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Health In All Policies

Health in all policies, national level. Volume 1

Health in all policies, national level. Volume 1
Cars, bikes and the transport budget

Health in all policies basically equates to all policies reflecting some aims of getting a healthier population, not using the “health (care) budget to do better things in other policy domains, though that would be nice (see reference at bottom – bike lanes v cancer drugs )

How to effect health in all policies at national level. Here’s the first in a series of blogs on the matter. This time transport.

Cycling is good for us and the planet. Etc. I know you know this.
have a look at this from Glasgow – learning over last 10 years around active travel. Not much change delivered by individual behaviour change. More by infrastructure + committed leadership
Seems v. similar?
http://www.gcph.co.uk/publications/702_active_travel_in_glasgow_what_we_ve_learned_so_far

We drive too much and don’t cycle or walk enough. This causes all manner of problems.

Why is this.

The money
I was told recently that refurbishing 10 miles of the M62 costs roughly the same as the whole of the active travel budget for DFT for England
is it any surprise we never build many miles of cycle lane etc – there’s no money by the time DfT and Highways England have built all those 7 lane smart motorways.

There are rather a lot of 10m stretches of motorway being refurbished.

Then think about ROI (and I know you know this has to be used advisedly)
I’d lay odds that the ROI for building roads doesn’t include the health disbenefits of air pollution (on account of extra cars) and disbenetifs of deterred cycling (cars again, nobody likes cycling on busy roads).
The ROI for bike lanes does include health benefits of cycling, it’s an obvious link. Obviously.

I’m told the ROI for building roads is tiny compared to the ROI of building bike lanes. Given the above paragraph, if one were to build health consequences into the ROI for road building the difference would be even greater, in favour of bike lanes.

Then think that if I invest £100m in building roads, and the ROI is say 2:1 that buys £100m of net economic gain if I’m sat in HM Treasury. If there’s £8m left and the ROI for bike lanes is 4:1 that buys my £16m of net economic gain if I’m in the treasury.

In a world of cold hard cash, despite bike lanes being better value, roads win, they net more cash.

The standard economic model thus seems to incentivise road building. This is bad for our health in many ways.

And locally.
Not many people would want to cycle on trunk roads and motorways, so what does the above matter. Firstly once we’ve built all those trunk road extensions there’s no cash left for local authority run schemes. Secondly I’d lay odds that the dft model operating as described above is also used to distribute resource to local schemes.

Thus roads (and cars) are at the top of the priority list for local transport resource also.

So – the job is influencing DfT (and HMT?) re their standard approach to economic modelling around transport system – that basically drives the investment plan for transport budget, that in turn sets in place what “health” can be achieved through the transport budget.

Healthier folk cycling / walking / getting bus thus not driving is not part of the economic model, but building more roads (that creates jobs etc and – apparently – eases congestion) IS the mission critical function.

this means that when the transport budget divvied up – road is king, thus car is king, thus active travel budget is the scraps that fall of the edge etc

So if we really want to effect a modal shift we may need to invest. The only place investment may come is from the current resource envelope.
Thus difficult choices are needed. Vested interests and policy inertia may need to be upset.

Who argues against
Even if HMT & DFT are neutral or receptive to this theres would be fierce lobbying by powerful vested interests – oil and car industry stand to loose from significant shift from car to non car
have a look at the tactics of other industries that may sell us stuff that’s bad for us, and we may get an insight into possible tactics.

Policy inertia from moving one form of investment to another may also be a factor.

I know theres a not insubstantial belief gap also … its not all about the numbers etc… but…

Who’s going to push this
Who is going to advocate for Health in All Policies nationally. HMT or DfT probably don’t have an interest, DH are interested in the solvency of the hospital, and honestly I’m not sure they’ve an interest in anything wider.

Hopefully someone, somewhere can be a better advocate for health in all policies with national govt.

Next up – planning framework, welfare reform, licencing – gambling & booze, maybe economic growth / inclusive growth

Refs
Bike lanes and parks v cancer drugs and cath labs. The value of different forms of investment
https://gregfellpublichealth.wordpress.com/2016/10/01/parks-and-bike-lanes-and-healthy-folk-on-the-value-of-different-forms-of-investment/

Ten thoughts on reframing transport policy
See point 7
https://gregfellpublichealth.wordpress.com/2016/11/02/ten-thoughts-on-reframing-transport-policy-as-a-health-investment/

4 replies on “Health in all policies, national level. Volume 1”

Thanks Greg, do you know how much of ROI is cars and how much lorries, transport of goods, etc ie business / economic growth…?

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The DfT methodology for cost-benefit analysis places great emphasis on time savings for drivers. A few seconds shaved off journey times for each driver is multiplied up to produce figures in the multi-millions, which are then used to justify the multi-million ££s required for “improved” roads. Delays to cyclists and pedestrians are ignored of course, which may help to explain multi-stage crossings of major roads.

What this methodology largely ignores is the phenomenon of induced demand, which means that any improvement in journey time is typically very short-lived as more journeys are created by the improved road. Traffic is a non-linear phenomenon, so as a road or junction nears capacity, congestion rapidly increases. The school holiday phenomenon of free flowing traffic is a good example of this, as a relatively small fall in motor traffic melts away congestion, because roads are operating within capacity.

The laws of induced demand also apply to cycling infrastructure. Build it and they will come, and the impact on congestion could be significant, as you don’t need to switch that many drivers to cycling in the peak period. Try playing with the Propensity for Cycling Tool, and see what impact the E-bikes scenario would have on your most congested routes.

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