Accessibility and Essential Travel: Public Transport Reliance Among Senior Citizens During the COVID-19 Pandemic

Using smart card travel data, we compare demand for bus services by passengers of age 65 or older prior to and during the COVID-19 pandemic to identify public transport-reliant users residing in more car-dependent environments—i.e., people who rely on public transport services to carry out essential activities, such as daily shopping and live in areas with low public transport accessibility. Viewing lockdowns as natural experiments, we use spatial analysis combined with multilevel logistic regressions to characterize the demographic and geographic context of those passengers who continued to use public transport services in these areas during lockdown periods, or quickly returned to public transport when restrictions were eased. We find that this particular type of public transport reliance is significantly associated with socio-demographic characteristics alongside urban residential conditions. Specifically, we identify suburban geographies of public transport reliance, which are at risk of being overlooked in approaches that view public transport dependence mainly as an outcome of deprivation. Our research demonstrates once again that inclusive, healthy and sustainable mobility can only be achieved if all areas of metropolitan regions are well and reliably served by public transport

Towards new urban mobility: the case of London and Berlin

The report ‘Towards New Urban Mobility: The case of London and Berlin’ provides insight into how urban transport policy can better leverage new and emerging mobility choices in cities. Drawing on the LSE Cities/InnoZ household survey of 1,000 residents each in Berlin and London, it investigates how people’s attitudes towards transport modes, technology and travel frame their willingness to adopt new and more sustainable forms of transport. The study demonstrates how London and Berlin have both seen a pronounced trend towards new urban mobility with considerable increases in walking, cycling, public and shared transport, as well as substantial reductions in car use and ownership. It reveals that less than one in six residents in each city display a strong identification with car use and ownership, for reasons primarily including higher costs, adequate alternatives and environmental concerns. Such shifts have been accompanied by a large proportion of residents in both cities showing openness to new mobility services with travel applications being used almost daily by one in four of the respondents who owned smartphones. The report also illustrates how mobility attitudes are closely correlated with mobility behaviour. The choice of transport modes in both cities corresponds to respondents’ preferences, indicating the cities’ capacities to accommodate a wide range of travel demands. Nevertheless, accessibility and travel opportunities are strongly influenced by residential location, suggesting that a combined understanding of residential patterns and travel preferences is essential for a more detailed and complete understanding of travel behaviour. This new report was prepared by LSE Cities at the London School of Economics and Political Science and the Innovation Centre for Mobility and Societal Change (InnoZ), and supported by the German Federal Ministry for Transport, Building and Urban Development and Deutsche Bank’s Alfred Herrhausen Society

Gauging interventions for sustainable travel: a comparative study of travel attitudes in Berlin and London

So-called ‘soft’ policy instruments that respond to the psychological aspects of travel are regularly acknowledged as necessary complements to ‘hard’ infrastructure investments to effectively promote sustainable travel in cities. While studies investigating subjective orientations among travellers have proliferated, open questions remain including the role of recent technological advances, the expansion of alternative mobility services, locally specific mobility cultures and residential selection. This paper presents the methods, results and policy implications of a comparative study aiming to understand mobility attitudes and behaviours in the wider metropolitan regions of Berlin and London. We specifically considered information and communication technology (ICT), new types of mobility services such as car sharing, electric cars and residential preferences. In each region, we identified six comparable segments with distinct attitudinal profiles, socio-demographic properties and behavioural patterns. Geocoding of the home address of respondents further revealed varying contextual opportunities and constraints that are likely to influence travel attitudes. We find that there is significant potential for uptake of sustainable travel practices in both metropolitan regions, if policy interventions are designed and targeted in accordance with group-specific needs and preferences and respond to local conditions of mobility culture. We identify such interventions for each segment and region and conclude that comparative assessment of attitudinal, alongside geographical, characteristics of metropolitan travellers can provide better strategic input for realistic scenario-building and ex-ante assessment of sustainable transport policy

Gauging interventions for sustainable travel: a comparative study of travel attitudes in Berlin and London

