Why might a bus pass be good for your health?

Researchers from Imperial College London have found that free bus passes are associated with older people leading more physically active lifestyles. The study, which was published last week in the American Journal of Public Health, showed that those with bus passes tended to walk more frequently than their car-driving counterparts. These findings are in keeping with the results of a separate study in which it was revealed that 19 per cent of adults in Britain get their recommended amount of physical activity via walking, cycling or the use of public transport.

In 2006, the United Kingdom government introduced a policy of free bus travel for everybody over the age of 60. The main aim of this scheme was to reduce social exclusion amongst older people. Free bus passes, however, cost the government an estimated £1bn per year, and economic austerity has led some politicians to suggest measures such as means testing and raising the age of entitlement.

The study’s findings add an extra dimension for policymakers to consider. In addition tackling social exclusion, bus passes also seem to have resulted in unexpected health benefits for older people. Moreover, these associations have been identified across the socio-economic spectrum, indicating that both the wealthy and the poor are benefiting from the scheme equally.

I spoke to the author of the study Sophie Coronini-Cronberg from Imperial College’s Faculty of Medicine to find out why bus passes are so good for our health. I began by asking her whether or not bus passes encouraged physical activity regardless of age.

"As far as we can tell, they don’t," she replied. "One of the disadvantages of using an existing dataset, as we did in our study, is that you are restricted by the data that has been gathered. In our case, respondents were divided into those aged between 60 and 69 and those who were older than 70. ‘Active travel’ is a term which encompasses walking, cycling and using public transport. The data showed that those in the over-70s were less likely to engage in active travel than their younger counterparts. That’s not to say that they don’t do it, but that they do it to a lesser extent. Even so, I can only go as far as to say that this trend applies to the over-70s; they could be 90 for all I know."

I went on to ask Coronini-Cronberg whether or not she had been surprised by the fact that the association between free bus passes and health benefits was present across all socio-economic groups.

"Yes, to an extent," she answered. "Numerous other studies have shown that when you offer a universal health benefit, those that need care the least get the most of it. This is known as the Inverse Care Law. You tend to find that more affluent groups take advantage of offers sooner than poorer groups. In light of this, it came as a pleasant surprise to find that the health benefits associated with free bus passes spanned across the socio-economic spectrum.

"Having said that, the way in which the dataset measured socio-economic status was fairly crude. Respondents were asked about their employment status, which was not a particularly relevant question. In a survey of the over-60s, you are more likely to encounter people who have retired. Consequently, the only question that we could use to determine socio-economic status related to home ownership. When it comes to older members of society, this is quite an acceptable indicator. If you have been financially successful in life, you are more likely to own your own home. However, it is still a cruder measure than we might have hoped for."

Health benefits aside, the policy of free bus passes for the over-60s is undeniably expensive. Each pass costs the government approximately £100 per year. Moreover, it is not necessarily the case that bus passes would cease to provide health benefits if the policy was abandoned as having to pay to use the bus might not deter older people from engaging in active travel. I asked Coronini-Cronberg whether or not she believes that bus passes need to be free in order to encourage physical activity amongst older people.

"That is not a question that this particular study can answer," she replied. "The universal free bus pass has proven to be a divisive issue since its introduction in 2006. A local government report from 2009 put forward means testing as a possible alternative to universally free bus passes. Before the last general election, Nick Clegg also proposed this course of action. Policymakers are still arguing over whether the scheme should be maintained, scrapped or means tested.

"Whilst some might see means testing as the fairest option, it is still quite a costly operation," Coronini-Cronberg continued. "It involves the assessment of every single person according to a particular set of criteria in order to judge whether or not they are entitled to a pass. The costs involved in this process are potentially greater than they are at present. Again, our study does not give any clue as to whether means testing would be a good idea, but I think that this is a very important issue for policymakers to investigate."

To conclude our conversation, I asked Coronini-Cronberg whether or not she would be in favour of keeping the free system that is currently in place. As she explained, whilst cost-cutting measures may seem attractive in the current environment, further research must be conducted before any changes are made to the system.

"The government has spoken about the importance of health impact assessment," she said. "Essentially, this is the idea that before implementing a policy, you should consider its potential to impact health. The free bus pass was introduced for a different purpose. It aimed to reduce social exclusion amongst older people; particularly amongst poorer groups. To my knowledge, there has been absolutely no work carried out to find out whether or not free bus passes have contributed to this end. Our research has shown that free bus passes have resulted in an unintended health benefit. It is possible, therefore, that this scheme has brought about two benefits for the price of one. Unfortunately, I think that it’s quite typical of politicians to operate in this way. They might say that certain assessments need to be conducted, but in reality, very few actually are.

"Another important consideration is cost effectiveness. Are free bus passes for the over-60s worth the financial investment? The Department of Health estimates that physical inactivity costs the UK in the region of £10bn per year. Obviously, free bus passes only benefit older people but the scheme might still be offering value for money. Work needs to be conducted in order to quantify the economic implications of this scheme. If the debate is to continue, I think that politicians would be well advised to evaluate all of the available evidence. Even if it transpires that free bus passes have not served to reduce social exclusion, policymakers should still consider the associated health benefits. I don’t think that – on its own – our study can give a definitive answer as to whether or not bus passes for older people should remain free. However, the government talks about addressing inequalities and we have found that free bus passes are used throughout the socio-economic spectrum. Further investigations need to take place before a decision is made one way or the other."