Better Health For All

• By Dr Jayne Hutchinson
• Research Fellow
• University of York

Active travel, defined as walking and cycling short journeys such as visiting friends, commuting or going to the shops, is high on the policy agenda. In 2010 the Departments of Transport and Health published a joint strategy on active travel and many local authorities have now published their own active travel policies.

Active travel: getting more active and healthy

Active travel simultaneously tackles two of society’s big challenges: more sedentary lives and the health concerns associated with that, and environmental changes caused by burning fossil fuels.  Yet, the understanding about its social patterning is limited, particularly in relational to differences in socio-demographic predictors of active travel between urban and rural residents. Understanding variations between rural and urban populations may help local governments to devise policies that are appropriate and tailored to their communities.

Here at the ESRC-funded HOPE project (Health of Populations and Ecosystems) we have undertaken an initial analysis of the active travel of adults using data collected from Understanding Society, the largest UK representative household panel study.

In urban areas (defined as settlements of 10,000 people or more) we found that:
•    Residents were 64 per cent more likely to report that they always or very often walked or cycled short journeys of less than two to three miles.
•    Residents not in full-time employment and with no children are likely to walk or cycle more.
•    High-earners were less likely to take opportunities to travel actively, particularly if they had children, although those educated to degree-level were more likely to cycle or walk short journeys.
In rural areas, we found that:
•    Only seven per cent of the population reported not having a car in their household.
•    There were fewer socio-demographic predictors of walking or cycling short journeys.
•    Rural residents in both higher and lower income brackets tended to use their cars for shorter journeys regardless of education or whether they had children or not.

Although there are fewer opportunities for active travel for rural residents  than for those living in towns and cities, the habit of using cars even for short rural journeys should be challenged. People living in rural areas need to be more pro-active than urban residents in order to meet their physical activity recommendations and to reduce their carbon footprint.

There also seems scope for increasing active travel in urban areas for some groups of people such as women, those with children, or with lower qualifications. We know that people with lower qualifications and lower income are less likely to engage in vigorous active leisure pursuits than those in higher brackets, therefore encouraging more active travel for some could be an important factor in helping increase their everyday physical activity.

In the next phase of this research we will explore relationships between people’s environmental behaviours such active travel, energy use in the home and health behaviours such as fruit and vegetable intake, alcohol and smoking. An understanding of this may influence policies for improving the health of the population and the health of the environment.  

• Download the full paper ‘Differences in the social pattering of active travel between urban and rural populations: findings from a large UK household survey’

   

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Signatories:

• Dr Ben Bouquet
• Dr John Ashton
• Prof. Amanda Burls
• Prof. Simon Capewell
• Sir Iain Chalmers
• Dr John Middleton

In public health, there is a tendency to focus on numbers and statistics, which can detract from deeper understanding of the human stories involved.  To date, in excess of 1,400 Palestinians have been killed in Israel’s bombing of the Gaza strip.  Around one in five is a child.  The vast majority are civilians.  To date 56 Israeli soldiers have died and three civilians have been killed in Israel (1).

We need all sides in this conflict to work for peace. All forms of aggression, whether they are carried out in the name of Israelis or Palestinians, are harmful to the public health of people living in both countries.

Israel, as an occupying power in Gaza and the West Bank, has a number of legal and moral duties, which include the safeguarding and promotion of public health for the Palestinian population (2). In this regard it has undoubtedly failed.

The blockade of Gaza since 2006/7 has restricted supplies of food, fuel and the materials needed to rebuild communities following previous destruction.  This and the government’s dire financial situation are contributing to massive unemployment, which remains consistently in excess of 30%.

The government’s lack of funds and severe fuel shortages have precipitated a worrying sewage crisis, with raw sewage now passing into the Mediterranean and increasing greatly the risk of outbreaks of infectious disease.  Fresh water supplies have also been compromised and 90% of water supplies are unfit to drink.  Many households are now reliant on bottled water for drinking.

At least 140,000 dunums of land planted with fruit and vegetables are at risk of drought.  The effects on health services from the fuel shortage, the limited supply of medicines and medical equipment and damage from recent bombing are of grave concern (3).

The cause of the present extreme deprivation in Gaza is the Israeli blockade, compounded by the closure of tunnel trade with Egypt, for so long an economic lifeline.   It is in this context that the recent clashes have arisen: many Palestinians do not see any realistic route to achieve restoration and improvement of their daily conditions.They have a shrinking means to protest, to ask the world to listen to their pleas for the reinstatement of their dignity and their autonomy (4).

In the current conflict, there have been allegations of the deliberate targeting of hospitals and civilians (5). Recent reports indicate extensive damage to the health service infrastructure, including hospitals and primary care clinics (6).

