EXECUTIVE SUMMARY
Purpose of this research
1.1 This report sets out the findings from the research on joined up policy and practice in health and transport for the Scottish Executive.
1.2 This study was commissioned with the aim of exploring the growing links between transport and health at both the policy level, and the practice level, to learn from what is already done in this field in Scotland and elsewhere, and to recommend ways in which joined up working can be promoted further in the future.
1.3 The research was commissioned by the Scottish Executive, with a project advisory group consisting of the following:
- Scottish Executive Transport Strategy and Legislation Division
- Scottish Executive Health Department
- Sustrans
- West Lothian Council representative of SCOTS
- Dundee City Council representative of COSLA
- NHS Health Scotland
1.4 Details of the approach to the research are contained within the final report.
Scoping the problem
1.5 This study is focusing on the links between transport policy and initiatives, and health improvement. That is, the study is exploring where links have been made with health improvement, health promotion and transport initiatives, such as encouraging individuals to walk or cycle to work, school or other key destinations in their average day.
1.6 This approach has been taken for a number of reasons:
- Access to healthcare services is clearly a major issue across the UK, but a separate one to the contribution of transport to health improvement, which it is argued has received less attention to date.
- The links between transport and safety, and transport and the environment are established through the appraisal of transport schemes which considers safety and environmental impacts, and several statutory duties are in place which require consideration of the impacts of transport policy and projects in these areas. The link between transport and health improvement is less well made.
1.7 The research has focused chiefly on utility travel, that is functional travel to work, school, shopping and other activities, including transport initiatives at the local level through, for example, environmental improvements (such as Home Zones).
1.8 However, it should be noted that it may not be possible to completely separate the role of leisure travel from utility travel, as consultation for this research has suggested (anecdotally) that people are more likely to take up walking and cycling for utility purposes if they already do so in their own leisure time.
Why are increased links between health and transport desirable?
1.9 There is a growing body of research on the importance of physical activity to health. The World Health Organisation ( WHO) advocates that "walking and cycling as part of daily activities should become a major pillar of the strategy to increase levels of physical activity as part of reducing the risk of coronary heart disease, diabetes, hypertension, obesity and some forms of cancer", (as well as reducing air and noise pollution and improving the quality of urban life) 1.
1.10 Such levels of physical activity can have a significant impact on health. Adults who are physically active have 20-30% reduced risk of premature death, and up to 50% reduced risk of developing the major chronic diseases such as coronary heart disease, stroke, diabetes and cancers. The WHO calls physical activity as one of public health's "best buys".
1.11 The costs of physical inactivity are significant. The estimated costs of physical inactivity in England are £8.2 billion annually, which does not include the contribution of inactivity to obesity which in itself has been estimated at £2.5 billion annually. These figures include both the costs to the NHS and costs related to the economy, such as absence from work 2.
1.12 However, levels of physical activity across the UK are low, including in Scotland. Scotland's life expectancy lags behind comparable countries such as Sweden and Denmark, and also suffers in comparison to other parts of the UK including industrial regions like the North East of England.
1.13 Scotland's people are becoming more inactive, and suffer from poor health, not only as a result of inactivity, but a combination of other factors including poor diet. Moreover, people become less active as they grow older, and there is evidence to suggest that those with higher levels of activity earlier in life are likely to take these healthy habits forward into later life.
1.14 Following a commitment in the Scottish Executive's White Paper Towards A Healthier Scotland, Scottish Ministers set up a National Physical Activity Task Force in June 2001, and a Strategy for Physical Activity 3 was produced. The Scottish Executive's Physical Activity Strategy has the goal of increasing and maintaining the proportion of physically active people in Scotland. The associated targets are 50% of all adults aged over 16, and 80% of all children aged 16 and under, meeting the minimum recommended levels of physical activity by 2022.
1.15 Moreover, the Scottish Strategy for Physical Activity recognises the role of physical inactivity in health inequality, with the proportion of sedentary adults (doing 30 minutes or less of physical activity on one day a week or not at all) in the lowest socio-economic groups being double that among those from the highest socio-economic groups 4.
1.16 Car ownership and congestion is growing in Scotland, as it is across the UK. People are driving further (10 miles on average in 2000 compared to 5 miles a day per head in 1985/86), and more often. If unchecked, traffic levels are forecast to rise by 27% over twenty years 5.
