Welcome!
THE SCIENCE AND THE ART OF I NTERSECTORAL
COLLABORATION ON TRANSPORT PLANNING AND HEALTH
W I T H A D R I A N D AV I S B A , P H D F F P H
V I S I T I N G P R O F E S S O R O F T R A N S P O R T & H E A LT H , & S E N I O R F E L L O W,
UNIVERSITY OF THE WEST OF ENGLAND
Learning outcomes
To have identified some specific issues
with which public health staff can
engage better with transport planning
colleagues
To identify shared agendas and
opportunities for intersectoral
collaboration with transport planners
The opportunity
• Transport professionals can help tackle the
growth in non-communicable disease
especially through helping change
environments and behaviours to increase
active travel
• Public health can offer different skill sets inc.
for behaviour change, robust evidence and
other support mechanisms
The Guidance
 Ways in Which Transport Influences Health
 Health Promoting
Health Damaging
 Enables access to:
Injuries
physical activity
Sedentary lifestyles + weight gain
employment, shops,
Pollution:
goods, education,
other services,
countryside
particulates, carbon
monoxide and
nitrogen oxides
social (support) networks
travel
hydrocarbon and ozone, active
carbon dioxide, lead, benzene
well-being
Climate change
Noise and vibration
Stress and anxiety
Traffic danger
Loss of land and planning
blight
Severance of communities by
motor traffic
Road transport & health
Physical activity: Our greatest defence
Physical Activity contribution to reduction in risk of mortality and long term conditions
Disease
Risk reduction
Strength of evidence
Death
20-35%
Strong
CHD and Stroke
20-35%
Strong
Type 2 Diabetes
35-40%
Strong
Colon Cancer
30-50%
Strong
Breast Cancer
20%
Strong
Hip Fracture
36-68%
Moderate
Depression
20-30%
Moderate
33%
Strong
20-30%
Moderate
Functional limitation, elderly
30%
Strong
Prevention of falls
30%
Strong
22-80%
Moderate
Hypertension
Alzheimer’s Disease
Osteoarthritis disability
A
START ACTIVE, STAY ACTIVE (2011) BASED ON US DEPARTMENT OF HEALTH AND HUMAN SERVICES PHYSICAL
7
ACTIVITY GUIDELINES ADVISORY COMMITTEE REPORT (2008), WASHINGTON D.C.
The risk of premature death though physical
inactivity compared to road casualties
Deaths, 2008
Deaths, 2008
cyclists killed on road*
115
All road users**
2538
CHD attributed to inactivity***
32647
35000
Cancers
10000
Stroke
10000
30000
To update the chart, enter data into this table. The data is automatically saved in the chart.
25000
20000
15000
10000
5000
0
cyclists killed on
road*
All road users**
CHD attributed to
inactivity***
Cancers
Stroke
Source: * **DfT Road Traffic Casualties 2009 *** BHF statistics 2010 edition; McPherson et al 2002.
Why is active travel
important?
•Physical inactivity directly contributes to one in six deaths in
the UK and costs £7.4 billion a year to business and wider
society
•The growth in road transport has been a major factor in
reducing levels of physical activity and increasing obesity
•Short car trips (under 5 miles) are a prime area for switching
to active travel and to public transport
•Health promoting transport systems are pro-business and
support economic prosperity. They enable optimal travel to
work with less congestion, collisions, pollution, and they
support a healthier workforce
Benefits and risks: modeling
•
•
•
Physical activity ‘by far’ the most important
“Concern about pollution exposure…is unfounded when
compared to the benefits of the cycling activity”
Only includes mortality so total benefits likely to be much higher
◦
Access
 Access = Transport’s primary function is in
connecting people, goods and services. This itself
allows the activities for which people travel to
happen.
 Described as exchange opportunities - people are
entitled to the protection of their right to a just and
equitable share of exchange opportunities
(Engwicht, 1992).
 Can be achieved best where distances are short ie
high density settlements
Mobility
The focus of English transport policy since the
1940s has been on increasing mobility.
Mobility - measured through distance
travelled but of itself does not necessarily
lead to accessibility.
Focus on mobility has had effect of increasing
the ability of some groups to travel - by car,
plane and, to a degree, by other forms of
public transport.
