1. PATHWAYS TO HEALTH? Westport's Smarter
Travel Urban Greenways.
Examining the effects of the Greenways from a
health and well-being perspective.
______________________________________________
Darren Cawley
______________________________________________
Masters in Health Promotion
National University of Ireland Galway
School of Health Sciences, Discipline of Health
Promotion
Head of discipline - Prof. Margaret Barry
Research Supervisor - Dr. Lisa Purcell

2. Tableof Contents
Abstract............................................................................................................................ 1
Chapter 1: Introduction.....................................................................................................2
Policy context and research setting ................................................................................ 2
Westport and SmarterTravel.......................................................................................... 2
Rationale ...................................................................................................................... 3
Research Aims and Objectives........................................................................................ 4
Chapter 2: Literature Review ............................................................................................. 5
What is Health?............................................................................................................. 5
Health Impact Assessment............................................................................................. 6
HIA in the Context of Health Promotion..........................................................................7
HIA and the Social Determinants of Health Model........................................................... 7
The HIA Process ............................................................................................................ 9
Greenways.................................................................................................................. 10
Health Impact Assessment & Policy.............................................................................. 12
Difficulties of HIA in policy ........................................................................................... 14
Physical Activity........................................................................................................... 15
Physical Activity and the Built Environment............................................................... 17
Physical Activity and the Economic Perspective ......................................................... 18
Physical Activity and Smarter Travel.......................................................................... 20
Benefits of reducing motor vehicle use......................................................................... 20
Noise and Air Pollution............................................................................................. 21
Safety...................................................................................................................... 22
Mental Health Issues................................................................................................... 24
Health Inequalities ...................................................................................................... 26
Health Inequality and Policy ..................................................................................... 27
Health Inequality and Active Travel........................................................................... 28
Disability and Greenways ......................................................................................... 29
Chapter 3: Methodology.................................................................................................. 30
Community Profile ...................................................................................................... 30
Screening.................................................................................................................... 31

3. Scoping....................................................................................................................... 33
Key Stakeholders and (Study Sample)........................................................................... 34
Data Collection............................................................................................................ 36
Data Analysis............................................................................................................... 36
Ethics.......................................................................................................................... 37
Background to the Westport Smarter Travel Initiative. .................................................. 37
Chapter 4: Results........................................................................................................... 39
Results of the HIA........................................................................................................ 39
Outcome of screening ................................................................................................. 39
Outcomes of scoping................................................................................................... 40
Community Profile ...................................................................................................... 40
Themes identified from stakeholderinterviews............................................................. 41
Awareness of HIA........................................................................................................ 41
General Impressions of the Westport Greenway........................................................... 42
Positive inputs to partnership building and capacity building ......................................... 42
Other positive influences highlighted............................................................................ 43
Concerns highlighted................................................................................................... 43
Issues identified relating to Physical Activity ................................................................. 44
Safety Issues ............................................................................................................... 46
Anti-social behaviour................................................................................................... 48
Health Inequalities ...................................................................................................... 49
Mental Health............................................................................................................. 50
Educational Opportunities ........................................................................................... 51
Social Cohesion........................................................................................................... 52
Economic Prospective.................................................................................................. 53
Noise & Air Pollution ................................................................................................... 54
Stakeholder Recommendations.................................................................................... 55
Summary of Results..................................................................................................... 57
Chapter 5: Discussion...................................................................................................... 60
Introduction................................................................................................................ 60
Links between HIA and Health Promotion..................................................................... 60
Physical Activity........................................................................................................... 61
Health Inequality......................................................................................................... 62
Noise and Air Pollution ................................................................................................ 62
Mental Health Issues................................................................................................... 63
Exploring Future Recommendations............................................................................. 64

4. Discussion Summary.................................................................................................... 66
Limitations of the study............................................................................................... 67
Recommendations for Further Research....................................................................... 68
Chapter 6: Conclusion ..................................................................................................... 69
References...................................................................................................................... 70
Appendices..................................................................................................................... 78

5. Acknowledgements
To the lecturing and administration staff of the Health Promotion faculty. For
providing a terrific learning experience.
To my thesis advisor Dr. Lisa Purcell. You have went above and beyond the call of
duty. Your commitment and genuine interest were a source of great encouragement.
To members of the former Westport Town Co., Mayo Co. Co., and Mayo Sports
Partnership. Thank you for being so generous with your time and resources in
completing this work.
Thanks and gratitude to the 22 key stakeholders who partook in the interviewing
process. This thesis would be an empty shell without your most valuable contribution.
To my family. For understanding and patience once more as I embarked on another
challenge. You have always been there in support and love.
To my Donor. The "Gift of Life" has provided me a terrific quality of life and the
potential to perform anything. This thesis is proof of that. Thank you.
To Aoife. For sharing in the journey and being a rock of support through all things.
Without your love and support dreams would stay in my head. With Love.

6. 1
Abstract
Title: PATHWAYS TO HEALTH? Westport's Smarter Travel Urban Greenways.
Examining the effects of the Greenway from a health and well-being perspective.
Aim: The aim of this research is to identify and examine the health impacts of
Westport's Smarter Travel urban greenways initiative in the context of the town being
the first 'small town' where urban greenway policy has been implemented in Ireland.
Methods: This study used a qualitative community led, participatory approach to
assess the health impacts, framed through a social determinants of health model. The
tool being utilized was a retrospective health impact assessment following the
Liverpool Health Observatory's Merseyside Guidelines for HIA. Semi-structured
interviews were performed on identified key stakeholders from their involvement with
Westport's greenways.
Results: The results provided clear perspectives on the positive and negative health
impacts of the Smarter Travel initiative. In particular, issues highlighted were
increases in physical activity and a strong sense of social cohesion.
Conclusions: A number of important recommendations were identified by
stakeholders. These included improving linkages between existing greenways and
improving or establishing facilities such as toilets, water fountains and a park ranger
position. From a health promoting perspective the initiative was found to have a
positive impact on the social determinants of health for this community. It was very
much recommended as a strategy to be replicated in other areas.
Key Words: Smarter Travel. Greenways. Health Impact Assessment. Health
Promotion.

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Chapter 1: Introduction
“Transport and travel trends in Ireland are unsustainable, if we continue with present
policies, congestion will get worse, transport emissions will continue to grow,
economic competitiveness will suffer and quality of life will decline” (Dept of
Transport, 2009. P8)
Policycontext and researchsetting
The quote above from the executive summary of the Department of Transports (DoT) new
transport policy for Ireland 2009-2020 highlighted the situation and the need for a new
approach to transport policy in Ireland. The strategic approach that is highlighted by this
policy is implicit in its title Smarter Travel – A Sustainable Future. This document underpins
the policy context of the research undertaken in the current study. The strategy set out a
number of key objectives and actions aimed at ensuring alternatives to motorised transport are
made available, coupled with increased investment in cycling and walking infrastructure. It is
presupposed that these measures will improve the quality of life of the population across the
life course and increase accessibility and participation in active travel modes of transport.
Implementation of these actions is examined in the study presented here using a health impact
assessment (HIA) in the setting of a County Mayo town, Westport, that was designated as a
Smarter Travel ‘demonstration town’ under the Smarter Travel Areas Programme 2012 - 2016
(www.smartertravel.ie).
Westportand SmarterTravel
Westport is one of the few planned towns in the country. This bestowed a rich
architectural legacy that Westport Town Council promotes as providing an
“aesthetically pleasing urban core, high visual and amenity value, many fine streets
and urban spaces” (Westport Town Council, 2010). Many factors in Westport’s past

8. 3
including its unique infrastructure and location, its tight knit community and a
willingness of the town council to take initiatives in forward planning for the
betterment of the area, are factors that have been highlighted in winning a bid to
become a Smarter travel demonstration town in 2010 (www.smartertravel.ie). The
Smarter travel bid incorporated the town’s infrastructure, notably an abandoned
railway line system that links the town core to the Quay area (the town’s second urban
core). This provided a cycling and walking network for the local community and
tourists. Subsequently Westport utilised the Smarter Travel fund to develop further
urban greenways encircling the town and linking residential, workplaces, schools and
the town core thereby providing alternative transport opportunities for the population
(Appendix 1. Map of Westport Greenways).
The stated overall goal of Westport’s Smarter Travel bid was “to make Westport the
best possible Smarter Travel Town, where everybody, young and old, will choose
walking and cycling as their natural choice of travelling for short journeys within the
town and its environs” (Westport Town Council, 2010). A summary of Westport's
high level objectives for Smarter Travel are included in appendix 2.
Rationale
Westport is the first small town to demonstrate implementation of the Smarter Travel
initiative in Ireland, yet the initial Smarter Travel bid focused on the benefits to the
local economy and active tourism with limited focus on the potential health impacts to
the individuals and community within the town itself.
The research presented here, a health impact assessment, aims to contribute to
knowledge of the Smarter Travel Urban Greenway’s impact on the social determinants
of health as implemented in a small town.

