Ten thoughts on reframing transport policy  as a health investment

Air quality is a problem. We don’t walk enough, we don’t cycle enough, many argue we drive too much esp for short journeys.

 

I’m often asked my view of the solution to “the air quality problem”. 

My stock answer is – “drive less, walk and cycle more, get the bus, plant trees, the end”. 

I accept these things are harder to achieve than say. We are increasingly overwhelmed with pressing health priorities. Pressing health priorities will not be solved by investment in health services, other sectors make far greater impact. Transport is one of these. From my (admittedly limited) worldview, transport is dominated by the road + car is king mindset and engineering solutions. Maybe Im wrong, but…..

 

We all want more cycling and walking. We all want better air quality. However “a few schemes to encourage more cycling” won’t lead to much large scale change.

 

Changing the rules by which the system operates might. This is a conversation that is best framed in the language of public service reform – as we are reforming the “transport sector”, how might we best capitalise on the potential “health return”.

 

Here are 10 thoughts.

 

Firstly some simple stuff within the current model 

 

1)

Investable things is still the order of day. Some specific ideas:

 

a) Building activity into design phase (Arup and others good there)

for example http://publications.arup.com/publications/c/cities_alive_towards_a_walking_world

 

b) TFL- Healthy streets 

looks a handy idea

http://lcc.org.uk/articles/healthy-streets-are-cycling-and-walking-streets

considering the whole street from building line to building line to ensure better outcomes for people.

“The Healthy Streets approach sets out 10 high level outcomes that we should seek to deliver through policies at every level. “indicators of a healthy street” are centred around the experience of what it feels like to be on a street and include: things to see and do; places to stop; shade and shelter; clean air; pedestrians from all walks of life; easy to cross; people choosing to walk and cycle; quiet; safe-feeling; and people feel relaxed. 

Each of the 10 indicators has a scientific evidence base to support it as an essential ingredient for improving health, reducing health inequalities and increasing walking and cycling.” 

Here are some other handy ideas courtesy of @samwake

Modelling traffic flows

I can’t find the reference off hand, but it is usually the case that transport planning model flow simulations simply don’t consider cycling or modal shift to cycles. So the models always assume that if one route is made less convenient to drive, another route will always be used rather than some of the traffic shifting to cycling (or probably walking either) as a mode. Apparently cycles are categorically more difficult to model than cars – not sure why. 
Does expanding trunk roads cause more driving or ease congestion

The classic research on whether expanding (trunk) roads caused more driving is from SACTRA, summarised here http://www.bettertransport.org.uk/roads-nowhere/induced-traffic – seems horribly hard to measure conclusively, and contexts vary, but it seems to conclude that broadly more roads = more driving.

Economic effects from driving vs cycling was studied in Copenhagen https://www.sciencedaily.com/releases/2015/05/150512104023.htm

This study was used to justify significant investment in cycle infrastructure since it offers returns, while encouraging driving has large costs. 

Copenhagen has shown the most impressive recent increase in cycle rate, even from a high base: up from 36% to 45% in two years (seemingly due to major road disruption from constructing 17 new metro stations at once. 

A similar lesson to how Groningen started their cycle revolution by disrupting the traffic – something really cheap to invest in first: ‘no entry’ signs! 
Basically the message is think active travel when designing and building highways infrastructure. 

 

c)

Retro building active transport infrastructure into street and highway design – more difficult and expensive?

 

d)

Schemes for behaviour changes, skills and confidence building, marketing, enforcement – ie not just engineering solutions

 

2

Data, benchmarking and targets.

Data talks. 

How good is our benchmarking

How well does your city do compared to…..say similar cities

· Infrastructure – bike lanes per mile of road, 

· Trips & modality – what good data do we have, how is it changing, which groups

· Spend on behav change and marketing

· Spend on cycle and pedestrian infrastructure as a share of total

· Appropriate denominator obviously important

 

What’s our ambition

We need to be ambitious. Often our ambitions in this space are quite low in terms of modal share for journeys under 1.5 miles 

If we want adults to achieve minimum physical activity targets then the majority of these journeys need to be walk/cycle (20 mins per mile X 1.5 miles = 30 minutes physical activity). This is the equation London are working to – see above ref. We should too.

Otherwise, we may as well bite the bullet now and buy some bariatric buses with reinforced axels and extra wide seats….

3

Model how it’s done in really successful cities

Who, how, why, ingredients

Political

Technical

Other 

 

Recent useful reference:

Bik lanes. Build them and they will come – 1.3% absolute ⬆️ of commutes made by bike for 100m of bike lane http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2016.303454
 

Some more radical ideas – Here are some thoughts on changing the rules……

If we really want to change things, we need to change the standard operating procedures.

