Mainstreaming health in transport – who’s next?


In February 2014 Transport for London published the world’s first transport health action plan. I wrote this plan and oversaw its delivery over the past three years. This marked a transition from ‘health’ as a policy topic in a transport sector organisation to improving public health becoming the driving force for the long-term strategy.

The document was a major milestone. Transport for London became the first global city transport authority to commit to taking my Healthy Streets Approach. This is a radically different approach to transport planning that takes a whole street approach rather than choreographing a competition between transport modes. It was well received by local stakeholders and the international community, winning several awards including from the UK Chartered Institute for Highways and Transportation and the International UITP.

Each year a report was published setting out the progress made in delivering the three year action plan.  This included generating new evidence of the relationship between transport and health in the city, training staff to monetise health benefits of transport projects and building health into policies. Certainly a dry read, but these reports document the foundations being laid for mainstreaming health in transport. Digging into the detail of these reports reveals a story that could be replicated across the many other areas of public policy making that could and should be embedding public health considerations.

Public health is described as ‘the science and art of promoting and protecting health and wellbeing, preventing ill-health and prolonging life through the organised efforts of society‘.  To deliver improvements in public health therefore, it is essential that it is seen as ‘everyone’s business’  and systematically built into policy and governance of organisations across sectors, not just the health sector. When Transport for London published their transport health action plan they embarked on the process of building considerations of public health into their ‘organised efforts’.

The three annual progress reports on delivering this action plan chart the beginning of that process of building health considerations into transport sector decision making. This is much more than the cursory references to the health benefits of active travel that the transport sector has been making for many years.  This is taking ownership of the huge impact that transport has on health by changing practices, investments and decision making to deliver real improvements in population health.

Embedding public health in any sector is not a simple and straightforward process. It requires a realisable but ambitious vision, a coherent and robust framework for action, skillful employment of technical expertise, engagement and coordination of a wide range of players, political commitment and a solid evidence base. It is a process of changing the way a whole range of people think and giving them the skills and tools they need to change the way they behave.

The Transport for London transport health action plan has now come to a close. The final progress report has been published setting out how public health has become mainstream in the organisation and built into the governance. The Healthy Streets Approach has been adopted as the overarching framework of the draft Mayor’s Transport Strategy which includes ambitious targets for improving population health and reducing health inequalities (another world first). The organisation is producing the tools for embedding the Approach in their business as usual and supporting the other players involved in how streets are designed and managed to change their practices too.

The world’s first transport health action plan can be seen as a blueprint for laying the foundations of changing practice to deliver real improvements in population health.  This is transferable to the transport sector in other cities – and to other sectors too – so I am wondering which city will be publishing the world’s second transport health action plan?