April 2000 / Vol 10 / No 1 Health Promotion Journal of Australia
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Editorial: Transport and the Health Promotion Workforce

Cartoon of cyclistRob Moodie, Chris Borthwick

Debates over transport policy have raged for over a century in the planning community. Only recently, however, has any real attention been devoted to the health aspects of the matter. Newman and Kenworthy's Sustainability and Cities, for example, a key modern text on transport policy, lists 22 pages of references, of which none are from health journals (let alone health promotion journals).[1] In part this has been because roadbuilders and carmakers have not been anxious to introduce any issues into the debate that might work against them, but it has also been because the health promotion community has had little experience working with the transport sector, and has not consistently seen this as amongst their highest priorities.

Now, however, the political and public arguments over transport futures have reached the stage where a cross-sectoral effort is imperative and may perhaps have some success. Reports from the World Health Organization and the British Medical Association have explored and clarified the links between health and transport policy, establishing connections that have proved persuasive with some European policymakers. [2, 3] Australia, often the leader in health promotion, is lagging behind in this area, and here we have not yet managed to carry our message into government.

Our leaders are still able to get away with policies and rationales that have been exploded overseas. Cities such as Copenhagen and Zurich discourage parking and encourage buskers; we tend towards the reverse.[1] Even America, not always thought of as a leader in public health, offers us the example of the Surface Transportation Policy Project's successes in beginning to reorient national policy away from unrelieved automobile dependence. [4]

Those interested in promoting health are now faced with the considerable challenge of rearranging priorities and adjusting practices to take account of these new issues. The hardest part may well be lifting our gaze from the immediate tasks in front of us to locate our work, our goals and our accountabilities within a much wider perspective that includes the transport sector.

If we take a wider perspective, however, we are faced with a difficulty. In this new era of evidence-based health promotion, neither in the health sector nor in the transport sector are our evaluations designed to seek out all the effects-intended and unintended-of our interventions. Evaluation is directed instead to the more manageable question of whether the intervention achieves the goals that were specified in the original plan. If there are other, unplanned, effects-even if these are negative effects-that is nobody's business. Transport plans seldom include any reference to the health effects of their measures (and vice versa). We have achieved increased accuracy at the cost of increased specificity.

Health promotion professionals are scattered through all levels of the health system from medical centres to public health departments, and many find themselves engaging in small-scale activities that will be evaluated against specific single-issue criteria. These people may be excused for thinking of the wider determinants of health rather in the way that farmers think about the weather-important, influential and interesting, but hardly a high priority in its own right for any advocacy resources. One of the advantages of taking transport as a theme for this issue of the Health Promotion Journal of Australia is that the issue illuminates the possible connections between the social structures we take for granted and the actual practice of health workers in the field.

The problem does not lie with the health promotion workforce, which would be glad to mount wider and more comprehensive campaigns with a greater emphasis on transport. The problem is that it is always difficult, and sometimes impossible, to get health promotion involvement at the level of transport policy, where different priorities are reconciled. The problem is not so much to convince health promoters that transport is a health issue as it is to convince the transport sector that health issues must be included in the ambit of transport evaluations. It is here that health promotion-that the whole health sector-faces its greatest challenges.

How are we to establish a system that will break through the vertical intersectoral barriers and introduce new priorities, goals, responsibilities and accountabilities to policymakers who are already pressed to handle a vigorous cacophony of competing interests. To increase the difficulty, we are asking for major reallocations of government funding away from encouraging motor vehicles. The economic interests involved in the motor industry are enormous, and their influence and power is also enormous. Four kilometres of freeway require more funding than Australia's complete annual health promotion budget. We need to work with those in the environmental movement who are interested in the same outcomes as we in the health sector. The less dependent we are on cars, presumably the more benefits there will be for the environment. However, the public transport sector (now often privatised) is also interested in getting more bums on seats, and is prepared to fight for them. Are we ready to play in this league?

Health promotion is not without its strengths. We have turned around multi-million dollar industries before, and we have changed cultures. The means we employ include:

The role of Australian health promotion is to institute this sequence in the field of transport. We will have to work out where our own work intersects with this sequence and accept our responsibility to support it.

Up until now the leaders of the movement for transport reform have not been drawn from the ranks of health promoters and public health activists. It is time for us to leverage our skills and our experience in setting agendas in public health-time for us to claim a seat at the table (or on the bus).

References

  1. Newman P, Kenworthy J. Sustainability and cities. Washington: Island Press; 1999.
  2. WHO Europe. Charter on Transport, Environment and Health. Third Ministerial Conference on Environment and Health 1999 June. Available from http://www.who.dk/London99/WelcomeE.htm [accessed 20.6.2000]
  3. British Medical Association. Road transport and health. London: BMA; 1997.
  4. See website at http://www.transact.org

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