The Infrastructure of Health

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The American Federal Government has closed. Only essential services are continuing to be delivered. 

Although the rhetoric has shifted, this was started as a fight over Obamacare, and that’s a fight I find frustrating to begin with. I’m in the camp that believes the Affordable Care Act did not go far enough because it is only about health insurance, not health care. It is health care, or at least some elements of health care such as vaccinations, cancer screenings, emergency medical attention, basic maternity and pediatric care which I believe Governments should have a responsibility to provide. Healthcare is not a socialist nose poking itself into everyone’s personal affairs; it is part of the universal infrastructure of society like roads or sewers.  

The health and transport sectors have a lot in common. Both exist on the margins between public service and private enterprise. Both are highly political and require a high level of investment. Both are wide-ranging, diverse fields with plenty of room for individualism, free market enterprise and other buzzwords of capitalist democracy. However, both involve choices and actions the implications of which cannot be contained within individual households or companies. Rather, they, with other services like sanitation and education, form the fabric that connects households and companies. Or, to use the Oxford English Dictionary definition of infrastructure, they are part of ‘the basic physical and organizational structures and facilities… needed for the operation of a society.’ 

Let us consider a company with a supply chain and sales strategy. Does it not require some way of transporting raw materials and employees to its offices and factories and some means by which to distribute its goods or services to customers? Maybe it runs its own trucks and buses, but should it also build its own roads? To where? Customers, employees, suppliers; all have transport requirements. Those requirements change and so do the people a company can call its customers, employees, and suppliers. Even if the company in question is in the business of building roads or running buses, it is reasonable for government to have some oversight of transport infrastructure to support all those independent companies and consumers and choices. 

Likewise, every person is an employee or employer or customer, just as they are a son or daughter, mother or father, and many other roles besides. A certain level of healthcare is required within a certain proportion of the population if society is to have sufficient numbers who can function as employees and employers and customers as well as in their private lives. A certain level of healthcare is required for everyone if society has the goal of promoting the freedom for all employees to change who they work for and all customers who they buy from. This is not actually about life or death. It is about achieving at least enough quality of life for society to function while supporting those individual liberties and free markets. It’s not even about equality, but only its lesser cousin, equality of opportunity, or the something akin to that which is actually achieved. 

Regulations and standards are also characteristics of infrastructure and both the transport and health sectors require them, for the sake of safety at least. People wouldn’t know how to interact on the roads without rules. Buses and trains would never have any customers without an understanding of how, where and when to board them. As for health, how would diseases be controlled without regulated programs for vaccination? How would anyone be able to help someone who through injury had lost the power to communicate without standards for emergency care? What would happen if there was no government dictated number for emergency calls? 

Transport and healthcare are about how individuals and organizations can and do interact. They are the means to, rather than the end goal, which is a healthy, functioning society.  

It’s been two weeks since the government shutdown, and so the list of essential services is increasing because some things that can be done without for a day or two are missed after two weeks. In transport, employees like air traffic controllers and others with responsibility for the safety and operation of the network were deemed essential from the beginning, but only recently have some staff been recalled from the Center for Disease Control and Protection to deal with a salmonella outbreak. This is an unequivocal example of how health is fighting for its place as an essential service.   

Healthcare, like transport, is not only an essential service, but also part of the basic infrastructure of society. Until the American government and the people who elect it realize that ignoring that reality is the disease they are trying to cure, reopening the government will be no more than managing the symptoms.

Compelling Climate Sceptics

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Since the debate began, a few decades ago now, there have been climate change evangelists and fossil fuel fundamentalists. The followers of the former are climate change converts with varying degrees of eco-warrior activity, whilst the followers of the latter are climate change sceptics with varying degrees of gratuitous carbon consumption. Then there is everyone else; people who don’t pay too much attention to the debate, but swing one way or another in terms of the carbon emissions of their actions depending on which direction the currents of legislation, taxes, campaigns and cultural norms sweep them.

Transport is a major source of carbon emissions, so it is no surprise that it can often be a battle ground between evangelists and fundamentalists. As the Intergovernmental Panel on Climate Change (IPCC) release yet another report to a world that seems to be in a trend towards scepticism or at least indifference, I have seen a policy swing away from sustainable transport towards road-building and pro-motorist policies. What are sustainable transport promoters like myself to do? I would suggest we use different artillery.

I have long been of the view that the buzzword ‘sustainability’ is not a synonym for ‘environmentally-friendly’ or ‘low carbon’. It encompasses those concepts, yet is intended to mean so much more. Think of it, perhaps, as a synonym for a long-term solution. In the case of transport, we are looking for a long-term solution for all the people that want to travel now to get where they want to go. I propose that walking, cycling and public transport offer better long-term solutions, and thus are more sustainable than car use for reasons beyond climate change. Reasons that the general population, climate change sceptics and even those who, like myself, are followers in the cause of climate change yet without much passion are likely to find more personally compelling.

