ITC 2017 Annual Lecture
Transport, Travel and Health: a symbiotic relationship?
The 5th Annual Lecture
21st June 2017, The King’s Fund, London
The ITC was delighted to welcome almost 100 supporters and guests from across the transport, land use and health sectors to our fifth Annual Lecture. The ITC Lecture series, which was inaugurated in 2013, explores major strategic questions that will affect the future of transport and how we travel. This years Lecture, hosted in the heart of London at 11 Cavendish Square by the King’s Fund, considered the relationship between transport, travel and health.
To debate this important topic the ITC was pleased to welcome a distinguished panel of experts from the industry. Introduced by ITC Chair Terry Hill CBE and a welcome address from Sir Mark Walport FRS, Chief Scientific Advisor for the UK Government, delegates were then treated to two stimulating talks from our chief experts: Simon Stevens, Chief Executive of NHS England, and Tricia Hayes, Director General of Roads, Motoring and Devolution at the Department for Transport.
Transport, travel and health – Key issues raised by the speakers:
Sir Mark Walport – Chief Scientific Advisor, UK Government
Sir Mark Walport provided an introduction based around his role as the UK Government’s Chief Scientific Advisor. He began by observing that infrastructure – whether natural (e.g. climate, weather, geophysical events), built (engineered, technological), or social (relationships, community) – shapes our health and wellbeing, but we tend to take our infrastructure for granted until it does not serve us well.
In relation to the topic of the evening, transport and health, Sir Mark outlined four key drivers that are shaping this relationship. The first is that we are an increasingly urban population living in ever more congested cities, which is leading to a decreased ability to move efficiently around to the places where we live, work and play. The second key driver is environmental, related to air quality problems that stem from vehicle emissions, which is bringing a new set of challenges for policymakers to address. The third, Sir Mark stated, is quite simply health itself – obesity and inactivity is not only bad for our health, but also has high costs for our health service. Finally, the fourth driver is related to the ageing demographic with 70% of all population growth to 2040 in the 60+ age cohort. This again creates a significant challenge for both transport and health professionals and policymakers.
However, Sir Mark also explained that many opportunities that exist for the transport and health sectors to work together in making our cities and places better for all. For example, electric powered mobility can help to improve air quality and the Internet of Things (IoT) can provide us with real-time information on air quality that could potentially influence people’s travel decisions. Indeed, new transport opportunities, which could lead to safer travel and the more efficient use of our networks, could help to alleviate the strain on our health and transport systems.
Simon Stevens – Chief Executive, NHS England
Simon Stevens considered in his talk the changing spatial patterns of healthcare. Heading back through human history, Mr Stevens observed that travel in general has sometimes had negative impacts on human health, citing the mixing of the global population that brought us the bubonic plague and Montezuma’s revenge that brought syphilis back to Europe after the conquest of the Americas.
Similar to the arguments Sir Mark made during his talk, Mr Stevens stated that our transport systems have significant effects on our health, both positive and negative., Air pollution is now one of the most prominent policy concerns and through a series of charts, he illustrated the impact it has on our health, contributing to over 40,000 deaths per year. He asserted the importance of taking decisions on improving or mitigating air quality, alongside other environmental impacts and also road transport injuries.
The way in which we organise our transport systems itself produces a large dispersion in the health risks that go with it, and the evidence base is now sufficiently robust that we need to take more seriously the risks that pollution has on our health and the nudges we can design into the transport system to promote active forms of travel.
He then shifted his focus to the way in which the care we receive will change, and how that is partly dependent on how well our transport systems work. He outlined the two divergent forces that are at work in the healthcare systems of all industrialised countries: centripetal and centrifugal. In relation to the centripetal forces, some services are becoming more concentrated, offering services to larger population levels, which has been driven both by capital intensity but also by the benefit of medical specialisation. We have seen this in action recently with the terror attacks in London and Manchester whereby major trauma services have been concentrated into two dozen hospitals across the country so that the victims were taken not to the local hospital, but instead to the major trauma centre; however, despite the increased distance travelled in the ambulance, your chances of surviving have actually increased by over 25% in the last 3 years.
The flipside of centripetal forces are centrifugal diffusions affecting where care is being provided across the country, related to a steady and continuous shift of services from highly specialised hospitals into local hospitals, into general practice and the ultimately to home care. The net of the centripetal and centrifugal forces, Simon suggests, and what that means for the local hospitals that undertake the bulk of care is still unclear, but we do know that the way in which our transport systems work is the one variable in that equation.
Finishing with an anecdote about car parking at NHS services, Simon concluded that there are many prosaic issues that need addressing before we can get onto the larger arguments. However, there are clear opportunities around the contribution that the transport sector can make to improving our overall health status if we can mobilise the correct policy initiatives.
