Why a health-focused response to climate change will pay off

To reduce carbon emissions, councils need to make a political case that resonates and a business case that stacks up. The way to do both, Imperial College London’s Dr Neil Jennings tells Lee Baker, is to team up with non-transport bodies and give weight to another urgent public priority

The DfT wants to allow the public to be more mobile than ever alongside reducing emissions pumped into the atmosphere. Squaring this circle will require more people to walk and cycle more. Yet how do we win the funding and political support to create such streets? 

Pre-pandemic, there had been a long-term decline in both walking and cycling trips to 2019, which the DfT vowed to turn around last summer. But the £2bn of funding the Department pledged for a cycling and walking Gear Change was described by charity Cycling UK as insufficient to deliver on the strategy’s big ambitions. The strategy envisaged creating thousands of miles of new, protected bike lanes and Low Traffic Neighbourhoods. 

The subsequent Government decision to accelerate the timetable for decarbonising the economy upped the scale of the ambition still further. The 78% reduction in greenhouse gas emissions on 1990 levels by 2035 was based on the Climate Change Committee’s recommendation, which assumed that 9% of the vehicle miles currently driven each year – which would be 25bn, based on 2019 levels – will instead be done by bike or on foot.

“If we don’t reduce emissions quickly enough, England’s hottest ever summer of 2018 will be an average summer within decades, with huge implications for our infrastructure and the population,” warns Imperial College London’s Dr Neil Jennings. This is “yet another thing” local transport authorities have to achieve with existing budgets. 

“The challenge for local authorities is how to pay for bringing down greenhouse gas emissions, when they may not see any direct financial reward in the short-term.” Savings from preventing more extensive damage to local highways and transport networks from droughts, flooding and landslips will not accrue in a matter of years, he says. 

This is the question of incentives and the ability to make the case for investment that the Future Highways Research Group is also grappling with (LTT 17 May).

Highlighting the ‘co-benefits’

The task, says Jennings, is even more of an uphill struggle given the need for councils to maintain political buy-in. Whilst concern about the environment reached unprecedented levels in 2019, according to Ipsos MORI, with 27% of the public putting it in their top three priorities at the time of the protests by environmental movement Extinction Rebellion, this soon fell back. In March 2021 it was 10%, overtaken by concern about unemployment, education and poverty/inequality, after months of the third Covid-19 lockdown.

And while four in ten people said they cycled or walked more than they usually did during the first lockdown last year, and most expected to keep this up, one year on, the picture is mixed. Cycling levels were below February 2020 levels on half the days of April 2021. And traffic was on individual days between 69% and 96% of equivalent days pre-pandemic.

So, how can councils secure a big shift in travel behaviour in order to decarbonise the economy? Jennings, who is the partnership development manager at Imperial College London’s Grantham Institute for Climate Change and the Environment, sees a way forward. Local authority leaders and officers can both attract funding, and win political capital, for more widespread actions to shift travel behaviour and decarbonise the transport system.

“At the same time as transport authorities reduce emissions, they will also be bringing about many health and other benefits for their communities,” he says. “Health ranks consistently highly in the priorities of the public, and we now know every single organ of the body is impacted negatively by air pollution.”

This is why estimating and communicating these ‘co-benefits’ is part of the answer to the question of how councils make the case, Jennings believes. His Imperial College London paper with colleagues, Co-benefits of Climate Change Mitigation in the UK, underlines the importance of framing the need for action on climate change in the context of established priorities. This research found that many policies aimed at reducing greenhouse gas emissions could also bring about immediate benefits to public health – and that the regional and city level of governance is well-placed to take advantage of such co-benefits.

“Identifying the health co-benefits allows you to talk about things that are of more pressing concern to residents. It is a good way to make the case for intervening to change travel behaviour, that will also achieve the aim of decarbonising transport to tackle the climate emergency,” Jennings says. 

The health co-benefits of climate change address priority public concerns, and interventions to improve public health can have an immediate impact at the regional and city level

The case for healthy streets

The Ipsos MORI Issues Tracker has reported health as being in the top three issues most important to the public in the years the survey was conducted since 2007. The environment and climate change, meanwhile, only ever temporarily becomes a widespread concern before it falls in importance again, as YouGov has also found. Prior to Extinction Rebellion, an earlier record high of 23% making it a top priority in February 2014 followed a period of violent winter storms and flooding. YouGov says this increase in anxiety “did not outlast the poor weather,” with the number worried about the environment halving within two weeks.

This is the rationale for local transport authorities making the case for healthy streets. Public Health England (PHE) told local authorities that investing in walking and cycling would have “low-cost, high-value dividends”. This is based on a 2014 DfT review that, where the predicted health impacts are monetised for walking and cycling schemes, provide the lion’s share of the total positive impacts yielded. 

“It’s important that local authorities quantify the potential health impacts of schemes. The benefits are potentially huge,” says Jennings. PHE estimates that in the 18 years to 2035 there will be approximately 2.5m air pollution-related cases of disease in England. This will include diabetes and dementia, as well as cardiovascular and respiratory disease and cancers. PHE has made a tool available to pinpoint the impacts of pollution reduction interventions at a local level.

