Norman Swan: It makes sense that our choices we make in terms of how we get to work and travel on a daily basis, can affect our health. But it hasn't been very well documented, which is why Melbourne general practitioner Dr Margaret Beavis did her own study.

Margaret Beavis: We know that physical activity has enormous health benefits. A couple of years ago the World Health Organisation looked at what was going to improve population health and described physical activity as a best buy because it improves so many illnesses and prevented so many illnesses. The real background for me is that as a general practitioner I see people with blood pressure, diabetes, depression, cholesterol, kidney disease, and for all of these people I am saying go and exercise. And so I was trying to factor in the health benefits of the day-to-day exercise that people get just moving around, travelling around. What is the value of people taking active transport rather than travelling by car or private vehicle?

Norman Swan: So what did you do in the study?

Margaret Beavis: The Victorian Department of Transport did a very nice survey of about 30,000 people in Melbourne. They looked at how people travelled on a particular day to see how much exercise they did, or I looked, I took that data and sifted out how much exercise they did. I then looked at what the health impacts of that was.

Norman Swan: So you looked at this information on 30,000 Victorians, about how they went to work each day and how they travelled around, and what you were trying to find out was just how much exercise was involved in the various type of transport.

Margaret Beavis: Yes indeed.

Norman Swan: So let's take driving the car. What sort of incidental exercise was that?

Margaret Beavis: Well, if you were very generous in how you calculated it, the maximum people were averaging was 10 minutes a day.

Norman Swan: To and from the car.

Margaret Beavis: To and from the car.

Norman Swan: Tram?

Margaret Beavis: We shifted it into public transport in general, so tram, train, bus were all included together. For people who used public transport, people who drove to the station or to the bus, they got about half an hour a day, 31 minutes. People who walked to the station from home or to the bus or to the train, tram, got about 41 minutes a day, which is very impressive, given that we know that 30 minutes a day has really significant health benefits, it reduces premature death rate by between 20% and 22%, and helps an enormous number of other illnesses. Walkers and cyclists, which we combined together, averaged about 38 minutes a day. So once again, they did extremely well, they met the 30 minutes recommended level of physical activity each day that we know gives these enormous health benefits.

Norman Swan: But not as much as people who walk to the station or the tram stop.

Margaret Beavis: No, which was surprising.

Norman Swan: And is that because of where they live?

Margaret Beavis: Well, the other thing that we looked at was in fact who in which suburb was travelling the most. We looked at the outer suburbs, middle, inner, and then inner city, and we found that people in the outer suburbs, largely because they have reduced public transport availability and also the spread out of the destinations makes the car really the main travel option for most trips. So in fact people in the inner suburbs were six times more likely to get their 30 minutes of exercise a day compared to people in the outer suburbs, and this also has health impacts at a population level.

Norman Swan: And of course it's our outer suburbs where overweight and obesity is at its worst.

Margaret Beavis: Indeed. Although it's worth remembering that with one of the reasons the World Health Organisation was so keen on physical activity is that being more physically active works in the overweight and obese, it improves their health outcomes, even if they stay obese and overweight, and similarly works in the elderly. So it's quite an encouraging thing, in that if you can get people to get off the couch and start exercising, even just walking to get to work, that will really improve their health outcomes.

Norman Swan: And did you look at the downsides of public transport, such as getting off the tram in the middle of the street and a car passing you by and knocking you over?

Margaret Beavis: [Laughs] I'm afraid that the Department of Transport data didn't include that…

Norman Swan: It didn't include the car accidents in Toorak Road.

Margaret Beavis: No indeed.

Norman Swan: So you are kind of telling us what I suppose we know, but it just emphasises this, and presumably the postcode issue corrects for people's level of education because the level of education tends to go up the closer you are to our modern cities.

Margaret Beavis: Yes…

Norman Swan: And wealth, if you like.

Margaret Beavis: Yes, before you factor in age, occupation, income, it was roughly three times…that inner city people were three times more likely. But once you factored in age, occupation and income it became that six times figure. So that the inner city, inner density people were so much more likely to get that physical activity that was so important.

