Urban Transportation Planning in the Perspective of Public Health in the City of Jakarta, Indonesia

Public health is one of the basic sectors that are influenced by transportation. Public health factors related with transportation performances are environmental quality, people access to health facilities, traffic safety, mode choice and its relationship with health, and disease spreading risk. Based on the case of Transportation Master Plan (Rencana Induk Transportasi Jakarta, RITJ) of Capital Jakarta, Indonesia, this paper explores the topic of how adequate urban transportation planning in Indonesia accommodate health factors in its process and substance. This study takes quantitative method to identify Jakarta transportation condition in relation with health sector and to understand to what extent transportation planning accommodate health factors. Qualitative method is also used to analyze people perception regarding the level of the transportation planning process in accommodating their interest in health. The research concludes that the negative impact of transportation activities to the health sector in Jakarta such as air pollution, traffic accident, and passive mode choice are still high. The RITJ planning process did not accommodate urban health criteria adequately. This paper suggests a better transportation planning to assure adequate accommodation of urban health criteria both in its process and substances.


Introduction
Transportation activities significantly influence the degree of public health, through impacts on environmental quality, public access to health and social facilities, safety of road users, mode choice that has an impact on healthy lifestyles, and the risk of disease transmission [1].In Indonesia, the seriousness of health problems due to poor transportation performance can be indicated by the number of deaths due to traffic accidents that keeps increasing from year to year [2].Air pollution due to transportation activities places Jakarta in the 5th city with high air pollution concentration in the world with an average concentration of PM2.5 reaching 49.4 µg/m³ [3].In addition, the risk of being exposed to non-communicable diseases (NCDs) due to lack of physical activity should be reduced by choice of active transportation modes, such as walking and riding a bicycle.
The Law No. 23/2014 on Regional Government stipulates that the responsibility for health and transportation affairs, as a part of the concurrent government affairs, lies on the central and regional government (provincial and district/city) levels.To carry out concurrent affairs related to health and transportation, the government is obliged to formulate and establish policies as the basis for planning IOP Publishing doi:10.1088/1755-1315/1318/1/012007 2 and implementing a transportation system with a public health perspective.One of the transportation policies that form the basis for public health-minded transportation planning in Jakarta is the Jakarta Transportation Master Plan, which is stipulated through the Presidential Regulation No. 55/2018.
This study aims to understand the extent to which public health aspects are accommodated in the formulation of urban transportation policies.In elaborating on this topic, the case for the preparation of the Jabodetabek Transportation Master Plan (Rencana Induk Transportasi Jakarta, RITJ) was chosen as a case representation of the relation between transportation sector planning and urban health in Indonesia.RITJ covers the planning area of Jakarta Province as the core area and the areas of Bogor, Depok, Tangerang, and Bekasi as affected areas

Literature Review
Policy making is defined as "a series of actions produced by the government through political activities to address problems or issues that affect the dignity of society" [4]; [5]; [6]; dan [7].Two actors that participate in policy making are Policy Making Officials and Non-Government Participants [4]; [6].Participants of Policy-Making Officials consist of executive institutions, legislative institutions, judicial institutions, and bureaucrats.Meanwhile, Non-Government Participants consist of interest groups, experts, political parties, research organizations, communication media, and individual communities.
The process in making public policy consists of 4 stages [8]: a. Agenda Setting: Identifying problems that require government intervention.The issues and problems are then selected to be put on the agenda.b.Policy Formulation and Decision Making: The description of the objectives that should be achieved with the policy and consideration of various alternative actions.An example of the method used is Planning Programming Budgeting Systems (PPBS).The adoption stage of the proposed program has the main criteria.c.Implementation: The stage of execution or implementation of the policy by the responsible agency.The ideal conditions that must be met include a) detailed program specifications, b) resource allocation, and c) decisions in implementation.d.Evaluation and Termination: Policy should contribute to problem solving or problem reduction.
Termination of the policy is taken if there are problems from the policy that has been implemented or there is a policy deviation that is not effective against the objectives.For the purpose of understanding the transportation policy making in relation with urban health in Jakarta, this study elaborates on three main topics, namely: the existing condition of transportation in Jakarta from a public health perspective, the degree of accommodation of public health aspects in the transportation policy formulation process, and the degree of accommodation of public health aspects in the substance of transportation policies in Jakarta and its surrounding areas

Research Method
Firstly, the identification of the existing condition of transportation in the perspective of public health is done by analyzing the relationship factors between transportation and health [1] and [9].The data analyzed are secondary data obtained from the internet, literature, and related agencies.
Secondly, the method to identify the accommodation of public health elements in the transportation policy formulation process in Jakarta is an analysis of content of interviews with resource persons.The interview aims to explore the process taken in policy formulation [4]; [8].This includes an analysis of the actors involved and whether the process is in accordance with the criteria for the transportation policy formulation process that accommodates health.The data in this analysis were obtained through two main sources, namely interviews with resource persons from the Jabodetabek  Thirdly, the method to identify the accommodation of health aspects in the substance of the RITJ is a poll of 227 respondents.The poll aims to identify whether the content of the RITJ policy has accommodated the health criteria.The sampling criteria for determining respondents are people who live and work in Jakarta and are over 15 years old.Data collection uses an online questionnaire method from November -December 2021.

