Page 182 - GHES-3-3

Global Health Economics and
Sustainability
Transport and health of pregnant women

2.2. Transport and social exclusion nexus insights into its multi-dimensional, relational and

Various studies have demonstrated the links between dynamic nature. This understanding encourages a shift
transport and social exclusion (Charnavalau et al., 2022; from traditional system-based approaches to transport
Delbosc & Currie, 2011). Lucas & Jones (2009) found provision to one that is toward people-oriented and need-
that individuals who are socially excluded due to a lack of based social policies.
transport often feel isolated and have to rely on others to 2.3. Transport exclusion and healthcare
get around. Low mobility has been associated with limited
access to activities, facilities, and other services essential for Transport and the mobility it offers are critical
improving citizen’s quality of life (Kenyon, 2006). From the determinants of health and healthcare equity (Macleod
perspective of physical proximity, especially where distance et al., 2022). Transportation serves as an intermediary
is a significant factor in accessibility, the SEU (2003) factor in healthcare accessibility, as travel is often required
reported that increasing distances between residential to access healthcare to maintain a healthy lifestyle. It
locations and places of opportunities or other social goods facilitates access to facilities that can improve health,
essential for societal participation necessitates access to an such as recreational facilities (indoor and outdoor) and
efficient transport system. Without such access, citizens shops or stores selling healthy food, medical facilities, and
may suffer exclusion. Conceptually, Lucas (2004) presented medications. In addition, it supports social interactions
three causes of mobility-related exclusion, including with friends and family, which can improve mental health
person-type (individual-specific causes), transport and overall well-being.
system (such as a lack of or inadequate public transport Health equity, closely linked to the socioeconomic
services and dysfunctional local services), and spatial status of individuals and households, has the potential
factors. According to Lucas (2004), person-type factors to address systemic exclusion through empowerment
are more acutely experienced by individuals already facing (Braveman, 2014; Cole et al., 2019; Flaubert et al., 2021;
exclusion in other areas. This is supported by Hamilton
& Jenkins (1992) and Gao et al. (2022), who claimed that Marmot et al., 2008). Mobility and health disparities are
transport exclusion follows the well-established trajectory interrelated, as historical, political, and socioeconomic
of social inequality. This claim is substantiated by evidence conditions shape transportation systems and household
showing that individuals with lower income, compared to factors. Similarly, mobility patterns often vary based
their higher-income counterparts, are limited in both the on disability and socio-demographic characteristics.
length of journeys they can undertake and the range of However, mobility constraints – such as avoiding travel
transportation options available to them (Enders & Seekins, due to physical limitations or concerns over personal safety
2009). Similarly, individuals with mobility impairment or – can lead to disparities in social determinants of health,
physical disabilities, women, and those from minority including access to employment and participation in
ethnic groups are particularly vulnerable to abuse. health-promoting activities, such as active transportation
and preventive care. Cole et al. (2019) emphasized that
Spatial factors, such as proximity to activity locations, efforts to promote health equity would require addressing
road conditions, weather, and terrain, also significantly mobility disparities by investing in transportation systems
influence levels of accessibility and subsequent levels of that maximize the benefits of mobility and minimize harm.
societal inclusion. The consequences of transport-social However, Musselwhite et al. (2021) noted that balancing
exclusion often include barriers to opportunities such as population growth, service needs, and livability remains a
employment (especially for young people in rural areas). persistent challenge for achieving transport equity.
Since transportation is vital for maintaining employment,
the time and cost associated with commuting may lead 3. Methodology
individuals to decline job offers or accept low-paying
jobs as an economic alternative. In addition, poorly The study was conducted in three local government areas
managed transportation systems that fail to ensure user (LGAs) of Oyo State, Nigeria, namely Ibadan Northwest,
safety can foster fear and reduce individuals’ mobility Ibadan North, and Ibadan Northeast. These LGAs are part
levels. For those living in disadvantaged areas, limited car of the 11 LGAs that make up Oyo State in the southwestern
ownership further hampers access to social and economic part of Nigeria. A total of 113 health facilities within these
services, such as financial and health facilities. Despite LGAs were utilized for the study, comprising four federal
these outcomes of transport-related social exclusion, hospitals, two state hospitals, 44 primary healthcare centers
understanding the association between transport and (PHCs), and 63 private hospitals. The study adopted a
social exclusion provides policymakers with valuable multi-stage sampling method.

Volume 3 Issue 3 (2025) 174 https://doi.org/10.36922/ghes.5203