Bus Stop to Better Health

Waiting for the busIn this special guest post, Nick Bosanquet, Emeritus Professor of Health Policy at Imperial College sets out ways in which transport support could be used to connect people to work and therefore to better health.

The great health divide

There is a huge hidden problem of economic loss and wasted potential in the UK. At present 18 per cent of the adult working age population are out of the workforce permanently and another 7 per cent are unemployed. This is the great health divide.

There is a spiral of decline by which inactivity leads to worsening of health, poor diet and ever lower activity. Long term medical conditions affect those out of the workforce so that within a few years, levels of disability are 50 per cent in the inactive group. There is a great deal of misery and wasted human potential as well as higher mortality.

Economic inactivity creates a major burden in the form of increased welfare payments and loss of output. If the inactivity rate were the same across the UK as in the South East—around 9 per cent—the net gain to the public sector would be £100bn in reduced support payments and increased tax revenues.

If policy makers are serious about health inequality and poverty they have got to make a priority of providing assistance back into the workforce. Given that around half of households in the lowest income quintile have no access to a car or van, support to connect to employment opportunities using public transport, cycling and walking should form a key component of this assistance.

What might such a programme look like?

A new back-to-work rehabilitation programme

Working in partnership with other sectors  (including transport) the Department of Health, NHS England and the Department for Work and Pensions could develop special investment programmes for jobseekers including counselling and a special 12 week back-to-work rehabilitation programme.

The programme would need to reflect the complex range of barriers to employment faced by each individual – from childcare to housing issues. From a transport perspective, the programme could, for example, include personalised journey planning support to broaden travel horizons and help people understand the range of opportunities they can reach using public transport, walking and cycling. It could also include three month back-to-work travel passes to help meet the costs of travelling to interviews and travel costs during the first weeks of a new job.

The precise format of support should be informed by research into how people outside of the workforce view their main transport problems as well as by a consultation on the most cost effective means of providing transport support to jobseekers.

WorkWise signSuch a consultation could draw on the expertise of PTEs who have a long and successful track record of developing local initiatives that help unemployed people into work by removing transport barriers (WorkWise schemes, for example).

There is an opportunity for supporting these existing local schemes as well as further creative approaches which show how localism can produce results on an intractable problem that Whitehall policies have struggled with over the last 20 years. PTEs understand their local communities and the transport barriers they may face and are well placed to tailor interventions accordingly.

Greater integration between transport and health

These new back-to-work programmes could form part of a broader drive towards greater integration between the health and transport sectors.

GPs now have more power though the Clinical Commissioning Groups, whilst Directors of Public Health have a ring-fenced budget for spending on public health interventions. These powers could be used to commission provision that supports people back into employment or encourages them to become more active through everyday activities like walking and cycling.

There needs to be an organized drive across government on improving travel to work to assist more people back into the workforce. The next few years give an excellent opportunity to help those outside the workforce to share in the recovery.

Professor Nick Bosanquet