1.17 The Scottish Household Survey provides information about how people travel in Scotland. In 2003, the proportion travelling to work by car was 69%, with 13% walking and 2% cycling. For work journeys of between 1 and 2km, 59% of trips are by car, and for trips less than 1km, 31% are still by car.
The health sector in Scotland - policies, structures and priorities
1.18 There is a range of organisations involved in health care provision and health promotion across Scotland. The formal healthcare sector, as represented by NHS Scotland, is only one such stakeholder - local authorities and the voluntary sector also have an important role to play. Furthermore, various non-health sector public organisations have an interest in health promotion where it links with their objectives, such as Community Planning bodies, and local authorities.
1.19 Physical activity is seen as an important part of health promotion and improvement, and active utility travel is recognised as a key opportunity to promote health at the policy level. It remains to be seen however whether activity is being promoted as much through utility travel as through sport, and what is actually happening on the ground in terms of implementing the links between health and travel. It is also questionable as to whether the opportunities for physical activity promotion within the journey to work, school and so on, is being pursued as effectively as it could be.
1.20 Moreover, the health sector has many priorities, and it is unclear how much is being assigned to physical activity within health promotion, compared to the many other issues that have to be tackled, for example waiting lists.
The transport sector in Scotland - policies, structures and priorities
1.21 The recent Transport White Paper is perhaps amongst the more progressive documents to date which links health and transport together, and the 2005-06 Budget, which links into the objectives for transport stated in the White Paper, suggests that links to health are being taken into account through funding for Cycling, Walking, Safer Routes to Schools which includes funding of School Travel Coordinators and Cycling Scotland.
1.22 A number of local and regional transport strategies do appear to have considered health issues, although many of these are now out of date and need updating. Indeed, a key opportunity to further link transport policy to health improvement is approaching, through the development of statutory Regional Transport Strategies in 2006, and an updated round of Local Transport Strategies in 2006 (although these will not be statutory documents).
1.23 Importantly however, performance monitoring and how this relates to transport funding is potentially a key driver of decisions and priorities. Local Transport Strategies are voluntary documents and are not explicitly linked to receiving funding allocations, as is the case with Local Transport Plans in England. National transport targets are predominantly focused on passenger transport and congestion, whilst 2002 transport delivery indicators do include reference to modal shift on short journeys, although it is understood that these indicators will be reviewed and updated as part of the implementation of the Transport White Paper. A further issue is the general lack of integration of cross-sector targets with transport targets, although these linkages are increasingly being made through Community Plans.
1.24 There is a question over which is the most appropriate level for increased linkages between transport and health, as a regional transport partnership coordinator interviewed for this study held the view that the regional level was a strategic one, and care needed to be taken to ensure they were not "interfering" with more local issues, that were best dealt with at the local level.
Key findings on approaches to joined up policy and practice in health and transport
1.25 On the whole, it would appear that whilst our research has uncovered some examples of joined up working in transport and health, this joined up thinking and working is by no means mainstreamed across Scotland.
1.26 Increasing numbers of stakeholders are aware that it is in their interests to work with others to pursue common outcomes, even if their objectives may not be the same - this is something that can be built upon in the future.
1.27 Where joined up thinking has come about through work by local partners, this seems to be happening most effectively in areas where health issues are a significant motivation for policy as a whole, for example areas of deprivation and poor health.
1.28 However, the "actors" involved are much wider than just transport officers and health promotion staff in the NHS - for example, planning officers, community planning partnerships, outdoor access officers all have a role to play, and this needs to be appreciated and recognised to enable progress to be made.
1.29 Many of the strongest initiatives linking transport and health explicitly are predominantly health-sector, or health-motivation led, with the exception of some examples including School Travel Planning and specific action on developing cycleway infrastructure.
1.30 It is clear that significant progress needs to be made to convince policy makers across both health and transport sectors that there is merit in working together to achieve common outputs, even where sectoral objectives may contrast (for example, modal shift for transport, healthy living for health). Moreover, there is effort needed in the transport sector to convince decision makers that there is firstly merit, and secondly a duty to consider the health impacts of transport policies and projects, as well as actively seeking to maximise health improvement opportunities.
