Moving forward on transport and health: knowledge transfer and action Dr Adrian Davis NHS Bristol/ Bristol City Council

A vision from the 1960s “Television-sets and washing machines may for the time being take precedence in the hierarchy of domestic needs, but as a longer term objective it is questionable whether anything is so much desired as a family car.” Ministry of Transport, 1963 Traffic in Towns p.10

Buchanan Report- Interpreted to say: Car ownership and use would grow This was a legitimate desire of most adults More roads had to be built in towns to accommodate extra cars ‘Accidents’, noise and possibly air pollution were the negative health impacts

More space for motor vehicles =less for pedestrians/ cyclists Inner Leeds 1963 In total 365 homes and 174 commercial buildings were raised to the ground. People who were living in the demolished houses were moved to new estates such as Little London. The myth of progress 1990s

Ways in Which Transport Influences Health Health Promoting Health Damaging Enables access to: Injuries physical activity Sedentary lifestyles employment, shops, Pollution: goods, education, particulates, carbon other services, monoxide and countryside nitrogen oxides social (support) networks hydrocarbon and ozone, active travel carbon dioxide, lead, benzene well-being Climate change   Noise and vibration Stress and anxiety Traffic danger Loss of land and planning blight Severance of communities by motor traffic

Road transport and health British Medical Association Board of Science and Education, 1997

Official recognition of wider health impacts The way we travel is making us a less healthy nation Coronary heart disease is the biggest killer of adults in the country. Part of the blame is that we drive too much when we could walk or cycle. DETR, 1998 A New Deal for Transport: Better for Everyone. London: TSO.

Physical activity: the best buy in public health Those who think they have not time for bodily exercise will sooner or later have to find time for illness. Edward Stanley, Earl of Derby, in an address at Liverpool College, 20 December 1873 Physical activity must be one of the most undervalued interventions to improve public health Donaldson, L. 2000 Sport and exercise: the public health challenge, British Journal of Sports Medicine, 24: 409-410.

Transport and health knowledge time-line Traffic in Towns, 1963 ‘Accidents’, air and noise – dominance of and aspirations for car use Livable Streets, 1972 Road traffic volume and speed damage social support networks Social and environmental context for health Development of new public health from mid 1970s BMA cycling & health report, 1992 Health benefits outweigh the risks Royal Commission on Environmental Pollution, 1994 Traffic growth not environmentally or socially acceptable BMA, Road transport and Health, 1997 1st account of the myriad impacts of road transport on health DfT, 1998 A New Deal for Transport ‘The way we travel is making us a less healthy nation’ p.22 Half adult population in developed countries is sedentary or does minimal physical activity. Barriers to physical activity might have the greatest impact of all traffic-related health risks. WHO, 2000 Development of peer reviewed evidence base of health impacts Including studies linking obesity to sedentary travel DfT - premature deaths from poor air quality likely to be double previous estimate House of Commons Environment Committee, 2010

The disease-burden from road transport Adapted from: Cycling & Health – What’s the evidence? Cavill, N., Davis, A. 2007

Impact of car use on body weight Time spent travelling by car has increased and walking declined by 23% between 1972 & 2005 Adults who bought private motorised transport to travel to work doubled their likelihood of becoming overweight in comparison to those where there was no mode change 1 Countries with highest levels of active travel generally have the lowest obesity rates 2 1. Bell, C., e, K., Popkin, B. 2002 The road to obesity or the path to prevention: motorised transportation and obesity in China, Obesity Research, 10(4): 277-283. 2 Bassett, D., Pucher, J., Buehler, R., Thompson, D., Crouter, S. 2008 Walking, cycling, and obesity rates in Europe, North America and Australia, Journal of Physical Activity and Health, 5: 795-814.

Health impact distributions

Social Support networks

Ending of South Yorkshire Fairs Freeze Bus use rising from 1975 – against trends Intervention – 1985 Transport Act - 250% fare rise 62% and 60% reductions in bus use among unemployed and retired, 37% reduction for employed and 48% among children Steep rise in requests for formal home help

Speeding speeding traffic is rated as the greatest problem in local communities... Even when conducting analysis on the sub-groups, speeding traffic consistently came out as the antisocial behaviour perceived to be the greatest problem, whether respondents were male or female, young, middle aged, or old. Poulter, D., McKenna, F. 2006 Is speeding a “real” antisocial behaviour? A comparison with other antisocial behaviours, Accident Analysis and Prevention, 39: 384–389

NICE Physical Activity Guidance (2008) 94,172 possible papers: 54 studies were included in the reviews. Difficult to ascertain to what extent the interventions were responsible for the changes seen because:

The risk of bias – example from road safety education Misplaced focused – importance of partnership working – confused with whether intervention delivered a safety benefit Author bias, design bias etc… Throughout the culture of road safety education there is an absence of evidence as a key guiding criterion. McKenna, F. 2010 The public health benefits of road safety education for teenagers. University of Reading.

Built Env/Healthy City Public Health support within Bristol City Council: planning for synergy Transport Planning Dr Adrian Davis Active Bristol Clare Lowman Built Env/Healthy City Marcus Grant/UWE (0.1 fte) Planning & Health Stephen Hewitt Climate & carbon Dr Angela Raffle (0.6 fte) Health Policy Liz McDougall Cycling City Simon Carpenter (0.4fte)

Relationship between Public Health and Local Government: the critical friend The DPH is firmly independent of the executive leadership of the authority and can speak with professional freedom. Elston, T. 2009 Health Appointments – 6 Models of Practice, In Hunter, D. (Ed) Perspectives on Joint Director of Public Health appointments, London: IdEA

What’s good for health is good for the Treasury

Joint Local Transport Plan 3   Joint Local Transport Plan 3   A Consultation response from the West of England Directors of Public Health   Dr Pamela Akerman, Director of Public Health Bath and North East Somerset Dr Hugh Annett, Director of Public Health Bristol Becky Pollard, Director of Public Health North Somerset Dr Chris Payne, Director of Public Health South Gloucestershire.

Road Danger Reduction Knowledge Transfer Partnership funded with Bristol City Council and UWE (ph) – 9 months Investigate potential for shift from casualty reduction (ie to reduce danger at source) Modelled on Vision Zero (SE) & Sustainable Safety (NT) Key aspect:speed – 20mph for residential streets to reduce violence from traffic

Peak oil Peak oil: the point in time when the maximum rate of global petroleum extraction is reached, after which the rate of production enters terminal decline. Lloyds of London say: “What it [the report] outlines, in stark detail, is that we have entered a period of deep uncertainty in how we will source energy for power, heat and mobility, and how much we will have to pay for it.” http://www.lloyds.com/News-and-Insight/360-Risk-Insight/Research-and-Reports/Energy-Security/Energy-Security

Being there Informal opportunities to get health impacts included Being a source of knowledge to hand (eg Joint Local Transport Plan3 and Local Sustainable Transport Fund bids) Building trust Windows of opportunity Cost effective

Lessons learnt Leadership from Tier 1 is vital Need for specialist with sufficient knowledge/training in both disciplines Embedded post enables dialogue with all staff. Regular Tiers 2 & 3 briefings essential Public health USPs - leverage in support of transport case for low carbon economy

The future Return to local government offers chance to: embed public health across Councils to improve pop. health break through ‘silo’ mentality build trust and effectiveness/synergy improve cost effectiveness