d r paul butcher
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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
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