CAR COSTS IV - March 1995 - DOS file about 27KB
HEALTH COSTS OF THE CAR
THE MOST DANGEROUS ADDICTION
Why the medical community must be concerned about personal
motor transportation: problems and proposals
Thomas J. DeMarco, M.D. (University of Toronto, 1983)
Director of World Without Cars, 4276 West 10th Avenue,
Vancouver, BC V6R 2H4
(Paper presented at the "Medicine and the Environment"
Conference held in Nepal, Spring 1993)
Abstract
Is the medical community overlooking its greatest opportunity
to improve public health? The author will show how the
eventual elimination of personal motor transportation could
have profound benefits for both public health and the
environment.
Generally related only to respiratory illness and motor
vehicle accidents, reliance on automobiles as the primary
mode of displacement will be shown to play an equally
significant role, either directly or indirectly, in such
disparate medical conditions as occupational disease, cancer,
industrial accidents, presbycusis, stress and its related
syndromes, non-insulin-dependent diabetes, atherosclerosis
and osteoporosis. It will also be emphasized that automobile
manufacture, maintenance and operation along with associated
infrastructure is the single biggest contributor to the
gravest environmental threats, including habitat destruction,
loss of biodiversity, ozone layer depletion, acid rain, toxic
waste and the greenhouse effect.
The discussion will present high-mileage cars and alternate
fuel vehicles as unacceptable options. These technologies
only address emissions, a small fraction of automobiles'
total harm on health and the environment.
Rather than being a "sacrifice" it will be argued that the
abandonment of cars could actually enhance lifestyle and
benefit the economy. It could also help transform our
currently ecologically nonviable value system based on
material wealth to one that is biocentric and sustainable.
In the process, intercultural relationships may also improve.
The author will suggest some concrete action to be taken by
individuals, industry, the medical profession and government
to initiate the long process of weaning society off a most
dangerous addiction.
1. Introduction
Twenty years ago, physician advocacy played a preponderant
role in Canada during the successful crusade to ban all
television advertising of tobacco. The government had
responded after being confronted with overwhelming evidence
showing that smoking was a danger to health. Since then, the
cigarette habit has been in steady decline in our country.
Most publications have voluntarily stopped accepting
cigarette ads and many regional governments prohibit smoking
in public places. Physicians are pleased with these
developments and they continue to participate actively in
education and lobbying efforts directed against nicotine
addiction. But is it possible that the medical community has
largely overlooked an even greater opportunity to improve
public health? The author wishes to expose a habit that
represents the single greatest behavioral threat to safety,
health and the environment. At a conference such as this one
it is imperative to discuss personal motor transport and its
profound, pervasive negative impact on society.
The following discussion organizes the car's impact
separately under medical and environmental considerations,
though it is increasingly obvious that the two concerns are
intricately linked. A brief outline of potential
alternatives and action then follows.
2. Medical Effects of Personal Motor Transport
2.1 Motor vehicle accidents and respiratory disease
Since 1950, the world car fleet has increased by a factor of
seven1, to the current 500 million vehicles. Most doctors
are already aware of two concomitant phenomena that have
witnessed similar growth: car accidents and air pollution.
Fatal motor vehicle accidents now annually claim the lives of
300,000 people worldwide. Another million or more are left
with permanent sequelae of injuries. It is more difficult to
quantify the impact of automobile exhaust on health, due to
the multifactorial etiology of conditions such as asthma,
chronic obstructive pulmonary disease and lung cancer.
However, there can be little doubt that the growth of
personal motor transport has made a significant contribution
to the rising incidence of respiratory disease.
Based strictly on concerns about safety and emissions, three
Yale doctors in 1969 identified the automobile as "public
enemy number one"2. It is surprising to what extent this
warning has been ignored. Seatbelts, airbags, fuel-
efficiency standards and other advances apparently have been
considered adequate palliative measures even though the toll
exacted by increased rates of car ownership and operation has
substantially overcome the benefits of these technologies.
