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

Transport accessibility – postcards from academia

Academics want to let policy-makers know what they’ve been researching and what they’ve learnt. Policy-makers want to hear from academics, but don’t want to plough through impenetrable journal articles and research papers. Instead, they’d like the equivalent of the occasional postcard – keeping them up-to-date on what’s going on and summarising the information likely to be of most interest to them.

A recent seminar hosted by UCL (in collaboration with the Department for Transport) attempted to do just that. It gathered together policy-makers and delivered a series of quick presentations (by Professor Peter Jones, Professor Roger Mackett, Dr Catherine Holloway and Dr Kayvan Karimiho) on the latest insights to have emerged from the University’s research into transport accessibility. Here are some of the key points that struck a chord with me.

Conceptualising accessibility

Transport accessibility is multi-faceted – it concerns the physical environment (can I board this bus? Can I use these stairs to reach the train platform?) but also the affordability (can I afford this journey?); acceptability (do I want to walk down this street?); and availability (can I get to my appointment in time?) of transport services (we explore each of these aspects in our report, ‘Transport and Social Inclusion: Have we made the connections in our cities?’).

Steep steps

Accessibility is a continuum. You may be able to climb these stairs 95% of the time – but add tiredness, heavy shopping or an injury and they become inaccessible.

Transport accessibility is an issue for all of us. Dr Catherine Holloway described accessibility as a continuum – all of us will experience inaccessibility at some point. The example of stairs was used – stairs might be accessible to you 95% of the time, but the other 5% they become inaccessible because you’re too tired to climb them, or you’re carrying something heavy. Fares are another example – if they become too expensive, some people will be priced out and that mode of transport will become inaccessible to them.

For Professor Peter Jones, transport accessibility can be broken down into three levels – macro, meso and micro.

Macro is the strategic level of accessibility. It looks at the big picture – the planning of transport networks that enable people to make the connections they need to get to the places they want to go at the times they want to go there.

Meso concerns the accessibility of the neighbourhood or street level – for example, are there busy roads that people are reluctant to cross? Are the streets well lit at night?

Finally, micro looks at the accessibility of things like vehicles and infrastructure – for example, are buses low floor? Are ticket machines user-friendly?

Beat the clock

Focusing in on the macro level, Professor Jones illustrated how timing constraints experienced by individuals have a big impact on their ability to access services using the transport network. He highlighted the packed schedules we keep – we have to fit in the many things we need to do with the hours that services operate. Think, for example, of a busy working parent. They’ll be at work most of the day and will also need to fit in taking children to and from childcare or school. This leaves very small windows to fit in things like hospital appointments, for example. The windows that are available in their schedule may not correspond to when services are open. These windows are smaller still if the person doesn’t have access to a car and is therefore further constrained by when, and where, public transport runs (and how long it takes).

Accessibility is as much about where, when and how services are delivered as it is about providing transport connections to those services. Professor Jones reminded us that one way to overcome people’s timing constraints is to bring the services to the people (rather than the people to the services).

Inside Hillingdon mobile library

A mobile library in Hillingdon – changes to how, where and when services are delivered are as important as transport links in promoting accessibility

Once upon a time we had to travel to collect water from a well, now we have it piped directly into our homes. A more up-to-date example is online grocery shopping where we can select a delivery slot that suits our schedule rather than travelling to the shop. Indeed the internet is allowing us to access a wide range of services remotely, such as attending appointments with hospital specialists remotely via local GP surgeries. Services can also be made mobile – by no means a new idea of course – I have fond memories of the mobile library van parking at the top of my street, not to mention ‘the freezer man’ with his van full of chocolate mousse, fish fingers and other frozen delights.

Gold age pensioners

One group that you might expect to be less time constrained than most is older, retired people – however, as Professor Roger Mackett’s presentation showed, this group are far from idle. Older people cost the nation £136bn but, according to a report by WRVS (called ‘Gold Age Pensioners’) they contribute £176bn. This contribution comes in the form of consumer spending, unpaid childcare and adult social care and a wealth of volunteering. Professor Mackett argued that the easier we can make it for this group to travel, the more contribution they can make.

The free bus pass for older people undoubtedly assists with this – offering freedom and confidence to travel further. It also, he points out, eases the transition from ‘driving’ to ‘not driving’ allowing people to take the bus for trips they no longer want to make by car (for example, they may wish to avoid night driving).

Older people on a station platform with their Grandchildren

The more journeys older people are able to make, the greater their potential contribution to the economy.

He showed data indicating that as people age, they make more shopping and leisure trips – trips that are of great value to the economy. When asked what sort of trips they would like to make more of, older people said visits to friends and family. According to surveys, a lack of direct transport options is what limits older people the most in making these trips. What could we do to facilitate these suburb-to-suburb, rather than suburb-to-centre trips?

Professor Mackett also noted that the majority of older people do not have an impairment and that those they do have are frequently ones we should easily be able to design for and accommodate. Older people may have difficulties with mobility, lifting and dexterity. How might we design ticket machines, for example, to be easy to use for people with limited dexterity? Such designs are likely to be easier for everybody.

Street life

Professor Mackett’s presentation also looked at the accessibility of the street environment. UCL conducted a study in St Albans, mapping the streets and identifying lots of small barriers that could be making a big difference to people’s mobility. This could be anything from a poorly lit street to an A-board obstructing the pavement.

Professor Jones added that people are prepared to walk, on average, an extra 2.2 minutes just to avoid crossing a busy road. People are prepared to walk three times further to avoid poorly lit streets (rising to five times further among women).