Norman Swan: So whilst you want the fresh air of the outer suburbs, in fact the inner city is the healthier place to be.

Margaret Beavis: From an incidental activity point of view, indeed.

Norman Swan: Did the data differentiate between people who were in employment and people who were retirees?

Margaret Beavis: When you looked at the differences between those people there was really no significant difference that the amount of physical activity that they got it didn't vary with whether they were retirees or whether they were employed. What did vary was whether they were, for instance, labourers who presumably drove a car much more because they were carrying their tools, or whether they were professional drivers like taxi drivers. That group clearly got much less physical activity.

The other thing that fell out of the data that was interesting was that if your car was paid for by work you were less likely to get physical activity. So in some ways having your car paid for by work became a little bit of a health hazard as well.

Norman Swan: You calculated the gross benefits of this in terms of deaths and money saved.

Margaret Beavis: Yes, we did some modelling, which if 10% of car users started using public transport, then annually that potentially could save 89 lives and avoid almost 300 cases of disease, so in terms of prevention, and save about $10.5 million in health and productivity costs. So that was just if you've got people out of the car and got more people using public transport. And similarly if you compared the daily travel in people in the outer suburbs and then gave them patterns similar to those people in the inner city, again in terms of just prevention you could annually save about 270 lives, avoid about 900 cases of disease and save about $35 million in health sector and production costs.

Norman Swan: And weighed against the investment in public transport, which is considerable, I mean it costs a lot of money for an extra few kilometres of rail track or tram track.

Margaret Beavis: It does indeed. With economic modelling, health economists are by their very nature pretty conservative. These figures valued a human life at three months' income, so that's a societal cost of someone dropping dead, which is three months to reemploy them. So these were pretty tough numbers in terms of…

Norman Swan: So the real gains are much higher.

Margaret Beavis: Much higher, and it depended on the type of modelling you used. The other thing to remember in terms of real gains is that this is just looking at prevention of disease, it doesn't look at all the health benefits of the treatment of these diseases. So many of these diseases, you get people to exercise and they improve and that would also have major health benefits that are not measured by this economic model.

Norman Swan: And of course the implication here is of course if you walk to the bus or tram or train and you spend almost another hour exercising to and from, your trip to work is longer, but that's not necessarily true because you didn't factor…I presume you didn't factor in the length of the trip time into that because if you are sitting in a traffic jam on the freeway, South Eastern Freeway all day, it's not necessarily faster.

Margaret Beavis: No, and for people who have to spend an extra half an hour going to the gym, if you factor that into getting to work it's often quite time efficient. It might take you 10 minutes or 15 minutes longer, but if it saves you having to spend an hour going to the gym in the day it's exactly quite time efficient.

Norman Swan: Yes and I’m feeling jealous of all those people with perfect bodies.

Margaret Beavis: I don't know this will give you a perfect body but it will give you a much better health outcome.

Norman Swan: Margaret Beavis, thanks very much.

Margaret Beavis: Thank you.

Norman Swan: So that was Margaret Beavis, a general practitioner in Melbourne doing that fascinating study on public transport and how you get to work each day or how are you travel around each day.

And with me on the line from Melbourne is Billie Giles-Corti. Billie has been studying liveable cities for a long time and health and urban planning. I think I first interviewed you, Billie, when you were at the University of Western Australia.

Billie Giles-Corti: Yes, and we've met up in Queensland. We've had a few connections along the way.

Norman Swan: So tell me about this study that you are about to embark on, because you are trying to get urban planners to really get some metrics in when you are designing a city for health.

Billie Giles-Corti: Yes, this builds on a lot of work that we've been doing working with planners, transportation planners, trying to measure the way the built environment affects people's health and well-being. In this case what we are doing is trying to speak directly to what they are interested in. Around the world planners are interested in creating liveable cities. So what we are trying to do here is to look at liveability through a health lens. So we've defined health through a social determinants of health lens, and that is allowing us then to create metrics that not only speak to planners, because we are talking about liveability, but also allows us to speak to public health people and we are going to be measuring different aspects of liveability that impact chronic disease.