1.31 Furthermore, there is a lack of evidence of the cross-sector costs and benefits between the transport and health sectors, in part due to an inconsistent and non-prescribed approach to monitoring of transport outcomes. It is also difficult to isolate the impact of transport initiatives, for example projects that promote walking and cycling on general health improvement, given the extensive range of factors that contribute to this - although as this research reports, there is a recognised link between physical activity and prevention of some illnesses, and this link can be built upon. Overall, there is potential for mutual benefits by complementary policy initiatives, and indeed, through avoidance of conflicting priorities.
Approaches to joined up working - summary
Sector / Type of approach | Organisation or post led | Funding led | Statutory led | Policy led | Event / Programme / Campaign led | Voluntary and other | Good practice examples |
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Transport | Sustainable transport / walking / cycling officers Transport strategy officers School travel plan coordinators Travel Plan officers | School travel planning | Road Traffic Reduction Act 1997 Transport (Scotland) Act 2005 (access to health) | Transport White Paper 2004 Local Transport Strategies Road Safety Strategies Draft Walking Strategy | European Mobility Week Sustrans Safe Routes to Schools project, and Active Travel Scotland Programme Scottish Executive Choose another way | Sustrans Paths to Health Project | Fife Council Travel Planning, and integration with leisure walking activities Tackling travel behaviour and discussing benefits and motivations on a one to one basis - Scottish Executive Stepchange pilots and East Dunbartonshire Council Information dissemination - West Lothian Physical Activity Atlas, North Lanarkshire Council SMARTways |
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Planning / Environment | Outdoor Access Officers | Paths for All Partnership and Paths to Health Project | Land Reform (Scotland) Act 2003 Environmental Assessment of Plans and Programmes (Scotland) Regulations 2004 | SEA Environmental Reports | Scottish Executive Do a little, change a lot Bike Week Walk to School Week | Sustrans Paths to Health Project | Fife Travel Planning, and integration with leisure walking activities |
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Health | NHS Board Health Promotion Specialists (Joint) Health Improvement officers SHAW coordinators | Scotland's Health at Work Healthy Living Centre projects | | National Physical Activity Strategy (Joint) Health Improvement Plans Local Health Plans | Scottish Executive Healthy Living | Health Impact Assessment ( HIA) | Active Referral programmes - Highland, Glasgow Training and education of staff on physical activity - NHS Greater Glasgow Glasgow Physical Activity Strategy West Lothian HEPA |
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Education | Active Schools Managers and Coordinators | Active Schools Health Promoting Schools | | | | Sustrans (school travel) | School travel plan guidance for STPCs and Active Schools Coordinators - Highland Council School Travel Plan pack - Fife Council |
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Social Inclusion / Quality of Life / Cross sectoral | Community Planning partnerships and officers / coordinators Access Officers Community Safety Officers | | Local Government in Scotland Act 2003 (duty of community planning, power to advance well-being) | National Physical Activity Strategy Community Plans | | | Physical Activity Task Force (Fife) Physical Activity Forum (Fife) |
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Barriers and challenges to joined up working
1.32 Throughout this research, we have attempted to identify barriers to joined up working, and assess what needs to be done to overcome these to advance joined up policy and practice in health and transport in the future. We present here some of the challenges to joined up working. The next section in this report makes recommendations on how to overcome some of these.
Guidance and definition issues
1.33 Throughout the case study research, it became clear there were a number of barriers related to lack of guidance, and misunderstanding over definitions of terms and issues. The following table shows barriers to joined up working in this context.
Lack of a requirement to demonstrate joined up working and need for a high-level, strategic "push" from central government in this area. For example, there is a lack of formal monitoring requirements for local transport policy and progress from central government in Scotland, against an agreed set of targets and indicators.
Lack of guidance on links between transport and health, and differing perceptions of what this means.
Poor understanding in transport and health sectors of each other's priorities and issues, and of how each sector works - this also manifests itself in not knowing who to approach about certain topics, although the creation of joint-working forums and groups can help with this considerably.
Lack of a strategic lead from Scottish Executive, for example no final walking strategy, and lack of a comprehensive set of targets and indicators for transport.
Definition issues over what is meant by "physical activity", with the focus of policy and expenditure sometimes on sport and leisure (such as discount leisure centre passes) rather than active lives (such as the journey to work). Understanding of the term "physical activity" is often viewed as meaning sport, or even exercise, which can deter some people and will only appeal to a small proportion of the population, rather than a broader concept of incorporating activity into everyday lives.
