Reducing transport emissions is essential for tackling climate change, but it can also improve our health. Encouraging walking and cycling, improving public transport, reducing traffic and creating cleaner streets can help reduce air pollution, increase physical activity and improve wellbeing. Yet an important question is often overlooked – who benefits from these changes, and who might be left behind?
Our recent scoping review examined how evaluations of low-carbon transport interventions consider health inequalities, defined as systematic, avoidable and unfair differences in health between groups. We initially identified 26,422 potentially relevant papers and included 31 studies from around the world in the final review. These studies assessed low-carbon transport interventions and measured their health impacts across different population groups.
Most interventions appeared to deliver health benefits overall, but these benefits were not always distributed equally. Some studies found that interventions reduced inequalities, while others found little difference between groups. A small number showed that interventions could widen existing inequalities. For example, some low-emission or congestion-pricing schemes generated greater benefits for more affluent communities than for disadvantaged groups.
One of our key findings was the widespread inconsistency in how health inequalities were measured. Most studies focused on differences by socioeconomic status, geographical location or ethnicity. Far fewer considered factors such as age, gender or occupation, while disability, religion and social capital were absent from the evidence. This means that impacts on these groups may have been overlooked. Only one study explored intersectionality, recognising that people often experience multiple, overlapping forms of inequality.
Together, these findings suggest that health inequalities are often treated as a secondary consideration rather than a central objective when thinking about the impact of low-carbon interventions. The wide variety of methods and measures used to assess inequalities also makes it difficult to compare findings across studies.
Transport decarbonisation presents a major opportunity to improve both population health and environmental sustainability. However, achieving these benefits fairly will require a stronger focus on equity from the outset. Future evaluations should consider a wider range of population groups, use more consistent approaches to measuring inequalities, and involve communities in shaping both interventions and the outcomes that matter most to them.
If the transition to low-carbon transport is to improve health for everyone, equity cannot be an afterthought. It must be part of the journey from the very beginning.
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