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Working within local authorities…
What are the opportunities and challenges for the future?
Adrian Davis
Sarah Tickner
Amy McCullough
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Outline Time Session Speakers
13.15 Welcome and setting the context Amy McCullough
13.20 Introductions and first thoughts on opportunities and challenges
Sarah Tickner
13.35 Opportunities and challenges in working with Local Authorities: UsingBristol City Council’s Transport Department as an example
Adrian Davis
14.00 Group task: How do you influence your highway authority’s Local Sustainable Transport Fund bid?
Adrian Davis
With support from Amy McCullough and Sarah Tickner
12.25 Close
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Context
• NHS Reforms & Public health White Paper, “Healthy Lives, Healthy People” (November 2010).
• Transfer of public health powers to Local Authorities.
• Establishment of Public Health England, NHS Commissioning Board, GP consortia.
• “Moving into local government offers a real opportunity to create Public Health” (Mark Gamsu, Fellow of FPH).
• Challenges – how influence within the LA, working in a different political environment etc.
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Breaking Out of (or into) Silos:
Public health work within Bristol City Council’s
Transport Dept
Adrian Davis, Public Health Support to City Development, NHS Bristol
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Local Government and Public Health
• Medical appointee idea of giving direction to local authorities originated in Chadwick's report on the Sanitary condition of the working population of Great Britain (1842).
• 1st Medical Officer post in 1847 Dr Duncan tackled problems of poor housing and sanitary provision with Borough Engineer
• 1974 Medical Officer of Health post abolished, superseded by community physicians within NHS and local government health services subsumed in Social Services Depts.
127 years
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LeaderDeputy Leader, Cabinet Member for Capital Programme, Sport and CultureCabinet Member for TransportCabinet Member for Care and HealthCabinet Member for Targeted ImprovementsCabinet Member for Children and Young PeopleCabinet Member for Housing, Property Services and RegenerationCabinet Member for NeighbourhoodsAssistant Cabinet Member (responsibilities include Sustainability and CYPS
issues)Assistant Cabinet Member (responsibilities include Financial Management,
HR and Housing Benefit)
•Evidenced-base approach or political pragmatism?•Political sensitivity
Elected Members and Independent Public Health Advise
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What is the purpose of transport planning?
• Access = Transport’s primary function is in connecting people, goods and services. This itself allows the activities for which people travel to happen.
• Described as exchange opportunities - people are entitled to the protection of their right to a just and equitable share of exchange opportunities (Engwicht, 1992).
• Can be achieved best where distances are short ie high density settlements
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More space for motor vehicles =less for pedestrians/ cyclists
Inner Leeds 1963
In total 365 homes and 174 commercial buildings were raised to the ground. People who were living in the demolished houses were moved to new estates such as Little London.
1990s
The myth of p
rogress
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The disease-burden from road transport
0
10000
20000
30000
40000
50000
60000
deaths
Road acc Cancer CHD/Str Climate c
Transport related health problems: direct, indirect & future
Source: Cycling & Health – What’s the evidence? Cavill, N., Davis, A. 2007
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Transport and health knowledge time-line
Traffic in Towns, 1963
Development of new public health from mid 1970s
‘Accidents’, air and noise – dominance of and aspirations for car use
Social and environmental context for health
BMA cycling & health report, 1992
Health benefits outweigh the risks
Royal Commission on Environmental Pollution, 1994
Traffic growth not environmentally or socially acceptable
BMA, Road transport and Health, 1997
1st account of the myriad impacts of road transport on health
DfT, 1998 A New Deal for Transport
‘The way we travel is making us a less healthy nation’ p.22
WHO, 2000
Half adult population in developed countries is sedentary or does minimal physical activity. Barriers to physical activity might have the greatest impact of all traffic-related health risks.
Development of peer reviewed evidence base
of health impactsIncluding studies linking obesity to sedentary travel
DfT - premature deaths from poor air quality likely to be double previous estimate
House of Commons Environment Committee, 2010
Livable Streets, 1972 Road traffic volume and speed damage social support networks
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Transport Planning
Dr Adrian Davis
Active Bristol
Clare Lowman
Built Env/Healthy
CityMarcus
Grant/UWE (0.1 fte)
Planning & HealthStephen Hewitt
Climate & carbon
Dr Angela Raffle (0.6 fte)
Health PolicyLiz McDougall
Cycling CitySimon Carpenter (0.4fte)
Public Health support withinBristol City Council: planning for synergy
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Relationship between Public Health and Local Government: the critical friend
The DPH is firmly independent of the executive leadership of
the authority and can speak with professional freedom.
Elston, T. 2009 Health Appointments – 6 Models of Practice, In Hunter, D. (Ed) Perspectives on Joint Director of Public Health appointments, London: IdEA
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What’s good for health is good for the Treasury
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Regional Public Health support Value for Money: BCRs
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Joint Local Transport Plan 3
A Consultation response from the West of England
Directors of Public Health
Dr Pamela Akerman, Director of Public Health Bath and North East SomersetDr Hugh Annett, Director of Public Health BristolBecky Pollard, Director of Public Health North SomersetDr Chris Payne, Director of Public Health South Gloucestershire.
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Local Transport Plan 3 Guidance
• Health Impact Assessment to be included
• Notes that LTP3 is a major opportunity to address the need to support and plan for more walking and cycling
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Road Danger Reduction
• Knowledge Transfer Partnership funded with Bristol City Council and UWE (ph) – 9 months
• Investigate potential for shift from casualty reduction (ie to reduce danger at source)
• Modelled on Vision Zero (SE) & Sustainable Safety (NT)
• Key aspect:speed – 20mph for residential streets to reduce violence from traffic
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Local Sustainable Transport Fund
• £560M – 4 years• 62% revenue• 2/3 of all highway authorities• £5 first tranche key component bid• Main bid by Dec 2011 – up to £50m• Opportunity for NIHR funded
evaluations
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Peak oil
• Peak oil: the point in time when the maximum rate of global petroleum extraction is reached, after which the rate of production enters terminal decline.
• Lloyds of London say:
“What it [the report] outlines, in stark detail, is that we have entered a period of deep uncertainty in how we will source energy for power, heat and mobility, and how much we will have to pay for it.”http://www.lloyds.com/News-and-Insight/360-Risk-Insight/Research-and-Reports/Energy-Security/Energy-Security
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Being there
• Informal opportunities to get health impacts included
• Being a source of knowledge to hand (eg Joint Local Transport Plan3)
• Building trust• Windows of opportunity• Cost effective
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Lessons learnt
• Leadership from Tier 1 is vital• Need for specialist with sufficient
knowledge/training in both disciplines• Embedded post enables dialogue with all
staff. Regular Tiers 2 & 3 briefings essential
• Public health USPs - leverage in support of transport case for low carbon economy
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The future
Return to local government offers chance to:
• embed public health across Councils to improve pop. health
• break through ‘silo’ mentality• build trust and effectiveness/synergy• improve cost effectiveness
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Web links
• http://www.bristol.gov.uk/tpevidencebase• http://www.euro.who.int/transport/modes/
20021009_1 • http://www.sustrans.org.uk/what-we-do/active-
travel/139/the-evidence• http://www.transportandhealth.org.uk/• http://www.dft.gov.uk/cyclingengland/
encouraging-cycling/professional-support/ • http://www.livingstreets.org.uk/
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• How do you influence your highway authority’s Local Sustainable Transport Fund bid? Identify the opportunities and challenges for influencing the bid.
• Try to identify 3 main areas for change/addition to aid discussion of the above.
Group Task