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Dr Paul Butcher Director of Public Health Calderdale 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 4 Health and wellbeing today We 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 protection BUT: 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 conditions Lifestyles 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 6 Local government’s new functions - New duty to improve the health of the population: Local political leadership critical to making this work. 7 Vision • “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. A new public health system • 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 question time please pick up your handsets • Do you have an effective working relationship with your public health department ? 11 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 12 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 14 question time please pick up your handsets • Are you engaged with your health and well being strategy? 15 Virtuous circle for health e.g. more sustainable housing, transport, and food systems More investment in health promoting systems + public infrastructure Less dependence of formal health and social care system 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 Adds more life to years, not just years to life Improves public health, reduces inequalities Based on: “Claiming the Health Dividend”, Coote, A. King’s Fund. May 2002 Source: IPCC AR5, Working Group 1, Climate Change 2013: The Physical Science Basis Public health consequences of… 600,000 2011 England and Wales deaths 500,000 Other cancers Breast, prostate, colorectal 59,568 83,613 484,367 Physical inactivity reduces mortality risks of these cancers by 3050% Around 35% of cardiovascular diseases attributable to physical inactivity + another ~25% partly attributable to air pollution 400,000 300,000 200,000 143,181 139,706 100,000 1,815 98 Transport accidents Cycles All deaths Cancer Diseases of the circulatory system 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 Overweight and obese, 1980-2011 70 65 In the USA, obesity increased from 2010 1978 60 % obese or overweight 55 50 45 Obese 15% Obese 36% Overweight Over33% weight 32% Normal or under 53% Normal or under 31% 40 35 30 25 20 UK USA Netherlands Italy Germany Sweden 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 24 25 Road deaths in GB 1930-2010 Cycle fatalities have fallen by 92% since the 1940s 2010 2008 2006 2004 2002 2000 1998 1996 1994 1992 1990 1988 1986 1984 1982 1980 1978 1976 1974 1972 1970 1968 1966 1964 1962 1960 1958 1956 1954 1952 1950 Fatalities per 100,000 Rate per 100,000 people 70 60 50 40 30 20 10 0 Per billion kms 120 Fatalities per billion kms 100 80 60 40 20 0 Measuring risk of cycling, wrong and right Which road user represents the most danger per mile travelled? 20 Road deaths of thrid parties per billion miles 18 16 14 12 10 8 6 4 2 0 Per billion miles travelled cycles are involved in fewer deaths of other road users than any other mode of transport. Which road user is involved in the most road deaths? 1,800 1,600 Cars, buses, van and lorries present far more risk to other road users, whereas pedestrians, cyclists and motorcyclists are more often victims. Road deaths 1,400 1,200 1,000 883 Others killed in collision with road user 800 600 Road user killed 453 362 400 200 0 107 7 34 27 28 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. Conclusions • Set targets and measure the right things… 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) Good Overall public health impact of different transport modes (road death or injury caused AND air quality, cardiovascular disease etc) Best • 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 - [email protected]