The Existing Condition of Transportation in Jakarta in the Perspective of Public Health 1. Air pollution and greenhouse gas emission
Air pollution and greenhouse gas emissions are the aspects directly affected by transportation activities.In 2021, the average air quality in Jakarta was in the "moderate" classification with an Air Pollution Standard Index (Indeks Standar Polusi Udara, ISPU) range of 51-100 based on the Regulation of the Minister of Environment and Forestry (LHK) Nbr.14/2020.This means the level of air quality can still guarantee the health of humans, animals, and plants.Although, in general, the ISPU value is still at a safe level, the levels of a number of harmful particles in the air at certain times have passed the safe threshold.PM2.5 air pollutant particles are the most critical pollutant particles compared to other polluting particles (PM10, SO2, CO, and O3) with the most critical point days and an average Threshold Value (TV) of 76.22 gram/m3.The limit value above the safe TV based on the standards of the Meteorology, Climatology, and Geophysics Agency (BMKG) is 65 gram/m 3 .In particular, transportation activities are known to contribute to 37% of the PM2.5 component in the rainy season and 47.33% in the dry season [10].Furthermore, transportation activities affect greenhouse gas (GHG) emissions that contribute to climate change so that they can affect human health [11].From 2011-2018, transportation activities became the activity that contributed the most to GHG emissions with a range between 42.82% -53.76% [12].

Public Access to Health Facilities
Assessment of public access to health facilities can be simplified into public accessibility to public transport since public transport users have greater barriers than private transport users [13].By looking at the level of service, especially on the availability of public transportation, an assessment is made of the existing conditions of public transportation in Jakarta, including: a) Time of public transportation services; b) public transport capacity; and c) the service coverage of the public transport with respect to the passenger's origin and destination points [13].
Table 2 Operational schedule of public transportation modes in Jakarta, operating hours, and headway  the number of passengers keeps increasing.In 2017, the load factor of the Commuter Line train at peak hours in the morning reached more than 150% (Figure 1), so that some service routes (e.g., Bekasi and Serpong routes) experienced a decline in service quality [14].The service coverage of the public transportation to the passenger's starting and destination points are based on the RITJ buffer criteria, i.e., 500 meters.The analysis results show that the coverage of public transport services to the area of Jakarta reaches 76% of the total area.This figure is close to the RITJ's public transport service coverage target, i.e., 80%.Specifically related to the health aspect, the coverage of public transport services in Jakarta has reached 93.36% of the location of health facilities.Thus, it can be concluded as a good condition.

Road User Safety and Security
Road user safety and security indicators are analyzed by identifying the number of accidents or injuries caused by traffic accidents [15].Based on the 2021 Jakarta Land Transportation Statistics [2], during the 2016-2020 period, there was an increase in traffic accidents by 6.8% per year.The average material loss each year reached Rp. 17.3 billion.On the other hand, data shows that the growth in the number of fatalities, serious injuries, and material losses decreased from year to year.As an illustration, traffic accidents along 2018 in Jakarta were dominated by motorcycles (60.7%), followed with private cars (22.9%), heavy vehicles (7.9%), public transportation (7%), and bicycles (1.5%) [16].When compared to the national scope, Jakarta Province is ranked 4 th (in 2018) and 2 nd (in 2019) with the highest number of accidents in Indonesia.Therefore, special attention is needed from related parties to reduce the number of accidents and fatalities due to traffic accidents.

Active Mode of Transportation Selection
The development of urban structures in Jabodetabek has brought up many new activity centers.It is predicted that in 2035, the concentration of activities will move to locations outside Jakarta, but the central role of Jakarta remains strong and will continue to be the center of Jabodetabek activities.This condition affects the increase in transportation that encourages people to move to these activity centers.In this case, JUTPI II encourages the provision of adequate public transportation and active transportation (cycling and walking) to anticipate trends in the use of private vehicles.However, the low quality of pedestrian paths and the limited integration between transportation modes are factors that reduce public interest in using active transportation [14].
The lack of public interest in using active and public transportation is reflected in the capital share of commuters in Jabodetabek urban areas.Of the total 1,093,042 commuters in Jakarta, the percentage of commuters who travel on foot is only 0.98% (10,754 commuters) and 0.23% (2,565 commuters) on cycle.The percentage of public transport users is only 20.36% or 222,490 commuters, in contrast to the percentage of private vehicle use consisting of motorcycles and cars which reached 72.11% or 788,175 commuters [17].The low use of active and public transportation would hinder the achievement of the minimum weekly activity target.Whereas the fulfillment of physical activity is needed to reduce the risk of exposure to Non-Communicable Diseases by 16% in Cardiovascular Diseases, 17% in Diabetes, 6% in Breast Cancer, and 20% (men) and 14% (women) in Colon Cancer [18].

