Health in All Policies – the transport connection

A few quick reflections on the thought provoking Health in All Policies conference we were a sponsor of on Wednesday and which our AD Rebecca Fuller spoke at (as part of our long term aim of getting better coordination across the health and transport sectors) 

– shamefully, health inequalities in this country are getting worse 

– all the focus in the public and media debate health is on clinical care (thus on transport the focus is air ambulances and free hospital parking) whereas the relative quality of clinical care is not the main factor in health outcomes. It’s wider economic, environmental and public health factors. The right transport policies can contribute to all these factors (such as promotion of active travel and healthy streets)

– having said that ‘social prescribing’ for some health problems is in vogue, as is a more place based approach to recent health reforms, which could help

– there’s a long way to go in getting the two sectors to understand what makes the other sector tick and although there is good guidance out there (including our transport and health hub on the UTG website) how do we get greater awareness of what’s our there?

Lots more to do then but with the CEO of NHS England now on record as saying the NHS has to reduce its environmental and transport impacts there’s some ways forward too. On which more soon!

 

Fostering Trust for Total Transport

Here at UTG, we’ve been talking about Total Transport for a long time, with our flagship report on this in 2011. And then, in 2015, DfT announced funding for a series of Total Transport Pilots, eventually funding 37 projects in 36 areas. These two year pilot projects, focused on rural areas, are now coming to an end, but much can be learnt from the successes and failures of these projects. A recent CIHT event focused on this very area.

For me, the highlight of the event was hearing directly from the authorities developing the Total Transport Pilots, both Devon County Council and Northamptonshire presented on the day.

In Northamptonshire they have taken a data driven approach to understanding the current transport needs in the region and identifying how a Total Transport approach might help to make operations more efficient. Uniquely within the pilots, the Network Northamptonshire project has established a Community Interest Company to deliver their project, allowing more room to innovate and try out different things, and also offering the opportunity to generate profits which can be re-invested in transport. They emphasise the need for leadership buy-in for a successful project of this kind.

Within Devon, the focus has been on improving health related transport. This has been undertaken by moving patient transport into the County Council’s Transport Coordination Service and changing the way that patient transport is commissioned. This has resulted in a reduction in complaints about patient transport to PALS, showing positive improvements in service delivery. But working with health has not been easy, and establishing effective working relationships was important in laying the foundations for this coordination.

We’ve recent produced a report with the Community Transport Association, looking at how Total Transport approaches can improve delivery of non-emergency patient transport. This included highlighting good practice examples from the pilot projects, such as Northamptonshire and Devon County Council.

There are clearly many barriers to Total Transport approaches, and these pilot projects have demonstrated this. But developing these projects as pilots have allowed partners to be creative and innovative, identifying the barriers and challenges throughout.

One thing that particularly struck me at the CIHT event was the recurrence of the theme of trust. Trust between partners was identified as critical to successful projects, particularly where cross-sectoral working was required. Working across transport and health has repeatedly been shown to be challenging, not just for Total Transport. Fostering effective relationships is at the heart of successful Total Transport approaches, and these pilot projects have shown that without trust, this may not succeed.

Moving forwards on transport and health

When we talk about transport and health it can feel like we’re in a hamster wheel of transport improves health, we could spend money from health budgets to improve transport and save health money, let’s get people active to improve health outcomes etcetera, etcetera… We talk about needing evidence, and being able to quantify the benefits. But we KNOW that getting people active and using public transport has benefits for public health and much, much more. So what’s stopping us? I attended the ‘Sustainable Transport and Health Summit’ last week in Bristol and some specific things struck me regarding the barriers to moving forward on these agendas and how we might start to overcome them.

Many people talk about needing a common language to bring together practitioners in transport and health. Technical language and a whole different flavour of acronym soup means that drawing the agenda together to work for common outcomes has been challenging at best and often seen as just too difficult to attempt. However, as someone recently pointed out, ‘we have a common language, it’s called plain English’. And, for me, they’ve hit the nail right on the head. If we can make the case for the co-benefits of transport and health in a clear, and non-technical way, then perhaps we can sell the vision of cities where active and public transport work together to improve health outcomes.

TfL’s Healthy Streets approach does just that. It makes the case for ensuring that streets are healthy places, using 10 simple indicators, see below. From ease of crossing to clean air and places to sit and rest, the indicators are simple and accessible to those of any background. And none of these indicators are controversial, who wouldn’t want a street that is quiet, feels safe and has things to see and do? And if there are health benefits in the process then great!

healthy-streets

We need political vision. Prioritisation of health in transport is picking up pace in London with the backing of a Mayor who has shown leadership and commitment to these issues and is driving forward the Healthy Streets approach. Urban transport authorities more widely have the potential to drive forward the health and transport agenda however they will need the powers and funding to deliver on this.

On evidence, there is a wealth of evidence making the case that transport can improve health. We’ve collected some of that on our web hub for health and transport. In addition, there are tools available which can be used to make the economic case for investment in active travel, including the HEAT tool (Health Economic Assessment Tool).

Here at the Urban Transport Group, we believe that transport can, and should, be working to deliver health outcomes. As such, we’ve committed to continue work on this agenda, starting out by updating and refreshing our web hub and promoting TfL’s Healthy Streets approach beyond London. If you’d like to find out more check out our resources and / or get in touch, we need to continue these conversations and keep this on the agenda!