Health promotion by stealth: active transportation success in Helsinki, Finland

Abstract

The promotion of active transportation (AT-utilitarian trips including walking, cycling, and public transit use), represents a well-recognized opportunity for increasing physical activity. This study examines the strong AT success achieved in Helsinki, Finland (in 2013, the share of daily trips in Helsinki completed by AT was 77 per cent) from a political perspective. Helsinki represents a noteworthy example of AT success given important challenges including the region's relatively low population density, its difficult winter climate, and Finland's high driving rate. This research applied the advocacy coalition framework (ACF), a formal policy process theory from political science. Interviews were conducted with 23 AT experts in Helsinki. Document review was employed as a secondary method. Overall, the research indicates that Helsinki's success may be attributed to the long-term dominance of municipal transportation policy by a pro-AT advocacy coalition. When viewed from the perspective of health promotion, it is striking that this success is not strongly attributable to health considerations or efforts from health-related fields. Rather, the data suggest that the coalition, comprised of members from a variety of non-health fields, was most strongly motivated by a desire to protect a high degree of livability. Importantly, a number of significant historical events and background-level factors greatly facilitated success. Overall, these results suggest that health promotion advocates may have very useful allies in non-health sectors, and that awareness of the importance of political factors is likely to contribute to stronger health promotion efforts. Finally, several possibilities for related and further research are suggested.

Attributes of Perceived Bikeability in a Compact Urban Neighborhood Based on Qualitative Multi-Methods

“…Previous studies noted active transportation as an alternative for automobile use for urban mobility [42,43]. However, there is little mention of problems arising from introducing active transportation.…”

Policies, Politics, and Paradigms: Healthy Planning in Australian Local Government

“…Alternatively, some advocates preferred to focus on co-benefits through "health by stealth", whereby "even if 'health' is not an explicit policy goal, integrated policies can have significant health co-benefits by addressing social determinants of health" [14]. The use of health by stealth concepts have been identified in the promotion of healthy food strategies, and also in some built environment [93,94] and behaviour change [95] settings. This has strong links to the use of other (co-)benefits for implementation, whereby health improvement is an implicit benefit rather than an explicit project motivator [94].…”

“…However, even where community health benefits were explicitly discussed by advocates, such benefits were generally expressed through the economic or lifestyle improvements resulting from them [BE7, BE9, BE14]. Advocates most commonly talked about the economic and (natural and built) environment benefits of what could otherwise be seen as healthy planning, in an approach that has been termed "health by stealth" [93][94][95]. Health by stealth employs co-benefits that have been identified as being politically viable (refer to Section 3.2.2) in order to promote projects, or uses terms that are considered more marketable and attractive than 'health', such as 'well-being' [BE4, BE11, CH9] or 'liveability' [CH11, BE11].…”

Stakeholders’ experiences of what works in planning and implementing environmental interventions to promote active travel: a systematic review and qualitative synthesis

“…Participants highlighted the importance of having a network and partnerships with other stakeholders. Multiple studies (n = 14) emphasised valuing a mix of professional backgrounds and expertise in collaborations (Adams et al, 2017;Allender et al, 2009;Cole et al, 2010;Dodson et al, 2014;Field et al, 2018;Grant et al, 2011;Koglin, 2015a;Le Gouais et al, 2019;Lenker et al, 2016;Lubitow et al, 2016;McAndrews et al, 2018;Saidla, 2018;Saidla et al, 2017;Witten et al, 2018). For example, Dodson et al (2014, p. 4) stated regarding a "complete streets" intervention in a US town that " … participants noted that the diversity of support may have been one of the greatest strengths of this movement".…”