The Degree of Public Health Accommodation in Transportation Planning Process
In identifying accommodation of the public health factors in the transportation policy formulation process, an analysis of comparison is made based on the criteria for the policy-making process that accommodates the health aspect [9].

Comparison between the criteria and the existing conditions
The analysis of comparison between the criteria for policy making that accommodate health [19] with the existing condition is presented in Table 4.The table shows that a number of inhabiting factors are constraining the ideal process of public health accommodation in Jakarta transportation planning.The table concludes that among the four criteria of an ideal policy making process, only the criteria of "including and considering the elements of spatial planning in transport policy making" adequately accommodated in the process.Meanwhile, the other three criteria do not adequately accommodated.2. Matrix of actors participating in Jabodetabek transportation policy making Most actors participating in policy making are the government bodies.Other actors involved in RITJ policy making are public transport operators, experts/academics, and the public.Based on the significance of participation at the pre-implementation (policy making) and implementation (postpolicy approval) stages, the participating actors can be grouped into the matrix in Figure 1.The figure shows that public (masyarakat) participation is low, both during the pre-implementation and post-implementation stages.On the other hand, high participation during the pre-implementation and post-implementation stages is dominated by government bodies.The matrix expresses the weak public involvement in transportation planning process, resulting in the limited access for them to express their concern regarding public health.

To do Analysis of Public Health Impact as Policy Making Foundation
Not carried out in making transportation policies The duties and functions of BPTJ are only oriented to the elements of road traffic indicators.Thus, it does not require an analysis of public health impact.
BPTJ more often uses research results as input for policy making so that if there is an urgency to compile a quantitative ADK, it will be more in line with the habits of BPTJ.
There is a perception that ADK = environmental impact analysis (AMDAL) which is not correct.This is because the health analysis in the AMDAL only relates to the construction of infrastructure to obtain environmental permits.Meanwhile, ADK has the scope to predict health impacts in implementing a policy.One example of ADK is in the research of [19], [18] Most of RITJ study models have accommodated scenarios with dependent variables in the form of traffic speed, level of use of public transportation, and traffic volume carried out in the JUTPI II document [14].It is uncommon for the involvement of health elements in the making of transportation policies.not only at BPTJ but also in other agencies.

The COVID-19 pandemic puts the urgency of health factors as an important thing to be accommodated in the formulation of transportation policies Policy makers do not understand the urgency of involving health elements in transportation planning
There is an assumption that elements of public health do not need to be involved as long as transportation infrastructure standards have been met

Health Aspects Accommodation in Jabodetabek Transportation Policy
Perceived appropriateness analysis aims to find out how the parties receiving the intervention and conformity to their preferences.The criteria for improving public health through transportation activities were obtained through a literature study to produce 4 categories of improving health aspects; namely: a) Reduction of air pollution; b) Facilitating transportation access to health facilities and social facilities; c) Improving safety in travel; and d) Encouraging people to use active transportation (public transportation, bicycles, or walking) so as to increase physical Source: this research analysis, 2021.
The analysis results show that policies in RITJ are generally considered as policies that have supported the improvement of respondents' health.Of the 24 strategies in the RITJ, only strategy 7.3 (Increasing the utilization of the Government and Business Entity Cooperation (PPP) scheme and optimizing the use of Corporate Social Responsibility (CSR) funds) is considered as does not significantly affect health improvement.In terms of air pollution reduction, Policy IX (Development of eco-friendly urban transportation) is the only policy considered to have significantly reduced air pollution in Jabodetabek.Meanwhile, in terms of improving safety on travel, Policy I (Improvement of safety and security of urban transportation) and Policy VI (Improvement of traffic performance) are considered to contribute to increasing safety for road users in Jabodetabek.Policy IV (Development of a rail-based urban transportation system) and Policy II (Development of a transportation infrastructure network) are considered to encourage people to use active transportation.The remaining policies (III, V, and VIII) are considered as policies that increase public accessibility to health and social facilities, as well as encourage people to use active transportation.

