transport and health—what is the connection? an exploration of concepts of health held by highways...
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Transport and health—what is the connection? An exploration of concepts
of health held by highways committee Chairs in England
Adrian Davis*
Transport Studies Group, University of Westminster, 35 Marylebone Road, London W1M 4UM, UK
Received 21 May 2004; revised 10 May 2005; accepted 13 May 2005
Abstract
Local authority highways committee Chairs in England are responsible for decision making in transport planning which includes impacts
on health. The study sought to explore how highways committee Chairs conceptualise health or order to provide insight into its influence in
their transport decision making as local government policy makers with regard to what they consider legitimate health-related issues for
transport planning. The paper draws primarily on data from telephone interviews. Findings are discussed relating to perceived key issues
connecting transport and health, whether they are becoming more important, and their implications for transport policy.
q 2005 Elsevier Ltd. All rights reserved.
Keywords: Transport and health; Highways committee chairs; Concepts of health; Telephone interviews
1. Introduction
The paper reports on a study undertaken in 2003 funded
through the UK Department for Transport’s (DfT) New
Horizons Programme. The paper explores how highways
committee Chairs1 (HCC) in England conceptualise health
and see this reflected in their authority’s transport policies
and practices. It has sought to provide insight into how this
conceptualisation might influence their decision making as
local government policy makers in relation to transport
decisions with health implications. While they receive
training and advise on matters relating to transport, their
understanding of health issues is likely to reflect that found
among lay people.
Health can be conceptualised narrowly as treatment of
sickness and injury, such as harm arising from transport
pollution or road crashes. Conversely, health can also be
conceptualised more broadly, so that its connections with
0967-070X/$ - see front matter q 2005 Elsevier Ltd. All rights reserved.
doi:10.1016/j.tranpol.2005.05.005
* Corresponding author. Tel.: C44 207 911 5073; fax: C44 207 911
5057.
E-mail address: [email protected] This paper uses the term highways committee Chairs (HCC) although
restructuring of local authority member functions has increasing lead to
‘Cabinet Member with responsibility for Transport’ and other derivations.
transport are more substantive. For example, transport can
include the health protective function of physical activity,
and its role in enabling social support networks to function.
Concepts of health can, therefore, determine whether the
health promotion potential within DfT policy initiatives, as
was outlined in the 1998 Transport White Paper (Depart-
ment of the Environment, Transport and Regions, 1998), is
grasped at the local level.
Hitherto, despite attempts to highlight links between
transport and health at the national level (British Medical
Association, 1997; MacNeill and Cullinan, 2002), there has
been little research to demonstrate how it has been received
and acted on at the local level. Moreover, in general terms
most transport surveys have focused on the perspectives of
transport professionals in developing guidelines and best
practice. Relatively few surveys have focused on the
perspectives of elected local government Councillors
serving on highways committees, let alone committee
Chairs (Else and Trinder, 1991).
The perspectives of HCCs is an important determinant in
the delivery of central Government transport policy
initiatives given local government powers to influence
policy implementation at a local level. Hence, a better
understanding of HCCs conceptualisations of health and so
its perceived relevance in local transport planning should
help identify barriers or opportunities in progressing
Government transport policies. The research has also sought
Transport Policy 12 (2005) 324–333
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A. Davis / Transport Policy 12 (2005) 324–333 325
to provide greater insight into how health impacts arising
from road transport are understood and considered in local
policy decision-making, and whether there is a need for
greater consideration by DfT as to how health issues integral
to transport policies are promoted to local highway
authorities.
It may be useful to note here that local authorities work
within the powers laid down under various Acts of
Parliament. Their functions are far-reaching. Some
functions are mandatory. The three main political parties
in England are the Conservatives, Labour, and the Liberal
Democrats. At local government level, one of these parties
usually has a majority of its candidates elected at local
elections and so controls decision making which includes
selecting elected candidates to various offices including
HCC. Some local government elections result in no
single party having a majority which results in some
power sharing.
2. Exploring lay concepts of health
Health is a very personal matter, but people’s health is
very much situated in their life experiences and so their
perceptions of health are likely to reflect their social
situation. Systematic investigation of the health accounts
and health practices of lay people in western societies, as
opposed to anthropological studies of other cultures, began
to gather momentum during the 1970s. Comparisons
between class, gender and race, amongst other categories
have been undertaken.
