Chief medical officer prescribes cycling

The Government’s chief medical adviser has recommended active travel – such as walking and cycling – as a way to help boost the nation’s health and reduce killer diseases such as cancer and heart disease. Dame Sally Davies said that the health benefits of cycling “far outweigh the risks” but urged councils to do more to make cycling safer. In April, local authorities will be put in charge of public health, via Public Health England, and there will be more scope for councils to invest in healthy travel rather than always catering for travel by private motor vehicles.

Dame Sally told The Times: “Cycling for all or part of your 150 minutes of physical activity each week can help to prevent or manage over 20 long-term conditions, including heart disease, stroke, type 2 diabetes, some cancers and mental health problems.” 

She added: “I think that investment in cycling to drive up physical activity might emerge as one of the ‘best buys’ in some areas.

“Cycling shorter journeys saves money, can help to address health inequalities and help protect our planet…However, we have to make sure that cycling is safe and is seen to be safe."

This intervention from the chief medical officer will be used in evidence in the parliamentary Get Britain Cycling inquiry. Another intervention from the medical community that could be used by the inquiry would be last year’s report from the British Medical Association. ‘Healthy transport = Healthy lives’ was released in July last year and covered by BikeBiz.com but the BMA buried the report, not sending out a general press release informing the mass media of one of the report’s key messages: curb car use. Cars kill, cars make us fat, said the BMA report. Reduce road space for cars, and give it to cyclists and pedestrians, urged the non-publicised report.

The BMA’s 103-page report called on the Government to curb car use, if it wants to improve the nation’s health. ‘Healthy transport = Healthy lives’ stressed the social and economic case for reducing car use, and getting more people to walk and cycle.

However, the BMA produced a similar report in 1997, and the recommendations – which were similar to the recommendations in the current report – were ignored by successive Governments. The BMA stressed that successive Governments have always put cars before people: "Much of UK policy to date can in part be attributed to the governmental focus on expanding the automotive industry, rather than prioritising the health of the nation."

The BMA recognises that reducing car use will not be easy but that making such reductions is vital and any delay will be detrimental to health:

"Decisions taken today concerning the UK transport infrastructure can determine how people travel for decades. Making the right decisions, and considering the impact on the health of the community they serve, is vital."

‘Healthy transport = Healthy lives’ brought together the latest evidence on the impact of transport policy on health. Its aim was to demonstrate to policy makers that integrating health into transport planning will have long-term health benefits for society.

The report was an update on the BMA’s 1997 publication ‘Road Transport and Health’. It highlights that while there has been little change to transport policy since the earlier report, the detrimental impacts on health continue.

Traffic in the last 60 years has steadily increased, and while car use has brought many social and economic benefits, it has also had negative impacts on health, says the BMA. These include the increased risk of road traffic accidents and greater exposure to air and noise pollution. The increased use of car use has also had the unintended result of far fewer people in the UK walking and cycling.

The health benefits of active forms of travel, such as walking and cycling, are well established, says the BMA. Yet the economy, rather than the health of the nation, is often prioritised when transport policies are developed, said the report.

Dr Vivienne Nathanson, Director of BMA Professional Activities, said:

“Economic considerations have been prioritised over health in transport and urban planning in the last two decades and this has led to increased car use and often expensive and inefficient public transport.

“The report urges the government to introduce transport policies in the UK that will encourage behavioural change so that people use their car less."

In a foreword to the report, Professor Averil Mansfield, Chairman of BMA’s Board of Science, said:

"Road Transport and Health [of 1997] highlighted the many ways in which transport affects health. There has been little change in transport policy since this publication. The number of car users continues to increase, numbers walking and cycling have stagnated, and changes to the built environment continue to prioritise the ability to travel, rather than the ability to reach destinations. All of which mean that the health of the nation continues to suffer.

"To date the approach to transport policy in the UK has in part been based on short-term objectives, even though the decisions taken can potentially last decades. Economic considerations have been prioritised over health. This is despite a substantial evidence-base demonstrating that making health a key objective in transport policy is cost effective, and will have short-, medium- and long-term benefits. It is vital that we have policies that encourage a modal shift away from unnecessary car use and the development of a transport environment that facilitates active and public transport journeys."

The lowlight of the report includes a recommendation that all cyclists should be forced to wear helmets but there are a great many highlights in the report.

