Westminster s Joint Health and Wellbeing Strategy

Westminster s Joint Health and Wellbeing Strategy 2013 2016 Response from Sustrans General comments From a strategic perspective, Sustrans welcomes the Health and Wellbeing Strategy s focus on encouraging active travel and reference to the National Planning Policy Framework. Importantly, the NPPF prioritises both promoting sustainable transport by giving high priority to pedestrian and cycle movements and promoting healthy communities by providing access to high quality open spaces that encourage people to walk and cycle. However, we urge that the Health and Wellbeing Strategy considers the wider context throughout the document, not just in the introductory sections. We recommend that the five priorities are presented within a framework that describes borough-wide and city-wide moves to increase active travel, bring down traffic speed, improve road safety and tackle air quality. As Westminster falls within the worst 20% of areas nationally for outdoor living environment, road traffic accidents, and parts of the city are among the worst performers in air quality tests in Europe, it is critical to link these challenges more strongly to the individual priorities and actions that will address them. We welcome the Health and Wellbeing Strategy s reference to developing walking and cycling strategies to encourage people to travel actively for more of their everyday journeys, whether for work, school or leisure. It is important that local service delivery outlined in the priorities is backed up by the rest of the council s activities and linked with activities in other teams, especially transportation teams, to ensure an integrated and effective approach. Finally, Sustrans wishes to recommend the NICE PH42 guidance as an approach model (Obesity: working with local communities), which emphasises the importance of crossauthority working and that activities should be aligned with broader regeneration and environmental strategies. 1

Responses to the consultation questions Sustrans works in the field of active travel, engaging with planning, transport and environmental sectors as well as public health to promote more walking and cycling. Therefore, our comments relate to policy and practice around active travel, and the potential benefits gained from physical activity. We urge that active promotion of walking and cycling is prioritised within every area outlined above. 1) If there any priorities you would like to add, please include them in the box below. While the priority areas outlined above are important, transport, travel behaviour and active travel are areas which have a significant impact on health equality. Active travel (walking and cycling) and play are important factors in preventing child obesity, and these forms of physical activity are facilitated or suppressed by planning and transport policies. It is important that the approach to health equality at the local level recognises the contribution of transport and planning. Although transport and planning are most influential by facilitating (or suppressing) walking and cycling, they also affect road safety, air quality and noise. These areas need to be addressed to create a better environment for children, adults and their families to travel actively. We would welcome an emphasis on detailed initiatives to increase physical activity. For example, we would advocate the provision of soft interventions such as community-based Active Travel Champions (a Sustrans programme) to support behaviour change. The BMA report (2012), Healthy Transport = Healthy Lives states that transport policy should encourage a modal shift away from private motor transport towards active forms of travel which benefit health. In relation to enabling people to adopt healthier behaviour, the Lancet Physical Activity Series (Das and Horton, 2012) refers to walking and cycling specifically while noting that efforts beyond the health sector through social and environmental change will be necessary if we are to see greater uptake of this healthier behaviour in people s lives. The importance of walking and cycling in public health is recognised by the National Institute for Health and Clinical Excellence (NICE). In November 2012, NICE published guidance addressing the public health role of walking and cycling, with recommendations aimed at the full range of local decision makers (PH41 - Walking and cycling: local measures to promote walking and cycling as forms of travel or recreation ). In addition, a July 2011 report from the four home countries Chief Medical Officers Start active, stay active: a report on physical activity, outlines that for most people, the easiest and most acceptable forms of physical activity are those that can be incorporated into everyday life. Examples include walking or cycling instead of travelling by car, bus or train. 2

2) What would you see as the most important health and wellbeing goals for the future? (Please write in the box below) Physical activity deserves to be prioritised as a separate indicator (i.e. Increasing physical activity ) rather than included as an action under the indicator Children entering and within primary school are of a healthy weight. This is especially important given that child obesity in Westminster maintained primary schools is consistently higher than nationally with nearly a quarter of pupils, aged 11, overweight or obese. In addition, physical activity is beneficial to heart health and has a positive impact on mental health. Regular physical activity decreases the risk of cancer and diabetes as well as addressing obesity. Although we recognise that Westminster s first priority is: every child has the best start in life, Sustrans would like to see the inclusion of increasing physical activity for both children and adults. Therefore, the most important health and wellbeing goal is to increase the percentage of children and adults who engage in regular physical activity, particularly walking and cycling. Investment in walking and cycling helps people to get fitter, reduces levels of obesity and has multiple health benefits as mentioned above. Measures to achieve this include providing better infrastructure for pedestrians and cyclists; and active promotion of walking and cycling. For example, we would advocate the provision of interventions such as community-based Active Travel Champions (a Sustrans programme). 3) What, if anything, do you think we should do in order to tackle priority 1? (See page 14 of the full strategy). (Please write in the box below) Priority 1 - Every child has the best start in life Westminster currently has a part-time Sustrans Bike It Officer working with children and their families to give them the skills and confidence to cycle safely to school and for other everyday journeys. We call for Bike It to be commissioned on a full-time basis so that we can reach more children and young people in the Borough, thereby having a greater impact on improving local children s health. As mentioned above, physical activity deserves to be prioritised as a separate indicator (i.e. Increasing physical activity rather than included as an action under the indicator Children entering and within primary school are of a healthy weight. Sustrans welcomes the plan to Develop initiatives which encourage more active travel among young families and support the Active Communities programme which will develop opportunities for formal/informal and everyday activity in less traditional and more accessible locations and ensure it meets then needs of young children and their families. However, we would welcome a more detailed description of proposed interventions to increase physical activity. For example, we would advocate provision of soft interventions 3

