Air quality and public health co-benefits of national transport policies

Clinical Snapshot

Key Findings

• P Value: Not reported

• Effect Size: Not quantified; narrative synthesis only. Direction of effect consistently favourable across all 10 included studies for PM2.5 reduction and health co-benefits

• Primary Outcome: Reductions in PM2.5 concentrations and avoided premature mortality associated with national/regional transport policies, with the largest and most consistent benefits observed for integrated policy packages combining regulatory, technological, and fiscal/behavioural instruments

• Nnt Or Sensitivity: Not calculable from available data; no pooled estimates provided. Individual study estimates of avoided premature deaths and hospitalisation reductions are referenced narratively but not synthesised quantitatively

• Confidence Interval: Not reported; no meta-analysis performed

Clinical Application

Transport policy interventions (EV incentives, fuel quality regulation, diesel phase-out, public transport investment) are feasible at national and subnational government levels. Clinical applicability is indirect — clinicians can advocate for these policies and counsel patients on the health benefits of reduced transport emissions, but implementation requires government and regulatory action. Health impact assessment integration into transport planning is feasible and recommended. Australia has direct policy relevance to this review. Australia currently lacks a national fuel efficiency standard equivalent to those in the EU or USA, though the New Vehicle Efficiency Standard (NVES) was legislated in 2024, representing a significant policy development aligned with the review's recommendations. The TGA and RACGP have both recognised air pollution as a modifiable determinant of cardiovascular and respiratory disease. The PBS does not directly intersect with transport policy, but reduced hospitalisations from improved air quality would reduce healthcare system burden. Australia's high rates of diesel vehicle ownership, urban traffic congestion in major cities (Sydney, Melbourne, Brisbane), and ongoing EV transition debates make this evidence directly pertinent to Australian public health policy. The review's finding that integrated packages (combining vehicle electrification, fuel quality regulation, and active transport promotion) yield the greatest co-benefits is consistent with recommendations from the Australian Institute of Health and Welfare and state-level clean air strategies. The underrepresentation of Asia-Pacific settings in the evidence base is a limitation for direct Australian application. Urban and peri-urban populations exposed to transport-related air pollution, particularly those with pre-existing cardiovascular and respiratory conditions who bear disproportionate burden from PM2.5 exposure. Populations in high-income countries with established vehicle fleets and regulatory capacity are most directly represented by the evidence base.

Abstract

INTRODUCTION: Transport is a major contributor to urban air pollution and premature mortality worldwide. This systematic review evaluates the air-quality and public health co-benefits of national and regional transport policies aimed at reducing population exposure to air pollution. CONTENT: Following PRISMA 2020 guidelines, this review synthesized evidence published between 2011 and 2024 on the health and environmental impacts of national or regional transport policies. Ten eligible studies were reviewed, covering diesel vehicle phase-outs, inspection and maintenance programs, electric vehicle incentives, fuel taxation, and promotion of public or active transport. SUMMARY: Across multiple settings, these policies were associated with reductions in PM2.5 concentrations and with avoided premature mortality, respiratory and cardiovascular hospitalizations, and healthcare costs. The largest and most consistent health benefits were observed for integrated policy packages, particularly those combining regulatory and technological measures such as fuel quality improvements, vehicle electrification and diesel phase-out, complemented by behavioral or fiscal instruments. Most available evidence originates from high-income countries, while studies from low- and middle-income regions remain scarce. The limited number of eligible studies and their concentration in specific regions and modeling approaches constrain generalizability, especially to settings with different transport systems, resource availability, and air-quality profiles. OUTLOOK: Embedding health-impact assessment within transport planning and expanding long-term evaluations in low- and middle-income countries are essential to ensure equitable and sustained air-quality and health improvements. Future policy frameworks should prioritize source-oriented regulatory and technological measures such as vehicle electrification, fuel-quality regulation, and diesel phase-out implemented within integrated policy packages to maximize public-health co-benefits.

References

1. 1.Naw, A. T. H., Papong, S., Rattanapan, C., & Biró, K. (2026). Air quality and public health co-benefits of national transport policies. Reviews on Environmental Health. https://doi.org/10.3390/app10175970