Will driverless cars be good for us? Now is the time for public health to act together with urban and transport planning

Angela Curl; Helen Fitt

摘要

A new “drug” currently undergoing development could treat at least two persistent global health conditions: mortality and morbidity from road traffic collisions, loneliness and exclusion for less mobile individuals. This drug is widely known as the “driverless car”. Unfortunately, side effects may be substantial and there is risk of dependency, as with the private car [ 1 ]. Claims that driverless cars will considerably reduce transport related non-communicable diseases (NCDs) and injury are prevalent and compelling. Road crashes are the eighth leading cause of death globally and result in 1.35 million deaths per year [ 2 ]. Up to 90% of traffic collisions are attributed to driver error [ 3 ], which could be eliminated by vehicle automation. Additionally, experiences of social isolation, exclusion, and loneliness – that can occur as a result of limited transport options – pose mortality risks comparable to smoking [ 4 ]. Driverless cars may enhance the mobility of non-drivers, thus facilitating social connection and well-being, especially in ageing populations. The health sector should, therefore, be interested in the potential of the driverless car ‘drug’ to address some global health concerns. However, potential repercussions of driverless cars for other health outcomes have been the subject of little research [ 5 ]. These can be illuminated by lessons from historical transport transitions. The widespread adoption of private cars led to economic and social benefits but also extensive environmental and health costs. It is widely accepted that dispersed urban environments and associated car dependence in many countries contribute substantially to the global burden of NCDs and injury through exposure to risks such as physical inactivity, noise, pollution, and inaccessibility for non-drivers. Exposure to such risks results in conditions including respiratory illnesses, cardiovascular conditions, type II diabetes, cancer, road trauma and poor mental well-being [ 6 - 8 ]. An adoption of driverless cars will, likewise, have implications for travel behaviour and urban environments with pervasive impacts on population health. There is currently little discussion of how a transition to automation will impact global regions differently. The health impacts of automation will vary globally according to prevailing levels of car reliance, conditions of the road network, and availability and affordability of new technologies. As a result, the global north may be first to benefit from improved safety, while 93% of road traffic deaths are in low to middle income countries [ 2 ]. Already, transport planners do not expect that safety benefits will be evenly distributed among population groups [ 9 ]. Transport technologies have the potential, therefore, to alter trajectories of development and increase or decrease global inequalities. Many claims about the potential of driverless cars to treat global health concerns rely on assumptions of full automation, electric vehicles, and shared transport, which are not guaranteed. Partial automation could result in an increase in risky driver behaviour [ 5 ] and deteriorations in road safety; resistance to shared transport could result in growing traffic volumes; and continued use of internal combustion engines could result in worsening pollution. Even if full automation, electrification, and sharing eventuate, this will not be instantaneous and the period of transition could include problematic dynamics. Recent years have seen increased recognition of the role urban environments play in influencing a plethora of health outcomes [ 6 - 8 ]. This has highlighted a need to focus on the social and structural determinants of health and has increased dialogue between urban and transport planners and public health professionals. In the face of forthcoming changes to transport systems and cities, this dialogue is important as ever. If driverless cars are a given, urban and transport planners have an important role to play in how effective this technological development is in addressing global health inequalities. However, good urban and transport planning are also preventative health measures. Urban planning which supports active modes of transport and improves local accessibility can help prevent many of the health issues which driverless cars are claimed to “treat”. We currently have a (time-limited) opportunity to shape future social determinants of health through transport system transitions. Meeting the challenges ahead requires action in at least three domains. First, we need to take a preventative approach to non-communicable diseases including those related to transport and urban environments, rather than waiting to treat the problem, as we are now doing in response to the growth of private car use. Second, we need to increase collaboration between urban planners and health professionals. Health professionals can bring considerable expertise to urban and transport planning, including

机译：当前正在开发的一种新的“药物”可以治疗至少两种持续的全球健康状况：道路交通碰撞，孤独和排斥流动性较弱的人的死亡率和发病率。这种药物被广泛称为“无人驾驶汽车”。不幸的是，与私家车[1]一样，副作用可能很严重，并且存在依赖的风险。声称无人驾驶汽车将大大减少与交通有关的非传染性疾病（NCD）和伤害的说法是普遍且令人信服的。道路交通事故是全球第八大死亡原因，每年导致135万人死亡[2]。多达90％的交通冲突归因于驾驶员错误[3]，可以通过车辆自动化消除该错误。此外，由于交通选择有限而可能发生的社会孤立，排斥和孤独的经历，造成的死亡风险可与吸烟相比[4]。无人驾驶汽车可以提高非驾驶员的机动性，从而促进社会联系和福祉，尤其是在人口老龄化时期。因此，卫生部门应该对无人驾驶汽车“药物”解决全球健康问题的潜力感兴趣。然而，无人驾驶汽车对其他健康结果的潜在影响一直是很少研究的主题[5]。这些可以通过历史运输转换的经验教训加以阐明。私家车的广泛采用不仅带来了经济和社会效益，还带来了巨大的环境和健康成本。人们普遍认为，分散的城市环境和相关的汽车依赖性在许多国家中会因暴露于身体不活动，噪音，污染和非驾驶员无法通行等风险而大大增加非传染性疾病和伤害的全球负担。暴露于此类风险下会导致各种疾病，包括呼吸系统疾病，心血管疾病，II型糖尿病，癌症，道路创伤和不良的心理健康[6-8]。同样，采用无人驾驶汽车也将对出行行为和城市环境产生影响，并对人口健康产生普遍影响。当前几乎没有关于向自动化过渡如何对全球区域产生不同影响的讨论。自动化对健康的影响将根据汽车的普遍使用水平，道路网络的状况以及新技术的可用性和可承受性而在全球范围内变化。结果，全球北部可能首先受益于改善的安全性，而93％的道路交通事故死亡发生在中低收入国家[2]。交通规划人员已经不期望安全利益会在人群中平均分配[9]。因此，运输技术具有改变发展轨迹和增加或减少全球不平等的潜力。许多关于无人驾驶汽车可能解决全球健康问题的主张都基于完全自动化，电动汽车和共享运输的假设，但这些假设无法得到保证。部分自动化会导致危险的驾驶员行为增加[5]并导致道路安全恶化;对共享运输的抵制可能导致交通量增长;继续使用内燃机会导致污染加剧。即使最终实现了完全自动化，电气化和共享，这也不会是瞬间的，过渡期可能会出现动态问题。近年来，人们越来越认识到城市环境在影响众多健康结果中的作用[6-8]。这突出了需要关注健康的社会和结构决定因素，并增加了城市和交通规划者与公共卫生专业人员之间的对话。面对即将到来的交通运输系统和城市的变化，这种对话一如既往地重要。如果提供无人驾驶汽车，那么城市和交通规划人员就可以在技术发展如何有效解决全球健康不平等方面发挥重要作用。但是，良好的城市和交通规划也是预防性健康措施。支持主动交通方式并改善当地交通便利性的城市规划可以帮助预防许多无人驾驶汽车被称为“治疗”的健康问题。我们目前有一个（时间有限）的机会，可以通过运输系统的过渡来塑造未来健康的社会决定因素。迎接未来的挑战需要至少在三个领域采取行动。首先，我们需要对非传染性疾病，包括与交通和城市环境有关的非传染性疾病采取预防措施，而不是像现在为应对私家车使用的增长而等待治疗那样。第二，我们需要加强城市规划人员和卫生专业人员之间的合作。卫生专业人员可以为城市和交通规划带来大量专业知识，包括

Will driverless cars be good for us? Now is the time for public health to act together with urban and transport planning

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