Norman Swan: And when you say social determinants, you mean what?

Billie Giles-Corti: All the things that create the conditions for good health. We often focus on health behaviour, and we know that it's better to have healthy behaviours. But actually why is it that people behave the way they do? Some people choose to and there's no question that it's a matter of choice, but some people make choices from the limited choices that they have available. And what we are interested in doing is understanding those factors, about the choices that people have, and then trying to optimise and work with policymakers who can change those conditions to make it easier for people to act on good intentions or to make it easier just to choose a healthy choice rather than an unhealthy choice.

Norman Swan: So how important…just going to Margaret Beavis's study there on the mode of transport and how much incidental exercise you get, how important is transport in all this?

Billie Giles-Corti: It's really critical, it really underpins…everyone should have the right to a multimodal…by that I mean a multimodal system is one where people could choose to walk, they could choose to cycle, they could choose to use public transport or they could choose to drive. To me that is a right that people should have, and that does affect the choices people make in terms of the transportation choices. So if you are someone living on the urban fringe, the only choice you really have is to drive because often there are no places to walk to and there are no shops and services, there is no frequent public transport system. It does make a big difference, the decisions we make around policy, and they do create the conditions for people to choose a healthy choice or an unhealthy choice, in this case transportation.

Norman Swan: And how closely are you going to connect to the economics…a few days ago when I was presenting Late Night Live I had Peter Newman on from Curtin University, a renowned urban planner who says we are outdated when we say that really roads are the only thing we are going to fund out of the public purse because people want and need public transport to get into our main cities for the brain based industries, if you like, of the future.

Billie Giles-Corti: I think Peter is completely right. What the future really holds for us is a transportation system which is about the alternatives—walking, cycling, public transport use—that's what people need and want…

Norman Swan: So you are arguing that there is a synchrony with economics and health.

Billie Giles-Corti: Absolutely. We haven't done this yet. We've got a centre of excellence on healthy liveable communities which has been funded by the National Health and Medical Research Council, and in that what we include is a focus on how much of these built environment interventions do we need, so how much public transport would encourage people to use public transport or to use the alternative, and then what's the economics of that. So we have embedded in our study an understanding of what the built environment interventions need to be and we are going to look at the economics. I don't have the evidence now, but I'm confident that Peter is right.

Norman Swan: So when you see these international league tables and they say Melbourne is the most liveable city, and then next year it's Sydney, whatever the statistic might be, but Australian cities often do quite well. What are their metrics when you get these league tables internationally?

Billie Giles-Corti: Well, the league tables…there's the Economist Intelligence Unit and that clearly puts Melbourne as one of the more liveable cities in the world or the most liveable city in the world, and then there has been the recent one…

Norman Swan: But what are their metrics?

Billie Giles-Corti: The same as the OECD, the Better Life Index. What they use is the sorts of things that we are using, so they will use things like how safe the community is, whether people have access to affordable housing. They'll ask about access to education. But what they do is they look at whole cities and they don't look within cities. It's not to say that Melbourne…some parts of Melbourne are entirely liveable. If you live in inner Melbourne it is a fantastic place to live, there's fantastic public transport, there's wonderful green space. But what we are drawing with our lens is taking a health lens, so we are actually putting in additional things…

Norman Swan: Right into the new greenfield sites on the outer limits of Melbourne which have been opened up, controversially.

Billie Giles-Corti: That's right, and we are looking at things like access to healthy food, access to alcohol outlets as well, access to public open space because we know that that encourages people to be more physically active and it’s also good for mental health. So we are looking at the detail, it's a spatial measure, and then we will be able to unpick where things are going well and where things are not going so well, and we are going to be able to compare Australian cities between one another with a common metric, which is spatial. And we are also going to be able to look within cities to identify areas where there may be problems.