9. 4
ResearchAims and Objectives
Aim
The aim of this research is to identify and examine the health impacts of Westport's
Smarter Travel urban greenways initiative in the context of the town being the first
'small town' where urban greenway policy has been implemented in Ireland.
The objectives are to:
 Identify key stakeholders in the Westport Smarter Travel Urban Greenways
initiative
 Undertake a retrospective, rapid health impact assessment (HIA) to examine the
potential health and well-being implications
 Review evidence relating to Smarter Travel initiative developments.
 Conduct semi-structured interviews with identified stakeholders to:
o Explore their perspectives in relation to urban greenways in built-up
areas, on social determinants of health
o Explore their recommendations arising from their involvement with
Westport’s greenways.

10. 5
Chapter 2: Literature Review
“This stage involves the collation of a body of knowledge or key evidence and the
systematic analysis of the potential impacts, their significance, the population groups
likely to be most affected and the strength of evidence of these impacts” (Ginnell,
2013)
The literary review is part of the evidence gathering process for the HIA. It entails a
summary of evidence in relation to the health impacts identified in the screening and
scoping stage of the HIA process. There is also a section based on HIA in relation to
policy and the potential barriers within this area.
The analysis for this literary review looked at previous HIAs especially those dealing
with urban regeneration and the utilisation of greenways to promote positive health
impacts and Smarter Travel policy documents. The Institute of Public Health and the
World Health Organisation (WHO) database of HIA related information offered a lot
of useful information. Alongside this Google scholar and university databases to
analysis the potential health impacts identified were utilised.
What is Health?
The focus of a HIA is to consider the impacts of an initiative on Health. Health can be
a difficult word to conceptualise, to some it is seen as the absence of disease and
indeed the oft most used metric of health are measures of ill-health, disease and
premature death (Naidoo & Wills, 2000 P.69). The definition being used in this
research views health in a more holistic, all-encompassing way, where communities or
individuals have the ability to accept health as a key resource for everyday living. This
view incorporates the WHO (1986) definition of health “…as a state of complete

11. 6
physical, mental and social wellbeing” and acknowledges that good health is a
“…major resource for social, economic and personal development and an important
dimension of quality of life” (WHO, 1986).
Health Impact Assessment
The WHO has defined Health Impact Assessment (HIA) as “…a combination of
procedures, methods and tools by which a policy, programme or project may be
judged as to its potential effects on the health of the population and the distribution of
those effects within the population” (WHO, 1999). It is a tool employed to gather
information which can be used to address and influence the decision making process
in producing improved population health outcomes. Winters (1997) sums up its
essential purpose as being to minimise health loss and maximise health gain. Differing
types of HIA’s can be used which can not only promote health and well-being but also
health proof initiatives and policies through highlighting current or potential issues
pertaining to population health. This can occur even if the policy or program was not
specifically designed to impact on health. An example given by Doyle et al., (2003)
shows that a transport policy that promotes other forms of transport over motor
vehicle use would indirectly impact on the amount of physical exercise people take.
This is important as highlighting the relationships between public policy and health
enables the health implications of policy decisions to be acknowledged and acted upon
(Doyle et al., 2003). Health promotion guides us to an understanding that the health of
a community is determined not solely by its health service but by the many different
dimensions that influence society, be that economic, social, psychological and
environmental influences (Grinnell, 2013). HIA therefore is a tool that gives

12. 7
prominence to these determinants of health that can affect individuals or communities
and uncover the health impacts which can be both positive and negative.
HIA in the Context of Health Promotion
HIAs are used to generate evidence on how health can be promoted when
implementing any policy or initiative. HIA and health promotion have values and
principles in common that underpin their activities or processes. Health promotion is
“…the process of enabling people to increase control over, and to improve, their
health” (WHO, 1986). It can be seen as the process of enabling and empowering
people to make healthy choices by motivating them to become better self-managers. A
key aspect of health promotion is to highlight that health is not the sole responsibility
of the health sector but that it should permeate throughout all sectors of society. The
seminal work in health promotion is the Ottawa Charter (WHO, 1986) which
advocates for a move away from location specific health care to where people’s health
is ‘created and lived’ within the settings of their everyday life.
The core values underlying HIA as outlined by Metcalf et al., (2009) are Democracy,
Equity, Sustainable Development and the Ethical use of Evidence. They are in line
with the values and principles of health promotion as laid out in the Ottawa Charter
(1986). HIA's advocates for better population health across the life span of the
population. Through active community participation HIA's enable and empower
individuals to take more control of their health by having a say in policies and
programmes while also promoting health equity.
HIA and the SocialDeterminants of Health Model
The World Health Organisation (2008) identifies the social determinants of health as
“…the conditions in which people are born, grow, live, work and age, circumstances

13. 8
that are shaped by the distribution of money, power, and resources and which are
themselves influenced by policy choices”. The two main models of health used in
carrying out a Health Impact Assessment (HIA) are firstly a bio-medical model of
health which focuses more on categories of disease, morbidity and mortality rates,
utilising quantitative research methods to highlight health factors. The second is in
keeping with the principles of health promotion focusing on a social determinants of
health model. These principles include a whole population approach with
opportunities for public participation, a focus on risk and protective influences to
enhance health and well-being and interventions that promote and enhance
behavioural, socio-environmental and policy change (WHO, 1984). Mindell et al.,
(2003) note that HIA aims to rely on qualitative evidence and stakeholder knowledge.
The model most widely used to encapsulate and identify social determinants is that of
Dahlgren and Whitehead (1991) which Naidoo & Wills (2010) describe as depicting
the relationship between social, economic, environmental, behavioural and biological
factors (See Figure 1).
Figure 1. Dahlgren & Whitehead, (1991)

14. 9
The HIA Process
Health Impact Assessment (HIA) is a process whose aim is to predict positive and
negative health impacts of a proposal, policy or initiative (Mindell et al., 2003). HIA
can be carried out in 3 different ways according to Grinnell (2013). Desk-top HIA is
carried out under limited resources and usually office based. Community participation
is unlikely. A Rapid HIA may include some community participation but is often
undertaken with limited resources and time. Thirdly a Comprehensive HIA takes place
over a longer time period with greater resources and involves a more extensive
analysis of the issue being considered.
The Merseyside Model (Scott-Samuel et al., 2001) was developed in Liverpool in the
late 1990's and provides the following steps of a HIA framework:
Screening involves the selection process to judge which projects, policies or
programmes would warrant a HIA.
Scoping entails the formulation of a steering group for the HIA. This stage is
often referred to as setting the “terms of reference” or the “blueprint” of the
HIA as many items including the aims and objectives are decided at this stage.
Conducting the assessment entails a range of methodology to profile
communities, perform interviews on the stakeholders, assess the evidence and
establish the highlighted impacts and justify options for action.
Development of recommendations and negotiating favoured options
concerns the consideration of alternative options (or the undertaking of a
formal option appraisal).
Monitoring involves collecting and interpreting data in relation to the proposal
and establishes whether the recommendations in the proposal actually occurs.
(Scott-Samuel et al. 1998; IMPACT).

15. 10
There are three potential times when a HIA can be undertaken in relation to a policy,
programme or initiative. Firstly, through a Prospective HIA. This is seen as ideal due
to the ethos of HIA to uncover the impacts to health prior to the implementation
process at the proposal stage. This gives the opportunity to influence decisions being
made (Metcalf et al., 2009). The authors highlight Concurrent HIA as being
convenient in terms of reviewing a programme, especially as at this stage a lot more
detailed and technical information about the programme is available for use. Finally a
Retrospective HIA is undertaken after the policy or programme has been implemented.
A main benefit of this type of HIA is in the future it may prove useful in the planning
of a similar proposal as the health impacts have already been analysed (Metcalf et al.,
2009).
Greenways
The physical environment is a key determinant of health. Gordon -Larsen et al.,
(2006) discuss this growing awareness in relation to the rise in non-communicable
diseases, such as obesity and cardiovascular disease and show that health
organisations are starting to look to the settings where people live to find solutions.
Barton (2009) notes a growing consensus that to solve many of the world's health
issues there is a need to move away from personal factors and direct health services.
This study looks to examine greenways as a potential intervention combining health
and well-being with active travel to provide positive health outcomes.
Greenways by definition are linear open spaces or transport corridors such as old
railways or canals which have been converted for public recreational use, in a non-
motorised environment (Little, 1995). This study will use the term greenways
generally throughout the work although they can be known by other names in the

16. 11
literature such as 'ecological networks', 'green systems', 'biodiversity corridors' and
'trails and pathways' as shown by Fabos & Ryan (2004). The differing titles for
greenways are a testament to the multidimensional and multi-purpose nature and uses
greenways provide. Fabos (1995) proposes three major function greenways provide
for today's society. The first is in an ecological sense in that they offer pathways to
natural settings and systems. Secondly, form a recreational viewpoint in terms of the
physical and mental health benefits of the outdoors and physical activity, and finally,
greenways offer us a link to heritage and cultural values. Along with the stated
benefits above Salici (2013) discusses the aesthetical, educational and economical
benefits greenway potentially can offer, leading as she describes to a rise in quality of
life for individuals and communities. Another area where greenways potentially
impact on health, especially on urban people, and discussed by Searns (1995) is on a
spiritual disconnect often felt living in urban areas and that with access to greenways
and parks a sense of spiritual healing may occur.
In cities and towns today it is difficult to find space for large parks and to this end
Arslan et al., (2007) further highlight the positive aspects of greenways in that they
take up less space than conventional parks, becoming in effect linear parks. Built
effectively, they can link people's residence not only to green space but to urban cores,
commercial centres and employment areas. Similarly they link together the rural and
urban spaces within an area for the benefit of the population (Bueno et al., 1995).
Examples of greenways abound around the world today (Erickson & Louisse 1997,
Walmsley 2006, European Greenway Association, 2010). A main reason highlighted
for this, according to Fabos & Ryan (2004), is the adoption of greenways by
government and non-government agencies and also the academic community. They
further highlight the importance of benefits attributed to greenways, seen by the local