These impacts do not include those likely to flow from increased active travel across a population. Increasing active travel levels by at least 30 minutes each week day could save the NHS a further £17bn over 20 years, according to a study published in The Lancet.

For its part, Imperial College is working with a number of councils that are starting to incorporate such co-benefits in their strategies to address climate change. To achieve this will take some work. Councils will need to estimate the health outcomes in a way that is robust and can be communicated effectively, Jennings says. However, the potential prize is great: cities citing the co-benefits of their interventions to address the climate emergency reported 2.5 times more actions than cities that did not, according to the report The Co-Benefits of Climate Action: Accelerating City-Level Ambition. 

And the increased evidence base provided by implemented schemes adds to the evidence base for further schemes, he says. This includes a study commissioned by the London Borough of Waltham Forest, which asked King’s College London to model the health benefits of projected changes in air pollution concentrations from its Mini-holland scheme, which included closing 43 roads to cars.

Breaking down silos

The borough’s monitoring also pinpointed that residents are more likely to walk or cycle where infrastructure has been improved – walking and cycling for an extra 41 minutes each week in areas where interventions have been made. “It’s important to get this evidence to inform future schemes, otherwise you’re not capturing all the benefits to put into your cost-benefit analysis,” says Jennings. “The issue is, even when you do put in the work and resource to quantify the health co-benefits, those benefits often don’t accrue to the transport authority anyway. So, we have to break down silos.”

The current devolution of budgets and powers to transport authorities is a hurdle for most authorities. Whilst powers exist to devolve health budgets to any metro mayor, currently only Greater Manchester’s mayor Andy Burnham controls a health and social care budget. Consequently, the walking and cycling schemes that he invests with his transport budget could lead to savings in the same authority’s health budget.

Where further devolution is not a prospect, however, local authorities could make progress by collaborating with the health sector, suggests Jennings. Some hospitals and health foundations had urged emergency active travel measures at the start of the pandemic, after evidence from Wuhan, China, where Covid-19 was first diagnosed, of a doubling of private car use. They might also be able to help to implement walking and cycling schemes.

Guy’s and St Thomas’ Foundation, an independent health foundation, has gone further, providing an officer at Southwark Council to progress schemes through its charitable arm, Impact on Urban Health, and funding walking and cycling schemes (see panel below).

Will such collaborations allow the spread of schemes that both tackle the climate emergency declared by local authorities, and improve health and longevity? Jennings, who will be speaking on co-benefits at the South West Highways Alliance conference, is hopeful that the issue is firmly on the policy agenda. “There’s a big opportunity here for local authorities to respond to public priorities and to improve public health.” 

Join the discussion at The South West Highways Alliance conference: The Highway to Zero Carbon – A series of three webinars: https://hopin.com/events/swha-highway-to-zero-carbon

1. Co-benefits of Climate Change Mitigation in the UK https://tinyurl.com/h8akcz5w
2. The Co-Benefits of Climate Action https://tinyurl.com/uma4kke5

Public health and transport teams maximise impact by working together

The public health crisis, climate change and the economic collapse are all huge issues to address, made even tougher by funding cuts. A creative response to these challenges is being developed by a health foundation, a council’s public health, highways and transport teams, and a public health specialist who is also a transport planner and urbanist.

Impact on Urban Health, part of Guy’s and St Thomas’ Foundation, is investing £250,000 in three pilot schemes in Southwark in south London designed to have maximum public health benefit, for minimum cost. Funding is earmarked for an evaluation that will compare active travel levels with control areas of similar demographics, street characteristics and health indicators, thereby accounting for fluctuating walking and cycling levels during the pandemic.

The pilot locations were selected in low income areas with schools with low air quality and high childhood obesity levels. These areas also scored poorly against the London Mayor’s ‘Healthy Streets’ indicators, such as whether they are relaxing places to walk. Streets fall down if the amount and speed of traffic is intimidating, there is not enough space for walking and cycling, and surfaces are not level and accessible.

In each location, a combination of measures is being tested: traffic filters; temporary pavement widening; adding dropped kerbs to improve accessibility; improving crossing points; removing parking spaces; adding seating; and improving cycling access.

The evaluation will consider how people used the streets differently and how the flow of motorised vehicles and cycles changed, both on the streets, and on the boundaries, in the period of the trial, between December 2020 and May 2021. The changes will be compared with what is observed in two control areas where no changes have been implemented. Community engagement will aim to ensure the opinions of people who would not typically take part in consultations are heard. 

Lucy Saunders, director of Healthy Streets, is a consultant with both a transport and public health background. “There’s a huge need to improve the healthiness of streets everywhere, so it’s a difficult decision trying to work out where to put your focus,” she explains. “We considered local demographics and health needs and narrowed down our search by looking in particular at routes to school. We wanted benefits that would be big enough to measure.”

The other key consideration was how to make a relatively small budget go as far as possible. “Our pavements are, in general, not flat enough and not wide enough; but addressing that can be very expensive. We are testing widening the pedestrian area with separators such as wands.”

Guy’s and St Thomas’ Foundation’s Impact on Public Health had been a full participant, even supporting an officer post in Southwark specifically to deliver co-benefits, says Saunders. “We were able as a team to ensure that the pilots were focused on addressing health inequalities and were additional to what the authority was planning to deliver.”