Title: Health and economic benefits of providing free bus travel to older people in England
Funder: Department of Health (England)

Abstract: Background: There is limited information on which interventions are effective at increasing physical activity in older people. High level evidence reviews have found that behavioural and cognitive interventions (delivered at the individual, group or community) have only modest impacts of physical activity levels (1-3). This evidence is reflected in recent NICE guidance which recommends that policymakers should “shift attention away from focusing on individual risk factors and isolated, small-scale interventions and ensure programmes comprise an integrated package of measures” (4). Measures which address the structural, environmental and/or financial barriers to active travel are more likely to have sustained impacts as they are able to embed physical activity into everyday activities (5). This project will evaluate the health and economic costs and benefits of the provision of free bus travel to older people in England. The project will answer the following research questions: (1) Was the provision of free bus travel to older people associated with changes in bus use and in overall physical activity levels? (2) Are population health benefits of the intervention indicated by reductions in:- i) risk factors for chronic disease, ii) hospital admissions from cardiovascular disease and hip fractures and iii) deaths from cardiovascular disease, hip fractures and all causes? (3) Does an economic evaluation of the policy indicate that the provision of free bus travel to older people represents good value for money? The methods for the project will include a series of cross-sectional and longitudinal analyses using the English Longitudinal Study for Ageing (ELSA) which will be linked to Hospital Episode Statistics (HES) and mortality data for the project and the National Travel Survey (NTS). The following studies will be conducted:- (1) ELSA: longitudinal analyses will be undertaken to assess how eligibility for free bus travel is associated with public transport use, physical activity levels, BMI, other risk factors for chronic disease and physical functioning. Analysis of cross-sectional data from ELSA Wave 6 will be used to examine socio-economic predictors of pass holdership, bus use and associated physical activity levels. Associations between public transport use and objective measures of physical activity levels will be examined using accelerometry data. (2) ELSA-HES/mortality linked datasets: longitudinal analyses will be undertaken to examine hospital admissions for CVD and hip fractures and hip fracture, CVD and all-cause mortality occurring up until 2012/13 by earlier public transport use. (3) NTS: will be used to examine patterns of bus pass holdership, bus use and transport associated physical activity in each year between 2005 to 2012 (or later data if available). Associations between bus pass holdership, bus travel and regular walking will be examined. (4) Economic evaluation: we will undertake a cost-consequences analysis from a public sector perspective, as recommended by NICE in its public health reference case (6), as well as a cost-effectiveness analysis. We will undertake a detailed analysis of the cost of the bus pass scheme, and model the health impacts and cost impacts, accounting for impact on use of NHS and other public services. Research team: consists of experts in public health, transport and health economics from Imperial College and UCL. The team has extensive experience of using routine and survey data to evaluate major policy initiatives and is well placed to carry out this project. Potential policy impact: The project will provide an evidence base to inform the decision about whether the National Bus Pass scheme should be continued. Current pressure on public spending has led to proposals to cut or amend the scheme. However, there is little direct evidence about the population health benefits, nor of the economic impacts, of providing subsidised public transport to older populations.


Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING;8.2 HEALTH AND WELFARE ECONOMICS
Health categories: STROKE;CANCER AND NEOPLASMS;METABOLIC AND ENDOCRINE;CARDIOVASCULAR;ORAL AND GASTROINTESTINAL