The main power plant has been hit which is now further affecting the water supply. Paramedics have been unable to access civilian casualties and lack a safe passage out of conflict areas.  Similarly there is no agreed safe zone for civilians and shelters and two UN schools have been hit.  (7)

In a video seminar with London public health specialty registrars this week Mahmoud Daher of the World Health Organisation in Gaza, described the current conditions, his sleep deprivation amid the sounds of the bombing, and the difficulty of comforting his children in these extreme circumstances.  He stated:

“The international community is suffering from a deficiency of conscience.  The killing of children and targeting hospitals has become a matter of numbers and incidents to report. A state of desensitization to the human aspect of this will be dangerous on humanity, we only see numbers, but there is a story behind each number, a human being. I witnessed today a targeting of the outside wall of Shifa hospital; I was there, about 15 meters from the wall. A few minutes after a bigger bombardment was heard and children arrived – dead bodies to the emergency room of Shifa, that was horrible. 8 children and 2 adults were killed while they were playing in the playground at Shati refugee camp. Can anyone in this world explain why? They are not numbers.”

The public health community has a strong tradition of seeking to save lives and prevent suffering, to analyse the root causes of inequalities and propose solutions, to follow non-violent codes of conduct that transcend narrow political and factional divides and support the cause of common humanity.  We invite the public health community to acknowledge and make links with Palestinian and Israeli human rights and health organisations and to support them in their work (8). We echo these organisations in calling for the following actions:

• Cease the bombardment of inhabited homes, neighbourhoods and areas in the Gaza Strip (9).
• Open a safe route for civilians to escape the battle zone and declare a safe shelter zone in the Gaza Strip (7).
• Ensure the adequate provision of immediate medical and humanitarian assistance to the people of Gaza to ameliorate the consequences of the massive destruction of homes and infrastructure.

There have been calls for consumer and academic and cultural boycotts of the kind seen during Apartheid South Africa and with French nuclear testing in the Pacific.  We call on the international community, including our own government, to implement an arms embargo on Israel and Israel must abide by international law under the conventions it has ratified.

We urge those with influence in the Israeli government to speak out and to call for unconditional and meaningful talks with the Palestinian coalition government.   In this call they are supported across the world in their effort to end conflict and to reach a peace in which all parties can live with dignity, autonomy and freedom from aggression and intimidation.

We express our sympathy with the friends, families and loved ones of all those who have been killed.  Peace is possible, and it starts with talking.  As Nelson Mandela said, “If you want to make peace with your enemy, you have to work with your enemy.  Then he becomes your partner.”

References:

(1) Burke J. (31st July 2014). Gaza ‘faces precipice’ as death toll passes 1,400. The Guardian

(2) Occupation and international humanitarian law: questions and answers (2004).  The International Committee of the Red Cross

(3) Gilbert M. (June 2014) (links to a pdf) Brief report to UNRWA:The Gaza Health Sector as of June 2014.  University Hospital of North Norway

(4) Manduca P., Chalmers I., Summerfield D., Gilbert M., Ang S. and more than 20,000 signatories (23rd July 2014).  An open letter for the people in Gaza.  The Lancet.

(5) Dr Mads Gilbert in an interview with Rania Khalek (23rd July 2014).

(6) Israeli fire kills nineteen in Gaza UN school (31st July 2014).  Al Jazeera

(7) Mahmoud Daher (WHO), direct reporting.

(8) Laub K., Goldenberg T. (28th July 2014).  Gaza’s Al-Shifa Hospital Compound, Nearby Park Hit In Attack. The World Post (a partnership of the Huffington Post and Berggruen Institute on Governance)
(9) Sherwood H. (30th July 2014).  Gaza’s only power plant destroyed in Israel’s most intense air strike yet.  The Guardian

(10) 11 Israeli HR Organizations urgent call: Open a safe route for civilians to escape the battle zone and declare a safe shelter zone in the Gaza Strip (25th July 2014)

(11) Sherwood H. (30th July 2014).  Gaza: at least 15 killed and 90 injured as another UN school is hit.  The Guardian

(12) The eleven Israeli organisations which recently called to open a safe route for civilians to escape the battle zone and declare a safe shelter zone in the Gaza Strip are:

–    Adalah – The Legal Center for Arab Minority Rights in Israel
–    Association for Civil Rights in Israel
–    Bimkom – Planners for Planning Rights
–    B’Tselem – The Israeli Information Center for Human Rights in the Occupied Territories
–    Gisha – Legal Center for Freedom of Movement
–    HaMoked – Center for the Defence of the Individual
–    Machsom Watch
–    Physicians for Human Rights – Israel
–    Public Committee Against Torture in Israel
–    Rabbis for Human Rights
–    Yesh Din – Volunteers for Human Rights

(13)  B’Tselem calls on the Government of Israel to immediately cease the bombardment of inhabited homes, neighborhoods and areas in the Gaza Strip (21st July 2014)

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