Working within local authorities…

What are the opportunities and challenges for the future?

Adrian Davis

Sarah Tickner

Amy McCullough

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

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.

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

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• 1974 Medical Officer of Health post abolished, superseded by community physicians within NHS and local government health services subsumed in Social Services Depts.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

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

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

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

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

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

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

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

What’s good for health is good for the Treasury

Regional Public Health support Value for Money: BCRs

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.  

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

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

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

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

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

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

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

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/

• 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