An influential early work on lay concepts of health was
Herzlich’s sociologically based study in France (Hertzlich,
1973). This involved 80 predominantly middle class people
in urban and rural settings. In the social construction of
reality, she argued, increasingly society had assisted its own
health disenfranchisement: health had become an item,
sectioned off, to be dealt with by professionals, who were
increasingly seen as the unassailable source of knowledge.
Herzlich argued that from this base lay definitions were
constructed, a mix of experience, from encounters with
professional health specialists and other life experiences
mediated by social norms, blended with handed-down
popular beliefs about health. Such a mix of beliefs
is, perhaps, unsurprisingly likely to result in some
contradictions. Calnan’s work reinforces the idea that the
legitimisation by medical practitioners is mediated by
beliefs. As he states:
“The lay person is typified. as one who is active and critical,
who has his own complex system of ideas about health and
its maintenance and illness and its management, who
manages their own health requirements, and who is
discriminating in their use of professional medical advice
and expertise” (Calnan, 1987, p. 8).
Indeed, a link between lay belief and professional
knowledge has been identified in the literature on lay
concepts of health so while health beliefs may be linked to
‘common-sense’ knowledge there can be a strong
interaction between this and expert systems of knowledge.
This is because common-sense understandings are imbued
with professional rationalisations. As Shaw highlights, in
western society the general public is bombarded by
professional messages and concepts of health directly and
through the media (Shaw, 2002). This means that lay
concepts are, to varying degrees, very likely to be informed
by and assimilate expert knowledge.
A number of studies have sought to categorise concepts
of health. Herzlich’s study identified three different
concepts:
† health as the absence of illness
† health as a reserve of strength
† health as equilibrium.
Health defined by the absence of illness or serious illness
which impedes functional activities is a relatively common
finding amongst the research literature (Pill and Stott, 1982;
Blaxter and Patterson, 1982; Blaxter, 1987). This is
unsurprising given that health is a norm, or at least lack of
ill-health is a norm, so that ill-health is a break with that
norm. However, the literature suggests that higher socio-
economic status is associated more with positive and
expressive terms than among those of lower socio-economic
status when health is conceptualized more in terms of
absence of ill-health (Calnan, 1987). Health as a reserve of
strength, an organic biological characteristic of the
individual, allows a certain degree of control over one’s
health through physical robustness and the ability to fight
attacks on the body.
The third state identified by Herzlich is that of
equilibrium. This encompasses a broader interpretation of
health. It comprises the following themes: physical well-
being, plenty of physical resources; absence of fatigue;
psychological well-being and evenness of temper; freedom
of movement and effectiveness in action; and good relations
with other people. It is the state where the absence of
awareness of the body gives way to the feeling of perfect
physical well-being.
Flick added a fourth conception, ‘Health as lifestyle’
(Flick, 2000). This is explained by evidence of a much
greater awareness of health-related topics such as cycling
instead of driving, fitness and healthy nutrition, playing a
more substantive role than in Herzlich’s study. Flick reported
greater likelihood of inclusion of health as lifestyle among
West as opposed to East German (GDR) women. She
interpreted this as relating to the former GDR’s centralized
health system which took care of people’s needs much more
than is experienced in the unified Germany although the
GDR system tended to neglect issues like pollution and
nutrition as factors influencing people’s health. In the new
A. Davis / Transport Policy 12 (2005) 324–333326
system, much more awareness and self-responsibility are
demanded in finding the best way to care for one’s own
health, with increasingly differentiated health services.
2 The LTP system in England, introduced in full in 2000, is built around
five year integrated transport strategies, devised at local level in partnership
with the community. LTPs are the key local transport policy development
document and the principal means for local authorities to obtain funds for
the local transport system from central government. The structure of local
authorities varies across England but there is a two tier system within
counties with County Councils being responsible of LTPs. Unitary
authorities and metropolitan authorities being single tier are also
responsible for LTPs. In London, Local Implementation Plans are produced
by each of the London boroughs to set out how they will implement the
Mayor of London’s Transport Strategy in their area. The plans are statutory
documents and similar to LTPs.3 The Social Exclusion Unit is a government policy and Strategy unit.
