Esther Fobi was the winner of the ITS UK 2024/25 Early Careers Competition, for the best essay in the student/apprentice category. Here, you can read her winning essay. Find out more about the competition here.

Introduction

The day my doctor informed me that my skin condition was “manageable but incurable,” my perspective on healthcare—and by extension, engineering—transformed profoundly. That pivotal moment revealed a fundamental truth: doctors, like engineers, aren’t always focused on complete cures or perfect solutions, but rather on creating systems that make life more navigable despite limitations. This realisation illuminates a powerful opportunity for the Intelligent Transport Systems (ITS) sector: by forging stronger connections between medical data and transportation engineering, we can design more inclusive mobility solutions that better address diverse human needs, even when perfect solutions remain unattainable.

In today’s data-driven world, the traditional approach to accessibility in transport—primarily designed for the majority population with some accommodations for broad categories of disability—fails to address the reality of human diversity. Whether it’s the 10 million people in the UK with arthritis(1), the 2 million with sight loss(2), or countless others with “invisible” conditions, current accessibility measures frequently fall short. This essay proposes to initiate an approach for creating truly inclusive transport networks by establishing systematic collaboration between healthcare providers and transport engineers, leveraging anonymised patient data to inform design decisions and create responsive systems that evolve with our understanding of human needs.

The Data Disconnect: Why Current Approaches Fall Short

Despite well-intentioned accessibility regulations, transport systems worldwide continue to present barriers for many users. The fundamental problem is a data disconnect—engineers design based on standardised accessibility requirements rather than the users’ diverse, complex, and evolving needs.

Traditional accessibility approaches typically address visible disabilities through standardised solutions: wheelchair ramps, tactile paving, or audio announcements. While valuable, these fail to accommodate the vast range of conditions that affect mobility, cognition, sensory processing, or energy levels. The woman with fibromyalgia who cannot stand for more than five minutes, the child with autism overwhelmed by crowded platforms, the person with Chronic obstructive pulmonary disease (COPD) who cannot walk long distances—these diverse needs remain largely invisible to transport planners.

The disconnect extends to emerging conditions and diagnoses. Medical understanding evolves continuously, with new conditions identified and existing ones better understood each year. Many needs-both long-recognised and newly identified-remain unaddressed. Traditional engineering approaches aren’t agile enough to respond to this dynamic landscape of diverse requirements.

Beyond Categories: The Medical-Engineering Interface

The solution lies not in creating more rigid categories of accessibility but in establishing a systematic interface between medical insights and engineering practices. This interface would:

1. Create anonymised data pipelines: Develop systems for healthcare providers to share anonymised, aggregated data about mobility-affecting conditions with transport planners—respecting privacy while illuminating needs.
2. Establish collaborative design processes: Form multidisciplinary teams including medical professionals, patients, and engineers to interpret data and translate it into design requirements.
3. Implement adaptive infrastructure: Design transport systems that can be modified easily as needs evolve, moving away from “permanent” solutions toward modular, updatable designs.

While this represents a significant departure from traditional infrastructure approaches and poses engineering and budgetary challenges, the long-term benefits outweigh initial implementation hurdles—particularly when considering the lifecycle costs of prematurely obsolete fixed infrastructure.

The Swedish Transport Administration has begun exploring this approach, partnering with healthcare providers to collect anonymised data about mobility challenges faced by patients with various conditions(3). This data informed the redesign of Stockholm’s central station, implementing features like customisable lighting levels, quiet zones, and rest areas placed at specific intervals—addressing needs beyond traditional accessibility categories.

Real-World Applications: From Data to Design

This medical-engineering interface could transform transport infrastructure across multiple dimensions:

Physical Infrastructure: Rather than designing to minimum standards, data about the actual distribution of mobility capabilities could inform decisions about distances between rest points, gradient changes, and surface textures. The Crossrail Elizabeth Line in London incorporated some of these principles, using medical data about energy expenditure to place seating at optimal intervals(4).

Information Systems: Understanding cognitive diversity could revolutionise way-finding and information delivery. Transport for London’s recent experiment with customisable navigation apps(5)—allowing users to select routes based on specific needs like minimal walking, sensory considerations, or anxiety-reducing features—demonstrates this potential.

Service Design: Train frequencies, operating hours, and assistance services could respond to data about when and how different populations travel. Japan’s railway systems have pioneered this approach, using healthcare data to identify peak travel times for elderly passengers and adjusting staffing accordingly(6).

Emerging Technologies: Autonomous vehicles, micro-mobility options, and Mobility as a Service (MaaS) platforms present unprecedented opportunities to personalise transport. By incorporating medical insights into their development, these technologies could address needs that traditional fixed infrastructure cannot.

Implementation Challenges and Solutions

This vision isn’t without challenges. Privacy concerns, data standardisation issues, and institutional resistance must all be addressed.

