Rail as a force for health equity: how industries can use systems thinking to create health

Abstract Issue Health inequity is causing avoidable poor health in many countries. For GB rail, it means low investment, low passenger numbers and high sickness absence. Changing this situation requires a new approach and action by industry. Description In 2023 the UK had more sickness and avoidable mortality than all other G7 countries aside the USA. In GB rail, sickness absence is twice the national average: we are recruiting sick people, and their work is making them sicker. The causes of sickness are complex and societal, so our disjointed and superficial health initiatives are ineffective, despite costing millions. The Rail Safety and Standards Board (RSSB) has developed a health equity strategy which uses systems thinking and a health equity framework to provide a new perspective on the role rail plays in UK health. Results We produced a health equity strategy for rail which highlights nine areas where rail can take action to influence the health of staff, customers and the communities. These are based on work by the UCL Institute of Health Equity, which published a review in 2022 outlining the role businesses need to play in improving equity in the UK. We found rail was already doing work in many of these spaces, but with small returns on investment. We will now work with industry to map the rail health landscape as a system. This will allow us to identify gaps, obstacles and synergies between different projects, so that meaningful, lasting improvements can be made. Lessons Across the rail industry, many health and equity projects are underway, but disconnects between them mean that rail continues to experience a high level of sickness absence, and communities near rail do not always benefit from such activities. We present a new, unifying, systems-based, equity focussed approach to planning such projects. This approach could be adopted by other industries within the UK and across Europe to help inform health, equity, and social value decisions. Key messages • The health problems that impact UK rail are too complex and deep-rooted for individuals to solve. They need coordinated action by industry, government, individuals and communities. • Systems thinking is critical to making impactful health investments.