This week's column is filed from the annual meeting of the US Transportation Research Board. Held every January in Washington since 1920, it is the largest transportation research conference in the world. The topics range from road safety through to bridge and airport construction, and over the years there is a slow but sure increase in medical input to complement transport engineering and planning.
Transport is the invisible glue that holds our lives together, an under-recognised contributor to economic, social and personal wellbeing.
Up until quite recently, the focus of the medical profession on traffic medicine was almost exclusively on the down-side of transport.
This is exemplified by the chapter on transport in one of the key texts on public health, Marmot and Wilkinson's otherwise excellent Social Determinants of Health. It makes for grim reading – accidents, pollution and the impact of cars on exercise, and no mention of how lack of access to transport is associated with impaired health and social inclusion.
Happily, there is a movement to re-evaluate transport as a determinant of health (trbhealth.org) , and in particular to examine barriers to accessing transport for vulnerable populations. As a researcher on transport and older people for 20 years, I have seen a wave of research which has transformed our view of older people in traffic.
One of the myths exploded is that of risk attached to older drivers. We now know that not only are they the safest group of drivers on the road: they also increase traffic safety among other generations: the risk of serious injury to children is halved if driven by grandparents rather than parents.
In addition, there is increasing evidence that medical screening of older drivers is not just ineffectual: research from Australia and the Nordic countries shows that it is associated with more deaths by increasing death among older pedestrians.
On the basis of this research, the National Programme Office for Traffic Medicine in Ireland has recently recommended the replacement of current medical screening with self-declaration of relevant illness at licence renewal.
The emerging research needs for older people in transport are predominantly in terms of access, particularly for those who can no longer drive and for whom public transport is neither available nor feasible. From a road-safety perspective, better medical fitness-to-drive guidelines, pedestrian safety, and age-attuned car safety features are the most relevant topics.
In a vivid exemplar of the dictum that if you design for the old you include the young, I was fascinated that we have learned older drivers and transport users can shed light on problems for other age groups. The first workshop I attended covered driving and transport for those with intellectual disability, autism spectrum disorders and severe anxiety.
The latter group included veterans from Iraq and Afghanistan with post-traumatic stress disorder whose experience of roadside bombs and attacks were being relived while driving back home.
I also learned of gephyrophobia – the fear of crossing bridges – and many
large bridges in the US offer special assistance to lead those so affected across the bridge.
In terms of the new Irish guidelines on medical fitness to drive, Sláinte agus Tiomáint, it was interesting to see how medical fitness-to-drive issues in many countries were channelled in very different ways by doctors, police, courts and driver licensing agencies: the TRB meeting is a quite unique space where all players meet in one room.
It is also clear that many jurisdictions struggle with illicit drug-taking and driving, and no clear consensus arose from the sessions.
But perhaps medical fitness-to-drive issues may change, and even fade in prominence, in tantalising glimpses into the future of driverless cars which have featured at the last few meetings. Fuelled as much by congestion as by safety, many elements of the system are being put in place, and trials are ongoing in many parts of the US.
If successful, these systems might provide an interesting solution to transport for those who can no longer drive – and indeed those of us who would rather read on the way to work.
However, it will be some time before these are rolled out more widely, so traffic medicine – and much more research – will be required for some time to come.
Prof Des O’Neill is a consultant in geriatric and stroke medicine and director of the National Programme Office for Traffic Medicine.