Tricia Hayes – Director General for Roads, Motoring and Devolution, Department for Transport
Ms Hayes began by noting that her role in the Department for Transport involved responsibility for about 90% of the kilometres travelled and around 98% of the journeys undertaken in the UK. She focused on the definition of symbiotic relationship, and noted that while Mr Stevens’s talk addressed what the health sector needs from the transport sector, would now highlight the ask of transport from the health sector. The message of her Lecture was that progress was being made in strengthening the symbiosis between health and transport, but more work needed to be done.
Ms Hayes agreed that air quality and physical activity were currently high on the public policy agenda, and pointed to the successes achieved addressing one of the longest standing public health concerns –road safety. She noted that the UK’s roads ranked in international comparisons amongst the safest countries in the world with the second lowest rate of road deaths on record in 2016. However, Ms Hayes warned against complacency and argued that we must continue to work hard to reduce risk particularly for the most vulnerable (who are over-represented in death and injury statistics). It is clear that regulatory measures such as the implementation of speed management and seatbelt wearing, and recently an intense focus on drink and drug driving as well as mobile phone use, have enjoyed strong public support and have contributed to shifting road deaths into injuries. However, Ms Hayes stated that we should not underestimate the significant contribution of the health sector to the improvement, notably through the professionalisation of trauma services and improved ambulance provision.
One of the areas Ms Hayes identified where the transport and health sectors could operate more symbiotically was through the legislation around drug driving. Rather than thinking about it solely through a transport lens and from the perspective of a car driver, she explained it was important also to understand the behavioural causes that make people to decide to drive under the influence of drugs and risk their lives and those of other road users. Through a holistic understanding of the mental and behavioural decisions taken by such people, and their risk appetite in aggregate (not just in relation to travel), we could develop more effective policies in tackling such problems in years to come.
Ms Hayes continued by outlining the positive the impact that increasing travel opportunities have had on individuals and the nation. For our nation, she observed that the UK’s high quality transport infrastructure supported a productive economy and urban agglomeration, generating the resources required to pay for our health services. For the individual, good transport access fulfilled lives by increasing job and leisure activities, as well as access to health services. One of the particular initiatives that the DfT has helped to champion is Community Transport Networks, which the Department uses to support transport operators in providing local community services that might not otherwise be financially viable, particularly in rural and isolated areas. To conclude Ms Hayes encouraged an approach seen in the concept of ‘total transport’. This, she explained, co-ordinates planning across many policy areas, including education, health and transport, in order to improve local public transport provision, reduce the duplication of resources, and increase efficiency. She urged attendees to help create a more symbiotic relationship between transport and health by championing the total transport concept in the areas they worked in, as well as by sharing ideas and mobilising initiatives.
Several key themes were raised in the audience discussion session:
Creating the space, time and opportunity for NHS workers to get engaged in discussions about transport can mean the difference between the success and failure of healthy transport initiatives. There needs to be a link between the two sectors to show that the NHS and the health sector in general are supportive of policies aimed at shifting people towards more sustainable and healthy forms of travel. One delegate noted that challenges around air quality and obesity can be solved through the transport and health sectors working collaboratively on a national health and transport plan much like STPs (Sustainability and Transformation Partnerships between the NHS and local government).
The common denominator in the symbiosis of transport, travel and health is people – how can we identify what people want? Although it is imperative that policy makers and health service providers develop their professional knowledge and apply the highest standards to their work, change is often driven by public opinion and what people tell their political leaders they want. As a result, policy makers can sometimes hamstrung by public opposition when making practical changes, such as encouraging people out of their cars and towards other modes.
It sometimes takes a bold and innovative leader to drive change at a local level, creating visible and direct impact on the ground. Although the UK is very centralised in its governance structure, there is a significant role for local leaders in the transport industry and the health sector to influence public opinion for healthy travel. At the same time, central government should continue to develop innovative interventions aimed at changing public behaviour. The drivers for change must come from both above and below so that learning between the sectors can be shared.
Although the goal is symbiosis, we should recognise where there are divergences between the policy objectives of the health and transport sectors. Key objectives for transport policy makers include releasing network capacity and the level of services, whereas the health sector’s priority is in promoting forms of travel that improve public health. Harmonising such objectives so that they pull in the same direction is important. By working cross-departmentally senior civil servants can help to achieve this outcome, and the transport and health sectors can then join forces to endorse behavioural change and introduce policies that achieve their wide range of objectives.
The ITC would like to express its gratitude to each of our expert speakers who so kindly participated in the Annual Lecture. We also acknowledge the King’s Fund’s kindness in providing the venue at 11 Cavendish Square, and the work of the catering team and our photographer, Ben Richardson. The ITC has no endowment, and the event was made possible through the support of our corporate subscribers, a list of whom can be found on our website. We gratefully acknowledge their generosity.