Public Health

The Coalition will be publishing its long-awaited Public Health White Paper later this week.

It's expected to continue the theme of localism: in other words, palming the responsibility off onto local government.

Dr Frank Atherton, president of the Association of Directors of Public Health, quoted on the BBC, said:

"It feels like we are coming home. Most public health directors are comfortable with being back in local government. This is where the power is to influence all those environment factors, such as housing, leisure and transport, lie and so the potential to really make a difference is definitely there."

The other trend expected to be in the White Paper is 'nudge': creating the right environment and encouraging people to make the right choices.

Getting people to make the right choices is the hard part however. Habits die hard. Large numbers of people, indeed large numbers of increasingly large people, continue to smoke and eat fatty foods despite previous public health campaigns. People don't want to stop eating chips or chocolate even though they know fine well the harm it's doing to them. But a lot of people do want to cycle. With cycling, the hard part of persuasion is already done: if you provide decent, safe cycle routes then people will cycle. In addition to the public health benefits, there's valuable contributions to reducing pollution and carbon emissions.

From a cycling perspective, it does make sense to have transport, the environment and public health under the same remit, as the benefits impact on all those spheres.

There are a couple of problems however. First is the lack of money. Without ring-fenced funds, will local authorities prioritize public health, and cycling in particular, above the local election 'hot buttons' of convenience of driving and parking, education and rubbish collection? Second, will they take the tough decisions that are necessary to establish a usable cycle route network?  Third, an integrated cycle network has to cross borough boundaries. With boroughs like Westminster so anti-cycling, surrounding boroughs will be limited in what they can achieve.

Health Secretary Andrew Lansley is making some of the right noises. "We have got to arrive at a point where politicians stop just telling people how to be healthy but actually help them to do it, which is about positive steps on supporting people on things like physical activity as well as necessary interventions," he told the Today programme. However, cutting programmes such as cycling, school sports,and  free swimming for children and the elderly are rather at odds with 'supporting physical activity.

We can't allow the Coalition to make noises about public health without actually delivering. Cycling is in many ways the easiest and cheapest way to get lots of people to increase their level of physical activity, because a lot of people want to do it and are only held back by fear of traffic. But it won't happen by magic and it won't happen without a change away from the failed approaches of the past. You can't grudging accommodate cyclists in narrow lanes in gravel-strewn gutters on busy roads and expect more people to cycle. You can't expect them to wobble around pedestrians on narrow shared pavements. You can't expect them to 'share the road' with multiple lanes of HGVs. You need to make cycling attractive and subjectively safe. You also can't expect local highways departments to change their lifelong habits of treating cyclists as an irritation rather than a transport mode, any more than you can expect a 20-stone smoker to suddenly become a triathlete. There are people in local government who 'get it', but the establishment for the most part is institutionally anti-cycling and car-centric, and without a serious culture makeover they won't be able to deliver. That's what the Public Health White Paper must to address if it is to succeed.