Privacy Protection: Implementation requires robust anonymisation protocols and transparent governance structures. The Finnish “Health Data Sandbox” model demonstrates how health data can be shared for public benefit while protecting individual privacy through multiple layers of anonymisation and strict usage limitations(7).

Cost Considerations: Critics might argue that this approach would dramatically increase infrastructure costs. However, evidence suggests the opposite—designing correctly the first time is less expensive than retrofitting. Moreover, economic analyses from the International Transport Forum show that improvements in transport accessibility generate substantial returns through increased workforce participation and reduced healthcare costs(8).

Institutional Frameworks: Transportation design inherently involves trade-offs, as features benefiting one group may create obstacles for others. The German Federal Ministry of Transport’s Accessibility Advisory Board (Beirat Barrierefreiheit) offers an effective approach, to this dilemma by establishing a structured decision-making framework where diverse stakeholders collaboratively evaluate these trade-offs. Their process explicitly acknowledges competing needs and focuses on identifying solutions that enhance accessibility for underserved populations without compromising the overall system’s effectiveness. This approach recognises that while perfect solutions may be unattainable, collaborative decision-making can identify optimisations that significantly improve inclusivity.

The Path Forward: Incremental Implementation

Realising this vision requires staged implementation:

1. Pilot Projects: Begin with targeted collaborations between healthcare providers and transport authorities in specific regions or around particular conditions, building evidence for broader application.
2. Data Standards Development: Create standardised systems for translating healthcare insights into engineering requirements, ensuring consistency across projects.
3. Regulatory Evolution: Update accessibility regulations to stimulate data-informed, outcomes-based approaches rather than prescriptive standards.
4. Workforce Development: Develop interdisciplinary teams comprising specialists in engineering, healthcare, and data science, alongside fostering professionals with cross-disciplinary literacy who can facilitate collaboration across these domains.

The Tokyo Metro’s accessibility initiative demonstrates this approach, beginning with data collection from disabled passengers at select stations before implementing targeted improvements and gradually expanding to the wider network based on proven results(9). This project shows how starting small, with focused interventions for specific user groups, can build momentum toward larger systemic change.

Conclusion: Engineering Human-Centred Mobility

My doctor’s words about my skin condition being “manageable but incurable” reflect a fundamental truth that applies equally to transport engineering: perfect solutions may be unattainable, but thoughtful management of limitations can dramatically improve quality of life. By bridging the worlds of healthcare and transport engineering through systematic data sharing and collaboration, we can create transport networks that respond to human diversity in all its complexity.

This approach represents more than incremental improvement—it exemplifies a shift from accessibility as compliance to accessibility as responsive human-centred design. The ITS sector stands at a crossroads: we can continue designing for broad categories and minimum standards, or pioneer this new paradigm of data-informed, medically-enlightened transport engineering.

The choice is clear. By embracing the medical-engineering interface, we move beyond merely accommodating diversity to genuinely valuing it as the central consideration in transport design. In doing so, we fulfil the true promise of intelligent transport systems: creating mobility networks that serve humanity in all its wonderful, complex variety.

References

1. The State of Musculoskeletal Health [Internet]. 2024 [cited 2025 Feb 20]. Available from: https://versusarthritis.org/about-arthritis/data-and-statistics/the-state-of-musculoskeletal-health/
2. Blindness and vision loss – NHS [Internet]. 2021 [cited 2025 Feb 20]. Available from: https://www.nhs.uk/conditions/vision-loss/
3. Fenton P. Sustainable mobility and transport in Stockholm: Moving from Eccentric to business as usual. 2020 Mar;
4. Brozek S. The Elizabeth line has set a new standard for accessibility – New London Architecture [Internet]. 2023 [cited 2025 Mar 1]. Available from: https://nla.london/news/the-elizabeth-line-has-set-a-new-standard-for-accessibility
5. TfL GO – VCCP London [Internet]. 2025 [cited 2025 Feb 27]. Available from: https://www.vccp.com/work/tfl/tfl-go
6. Jordan E. New passenger assistance technology launched across Japan – Global Railway Review [Internet]. 2025 [cited 2025 Mar 1]. Available from: https://www.globalrailwayreview.com/news/198238/new-passenger-assistance-technology-launched-across-japan/
7. Sandbox environments – System Developers [Internet]. 2025 [cited 2025 Mar 1]. Available from: https://www.kanta.fi/en/system-developers/sandbox-environments
8. Economic Benefits of Improving Transport Accessibility Roundtable Report Airport Demand Forecasting for Long-Term Planning Economic Benefits of Improving Transport Accessibility. Paris; 2017 May.
9. Breaking Down Barriers: Advances in Barrier-Free Technology and Design Make Tokyo 2020 Accessible for Everyone | Travel Japan（Japan National Tourism Organization） [Internet]. [cited 2025 Feb 23]. Available from: https://www.japan.travel/en/tokyo2020/barrier-free-for-everyone/