Walking & cycling: How can our system deliver? Ashley Gould Consultant in Public Health

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1 Walking & cycling: How can our system deliver? Ashley Gould Consultant in Public Health Wales: A Walking and Cycling Nation, Nov. 2015

2 The Next 20 minutes... Context Walking, cycling and public health Systems working An approach to improvement Public Health Wales role(s)

3 Context the basic links Yep, active travel is a public health issue! walking and cycling are physical activity, so can cut the chance of individuals developing: type 2 Diabetes by 40 per cent, cardiovascular disease by 35 per cent, and breast and colon cancers by 20 per cent Physical activity has been proven to improve sleep, manage stress and improve quality of life. Active travel also reduces traffic congestion, air pollution and greenhouse gas emissions determinants of health.

cent, cardiovascular disease by 35 per cent, and breast and colon cancers by 20 per cent Physical activity has been

4 Context risks and health Building-block and byproduct Health and well-being Physiological risks High blood pressure High cholesterol Stress hormones Anxiety/depression Behavioural risks Smoking Poor diet Lack of activity Substance abuse Risk conditions For example: Poverty Low social status Unsafe environments Discrimination Steep power hierarchy Gaps/weaknesses Psycho-social risks Isolation Lack of social support Poor social networks Low self-esteem High self-blame Low perceived power Loss of meaning/purpose of life World Health Organisation

Poverty Low social status Unsafe environments Discrimination Steep power hierarchy Gaps/weaknesses Psycho-social risks Isolation Lack of

5 Context recent evidence Build it and they will come? October 2015 BMJ article from the Centre for Diet and Activity Research (CEDAR) Study of exploring reasons behind the effects of new walking and cycling routes in cities including Cardiff The physical improvement of the env. itself was the key to the effectiveness of the intervention...suggesting that behaviour can be promoted by changing environmental cues without explicitly encouraging behaviour, sometimes referred to as nudging. BUT... Build it and they will come?...who came?!...did we want them to come more than others?!

cycling routes in cities including Cardiff The physical improvement of the env. itself was the key to the effectiveness of the intervention.

6 Segmenting and engaging... Think of a lifestyle change (please) - drink less alcohol, walk or cycle more... JDI! Courtesy of Steve Rollnick

7 it s not that easy! Reactions: Competence/self-efficacy (not sure I can) I d prefer to make my own mind up! Autonomy (is it that important to me?!) who are you to tell me!? Relatedness (flying in with idealised answer!) Fundamentals of motivation to change that must be addressed before change can happen They differ across people/communities...so we have to co-produce to succeed not generate more inequity!!

Autonomy (is it that important to me?!) who are you to tell me!

8 Who are the WE? Urban Planners Transport Countryside Civil Engineering Community Regeneration Third sector Parks & Leisure Architects Public Health

9 Systems working Not about imposing order and rationality on a complex world! Living with ambiguity, not sweating the structures we are all working within, but Focus on Our common purpose (goals) Recognise our collective assets Deliver improvement

10 Systems working Welsh Government s Physical Activity Executive Group is driving a systems approach... active travel as a shared goal to align action across the system acknowledging we may not all be interested in the same outcome e.g. economic, health, environmental protection

.. active travel as a shared goal to align action across the system

11 Innovation & creativity Support, encourage, test & scale-up Relationships Modes of working & specific activity to bridge & bond Engagement Segmentation, pool intelligence, all place assets Capacity building Systems working Training, guidance/benchmarks, networking

bond Engagement Segmentation, pool intelligence, all place assets

12 Can we deliver improvement?

13 Change and improvement Change is widespread BUT delivering improvement...a bit of a weakness within the system generally? Sometimes lack focus on whether it is making a difference. A thought...use improvement science to describing what needs to happen, measure it, and sharing learning.

Sometimes lack focus on whether it is making a difference. A thought.

14 Public Health Wales roles Health & Well-being Directorate Health Improvement Division (supporting the system once for Wales; meshing of organisations, policies, individuals) Local Public Health Teams (working with local partners) Public Health Wales Observatory (data and intelligence) 1000Lives Improvement Service Improving Quality Together and Behavioural Insights links

Public Health Teams (working with local partners) Public Health Wales Observatory (data and

15 Public Health Wales roles Embedding goals in our settings based programmes Wales Network of Health Schools Scheme - requiring schools to know how pupils get to school; Healthy Working Wales - same approach for staff NHS - helping health professionals understand that active travel contributes to increased activity and should feature as they try to make every contact count Support you...please get in touch!

approach for staff NHS - helping health professionals understand that active travel contributes to

16 Art of the possible... Health could be measured by what people take two-at-atime...pills or stairs!! (Welsh, quoted by Housmann, 94)

17 Thank you for listening

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