17. 12
communities in small towns and urban areas, as a vital part of the growth of
greenways. (Fabos & Ryan, 2004).
The city of London has shown good leadership in implementing (as of 2011) over
375km of routes, with a further 19,000km planned for the future (Transport for
London, 2012). Research in the London Greenways Monitoring Report- 2011
highlights the benefits to the city such as an increase in walking and cycling rates,
adoption of the greenways for leisure, shopping and increased access to work and
schools (Transport for London, 2012).
In America several high profile greenways have been delivered. The Highline Project
in New York City is described as an 'innovative and emancipator' project (Armstrong,
2006). It comprises the re-imagining of a 1.5km redundant piece of unused elevated
railway in Manhattan and re-purposed it as a linear greenway (Heller & Bhatia, 2007).
Atlanta is currently developing a 22 mile former rail loop which encircles the city into
urban greenways. According to Green (2013) $250 million will be spent on the
greenways for this initiative coupled with an estimated $500 million spent on
developing parks. Heins (2015) looking at differing approaches to urban design,
highlights that apart from increasing the capacity for active travel it aims to use the
greenway to knit together neighbourhoods of different socio-economic and racial
backgrounds.
Health Impact Assessment& Policy
The Ottawa Charter back in 1986 offered a clear mandate to health promotion “to
move into the arena of healthy public policy and to advocate a clear political
commitment to health” (WHO, 1986). As has been noted, a goal of HIA is to address

18. 13
and influence this policy making process to produce better population health outcomes
and minimise negative health impacts.
Over the past decade there has been an increase in the use of HIA with a goal to
influence the development of public policy, in areas outside the health sector (Lee et
al., 2013). The main goals and capabilities of HIA according to Barnes & Scott-
Samuel (2000) is in providing a pragmatic, effective tool which informs policy
decisions through an in-depth assessment of their potential health impacts. They also
highlight that HIA proactively creates health awareness in the policy making process
at every level. This makes improving public health the standard when developing all
public policy, not just within the health sector.
Within the European Union both the Maastricht Treaty (1992) and the Amsterdam
Treaty (1997) have put in place articles to ensure that policy proposals have no
adverse effect on health (Elliot, 2001). This is further compounded by the WHO’s
Regional Office for Europe’s Health 21 Strategy that by 2020 all member states
should have systems in place for HIA so that all departments become answerable to
the impacts their policies have on health and well-being (Elliot, 2001).
In the Irish context terms such as the “Health Proofing” of policy has been included in
policy documents going back over 15 years including the Department of Health and
Children’s National Health Promotion Strategy 2000-2005. The National Institute of
Public Health takes a lead role in promoting and disseminating knowledge and
training in HIA in Ireland with an all-island approach. It is a key resource with public
access to an archive of completed HIA and information on the HIA process
(www.publichealth.ie.).

19. 14
Healthy Ireland- A Framework for Improved Health and Wellbeing 2013–2025 has 4
goals. “To increase the proportion of people who are healthy at all stages of life, to
reduce health inequalities, to protect the public from threats to health and wellbeing,
and to create an environment where every individual and sector of society can play
their part in achieving a healthy Ireland” (Dept of Health, 2013). The Healthy Ireland
document emphasises that using a tool such as HIA with an intersectoral approach will
help achieve the agenda set out in that document.
Difficulties of HIA in policy
Limited understanding of health issues by other sectors, for example the impact
certain transport polices can have on health (i.e. increased active transport as a result
of increasing petrol/tax on motorised vehicles), accentuates the need for a greater
understanding of HIA. Research carried out by O’Mullane (2008) shows that the
reverse can also be true as there is a lack of awareness from the HIA community of the
needs that decision makers require from the process. This shows the urgency for
greater communication and understanding, both of which occur during the HIA
process if utilised effectively. Putters (2005) believes too much time is expended on
defining the HIA process and more resources are needed considering the policy
process. This after all must assimilate the outcomes from HIA which would greatly
add to the impact HIA could have at policy level.
Although seeing HIA as an ‘intuitively appealing and simple concept’, Parry &
Stevens (2001) highlight many potential flaws in the process from systematically
carrying out the HIA to the multitude of approaches used. They see HIAs as merely a
tool for predicting impacts and call for ‘mini health impact assessments’ to be used by
decision makers. The information compiled, they believe, would be ample with

20. 15
sizeable reductions in time and resources. Highlighting the flaws as above however
negates the many positives of HIA including encouraging a ‘bottom-up’ approach to
policy and enabling stakeholders to have a voice during the policy process.
Undoubtedly, as Kickbush (2003) points out, the focus of health policy remains on
medical care expenditure as opposed to promotion, prevention and investment in
tackling the health determinants. Kickbush looks for a paradigm shift in thinking
leading to institutional leadership and support for tools such as HIA to be better used
and understood. This coupled with more engagement across departments and a deeper
understanding of the positives HIA entail, can lead to health promoting becoming
more ingrained in decision makers minds (O’Mullane, 2008).
In summary the Commission on the Social Determinants of Health (WHO, 2008) have
outlined many proposals and suggestions to aid in promoting health and well being in
urban areas. In the majority of European planning systems areas such as health,
sustainability and equity are not being targeted and contemplated effectively
(www.eurohealthnet.eu). To avoid other departments within governments creating
public policy but relegating health issues to an aside the importance of tools such as
HIA need be advocated and there proven effectiveness.
PhysicalActivity
"Physical activity plays a vital role in maintaining health and preventing disease, in
improving mental health, and in increasing lifespan" (Heller & Bhatia, 2007 P4).
Smarter Travel- A Sustainable Future documents the ever increasing risks of obesity,
heart disease, mental health issues and other chronic diseases to the Irish population
(Dept. of Transport, 2009). The national Health Strategy, the Report of the Task Force
on Obesity and the National Recreation Policy similarly highlight the need to

21. 16
advocate for an increase in physical activity as the most likely way of reversing these
trends (Department of Transport, 2009).
In recent years obesity levels in Ireland have reportedly levelled off (Keane et al.,
2014). The current plateau is at an undesirable high level. Perry et al., (2009) looked at
the statistics for children's weight from the late 1940's until 2002 and found
consequential increases in weight of 24kg per child over that time span. Perry et al.,
believes as Ireland became more economically successful so too significant increases
in the weights of children become more visible. The authors add that many factors can
be attested to these figures highlighting diet as a key factor in these trends, and
suggest a need for the development of public policies to "promote walking and
cycling" (Perry et al., 2009 p.264). Such trends are not isolated to children alone, the
Healthy Ireland document states that 61% of all adults in Ireland are overweight or
obese, with the WHO (2003) stating that over 60% of adults are not participating in
adequate levels of physical activity. Adults are not living within the recommended
ranges for weight or physical activity, both key determinants of health.
A key goal of the Healthy Ireland document (Dept of Health, 2013) is to increase
health for people across the entire life course. Physical activity carried out in suitable
and safe environments has the capacity to make this objective a reality. Warburton et
al., (2006) show that there is "irrefutable evidence" that habitual physical exercise has
a positive impact on numerous non-communicable chronic diseases such as obesity,
heart disease, diabetes, high blood pressure, and depression. A further systematic
review, on the effectiveness of physical activity to bolster the health of school aged
children, by Janssen & LeBlanc (2010), show that the more physical exercise young
people get the greater the benefits to their health.