Conslusions and Recommendations
The analysis of Jakarta public health condition in relation with transportation activities reveals that in general the condition is still acceptable.However, this study notes that PM2.5 air pollutant particles are still exceeding the average Threshold Value (TV) based on the standards of the Meteorology, Climatology, and Geophysics Agency (BMKG).Although public transport service coverage is found to be nearly ideal, this study also notes that the level of active transport modes (walking, bicycling, and public transport) is still low.
Accommodating public health aspects in transportation policy in Jakarta is generally perceived to potentially improve public health.However, the planning process has not been able to guarantee adequate accommodation of public health factors in the transportation policy formulation.From the four criteria of good transport policy making process to accommodate public health factors, only spatial planning consideration found to be adequately accommodated.
Regarding the accommodation of health aspects in the substance of the transportation planning, the analysis results show that policies in RITJ are generally considered as already supported the improvement of public health.The only strategy that is considered to not really success is the utilization of the Government and Business Entity Cooperation (PPP) scheme and the Corporate Social Responsibility (CSR) funds for public health improvement.
The recommendations for reducing the negative impact of transportation activities on urban health problems and future strategy to improve health accommodation in transportation policies making are as follows: 1. Improving Public Health by Intensifying Transport Policy Air pollution reduction, road user safety, and the choice of active transportation modes, can be interpreted as a causal loop [20]; [21].Since RITJ policies are considered to represent the transportation policy criteria, the categories 'Increasing Accessibility to Health Facilities and Social Facilities' and 'Encouraging the Use of Active Transportation' are important to be pushed in the future.Policies to reduce air pollution levels must also be carried out as a support to reduce the adverse impact of transportation on public health.
2. Infiltrating the importance of public health accommodation in the transportation policy-making process.Point D: Optimizing community participation, policy makers must at least involve elements of the community who are directly affected or through interest groups.This is done to communicate the impact of transportation policies, particularly on health impacts.At the technical level, policy makers can also optimize the public complaint channel, namely SP4N Lapor which is managed by the Ombudsman which can be a medium for direct public communication to BPTJ.
Notes: *Section with the highest number of passengers on the route; ** average hourly trains over a 2-hour period (4.00-6.00 in the morning and 16.00-18.00in the afternoon); ***number of trains x number of series (10) x capacity per train (160) (JICA & Coordinating Ministry for Economic Affairs of the Republic of Indonesia, 2019) In terms of the service time, most of public transportation modes in Jakarta have served the public from morning to night.However, in terms of public transport capacity, there is limited capacity as Mode Operating hours Headway Train Commuter Line 04.00 -00.00 5.5 -46 minutes depending on the train route MRT Jakarta 05.00 -22.00 5 minutes during peak hours and 10 minutes during normal hours LRT Jakarta 05.30 -23.00 10 minutes Transjakarta and Mikrotrans 05.00 -22.00 22.00 -04.30(Night Transport) 15 minutes (AMARI) Source: KRL.co.id,LRT Jakarta, Transjakarta, and MRT Jakarta

Figure 1
Figure 1 Matrix of the Significance of the Roles of Actors in Making Transport Policy in Greater Jakarta

Figure 2
Figure 2 Recommendation Framework for Accommodating Public Health Aspects in the Transportation Policy Formulation Process in JabodetabekThis research emphasizes the policy-making process that accommodates more health criteria through the infiltration of ideas from all stakeholders about the health aspect to transportation policy making, as illustrated in Figure2.Point A: Optimizing the role of experts/academics as external parties to trigger the accommodation of health issues in policy making.In this case, experts/academics, based on the results of interviews, are considered as parties who can convey innovations or new ideas in the preparation of transportation policies.Points B and C: This infiltration of ideas can be carried out through two channels, namely through stakeholders who directly handle the transportation sector (Point B) or through stakeholders who are not directly authorized to the transportation sector (Point C), such as National Development Planning Agency, the Coordinating Ministry for the Economy, or the Ministry of Health itself.This model adopts the Kingdom plot where an issue can be included in the policy-making process if it meets the political elements, problem, policy and window of opportunity.Point D: Optimizing community participation, policy makers must at least involve elements of the community who are directly affected or through interest groups.This is done to communicate the impact of transportation policies, particularly on health impacts.At the technical level, policy makers can also optimize the public complaint channel, namely SP4N Lapor which is managed by the Ombudsman which can be a medium for direct public communication to BPTJ.

Table 1
Analysis Methods for Identification of the Existing Transportation Conditions in the Perspective of Public Health

Table 3 Commuter
Line Passenger Demand and Capacity in 2017

Table 4
Implementation, Inhibiting and Supporting Factors for the Implementation of Public Health Accommodation in the Policy Formulation Process

Table 5
Categorization of Stakeholder Roles in Making and Implementing Transportation Policies

Table 6
Respondents Perception of RITJ Policy in Public Health Perspective Margin of Error) in column iii is obtained through calculations with the number of respondents who chose the "Suitable" option for the Conformity to Health Improvement option.

Table 7
Recapitulation of respondents' perceptions of the category of health improvement in policies and strategies at RITJ