So-called ‘soft’ policy instruments that respond to the psychological aspects of travel are regularly acknowledged as necessary complements to ‘hard’ infrastructure investments to effectively promote sustainable travel in cities. While studies investigating subjective orientations among travellers have proliferated, open questions remain including the role of recent technological advances, the expansion of alternative mobility services, locally specific mobility cultures and residential selection. This paper presents the methods, results and policy implications of a comparative study aiming to understand mobility attitudes and behaviours in the wider metropolitan regions of Berlin and London. We specifically considered information and communication technology (ICT), new types of mobility services such as car sharing, electric cars and residential preferences. In each region, we identified six comparable segments with distinct attitudinal profiles, socio-demographic properties and behavioural patterns. Geocoding of the home address of respondents further revealed varying contextual opportunities and constraints that are likely to influence travel attitudes. We find that there is significant potential for uptake of sustainable travel practices in both metropolitan regions, if policy interventions are designed and targeted in accordance with group-specific needs and preferences and respond to local conditions of mobility culture. We identify such interventions for each segment and region and conclude that comparative assessment of attitudinal, alongside geographical, characteristics of metropolitan travellers can provide better strategic input for realistic scenario-building and ex-ante assessment of sustainable transport policy

Beyond automobility? Lock-in of past failures in low-carbon urban mobility innovations

Automobility, including the infrastructures, technologies and institutions that created high dependence on private car use, has led to significant environmental and climate problems and notably high carbon emissions. Now cities are attempting to move beyond this failed regime by experimenting with a range of different mobility innovations. In this paper, we examine whether emergent policy-led experiments and innovation processes in low-carbon mobility are learning from the past, or whether they are reproducing key elements of past policy failures. Through four case studies – Birmingham, Stavanger, Milton Keynes and Melbourne – we assess attempts to break out of high-carbon automobility through three key factors, namely diversification of travel options, a shift from individual to shared forms of mobility, and whether these aspects are implemented at scale. We find that while all cities show potential for diversification and sharing at scale, current modes of innovation exhibit features that may reproduce rather than reduce high-carbon automobility. Our analysis attributes this risk of continued failure to how policy-led experimentation and innovation are structured and themselves become locked in, thereby upholding the obdurate automobility regime

Ethnic disparities in preventable hospitalisation in England: an analysis of 916 375 emergency admissions.

OBJECTIVES: To study ethnic inequalities in ambulatory care sensitive conditions (ACSC) in England. DESIGN: Observational study of inpatient hospital admission database enhanced with ethnicity coding of patient surnames. The primary diagnosis of the first episode in spells with emergency admission were coded with definitions for acute ACSC, chronic ACSC and vaccine-preventable diseases. SETTING: National Health Service England. PARTICIPANTS: 916 375 ACSC emergency admissions in 7 39 618 patients were identified between April 2011 and March 2012. MAIN OUTCOME MEASURES: ORs of ACSC for each ethnic group relative to the White British majority group adjusted for age, sex and area deprivation. RESULTS: Acute ACSC admission risk adjusted for age and sex was particularly high among Other (OR 1.73; 95% CI 1.69 to 1.77) and Pakistani (1.51; 95% CI 1.48 to 1.54) compared with White British patients. For chronic ACSC, high risk was found among Other (2.02; 95% CI 1.97 to 2.08), Pakistani (2.07; 95% CI 2.02 to 2.12) and Bangladeshi (1.36; 95% CI 1.30 to 1.42). For vaccine-preventable diseases, other (2.42; 95% CI 2.31 to 2.54), Pakistani (1.94; 95% CI 1.85 to 2.04), Bangladeshi (1.48; 95% CI 1.36 to 1.62), Black African (1.45; 95% CI 1.36 to 1.54) and white other (1.38; 95% CI 1.33 to 1.43) groups. Elevated risk was only partly explained in analyses also adjusting for area deprivation. CONCLUSIONS: ACSC admission was especially high among individuals of Bangladeshi, Pakistani, Black African, white other or other background with up to twofold differences compared with the white British group. This suggests that these ethnic groups are not receiving optimal primary care

Names-based ethnicity enhancement of hospital admissions in England, 1999-2013.

