Ambitious decarbonisation of travel in urban areas could provide significant public health gains, according to a report from the International Transport Forum (ITF) on the health impacts of low-carbon transport in cities [1].
Air pollution is cited as the second highest cause for premature deaths worldwide after cardiovascular disease leading to 5.7 million premature deaths in 2020, with 95% occurring in developing countries [2]. As the leading source of air pollution in most urban environments, emissions from the transport sector play a major part in exacerbating various chronic health conditions with pollutants like nitrogen oxides (NOx) and particulate matter (PM).
The ITF contrasts two scenarios for the future of city travel. The Current Ambition scenario outlines the transport sector’s impact if today’s policies were to persist, which are expected to be insufficient to protect from hazardous PM concentrations by 2040 [2]. The High Ambition scenario however, layers on the entire gamut of feasible policy implementation across 5 categories: carbon and road pricing, active mobility-friendly streets, better public transport, strict road regulations, and transit-oriented land use planning. Modelled for 38 OECD countries including China, India and major Latin-American and Caribbean nations, this combination could add 13 trillion life years and avert 21.5 trillion disability adjusted life-years (DALYs) between 2022 and 2050.
Recent evidence from London strengthens the ITF’s case. A University of Bath study published in April 2025 found that the capital’s Low and Ultra-Low Emission Zones reduced sick leave counts by 18.5% and respiratory issues by 10.2% compared to pre-LEZ levels [3]. Leading the study, Dr Habtamu Beshir called clean-air policy “smart policy”, echoing the ITF’s insistence that climate and health targets can, and must be pursued together.
Robust transport decarbonisation efforts could cut public health costs stemming from poor air quality by US$875 billion, a value between 0.1% to 2% of expenditure under the Current Ambition scenario [1]. The report notes that these savings are enough to offset the added capital cost of clean transport, making the transition economically self-sustaining. However, the ITF warns that benefits will be uneven unless planners worldwide confront big differences in density, income, and mobility habits. High-income regions with rapid EV uptake will see the quickest air-quality improvements, while low and middle-income countries (LMIC) that bear disproportionate burdens of chronic diseases risk being left with ageing diesel fleets. Furthermore, ensuring safe and affordable active-mobility routes for women, older residents, and people with disabilities is a key equity concern that warrants careful consideration in urban planning.
To further the initiative of cleaner air and improved public health, the report sets out two high-priority actions. One, health metrics should be ingrained into every transport decision, and two, a redirection of funds towards active mobility and public transport is vital. Extensive implementation of policy measures serving decarbonisation as outlined above promises large health dividends and cost savings.
