Public health must continually respond to new threats reflecting wider societal changes. Ecological public health recognizes the links between human health and global sustainability. We argue that these links are typified by the harms caused by dependence on private cars.
We present routine data and literature on the health impacts of private car use; the activities of the ‘car lobby’ and factors underpinning car dependence. We compare these with experience of tobacco.
Private cars cause significant health harm. The impacts include physical inactivity, obesity, death and injury from crashes, cardio-respiratory disease from air pollution, noise, community severance and climate change. The car lobby resists measures that would restrict car use, using tactics similar to the tobacco industry. Decisions about location and design of neighbourhoods have created environments that reinforce and reflect car dependence. Car ownership and use has greatly increased in recent decades and there is little public support for measures that would reduce this.
Car dependence is a potent example of an issue that ecological public health should address. The public health community should advocate strongly for effective policies that reduce car use and increase active travel.
environment, public health, transport
Are cars the new tobacco?
The history of public health reflects the problems of each age and evolving understandings of health.1 In the late nineteenth century, the pressing problems were communicable diseases associated with environmental conditions and efforts were directed to improving water and sanitation and reducing overcrowding. In the twentieth century, the rise in non-communicable diseases associated with ‘lifestyle’ factors led to a focus towards strategies to persuade and empower individuals to adopt ‘healthy choices’ and deliver healthcare to individuals. It is argued that this focus became increasingly individualistic and ignored environmental influences.1 There is now recognition that these types of activity are insufficient to address increasingly complex problems of the current age such as obesity and poor mental well-being. An ecological model of public health is proposed that recognizes the complex interplay of physiological, physical, social and cognitive factors that influence health at individual, community and global level, and also recognizes the relationships between human health and sustainability.2
Tobacco is arguably the archetypal behavioural risk factor. Smoking tobacco is a single behaviour causing many conditions including cardiovascular disease and cancer, killing more than 5 million people annually.3 Epidemiological studies showing the harms caused by smoking date back to the 1950s. Subsequently public awareness of the risks grew steadily.4 Research on passive smoking since the 1970s showed that exposure passively to ‘sidestream’ smoke is also harmful.5 Policy responses were slow and incremental.4 Initial actions focused on education seeking to inform individual choice. Legislation prohibiting smoking in public places was finally introduced in the UK in 2005.6 Crucially, tobacco control relies on action targeting both behaviour and social structures.
This paper argues that private cars share many characteristics with tobacco and could be regarded as the archetypal ecological risk. Like tobacco, cars harm the health of users and others. Moreover, cars damage global sustainability. Like tobacco, car use is seen as an individual choice and policy responses to limit it are resisted by a powerful industry lobby. But it is over-simplistic to view car use as a simple behavioural choice. This paper will argue that the use of private cars reflects and reinforces the physical and social environment that we have created, and that an ecological approach is needed to understand and address the harms caused by car dependence.