Dr Paul ButcherDirector of Public HealthCalderdale MBC

Embedding road safety In wider public health practice

To cover – Public health department and road safety connections• Health and well being • New public health systems• Public health outcomes • Road safety and public heath shared agendas• Active travel• Sustainability

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Health and wellbeing todayWe are living longer than ever before with dramatic changes in the nature of health over the last 150 years• infectious diseases now account for only 2% of deaths• 4 in every 5 deaths occur after the age of 65• clean air, water, and environmental protectionBUT: success brings new challenges• circulatory diseases account for 34% of deaths• cancers 27% and respiratory diseases 14%• rising prevalence of mental ill-health • persistence of long-term conditionsLifestyles and behaviours influence our outcomes and inequalities• 21% of the adult population still smoke• 61% of adults are overweight or obese• Fewer than 40% of adults meet physical activity guidelines• 2.4 million adults regularly drink more than recommended

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Local government’s new functions

- New duty to improve the health of the population:

Local political leadership critical to making this work.

• “To improve and protect the nation’s health and to improve the health of the poorest, fastest”

Approach• Society, government and individuals to share the

responsibility to improve and protect the health of the population, and especially those with the poorest health in our society

• Promote joint working where all organisations understand the contribution they can make to this common goal.

Vision

• Public Health England – a national public health service• A return of public health leadership to Local Government• Professional leadership nationally and locally• Dedicated resources for public health at national and

local levels• Focus on outcomes and evidence based practice

supported by a strong information & intelligence system• Maintaining a strong relationship with the NHS, social

care and civil society

A new public health system

question time

please pick up your handsets• Do you have an effective working relationship with

your public health department ?

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Public health outcomes framework • Life expectancy • Healthy life expectancy

4 domains • Improving the wider determinants of health• Health improvement• Health protection• Healthcare public health and preventing premature mortality

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Local Transparency and accountability

• Outcomes framework will be used alongside the Joint Strategic needs Assessment to determine local priorities

• Health and Wellbeing boards to determine local priorities and set out strategies which they will be held locally accountable to deliver

Connections PH indicators and road safety• Killed or seriously injured casualties on England’s

roads• Utilisation of green space for exercise/health reasons• Mortality attributable to particulate air pollution• % of population affected by road, rail, air noise • Social contentedness (Placeholder)• Older people’s perception of community safety

(Placeholder)• excess weight in 4-5 year olds and 10-11 year olds• excess weight in adults.• proportion of physically active and inactive adults

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question time

please pick up your handsets

• Are you engaged with your health and well being strategy?

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Improves public health, reduces inequalities

Less road trauma, less air pollution, less fuel poverty, fewer winter deaths, more physical activity, fewer overweight/obese people

Lower levels of long term, multiple preventable conditions

More investment in health promoting systems + public infrastructure

Adds more life to years, not just years to life

Less dependence of formal health and social care system

Based on: “Claiming the Health Dividend”, Coote, A. King’s Fund. May 2002

e.g. more sustainable housing, transport, and food systems

Virtuous circle for health

Source: IPCC AR5, Working Group 1, Climate Change 2013: The Physical Science Basis

Public health consequences of…

All deaths Cancer Diseases of the circulatory system

Transport accidents Cycles -

100,000

200,000

300,000

400,000

500,000

600,000

484,367

143,181 139,706

1,815 98

2011

Eng

land

and

Wal

es d

eath

s

59,568

83,613

Other cancers

Breast, prostate, colorectal

Physical inactivity reduces mortality risks of these cancers by 30-50%Around 35% of cardiovascular diseases attributable to physical inactivity + another ~25% partly attributable to air pollution

The risk of physical inactivity compared to road casualties

Source: * **DfT Road Traffic Casualties 2009 *** BHF statistics 2010 edition; McPherson et al 2002.

More cycling and walking achieves multiple public health objectives

• Achieves physical activity objectives in the public health outcomes framework

• Reduces obesity • Reduces road traffic casualties • Improves local air quality • Reduces CO2 emissions• Increases social interaction and builds social

capital

Example: • Across a town of

150,000 people, if everyone walked an extra 10 minutes a day, the HEAT model estimates:• 31 lives saved • Current value of

£30m per year

19781979

19801981

19821983

19841985

19861987

19881989

19901991

19921993

19941995

19961997

19981999

20002001

20022003

20042005

20062007

20082009

20102011

20

25

30

35

40

45

50

55

60

65

70

UK USA Netherlands Italy Germany Sweden

% o

bese

or o

verw

eigh

t

Overweight and obese, 1980-2011In the USA, obesity increased from

Obese15%

Over-weight32%

Normal or under

53%

1978

Obese36%

Over-weight33%

Normal or under31%

2010

Public health and road safety – shared agendas• Public health has a £ uplift in a number of councils • Road safety funded by PH budget • Joint action on 20mph zones /limits • Road safety managed within public health• Links between active travel, climate change, road

safety • Living streets /play streets• Commissioning additional activity – eg sustrans• Bikeability and health legacy from Tour de France • Data sharing and contribution to JSNA

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Road deaths in GB 1930-2010

Cycle fatalities have fallen by 92% since the 1940s

Rate per 100,000 people

19501952

19541956

19581960

19621964

19661968

19701972

19741976

19781980

19821984

19861988

19901992

19941996

19982000

20022004

20062008

20100

10

20

30

40

50

60

70

Fata

lities

per

100

,000

Per billion kms

19501952

19541956

19581960

19621964

19661968

19701972

19741976

19781980

19821984

19861988

19901992

19941996

19982000

20022004

20062008

20100

20

40

60

80

100

120

Fata

lities

per

bill

ion

kms

Measuring risk of cycling, wrong and right

Cyclist

s

Motorcyclis

ts

Car occu

pants

Bus occu

pants

Van occu

pants

HGV occupan

ts0

2

4

6

8

10

12

14

16

18

20Ro

ad d

eath

s of t

hrid

par

ties p

er b

illio

n m

iles

Per billion miles travelled cycles are involved in fewer deaths of other road users than any other mode of trans-port.

Which road user represents the most danger per mile travelled?

Pedestrians

Cyclist

s

Motorcycli

sts

Car occu

pants

Bus occu

pants

Van occupants

HGV occupants

Other vehicl

e occupants

0

200

400

600

800

1,000

1,200

1,400

1,600

1,800

Others killed in collision with road user

Road user killed

Road

dea

ths

Cars, buses, van and lorries present far more risk to other road users, whereas pedestrians, cyc-lists and motorcyclists are more often victims.

Which road user is involved in the most road deaths?

453

107

362

883

7 34 27

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Where ‘road safety’ goes wrong

• Any intervention or law that reduces physical activity will almost inevitably do more harm than good.

• de Jong (2012) – helmet legislation or promotion only has a net health benefit if injuries prevented exceed health costs lost to reduced cycling.

Numbers of people killed or seriously injured Very bad

Rate of death or injury to users per 100,000 population (current) Poor

Rate of death or injury per mile, trip or hour (measured by some) Better

Rate of death or injury to third parties (danger posed) GoodOverall public health impact of different transport modes (road death or injury caused AND air quality, cardiovascular disease etc)

Best

Conclusions

• Set targets and measure the right things…

• Get the balance right between promoting cycling for public health and road safety campaigns or laws which deter people from cycling

Questions?

• How is safety and risk measured where you live?• How do we change institutional and organisational

approaches to risk and safety?

Thanks!

References: Christopher Peck - CTC – the national cycling charity - 2013 - chris.peck@ctc.org.uk