3. Transport policy and health connections
In the post-war period from the time of the establishment
of the UK National Health Service (NHS) to the 1998
Transport White Paper, the road transport sector collabo-
rated little with health professions beyond the involvement
of environmental health officers in the monitoring of air and
noise pollution and the health services with regard to traffic
casualties. Indeed, transport has been described as a hidden
health issue (Jones, 1994). With the dominant view in both
the health and transport sectors of three quantifiable effects
of transport on health there was little information to
encourage professionals from disciplines within either
sector to consider other possible affects on health. From
the 1960s until the late 1980s the relationship between
transport and health was almost universally focused solely
on the above three quantifiable effects on health.
From the late 1980s there were calls from within the
public health movement for action on transport. This related
both to issues such as traffic injuries and pollution and also
to the environmental and social consequences of transport
(Radical Community Medicine, 1989; Transport and Health
Study Group, 1991). In England it was suggested that health
authorities should add their voices to those calling for safer
cycling and walking environments and for funding for
healthier forms of transport (Health of Londoners Project,
1996). Some public health researchers saw a convergence of
interest between those concerned with public health, the
environment and engineering, with tentative suggestions
that issues in common may be enough to overcome barriers
of language between these sectors (Fletcher and McMi-
chael, 1997). It has also been suggested that the call to act
‘for the public health’ could provide the unifying and
rallying theme for many interest groups (Jones, 1994). In
1997, the British Medical Association (BMA) added its
voice in the form of a report and policy statement on the
issue. This formed the main submission from the BMA to
the then Department for the Environment, Transport, and
the Regions regarding the consultation prior to the
publication of the 1998 Transport White Paper (British
Medical Association, 1997).
The 1998 Transport White Paper itself made significant
references to health and began by acknowledging that:
“The way we travel is making us a less healthy nation”
(Department of the Environment, Transport and the
Regions, 1998, p. 22).
It noted that coronary heart disease is the biggest killer of
adults and that an over-reliance on motorised transport was
implicated because people do not walk or cycle as much as
they used to do. In addition, the first full guidance to local
authorities from the DfT on the development of Local
Transport Plans (LTP) issued in 2000 included a section on
‘Working In Partnership’. Most local highway authorities in
England, outside London, are required to produce and
implement an LTP, in a way that takes account of statutory
guidance issued by the Secretary of State.2 Specifically the
first full guidance stated that:
“Transport is an important underlying factor affecting health
and LTPs should help to improve health and to tackle
health inequalities. A detailed guide to linking transport,
health and environmental policies was published by
the Health Education Authority in 1999. Making THE
Links is aimed at managers in health authorities and local
authorities to help the development of joint plans.
Authorities need to develop a close and effective relation-
ship with public health specialists in health authorities at the
early stages of devising LTPs” (Department of the
Environment, Transport and the Regions, 2000, p. 19).
The publication in February 2003 of the Social Exclusion
Unit report on transport and social exclusion gave the issue
of accessibility significant prominence within UK transport
planning (Social Exclusion Unit, 2003).3 It was particularly
focused on access to those opportunities that have most
impact on life-chances, such as work, learning and
healthcare. Its on-going influence is reflected in the second
edition of guidance on Local Transport Plans, issued in
2004, which states that:
“Transport can impact both positively and adversely on the
health of local communities. Authorities, in their LTPs,
should ensure that their policies and schemes limit or
mitigate the adverse effects of transport on health and
maximise the positive contribution that they can make. The
most obvious effects are in the areas of air quality and road
safety.A third shared priority, accessibility, is also
crucial. improving access to health care, particularly for
those from deprived groups and areas, can contribute to
healthy communities by ensuring that appointments are not
missed and that medical help is sought at an early
opportunity” (Department for Transport, 2004, p. 50).
A. Davis / Transport Policy 12 (2005) 324–333 327
The 1998 Transport White Paper also advocated action in
the health sector to develop travel plans:
“We are particularly keen that hospitals are seen to be taking
the lead in changing travel habits. By the very nature of their
work, hospitals should be sending the right messages to their
communities on acting responsibly on health issues. We
would like to see all hospitals producing green transport
plans” (Department of the Environment, Transport and the
Regions, 1998, p. 143).
Some health trusts, notably large acute hospital trusts
have implemented travel plans (Department for Transport,
2002). Others, including the primary care sector have still to
do so. There are specific and separate requirements from the
NHS to develop travel plans (Horne et al., 2004).
