Five takeaways from Health in All Policies 2019

Prevention is better than cure’ is a truth universally acknowledged and one that has recently taken centre stage in UK health policymaking. The extent to which we can prevent poor health depends on influencing the wider determinants of health and wellbeing, neatly summarised here…

Social determinants of health

Many of these determinants are within the control of local authorities, underlining the case for a ‘Health in All Policies’ (HiAP) approach which:

‘systematically and explicitly takes into account the health implications of the decisions we make; targets the key social determinants of health; looks for synergies between health and other core objectives and work we do with partners; and tries to avoid causing harm with the aim of improving the health of the population and reducing inequity.’

The recent HiAP 2019 conference at the Royal Society of Medicine sought to identify those synergies. I spoke at HiAP 2019 about the connections between transport and health and the opportunities for collaboration between the two sectors. You can read my presentation here.

Here are five things I took away from the day:

1. Give up power

Throughout the conference was a recognition that, to achieve HiAP, health – and other professionals – need to be willing to give up some power and, where possible, some funding. That might include, for example, the health sector giving up some power to enable other sectors – such as transport, housing, playwork – to tackle the wider determinants of health. It might also include professionals recognising that the amenities, services and places we design must work for the people and communities that we want to see using them. That means co-design, listening and acting on what communities say they need rather than what we think they should have.

2. Social participation is vital for good health

Dr Piroska Ostlin of the World Health Organisation talked about social participation as a key means for, and goal of, health equity. If we ask and act on what communities say they need (which itself is social participation) they are more likely to get out of the house and use it once it is delivered– whether that’s an attractive, well-cared for green space in the neighbourhood or a new bus service. Good public transport, walking and cycling have a vital role in linking people to each other and to opportunities to participate.

3. Place-based, not service-based

In line with HiAP, health policy is increasingly looking to intervene at the level of place rather than individual health services. How can we design our places and provide the amenities required to promote health and wellbeing? This plays directly into our Year of Action on Healthy Streets – an approach that seeks to put people and their health at the heart of the way we design individual streets. At HiAP 2019 I learnt about other models and frameworks that can help us think about how whole places can be designed with health in mind including the TCPA’s 6 elements of healthy places and Scotland’s Place Standard, pictured below. How people travel and move around a place is a central consideration in both frameworks.

Scotland's Place Standard

4. These places are already putting HiAP…

Wales: The Well-being of Future Generations (Wales) Act requires public bodies to think about the long-term impact of their decisions, to work better with people, communities and each other, and to prevent persistent problems such as poverty, health inequalities and climate change.

Norway: Government departments and politicians have a mandatory obligation to take account of health in all policy decisions.

New Zealand: The forthcoming 2019 Budget will place wellbeing, kindness and compassion at its heart. For the first time, alongside GDP, it will measure performance against five key priorities aimed at improving New Zealanders’ quality of life including: supporting mental health; improving child wellbeing; and creating opportunities. Any Minister wanting to spend money must prove it will improve inter-generational wellbeing.

5. Watch out for these…

A raft of new publications and resources are due in summer:

  • The Department for Health and Social Care’s Green Paper on prevention.
  • Public Health England’s Joint Strategic Framework for Health Inequalities (working title). A live, modular resource, the Framework is intended to provide a structure and vision for people working at local level on place-based action to tackle health inequalities.
  • The Health Foundation’s HiAP case studies collection.

For more on the connections between transport and health as well as tools to foster collaboration take a look at our Health and Wellbeing Hub.

Rebecca Fuller

Tackling transport challenges, together

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People will always need to travel to places. So, there is a strong consensus around the need for high quality, integrated urban public transport networks that can support the greener, healthier and more prosperous city regions that we want to see. But the big question is how to sustain a public transport offer when passenger numbers are falling, congestion is rising and resources continue to reduce?

Cooperating in partnerships, with operators and local authorities, and working closely with other regions as the Urban Transport Group, to exchange intelligence and expertise, is one of the ways we can try to achieve more with less. But we need to recognise that responding to the challenges facing us isn’t a case of one size fits all. On the contrary, to stimulate growth, more than ever we now need to understand local markets, and their demands and needs, in order to meet them.

Investment is critical: investment in research into public travel patterns and preferences; investment in attractive infrastructure; and investment in people and embracing diversity, to sustain a strong industry workforce that strengthens the transport skill and knowledge base to generate new ideas and take a fresh approach.

Collective insight and analysis can help policy makers and providers offer modes of transport that are competitive with, or even better than, the alternative. Everyone’s familiar with the climate rhetoric, but more needs to be done to make the grass look greener if travel behaviour is to change. It’s about increasing awareness around the impact an individual’s travel choice has on the whole community, and the benefits an efficient and integrated public transport network can bring to all – by reducing congestion on roads, for bus users and car drivers, whilst contributing towards cleaner air and a healthier community.

Research shows that using public transport helps to integrate physical activity into a daily routine, because most walk or cycle to and from bus, tram or train stops. This is an easy way to try and achieve the British Heart Foundation’s recommended 150 minutes of moderate exercise per week. People who travel by bus, tram or train are ‘happier’ too, according to a study from the University of East Anglia – simply because they have more time for mindfulness, to relax and to concentrate on themselves.