such as community-based Active Travel Champions (a Sustrans programme), together with cycle and road safety training for children and young people like Sustrans Bike It project which promotes long-term behavioural change. These measures maximise the benefits of improved cycling infrastructure and make people aware of the wider benefits of cycling. Sustrans Bike It project works directly with schools, getting thousands of children on their bikes and cycling to school every day. Bike It Officers work with schools, talking and listening to parents, teachers and children, then running a year-long programme of school projects, training and fun events to get the whole school community cycling together. Bike It helps children to get fit and healthy by teaching them the skills they need to cycle safely and responsibly. Within each school, a cycling Champion is identified, usually a teacher or parent, who assist the BIO and then help continue the momentum of activity long after the BIO leaves the school. Over the last five years, the Bike It project in London has operated in 20 London boroughs and over 120 schools. Key statistics across London: Before Bike It, 47% of pupils said they would prefer cycling to be their mode of transport to school, yet 73% told us they never cycled to school. The proportion of children regularly cycling to school (pupils cycling once or twice a week or more) has increased from 12% to 20.4%. The proportion of children cycling to school every day has increased from 3% to 6.5%. The proportion of children never cycling to school has decreased from 77% to 64%. In terms of monitoring and evaluating the success of interventions to increase physical activity, we recommend an indicator of % increase in children engaged in regular physical activity, rather than just slow, then reverse the trend for increasing excess weight in 4-5 year olds and in 11 year olds. 4) What, if anything, do you think we should do in order to tackle priority 2? (See page 16 of the full strategy). (Please write in the box below) Priority 2 - Enabling young people to have a healthy adulthood In general, the transition from primary school to secondary school is a time when children want to become more independent. However, in Sustrans experience this transition period is also a time when children are at risk of being less physically active. Therefore it is essential to have an integrated approach and to invest in better infrastructure at the same time as activities to encourage cycling and walking and to promote long-term behaviour change, such as Sustrans Bike It project. It is also important to provide young people with tailored 4

opportunities to engage in physical activity that appeal to their varied interests for example some young people will respond better to activities such as after-school BMX or mountain biking sessions than other planned activities during the school day. Sustrans believes that it is also important to consider the cultural environment and to tailor the approach to make active travel the norm across different segments of the population. 5) What, if anything, do you think we should do in order to tackle priority 3? (See page 17 of the full strategy). (Please write in the box below) Priority 3 - Supporting economic and social wellbeing and opportunity Sustrans welcomes the emphasis on identifying actions through the Council s walking and cycling strategies to encourage more active travel to work (which offers a healthier and more economical alternative to public transport). Sustrans information sheet on Active Travel and mental well-being highlights that surveys show that physically active people feel happier and more satisfied with life (Biddle, 2000 Emotion, mood and physical activity in Biddle et al, Physical activity and psychological wellbeing). We would welcome the inclusion of a KPI for the percentage increase in adults in Westminster engaged in regular physical activity and a separate KPI for active travel. 6) What, if anything, do you think we should do in order to tackle priority 4? (See page 19 of the full strategy). (Please write in the box below) Priority 4 - Ensuring access to appropriate care at the right time We support the Health and Wellbeing Board s intention to identify actions to reduce the number of people killed or seriously injured on Westminster s roads, in the Council s Walking and Cycling strategies and Local Implementation Plan. However, we urge that specific KPIs i.e. pedestrian and cyclist casualty reduction targets - are introduced to support this aim. 7) What, if anything, do you think we should do in order to tackle priority 5? (See page 21 of the full strategy). (Please write in the box below) Priority 5 - Supporting people to remain independent for longer Although we welcome the intention to expand the opportunities (e.g. active travel) available to older people in the borough, more emphasis is needed on promoting active travel (i.e. 5