A practical connection between transport and health has
also been developed through Local Strategic Partnerships
(LSPs). These were first established in the most deprived
areas of England on a statutory basis from 2000. However,
all local authorities are encouraged to establish these with
other key organisations at the local level. LSPs represent an
attempt at the formalisation of informal alliances and loose
collaborative arrangements between sectors and other local
interests which already exist in many areas (Bailey, 2003).
Importantly, they bring transport and Primary Care Trust4
(PCT) staff together, among others, in a forum where
partnership working is a sought outcome.
4. Methodology
The methodological approach was divided into four
stages using a combination of quantitative and qualitative
approaches. These were:
† a literature review focusing on lay concepts of health
† three face-to-face, loosely structured, exploratory inter-
views with HCCs. Stage 2 was guided by evidence from
the literature review and previous work undertaken by
the researcher which suggested that some politicians
conceptualise health primarily in terms of ill-health
(Davis, 2001).
† a postal questionnaire reflecting the key areas and issues
raised. A total of 75 questionnaires were returned having
been completed by HCCs. This represented a response
rate of 50.3%.
† telephone interviews with eleven questionnaire
respondents.
4 Primary Care Trusts were established in England from 2001 to replace
the previous Health Authorities and in so doing act as commissioners of
primary health care at a more local level than previously.
5. Telephone interviews findings and commentary
The telephone interview questions sought to explore
further some of the issues raised through the postal
questionnaire and also to introduce several additional issues
in the context of what might be conceived of as health-
related transport issues. Responses discussed by the
Councillors during telephone interviews are provided
below with numeric data provided from the postal survey,
where appropriate, to further illuminate the findings.
5.1. What is health comprised of?
Respondents were first asked to consider what health is
comprised of ‘at the individual level’, that is, reflecting their
general view of what is at the core of health. Responses were
often contextualised within a highway setting so that pollution,
road safety and stress, as negative impacts, were at the fore in
their answers. Positive impacts, notably the physical activity
benefits of walking and cycling were also readily referred to.
“As I put in my questionnaire response [physical fitness,
mental-well-being], I thought ‘what is the impact?’ I clearly
perceived the impact to be cars on health, breathing and
traffic fumes, but also there is the more positive aspect of
walking and cycling and walking and public transport use.
Stress is also an issue and perhaps more so in London,
because people are travelling longer, especially commuting
by car or public transport.” (London Borough, Labour)
“You need to have a basic capacity for mobility, to drive
safely and similarly for cycling, walking and public
transport use. A de-coupled view is that it is good idea to
separate the physical from the emotional. It could be that a
person is emotionally ok but if late [for an appointment] this
could override normal emotional well-being. On the
physical side problems with eye sight can affect health in
the sense of your body and the ability to drive.” (County
Council, Conservative)
“Within the context of my Portfolio responsibility, working
and living in today’s environment, quality of life is
important and transportation also means the impact it has
on the individual such as pedestrians and cyclists or people
just living by it e.g., noise and air pollution, the never ending
movement is extremely disconcerting. This is augmented by
a lack of appreciation of these and other factors within
transportation.I didn’t mention physical activity because if
the other things are done then it falls into place. People don’t
make the connections e.g. they drive to the gym. This is one
of the things the Council is trying to change e.g. it thinks
that people living within 1.5 km should be able to walk.”
(Unitary, Liberal Democrat)
The prominence of mental well-being in both the
telephone interviews and postal questionnaire signals
A. Davis / Transport Policy 12 (2005) 324–333328
the perceived degree to which the transport system may
impact on well-being and overall equilibrium. The
prominence of physical activity may be an indication of
respondents understanding as to the importance of physical
activity for health promotion. As noted earlier, the general
public is bombarded by professional messages and concepts
of health. HCCs are just as likely as other lay people to be
informed by and assimilate expert knowledge. This will
include health promotion messages advocating increased
physical activity. It may also be a reflection of the
prominence given to walking and cycling in the LTP
guidance and other key transport policy documents, and
more general promotion within transport planning,
(Department for Transport, 2003; and 2004).
Absence of ill-health was not so frequently cited in the
telephone surveys as in the postal questionnaire where it was
an option in a tick box menu. This variation may indicate that
for many HCCs ill health may be less of an immediate concern
to them, being reflective generally of their health experiences
as those of higher socio-economic status. As the literature
suggests, higher socio-economic status is associated more
with positive and expressive terms than among those of lower
socio-economic status when health is conceptualised. The
latter more readily identify absence of ill-health.
