energy Study Institute (EESI) notes that roughly 40% of all personal trips are under two miles – a distance easily covered on foot or by bicycle. This represents a massive untapped potential for shifting trips away from cars.

The U.S. Environmental Protection Agency (EPA) promotes “complete streets” – roads designed for safe use by drivers, pedestrians, cyclists, and transit riders alike. These approaches typically feature elements like separated bike lanes, street trees, and accessible transit stops, creating streets that function better for everyone.

Integrated urban planning and smart mobility 🔗

Sustainable transport cannot work in isolation – it must be embedded in broader urban planning strategies. Transit-oriented development (TOD), which concentrates housing, offices, and amenities around public transport hubs, reduces the need for long car-dependent commutes. Compact, mixed-use neighbourhoods enable residents to walk, cycle, or use public transit for most daily needs.

Cities are also increasingly turning to data-driven traffic management. Real-time analytics from connected vehicles and sensors can optimize traffic signal timing, improve transit scheduling, and reduce bottlenecks before they escalate. Low emission zones (LEZs) and ultra-low emission zones (ULEZs), like the one in London, restrict the most polluting vehicles from city centres, directly improving local air quality.

The transition also requires thinking about equity. Women, people with disabilities, children, and lower-income populations often depend on public transport the most, yet their needs are frequently overlooked in planning. Designing inclusive transport systems – with better accessibility, improved safety, and services that account for diverse travel patterns – is essential for ensuring that the benefits of sustainable mobility reach everyone.

The path forward 🔗

The evidence is clear: urban transport choices have direct and measurable consequences for public health. Traffic congestion wastes billions of hours and economic resources. Air and noise pollution from vehicles contribute to millions of premature deaths. Car-dependent urban design fuels physical inactivity and its associated chronic diseases.

But these are not inevitable outcomes. Cities that invest in green public transit, build safe infrastructure for walking and cycling, and integrate transport planning with public health goals can reverse these trends. The shift requires political will, sustained investment, and a willingness to prioritize people over cars.

Two-thirds of the world’s population is projected to live in urban areas by 2050. The transport systems we build now will determine the health and quality of life for billions of people in the decades ahead.

What do you think? Does your city prioritize public health in its transport planning – or does car-centric infrastructure still dominate? What changes in urban mobility do you believe would have the biggest impact on community health?

References

1. https://inrix.com/blog/analyzing-urban-congestion-in-2024-and-understanding-how-cities-can-adapt/
2. https://transportgeography.org/contents/chapter8/urban-transport-challenges/
3. https://www.who.int/teams/environment-climate-change-and-health/healthy-urban-environments/transport/health-risks
4. https://pmc.ncbi.nlm.nih.gov/articles/PMC11348364/
5. https://www.itf-oecd.org/sites/default/files/docs/health-impacts-low-carbon-transport-cities.pdf
6. https://www.wri.org/update/public-transport-all-climate-development-benefits-sustainable-mobility
7. https://magazine.publichealth.jhu.edu/2024/climate-smart-transportation
8. https://www.eesi.org/topics/public-transit-walking-biking/description
9. https://www.epa.gov/smartgrowth/smart-growth-and-transportation