Definition issues over what is meant by "health", with the inference of healthcare services and sickness rather than general quality of life and "well-being.
There is a feeling amongst some professional officers who deal with cycling and walking issues in local authorities that it is impossible to separate leisure travel by sustainable modes from utility / functional travel - those who enjoy walking and cycling in their own time are more likely to do so when travelling to work for example.
From the Expert Panel seminar carried out as part of this research ( see Appendix D), there was a call for improved sharing of good practice, and a concern that staff were working in isolation across Scotland on similar initiatives at a risk of "reinventing the wheel".
Staffing and management issues
1.34 Another set of barriers encountered to joined up working is in the context of staffing and management, including motivation of staff to pursue joined up working, shown in the following table.
Dependency on enthusiastic and motivated staff to drive forward mechanisms, which is fine where these are in post, but means lack of progress elsewhere
Loss when a key staff member leaves - this is particularly the case where an individual has been instrumental in building links on a particular issue and getting involved due to their own interest, rather than wider, departmental or organisational / policy-driven sign-up to an issue
Under staffing in many transport departments and NHS Boards, which puts pressure on existing staff who can only deal with so much
Inability to spend adequate time on certain issues, for example reviewing development control applications for cycling and walking provision
there is a growing array of roles within local authorities in particular, but also the health sector, which have been developed to focus on specific issues that are of interest to this research, for example School Travel Co-ordinators, Active Schools Managers, Travel Plan Coordinators, Cycling Officers, Health Improvement Officers. Each of these roles has their own specific priorities (often linked to a specific funding stream), and many do not think it is their responsibility to further develop the links between transport and health on their own. Furthermore, there is a lack of consistent coverage of Scotland of these various roles (for example not all authorities have specific Cycling Officers or Travel Plan Coordinators). It is therefore difficulty to see who can have a co-ordinating role, without which, progress can be slow or absent altogether
Related to this latter point, many of these roles, even when based in the local authority, are based in different departments/divisions and may not have appropriate networks of communication with other relevant bodies (for example Joint Health Improvement Officers tend to be based in various departments). Furthermore, whilst there are good communication networks, these are not uniform across Scotland, such as Physical Activity Task Forces in some local authority areas, but not all. Lack of communications within organisations and between organisations means that it is sometimes hard for an officer to know who to contact in a specific department, or the local health authority to discuss a particular issue with.
Funding issues
1.35 Several barriers exist related to funding, in terms of the types of funding available, and lack of funding completely.
Lack of ringfenced / dedicated funding, although where ringfenced funding exists, it is targeted only at some groups / activities, whilst neglecting others, such as dedicated national funding for school travel planning but none specifically for employee travel planning. Furthermore, finding funding for certain elements in ongoing initiatives, such as publicity and promotion, is acting as a barrier to implementation on the ground.
Temporary funding for posts, often in three year cycles, for example original Outdoor Access Officer posts, Paths to Health projects, which creates job insecurity and can stultify progress.
"Drying up" of valuable funding sources for walking and cycling, such as the Public Transport Fund, although the Scottish Executive states that existing sources of funding for cycling and walking ( CWSS) to local authorities has been increased accordingly. However, as our review of transport expenditure in our research illustrates, walking and cycling as modes of transport do receive substantially smaller spending allocations from the Scottish Executive in relation to other areas of transport expenditure. This makes it difficult for local authorities to prioritise walking and cycling, where it is appropriate for their authority area, and subsequently makes progress in transport and health joined up working difficult.
Political will and priorities
1.36 Finally, barriers are faced in terms of what decision-makers want to see and do in their communities. Priority given to areas of expenditure can also be traced back to what (health and local) authorities are required to monitor and illustrate performance or delivery on, as directed by central government.
