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

Transport should be at the heart of new developments – and here’s how

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What is transit oriented development?

You might not instantly recognise this American term, but if you’ve been to the new development north of London’s King’s Cross station, then you’ll know what one looks like. Although still not fully completed, this once unused industrial site represents a flagship transit oriented development – the principle of putting public transport front and centre in residential and commercial developments, with the aim of maximising access by public transport, encouraging walking and cycling, and minimising the need to own and use private cars. With its shops, restaurants, offices (Google is located here), public sector organisations (Camden Council has offices here) and excellent public realm – all located within striking distance of plentiful transport options such as rail, tube, buses and active travel infrastructure like cycle superhighways, it certainly fits the bill.

Transit oriented development is not only found in large world cities. Northstowe, in Cambridgeshire, is part of the NHS Healthy New Towns programme, which aims to encourage active lifestyles and incorporate healthcare facilities into new town developments. Good public transport options are available here via the Cambridgeshire Guided Busway and the nearby Cambridge North Railway Station. And in West Yorkshire, a new railway station at Kirkstall Forge outside of Leeds, is part of a new transit oriented development which, on completion, will provide over 1,000 new homes, 300,000 square feet of office space and 100,000 square feet of retail, leisure and community facilities, including a school – all just a six minute ride train journey from the city centre.

Our new report – The place to be: How transit oriented development can support good growth in the city regions – looks at how ‘Transit oriented development’ can help meet housing demand and reduce car-based urban sprawl, and provides examples like these, and many more.

For instance, Vauban in Freiburg, Germany, is a transit oriented development which prioritises walking and cycling by having low speed limits. The area is served by a high frequency tram and all homes are within 400 meters of a tram stop. This integration of sustainable transport means that car ownership is low, at 150 cars per 1,000 residents, compared to 270 for Freiburg as a whole.

So, integrating public transport into new developments, along with providing urban realm that encourages walking and cycling, can help us move away from a car based sprawl approach to delivering new housing, one which locks residents into car-based lifestyles and exacerbates the challenges of congestion and poor air quality in our cities. We’ve identified seven key success factors for transit oriented development schemes in our new report, including: integration of public transport, support for walking and cycling and discouraging car ownership and use, high density development on brownfield sites, integration of services and the involvement of the public sector. You can see these in our new infographic below (which can be downloaded here).

ugt tod info-graphic

But how exactly do we go about achieving such developments, and overcome some of the barriers?

Our members – city region transport authorities – have an important role to play, as they are often some of the biggest land and property owners in the cities they serve. In order for them to make transit oriented developments happen, they need:

  • a national planning framework that favours transit oriented development rather than car-based low density sprawl
  • a national funding framework with more options for ensuring that value uplift from new developments can be used to improve transport connectivity – like we have seen with Crossrail in London and in places like San Francisco’s Bay Area. In particular, we need a joint programme of work between city regions and national Government to examine the issues, and develop the options, on land value capture mechanisms.
  • more influence over land held by agencies of national Government which would be prime sites for transit oriented development schemes. We’d like city region authorities in England to have the same veto powers over Network Rail land sales that the Scottish Government currently enjoys.
  • more devolution of powers over stations where a city region transport authority has the ambition and capacity to take on those responsibilities.
  • measures to improve the planning capacity of local authorities in order to respond effectively, rapidly and imaginatively to opportunities for high quality transit oriented development.

As our Chair Tobyn Hughes notes, transit oriented developments are “an idea whose time has truly come”… but if we are to embark on a new era of transit oriented developments, and realise the benefits they can bring, we must overcome these obstacles. We hope that by following these recommendations, we can usher in this new era.

Clare Linton is Researcher at Urban Transport Group

(Picture top: R~P~M via Flickr)