Reason number one: congestion. Otherwise known as traffic jams or at least the inability to drive as fast as the speed limit and road layout allow. Everyone could drive carbon-neutral electric cars (assuming that the electricity doesn’t come from fossil-fuelled power stations, of course) and it would not solve the problem of congestion in towns, cities or on the strategic road network. Walking, cycling and (busy) public transport are all much more efficient ways to travel in terms of space used per person.

Building more roads creates more space for the car, but it is not sustainable in the sense that there are a finite number of cars that can fit on our road network and a finite amount of land to use for roads in places where people want to travel between homes and jobs, services and facilities. There are even fewer options if valuable housing or employment land is excluded. In the centre of our biggest cities, like London, one might almost say there is a negative amount of land for new roads. That’s why the congestion charge there makes sense. It’s not an environmental measure to reduce carbon, although that is a co-benefit. It’s a measure to tackle congestion.

Reason number two: health. We live in an age of sedentary jobs and sedentary leisure activities. Yet our bodies require quite a lot of moving around to operate at their optimum. What better way to fit regular exercise into your daily routine, for no additional cost, than walking and cycling when you need to travel? It’s a lot cheaper than a gym membership and you can save money compared to driving. If the distances are longer, taking public transport usually provides the opportunity to walk at one or both ends of the journey. Depending on the route, distance and infrastructure, walking, cycling and public transport might take less time than driving. Even when it takes more time to travel, you save the time you were otherwise planning to spend forcing yourself to jog around the block. Exercising more, being healthier – doesn’t that equate to a more sustainable lifestyle?

Reason number three: ‘it’s the economy, stupid.’ Okay, the motor industry does contribute substantially to the world’s economic output. But what about the cost of owning a car, even before fuel prices or parking charges? A family who keeps one car on the road instead of two can save a lot of money. Then there’s the cost of congestion to lost productive time, the cost to businesses of absenteeism due to low physical fitness, the cost of traffic accidents and yes, even pollution. I’m thinking of local air pollution, not just carbon. The stuff that can give people chronic respiratory conditions, with high healthcare costs. The cost to the healthcare system of all these sedentary, unfit families is even higher. So sustainable travel is sustainable for the economy and particularly your household economy.

The IPCC is now 95% sure that man-made climate change is occurring. A large proportion of greenhouse gas emissions are coming from vehicle tailpipes. But if you’re still a climate sceptic, I hope you find that one of the sample of other sustainabilities I describe compels you to occasionally leave your car at home.

What is a Transport Planner?

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“So what do you do?”

“I work for XXXX.”

“Oh.” And sometimes the conversation ends there.

But sometimes it doesn’t. “Doing what?”

“I’m a transport planner.”

“Oh.” And sometimes the conversation ends there.

But sometimes it doesn’t. “So what do you do?”

When people ask me what I do for a living, the only short answer is a tautology: I plan transport. It is unsatisfactory, yet I don’t want to bore a new friend, an old cousin, or my husband’s work colleague with tedious detail, so I waffle, “You know, walking, cycling, buses, road layouts, road safety.” I cannot even come up with a complete sentence.

It can be easier to understand what I don’t do. I don’t design or build roads or bridges, I don’t drive buses or trains, I don’t repair bicycles or even fill potholes. Sometimes I mention a specific project I am working on when I think it will capture my interrogator’s imagination. Yet for those many times when I could not provide an example, this is what I would have liked to say:

I develop policy and strategy on any topic that involves or is related to moving around in public spaces and sometimes in private outdoor spaces too. I guide such policies through the democratic process, both public and political. I bid for funding to implement those strategies. I procure and manage contracts and services, model and monitor outcomes. Sometimes I even get to draw that first line on a map before it gets to the engineer or architect to design. The results of my work are often long term, but they are tangible. The reward is making a positive social difference. How many others in office-based careers spending their days writing reports, crunching spreadsheets and attending meetings can say that?

And what would I say to our vocal detractors who believe that they’d be better off if things weren’t planned? If there were no parking restrictions and no traffic lights. If public transport were completely controlled by market forces and all road users, including pedestrians and cyclists were left to sort out their own differences?

I would say that they have answered their own question. Who else but transport planners have the responsibility to consider all road users and balance their needs within the limited resources of space and distance to best achieve mobility and access for all over the long term? Whether we achieve that balance is another question, but who else has the job of looking at the bigger moving picture?