There may be a desire to have "photo opportunity" projects, for example a new leisure centre, compared to low-profile local initiatives, such as people walking on local paths
Health improvement is rising on the health agenda, and increasing links are being made with other sectors where it helps to contribute to their objectives, such as using health improvement as an incentive for modal shift for employees or school children, targeting travel in physical activity campaigns. However, it could be suggested this has not been "mainstreamed" as an approach as yet, as it tends to be an "add-on" in relation to other policy objectives such as reducing congestion or improving road safety. It is also questionable how health improvement fares as a policy priority in contrast with waiting time targets and other areas of policy commonly in the public eye; similarly, transport priorities are arguably congestion driven with a focus on large schemes. In this context, it is hard to identify a clear policy priority driving policies and projects which link transport and health
Tobacco is a huge priority for health improvement and disease prevention in Scotland, and is receiving a concordant amount of investment. However, physical activity is arguably as important an issue with regards the health of the Scottish people as tobacco, and indeed, evidence exists to suggest that the health impact of inactivity in terms of coronary heart disease, for example, is comparable to that of smoking 6
Medical professionals are given a strong lead from Government through funding, targets and exhortation that tackling issues such as waiting lists and acute diseases is their priority. This may make them reluctant to get involved in projects linking physical activity, health and transport, as they may perceive these as being of lower priority and of less relevance to their patients, particularly in poorer areas of the country. They may also lack training and even awareness in this subject area, and / or may lack the time to sufficiently deal with these issues in their day to day work.
Community planning is a statutory requirement, led by local authorities, and health improvement is a key element of this (linking with Joint Health Improvement Plans), so the mechanisms are potentially in place for joined up working. However, it remains to be seen how this fares against other local policy priorities in each local authority area. Moreover, Community Planning partnerships tend to have multiple sub-groups, and health improvement may be less of a priority in some authority areas than others.
Summary of barriers and challenges
1.37 Clearly whilst there is joined up working ongoing between transport and health areas, there are key barriers and challenges to this, particularly in relation to:
- Guidance and definition issues over what links between transport and health means, perhaps inevitable given the early stage of development of links, but clearly something that needs to be improved upon to develop a consistent approach across Scotland.
- Staffing and management issues, with a dependency on motivated staff due to a lack of mainstreaming of joined up transport and health at a more strategic level.
- Funding, related to the nature of funding available (often short term), and the relative lack of funding dedicated to the areas of transport which can have a key role in health improvement, that is, walking, cycling and local community projects to promote physical activity.
- Political will and priorities allocated at the local level, often driven by central funding and performance monitoring, as well as the desire to have high-profile "photo opportunity" projects.
Key recommendations
1.38 We have produced a set of recommendations on how to improve joined up working between transport and health in the future, at the policy and practice level. These recommendations are based on our key findings on joined up working between health and transport, the barriers and opportunities for improved joined up working in the future ( see section 8 of this report).
1.39 Overall, it is clear that there needs to be some fundamental features in place for joined up working to happen, that is:
- A strong policy framework, one that is statutory, and clearly states the need to link health improvement with transport policies and projects.
- A requirement to monitor, to ensure that progress is achieved, and lessons can be learnt from what is working or not working.
- Secured and long-term resources to assist with the above, and to make progress on the ground, both in terms of staff and funding.
1.40 Furthermore, a message emerged from the Expert Panel seminar held as part of this research that there may not be the desire for another initiative to emerge from the Scottish Executive, in this case, a health and transport initiative - given the range of initiatives that health boards and local authorities already deal with. Moreover, there is clearly a need to better incorporate the links between transport and wider quality of life and well-being issues through existing frameworks - that is, to mainstream the links between transport and health.