Among other factors, we’re working against a rise in car ownership, a shift in people’s expectations for more bespoke and on demand services, fare prices, increased online shopping, different work patterns and reduced investment. All of this impacts on public transport. Given this environment, it’s vital that transport leaders influence and shape what’s in their backyard and maximise every opportunity to affect change. South Yorkshire Passenger Transport Executive (SYPTE) is supporting Sheffield City Region’s Mayoral Combined Authority in a bid for the Transforming Cities Fund, combining public transport improvements with a wider development and growth plan. Part of this would see investment in a cleaner fleet of buses. They’ll run on the most polluted corridors around the region, connecting people to employment and education, whilst contributing to air quality and congestion issues. It’s a step in the right direction. As is our Active Travel campaign, encouraging people to make small changes to the way they travel to bring big benefits for themselves and their environment.

In times of less resources, the way ahead is to share them. Together we can tackle the challenges to transform public transport. Today, and for future generations.

Stephen Edwards is Executive Director at SYPTE and the new Chair of Urban Transport Group

Read Stephen’s biography here

The secret life of the street – and what we need to know to make future streets work

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For a couple of years now I have been banging on about the need for a debate on future streets (i.e. about how best to reconcile the complexities of all the different calls on street space – or more accurately the space between the buildings).  So I am pleased to see that this is an issue that has now caught fire with two projects under the ‘future streets’ banner (one from ITS Leeds and one from UCL) as well as a London conference on future streets that we are sponsoring.

On Tuesday I took part in a seminar at the Chartered Institution of Highways and Transportation (CIHT) on the outcomes, so far, of the ITS project which will hopefully result in guidance for authorities.

I thought reconciling the different demands on road space was complex before I went into the room. However, I left the room realising it was even more so than I had initially thought. I went in thinking that streets need to accommodate the different needs of different types of vehicles – buses, taxis, bicycles, powered two wheelers, cars, freight and logistics, as well as the different types of users including people with disabilities, and different objectives such as clean air, crime reduction, thriving high streets, reduced carbon emissions, provision for electric vehicles, provision of connected and autonomous vehicles, healthier streets and more…

However, all these are in principle broad brush issues. What the seminar taught me was that there are so many other variables – for example dealing with the unusual (funeral corteges, removal vans, deliveries that take time such as beer to pubs, skips). There is also street furniture, the paraphernalia that shops and cafes put in front of their premises, street beautification (raised planters, etc.), and emergency services needs. And all these complex needs and variables play out differently on different streets and at different times of the day.

ITS had an A3 sheet with a closely typed list of factors to consider (which got longer by the end of the day) when looking at the street of today – never mind the streets of the future. All of which suggests firstly the need for a more sophisticated and holistic approach to street management (rather than single issue, for example ‘we need to get a lot of EV chargers in ASAP’). Secondly, there is a need for more people to observe how each busy street operates now, to think deeply about how to make it work better (what trade offs need to be made on the basis of what priorities) and then make it happen (not forgetting the need for on-going management, enforcement, maintenance and adjustment).

future streets long list (jonathan bray)

Here are five further thoughts from the day…

  1. Parking and loading regulation is shouty, complicated and often ambiguous (what happens if you park on a cycle lane? What is the status of the shop forecourt in front of the shop but behind the curb line?). This can lead to people going round what they see as the regulated parts of the road space (even free parking bays) and parking on what they see as sitting outside the regulated areas (including pavements). Bus lanes can often be something that people see as very clearly a regulated and enforced space – which leads to the phenomena of people not driving in bus lanes even when they are not in operation. Some drivers are perhaps pavement parking out of consideration for their fellow drivers (i.e. to make space for them to park or pass) without thinking about the impacts on pedestrians. All of which suggests there could be a need for more research into the deeper reasons behind what makes drivers do what they do (including etiquette, peer pressure, fear of embarrassment, etc.).
  2. A lot of British streetscapes are so ugly and dilapidated that drivers may be making the unconscious decision that some ugly parking behaviour isn’t going to make them any worse.
  3. Physical signs and lines to regulate the road space create clutter, are not always read or understood by drivers and are inflexible (i.e. it is difficult to change the use of space at different times of the day or to allow two or more different functions for the same space). Digitalising the allocation and regulation of road space (including through geo-fencing) would make sense in that it would be clearer, more flexible and less ugly. However, the extent of data sharing necessary (and the knock on concerns about data ownership and privacy) is daunting.
  4. The current limitations on taxi and PHV pick up and drop off are few and mostly unobserved. If taxis and PHVs grow further then the problems caused by dropping off and picking up anywhere will grow. And how will taxi share work in practice if multiple taxis are trying to pick up / drop off different people from the same area of curb space?
  5. The enforcement of parking and loading regulation is constantly demonised by the media and by some politicians. But then the case is rarely made for it in a positive and pro-active way, and its complexity, ambiguities and its officious language and branding isn’t helping. Is there a need for a comprehensive rethink about how parking and loading restrictions and enforcement is communicated to the public as something that is there to help streets thrive and keep moving in a safe way? This is something that might relate to further research into how drivers feel about the regulation of streets.

Roll on the Future Streets conference on February 12. This is a topic where we need to revel in exploring all its complexities before we can make progress.

Jonathan Bray is Director of the Urban Transport Group.

You can find out more information and register for the Future Streets conference here.