Overall, the results indicate that physical activity and
fitness, and mental health are the most prominent issues
among HCCs when they think about what health is
comprised of. This was also generally reflected in the
postal survey responses, as set out in Table 1.
5.2. Does transport planning have a responsibility
to promote health?
The majority of Councillors interviewed stated that
transport planning has a responsibility for health. Traffic
casualty reduction, reducing pollution, and the promotion of
walking and cycling, featured prominently as reasons why
this is so.
“Transport planning does not have a public health function
but there are positive side effects. Road safety is the core
business of transport planning.” (London Borough, Labour)
“Killed and seriously injured, that is something obvious and
children are disproportionately involved in these. There is
Table 1
What is health comprised of?a
Physical fitness Well enough to
do what you
need to do
Mental well-
being
A
w
se
Percentage of
respondents
selecting cat-
egory
83% 44% 84% 6
a Respondents could tick as many of items as they wished.
also air pollution and the issue of asthma levels. It’s
important because of the rise in asthma. We have worked on
campaigns in the Council and used a heart branding and got
managers from bus companies, Councillors, health sector
people-those with a high profile to walk for an hour a day.
Some say that they have never done that much walking.”
(Labour, Unitary)
“Physical activity has to be there because of the link
between physical activity and health. There is also tension
when driving. Road safety has to be at the top because of the
devastation it causes. Social inclusion, probably is most
related to good mental health and isolation. To be able to
indulge in leisure time physical activity there needs to be
accessibility and some people are socially excluded because
of lack of accessibility. There appears to be a lack of
statistical evidence for the links between walking and
cycling and health benefits. I asked a local Doctor who
didn’t know of any data.” (Unitary, Liberal Democrat)
From the above and other statements it is clear that road
safety is understood as a core activity of transport planning
because of the direct acute impacts on health arising from
road traffic casualties. Air pollution is more likely to be
understood as a chronic symptom arising from road
transport, its health impacts being harder to quantify but
nonetheless understood as harmful. Its prominence in both
telephone interviews and in the postal survey can be
explained by the fact that air quality is an issue identified in
LTP guidance to be addressed within transport planning. In
large urban areas, air quality can be a major driver of LTPs.
It was notable that the issue of climate change and health
was mentioned briefly by just two interviewees.
The telephone interviews raised the issue of access to
services more than walking or cycling. This focus on
accessibility was particularly towards access to health
services. This may well reflect the attention given to
accessibility and particularly the focus on access to health
services provided in the Social Exclusion Unit report,
published three months earlier to the telephone surveys. It
may also reflect pre-existing concerns about access to health
services among highway committee Councillors given that
such access is a basic human need.
The issues of walking and cycling and an understanding
of the potential health benefits attributable to these modes
bility to cope
ith daily stres-
s
Absence of ill
health
A reserve of
strength
Other
0% 67% 28% 7%
Table 2
The three most important health-related issues for transport planning within your highway authority?
Road traffic
casualties
Air quality Walking and
cycling
Social inclusion Noise Transport-
related stress
Community
Severance
Total responses
(weighted)
125 71 63 58 20 16 6
A. Davis / Transport Policy 12 (2005) 324–333 329
does receive some acknowledgement in the telephone
surveys. However, the health benefits tend to be viewed as
spin-off benefits, that is, where walking and cycling can be
promoted there will be health benefits. The disparity
between the telephone responses and that of the postal
question results may signal the practical barriers to the
promotion of vulnerable modes of travel given the core
concerns for road safety and casualty reduction and given
limited highway space.
5.3. What do you think are the 3 most important
health-related issues for transport planning
within your highway authority?
This question sought to delve further into the detail of the
responsibilities that transport planning might be perceived
as having for promoting health. Although this question
sought to ascertain the most important health-related issues
for transport planning it transpired that the same issues
emerged as when the Councillors discussed transport
planning’s responsibility to promote health in general.
There was almost total agreement among the interviewees
with the ranking of road traffic casualties, air quality, and
walking and cycling as the three most important health-
related issues. This ranking was also generally reflected
through the postal questionnaires. This reinforces the view
that road safety is the most important health-related issue for
transport planning. It is exemplified in the following
responses.