Recommendations and lead responsibilities for action
Category | Link to barrier identified in report | Recommendation | Other considerations | Lead responsibility |
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Good practice / information dissemination | Guidance and definition issues | Good practice guide from this research, to promote the positive elements and lessons that are being learnt from existing initiatives | | Scottish Executive Project Advisory Group |
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Policy and guidance | Guidance and definition issues Political will and priorities | Ensure that National Transport Strategy (in development, due 2006) will provide a strategic direction on how transport can contribute to health improvement, as per the 2004 Transport White Paper objective of protecting our environment and improving health, and not focus solely on access to healthcare facilities | | Scottish Executive Transport Divisions |
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Policy and guidance | Guidance and definition issues Political will and priorities | Develop wider range of transport indicators and targets at a national level (which also includes cycling and walking) | | Scottish Executive Transport Divisions |
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Policy and guidance Good practice dissemination | Guidance and definition issues | Better guidance on how to monitor cross-sector initiatives, linking in with a range of existing data sources and indicators across sectors, as well as making monitoring of LTSs a formal requirement, with specific indicators for walking and cycling. Showcase some good practice evaluations already carried out in good practice guidance in this area | Sustrans are currently working with Paths to Health on monitoring approaches | Scottish Executive Transport Divisions and general |
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Policy and guidance | Guidance and definition issues | If making LTSs statutory documents is not a feasible option (although this would be desirable), with meaningful monitoring requirements, it is certainly desirable for meaningful monitoring to be built into the new statutory RTSs, so that a baseline of data can be developed and progress monitored on an annual basis, including targets for walking and cycling. | RTS guidance is due out for consultation in autumn 2005 | Scottish Executive Transport Divisions |
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Policy and guidance | Guidance and definition issues | Produce final Walking Strategy (Scottish Executive) with targets, or if this is not to be provided, provide clarity on direction of national walking policy. | | Scottish Executive Transport Divisions |
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Policy and guidance Good practice / information dissemination | Guidance and definition issues | Specific guidance on school travel plans and on the development of school travel packs (bearing in mind that many authorities have already begun the process of developing their own packs in the absence of a central resource), including role of Active Schools and Health Promoting Schools, including how to incorporate active travel and links that can be made with health - can draw on examples already developed by local authorities across Scotland. Consideration of 'School Well-being Partnership' - partnership of School Travel Plan Coordinator(s), Active Schools, Health Promoting Schools, Education Department, walking / cycling officer and public transport officer. | Await outcome of existing Scottish Executive research on effectiveness of school travel plan coordinators | Scottish Executive Transport Divisions, Education and Health departments |
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Policy and guidance | Guidance and definition issues | Basis for promoting physical activity as a wide-ranging concept is there in the national physical activity strategy - work is needed to continue to get this message across to policy makers and decision makers on the ground through implementation of the national strategy | | Scottish Physical Activity and Health Alliance / Council |
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Good Practice and information dissemination | Guidance and definition issues Staffing and management issues | Increase awareness of the fact that a Physical Activity coordinator post is ongoing in the Scottish Executive (our research suggested that most individuals perceived this to be a temporary post), and the existence of the new National Physical Activity Alliance | National PA Alliance has formed since the start of this research, and secondment of Mary Allison as PA coordinator ended during the research | Scottish Executive Health Department |
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Good Practice and information dissemination | Guidance and definition issues Staffing and management issues | Monitor progress of development of Physical Activity Strategies and Forums across Scotland, and provide more prescription on how this can be achieved, with monitoring requirements linked to funding, and Community Planning process | | Scottish Physical Activity and Health Alliance / Council |
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Policy and guidance Good Practice and information dissemination | Guidance and definition issues | Specific updated design guidance on how to better incorporate walking and cycling into new development, urban design, travel planning etc. for a wide range of audiences and everyone with a role to play in how people access services/facilities, and use public space. Potential to review and draw on local authority guidelines illustrating good practice approaches (such as Fife) | Recently published guidance on Transport Assessment provides some guidance, but not on a detailed level. "Cycling by Design" has been produced in 2000, but in consultation form. | Scottish Executive Transport and Planning Divisions |
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Good practice dissemination | Guidance and definition issues | Showcasing of a medical referral scheme that is widening the scope of referral to include walking and cycling schemes, as well as advice on building activity into everyday life e.g. Linlithgow. | This could be built into a good practice guide based on this research | Scottish Executive Project Advisory Group |
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Policy and guidance Funding and appraisal | Guidance and definition issues Funding issues Political will and priorities | Incorporate focus on health improvement into assessment of transport policies, including forthcoming Regional Transport Strategy guidance, any updated Local Transport Strategy guidance, and Strategic Environmental Assessment guidance, potentially making direct links with the health sector's Performance Assessment Framework field of "health improvement and reducing inequalities (New requirement to consult health authorities in development of RTSs will assist, although Transport Act Scotland mentions only access to health service, and not wider contribution to health improvement) | SEERAD currently developing guidance on SEA which will include section on health | SEERAD in partnership with Scottish HIA network including representatives from NHS Health Scotland Scottish Executive Health Department and Transport Divisions |