22. 17
PhysicalActivity and the Built Environment
Frank & Engelke (2001) examines how the built environment can impact activity
patterns by looking through the lens of urban design and planning's effect on public
health. As has been shown, improvements in health could be achieved with more
individuals and communities participating in physical activity. They highlight that
many people have no interest in participating in structured activity and many have no
time or access to facilities. If physical activity can be integrated into daily living in
terms of travelling to work or schools this would improve activity levels. What is
needed therefore is to create supportive environments, through more health conscious
urban design, to facilitate physical activity and active transport. One failing is noted
as the lack of cross-over and understanding of public health needs by town and city
planners. Frank & Engelke (2001) call for a "retrofitting" of existing urban areas
through the establishment of greenways and pathways and where possible away from
the mainly motorized roadways. The important thing is that the greenways must be
useful to the community living in the urban environment in a very real and meaningful
way. Planners need to connect residential areas to schools and commercial hubs
thereby removing some of the barriers to active travel. This in turn will incorporate the
undertaking of non-motorized transport into people's day to day activities. Similarly, it
is possible to limit air and noise pollution and have a positive impact on the quality of
those living in urban areas with the decrease in motorized forms of transport (WHO,
2003).
These issues are not unique to Ireland but are commonly highlighted throughout the
western world. Smarter Travel is taking this on board and through the Smarter Travel
demonstration areas offering a tangible response to reverse the health trends affecting
the population. This is achieved with the implementation of Smarter Travel initiatives,

23. 18
notably in Westport, through the development of urban greenways and pathways.
Furthermore, cycling, walking and other forms of active transport will be pivotal to
achieving some of the goals in national health policies to promote physical activity
(Dept of Transport, 2009).
PhysicalActivity and the Economic Perspective
"Health is a personal, social and economic good, and the health and wellbeing of
individuals, and of the population as a whole, is Ireland’s most valuable resource"
(Healthy Ireland, 2012).
As the above viewpoint shows health is seen as an 'economic good and a valuable
resource' from the perspective of government. Health expenditure is an incredibly
expensive outlay however with Government estimating to provide up to €13.1billion
for the delivery of health services in Ireland in the current year (Dept of Finance,
2014).
Within commercial and workplace settings the WHO (2007) Steps to Health document
tells us regular physical activity has been shown to lead to improved employee health,
increased productivity, a decrease in health and safety issues, enhanced job
contentment and improved team spirit. Furthermore, physical activity enhances mood
and performance and improves concentration" (WHO, 2007.). Research from the USA
show that the economic benefits of physical activity initiatives within the work place
can dramatically lessen short-term sick leave by 6% - 32% with a positive add-on of
reducing health care costs by between 20% - 55% and increased productivity of 2% -
52% (WHO 2003). A wellness programme, highlighted in the Health Promotion
Strategic Framework document, shows that using intervention which includes
physical activity and free water and fruit led to a decrease in absenteeism of over four

24. 19
working days per employee a year from 2001-2007 (cited in Health Service Executive,
2012). As can be seen savings can and should be made through improving workforce
health. The WHO (2003) point out that savings incurred from the improvement in
staff health and well-being prove to be approximately four to six times the cost of the
initiative or programme implemented. Companies who view employee health as an
issue purely for the individual to deal with are in the long run doing a disservice not
merely to their employees but also to themselves and their profitability.
In terms of the specific benefits of greenways and trails a paper by Snepenger et al.,
(1995. cited in Loh et al., 2012) revealed that 'one in four' of the business started in the
area being studied began after the owner visited and experienced the location as a
tourist. This author highlighted that start-ups experienced a quality of life and social
cohesiveness which was sparked by the non-motorised infrastructure. This in-turn they
suggest "lures companies, increases residential quality of life and retains a qualified
workforce. Trails are vital to the business, the economy, and jobs" (Loh et al., 2012
p12). The above points show that a healthy population form a public health
perspective, have the potential to save government spending in health large sums.
Economically for the workforce and employers a healthy population offers savings in
terms of time off work and increased productivity, both tangible reasons to promote
regular physical activity. The implementing of healthy urban infrastructure can be
seen to offer potential business's a key incentive to start-up business in the areas where
greenways are part of the setting.

25. 20
PhysicalActivity and Smarter Travel
"Interventions that encourage walking and do not require attendance at a facility are
most likely to lead to sustainable increases in overall physical activity" (WHO, 2002.
p 9).
Walking, and cycling, is central to achieving the goals in relation to national health
policies to promote an increase in physical activity (Dept of Health, 2009). It can
appear the easiest thing to do is walk, to utilise the benefits of physical activity. An
individual needs little equipment or resources, and walking is one of the best types of
activity for health (WHO, 2014). The reality however in urban areas is often different.
Little or no footpaths in certain areas, poor connectivity of pathways, the danger of
motor vehicles of different sizes travelling at different speeds, poor lighting and the
potential of anti social behaviour are some of the issues that need to be considered.
The Westport Smarter Travel Bid document highlights the positives health impacts
that increasing physical activity has on the community. The document highlights the
positive association between activity and coronary heart disease, type 2 diabetes,
osteoporosis and colon cancer (Westport Town Council, 2010). It also asserts that for
community participation in active transport to increase, a safe, urban environment for
non-motorised forms of transport is necessary.
Benefits of reducing motor vehicle use
This section looks at some of the other determinants of health impacted by similar
urban planning policies such as the Smarter Travel initiative. These include air
pollution, noise, and safety issues. The UK's National Institute for Health and Clinical
Studies (NICE) believes that an increase in active transport reduces the incidental

26. 21
costs in relation to poor air pollution, congestion and traffic accidents in urban areas.
They estimate the societal costs in the region of £10 billion annually (NICE, 2012). In
several cases urban design is a major cause of the difficulties of promoting active
transport opportunities. Frank & Engelke (2001) note that although widening a
roadway can improve the flow, and increase the speed of traffic, it may also reduce the
space for non-motorists. This is essentially a form of inequality benefiting those
partaking in motorised forms of transport. Enrique Penelosa, former mayor of Bogotá,
Columbia, discusses this inequality within urban areas. He states that if pedestrians
and cyclist are forced to walk along the side of the road or on poorly developed
footpaths while cars drive on paved or tarred road surfaces then those who walk are
being treated as third class citizens while those who drive first class. With the
implementation of greenways for active transport he states that a person on a $100
bike is equal, in terms of opportunity and safety, to an individual in a $30,000 car.
Similarly, he suggests that although policy and programme implementation rarely
reflect this, if a bus carries 50 people, is it not entitled to 50 times more road space
than a car with one person (Penelosa, 2013). This outlook acts to encourage the
development of active transport policies which according to the WHO (2002) will
reduce air and noise pollution, prevent injuries and improve the quality of urban life.
Noise and Air Pollution
Analysis of major reviews on the health impacts of noise by Kavanagh et al., (2009)
states finding the causal link between noise pollution having an adverse affect on
health is difficult. This being said numerous studies, including Rattle (2015), drawing
on the results of a retrospective policy HIA, show that prolonged exposure to noise
can bring about negative health impacts including stress, changes in mental health,

27. 22
sleep disorders and raised blood pressure. This study also points out that children are
especially vulnerable to adverse noise pollution (Rattle, 2015).
Air pollution is commonly identified as a key measure targeted in decreasing the
quantity of motor vehicles (Small & Kazimi, 1995). Through the replacement or
reduction of private motor vehicle trips with active transport forms of travel,
Woodcock et al., (2009) show that important gains and reductions in CO2 emissions
can be accomplished. The reduction in motor vehicle trips has an effectual impact in
relation to air quality. Research by Riediker et al., (2004) looking at the potential
effects, in-vehicle and roadside, of exposure to particulate matter (PM) from
motorised vehicles showed negative impacts on health. Similarly an adverse link
between mortality and PM was observed by Pope et al., (1995). In Australia it is
reported that between $1.5 and $3.8 billion Australian dollars are spent annually on
the treatment of non-communicable disease such as cardiovascular and respiratory
disease as a result of air pollution from cars (Amoako et al., 2005). Finally the adverse
impacts to health of air pollution especially the increased risk to respiratory and
cardiovascular disease to elderly, pregnant women, children and those with long term
illness was found by Mannucci et al., (2015).
Safety
There is an estimated 1.2 million road deaths a year throughout the world (Richter,
2006). There are a substantial numbers of cars constantly on Irish roads. The database
of the Irish National Vehicle and Driver File comprises details of 2.5 million
registered vehicles in Ireland (Dept of Transport, 2015). With approximately 75% of
all journeys made in Ireland by private car (Environmental Protection Authority,
2015) it is not surprising that almost four people die on Irish roads yearly with a figure

28. 23
of 196 road fatalities in 2014. In terms of vulnerable road users (pedestrians, cyclists
& motorcyclists) the greatest number of deaths were among pedestrians, and within
this statistic younger and older people feature predominantly (Dept of Transport,
2015). The above information reveals that a large volume of cars are on the roads,
there are many fatalities and that pedestrians are the most vulnerable road users in
Ireland. Antov et al., (2009) highlight that road safety is a serious issue in most
countries noting urban crossings providing the greatest danger. Traffic calming
measure are a key feature in today's urban landscape, and offer a feasible method in
reducing road traffic accidents (Bunn et al., 2003). Traffic calming schemes are
introduced with the aim of reducing vehicle speed and increasing safety. A meta-
analysis of 33 studies looking at area-wide traffic calming schemes in urban areas
uncovered a decrease in accidents of approximately 25% in residential areas and 10%
for main roadways (Elvik, 2001). Other benefits in the implementation of
interventions looking to increase the safety of roadways note a rise in pedestrian
activity within an area where traffic calming was introduced and indicators showing
improved population health were noted (Morrison et al., 2004).
Although personal motor vehicle ownership is seen as a fast, efficient and safe
mechanism of transport it is not, as has been shown, without negative impacts to
population health. To reduce the number of vehicles on the road Woodcock et al.,
(2009) rightly points out that a safer, more convenient and user-friendly alternative is
needed to reduce the inducement of private motor vehicle use. The development of
greenways and pathways offers an opportunity to participate in active travel within a
safe environment. This coupled with traffic calming schemes, especially at pedestrian
crossing areas has the potential to improve safety for vulnerable road users.