The bad news
Health is not intrinsically a
policy driver of transport
planning or considered
seriously as such among most
transport planners
But… the policy drivers are…
 Economic growth
 Carbon reduction
 Congestion reduction
 Air quality
 Safety and health
 Health particularly appears with Local Transport as a ‘sustainable
transport mode’
 Need to identify ways to align health with these! (Co-benefits agenda)
https://www.gov.uk/government/publications/healthy-lives-healthy-people-improving-outcomes-and-supporting-transparency
Jargon…
 Mobility =
a measure of km travelled
 Investment =
roads and rail
 Subsidy =
public transport
 LSTF
Local Sustainable Transport Fund
 Suppressed demand
People wishing to travel by a mode but
not
 Filtered permeability
direct access to those on foot and on
bicycles but not for those in private
motorised transport

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








JSNA
PHOF
Inverse Care Law
Dose response curve
Co-benefits
Disease Burden
HEAT
PAR
Comorbidities
Aetiology
Evidence Hierarchy
Utilising co-benefits
Children,
MVPA and
academic
attainment
19
Utilising Co-benefits
Issue
Impact of active travel
Traffic congestion
Reduces
Local air quality
Improves
Carbon emissions
Reduces
Road casualties
Reduces
Social cohesion
Improves
Public realm
Improves
Quality of life
Improves
Source: Revised from National Obesity Observatory, 2013 A Briefing for Local
Authority Elected Members. London: Public Health England.
Active Travel integration across Transport, Planning and
other Council policies
Housing
Strategy
Public
Transport
Strategy
Resilience
to future
shocks
Road
Safety
School
Travel
Parking
Management
Urban
Realm
Active
Travel
Education
Policy
Spatial
Planning
Core
Strategy
Play
Policy
Transport
Policy
New Ways of Thinking about the Built Environment
Evidence based practice
Safe System Approach promoted by WHO, OECD
Underpins Vision Zero (Sweden) and Sustainable Safety (
Netherlands) road safety strategies
Underpinned by evidence that greatest effect is achieved by
addressing all road users (not outliers) – ie a population level
strategy
Vision: Bristol should be a city safe for a 10 year old to walk
independently to school
Agenda for Action
Key tasks: Policies
•Active travel should be enshrined in transport policies (and budgets);
•Encourage new and existing developments to maximise opportunities for
active travel with appropriate infrastructure (eg cycle lanes, cycle parking);
•Ensure that Travel Plans for new developments (including schools) prioritise
and support active travel over car transport as part of designing safe and
attractive neighbourhoods.
Key tasks: Implementation
•Ensure that new developments don’t adversely affect capacity and safety of
surrounding cycling networks;
•Support 20mph speed limits in residential areas, and promote road safety in
urban and rural settlements to complement school policies on safe and
active travel;
•Ensure monitoring and evaluating – eg the use of Travel Plans.
For Public Health professionals
•Engage with your transport planning team and contribute to any
refreshes of the Local Transport Plan;
•Assess the likely impact of the Local Transport Plan (LTP);
•Support bidding to Government agencies for sustainable transport
initiatives;
•Support the involvement of transport planning colleagues in JSNAs,
health and wellbeing boards and strategies, and demonstrate the links
between Public Health Outcomes Framework and transport planning
goals;
•Provide evidence-based summaries and modelling tools such as the
WHO HEAT tool on key transport issues and/or work with local
university departments in providing this function.
www.travelwest.info/evidence
www
Being there
Windows of opportunity - to get health impacts
included
Being a source of EVIDENCE (eg Cycling City/ Local
Sustainable Transport Fund bids/ Access Fund)
Building trust
Changing departmental thinking about health
Cost effective
Building appropriate relationships
The Boss?
PEAK
RAPPORT
Trust
Increases
FEELINGS
AND EMOTIONS
OPINIONS
AND JUDGEMENTS
FACTS AND INFORMATION
RITUALS AND CLICHES
OPPONENTS
Exercise
What are your top five items to take forward with
your transport planning colleagues and evidence
for?
Rank them 1 to 5 (with 1 being top) and give the
reasons why you have chosen each.
Consider how important or not each might be to
Transport Planners on a 1 to 5 scale of very
important = 1 to No priority at all = 5
Joint Transport and Health Workshop
top items to take forward
Use of Health Economic Assessment Tool
http://heatwalkingcycling.org/
20mph – ‘a little bit slower, a whole lot better’ -£1530k campaign
New Residents travel behaviour and accessibility
maps
Social Isolation/social capital
Children and road traffic injuries
Obesity
Top actions
 Health Economic Assessment Tool – get trained
up and try to embed its use – for walking and
cycling networks across the authority
 Targeting sub-groups of the population as
identified in the JSNA possibly applying social
marketing approaches with an emphasis on fun
and freedom, possible use of pester power to
parents
Top actions
 Cycling and families – following on from Bike It
(or more of it) - as family activity
 20 mph speed limits (signs only) – build on
change of policy position by the authority to
push a ‘slow-burn’ agenda supporting 20mph
speed limits – maybe on multi-pronged basis –
to increase physical activity, improve social
connectivity, & for reduced traffic danger.