We need to talk about transport and health....

Population health professionals are currently under-engaged with transport. What more needs to be done to better integrate health into transport and planning policy objectives?

Exercise is a miracle cure that improves physical and mental health and reduces demands on NHS and social care services. The best forms of exercise are those that fit into everyday life, making active travel a “best buy” for improving population-level health – and, by extension, the health of the economy.

Public health, transport and urban professionals need a full understanding of the causal chain that causes poor health, including low levels of activity, environmental pollution, poor built environments and limited mobility options. They need to come together and deliver outcomes that alleviate these negative influences.

This is why Landor LINKS, working with Active Travel England, is bringing the fifth Transport + Health conference to Bristol on October 15 2024. Transport + Health is focused on showing how population health could be better integrated into transport and planning policy objectives. There cannot be a healthy economy without a healthy population, and there is hope, with an new government taking form, that both health and active travel spending cuts may soon be reversed.

Exercise improves health and Active Travel England’s mission is shared by the health service. We all want to see more people incorporating active travel into their day as a way to keep mentally and physically fit. Professor Chris Whitty, England’s Chief Medical Officer and Active Travel England board member

The context for action

Public health was transferred to local government in England through the Health and Social Care Act 2012, which moved the responsibility and funding for a range of public health services from the NHS to councils in April 2013.

Health Boards elsewhere in the UK remained, so that opportunities for local collaboration remained challenging not least due to organisational differences, goals and cultures.

With public health responsibilities changing dramatically during the pandemic – which greatly exacerbated health inequalities – there is now a key opportunity to reboot the critical collaboration between health, place and transport professionals.

However, the public health grant has been cut by 28% on a real-terms per person basis since 2015/16. Local authority public health interventions funded by the grant provide excellent value for money, with each additional year of good health achieved in the population by public health interventions costing £3,800. This is three to four times lower than the cost resulting from NHS interventions of £13,500.

Responding to reports that the previous Conservative Government has ‘effectively dismantled’ the Office for Health Improvement and Disparities (OHID), Dr Penelope Toff, chair of the BMA public health medicine committee said: “There are serious questions about whether these changes to OHID will mean a scaling back of vital national public health leadership and functions.

"This is happening in a context where public health funding in the UK has been relentlessly eroded for almost a decade – with the local authority public health grant in England now 27% down per person compared to 2015 and many local services scrapped."

Let's hope the incoming Labout government can address these issues quickly and comprehensively.

New hope for public health?

Local authority decision-makers value the evidence-based approach and tools used by public health professionals. Public health officers value the direct links councils have with communities, and the deep understanding of transport professionals into how mobility choices shape life opportunities and outcomes.

A recent Local Government Association (LGA) report identified great potential for public health professionals to collaborate at the system, regional and combined authority levels. One key area, identified by medical professionals as a major area of focus for future health improvement activity, is active travel.

However, according to the LGA, public health professionals are currently under-engaged with transport and local economic development.

These are missed opportunities, it says, and notes that spending on activities that support public health, such as housing, culture, transport, adult social care and environmental services, has fallen.

Active travel is a key part of achieving so many of the government’s top priorities, so we want to link up with those agendas from the very start. Providing low-cost, healthy travel options to get to schools, shops and workplaces will revitalise high streets across the country and help us decarbonise at the same time.
Chris Boardman, National Active Travel Commissioner

Enabling effective collaboration

A clear message from this research that to have the most impact, professionals need to work together to keep influencing the decisions that are being made across local government.

There is an urgent need to resolve competing planning imperatives. Growth and economic development have greater regulatory weight than health. In fact many economic imperatives detract from health promotion.

There are a wealth of studies on the links between health, transport and the built environment, but there is little direct guidance.

This means that many local decision-makers and planners are cautious about acting, albeit in response to government imperatives, to design ‘healthy cities’ when the evidence is limited. 

In the absence of direct regulation or guidance, according to a recent LGA report, those with a commitment to delivering health as part of planning practice suggest that local authority tools such as Joint Strategic Needs Assessments (JSNAs) and Local Authority Core Strategies provide routes to get health into practice.

However the same report noted that there were mixed opinions about the use of Health Impact Assessment (HIA) tools, with many professionals being skeptical about their usefulness, particularly given the time and cost involved. 

Bristol – a transport and health pioneer

in 2008, Bristol was the first UK local authority to embed public health specialists in its transport planning team and so to anchor health perspectives into its policy development processes.

This strong cooperation between the transport and health teams led to the development of programmes promoting integrated strategies for physical activity and active travel.

The positive outcomes were clear: by 2011 the amount of people cycling for their commute increased by 94 per cent, with 40 per cent more people walking to work, 80% of Bristol's streets had lowered speed limits to 20 mph or had traffic-calmed zones, and 26% of respondents had altered their travel habits as a result to include more walking and cycling and a reduction in car use.

Cross-sectoral collaboration and health's inclusion in integrated planning processes were evidenced in the creation of the Supporting Healthy Inclusive Neighbourhood Environments Team Health Integration Team (SHINE HIT). Walking has been a key focus of SHINE’s work.