“I agree with these rankings. Road traffic accidents because
of the number of accidents. Air quality, pollution and air
quality, because people don’t have a choice, whereas
walking and cycling people do have a choice.” (Metropo-
litan authority, Conservative)
“Top priorities are traffic reduction, air quality targets and
air quality monitoring, then cycling and walking. When you
look around you see the influence of asthma, the heavy
concentration of traffic on our local High Street and the
fumes which affects people.” (Unitary, Labour)
“I agree with the ranking of road safety/casualty reduction,
pollution, then walking. Accidents is a Public Service
Agreement5 target for us. I think that air quality issues,
5 Public Service Agreements are shared priorities for public service
improvement shared between central and local government.
the level of traffic as an outcome of road safety initiatives,
promoting walking and cycling as part of the sustainability
strategy-as part of wider environmental issues-all help to
promote health.” (London Borough, Labour)
Therefore, road safety issues are perceived by HCCs as a
given in relationship to transport and health, at least in terms
of the avoidance of ill-health. The ranking listed in Table 2,
drawn from the postal questionnaire, can be interpreted as
the ranking for other issues perceived by HCCs as key
health-related transport issues. This suggests, for example,
that road safety is perceived as twice as important a health-
related issue for transport planning than walking and cycling
combined, themselves viewed slightly less important than
air quality.
5.4. There is more information and media coverage of the
issues of overweight and obesity in England and other
western nations. To what extent do you believe that these
are influenced or affected by transport and transport policy?
The majority of the telephone interviews perceived that
there is a link between transport and the rise in obesity in
England. Increased car use was related to increased wealth
which led to increased car ownership, and this was seen to
be influential in facilitating less active lifestyles. Related to
this, there was also some discussion about the spiral of
decline in walking and cycling, especially among children
as parents perceived roads to be too dangerous. Several
Councillors also identified the school run as contributing
specifically to the problem of overweight and obesity. Other
Councillors linked this to the need for both parents in many
households to work compared with when the interviewees
were children.
“I think that it is not so much how people have become in
this country, it is as a result of the increase in wealth and the
promotion, the sexy sell, of vehicles-‘don’t walk to the
shops but drive in this car’. It’s not that public transport
provision reduced because it wasn’t funded but rather that
people chose the car because it has status. Obviously there is
a link between driving and obesity and overweight.”
(Labour, Unitary)
“It is affected by the school run and not walking to school. It
is the lifestyle we live now. When I was a child my mother
largely spent her time looking after me and women had time
to walk to school and back. The economic necessities of life,
A. Davis / Transport Policy 12 (2005) 324–333330
including paying the mortgage, dictate that women have to
work and taking children to school and then to work is part
of it. It’s the economics of the country.” (Labour, Unitary)
“Inactive lifestyle leads to more obesity e.g. young children
which is partly to do with transport and less playing out of
doors but rather watching tv and because their parents are
happier that they are safer indoors. So it is quite closely
related to transport and the safety aspect-parents are terrified
about the risks of cycling and worried about walking
because the roads are too dangerous”. (Liberal, Unitary)
The question of a connection between transport and
obesity focuses around a decline in physical activity. This is
partly as a result of lifestyle choices and traffic fears which
are principally focused around child road safety. Previously
discussed responses from the Councillors also highlighted
the importance of physical activity so that there appears to
be a continuum of thought between the importance of
walking and cycling in promoting the physical activity
benefits, the decline of the use of these modes, and the
reported rise in obesity. It should be noted that there were a
few dissenting voices. Three Councillors thought that there
was little connection between transport and transport policy
and obesity, two stating that diet was the most important
determinant, while another believed that genetics was the
key determinant of obesity.
5.5. Has the 1998 Transport White Paper (A New Deal
for Transport) had any influence on how you think
about transport and health-related issues?
Two Councillors thought that national transport policy
was encouraging local highway authorities to consider
health-related issues. However, a further five gave a
qualified ‘yes’ with comments about obstacles for local
highway authorities such as a lack of connections being
made at the national and local levels and lack of funding for
measures which will provide health ‘spin-offs’. There was a
perception that there had been a failure to deliver on
commitments made in the White Paper which would have
either directly or indirectly improved conditions vis-a-vis
health-related transport issues. This included a number of
Labour Councillors where there was a feeling that the health
issues identified in the White Paper had not been sufficiently
taken forward because of a lack of support from central
government. A further four Councillors did not think that
national transport policy was encouraging local highway
authorities to consider health-related issues.