Equally tragic is society's ignorance of several other
automobile-related threats to public heath.
2.2 Presbycusis
Contrary to popular belief, presbycusis is not truly age-
related, but more precisely a function of cumulative noise
exposure. The internal combustion engine is the single
biggest contributor to noise in the twentieth century.
2.3 Industrial accidents and occupational disease
Road traffic accident statistics do not by any means reflect
the total number of trauma victims related to personal motor
transportation. Mining and industrial activity related to
the "car cycle" add significantly to morbidity and mortality
attributable to automobiles. The "car cycle" encompasses not
only all activity involved in the manufacture, operation and
maintenance of motor cars but also includes motorists' share
of processes pertinent to the creation, maintenance and
distribution of related products such as oil and roads3.
2.4 Cancer
The "car cycle" contributes more to toxic waste generation
than does any other form of economic activity. Eleven of the
22 enterprises recognized as the USA's most polluting are
intimately involved in the automotive industry. It is
impossible to calculate precisely what total contribution is
thus made to the incidence of several respiratory and non-
respiratory neoplasms, but it is reasonable to suppose it is
significant.
2.5 Stress
Stress with its myriad physical and mental manifestations is
widely recognized as "epidemic" in modern society. The
automobile is often identified as one of the causes or
aggravators of stress. Exposure to the noise, congestion,
danger and frustration of traffic is a regular, unpleasant
stimulus to motorists and non-motorists alike. Furthermore,
the "car culture" can be a stressor in more subtle but more
pervasive ways. Car-dependent suburban communities often
leave car-less inhabitants socially isolated, particularly
housewives and children.
Time constraint is often a factor in stress. Car-dependent
development forces people to spend inordinate amounts of time
in displacement for work, entertainment, recreation and
family activities. The total amount of individuals' time
devoted to car ownership and operation in western countries
is estimated at 1,600 hours per year4, or over four hours a
day, including the time spent at work earning money to meet
car costs.
Money worries also frequently constitute an important
stressor. In Canada the total cost of individual car
ownership is estimated to be a total of $8,000 a year.
2.6 AIDS, violence and drug abuse
The incidence of these is largely related to local social
conditions. In big American cities, urban decay has been
rampant this century, largely a function of car-related
growth of suburbia. In the USA, AIDS, violence and drug
abuse are progressively epidemic in inner cities.
2.7 Disease related to sedentary existence
This may be the automobile's single greatest current
contribution to human morbidity and mortality. It is widely
acknowledged that obesity and lack of regular exercise
represent important factors in the etiology of common serious
conditions such as osteoporosis, non-insulin-dependent
diabetes mellitus, atherosclerosis, coronary artery disease
and cerebrovascular disease. The nature of a lifestyle
reliant on the effortless convenience of personal motor
transportation thus helps foster these conditions.
2.8 War
Many modern armed conflicts have implicated sources of
automotive fuel. For example, it is argued that were it not
for its dependence on automobiles, the USA would be self-
sufficient in oil and would likely have had much less
interest in initiating recent hostilities in the Persian Gulf
that left 200,000 dead.
3. Environmental Effects of Personal Motor Transport
Acid rain, greenhouse effect, ozone layer depletion, ground-
level ozone, habitat destruction, loss of biodiversity and
decreased agricultural production...what's bad for the
beehive cannot be good for the bees. Let us now address
another branch of public health: the environment.
The "car cycle" is a major contributor to every one of the
processes just listed. Separately, each of them represent
very important threats to large numbers of human beings.
Together they threaten the lifestyle, health and very lives
of our children and grandchildren, wherever they may call
home. Already strained considerably with today's population
of 5.5 billion people, the carrying capacity of our biosphere
is certain to diminish considerably if we continue our heavy
reliance on personal motor transportation. The discussion
will describe how car-dependence contributes to the litany of
environmental threats, concentrating on frequently overlooked
consideration. With human numbers increasing by 95 million
annually, threats to future food production capacity will be
emphasized. The welfare of the other thirty million species
with whom we share the planet shall only be mentioned with
respect to implications for human health, an admittedly
biased and probably dangerously anthropocentric perspective.
