How can walking and cycling benefit from the transfer of public health to councils?

Adrian Davis is an independent consultant specialising in public health and transport. Since 2008 he has been embedded part-time within the transport department of Bristol City Council. His ‘Essential Evidence’ series is available at www.bristol.gov.uk/tpevidencebase

Adrian Davis is an independent consultant specialising in public health and transport. Since 2008 he has been embedded part-time within the transport department of Bristol City Council. His ‘Essential Evidence’ series is available at www.bristol.gov.uk/tpevidencebase

One hundred and one years after the compulsory appointment of medical officers of health by local authorities, the NHS Reorganisation Act 1973 set in train the removal of the public health function from local authorities. Consequently, most transport planning practitioners working today will have no recall of this 1970s milestone (and not all public health practitioners will either).

Public health has spent most of its life within municipal government.The sanitary reform movement of the 19th century was entwined within and part of the early development of local government when issues such as the eradication of cholera, tuberculosis, typhoid and smallpox followed the sanitation reforms championed by the likes of Edwin Chadwick and Florence Nightingale. These reforms helped save lives and improve the living conditions of millions. So, the transfer of public health to top-tier local government in England this April is indeed a return.

‘But what is public health?’ you may ask. Public health is the science and art of preventing ill health and prolonging life and promoting physical and mental health through the organised efforts of society. Public health practitioners adhere to a ‘health in all policies’ approach that means seeking to assess the health impacts of the range of public policies and interventions, and both how they impact on human health and are distributed across society. The latter is especially important in terms of a strong focus on reducing health inequalities and supporting those in most health need. Consequently, public health practitioners seek to work inter-sectorally and collaborate with colleagues across a range of professions.

Public health takes a systems-based approach. A few public health practitioners have a long history of working in and with transport planning. For the majority, however, their experience will be as outsiders looking in and trying to understand the ways of working of a range of disciplines within the rubric of transport planning and decoding the ‘languages’. ‘It works both ways,’ I hear you say. Indeed it does. So building relationships will take time in order to develop trust and mutual understanding necessary for effective collaboration.

Where public health practitioners are located within the local authority could have a significant bearing on how successfully the transport and public health functions integrate. Being located in the same building and sometimes even on the same floor does not in itself guarantee collaboration. There has to be conscious and sustained effort.

Public health comes with certain sets of expertise. I have particularly drawn on public health skills in systems thinking, behaviour change, and a strong evidence-based approach for my work in transport planning. The top transport agenda item for directors of public health is likely to be physical activity deficiency (a deficiency is defined as less than 150 minutes of moderate physical activity each week) and the contribution made to this deficiency by a car-based transport system. This includes some very large costs incurred to businesses and health services: absenteeism, and the disease burden itself through increased heart disease, stroke, diabetes, etc.

Over 36,000 people die each year in England from just five key diseases and conditions associated with physical activity deficiency. Not all of these deaths can be claimed as outcomes of habitual motorised vehicle use but reductions in physically active travel (including public transport) has had a profound impact on physical activity levels since travelling provides the key means through which humans are physically active. Deaths from physical activity deficiency account for many more lives lost than through road traffic crashes, though I am not seeking to belittle the challenge to address the road collisions and casualties agenda.

Public health practitioners will want to continue to help reduce casualties – not least through a safe systems approach where more people feel free – and are free – from fear of harm when walking and cycling and so do them more often. There is also public health expertise in monetarising physical activity benefits through the World Health Organisation’s Health Economic Assessment Tool. HEAT is already embedded within the DfT’s WebTAG transport appraisal guidance (Unit 3.14.1).

Funding public health interventions in transport remains an issue. Public health funds are ring-fenced and a large public health budget to support transport interventions is unlikely; but many public health teams will contribute through staff time and skills. And, yes, some may be able to offer financial assistance, albeit at a small-scale. This may depend on how well engaged transport planning and public health staff are at the local level, what collaborations have already been established, and thus the level of trust developed.

In health commissioning, new structures exist to help Clinical Commissioning Groups (GPs) who now hold the lion’s share of funds. Prominent within the new operational structures are the local Health and Wellbeing Board and their strategy that will inform decision-making. Getting a transport voice within this agenda could be a wise move for transport planners keen to pursue health collaboration. The strategy will be informed by a joint strategic needs assessment (JSNA) which assesses the health needs of the local population. So, access to the board via the JSNA is an obvious route, not least in demonstrating the role of active travel in increasing population level physical activity.

While some excellent examples of collaboration on transport and health existed prior to 1 April, the difference now is that public health is again part of local government, working to the same elected members and chief executive as transport planning. So, there is a journey of collaboration on health to pursue which has just become significantly more appealing. 

Landor LINKS training events Influencing Travel Behaviour and Walking: Making a step Change cover this topic in detail