Working within local authorities… What are the opportunities and challenges for the future? Adrian Davis Sarah Tickner A

1. Working within local authorities… What are the opportunities and challenges for the future? Adrian Davis Sarah Tickner Amy McCullough

2. Outline

3. 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.

4. 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

5. 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problems of poor housing and sanitary provision with Borough Engineer • 1974 Medical Officer of Health post abolished, superseded by community physicians within NHS and local government health services subsumed in Social Services Depts. 127 years

7. Elected Members and Independent Public Health Advise • Leader • Deputy Leader, Cabinet Member for Capital Programme, Sport and Culture • Cabinet Member for Transport • Cabinet Member for Care and Health • Cabinet Member for Targeted Improvements • Cabinet Member for Children and Young People • Cabinet Member for Housing, Property Services and Regeneration • Cabinet Member for Neighbourhoods • Assistant 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

8. 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

9. 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. The myth of progress 1990s

10. The disease-burden from road transport Source: Cycling & Health – What’s the evidence? Cavill, N., Davis, A. 2007

11. Transport and health knowledge time-line Traffic in Towns, 1963 ‘Accidents’, air and noise – dominance of and aspirations for car use Livable Streets, 1972 Road traffic volume and speed damage social support networks Social and environmental context for health Development of new public health from mid 1970s 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 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. WHO, 2000 Development of peer reviewed evidence base of health impacts Including 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

12. Transport Planning Dr Adrian Davis Cycling City Simon Carpenter (0.4fte) Climate & carbon Dr Angela Raffle (0.6 fte) Health Policy Liz McDougall Active Bristol Clare Lowman Planning & Health Stephen Hewitt Built Env/HealthyCity Marcus Grant/UWE (0.1 fte) Public Health support within Bristol City Council: planning for synergy

13. 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

15. What’s good for health is good for the Treasury

16. Regional Public Health support Value for Money: BCRs

17. 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 Somerset Dr Hugh Annett, Director of Public Health Bristol Becky Pollard, Director of Public Health North Somerset Dr Chris Payne, Director of Public Health South Gloucestershire.

18. 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

21. 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

22. 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

24. 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

26. 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

27. 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

28. 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

29. 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/

30. Group Task • 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.