REDUCE ROAD SPACE FOR MOTOR VEHICLES
"Transport policy should aim to reduce congestion and improve the usability of roads by pedestrians and cyclists through reallocation of road space, restricting motor vehicle access, road-user charging schemes, and traffic-calming and traffic management."

ELECTRIC CARS TAKE UP SAME SPACE AS NORMAL CARS
"Any efficiency savings in engine technologies should be accompanied by regulation that prioritises active and sustainable forms of transport, and planning decisions that prioritise accessibility over mobility, to ensure efficiency savings are not translated into a higher prevalence of car use."

BUILD IT AND THEY WILL COME
"While the focus on motorised mobility in the UK throughout the 21st century may have led to dramatic falls in cycling levels, if cycling infrastructure is well integrated into the built environment, there is demand and scope for cycling levels to increase."

TALK IS CHEAP
"Cycling promotion on its own, without improved facilities and infrastructure, has been less effective. Research conducted in the US in 2007, suggested that combining the use of educational and promotional activities by teachers to motivate parents to walk and cycle to school had no effect on increasing rates of cycling to school. This demonstrates that promotion of cycling alone is insufficient to increase uptake."

RETHINK ROAD PRIORITIES
"Healthcare organisations should work in partnership with local authorities to ensure local transport plans/infrastructure, and proposals for urban development and regeneration support physically active travel, including prioritising the needs of pedestrians and cyclists over motorists."

IT’S THE ECONOMY, STUPID
"Active forms of transport, such as cycling and walking, are highly cost effective forms of transport. To the individual, walking has few costs associated with it, while the costs associated with cycling are minimal compared to those of motorised transportation. Active travel contributes savings to healthcare budgets, in terms of savings on treating chronic illness. Transport-related physical inactivity in England is estimated to cost £9.8 billion per year to the economy. This figure is in addition to the £2.5 billion in healthcare costs spent annually on treating obesity.

"A 2007 Cycling England report that estimated the economic value of cycling, found that the health benefits could be valued at £87-300 per cyclist per year, depending on their age, fitness level, and neighbourhood. This did not account for the substantial social benefits of cycling, which include offering more independence to children, improving the quality of life for communities and, in some areas, supporting tourism.

"A 50 per cent increase [in cycling] could lead to health savings of £1.3 billion…All [international] studies reported highly significant economic benefits of walking and cycling interventions. The median result for all data identified was a benefit to cost ratio of 13:1 and for the UK, the figure was higher at 19:1."

GET PEOPLE OUT OF CARS TO INCREASE HEALTH FOR ALL
"Reducing the negative impact of transport on health will necessitate a shift in societal norms, to one where travelling by car is not always seen as the most effective means of travel. The focus should be on developing an environment where travelling actively or by public transport is as efficient and effective as travelling by car. This will provide a range of co-benefits to the health of the nation, in terms of reductions in road traffic crashes and health-related harms from emissions. It will also contribute to mitigating the impact of climate change."

POLITICIANS: GROW SOME BALLS
"Achieving [a] shift in UK transport policy requires strong governmental commitment and leadership as the benefit to health will not always be instant. Given transport decisions have the potential to last decades, it is essential the right decisions are made, and health improvement should always be recognised as a pivotal component in transport strategies and programmes."

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Dr Nathanson said:

"Depressingly, many of our long-sighted recommendations in 1997 have had little impact in forcing politicians to take the action needed to put health at the heart of transport planning.

"Communities are still fragmented by busy roads, reducing the likelihood of children walking to school, and making it difficult for more of us to use active transport — such as walking or cycling — for our short journeys. High traffic density makes active transport unappealing and, especially in the case of pedestrians, dangerous. Parents wanting the best for their children drive them to school, when walking or cycling would have positive health benefits, as well as making a tiny but cumulatively important contribution to reducing greenhouse gas emissions.

"Noise pollution from traffic plays an increasing role. Visitors to British cities often comment on road noise, and its impact on their ability to sleep; we tolerate it, often unaware of the health consequences.

"We understand more about the positive health impact of walking and cycling, of engineering road conditions to make those easier and safer, and to encourage community building.

"We seek to make an impact in the critical area of getting policy makers at national and local government to understand the importance of active transport, and to influence transport policy to support improvements that give us all the opportunity to walk and cycle in far more safety and comfort.

"The report is not anti-car; we explicitly recognise that for many journeys they remain the only feasible option. What we want, what we believe society has a right to expect, is that we will be offered more realistic options for all transport modes."

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Pic by Pete Drew.