As with the medical considerations above, it will generally
not be attempted here to identify automobiles' precise
relative contribution to the individual processes, because
the data is not available and is in fact incalculable. For
example, figures related to the effect of automobile exhaust
do not come close to reflecting the sum damage of the entire
"car cycle".
Car exhaust is widely acknowledged as one of the principle
factors in the build-up of greenhouse gases, perhaps
contributing 20% of the total5. But the significant
contribution of industrial activity related to the rest of
the car cycle must not be ignored. Furthermore the paving
over of previously vegetated areas for roads and parking lots
inhibits the biosphere's ability to absorb carbon dioxide,
the most important greenhouse gas. Global warming ultimately
threatens large areas of currently productive agricultural
lands, either though flooding or climate change, or through
urbanization by refugees fleeing inundated territory. Warmer
climate will also favour the poleward expansion of many
tropical and subtropical infectious agents such as malaria6.
The air conditioners in cars account for the release of a
significant fraction of ozone-layer-depleting chemicals. As
well as weakening human immune systems, the resulting
increase in radiation will likely negatively impact crop
yields.
In contrast to the protective high altitude ozone layer,
ground-level ozone, or "smog", of which up to 50% originates
in auto exhaust alone, is already causing measurable
decreases in agricultural production in areas near urban
centres7. Acid precipitation, another car cycle product, is
likely starting to have harmful effects on some harvests as
well. Another car-related stress to farmland adjacent to
cities is the accelerating growth of suburbs and satellite
communities. Both types of development are direct
consequences of automobilization. They continue to claim
larger and larger tracts of some of the world's most
productive farming areas.
The ever-expanding road network, which can never satisfy
motorists' demands, allows access to and destruction of
natural habitats, with resultant loss of biodiversity,
continuously diminishing genetic reserves and progressively
limiting the potential for future discoveries of plant and
animal products useful as medicine or food. "Roads~it would
be difficult to destroy the planet without them", sighs one
environmentalist8. Road-related habitat destruction also
directly robs indigenous peoples of physical and emotional
sustenance, as well as exposing them to communicable disease
for which they may not have immunological resistance. Road
kills of vertebrate animals also deprive many people of
traditional food sources. Road kills are estimated to occur
at a rate of four per car per year, or two billion annually9.
4. Alternatives
Despite unavailability of precise data on motorcars' total
contribution to environmental and health problems, it should
now be appreciated that society cannot afford to delay
initiation of concrete measures to reduce car dependence.
The need for further research on the matter must not be
offered any longer as justification for inaction. Similarly,
reiterating that cars damage us and imperil us far beyond the
impacts of accidents and emissions, it should hardly be
necessary to emphasize that faith in technological
"solutions", such as airbags or vehicles powered by
alternative fuel, must be abandoned. The full spectrum of
devastation wrought by automobilization can ultimately only
be mitigated by reducing or eliminating personal motor
transport. If some hope is still harboured for the
development of cars that are truly "user-friendly", it should
be emphasized that their production alone would constitute an
unbearable
ecological load. The manufacturing process involved to
replace half a billion cars would produce 12.5 billion tonnes
of waste. In fact it has been estimated that a typical
automobile produces more environmental load in its creation
than it does during its entire operational life of
emissions10.
