A public health perspective on transport policy priorities

摘要

This paper briefly considers the history of public health delivery in England, its transition from local government to NHS leadership and back again, and the consequences of that shift in terms of transport policy as a determinant of health and wellbeing. General principles of modern public health thinking are outlined, emphasising the need for policy choices to consider the Rose hypothesis - that small changes in large populations are likely to deliver greater net benefits than large changes in small populations. Thus, in tackling the epidemic of obesity, a greater impact would arise from small alterations of exercise behaviour in the whole population than from large changes among the most obese. Against a policy background that emphasises 'nudge' approaches rather than legislative or regulatory action, a chain of rational decisions by individuals, communities and authorities is discussed that in aggregate leads to substantial adverse outcomes. It is suggested that there is no calculus of individual gain that can achieve optimal population benefit with regard to some aspects of transport policy. Features of the general strategic approach to health and wellbeing improvement in the North East of England over recent years are outlined, with a brief exploration of the issues that these raise for public health delivery by non-health service authorities. New opportunities for health and wellbeing gain are offered by shifts in the focus of public health delivery as we step back from an individualised medical model and re-assert the importance of civic and cross-sectoral action.