Healthy place and transport development

Local government and the private sector is working together to develop a fuller understanding of the causal chains that cause bad places and poor health, and to support more collaborative urban, transport and health public health planning. Juliana O'Rourke explores in more detail

Supporting healthier and happier lifestyles for all is high on the political and social agenda. Yet, with a few notable exceptions, few local authority professionals working in public health are making all the necessary connections across the collective place disciplines, such as built environment, housing, an active urban realm, green space. Local planning policy is not yet efficiently addressing challenges such as obesity and diabetes. Likewise, few transport professionals, whose focus is on smarter mobility, active travel and enabling modal share away from the private car, are currently making the best use of public health frameworks to understand societal health impacts, and need additional public health input to understand their role in tackling health inequalities.

However, things are beginning to change. Working together for the first time, public health, transport and urban professionals in cities like Bristol and London, for example, are starting to develop a full understanding of the causal chain that causes bad places, lack of activity and poor health, and to plan for and deliver outcomes to alleviate negative influences.

Local authorities have, since 1 April 2013, been responsible for most public health services. Whilst relationships between transport and health, and place and health, are generally recognised in broad terms, this new framework means that a more integrated relationship is needed between transport planning, urban planning and public health. Areas of interest revolve around the possibility of integrated strategic planning and funding streams. Investment in transport is moving from dedicated pots to being part of one large ‘single pot’: a single local growth fund which devolved to Local Enterprise Partnerships (LEPs) from 2015.

This will see transport schemes 'compete against' other priorities, rather then being part of a combined package (health, activity, play, education, housing, etc). Policy and planning areas that need to be, and now can be, considered holistically for the first time (whole system thinking) include active travel planning, environment and air quality, walking and cycling, modelling and analysis, monitoring and evaluation and integrated urban and transport planning.

A complex relationship
There are some key challenges: public health professionals have their traditional, 'scientific' and highly evidence-based ways of working, and these are not always the same approaches used in urban/transport fields, which favour incremental best practice. The differences in view and approach are interesting grounds for study. The development of new exemplar working schemes, such as that pioneered by NHS Bristol and Bristol City Council by embedding a senior public health professional into the city’s transport department from April 2008 to September 2016, have proven to be very useful. Similarly, Transport for London has a public health expert on its staff, and is adopting a successful ‘back to basics’ urban design principle as a recipe for success, namely, a street that works for people is a street that works for health.

However, recent work in the sector has indicated that many more local authorities realise the urgent need to more closely integrate public health with transport and urban planning, and that a much wider cross-section of people need to work on the places we create if they are to be successful, sustainable and equitable. Transport and urban planning professionals are beginning to explore this new area, its needs and its opportunities and, in the past year or two, several new transport and health-oriented academic and professional organisations have come into being.

Working together

Lots of elements go into making good and healthy places: viable and active transport options, safe streets, accessible amenities, decent homes and the close proximity of public squares, parks and gardens, for example. The real challenge of making better – and healthier – places is to take a much more holistic approach. Current public health studies have tended to explore links between housing and health or transport and health, but not both.

But how much is actually known about the relationships between public health, place and transport? Manchester, for example, ticks many boxes for active travel success and good urban design, yet has one of the lowest life expectancy rates in the UK. Could the interrelationships be much more complex than better housing, green spaces and more active travel? It would seem so: many local authorities with the most improved life expectancy, in public health terms, are not considered to be 'nice' places by urbanists, for example Hartlepool and Darlington. How do we better integrate all the strands of well-being to deliver better outcomes?

Delivering better outcomes
Several initiatives have responded to the need to understand how planning can respond positively to health and wellbeing requirements within the framework of shifting regulatory regimes: the National Planning Policy Framework, developing transport planning frameworks and Public Health Outcomes Frameworks. The Wellcome Trust, for example, funded the Sustainable Healthy Urban Environments (SHUE) project in 2015, aimed at exploring opportunities for improving population health by reducing current unhealthy exposures and behaviours, including transport, which contribute to patterns of unsustainable living.

As the UK transport environment has become increasingly complex, transport's impact on health is increasingly negative. Transport agencies have tended to undervalue strategies that improve air quality, offer more active mode choices, and vehicle travel, but this is now definitely changing for the better, with a large body of work now driven by transport sector focused on active and smarter travel, led by the Department for Transport's 2011-2016 Local Sustainable Transport Fund, followed by the Sustainable Travel Transition Year Revenue Competition (2016-2017) and the longer term Access Fund for sustainable travel and, under the Infrastructure Act 2015, the Cycling and Walking Investment Strategy (CWIS) for England.

However, these approaches are often practical in application, and lack the robust, evidence-based health/medical focus much preferred by policy makers. However, as the transport and health professional sector matures, additional evidence-based consultancy work is being carried out across the active travel, air quality and behaviour change and urban sustainability fields.

Cross-organisational approaches led by both transport and health focused bodies do exist, alongside an existing body of academic, evidence-based work into air quality, environmental impacts, social and health inequalities, lack of access to mobility options, and a lack of robust monitoring and evaluation practices on the impacts and performance of transport schemes; with the latter being a serious barrier to developing the evidence base and improving investment decision-support tools.

The reason that a new approach is needed now is that attitudes are shifting. New thinking, new technologies, and new levels of citizen engagement are combining to offer real potential and opportunities for positive change. People everywhere are increasingly concerned over poor air quality, low levels of physical activity, congestion, crowded public transport, degraded natural and built environments, cookie-cutter development and declining town centres. And there are strong appetites for change.

Collaborative working, and much more of it, is the obvious answer. Currently research and practical focus is largely divided into health-friendly sectors such as obesity, nutrition, exercise and diet, obesity and physical activity, rather than transport/urban-friendly sectors such as active travel or sustainable housing. Local authorities have a key role in linking local health policy with other policy and practitioner areas such as planning, transport infrastructure and housing.

The challenge is to create a mutually-agreed framework for progress. Is the potential of wider synergies sufficiently understood and valued? Should local spatial plans be the focus for holistic transport, health and well-being development? Public Health England has noted that local authorities have funds and resources available that could help to initiate and develop new strategic models of collaborative planning to support the cash-strapped transport bodies that are facing ever-harder cuts.

Juliana O'Rourke is a consultant with Landor LINKS, which delivers authoritative information, news and analysis across the transport and urban sectors.

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