Table 3
Has the 1998 Transport White Paper had any influence on how you think about t
Very influential – –
Total no. of
respondents
9 19 23
“I think that you have to look at the Annual Progress
Reports for the LTPs for spending money to see that
authorities are spending funds on transport and health-
related issues. But the Government needs to do more. If
there had not been so much privatisation within transport
prior to 1998 the policy may have worked better. It’s about
getting the message over to local authorities.” (Unitary,
Labour)
“When it was launched in 1998 it raised the public profile of
transport for the first time but I feel that it has collapsed. The
priority given to transport which impacts on health is not
understood by central government. In our local authority we
are very conscious of the health issues, trying to build in
health as a factor e.g. with the Royal United Hospital.”
(Unitary, Lib-Dem)
“It has not really been influential on decision making. It
really didn’t feature in such a way as to become flagged up,
not by officers, when making recommendations. There have
been no changes in funding. The criteria has not changed in
terms of decision making.” (London Borough,
Conservative)
The postal questionnaire was also revealing. This
question provided a scale of 1–5 where 1 indicated ‘very
influential’ and 5 ‘not influential’. The data is set out in
Table 3. This generally reflects the ambivalence of the
telephone responses as to any influence of the 1998
Transport White Paper on how the Councillors thought
about transport and health-related issues. The most notable
aspect is that the London Borough Councillors least
perceived the Transport White Paper as having influence
in how they think about transport and health-related issues.
This may well be accounted for because of the limited role
of national government in London where Transport for
London and the Greater London Authority are major actors
within policy formulation and implementation.
5.6. Do you think that health-related issues have become
more significant in transport planning within local
government since 1998?
The majority of the telephone interviewees believed that
health-related issues have become more significant in
transport planning within local government since 1998.
This was also reflected in the postal questionnaire responses.
These finding gives weight to the view that health-related
ransport and health-related issues?
– Not influential Total
11 7 69
6 A home zone is a street or group of streets designed primarily to meet
the interests of pedestrians and cyclists rather than motorists, opening up
the street for social use. The key to creating a home zone is to develop street
design that makes drivers feel it is normal to drive slowly and carefully.
www.homezonenews.org.uk/ accessed 10th May 2005
A. Davis / Transport Policy 12 (2005) 324–333 331
transport issues are now a substantive concern among
highway authorities. This is reflected in statements below.
“Health is getting more important as people make the health
connections and this is more so than in the past. There are
changes in ideas about what makes you healthy. From a
public relations point of view playing the health card is
important. There is still the old idea that as a caring parent
you drive you child but this is changing, both because of the
physical activity issues and also its mentally better. This is
better than telling people to drive less because of
congestion, pollution, and the environment. It’s a changing
hearts and minds exercise, that it is good for them, gradually
changing.” (Unitary, Lib-Dem)
“Yes. Transport planning use to be the preserve of transport
planning professionals such as engineers but we are
becoming more joined up e.g. SRS [Safe Routes to School]
wider range with health and social and environmental
concerns. There is the Local Strategic Partnership and the
Health Trust sits on this and the partnership has adopted it’s
own targets around road traffic accidents and looking at it
from another angle which is a good thing, is from the
viewpoint of the PCTs, police etc. It is also up to each
local authority as to how they use their Health Scrutiny
committee.” (London Borough, Labour)
“They are becoming more important because of the
problems of access to health and the increasing expec-
tations.” (County, Conservative)
It appears from the telephone interviews that irrespective
of actions by national government, local authority highway
committee Chairs believe that their authorities are pressing
ahead and are addressing health-related transport issues
through collaborations with PCTs, other organisations
within the NHS, as well as through LSPs.
5.7. Are there things which central government could do to
help the planning and delivery of health-related transport
issues at the local level?
There were some differences to this question according
to the political party membership of each Councillor. The
main themes taken up by the Labour Councillors were
greater awareness raising for the general public about the
health impacts and potential benefits of walking and
cycling, and changing the environment to help bring about
modal shift to these modes from the car. The Liberal
Democrat Councillors focused most on specific aspects such
as the potential use of Health Impact Assessment of
transport schemes and understanding of the importance of
transport’s role in health in government thinking. The
Conservative Councillors focused most on the need for
greater levels of funding, and a need for caution when
considering making changes within the highway network to
meet the varying needs of different road users. The
statements below reflect many of these concerns.