 

 

4

Demand vs supply side interventions

As I see it, roads are like hospital beds – you can never have too many, and as soon as you’ve built it then its full of cars as demand expands to fill available supply. With all the downstream consequences. In health care we completely over focus on demand side interventions in our quest for solutions and ignore the supply side.

Is it the same in transport policy?

“We need more roads to ease congestion and secure economic growth”

It’s a powerful narrative. Maybe it’s effective, but more supply will usually equate to more demand – in a non limited system were prices are hidden (economists will correct my sloppy language) demand will expand to fill available supply and we will be back to congestion again. And the increased demand may well support economic growth (folk being able to get to jobs etc) obviously this is good. Economic growth may be harmed a little on account of more air pollution and less cycling as a result of more demand on the roads etc.

All a bit circular.

Definately familiar from a health care policy perspective!

 

 

There are other examples of where building more roads doesn’t seem to solve the problem it promised to solve

(Bit like building more hospitals?)

Effects of new urban motorway infrastructure on road traffic accidents in the local area: a retrospective longitudinal study in Scotland

http://jech.bmj.com/content/70/11/1088.short?rss=1

J Epidemiol Community Health 2016;70:1088-1095 doi:10.1136/jech-2016-207378

I should stress I’m not anti car. People think cars are good for the economy, they probably are if they help folk get to jobs. They are less good if too many cars leads to harmed health and all that stuff. A tricky balance I accept, currently the detrimental aspect of cars is invisible in the calculus, this needs to change.

5

Resources to do stuff – where does it come from

Maybe with new money and resource where available – but there isn’t much. So maybe we need to focus on optimising the “return” of the resources we have already committed.

 

Maybe Im being over critical but my sense is that in the minds of many of those responsible for transport planning – congestion and road, thus car is king. There’s always (well often) odd bits of funding here and there for “little schemes” – never enough to make a substantial difference.

 

It’s a q of what outcomes we want from say the road building budget etc. Yes of course we want smooth flow of traffic, but back to the roads are like hospitals line.

Shifting some of the £millions earmarked for expanding the road systems to schemes that improve the local environment for cycling and walking will improve health, cut congestion and tackle climate change all at once. 

 

It’s the same argument about small shifts in the health care budget can do big things.

 

 

6

Redefining the measure of “success” of the “transport system”

So that success in the transport system should be defined by things that have environmental and wellbeing and economic benefit

So it’s not just PH and helath and well being and environmental folk fighting their way in to get a few schemes funded, but the system is defined and measured many walk, cycle and air pollution levels etc

(this lesson can also be applied elsewhere in other policy areas)

 

7

Redefine the ROI calculation process 

How are schemes prioritised AND the ROI calculations

 

Current model is basically over simplistic

SCR prioritise devolved transport schemes based on GVA (wages*people) impact alone.

The evaluation of ROI for roads and other transport schemes fails to include their environmental and health and well being impact (obviously interlinked). 

 

A policy effort to monetise health and well being benefit would be worth it. Maybe we should get into industrialising SROI methods (yes I’m dubious of methodology but means / end etc). We need to get good at this.

Being explicit re monetised health benefit may revolutionise the type of schemes that are prioritised – health impacts tend to far outweigh all other considerations when measured economically.

 

Change the model. Use ROI methodology that monetises and makes explicit the “health” ROI from all policies.

TFL have a Useful looking quantification – ( I’ve Not read yet)

https://www.london.gov.uk/sites/default/files/transport_and_health_in_london_march_2014.pdf

 

Parks and bike lanes v cancer drugs and cath labs

https://gregfellpublichealth.wordpress.com/2016/10/01/parks-and-bike-lanes-and-healthy-folk-on-the-value-of-different-forms-of-investment/

The bike lane ref is in this. Instead of paying for cancer drugs and cath labs to stent those with stable angina (for no gain) buy bike lanes (and parks etc)
Same argiument can be made about Safer Routes to schools

Net saving to public purse.

The cost-effectiveness of New York City’s Safe Routes to School Program – https://www.ncbi.nlm.nih.gov/pubmed/24832430

Saves money and improves health ‘SRTS was associated with an overall net societal benefit of $230 million and 2055 quality-adjusted life years gained in New York City.’

 

 And there’s more

Sustrans have done some great stuff in this space.

 Cycling – benefit-to-cost ratios can be in the range of 5:1 to 19:1 (some as high as 35.5:1). See page 26

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/509587/value-of-cycling.pdf

walking = £8:1 Return on Investment

Glasgow SROI walking

http://www.paha.org.uk/Resource/walk-glasgow-sroi-study

 “for every £1 invested in Health Walks in Glasgow, there were £8 of benefits generated for society. The research analysed the impact of the Walk Glasgow project which develops and promotes walking opportunities across the city, through delivery of Health Walks, which are short, free, gentle walks led by trained Volunteer Walk Leaders. We deliver this valuable service together with a range of partners including Glasgow Life, North Glasgow Healthy Living Community, Paths for All, and NHS Greater Glasgow and Clyde. The social return on investment (SROI) analysis looked at the impact of the Health Walk programme and assigned a monetary value to the changes it created. The findings are compelling, not only proving that investment in the programme is sound, but also giving a rich picture of the multiple social benefits experienced by walkers and volunteers. Health Walks are proven to make people fitter, healthier and happier.”
 