walking and cycling). In relation to helping people with long term conditions to remain in their own homes for longer, we suggest inclusion of the following action: Provide interventions, whether or not designed with overt and explicit health objectives, which support people to make a change in their behaviour and to live a healthier life. 8) How do you think the Westminster City Council and health bodies could work together better? (Please write in the box below) No response. 9) What roles do you think individuals and communities can play in improving health and wellbeing in their area? (Please write in the box below) Sustrans has many years experience of working closely with communities to improve health and wellbeing in their area. For example, we ran an Active Travel project on the Oceans Estate in Tower Hamlets with a selected group of women to encourage wider participation in cycling. All participants increased their levels of physical activity from the project and their levels of cycling. Benefits of the project included increased physical fitness, improved confidence, learning new skills, forming social bonds and improving their general wellbeing. Importantly, the benefits of the project have been felt throughout the whole community as well as by the individuals who took part. The project participants have been cycling with friends and family. One of the social benefits of the project is that the participants have been meeting outside project activities to cycle together, and taking friends and family who did not work with the project cycling with them as well. Some of the participants have formed community bonds with the group and intend to continue cycling with the others in a selforganised group. Only respond to the following question if you are completing the survey on behalf of a business or retailer. 10) As a business or a retailer, what do you think the Health and Wellbeing Board could do to work with you, to champion the health and wellbeing of those who work in the City of Westminster? (Please write in the box below) Sustrans is not a commercial operation, but we are of course keen to work with the Health and Wellbeing Board on practical measures to promote health and wellbeing through active travel. Our projects are particularly effective at reaching groups that are currently underrepresented in walking and cycling, such as those who are living in areas of high health deprivation. 6

11) Please use this box for any further comments on the Health and Wellbeing Strategy. (Please write in the box below) We were pleased to see reference to air quality in the strategy, given that Westminster falls within the worst 20% of areas nationally for outdoor living environment, road traffic accidents, and that parts of the city are among the worst performers in air quality tests in Europe. Investment in walking and cycling not only helps people to get fitter and reduce levels of obesity; it also encourages people out of their cars, thereby reducing transport s contribution to climate change. It offers people who live in, work or visit Westminster a greener, cleaner choice of journey with less risk from air pollution. Sustrans projects make a major contribution to public health delivery and policy. Our programmes address both the physical environment a critical determinant of individual lifestyle choices and the behaviour of individuals. They have a significant impact on physical activity and health (Sustrans, 2012, So simple, Annual Review 2011). Nationally, in 2011 our Bike It programme worked with over 340,000 children, and doubled regular cycling to school across all the participating schools The National Cycle Network carried 484 million trips on foot and by bike in 2011, made by 3.3 million individuals: over 2 million of these users report increased levels of physical activity, of whom more than half were below the recommended activity levels; usage increases every year Using the World Health Organisation Health Economic Assessment Tool, usage of the National Cycle Network created health benefits worth 442 million. Across the UK, 20,000 households received tailored travel information under our Personalised Travel Planning programme, shifting up to 11% of car trips to walking, cycling and public transport. ` We led the Travel Actively consortium all of the national walking and cycling groups jointly delivering 50 projects across England which has helped 1.5 million people, in communities, universities and workplaces, get more active through walking and cycling. We have played a major role in planning, implementing, monitoring and evaluating official programmes such as the Sustainable Travel Demonstration Towns and Cycling Demonstration Towns, each of which is an important public health intervention, and with Change4Life. Our work was honoured in the inaugural Chief Medical Officer s awards in 2009. Sustrans view is that in our field behaviour change from sedentary motorised transport to active travel the greatest change is likely to result from an integrated package of interventions, including elements such as improvements to walking and cycling infrastructure, communications programmes and changes to social culture, as well as individual-focused behaviour change actions. We also strongly advocate for a default 20 mph speed limit on borough-controlled roads. This would play a critical role in improving pedestrians and cyclists safety. A recent London Assembly Transport Committee investigation found that 20 mph limits had made an important impact on London s road casualty rate and offered 7

potential to increase levels of walking and cycling (Braking Point, 2010). Public opinion strongly favours the introduction of universal 20 mph speed limits. The British Social Attitudes Survey (2005) showed that 71% of the public want the speed limit dropped to 20 miles per hour in residential areas to make them safer (National Centre for Social Research, 2005, British Social Attitudes Survey). There is strong evidence for the safety, health and economic benefits. Research from the British Medical Journal shows that the introduction of 20 mph zones was associated with 42% fewer road casualties. Younger children were the main beneficiaries in this reduction in casualty numbers, and serious injuries and fatalities also dropped significantly. (BMJ, 2009, Effect of 20 mph traffic speed zones on road injuries in London, 1986-2006). 20 mph speed limits also encourage more people to walk and cycle. Research by Oja and Vuori (2000, Promotion of Transport Walking and Cycling in Europe: Strategy Directions, The European Network for Promotion of Health-Enhancing Physical Activity) shows that a lower speed limit in built-up areas allows for the safe mixing of motorised and non-motorised modes of transport, and makes it easier for pedestrians and cyclists to enjoy the same direct and safe routes for their journeys as motorists. As the draft Joint Health and Wellbeing Strategy acknowledges, Westminster has significant health challenges and health inequalities. Improving opportunities and conditions for walking and cycling, particularly in areas of ill health, can help address these inequalities and improve quality of life. 8