Better Health For All

Cities across the world compete to win inward investment and employment. Could we do more to help them compete on grounds of health-enhancing environments?

I am always impressed by the enthusiasm of public health colleagues for cross-sector partnership working, particularly in my field of work, built environment and transport. Professional bodies – including the Faculty of Public Health – form multi-sector partnerships to influence government thinking. NICE, Public Health England and other agencies work to influence non-health sector professionals who create the conditions that determine population-level behavioural choices. Individual public health professionals support their local colleagues in these fields, offering them support and advice.

A hostile environment is also less appealing to business (photo: P. Insall)

Among these local partnerships are collaborations with major private sector employers. These demonstrate that business is aware of the benefits to be gained by, for example, more staff walking and cycling to the workplace. However, such local projects may as yet be somewhat marginal to the business, packaged as corporate social responsibility rather than part of the core focus on productivity.

At the same time, some businesses can be obstinate opponents of local authority efforts to create health-enhancing environments, such as better conditions for active travel as recommended in NICE guidance.

Cycle commuting is growing rapidly in London: good for productivity (photo: D Williams)

An example of this problem is retail traders, who often overestimate the importance of private motorised transport in bringing custom to their businesses.

In the Austrian city of Graz, retailers overestimated the importance of car access to their businesses by almost 100%.

In Edinburgh, shoppers’ concerns were overwhelmingly about the safety and comfort of the pedestrian environment, but retailers’ number one issue was “more parking”.

Wouldn’t you like to live here? Business leaders might feel the same way (photo: D Black)

In a Bristol study, retailers thought customers on foot and by car would each be about 40% of the total: in reality, 55% walked and only 22% drove. This kind of misperception almost guarantees that traders will lobby against their own interests, and in favour of more traffic, noise, congestion and pollution, to the detriment of public health.

So is it worth putting precious effort into cultivating a private sector which can seem to be an obstacle? I would say, yes it is. Business is much better than government, at any level, when it comes to horizon scanning, long-term planning, and ruthless decision making. In a shrinking and increasingly competitive world, factors such as Brexit and the ageing workforce mean that ‘business as usual’ is not an option for business leaders. Public health can make the case that disease prevention and health promotion should be important factors in the planning of the private sector as a whole and the individual businesses within it.

Take for example the CBI. The CBI was involved in the 2015 Active Cities Summit, launching research – from Active Living in the USA – which indicated economic advantages for cities which facilitate active lifestyles. The CBI this year went on to launch its own Health and Wellbeing Survey to “uncover what more could be done to support employees in the workplace”.

Meanwhile, the Institute of Directors has recognised “a basic business case that attention to [employee] health and wellbeing boosts productivity and engagement”, and now offers evidence and advice to its member businesses.

The ‘feel’ of a city can influence its commercial competitiveness (photo: P Insall)

These initiatives are in themselves positive, and should offer opportunities for us to work more closely with the private sector. However, the opportunity presented by the Active Cities approach goes much wider. As I noted for the government’s Foresight study into the Future of Cities,

“Any city in any nation is already today in competition with others, for influence, brand recognition, economic activity and employment.

“If the global perception of a city is that children scoot or cycle safely to school along quiet, tree‑lined back streets – and if a CEO considering inward investment can visualise his or her children doing so – it may have a critical competitive advantage.”

Safe, attractive routes to school, appealing to all parents (photo: Sustrans)

Can business and public health make common cause on this? Can we work to drive the creation of healthier environments where individuals can make healthy lifestyle decisions, directly assisting cities to win inward investment and businesses to maximise their productivity.

Maybe it’s time for another Summit, this time bringing together the national leaders in public health with those developing the strategies of the private sector as a whole.

My comments above relate primarily to transport, planning and public health – active travel and physical activity, air quality, climate change and the associated social issues. I hope though that they may have some relevance in other fields, including food and nutrition, alcohol and smoking.

Written by Philip Insall, Director, Insall & Coe, and Honorary member of FPH. You can follow Philip on Twitter @philipinsall.