BACKGROUND: Accurate recording of ethnicity in electronic healthcare records is important for the monitoring of health inequalities. Yet until the late 1990s, ethnicity information was absent from more than half of records of patients who received inpatient care in England. In this study, we report on the usefulness of a names-based ethnicity classification, Ethnicity Estimator (EE), for addressing this gap in the hospital records. MATERIALS AND METHODS: Data on inpatient hospital admissions were obtained from Hospital Episode Statistics (HES) between April 1999 and March 2014. The data were enhanced with ethnicity coding of participants' surnames using the EE software. Only data on the first episode for each patient each year were included. RESULTS: A total of 111,231,653 patient-years were recorded between April 1999 and March 2014. The completeness of ethnicity records improved from 59.5 % in 1999 to 90.5 % in 2013 (financial year). Biggest improvement was seen in the White British group, which increased from 55.4 % in 1999 to 73.9 % in 2013. The correct prediction of NHS-reported ethnicity varied by ethnic group (2013 figures): White British (89.8 %), Pakistani (81.7 %), Indian (74.6 %), Chinese (72.9 %), Bangladeshi (63.4 %), Black African (57.3 %), White Other (50.5 %), White Irish (45.0 %). For other ethnic groups the prediction success was low to none. Prediction success was above 70 % in most areas outside London but fell below 40 % in parts of London. CONCLUSION: Studies of ethnic inequalities in hospital inpatient care in England are limited by incomplete data on patient ethnicity collected in the 1990s and 2000s. The prediction success of a names-based ethnicity classification tool has been quantified in HES for the first time and the results can be used to inform decisions around the optimal analysis of ethnic groups using this data source

Ethnic inequalities in hospital admissions in England: an observational study.

BACKGROUND: Ethnic inequalities in health are well-known and partly explained by social determinants such as poorer living and working conditions, health behaviours, discrimination, social exclusion, and healthcare accessibility factors. Inequalities are known both for self-reported health and for diseases such as diabetes, cardiovascular diseases, respiratory diseases, and non-specific chest pains. Most studies however concern individual diseases or self-reported health and do not provide an overview that can detect gaps in existing knowledge. The aim of this study is thus to identify ethnic inequalities in inpatient hospital admission for all major disease categories in England. METHODS: Observational study of the inpatient hospital admission database in England enhanced with ethnicity coding of participants' surnames. The primary diagnosis was coded to Level 1 of the Global Burden of Disease groups. For each year, only the first admission for each condition for each participant was included. If a participant was readmitted within two days only the first admission was counted. Admission risk for all major disease groups for each ethnic group relative to the White British group were calculated using logistic regression adjusting for age and area deprivation. RESULTS: 40,928,105 admissions were identified between April 2009 and March 2014. Ethnic inequalities were found in cardiovascular diseases, respiratory diseases, chest pain, and diabetes in line with previous studies. Additional inequalities were found in nutritional deficiencies, endocrine disorders, and sense organ diseases. CONCLUSIONS: The results of this study were consistent with known inequalities, but also found previously unreported disparities in nutritional deficiencies, endocrine disorders, and sense organ diseases. Further studies would be required to map out the relevant care pathways for ethnic minorities and establish whether preventive measures can be strengthened

British surname origins, population structure and health outcomes-an observational study of hospital admissions.

Population structure is a confounder on pathways linking genotypes to health outcomes. This study examines whether the historical, geographical origins of British surnames are associated with health outcomes today. We coded hospital admissions of over 30 million patients in England between 1999 and 2013 to their British surname origin and divided their diagnoses into 125 major disease categories (of which 94 were complete-case). A base population was constructed with patients' first admission of any kind. Age- and sex-standardised odds ratios were calculated with logistic regression using patients with ubiquitous English surnames such as "Smith" as reference (alpha = .05; Benjamini-Hochberg false discovery rate (FDR) = .05). The results were scanned for "signals", where a branch of related surname origins all had significantly higher or lower risk. Age- and sex-standardised admission (alpha = .05) was calculated for each signal across area deprivation and surname origin density quintiles. Signals included three branches of English surnames (disorders of teeth and jaw, fractures, upper gastrointestinal disorders). Although the signal with fractures was considered unusual overall, 2 out of the 9 origins in the branch would only be significant at a FDR > .05: OR 0.92 (95% confidence interval 0.86-0.98) and 0.70 (0.55-0.90). The risk was only different in the quintile with the highest density of that group. Differential risk remained when studied across quintiles of area deprivation. The study shows that surname origins are associated with diverse health outcomes and thus act as markers of population structure over and above area deprivation