29. 24
Mental Health Issues
“Mental health is the emotional and spiritual resilience which allows us to enjoy life
and to survive pain, disappointment and sadness. It is a positive sense of well-being
and an underlying belief in our own, and others’ dignity and worth.”Health Education
Authority (1997).
The Commission on the Social Determinants of Health (WHO, 2008) emphasises the
point that where people live and their surroundings have a substantial influence on
their mental health and well-being. This is shown to be a global issue and based on
data reviewed by Kessler et al., (2009) who conclude mental health issues are
commonplace and far-reaching from a societal viewpoint, in the 28 countries
analysed. This point can be further highlighted by the trends that suggest depressive
mental illnesses will be the number one cause of chronic disease in the western world
by 2030 (Mathers et al., 2008).
The seriousness of mental health issues can be seen in the Irish context by statistics
from the Healthy Ireland document. It relates that 1 in 4 people are likely to
experience mental health problems in their life (Dept of Health, 2013). More worrying
is that in Ireland the rate of suicide in the 15-24 and 15-19 age categories are the
fourth and third highest respectively in Europe (HSE, 2010). The depth of the issue is
further compounded by statistics from the Annual Report from the National Office for
Suicide Prevention (2011) showing over 12,000 presentations to hospitals occurred in
relation to deliberate self-harm (HSE, 2012).
The challenge of poor mental health, examined from the view-point of greenways,
green spaces and urban planning and design, gives a large body of evidence in terms
of positively impacting this key determinant of health. This combined with the

30. 25
benefits of physical activity in treating mental health issues a powerful argument can
be put forward. Through examining the literature on the link between mental health
and exercise the results show improved mental health and well-being, a reduction in
anxiety and depression, greater self-esteem enhancement and improved cognitive
functioning (Callaghan, 2004, Penedo & Dahn, 2005 & Barton & Pretty 2010).
There is enough evidence, according to Fox (1999), to show the effectiveness of
physical activity in the treatment of clinical depression and mental health issues.
Callaghan (2004) however suggests that this evidence is being overlooked in the
treating of mental health issues. Although the case may be that the benefits of exercise
are not always advocated by the medical community Sturgeon (2006) encourages the
promotion of exercise and physical health for the positive impacts to mental health,
especially she notes in older people. If, as further noted by Sturgeon (2006),
cardiovascular disease has been shown to double in those with depression, physical
exercise can be seen as a 'good-fit' in providing interventions to overcome the negative
impacts that arise from poor mental health.
Barton & Pretty (2010) look at the term "green-exercise" signifying activities
performed outdoors in nature. Through multi-study analysis they uncovered that time
spent exercising in nature led to positive increases in mood and self-esteem, with the
greatest benefits to those with mental health issues. Similar results including improved
mental functioning and improved psychological, emotional and mental health from
spending time in green spaces can be found in the literature (Kuo et al., 1998).
Green spaces in the form of parks or greenways are often the refuge for those who,
although not clinically suffering from mental health issues, use these green areas to
attenuate the day to day stresses of everyday life. A study to investigate whether green

31. 26
spaces can enable people to cope better supported the idea that parks and greenways
can provide a barrier against the negative health impacts from the challenges of daily
life (Van Den Berg et al., 2010).
Healthy Ireland illustrates the positives of green space for physical and mental health
and well-being. They suggest improvements emerge only when green spaces are of
suitable quality easily accessible and safe to use. If the green space is suitable it can
act to remove the stressors that potentially cause or prolong mental health issues in a
person's life. This coupled with the potential for social interaction and cohesion
provides the opportunity for positive health impacts (Dept of Health, 2013).
Health Inequalities
The unequal distribution of the determinants of health, according to Tones & Tilford
(2001), is the most acknowledged critical phenomena relating to health. This is known
as health inequality. Reducing health inequalities is a key aim of health promotion and
according to the Ottawa Charter (1986) reducing differences in health status, and
ensuring equal opportunities is the way forward in enabling people to attain positive
health results (WHO, 1986).The institute of public health in Ireland sees health
inequalities as the "differences in health outcomes and expectancy between different
population groups" (Lavin et al., 2011 p11). These population groups are normally
categorised in terms of social status such as people's social class and socio-economic
background. The Commission on the Social Determinants of Health (WHO, 2008)
show this to be a global issue. Through showing the mortality rates between countries,
it points out that if a person is born in Japan or Sweden they estimate a life expectancy
of over 80 years. People born in several African nations however can expect a life
expectancy of up to 50 years. Similarly within countries, using the city of Glasgow in

32. 27
Scotland as an example, a gap in mortality rate within this population of 28 years has
been shown within a distance of less than 15 miles (WHO, 2008). In 2010 over half
the world's population, and as much as three quarters in Europe alone, now live in
urban areas (Borrell et all, 2013). The authors also point out that health inequalities
are more pronounced in urban areas citing the concentration of deprived and poor
populations within specific regions as a major factor.
Health Inequality and Policy
In policy terms much has been done to approach and deal with the subject. The Fourth
International Conference in Health Promotion's Jakarta Declaration, called for a
significant reduction in health inequalities suggesting the use of "equity focused health
Impact assessment" as a key part in the policy making process (WHO, 1997).
Following the conference there has been a number of other reports relating to health
inequalities with an equity focused outlook including the Acheson Report (1998),
WHO Commission on the Social Determinants of Health (WHO, 2008) and the
Marmot report ‘Fair Society, Healthy Lives’ (2010) (cited in Friel et al., 2011). An
earlier look at equity and health by Whitehead (1992) explains that equity policies
need to look at ways to improve living and working conditions and focus on enabling
people to adapt healthier lifestyles. To do this, the author believes, involves the
encouragement of people to participate in the policy process at all levels advocating a
bottom up approach to get health impacts on the policy agenda. Even when health is
on the agenda Whitehead regards awareness of health impacts as challenging for
policy makers. Health has many consequences which are difficult to define, especially
on vulnerable sectors of society. For this reason tools such as HIA act as an awareness

33. 28
raising exercise, highlighting in a clear way how policy can influence health
(Whitehead, 1992).
From the outset HIA's methods and procedures have aimed to identify health
inequality. According to Douglas & Scott-Samuel (2001), the focus of HIA needs to
address the distribution of health impacts across the population and on vulnerable and
disadvantaged peoples and communities. When looking at public health, community
involvement and active participation is achieved by giving a voice to those affected
within the decision making process. Along with participant involvement HIA has the
potential to recommend suggestions with the goal of reducing the identified health
inequalities and maximising potential for health equity (Elliot, 2001). The
Commission on the Social Determinants of Health (WHO, 2008) highlights the
benefits of being included in policy processes in terms of empowerment and
inclusiveness However Mindell et al., (2003) declares that HIA continue to be
performed without community involvement even with the acknowledged positives
highlighted above.
Health Inequality and Active Travel
Active travel is essentially all forms of non-motorized transport and has been
identified as having a key role in reducing health inequalities (Dora & Phillips, 2000).
If transportation policies fail to account for the vulnerable sectors of society a
widening of health inequalities can occur. A study by Turrell et al., (2013) found that
designing neighbourhoods with access to employment, commercial centres and public
transport has the potential to reduce health inequalities due to the increase in active
transport. Similarly, a HIA was carried out on a transportation policy which aimed to
promote active transport and reduce motor-vehicle use in Edinburgh. In analysing the

34. 29
impacts experienced by different population groups, they found that those of a lower
socio-economical status carried the heaviest burden of the negative impacts and
benefited more from positive impacts. They concluded that forward thinking
transportation policies offers potential for a reduction in health inequalities (Gorman
et al., 2003).
Disability and Greenways
A key stakeholder to acknowledge in designing and implementing greenways and
urban design is people with disabilities. The European Greenways Association (2000)
endorses taking account the views and experiences of disabled people and
organisations when implementing greenways. To those with disabilities, greenways
can often offer the only safe means of getting exercise, travelling to work or accessing
shopping and commercial areas by themselves. A key aim therefore for enhancing
health equity of this group according to Kinne (1999) is providing further
opportunities and access to appropriate sites to enjoy leisure activities, something
Swain (2004) states in many instances is missing. The establishment of safe and
adequately designed greenways therefore has the potential to offer those with
disabilities a safe adapted environment which can promote social integration within a
positive outdoor environment away from motorised traffic (The European Greenways
Association, 2000).

