ITC explores links between transport and health
Making connections: what are the links between transport and health?
Travel and movement impact our health in a variety of ways. We can improve our health through remaining active and through physical activity. Transport can also deliver health, through the fine work of our medics and ambulance service, and yet it can also impact health negatively through accidents and sedentary behaviour on long-distance journeys. A better understanding of these links is crucial for improving the health of the nation, and a transport service that positively impacts our well-being.
To debate these important issues the ITC hosted a Discussion Evening on 28th April 2015 chaired by ITC Chairman, Simon Linnett. Almost 70 guests attended and the subject was introduced through presentations from a distinguished panel of experts comprising: Clare Moriarty, Director-General of the Rail Executive at the DfT; Phil Insall, Head of Health at Sustrans; Richard Hunt CBE, Chairman of London Ambulance Service; and Simon Craven, Special Advisor to the CEO of Go-Ahead Group.
Links between transport and health– key issues raised by the speakers:
- Clare Moriarty explained that, from a policy perspective, there were important ways in which transport affected health. She observed that there were structural similarities between rail and the NHS, noting that both involved large, complex, customer-facing delivery mechanisms with divergent incentives and cycles of change. The effects of transport on health could be both positive and negative; the latter were particularly evident in road transport where the economic costs of accidents and impaired air quality were high. A range of solutions could be used to mitigate these health-related costs, she explained, from safety measures such as speed limits to behavioural change programmes. She pointed out how the Local Sustainable Transport Fund was promoting more sustainable modal choices in transport, such as walking and cycling, and explained that the Social Impacts Toolkit was encouraging policy makers to think about the impacts of transport planning on other areas of policy, including health.
- Phil Insall focused on the public health implications of transport policy. He argued that many studies had shown the massive negative health costs of transport, and that too much emphasis was placed on prioritising general mobility over access to the things we need. He criticized the ‘windscreen perspective’ of policy and decision makers who were also car drivers. Mr Insall explained that the major health and economic benefits of physical movement, such as walking and cycling, were well known, and suggested that new ways need to be found of encouraging use of these modes. There was a problem, he noted, where investors in transport often did not benefit from the cost savings arising from physical movement, but he pointed to new schemes from the NHS and DfT that could help improve the situation.
- Richard Hunt explained how the Ambulance Service in London delivers health services. He noted that the Service (LAS) is effectively a logistics and transport organization, and had experienced significant growth in demand over the past decade. Amongst the challenges faced was the need to reach arbitrary targets, such as responding to 75% of Category A (life threatening) calls within 8 minutes. This was often achieved through multi-vehicle deployment. He explained that the service faces many of the same transport issues as ordinary Londoners, such as congestion, one-way systems, roadworks, speed humps, width restrictions, and cycle superhighways. He added that it was important to dampen demand on the LAS, and this was being achieved by providing on-the-spot treatment (requiring no further travel to hospitals for treatment), ‘hear-and-treat’ which attempts to solve customer problems over the phone, and the installation of several thousand defibrillators in London which were already saving lives.
- Simon Craven provided a transport operator’s perspective and suggested that public health ought to move further up the commercial agenda. He observed that operators were focused on selling mobility, and ‘health and safety’ policy was mainly focused on the latter. In various arenas, however, health issues were becoming more prominent, including the need to improve air quality, the benefits of accessibility (for instance, one of the main benefits from concessionary fares is the improved public health that arises from more use of public transport), and the operational benefits arising from better treatment of mental health. Public health should be given greater emphasis as a high-level outcome when making transport investment decisions, he argued, and there was a need for better co-ordination between policy areas.
Key themes raised in the discussion:
- Greater cross-departmental collaboration is essential if the impacts of transport on health are to result in improved policies. Although recent years had seen improved dialogue between the Department for Transport and the Department of Health, better dialogue across departments should lead to an improved understanding of the full costs and benefits of policy. Some guests suggested that the Treasury should take a closer interest in the cost savings that could arise from more health-conscious transport policies. Others thought it would be valuable for the Department for Transport and others to appoint a Chief Medical Officer to advise on public health in order to help ensure that these issues were considered together by policy makers.
- Better appraisal mechanisms are required for understanding the health impacts of transport. Delegates were generally supportive of aligning incentives to use various travel modes, and rethinking how we design existing transport infrastructure to encourage active travel and discourage car dependence. There were calls to adjust the assumptions that underlie our appraisal methodologies in order that these account better for the health impacts of travel. Participants also mentioned the WHO Health Economic Assessment Tool for walking and cycling, which calculates health values for changes to travel behaviour.
- Health professionals have a key role to play in encouraging active travel. Clinical experts argued that doctors can help raise awareness of recommended physical activity rates, and use this in prescribing exercise as much as pharmaceutical drugs. Providing travel guidance when directing people to appointments would also be beneficial, as well as new strategies that rely less on vehicular travel, such as home births or providing hospital patients with iPads so they can communicate with friends/family and require fewer visits. Some guests also pointed out the need to address the obesity epidemic, but others noted that the obesity debate is rather dominated by diet and nutrition, whereas physical activity has a much wider range of health benefits. There were calls for more healthy food to be available on trains.
- We need to find ways of making active travel, particularly walking, more attractive. There was shared agreement that encouraging active travel was a crucial policy objective. Many guests noted that walking needed to achieve a much higher level of public interest and trendiness, similar to that which cycling had achieved in recent years. A discussion arose about how to generate greater interest from public and politicians. Some suggested promoting greater awareness of the way in which walking could create a shared sense of purpose and cohesion in communities. Others pointed to the work of groups such as Living Streets and initiatives like the ‘3 seconds more’ campaign to make walking appear less dangerous in urban areas. One radical suggestion was to invert the hierarchy of modes in transport planning so that pedestrians are at the top and cars at the bottom, although others noted that few politicians were likely to adopt such an anti-car platform due to the fear of losing votes.
- Planning decisions can often have a major impact on the public health impacts of transport. A number of delegates pointed out that planning decisions about where to site hospitals, schools and shops strongly affected car use, and by extension active travel. One delegate noted that in the Netherlands planning allowed for bikes and buses to be parked closest to the entrance of stations, with cars furthest away; a similar mentality, it was suggested, should prevail in the UK. Others pointed out that we should be conscious that many people do not have a great deal of choice over their travel decisions, which were often linked to working flexibility, physical disabilities, income, and distance to reach a particular amenity.
- The relationship of transport to mental as well as physical health needs to be considered. A number of attendees noted that mental health issues were important and often connected with physical health. Addressing this would be important for transport policy since travel could be used to improve well-being.