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Policy and guidance Funding and appraisal | Guidance and definition issues | Provide guidance on HIA related specifically to transport, including quick desktop method and more in-depth method. Providing funding for pilot HIAs on development of LTSs and RTSs (building on the SEA health element, which is currently potentially too narrow to take into account the impact of transport on quality of life and well-being, although SEA application to transport strategies is still in its early stages)". | | Scottish Executive Health Department and Transport Divisions, NHS Health Scotland |
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Funding and appraisal | Guidance and definition issues Funding issues | Make health a stronger consideration in appraisal of transport schemes through STAG (which should be applied to any transport strategy, plan or project requiring public funding), with consideration of additional Physical Fitness sub-objective within appraisal of environment in English transport appraisal 7 in any updated STAG. Most appropriate location for an indicator based on physical fitness impacts may be within STAG environment objective, although consideration should be given by Scottish Executive staff as to the appropriateness of this compared to the objective of accessibility and social inclusion | | Scottish Executive Transport Divisions |
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Funding | Funding issues | Building on Cycling Scotland's recent review of local authorities expenditure and performance on cycling, funded research on outputs and outcomes in areas of walking and cycling and links to levels of expenditure on cycling and walking initiatives, to understand how local authorities are funding such initiatives through non-ringfenced funding pots | | Scottish Executive |
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Funding | Funding issues | Give strong consideration to continuation of funding for Paths to Health Project in the long-term, and provide longer term funding for support and training to progress local initiatives | May need to be subject to a full evaluation of the Paths to Health Project outcomes | Scottish Executive and SNH (as core funders of Paths to Health) |
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Funding | Funding issues | Build on work which Paths for Health Project and Living Streets have begun on work with local authorities and communities to carry out community street audits - since the research began, Living Streets Scotland have appointed a coordinator, and indeed received funding from Paths for All to deliver a series of community street audit workshops and audits in Scotland. | | Scottish Executive and SNH (as core funders of Paths for All) |
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Funding / Good Practice and information dissemination | Funding issues | Provide funding to disseminate good practice tools that already exist, but which are becoming increasingly hard to access, namely the Walk in to Work Out pack from Glasgow, 8 which is now subject to a charge (was free previously), and other tools as determined suitable by the Scottish Executive | Walk in to Work Out pack is now the subject of a Sustrans project in partnership with Paths to Health, funded by the Scottish Executive Health Department | Scottish Executive Health Department and Transport Divisions |
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Funding | Funding issues | Revisit short-term funding cycles in place for various posts and initiatives (such as Paths to Health projects), as three year funding terms stultify progress and development, and could lead to staff retention issues | | Scottish Executive |
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Good Practice and information dissemination | Staffing and management issues | Improve coordination of posts carrying out work in areas of overlap - e.g. school travel is potentially covered by Health Promoting Schools, Active Schools, School Travel Coordinators. Establish pilot healthy schools forums at a local level, involving partnership across all these posts and linking to Community Planning | | Scottish Executive Health, Education and Transport Departments/ Divisions |
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Good Practice and information dissemination | Guidance and definition issues | Requirement for all public bodies (local authorities and health boards) to produce a travel plan, to lead by example. | | Scottish Executive Health Department and Transport Divisions |
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Summary of key opportunities for the future
1.41 The community planning process is an opportunity for joined up working across sectors, including transport and health. Its key strength however may be in setting a policy framework in place for decision-makers to act upon, as opposed to setting up initiatives on the ground, although this may change as the process becomes better developed in the future.
1.42 Local Transport Strategies are not statutory documents, and therefore not considered by developers. There is also no formal requirement to monitor the progress of these strategies or to link them to funding. However, a second round of LTSs are being prepared by authorities across Scotland, and the current guidance released by the Scottish Executive does encourage authorities to take account of "healthy modes" in their LTSs.
1.43 LTSs are not however linked to funding, although the principles of STAG should be applied in the development of them. The key opportunity therefore may be in how transport initiatives emerging from them are appraised and assessed in funding awards, through the application of STAG in particular, and through how they relate to Regional and National Transport Strategy priorities (see next point).
1.44 Statutory Regional Transport Strategies meanwhile will have to be developed by new Regional Transport Partnerships covering the whole of Scotland from March 2006 (many replacing existing voluntary structures, albeit with some changes). However, the Transport (Scotland) Act 2005 makes specific reference only to the requirement for RTPs to consider access to healthcare, and does not mention health improvement. It is hoped that RTSs will indeed consider the impacts of transport on health improvement, and that forthcoming guidance on the RTSs from the Scottish Executive takes this into consideration.
