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Healthy and sustainable: why walking and cycling are central to public health policy
Philip InsallDirector, Active Travel, Sustrans
Transport policy has damaged public health
• climate change emissions
• local air pollution• obesity epidemic• road danger• difficulties of access• quality of life
Global climate change
Climate change is also a public health issue
Climate change killed 150,000 people in 2006,
according to the World Health Organisation*
*www.who.int/globalchange/climate
Source: European Environment Agency
ozone nitrogen oxides PM10 particulates
EU urban population exposed to air pollution above EC limits, %, 1999
Polluted urban air
Europe, 2005:
41,000 dead
1.9 million injured
The roads ARE dangerous
Road casualties
Inactive lifestyles• obesity• cardio-vascular
disease• type II diabetes• many cancers• mental ill-health….• cost over €15 billion
in UK alone
“Besides the human costs of inactivity in terms of mortality, morbidity and quality of life, the report highlighted an estimate for the cost of inactivity in England to be £8.2 billion annually. This excludes the contribution of physical inactivity to overweight and obesity, whose overall cost might run to £6.6 - £7.4 billion per year according to recent estimates.”
Choosing Activity: a physical activity action plan (DH, 2005)
Physical inactivity is a big problem
We eat too much, and choose unhealthy foods
We are not active enough, including in our travel choices
A worldwide epidemic of obesity
Who do you think?
Who leads the world in obesity?
….. the following slides are courtesy of the Centers for Disease Control and Prevention, USA…..
Obesity Trends Among U.S. Adults1985
Source: Behavioral Risk Factor Surveillance System, CDC
No Data <10% 10%–14%
Obesity Trends Among U.S. Adults1986
Source: Behavioral Risk Factor Surveillance System, CDC
No Data <10% 10%–14%
Obesity Trends Among U.S. Adults1987
Source: Behavioral Risk Factor Surveillance System, CDC
No Data <10% 10%–14%
Obesity Trends Among U.S. Adults1988
Source: Behavioral Risk Factor Surveillance System, CDC
No Data <10% 10%–14%
Obesity Trends Among U.S. Adults1989
Source: Behavioral Risk Factor Surveillance System, CDC
No Data <10% 10%–14%
Obesity Trends Among U.S. Adults1990
Source: Behavioral Risk Factor Surveillance System, CDC
No Data <10% 10%–14%
Obesity Trends Among U.S. Adults1991
Source: Behavioral Risk Factor Surveillance System, CDC
No Data <10% 10%–14% 15%–19%
Obesity Trends Among U.S. Adults1992
Source: Behavioral Risk Factor Surveillance System, CDC
No Data <10% 10%–14% 15%–19%
Obesity Trends Among U.S. Adults1993
Source: Behavioral Risk Factor Surveillance System, CDC
No Data <10% 10%–14% 15%–19%
Obesity Trends Among U.S. Adults1994
Source: Behavioral Risk Factor Surveillance System, CDC
No Data <10% 10%–14% 15%–19%
Obesity Trends Among U.S. Adults1995
Source: Behavioral Risk Factor Surveillance System, CDC
No Data <10% 10%–14% 15%–19%
Obesity Trends Among U.S. Adults1996
Source: Behavioral Risk Factor Surveillance System, CDC
No Data <10% 10%–14% 15%–19%
Obesity Trends Among U.S. Adults1997
Source: Behavioral Risk Factor Surveillance System, CDC
No Data <10% 10%–14% 15%–19% 20%-24%
Obesity Trends Among U.S. Adults1998
Source: Behavioral Risk Factor Surveillance System, CDC
No Data <10% 10%–14% 15%–19% 20%-24%
Obesity Trends Among U.S. Adults1999
Source: Behavioral Risk Factor Surveillance System, CDC
No Data <10% 10%–14% 15%–19% 20%-24%
Source: Behavioral Risk Factor Surveillance System, CDC
No Data <10% 10%–14% 15%–19% 20%-24%
Obesity Trends Among U.S. Adults2000
Source: Behavioral Risk Factor Surveillance System, CDC
No Data <10% 10%–14% 15%–19% 20%-24% 25%
Obesity Trends Among U.S. Adults2001
(*BMI 30, or ~ 30 lbs overweight for 5’4” person)
Source: Behavioral Risk Factor Surveillance System, CDC
No Data <10% 10%–14% 15%–19% 20%-24% 25%
Obesity Trends Among U.S. Adults2002
Source: Behavioral Risk Factor Surveillance System, CDC
No Data <10% 10%–14% 15%–19% 20%-24% 25%
Obesity Trends Among U.S. Adults2003
Predicted UK growth in obesity-related disease by 2030From “Our health, our care, our say” white paper
0%
10%
20%
30%
40%
50%
60%
Stroke Angina Heart Attack Hypertension Type 2 diabetes
+5%
+12%
+18%
+28%
+54%
Source: Living in Britain 2004: Results from the 2002 General Household Survey; National Food Survey 2000 Table B1
Source: Fox / Hillsdon presentation to UK government Foresight policy development programme on obesity
The UK obesity epidemic…..….. is explained by <1.5 kg per annum weight gain
Distance walked per person per annum…..
Source: Fox / Hillsdon presentation to UK government Foresight policy development programme on obesity
0
100
200
300
400
500
600
1975/6 1989/91 1995/7
Walk miles
Car miles x 10
The UK obesity epidemic…..….. is explained by <1.5 kg per annum weight gain
….. equivalent to 1kg of fat gain, per annum….. fell 110km over 20 years…..
