BACKGROUND Physical inactivity is a global public health problem, partly due to urbanization and increased use of passive modes of transport such as private motor vehicles. Improving accessibility to public transport could be an effective policy for Governments to promote equity and efficiency within transportation systems, increase population levels of physical activity and reduce the negative externalities of motor vehicle use. Quantitative estimates of the health impacts of improvements to public transport accessibility may be useful for resource allocation and priority-setting, however few studies have been published to inform this decision-making. This paper aims to estimate the physical activity, obesity, injury, health and healthcare cost-saving outcomes of scenario-based improvements to public transport accessibility in Melbourne, Australia. METHODS Baseline and two hypothetical future scenario estimates of improved public transport accessibility for Melbourne, Australia, were derived using a spatial planning and decision tool designed to simulate accessibility performance (the Spatial Network Analysis for Multimodal Urban Transport Systems (SNAMUTS)). Public transport related physical activity was quantified by strata of age group and sex from Melbourne travel survey data (VISTA survey) and used with the SNAMUTS Composite Index to estimate input data for health impact modelling for the Melbourne population aged 20-74 years. A proportional multi-state, multiple cohort lifetable Markov model quantified the potential health gains and healthcare cost-savings from estimated changes in physical activity, body weight and injuries related to walking to access/egress public transport under two scenarios: (S1) public transport accessibility under current policy directions, and (S2) multi-directional, high-frequency network improvements. RESULTS Multi-directional, high-frequency improvements to the public transport network (S2) resulted in significantly greater health and economic gains than current policy directions (S1) in relation to physical activity (mean 6.4 more MET minutes/week), body weight (mean 0.05 kg differential), health-adjusted life years gained (absolute difference of 4878 HALYs gained) and healthcare cost-savings (absolute difference of AUD43M), as compared to business as usual under both scenarios (n = 2,832,241 adults, over the lifecourse). CONCLUSIONS Based on our conservative analyses, improving accessibility to public transport will improve population health by facilitating physical activity and lead to healthcare cost savings compared with business-as-usual. These wider health benefits should be better considered in transport planning and policy decisions.

中文翻译：

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更好的交通便利性，更好的健康状况：澳大利亚墨尔本的健康经济影响评估研究。

背景技术缺乏运动是全球性的公共卫生问题，部分是由于城市化和诸如私人机动车之类的被动运输方式的增加使用。改善公共交通的可及性可能是各国政府在运输系统内促进公平和效率，增加人口从事体育活动的水平并减少对汽车使用的负面外部影响的有效政策。定量评估改善公共交通无障碍对健康的影响可能对资源分配和确定优先重点很有用，但是很少有研究发表有关该决策的信息。本文旨在评估基于情景的墨尔本公共交通可达性改善所带来的体力活动，肥胖，受伤，健康和医疗保健节省成本的结果，澳大利亚。方法使用旨在模拟可访问性表现的空间规划和决策工具（用于多式联运城市空间系统的空间网络分析（SNAMUTS））得出澳大利亚墨尔本改善公共交通可访问性的基线和两个假想的未来情景估计。通过与来自墨尔本旅行调查数据（VISTA调查）的年龄组和性别分层，量化了与公共交通相关的体育活动，并将其与SNAMUTS综合指数一起用于估算20-74岁墨尔本人口健康影响模型的输入数据。比例多状态，多队列生命周期马尔可夫模型量化了体育锻炼的估计变化所带来的潜在健康收益和医疗成本节省，在两种情况下与步行进入/驶出公共交通有关的体重和伤害：（S1）当前政策指导下的公共交通可达性，以及（S2）多方向，高频网络的改进。结果与身体活动（平均每周MET分钟增加6.4分钟）相比，公共交通网络（S2）的多方向，高频改善带来了比当前政策方向（S1）更大的健康和经济收益。两种情况下的照常营业情况（n = 2,832,241名成年人，一生中平均寿命相差0.05公斤），获得健康调整的生命年（获得4878个HALY的绝对差额）和节省医疗费用（获得4300万澳元的绝对差额） ）。结论根据我们的保守分析，与通常的情况相比，改善公共交通的可达性将通过促进体育锻炼来改善人口健康，并节省医疗费用。这些更广泛的健康益处应在运输计划和政策决策中加以更好地考虑。