Road space reallocation in Scotland: A health impact assessment
Introduction
The places people live affect health through multiple pathways and are influenced by the interaction between transport, spatial and community planning (Marmot et al., 2010). Places promoting good health should include sustainable transport options, good quality green and public spaces, equitable access to employment, goods and services, good maintenance, safety and opportunities for community influence (Improvement Service, 2022). Environments dominated by motor vehicles are unlikely to show these characteristics, instead being associated with severance, poor air quality, noise pollution, physical inactivity, road traffic casualties and carbon emissions (Teuton et al., 2020).
Road space reallocation involves re-distributing space away from motor vehicles, including car parking and carriageway space, towards other uses like active travel infrastructure, bus lanes, local retail, play space and greenspace (Victoria Transport Policy Institute, 2019). Reallocation measures may include removal of parking spaces, removal or narrowing of road lanes, replacing roads with pedestrian or cycling infrastructure, bus gates, modal filters that restrict through traffic, signage and restricting vehicle use (Victoria Transport Policy Institute, 2019). Space can be reallocated permanently, temporarily, or at specific times, for example creating play streets (Playing out, 2022) or safer access to school at the start and end of the day (School Streets Initiative, 2022). Changing road priority, reducing dominance of car traffic and a placemaking approach can support more sustainable modes and improve liveability (Curtis and Tiwari, 2008; McAndrews and Marshall, 2018; Tsigdinos et al., 2021) The stated aims of reallocation vary and may be unclear, inhibiting their evaluation. Reallocation may aim to discourage use of motor vehicles and/or encourage more sustainable travel modes, to improve public space, or have other aims (Victoria Transport Policy Institute, 2019).
Health impact assessment (HIA) is a recognised process to identify and assess the impacts of policies and actions across sectors on health and health inequalities, to inform decision making and improve health and equity (Douglas, 2019). Best practice principles (Winkler et al., 2021) state that HIAs should consider a comprehensive range of health determinants including impacts on equity and sustainability, involve stakeholders appropriately and use a range of evidence sources impartially. HIA follows the structured process shown in Table 1, but the assessment depth and evidence used are adapted to suit the circumstances. HIA can support a ‘health in all policies’ approach, characterised by holistic consideration of health determinants, partnership working and ensuring public policies enhance health benefits and minimise health harms (Green et al., 2021).
The Scottish National Transport Strategy has four priorities – equality, climate action, health and wellbeing, and economy (Transport Scotland, 2020a). It promotes the Sustainable Travel Hierarchy, prioritising walking and wheeling, followed by cycling, then public transport, then shared transport, with private cars lowest priority (Transport Scotland, 2020a). Scottish Government has set a target to reduce car kilometres travelled in Scotland by 20% by 2030 and consulted on policy measures to achieve that, which could include road space reallocation (Transport Scotland, 2022b). Understanding benefits and risks to health can help ensure these measures promote health and equity, meeting the National Transport Strategy priorities.
Public Health Scotland hosts the Public Health and Sustainable Transport Partnership group (including the current authors). This brings together transport and public health professionals and policy makers to identify health and equity implications of transport policies and influence responses to improve these impacts (Douglas, 2022).
During the Covid-19 pandemic in Scotland, road space was temporarily reallocated to provide space for people to safely distance while walking, wheeling or cycling under the ‘Spaces for People’ programme. Scottish local authorities can decide to make temporary ‘Spaces for People’ schemes permanent or introduce new schemes (Sustrans, 2021). The Partnership group identified road space reallocation as a policy response likely to have wider effects on health and wellbeing as well as the economy, emissions and equity. Despite potential benefits, it is often contentious (Anderson, 2021). Partners identified HIA as a useful way to understand the impacts and to inform future decisions across Scotland.
The HIA aimed to identify and assess both positive and negative impacts of road space reallocation on health and wellbeing in Scotland, including differential impacts on populations that experience poorer health. This paper will describe the methods and sources used in the HIA, present the findings, the impacts identified, set these in context of other literature and discuss the recommendations made to Scottish Government and local authorities.
Section snippets
Materials and methods
We used several sources of data and evidence to identify and assess affected populations and health impact pathways.
Transport access and use in Scotland
Scotland has a population of 5.5 million people, 71% living in urban areas, 20% in accessible small towns and 9% in remote rural areas including islands (National Records of Scotland, 2021d). Life expectancy at birth is lower than other Western European countries, at 77 years for men and 81 years for women in 2020 (National Records of Scotland, 2021c). Healthy life expectancy in 2020 was 62 years for both men and women, so people spend many years in poor health (National Records of Scotland,
Key findings
This HIA integrated a rapid review of existing research, routine data and new primary qualitative research with key informants. It found that road space reallocation in Scotland can affect health through several pathways: reduced motor traffic, modal shift to active travel, benefits from alternative uses of space including greenspace and play space, support for public transport and local businesses, improved equity of access to services, amenities and employment, and community engagement.
Conclusions
This HIA highlighted that road space reallocation can benefit health and health equity through multiple pathways, with little evidence of harmful effects. Road space reallocation is often contentious and the HIA identified concerns raised by some stakeholders. The HIA recommendations include supporting alternative transport modes, using reallocated space to create quality environments that benefit communities and ensuring good practice in community consultation and engagement. As well as
Ethics
Key informant interviews were conducted in line with Public Health Scotland research governance procedures, including advance approval of the protocol and research materials by the research services officer. All participants opted in and gave signed informed consent before the interview.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
For the purpose of open access, the author has applied a Creative Commons Attribution (CC BY) licence to any Author Accepted Manuscript version arising from this submission.
Authors Statement
Margaret J Douglas: Conceptualization, Methodology, Investigation, Analysis, Writing - original draft.
Joanna Teuton: Conceptualization, Methodology, Investigation, Analysis, Writing – review and editing.
Alison Macdonald: Writing – review and editing.
Bruce Whyte: Resources, Visualisation, Writing – review and editing.
Adrian L Davis: Writing – review and editing.
Declaration of Competing interest
A conflict of interest may exist when an author or the author's institution has a financial or other relationship with other people or organizations that may inappropriately influence the author's work. A conflict can be actual or potential. At the end of the text, under a subheading ‘Disclosure Statement’, all authors must disclose any actual or potential conflict of interest including any financial, personal or other relationships with other people or organizations within three (3) years of
Acknowledgements
The authors would like to acknowledge the key informants who participated in the interviews, and the other members of the Public Health and Sustainable Transport Partnership group, who oversaw the work and contributed important insights and understanding to inform it.
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