We have made our environments “obesogenic”
Levels of cycling (DfT 1996)
UK
Sw
eden
Ger
man
y
Sw
itzer
land
2%
10% 11%
15%
Prevalence of overweight children (IOTF 2002)
22%
18%15% 16%
Environments condition behaviour
Modification of social, economic, and environmental
factors may yield greater health dividends than individual lifestyle approaches. Indeed such interventions may be necessary before individual lifestyle approaches can be effective.
Lawlor et al, Journal of Epidemiology and Community Health
A cross-sector issue
With cross-sector solutions
Transport policy can now contribute to healthy, low-carbon lifestyles
Restrain private motor traffic
“we recommend that the government develops and strengthens requirements for Local Transport Plans, such that by the end of 2008 they can include statutory targets for reduction in urban traffic”
Royal Commission on Environmental Pollution Report on the Urban Environment, 2007
Changes people can really make
“For most people, the easiest and most acceptable forms of physical activity are those that can be incorporated into everyday life. Examples include walking or cycling instead of travelling by car…..
At least five a week; the Chief Medical Officer’s report on physical activity, 2004
“Urban planners .…. need to integrate health and active living considerations fully into their work… … transport officials can provide a balanced transport system that enables residents to walk or cycle to shops, school and work.”
Promoting physical activity and active living in urban environments, World Health Organisation, 2006
Urban transport and healthy living
Mobility….. or accessibility?
Mobility….. or accessibility?
• Transport policy has prioritised mobility : the ability to travel – sometimes long distances
Mobility….. or accessibility?
• Accessibility : access to the goods and services people need
• the ideal is maximum accessibility with minimum mobility
Potential for change
Analysis of travel behaviour shows very significant potential for change to more active modes
Constants in travel behaviour
Five out of six trips begin or end at homeSpatial orientation
Only one in five trips is work-relatedActivities
10% are not further than 1km, 30% are not further than 3km and 50% are not further than 5km
Car trips
On average, people make three trips per day, spending one hour travelling
Daily mobility
Potential for change
What scale of travel behaviour change is possible?
Potential for sustainable travel modes% trips per person: Sustainable Travel Demonstration Towns
35
9
Circumstances enforce car use
Actual usage (walking, bicycle, public transport)
9
2735
No adequate alternative
Actual usage (walking, bicycle, public transport)
Potential for sustainable travel modes% trips per person: Sustainable Travel Demonstration Towns
Circumstances enforce car use
35
29
27
9No adequate alternative
Actual usage (walking, bicycle, public transport)
Only subjective reasons against STM
Potential for sustainable travel modes% trips per person: Sustainable Travel Demonstration Towns
Circumstances enforce car use
Immediate potential for walking, cycling & public transport
Environmental factors “enforce” private motorised
modes
Potential for sustainable travel modeswithout significant environmental modification
64
36
Potential for sustainable travel modeswith environmental intervention
75
25
Walking, cycling & public transport
Motorised private modes
“Idealistic, unrealistic
, radical…..”
Idealistic, unrealistic, radical?
Mode choice in Basel, Switzerland% trips per person
75
25
Walking, cycling & public transport
Motorised private modes
Examples of intervention
What should we do to make urban transport systems better?
Re-allocate road space
Take space from motor traffic and return it to walking and cycling
Bristol, UK
Wien, Austria
Keep motor traffic out
Nordrhein-Westfalen, Germany
Design for healthy, sustainable travel
• Target: cycling up from 12 to 25% of urban trips• Investment: €1.4 billion, 1978 - 2006• Some cities now achieve 35% of trips by bike
London Congestion Charge
Significant, incremental, long-term
Show leadership
Case study: Odense
Odense – Denmark’s “cycling city”• 185,000 citizens (typical Scandinavian city)
• multi-year programme – main intervention 1999 – 2002
• central government funding at €11 per capita per annum
• main focus on cycling
• very wide range of measures
• physical measures – bus and cycle priority
• promotion and marketing – many initiatives
• monitoring
Odense – results (1999 – 2002)• cycling up 20%, still growing
• car traffic down 15%
• shift to shorter local journeys
• increase in walking
• public transport travel fell too
• improved road safety
• raised physical activity levels
• significant reduction in cost of ill-health
• Odense continues to innovate…..
Case study: National Cycle Network
Composition of the Network
Traffic-calmed urban roads
Quiet rural roads and lanes
Composition of the Network
Traffic-free greenways (30% of total)
Composition of the Network
Designed for multiple trip purposes
leisure and recreation…
…shopping and personal business...
…commuting to work...
…school travel
… attractive traffic-free routes...
…without gaps or obstacles...
…with iconic, memorable structures...
Art and the travelling landscape
Development of the Network
National Cycle Network 1995: plans for 2,500 miles (4,000km)
National Cycle Network5,000 miles (8,000km) open in 2000
National Cycle Network10,000 miles (16,000km) in 2005
….. and construction continues…..
The National Cycle Network: changing people’s travel behaviour
• 338 million active trips in 2006• 50:50 walking and cycling• 91 million replaced a car trip• 78% “more active thanks to the
Network”• focused on deprived
neighbourhoods• used for all trip purposes
Walking and cycling investment is excellent value for money
cost : benefit analysis of three UK construction projects
• average benefit : cost ratio 20:1
• motor transport projects, ratio 3:1
• many road transport projects have negative value