35. 30
Chapter 3: Methodology
The study methodology used is based on a qualitative approach to research. The tool
being utilised was a retrospective health impact assessment following the Liverpool
Health Observatory's Merseyside Guidelines for HIA (Scott-Samuel et al., 2001).The
focus of the HIA was on the positive and negative health impacts of Westport's
Smarter Travel urban greenways, utilising a community led participatory approach to
assess the potential impacts. This was achieved through carrying out semi-structured
interviews on identified key stakeholders within the community.
The Merseyside guidelines make an important distinction between the procedures for
HIA and the methods used (Scott-Samuel et al., 2001). The authors describe the
procedures as the frameworks for commissioning and implementing the HIA, whereas
the methods are the design process of the HIA. This is shown in diagrammatic form in
appendix 3. As the Smarter Travel Initiative is already in place a retrospective HIA
was considered the most suitable tool to uncover the potential health impacts.
Metcalf et al., (2009) points out that Prospective HIA's are the ideal due to their
potential to influence the decision, or policy, being made before the project is
implemented. The authors believe the usefulness of retrospective HIA's lies in its
ability to uncover health impacts on a current project which may be useful when a
similar proposal is being planned in the future. Westport being a demonstration town
for the Smarter Travel initiative therefore offers this potential.
Community Profile
The reason a community profile is created is to allow a localised image to be created.
Within the HIA framework this section looks to identify the target population in which

36. 31
the initiative is being established (Grinnell, 2013). The department of transport (2009)
looked at the negative impacts to health through increasingly sedentary lifestyles in
the population. With this in mind the Smarter Travel initiative looked to encourage
more active travel opportunities, not to individual sectors of society but, to the
population as a whole across the life course. Westport was chosen to represent this and
as such the community as a whole therefore no specific profile was carried out on the
town, as it is not called for in this instance. Basic information from Westport Town
Councils bid proposal to become a Smarter Travel Demonstration Town was used.
The document was made available for this study (Westport Town Council, 2010). This
coupled with further Mayo Co. Co. and Census data gave an up to date profile of the
town and community.
Screening
There are many current and potential projects, initiatives, policies and programmes in
the public forum in relation to health promotion. When narrowing down a potential
area to carry out research it is necessary to firstly assess whether the need to carry out
a health impact assessment on an area is warranted. Screening therefore “establishes
whether a particular policy, programme, or project has an impact on health and
whether a HIA is appropriate or necessary" (Doyle et al., 2001).
Through further research it was clear that in relation to the newly developing urban
greenways in the town, and the Great Western Greenway from Westport to Achill, the
only research being carried out, or that was planned to be carried out, was based
mainly on the economic and tourism benefits of such programmes (Fitzpatrick
Associates, 2005, Caufield et al., 2013, The Greenway, 2013). With the intention to
carry out a HIA, the Westport urban greenways were looked at in more detail.

37. 32
It was found that in 2009/2010 the then Westport Town Co, in conjunction with Mayo
Co. Co. and various stakeholders in the town had bid, and won, to be recognised as a
Smarter Travel Demonstration Town. This meant that over €5 million was being
allocated to improving and altering the urban landscape to promote active travel and
decrease use of motorised transport. As a demonstration town for the Smarter Travel
initiative, Westport was to be a showcase to other small towns with the results of the
initiative to be fed back up through Smarter Travel and utilised at policy level with the
goal of implementing similar infrastructure in other areas if the initiative proved
successful.
The development of a steering group to assess the need for a HIA is an integral part of
the screening process. Through working within Mayo Co Co. with Mayo Sports
Partnership the researcher was able to initiate a steering group of key stakeholders
who had knowledge and experience with the development and implementation of the
Smarter Travel project, and its implementation. Through consultation with this group
and another key stakeholder in study Dr Lisa Purcell, NUIG lecturer in Health
Promotion, it was discovered that the Westport Smarter Travel urban greenways did
warrant a HIA.
The research was approached, as described earlier, from a social rather than bio-
medical model of health highlighting the determinants of health within the settings of
people’s everyday life; where they learn, work, play and love (WHO, 1986). Through
the screening process several likely health impacts both positive and negative were
provisionally uncovered. Proceeding with the HIA these issues will be examined in
relation to the population as a whole within Westport’s urban setting.

38. 33
Scoping
Scoping is often referred to as setting the “terms of reference” or the “blueprint” of the
HIA. The areas to be calculated at this stage of the process include “the elements or
aspects of the proposal to be assessed; aims and objectives of the HIA; the
geographical area covered by the proposal implementation; the populations or
communities affected; stakeholders for the HIA and the nature of their involvement;
potential health impacts of concern; the resources (human, financial and material)
available; the methods to be used; and management arrangements” (Mindell et al.,
2003). Scoping is regarded as “the key step if not the most important step in the HIA
process (Harris et al., 2007 P.12).
In relation to this research the parameters in terms of time and resources did not allow
for a full scoping exercise to be carried out however meetings with key stakeholders in
the steering group did allow the study to proceed along the recommended
methodology of a full HIA. These communications with the steering group set the
boundaries of the assessment and defined the HIA in terms of size, the aims and
objective, the schedule and the questions and issues which were to be considered
within the HIA process. Through this process it was decided to carry out a
retrospective rapid HIA. This would further explore the potential health impacts of the
Smarter Travel greenways within the Westport urban setting approached through the
determinants of health model. The consultation process also helped to identify a
number of themes as discussed and utilised in the results section.

39. 34
Key Stakeholders and(Study Sample)
The process of HIA requires broad public participation in order to capture a
comprehensive picture of the positive and negative health impacts of an initiative. The
expertise, knowledge and opinions gathered are essential in uncovering local concerns
and for ethical reasons of social justice (Scott Samuel et al., 2001).
A broad variety of stakeholders can lead to greater insight, unavailable to those
developing proposals, which may affect health. Several stakeholders involved in the
steering group of this HIA are also residents in the area of the Smarter Travel project.
This led to the situation where those involved in the development of this HIA are also
directly affected by it, ensuring good community participation. This can be seen as
positive as Ison (2002) discusses that individuals in the community that may be
affected by a proposal or project should participate in HIA.
Selection and identification of key stakeholders was carried out through consultation
with the steering group. This process proved relatively easy as the Smarter Travel
project was recently established meaning identified stakeholders were easily
assessable. Parry & Wright (2009) however discuss the difficulties inherent in
community participation. They recommended limiting participation to a relatively
small group of key stakeholders. This approach, carried out effectively, should
provide an increase in knowledge generation and depending on the stakeholders
involved can hold a greater effect in influencing policy makers. With these factors in
mind the stakeholders were identified (Appendix 4.)
The study comprised 22 individuals with ages varying from those in their thirties to
seventies, both male and female, across a broad cross-section of the community.
Those selected included a Government Minister and a locally elected representative.
There were seven stakeholders working in the local authority including Mayo Co. Co.

40. 35
and Mayo Sports Partnership and a member of the Smarter Travel Team who have
each worked on the planning and implementation stages of the project.
Representatives from local business and voluntary organisations. A member of the
Road Safety Authority, of An Garda and a teacher were interviewed characterising the
greenway from the experience their professions provided. No children were
interviewed in the study but several representatives who work with the schools in
terms of the Smarter Travel initiative provide feedback on the positives and negatives
they witness in there day to day work. A Health Service Executive social worker in
the Westport area was interviewed. Although a number of the key stakeholders
mentioned both work and live in the area, several residents covering differing
demographics were asked to partake. These include senior citizens, mothers and also
several interviewees were chosen due to their location along the greenway to highlight
some of the social issues that they find pertinent in relation to their location as
residents along the greenway. A former chairperson of Westport Tidy Tows
committee was interviewed and finally a medical doctor with over 35 years experience
within the community area.
Each person was provisionally contacted about being involved in the study. All agreed
and welcomed the study being undertaken to assess the health impacts of the
greenway. Each of the identified stakeholders was approached on merit due to their
experience and knowledge pertaining to the greenway and on the grounds of equity of
representation.

41. 36
Data Collection
The method used in collecting the data was semi-structured interviews of the
identified key stakeholders. The interviews were carried out over a one month period
at a location convenient to the stakeholder. All interviewees were given an
information sheet and a list of potential questions before the interview to familiarise
them with the study they were partaking. The information sheet also contained the
researchers contact information (Appendix 5). Of the interviews carried out one
interview occurred with three participants at the onetime another occurred with two
participants being interviewed together, the rest were one on one interviews. These 19
interviews were recorded on a high quality digital voice recorder and transcribed into
a digital portable document format (PDF) kept in a password protected computer.
One participant was not a native English speaker, however her proficiency was at an
advanced level. Including this interviewee there was no issues with understanding or
comprehension. Interview lengths ranged from 7-24 minutes and total transcribed
words amounted to 34,182.
Data Analysis
The collected data was analysed using thematic analysis which according to Braun &
Clarke (2006) is a method identifying and reporting patterns, or themes, within
collected data. What is looked for is to capture something important within the data
which highlights meaning.
In the screening and scoping stages of the HIA, in consultation with the steering
group, certain themes were established. These pre-determined themes were then used
to examined the content of the transcripts and to see what issues emerged around these
themes for the stakeholders. Gomm (2008) sees thematic analysis as a version of

42. 37
content analysis which emerges to a degree in this research where there is a
combination between thematic analysis and content analysis in the processes used.
Ethics
Ethics can be seen as the discipline dedicated to moral reasoning in relation to what
we should do (Carter et al., 2012). In terms of ethical consideration the research
undertaken was achieved in acceptance of the principles set out in the "CompHP
Project Handbook (Barry et al., 2012) and the SOPHE Code (article 5,
www.sophe.org/ethics.cfm). Both documents emphasis proper ethical consideration
when carrying out research within the area of health promotion. The researcher is also
expected to have a high level of competence and to perform the roles expected in a
professional and ethically correct manner.
In relation to the research carried out an information sheet detailing what the research
was about and all necessary information was provided. After the interviewing process
all participants signed a consent form allowing the data to be used in accordance with
the information outlined in the information sheet. One interviewee asked to see any
information pertaining to the interview they were involved in before publication which
was adhered to without changes being made.
Backgroundto the Westport Smarter Travel Initiative.
The Smarter Travel initiative stems from the Smarter Travel Policy Framework
document "A new Transport policy for Ireland 2009-2020" (Appendix 6. for Policy
summary). The ambition of this policy was to improve the quality of life for all
citizens by reducing motorised transport through promoting active transport (Dept of

43. 38
Transport, 2009). This policy not only developed a vision but also provided funding of
which Westport attained over €5 million. This funding aimed to create a change in
travel behaviour in the Westport area, for the utilization and experience of locals and
tourists. The vision as developed by Westport Town Council and Mayo County
Council was in developing existing, abandoned railway lines to develop a high quality
walking and cycling greenway. A crucial part of the greenways was in connecting
residential areas with schools, work places and the town centre.