And the beauty of it is that we are going to tie it to policy, so all of our measures are tied to what current policy is. We are looking at all the states where we are working, we are looking at five states and territories, and we have unpacked the policy, what's the policies here, we are going to say, well, which policies are working best? So in WA there might be one policy on public open space, they say that 10% of land needs to be allocated to public open space, whereas in Melbourne they say that everyone should live…

Norman Swan: Well, in WA the policy is we will have as big a city as we possibly can or as least densely populated, relying on the car more and more. WA, Perth is a disaster.

Billie Giles-Corti: To be honest, Norman, really Melbourne is also building at 15 houses per hectare on the urban fringe. We have a problem with our densities. In fact Perth now has its liveable neighbourhood guidelines, we've just done a 10-year evaluation of it, and they are getting up to 19 houses per hectare. We really think that to be able to create a walkable environment at the very, very minimum, and I'm talking very minimum, you really need about 22 houses per hectare, and we are building in Melbourne at 15. So I think we have some significant problems in the way we are approaching our planning at the moment.

We do need to increase our densities, and I think there needs to be a grown-up conversation in Australia about that. And I'm not talking about high-high-rise, I'm talking about densities that allow us to have all the amenity that creates a good life—access to public open space but access to shops and services, good public transport, having services like community services, health services nearby—we should be able to have those sorts of things but we can't when we are, as in Perth, 170 kilometres long.

Norman Swan: Just finally, when you've got this set of measures together in this multidisciplinary centre that you've developed, what's going to happen then? Are you just going to advocate and try and convince ministers for planning in an increasingly centralised planning environment what to do?

Billie Giles-Corti: Well, this project has been funded by the Australian Prevention Partnership Centre, and it's great because it does bring together all the health departments in all the states that are being funded; New South Wales, ACT have got the health departments involved, we've got the Victorian one as well. And so what we were able to do is…

Norman Swan: But that's a silo that's separate from urban planning.

Billie Giles-Corti: Yes, but in addition to that through our centre of excellence and healthy liveable communities what we've established in three of the states that we are working—Western Australia, Queensland and Victoria—all the major players are around the table. We have the metropolitan planning authorities, the departments of planning, departments of transport, they are all part of our advisory groups, and so we are working often at very senior levels, we are feeding back the information to them. And I think they are looking with great interest at this. They are all interested in liveability, that is something that is no doubt of interest across Australia. They're all concerned that we might find something that they don't want to find of course but…

Norman Swan: I still remember, I was chairing an obesity summit in Queensland, I don't know if you were there, but they started talking about the design of suburbs in south-east Queensland showing that people who lived in those kind of suburbs were six kilos heavier than people who lived in mixed development suburbs and the whole conversation was shut down by the Planning Minister. So we still have a way to go.

Billie Giles-Corti: I think we have, but actually I think people are starting to recognise now that it's not a departmental thing. The fact is it's a whole-of-government problem, and we can't solve any of these problems like the obesity epidemic if we don't take a whole-of-government approach. And it's the government's budget, it's the Australians' budget that we are dealing with, not the Planning Minister's budget or the Transport Minister's budget, it's the whole-of-government budget that is going to cause the problem. So I think people are starting to realise that we can't take the siloed approach to obesity and health problems because otherwise the health budget is going to overtake the whole state budget, as some states have demonstrated, if we don't curb some of these chronic diseases and the obesity epidemic.

So my sense is that people are starting to listen. We are certainly getting a lot of traction with our centre of excellence, and I think through the Australian Prevention Partnership Centre we are also doing the same thing, that people are starting to take interest in this. So I don't think that what we are doing is sitting on the outside, I think we are actually almost embedded, and I think the question is the way we present it to people, because it's not to criticise, it's really just to find a solution.

Norman Swan: Billie Giles-Corti, thank you very much, good luck to you.

Billie Giles-Corti: Thank you very much Norman.

Norman Swan: Professor Billie Giles-Corti is director of the McCaughey Centre for Community Wellbeing at the University of Melbourne.