1.45 The National Transport Strategy is being developed with a view to publication in summer 2006. It is intended that the NTS will provide direction and context for national transport policy in Scotland, which will in turn direct decisions at the regional and local level. It will build on existing policy objectives for transport, as per Scotland's Transport Future, the 2004 Transport White Paper, one of which includes a commitment "to protect our environment and improve health". It is hoped that the NTS will provide a focus on the need for transport decision makers to contribute to health improvement, and not only provide a focus on access to healthcare.
1.46 Core Path Planning is a key opportunity to link transport with health, a requirement from the Land Reform Act 2003, and related to the development of Access Strategies through Local Access Forums, and new posts of Outdoor Access Officers. Prior to the funding for these posts and the change in legislation, a view has been expressed in our research that many local path networks were unavailable. The Outdoor Access Officers have been able to bring about material changes in local path networks - whilst this may appear to be related to leisure travel mainly, there may be opportunities to link this with day-to-day journeys to work, education, and so on. Furthermore, promoting walking and cycling in leisure time is an important step to normalising this behaviour in everyday activity. The work of the Outdoor Access Officers in some local authorities, such as East Ayrshire, is multifaceted and has established good links with various agencies, such as healthcare providers and leisure services.
1.47 A continuation of Outdoor Access Officer posts, in association with recommendations discussed above, has the potential to strengthen and reinforce this joint working to the benefit of those most in need of physical activity in communities. However, as discussed in this research, it is at the local authority's discretion whether to fund a permanent Access Officer post, using non-ringfenced funding from central government.
1.48 The Paths for All Partnership, and Paths to Health Project is a further key opportunity, linked to the issue of outdoor access and promotion of physical activity through local walking initiatives. Paths to Health funds local schemes to promote activity with health benefits (with a focus on walking in particular). The Paths to Health Project has amassed a wealth of knowledge and experience in supporting local schemes. This knowledge and experience should be capitalised upon by the Scottish Executive, and so potentially all communities. Paths to Health should be supported in development opportunities to build upon their own best practice in partnership working with local communities and other agencies, such as local authorities and local NHS Boards. Their recent work with Living Streets Scotland on promoting the concept of community street audits could also provide a key opportunity for promoting health-enhancing environments at the local level, provided that adequate training and support is given to both communities and local authority officers on how to carry out and deliver on such audits.
1.49 There are a number of transport funding opportunities by which health and transport links can be made. Specifically related to transport is the Cycling, Walking and Safer Routes funding allocations ( CWSS) - although there is a danger this is being predominantly used for school travel at a loss to non-school related cycling and walking schemes, as observed in one of the case studies researched for this project. The Integrated Transport Fund ( ITF) may be an opportunity for funding for cycling and walking in the future, as confirmed in a Ministerial written answer in 2004, although guidance is needed for local authorities on this issue 9, and clarity is required (potentially through guidance) on what ITF can indeed be used for.
1.50 With regards to non-transport funding, there are a number of opportunities to access support for local initiatives that can promote physical activity in local communities, such as the Fresh Futures programme through the New Opportunities Fund funds organisations such as Glasgow and Clyde Valley Greenspace Trust 10, and access initiatives. Sustainable Action Grants 11 are available through the Scottish Executive, with the objective of funding research, demonstration projects and other relevant activities in support of sustainable development in Scotland. Such grants have in the past funded initiatives related to promoting walking and cycling.
1.51 There are clearly opportunities in utilising frontline health care staff in the promotion of physical activity, particularly where this can be linked into sustainable transport and travel behaviour change programmes led by the local authority. GP and other medical referral schemes are increasingly moving away from traditional leisure-centre based models, towards a more "active living" approach (as identified in our Glasgow and Highland case studies).
1.52 Programmes for travel behaviour change which work through local communities are an important opportunity to promote the health improvement potential of transport. The Scottish Executive Step change programme is a crucial opportunity in this regard, having been carried out in numerous communities across Scotland already, with expertise being built up in communities and amongst local authority staff. Other related initiatives that promote the health benefits of physical activity through travel planning (employee and school) are further important opportunities to build on for the future.
1.53 Overall, the progress to date through the development of a national physical activity strategy must be built upon, with further development of local strategies and forums at a local level.