44. 39
Chapter 4: Results
Results of the HIA
The aim of this study was to assess the health impacts of the urban greenways
initiative in Westport. This section presents the outcomes of the different stages of the
HIA undertaken on the initiative. The first section presents the outcome of stakeholder
consultations during screening, secondly the outcomes of stakeholder consultations
during scoping, the third presents outcomes of the appraisal including the community
profile and analysis of interviews with stakeholders. The final section presents
stakeholder recommendations regarding the issues highlighted during the HIA.
Outcome of screening
Through working with the Mayo Sports Partnership (MSP), within Mayo Co. Co., the
potential health impacts of the urban greenways then being established and enhanced
in Westport were beginning to be utilised. Through the "Men on the Move" initiative,
instigated by the MSP, the greenways within the urban areas of Westport town was
being employed as an ideal setting for promoting the physical and mental well-being
of those participating in the programme (Canavan, 2013). The Men on the Move
initiative was one programme focused on a small section of the community. It was
believed a broader understanding of the health impacts of the Smarter Travel initiative
would prove useful, especially as this was a demonstration of a new government
backed initiative looking to benefit the population. The establishment of a steering
group resulted in acceptance of a HIA as a suitable tool to carry out the proposed aims
and objectives. A retrospective HIA was chosen as the initiative was already
underway. A HIA screening tool was utilised (Harris et al., 2004) which gave further

45. 40
credence to the process as many of the criteria for carrying out a HIA, such as
whether the programme had an effect on health, would it effect the health of
vulnerable sections of the community and could the HIA effect or influence policy
were seen as potential outcomes of the HIA.
Through the screening process several areas of potential health impacts were
provisionally uncovered. These include the areas of air pollution, road safety,
physical activity, noise, access/mobility, mental health, social inclusion, the physical
environment and inequalities
Outcomes of scoping
The scoping stage clarified and defined in greater detail the aims and objections of the
retrospective HIA. The population of Westport town within the specified urban area,
within which the greenway is encompassed, is the area being researched. A great deal
of work in the scoping process went into identifying the key stakeholders, the themes
thought to affect health and addressing the techniques required in preparing for the
interviewing process. Themes highlighted at this stage identified as important related
to physical activity and safety. All interviews were carried out in the month of July
and transcribed by the 10th of August.
Community Profile
Westport is the third largest town in Co. Mayo. Based on 2011 census figures the total
population in the Westport Electoral District Urban area was 5, 543 with a wider
hinterland of approximately 20,000. There were 2,633 Males and 2,910 Females. Two
other statistics are noteworthy, firstly looking at self perceived health and secondly
peoples method of travelling to work, school or college. Almost 90% of this

46. 41
population (4,831 individuals) categorized themselves as good-very good health.
However, looking at the mode of daily transport for the Westport area only 27% (842
individuals) commute to work, school or college by foot or bicycle. These figures
from 2011 census were taken at the beginning of the Smarter Travel initiative and will
provide good base line information for future study (Central Statistics Office 2011).
Themes identified from stakeholder interviews
Through performing the semi-structured interviews the participants were asked to
relate their reactions, thoughts and opinions on the themes identified during the HIA
scoping process. Transcripts were examined to determine themes and issues in the
responses of interviewees arising from these predetermined themes. The issues and
themes identified and highlighted from the interviews include both positive and
negatives themes in relation to different aspects of the greenway. The results go
through each theme identified and a section summing up the results will follow.
Awareness ofHIA
Few of the interviewees were aware of HIA or its processes. Of those who had
experience of HIA discussed the usefulness as giving "...the government and the
legislature and the senate and the official departments the data that they need if they
are going to develop further schemes within those departments." In relation to the
Smarter Travel initiative the HIA process was considered advantageous in identifying
"...the impact of that money that has been spent" and also to see "...has it been
successful and to know of what usage are the facilities that we are actually putting
money into."

47. 42
General Impressions of the WestportGreenway
Throughout the interviews there was an underlying acknowledgement that the
greenway has strengthened community action and has provided a vital platform in the
creation of a supportive environment throughout the town. The following quotes from
five different interviewees from different backgrounds, ages and experiences highlight
a general consensus from the interviewees. "A really brilliant idea, such a fabulous
facility" - "Westport has exploded as a health destination" - "It's an easy sell" - "The
downsides are virtually nothing" - "The Greenway is the best thing to ever happen in
Westport"
Positive inputs to partnership building and capacitybuilding
Setting up a greenway within the urban area occurred before Westport won the bid to
become a Smarter Travel Demonstration town. The construction of an initial
greenway was described by an interviewee involved in the planning stages as "...a
success, so the town was keen to build on that." Capacity building with the key
stakeholders of the town from the outset was seen as vital and included a lot of
"...good communication between a lot of the local community groups." Groups
mentioned included, “Westport Town Council, both official and elected members of
Mayo County Council, An Taisce, Westport Chamber of Commerce, Tidy Towns
committee, the Garda and numerous voluntary groups and businesses." The initial
meetings to discuss the potential for extending the greenway and adapting a Smarter
Travel philosophy was considered to be a "...very good process as it brought all the
groups together in terms of looking at the goals the town had under Smarter Travel."

48. 43
Upon winning the bid to become a Smarter Travel demonstration town Westport
noticed many benefits. Interviewees involved in relation to the planning and
implementation process of the greenway found that "...linkages that have been made
to the residential estates, to the schools, to the town centre, and also to businesses,
have been amazing and the feedback very positive." The potential future benefits of
the greenway were highlighted by a interviewee involved in politics as "...the
healthier you get society, the healthier you get people, the less hospitals , the less
nurses, the less doctors will be required because we will have a healthier society."
Other positive influences highlighted
Many interviewees describe the positives of the urban greenways which was summed
up by one as "...a healthier population in our area. A safe environment to walk or
cycle and get exercise and make us a healthier people than we used to be." Another
interviewee, a mother, mentioned bringing her adult son on the greenway who had
"...not been on a bike for years. He went out the next day and spent €500 on a new
bike and has not been off it since." Similar stories were reported especially by family
members who saw the greenway as a way of "creating sustainable environments for
future generations."
Concerns highlighted
Participants expressed concern in a number of areas in relation to the greenways. One
participant was keen to highlight the use of the greenway for commercial events. This
interviewee thought it important to know from a community viewpoint whether the
greenway is to be a "...commercial entity or a social entity" and, if a mechanism was
in place to decide who uses the greenway, and for what. Other issues in relation to

49. 44
rubbish, lighting, anti-social behaviour and dogs, were also highlighted and are
explored in the coming sections.
In summary the perception of one interviewee, concerning the greenway from a health
and wellness point of view, was that "...the greenway empowers all of us to take a
little bit of control over our own health."
Issues identified relating to PhysicalActivity
Linking back to the scoping section of the study and proposing to identify the health
impact of the greenways in Westport, impacts relating to physical activity were a
theme strongly identified. Many interviewees highlighted the increase in physical
activity in the town with one interviewee, who works within the health sector, stating
that "...right across the board there has been a shift towards better health and the
Greenway has kick-started a lot of people." One interviewee explained the reason they
believed the greenway had increased physical activity for people in the area was
"...because one it's cheap, and two it's good for your health."
The dangers of using the road for exercise were suggested by a interviewee as having
a major negative impact on physical activity in that "...if you are on the road you just
won't do it [exercise]". Another factor that interviewees highlighted in relation to
physical exercise was Westport's hilly surrounding area. Many of the participants,
especially older citizens, expressed a key positive impact of the greenway was that it
offered an environment with a lack of steep inclines, and declines, and attributed its
success to this factor stating "...it is so effective because it is flat and Westport is so
hilly." Other interviewees noted that impacts of the greenway on physical activity
were not solely the domain of urban dwellers. One interviewee observed that many
people from the rural areas "...drive in and park and use the Greenway and walk

50. 45
because they cannot use the country roads, they are too busy." There was much focus
by interviewees on children now having a safe way to travel to school and it was
thought that this promoted more children and teenagers to participate in exercise.
Within the school setting, particularly the girl's secondary school, it was reported that
physical education classes were carried out on the greenway. An interviewee working
with schools in the area explained how "...some of the girls may not want to do high
intensity activities so they go for nice walks along the Greenway and they have
running clubs that use the Greenway as well."
Similar to schools, companies in the town reported using the greenway to promote
physical activity. An interviewee from one particular company reported using the
greenway when implementing health promoting activities for its staff stating that
"...some days we would have 50 employees walking, running, jogging up and down the
greenway." This interviewee proposed these activities wouldn't occur if "...we didn't
have the greenway and the infrastructure."
Organisations influential in developing and implementing healthy public policy
reported looking to the greenway when developing programmes that promote physical
activity. An interviewee from one such organisation saw the greenways as beneficial
in that "...it gives us the capacity to run programmes like Men on the Move, Get
Ireland Walking and Fit for Life Programmes." Similarly, another interviewee
mentioned that activities such as the nationwide “Park Run” initiative has been rolled
out successfully on the Greenway thanks to collaboration between different sectors in
the community “...Westport Town Council, Smarter Travel Team, Westport Athletics
Club & Mayo Sports Partnership”.

