Sunday 14 February 2016

Pushmi-Pullyu Health Promotion

Pushing in one direction are public health professionals keen to promote the enormous health benefits of making everyday journeys by foot or cycle.

Well-meaning trauma health communicators risk pulling people away from active travel if they take too narrow a perspective. Poorly executed campaigns and opportunistic press releases, intended to make people behave in a safer way, can scare people right off cycling, or letting their children cycle.

Look at the recent West Midlands Ambulance Service press release about a collision and related tweets.

Which parent would read the press release, look at the images, and think, "If I make my child wear a helmet they'll be fine in a collision like this with a van, so I'd like my child to start cycling to school"? There is no sense of celebration that a 14 year old is actively travelling to school, and no advice on how to avoid a collision. Implicit, I think, is a recommendation not to let your child cycle to school.

A key challenge is how to communicate effective and reasonable ways to reduce the likelihood or severity of an incident without discouraging people from doing an activity beneficial to their health. Ideally of course, the messaging should positively encourage more people to take up the desirable activity!

How can this be done?
Trauma related stories are newsworthy due to our love of other people's gore and misfortune. I think that professional health communicators must ensure their story sits within the wider health objectives. Though visually compelling, the image of a tuft of hair in the windscreen is probably not an appropriate one to provide to the media in this case, in fact a press release and tweets may be inadvisable at all.

Taking the West Midlands incident, I imagine that it could play out as follows (NB I don't know the full story, the area, the local authority, the local press or the school at all, so please treat this purely as fiction not fact)
  • The collision happened between a child cyclist and a van being controlled by an adult driver outside a secondary school on this B road (a clearway with a 30 mph speed limit so far as I can tell). The pavement appears not to be designated for shared use by pedestrians and cyclists. 
  • The child was injured, though apparently not seriously. 
  • The ambulance service does not consider fault. Messages should however be devised in consideration of Highway Code rule 204  "The most vulnerable road users are pedestrians, cyclists, motorcyclists and horse riders. It is particularly important to be aware of children, older and disabled people, and learner and inexperienced drivers and riders."
  • Is it known if the collision (regardless of fault) happened at a moderate speed? How significantly does speed affect the severity of impact, relative to other preventative measures?
  • The health service and council want more children to cycle to this school
  • The collision will result in a local concern about the safety of children cycling - some parents may stop their children cycling and others will not allow their children to start. Appropriate reassurance and remedial action is needed within that community as quickly as possible.
  • It is questionable whether there is positive value in publicising this collision in the wider community. Does the press need to be informed and are tweets beneficial here?
  • We need to identify and convey ways that the likelihood and/or severity of a cycling incident can be reduced while encouraging the uptake of cycling locally.
  • The authorities need to show they are acting in a joined up way to get people cycling in safety.
What could a press release say? (assuming one is needed)
I've doodled a few initial ideas here . I am sure that certain statements in this style could be 'stock' ones ready to be used without delay in the event of a collision where a vulnerable road user is hurt.


(Photo of the road outside school)

A van, being driven by a YY yr old man, has collided with a 14 year old who was cycling outside XYZ secondary school. The boy was treated in hospital for a cut to his head before returning home the same day.

The West Midlands Director of Public Health commented, "We want to see more children keeping fit and reducing air pollution by cycling to school instead of being driven. While collisions like this are rare, we are working with the council, police and schools to make cycling even safer. Obviously we would rather this collision had not happened, but we are thankful that serious injury was avoided, most likely because the collision happened at a moderate speed. We urge adults who are driving not to exceed 20mph in areas where children could be walking or cycling, and give these inexperienced road users plenty of time and space. "

The School's Head Teacher said, "We have asked the council to provide cycle training courses in school this term to encourage pupils to cycle and develop their skills. The training will include demonstrations of routes to school, where they exist, that avoid all or most traffic. Free bike marking, locks and helmets will be made available to all pupils. We would like the police to increase enforcement against careless road users on this road with immediate effect."

The Council's Head of Highways reported, "We have been moving towards 20mph speed limits on the city's roads since 2012 to reduce road danger. As this B road passes a school we will bring forwards plans for a 20mph limit here. We will also implement measures to improve off-road cycle routes and ensure they are well signed and convenient."

 West Midlands Ambulance Service wrote a blogpost reply to people's online criticisms of their tweets and press release. Do you think their reply encourages people in the area to cycle?
And finally, if the lad who was in the collision reads this - I think it's absolutely brilliant that you cycle to school.

UPDATE The subsequent three posts are within a few days of each other, all noting the approach taken in the West Midlands Ambulance Service. All are worth glancing at, but in particular the one involving the car occupants who suffered head injuries