 

8

And building on the above – Amend the prioritisation criteria for schemes 

Criteria for investment decisions – how do they look. Do they prioritise the social objectives we want to achieve appropriately?

The key message on priority is the need for sustainable transport options that promote walking>cycling>(affordable)public transport>car

 

9

Health in All Policies – HIAP

LGA have just published this ace reminder. Well done them.

http://www.local.gov.uk/documents/10180/7632544/1.4+Health+in+ALL+policies_WEB.PDF/b21cf56f-403e-45c4-8a29-2c96df48acdb

Obviously this represents another opportunity to nail the concept of transport and health interlinkages. There may be merit in this frameworks being considered through Health and Well Being Board lens. 

There are dangers to be watchful for – the ever present danger that it’s a framework that’s used for services to describe how what they already did improved health, and how they could do more if they got money (there isn’t any?) not about how they were going to change what they did to better address health. 

Watch that space

The POINT is using such frameworks to CHALLENGE existing resource commitments AND DO BETTER with a view to delivering more health return with them than is currently the case.

10)

Maybe different kinds of behaviour change interventions and infrastructure interventions in the development of our transport strategy
Policy and environmental interventions are the most sustainable approach given that ‘high agency’ individual behaviour change is very costly and not very effective and need to go ‘low agency’.

Lynn Sloman’s book, Car Sick a very interesting tour of how to reduce car use through soft measures – lots focused on how to shift to public transport, by focusing on the softer 40% of people who would like an alternative to driving but haven’t realised the options are already there (Google Maps searching bus routes/times is my favourite thing on this), followed by the next 40% who may need improvements in services/infrastructure to shift from driving, and worrying little about the last 20% hard core who just like to drive. I think this bears more on public transport than getting people cycling, as barriers to cycling are often reported strongly as lack of safe/appealing routes and infra. and people are already bombarded with the message that they ought to do things like cycling; they just don’t see it as an attractive option.

 

Obviously we need to develop a validated tool for “safe, intuitive and attractive” walking and cycling routes , determine the sample size for Sheffield and develop a baseline for current perceptions
Need joined up strategy – not just infrastructure, but infrastructure is really important in making the first two (walking and cycling) do-able for most people. Infrastructure for promoting walking and cycling needs to be nice (attractive, interesting, green, dry(ish), well surfaced, feel safe and well lit in winter, separate from cars, flat if possible, if not flat then need benches and to be separate from vehicles so slow moving bikes and people can take time on the gradient) routes into the city centre. Other components – price (esp around public transport), and polluter pays approach to cars (congestion charge makes most sense, but recognise politically very hard).

 

Another thing missing from current infrastructure is support for people to drive part way and walk/cycle the rest – needs park and walk approach (as opposed to park and ride).

 

Future trends – electric bikes (will remove excuses around hills), electric cars (still polluting somewhere, not a panacea) and self-driving cars (potentially a nightmare as they will be used to make four journeys a day (in-out in morning then again in evening) instead of two, because of parking problems).

 Electric cars – Side point, also uncited, but from following things like Fully Charged I don’t believe electric cars are simply moving the emissions elsewhere. They seem to be a notably more efficient use of energy, and their batteries will be very valuable to balance the grid once we sort out the model. It also doesn’t put extra demand on the grid. It takes a similar amount of electricity to just drill, ship and refine the petrol as it does to charge a car for the same milage achieved – so if we switched all energy taken in petrol production towards charging cars we’d not be using any more.

So I’m happy for any necessary driving to become electric rather than petrol/diesel as fast as possible, but not sure it justifies public spending compared to reducing need for driving altogether. Also electrifying solves none of the issues of inactivity, road safety (though self-driving may be a boon), consuming road space (to fit cycle space), parking space, road maintenance costs etc.

Worth looking at the success of the guided busway in Cambridge – http://www.cedar.iph.cam.ac.uk/research/directory/cahic/ or http://www.journalslibrary.nihr.ac.uk/__data/assets/pdf_file/0005/159476/FullReport-phr04010.pdf

 

Other major consideration which I suspect transport planners don’t always factor in as much as they should is the school drop/pickup influence – we have poor infrastructure for this.

On cycling being less accessible than walking, therefore walking being more valuable to concentrate on – I guess it depends on journey distance. A few miles being much easier to cycle than to walk. Obviously for other health reasons encouraging more walking generally is good, but for reducing driving specifically it seems to me that there won’t be nearly as many viable journey replacements. 