However, there is in fact one type of alternate-fuel vehicle
that is widely recognized as conducive to human health,
security and happiness. It is called the bicycle. The
British Medical Association having appreciated this, has
embarked on an extensive public education campaign favouring
this mode both as transportation and recreation. In the
United Kingdom, where 70% of men and 80% of women are
currently considered unfit, it is estimated that regular
activity in the form of cycling could potentially decrease
the incidence of coronary disease by 50% and the incidence of
stroke by 80%. A recent survey in the same country revealed
that over 95% of men and 87% of women considered themselves
capable of riding a bicycle. Comparing potential life-years
gained versus potential life-years lost, cycling's net
benefit to personal health outweighs the risk of injury,
according to the BMA, despite a traffic system totally
unsympathetic to cyclists11. The risks associated with
cycling are almost universally overestimated by motorists,
who likewise underestimate the risks of driving12. For those
who would contend that the replacement of cars with bicycles
is regressive, a Cuban man posed the following question after
witnessing first-hand the benefits of his country's recent
"velorution". "If saving on fuel, reducing pollution and
noise, improving health, and humanizing cities is going
backwards, then what is going forwards?"
Of course the automobile cannot be replaced by the bicycle
alone. Most countries shall require considerable improvement
and expansion of all alternate modes of transport. City
planning should henceforth incorporate all measures that can
reduce displacement distances to favour walking, cycling and
public transit.
Car use, which is currently subsidized by almost all
governments, must be made more costly and less convenient.
Enforcement of lower speed limits and the raising of minimum
age requirements for operators of motor vehicles would have
an immediate benefit on safety.
So long suckled by its comfort and convenience, many would
initially perceive abandonment of personal motor transport as
a considerable sacrifice. Yet most would quickly come to
appreciate tangible personal benefits, such as considerable
savings in time, money and stress levels.
Surprisingly perhaps, economic benefits of decreased reliance
on cars would also be virtually immediate and substantial.
Cost accounting consistently reveals the automobile as a net
drain on economies, even though the financial costs of many
of its negative impacts have been ignored in such
calculations. Being resource-intensive rather than human-
intensive, the "car cycle" is also a very inefficient
employer. For example, in Canada it costs ten times more to
create a job in the automotive sector as it does in farming
or fishing or housing construction. Rural economies are
particularly victimized by car dependence13.
Abandonment of cars could also help transform the prevalent
ecologically-non-viable value system based on material wealth
to one that is biocentric and sustainable. In the process,
inter-regional relationships between east and west, north and
south, native and non-native cultures may all improve as we
eliminate one of the greatest obstacles to social equity.
As the most respected authorities on health matters,
physicians should feel some moral and professional obligation
to initiate the persuasion of society to abandon a lifestyle
choice that is responsible for more morbidity and mortality
than are cigarettes, drugs, alcohol and unsafe sex combined.
As they did with tobacco 20 years ago, doctors must not only
show some community leadership in reducing personal use of
the automobile but they must also actively oppose its
publicity. And for those who feel it is hopelessly
idealistic to aspire to a healthier, happier, more
sustainable world~a world without cars~it should be
remembered that only those who have done nothing can be sure
that nothing can be done.
REFERENCES
1. Meyer, John. Zero Population Growth Newsletter, 1990.
2. Schneider, Kenneth. Autokind vs Mankind. New York
City, Shocken Books, 1971.
3. Finch, Bob. The Case for Banning the Car. Green Line.
August 1991, 9-10.
4. Zuckerman, Wolfgang. End of the Road. Vermont, Chelsea
Green Books, 1991.
5. Pollution Probe. Costs of the Car. Toronto, 1991.
6. Last, JM. Global Environment, Health and Health
Services. Syllabus of Health and the Environment
Conference. Boston, MIT, 1992.
7. Pollution Probe, 1991.
8. Lundberg, Jan. Alliance for A Paving Moratorium.
Update 4, 1992.
9. Earth First! Killing Roads. Boulder, Colorado,
Biodiversity Legal Foundation, 1990.
10. Finch, 1991.
11. British Medical Association. Cycling Towards Health and
Safety. Oxford, Oxford University Press, 1992.
12. Carr, Jean R. La situation de la bicyclette en France.
Perspectives mondiales sur le vlo. Montral, Vlo
Qubec, 1992: 49-55.
13. DeMarco, Thomas J. Why and How Rural Residents Must
Kick the Car Habit. Unpublished, 1992.