St Albans City and District Council took the findings of UCL’s street audit on board and used it to inform their Public Realm Delivery Strategy, which includes measures like installing benches every 100 metres to allow people rest stops along their journey.

St Albans’ approach chimes with the Dr Kayvan Karimiho’s belief that city planners should not just plan for accessibility, but use accessibility to plan, designing street layouts and transport networks that correspond to the way people naturally want to move about.

In his presentation, Karimiho described how, when walking or cycling, people prefer to take the smoothest, rather than the quickest route to their destination. When we look at a map, we choose a route with the most straight smooth lines, with fewer twists and turns down back streets. However, modelling of accessibility tends to be based on the shortest routes from A to B, rather than the way people actually move. Dr Karimiho’s methods and mapping reveal these real-world movements which can then inform street layouts and transport networks that maximise accessibility.

Pedestrian movement on a map

An example of Dr Karimiho’s approach to pedestrian movement analysis, showing the smooth paths people tend to take. (Source: http://www.spacesyntax.com)

UCL’s work in this area is assisted by Pamela (Pedestrian Accessibility Movement Environment Laboratory). This is UCL’s artificial street environment where researchers can test how people interact with their environment in real world situations. It can be used to model, for example, passenger boarding and alighting from public transport vehicles, shared space schemes and even the effects of mobile phone use on pedestrians.

Next steps

The seminar ended with a determination to organise more such information sharing events, something that, along with the recent launch of the ‘What works’ initiative by the Government, seems part of a wider trend to bridge the gap between policy-making and academic study. The ‘What works’ evidence centres for social policy will produce and disseminate research to local decision-makers, supporting them to invest in the services known to produce the best outcomes. We can therefore look forward to receiving many more postcards from what can sometimes seem a faraway place.

Rebecca Fuller

Ten years of the pteg Support Unit: Part three

In the last of a series of three blog posts, pteg Support Unit Director Jonathan Bray concludes his look back over ten years of the pteg Support Unit.

Ten years of pteg: the way we work and the way cities will work in the future

Evening city scene - Liverpool

Focus on what transport does for people, economies, cities, the environment and society.

The way we work

  • ‘Train hard, fight easy’. You need your stats, your evidence, your best arguments in place before you start to engage in a policy debate.
  • If you want to achieve policy change you need to be sharper, more relentless and be better at strategy than those who seek to defend the status quo because the incumbents always have the advantage and usually have greater resources.
  • Get the right staff. When your resources are limited and everything you do should be better than the incumbants (see above!) you need to make sure you have the right staff – so we put the time and effort into recruitment and got the right staff.
  • Press every button. It’s hard to know exactly why suddenly old policy consensus crumbles and new ones are established – so press every button available to you from reports, use of the media, stakeholder engagement – the lot.
  • Don’t commission research as a displacement activity or leave whoever is writing it to their own devices. Or let it sit on the shelf when done. Go through the pain barrier with whoever is working on it to ensure it fits the bill and then use it as the bedrock for the work you do in that area for the next couple of years at least. And find ways to get people to read it once it’s published.
  • Don’t go on about transport too much. Transport people love transport detail. The rest of the world doesn’t care. They are interested in what transport does for them, their economy, their cities, their environment, their society, the world they live in. Focus on that.

Building our reputation and effectiveness

pteg reports (Picture: Brainstorm Design)

Our reports have set a direction for emerging policy areas, like Total Transport (Picture: Brainstorm Design)

The Support Unit isn’t big, pteg may not always be liked – but we are good at what we do, we are a force to be reckoned with, we’ve saved our members millions and we have made the weather across a range of urban transport policy issues. Some of what’s been achieved is covered elsewhere in the previous parts of this blogpost, but it’s also been gratifying how we’ve been able to set a direction for emerging policy areas through focussed research and policy documents and through painstaking work to get internal and external stakeholders on board. Three examples:

  • In my view our work on social inclusion and transport over the decade (and in particular on young people in the last few years) has been the most lucid, consistent and focussed from any UK body in setting out the key challenges and how best they can be addressed
  • Our 2011 report on ‘Total Transport’ remains the primary document on pooling vehicle fleets and budgets
  • Our work on the opportunities for transport from the devolution of public health responsibilities is encapsulated in a hub on our website which provides the best introduction out there to local transport authority officers on what they can achieve in this area.

Smart cities / smart grid / smart transport

What seemed very far away now seems much closer. Cities with smart grids based on renewable energy powering largely electric transport systems. Mobile phones giving access to all forms of transport (from rental electric cars and bikes to public transport). Roads which are more social spaces than channels for cars. And this future is starting to form itself in big cities like Berlin. These kinds of developments transform the whole nature of the transport debate and open up some exciting opportunities for transport authorities to take the lead in guiding these changes in a way that maximises the benefits. There’s more on all of this in our recent blogpost on ‘Three global transport trends that should reshape our cities’.

Electric car, Berlin

Smart cities: there for the taking

So near…

Our city regions are not so far as it might sometimes seem from emulating what London takes for granted. Not in terms of underground rail networks and the scale of provision overall – but in getting the key building blocks in place. If the city regions can gain more say over rail and bus – then smart ticketing can fuse the two into the same single network that is the basis for London’s successful transport system. From there our cities can kick on to go smart and offer comprehensive total mobility packages, electrify transport systems in the most cost effective way and transform urban centres into more sociable, sustainable and prosperous places. It’s there for the taking.

Jonathan Bray

< Read Part two in the series ‘Ten years of the pteg Support Unit’, focusing on the unstoppable force of devolution.

< Read Part one in the series ‘Ten years of the pteg Support Unit’, featuring top ten highlights of the last ten years plus the influence of London.