Both walking and cycling are good and it’s important to think about both modalities.

We know we have rubbish cycling infrastructure because we have one of the lowest rates of cycling in the core cities, and even in comparison to other “northern” deprived cities, and it’s not just about hills. We can sort this. We should sort this. It’s not only a cycling issue. Given its greater accessibility and population impact walking is more important.

 

Perhaps instead of “nudging” people to come to the city centre to do their Christmas shopping by offering free car parking that they instead offer free park & ride and free bus/tram fares for children (you may say I’m a dreamer…).

Just a few ideas for a transport strategy…….

 Thanks to staff who will remain nameless, to protect the innocent, for their thoughts.
 

11)

Change the public narrative

Definitive media strategy needed.

Influence public views towards specific policy options

Definitive narrative shaping strategy needed

Face down the vested interests. Disucssion with them.

Additional references

Actively making driving less convenient (whether using the reclaimed space from lanes or parking for cycling or not):

https://inews.co.uk/essentials/news/making-harder-park-yield-health-benefits-study-finds/ 
Paris: Road closure causes ‘traffic evaporation’ of up to 50% within first weeks https://www.fastcoexist.com/3064157/when-paris-closed-a-major-road-to-cars-half-its-traffic-just-disappeared 
Making it harder to park could yield health benefits, study finds – The i newspaper online iNews

Making it harder to park could yield health benefits, study finds

When Paris Closed A Major Road To Cars, Half Its Traffic Just Disappeared | Co.Exist | ideas + impact

https://www.fastcoexist.com/3064157/when-paris-closed-a-major-road-to-cars-half-its-traffic-just-disappeared
New roads create new traffic | Campaign For Better Transport

http://www.bettertransport.org.uk/roads-nowhere/induced-traffic
Six times more expensive to travel by car than by bicycle: Study — ScienceDaily

https://www.sciencedaily.com/releases/2015/05/150512104023.htm
The 20 Most Bike-Friendly Cities on the Planet | WIRED

The 20 Most Bike-Friendly Cities on the Planet

Copenhagenize.com – Bicycle Culture by Design: The Greatest Urban Experiment Right Now

http://www.copenhagenize.com/2014/07/the-greatest-urban-experiment-right-now.html
How Groningen invented a cycling template for cities all over the world 

https://www.theguardian.com/cities/2015/jul/29/how-groningen-invented-a-cycling-template-for-cities-all-over-the-world

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9 thoughts on “Ten thoughts on reframing transport policy  as a health investment

  1. Interesting read. Changing/improving roads is maybe always seen as making life better for motorists – but it shouldn’t be!
    You may have seen this, but recently I heard about a shared space scheme in Poynton and thought you might be interested as it relates to your article. It seems to have been very successful and it would be great to see something similar in Sheffield! Although it only directly influences a small area, I wonder about the ‘knock-on’ effects. After driving through this area are motorists more aware of other users and do cyclists feel more confident to cycle else where? It would be good to find out!
    In the link below they make an intersting point that they decided to make a change that was best for the village not the motorists – which comes back to how are we framing the problem, we don’t have to be improving it for motorists!
    http://www.sustrans.org.uk/our-services/what-we-do/route-design-and-construction/shared-space-busy-intersection-poynton
    Thanks

    Like

      1. Shared space doesn’t work well if traffic volumes are high. See Exhibition Road in Kensington. Motor vehicles dominate southern section. Only northern section works because there is no through traffic.
        Removing through traffic from residential and shopping streets is often the missing and essential piece of the 20mph jigsaw.

        Liked by 1 person

  2. Check out the Hidden Cost of Free Parking by Donald Should. American paper, but principles apply for cities everywhere. Get it right and it can provide many of the benefits of a congestion charge at much lower cost. Matching pricing to supply and demand.

    Like

  3. Reblogged this on andrewjamespicken.com and commented:
    Great read Greg. I visited a the National bus expo conference recently. After a discussion with seat manufaturers they were struggling to design seats for bus dirvers in an already tight cockpit area for up to 30 stone bus drivers. This is a great indicator of sednetary jobs and its effects something I know some bus operators are trying to address. https://andrewjamespicken.com/2016/11/06/driven-to-inactivity/

    Like

  4. Great read Greg. I visited a the National bus expo conference recently. After a discussion with seat manufacturers they were struggling to design seats for bus drivers in an already tight cockpit area for up to 30 stone bus drivers. I thought of this when you referred to extra wide bus seats and reinforced axels.This is a great indicator of tthe impact of sedentary jobs, something I know some bus operators are trying to address. https://andrewjamespicken.com/2016/11/06/driven-to-inactivity/

    Like

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