51. 46
On exploring the greenway in terms of its potential impact of reversing non-
communicable diseases such as obesity, several interviewees offered differing
perspectives. It was thought, by an interviewee with a sports background that children
in schools are "...not reaching the levels of physical activity that they need to."
However an interviewee with a medical background thought that "...we are in one of
the most active periods of time since the beginning of the seventies," and stated that
"obesity levels have dropped" in the area. One interviewee considered the greenway as
a positive factor in battling obesity and promoting physical activity in that its
"...existence starts the process automatically because once it's there people will use
it." Although several interviewees expressed concern around the topic of obesity those
with a political background identified the use of the greenway "...as a resource”, for
tackling the issue, adding“...but we need more." They highlighting that the greenway
is a useful tool to use in conjunction with other approaches in working to decrease
obesity levels.
SafetyIssues
As in all new initiatives and programmes there were many concerns identified in
relation to the safety aspect of the greenway. In particular interviewees welcomed the
opportunity to highlight their views on such issues.
After the initial implementation of the greenway a safety audit was carried out on the
greenway by consultants on behalf of the Dept of Transport. An interviewee involved
in the implementation of the greenway highlighted that "...most of those
recommendations have been implemented at this stage."
Safety issues in relation to pedestrians and cyclists featured predominantly in
participant feedback. The greenway was perceived as providing a safe environment

52. 47
with most interviewees attributing it valuable in relation to family safety with one
interviewee describing the greenway as "...probably the safest place to take your kids
out on bikes and scooters and you don't have any of the worries of cars or traffic."
Interviewees were complimentary that it enabled people to exercise safely at night
because the majority of the Greenway is lit. One interviewee reported a belief that
"...with smarter travel there is not a child in the town of Westport that cannot safely
[travel] from his house to school and from his school back to his house safely off the
road."
There was a perception among most interviewees that more children were using the
greenway, but that there was a need greater road safety education. One participant
expressed concern stating "...a lot more education is needed for children in relation to
bike handling and courtesy." The ability of especially children to cycle safely was
mentioned by several interviewees. One pointed out the importance of young cyclists
being "...introduced not just to greenway cycling, but that they learn to cycle out in the
community where it is a very different matter." The fear highlighted by interviewees
was that moving from the safety of the greenway on to the main roads could prove
dangerous, especially for young children. One interviewee stated that the community
in general needs to be educated and aware that "...Westport is a shared space town and
that the children and adults that receive cycle training would have confidence to cycle
alongside traffic and cars."
Many of the participants felt that in areas where the greenways met with roads, such
as courtesy crossings, that more "...signage to make motorists aware approaching
those courtesy crossings" would prove a positive safety step.

53. 48
Anti-social behaviour
An area where safety concerns were expressed is in relation to teenagers and anti-
social behaviour on the greenway. One of the interviewee felt that "...kids partying,
drinking, cycling and having a bit of craic, which they might not cause any trouble,
but people tend to be intimidated." This area was revisited by other interviewees who
highlight that "definitely women wouldn’t feel safe going through a crowd of young
lads/people who are drinking shouting and roaring," with interviewees stating that the
police were called on occasion. Most interviewee stress there has never been any
trouble, but at the same time several interviewee would like to see a park ranger style
system with one participant stating the importance of "doing it now rather than
waiting for something to happen." A interviewee working in education thought it
important to highlight that teenagers always look for places for recreation and
mentioned that there was "...some drinking going on there at night but I don’t think the
Greenway is the cause of that."
The call for some sort of supervisory role was suggested by several interviewees, not
just in relation to anti-social behaviour, but in the case of rubbish also. Occasionally,
interviewees "...witnessing broken glass on the Greenway," which they pointed out to
be dangerous. A final stated safety concern discussed by interviewees is in relation to
dogs. "Dogs left off the leads, and faeces on the ground" are seen as a nuisance by
interviewees, but more worrying ,an interviewee explained that they "have been
attacked twice on the Greenway by a dog." These interviewees who use the greenway
regularly highlight the need for more stringent rules in relation to dogs and advocate
for a park ranger type position to be implemented.

54. 49
Health Inequalities
The Westport Smarter Travel urban greenway aimed to help in reversing health
inequalities as reported by interviewees although there is still several issues
highlighted that can to be addressed. Several older interviewees felt the greenway had
various benefits over using motorised transport "...the car can be very isolating as you
don't get to meet and say hello to anyone." In articulating a benefit to older people an
interviewee working in the tourism industry stated how hotels promote Smarter Travel
with the effect that "...lots of their more senior guests would tend to use the greenways
for recreation. There is plenty of room for manoeuvring and you can walk at your own
pace." Many of the participant felt that for over 65's "...access to it can be a bit of
problem" however interviewees universally stated that nothing could be done in
relation to this due to the geography of the town. One participant from a medical
prospective expressed the positive side of this, noting "...Westport is full of hills which
is good for their health."
In relation to the connectivity and accessibility of the greenways some interviewees
indicated that it is "...accessible from so many points in town, you can with 30
seconds link on to it" furthermore an interviewee shared that it provides "...shortcuts
to and from different communities and different establishments and different estates."
This proves not to be the case for some sections of the community. Concern was
expressed for those with limited mobility and wheelchair users who find aspects of
accessing the greenway difficult, with an interviewee addressing this issue "...the
greenway is sometimes nearly impossible with wheelchairs so we use the town. The
curves are too high." It is noted that although interviewees agree the greenway is fully
wheelchair accessible in reality there are difficulties. As stated earlier, geography
plays a large part. Two participants would like to see increased facilities for those with

55. 50
disabilities. "Para-cycles being made available for people with disabilities could
increase the usage for disadvantaged people." In a similar vein an interviewee
recounts how an individual with special needs had difficulty walking to his home one
kilometre away due to the heavy traffic in the town. With the introduction of the
greenway, of which a part links with the road to his house, he no longer has to
"...worry about crossing roads and it is a safe environment that is lit up and protects
his interests and empowers him to get home on his own." There was a strong feeling
that "getting someone with a disability involved with it at a planning stage" would be
useful in uncovering the impacts to this section of society in future developments as it
has the potential to make a tangible difference to those with disabilities.
Mental Health
"I talk to people that have mental illness and they tell me the one thing they love is
being able to walk/cycle and they love the fresh air and they love to get out." The
power of nature and the outdoors, encapsulated by the greenway, garnered
unanimously positive feedback from the stakeholders, especially when looking at the
topic of mental health. Those living within the town core professed the pleasure in
taking "...a little stroll and in less than a minute to feel that you are out in the
countryside in the green beauty of the surrounding area. And at the same time not
isolated and not feeling insecure or unsafe." The view of one interviewees working in
the area of health pointed to the greenway as a place for people to "...deal with their
anxieties and stresses by meeting other people, smelling the roses, looking at the
scenery " adding that "...they say exercise is better than tablets for anxiety which I
believe myself." Numerous responses again highlight the scenery and the positives
offered up by being in nature. An interviewees working within the setting of the

56. 51
greenway stated that "...from a mental [health] point of view and people suffering with
depression, they do speak about their depression and they love to go outside."
The terms of benefits to adults in helping deal with issues an interviewee recounted
that "...even domestically you might have problems to be addressed or decisions to be
made, your mental health is way better" from the time spend in the outdoors. In a
more generalized comment on the outdoors and health an interviewee narrated that it
"...keep us all healthy, active physically, active mentally, an absolute winner for
everyone."
As in many interviews most of those questioned view children as the main emphasis
for the potential of the greenway. This was summed up by an interviewee in relation
to the greenway and promoting the mental health of children "...it is going to create a
positive attitude in children because they are out using their bikes, walking and
running with their parents."
There were several responses in relation to mothers. Having an infrastructure to meet
with other mothers in a safe environment to talk and discuss issues relating to family
life in a "...stress free environment" was seen as positive. Another interviewee
emphasised that stress in relation to motherhood is "...a huge thing, the more you are
in the house the more you are not going doing something for yourself. Stress is the
main killer." This interviewee did finish by stating that in terms of the facility of the
greenway "...mentally we think it's fantastic."
EducationalOpportunities
Interviewees identified the greenways as having the potential to "...develop awareness
for nature and locality and where we are in our locality." Again the children of the
town are seen as the main beneficiaries of the greenway with an interviewee, who is a