“There is a need to link pedestrian networks and not allow
driving at 40 mph on local roads. We need more support for
Home Zones6 and new developments and in particular the
design guidelines need to change from the long sight line
and curves which make it easier to drive fast. There should
be more angles and make it safer for cyclists. Barriers which
make pedestrians walk long distances so as not to get in the
way of cars are for the benefit of motorists not pedestrians.
More road space for pedestrians not speeding vehicles.”
(Labour, Metropolitan)
“The thing Government has to decide is where the
responsibility for health regarding transport lies. There are
too many agencies involved, and no money for health in
transport. There is no health component within the LTP.
Central Government does not recognise the part played by
health in the economy and the relationship to well-being and
contentment. Transportation should be at the heart of
Government alongside education and health. They are the
holly triad. Health is a prerequisite, education leads to
opportunities and transport provides the access and choice
of travel.” (Unitary, Liberal)
“The main one would be better funding of road improve-
ments. To have some funding of by-passes of villages and
towns on a never, never list. These cannot be funded out of
the Council Tax. You have to make your case. The
Government Office decides and every now and again they
give us money but most of the time ‘No’ so we need a more
sympathetic attitude.” (County Council, Conservative)
6. Conclusions
In seeking answers to questions about how health is
conceptualised and then any perceived relationship to
transport, this research has illuminated views among
HCCs on a subject previously untapped. A central
conclusion is that transport is perceived as having a
significant impact on health, both positive and negative so
that health is seen more than just as the absence of ill health.
Moreover, there is general agreement with the statement
‘transport planning has a responsibility to promote health’.
Issues identified are comprised of a mix between health
protective, that is, reducing traffic casualties and air
A. Davis / Transport Policy 12 (2005) 324–333332
pollution and health promoting in terms of physical activity
through walking and cycling and improved access.
Importantly, this research indicates that transport
planning is consciously addressing some of the wider
determinants of health. While road traffic casualties are
clearly accepted as the most important transport health-
related issue, air quality and walking and cycling are
seen as the next most important issues within transport
planning for HCCs. The ability to promote walking and
cycling may, however, be somewhat constrained by the
primary focus on road traffic casualties and also a lack of
highway space so as to provide safely. Access issues are
understood to be particularly important in helping to
reduce health inequalities given the transport barriers to
daily access needs including healthcare. Interestingly
perhaps, climate change and its links to carbon dioxide
emissions which may bring about major threats to health
was little mentioned by telephone interviewees. The
reason for this may an outcome of the methods and
specific questions used in the telephone interviews.
Further research is needed to tease out how links may
be made between road transport, health and climate
change.
This paper contextualised the study within the frame-
work of the 1998 Transport White Paper which gave
significant prominence to health-related issues. A note-
worthy finding is the mixed response among HCCs for
the view that the White Paper has had influence on how
they think about transport and health-related issues. This
holds even among Labour Councillors, who, given
political allegiance, might be expected to stress the
importance of the White Paper as a departure from the
previous Conservative era or an endorsement for a
greater focus on health issues at the local level. They in
particular felt that central government had not followed
through on intentions set out in the White Paper to
promote the connections between transport and health.
An important aspect to the conclusions which provides
some intimations for future policy and practice is that a
majority of respondents think that since 1998 health
issues have become more significant in transport
planning. This may help give further resolve to the
DfT and cross-government initiatives, in providing
increased support for efforts directed to increasing
physical activity and concomitantly improving air quality
and road safety. Emerging out of the data generated is an
account of a significant and growing understanding in the
way that transports connections with health are made and
a desire for greater support from central government.
This may be in terms of funding but equally it could be
the need for a stronger policy steer which endorses and
supports highway authorities interested in making further
or stronger connections with health sector partners in the
delivery of local transport plans.
A coda to the study must be that this intersectoral area of
public policy is largely uncharted. Follow-up studies and
other research drawing together HCCs views on transport
and health will be valuable. This might include of
collaborative actions at the local level to advance transport
(and health) objectives including closer working relation-
ships with PCTs, or assistance from central government
such as a greater emphasis on the links between transport
and health being highlighted in LTP guidance.
Acknowledgements
The Department for Transport’s New Horizons pro-
gramme funded the study and is duly thanked. This paper
does not necessarily represent the views of the Department
for Transport. I am grateful to Dr Sarah Wixey of the
Transport Studies Group, University of Westminster, and Dr
Josephine Kelly of Aston Business School for comments on
an earlier draft of this paper, as well as to two referees for
insightful guidance.
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