In response to public health challenges facing the city, London introduced a Transport Action Plan in 2014. Developed by a Public Health Consultant working in Transport for London (TfL), the city's transport authority, it outlines transport-related measures for improving the health of Londoners. The Plan sets out 10 action points related to TfL's 'business as usual' processes that, if undertaken, should help TfL respond to public health challenges. By making the links between transport and health explicit, the Plan makes a clear contribution to public health. The Healthy Streets Approach contained within the Plan is crucial: this seeks to increase active mobility levels and in turn reduce the incidence of diseases and conditions linked to or exacerbated by physical inactivity, such as Type 2 Diabetes.
Like other big European cities, London's population is growing and it urgently needs to reduce emissions and manage congestion and traffic levels. Policies and measures to alleviate these problems are of vital importance to the city and its citizens' health. In England, the National Health Service was responsible for public health until 2013. However, it was then 'devolved' to local government, which restored the link between planning and public health. Whilst TfL has no direct responsibility for public health, it recognises its major role in improving the health of Londoners. The Plan was first adopted in 2014 and is being implemented until the end of 2017.
TfL has been implementing the Plan in partnership with Greater London's 32 boroughs (local authority districts) and the departments in London's city authorities responsible for urban planning and health. It provides a strategic approach to active travel promotion through the Healthy Streets Approach, which itself is based on 10 Healthy Street Indicators.
Aside from the Approach, the Plan also looks at:
- Improving air quality;
- The merits of 20mph (30km/h) traffic zones;
- Reducing the impact of road traffic collisions.
Products were created to support TfL in mainstreaming health into its decision-making processes, including a Healthy Streets Survey to engage the public in making changes to their streets; a Healthy Streets Check to ensure traffic planners integrate health considerations into new street designs; and a local manual for implementing the World Health Organisation's Health Economic Assessment Tool, which monetises health impacts in business cases for projects and policies.
TfL also published annual reports that demonstrate the progress made in acting upon the 10 action points, the plan's overall implementation, and how health is being mainstreamed into TfL's planning and operational processes.
The Plan has helped drive a shift towards active transport modes, especially in planning
and policy. In this way, it has provided a framework for considering ways to increase everyday physical activity levels amongst London's population, a large proportion of whom are inactive (27 per cent).
This is illustrated most clearly by the fact that the Healthy Streets Approach has become the overarching framework for the city's new 25-year transport strategy. The strategy predicts that 80 per cent of trips in London in 2041 will be made on foot, by bike, or using public transport: their current combined modal share is 64 per cent. This should deliver a radical shift in transport planning and investment that will finally see active mobility prioritised over private vehicles. Over the next five years, £ 2.1bn will be spent on creating healthy streets designed for walking, cycling, and public transport.
Furthermore, the Approach is being incorporated into all of the Mayor of London's statutory strategies. This will help ensure that the many stakeholders involved in delivering the outcomes outlined in the Indicators work together, including planners, designers, and public health professionals. The Plan has also been received well by the wider stakeholder group, including the Department for Transport and Public Health England. Both have been influenced by ideas developed in London.
The Healthy Streets Approach is applicable to any village, town or city, whilst the Plan's 10 action points can be applied at no additional cost by any transport or planning authority. Should an authority wish to implement them, then employing a public health expert is advised. Their technical expertise helps deliver the desired systems-change, whilst their presence helps combat any related scepticism.
Adopting the Healthy Streets Approach has led to TfL considering transport through a health ‘lens’ that is relatively well understood by transport professionals. However, establishing transport as a factor for consideration in the public health field still poses a significant challenge. Promoting active travel and its benefits might be a way to achieve this. Such plans also provide an opportunity to increase collaboration between the two sectors.
TfL learnt that activities should be selected based on regular stakeholders assessments: those that stakeholders are most receptive to participating in should be prioritised. In addition, if politicians and senior management do not initially commit to the required organisational change, then the focus should be on building the capacity of advocates within and outside the organisation and a coalition of support amongst wider stakeholder networks.
A clear plan with reported actions, which integrates the development of a range of policies, activities, and concepts, would be of great value across Europe. As well as providing a framework for action and collaboration, it offers practical tools to address and solutions for complex public health and transport issues.
Read the various policy documents referred to above:
- Transport Action Plan - click here.
- Health Streets for London - click here.
- Mayor of London's Transport Strategy 2017 (draft for public consultation) - click here.
The case study comes from the EU-funded PASTA project, which aims to show how promoting active mobility (cycling and walking) can lead to a healthier, more physically active population. Find out more here.