Healthy and Sustainable

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Healthy and sustainable: why walking and cycling are central to public health policy Philip Insall Director, 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 , 6 0 0 2 n i e l p * o n e o p i t 0 a 0 s i 0 , n 0 a 5 g 1 r d O lle th i l k a e e H g n d l a r h o c W e t e a Clim ing to th d r o c ac *www.who.int/globalchange/climate

Polluted urban air EU urban population exposed to air pollution above EC limits, %, 1999

100 80 60 40 20 0

ozone

nitrogen oxides

Source: European Environment Agency

PM10 particulates

Road casualties Europe, 2005: 41,000 dead 1.9 million injured

The roads ARE dangerous

Inactive lifestyles • obesity • cardio-vascular disease • type II diabetes • many cancers • mental ill-health…. • cost over €15 billion in UK alone

Physical inactivity is a big problem “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)

A worldwide epidemic of obesity

We eat too much, and choose unhealthy foods

We are not active enough, including in our travel choices

Who leads the world in obesity? Who do you think?

‌.. the following slides are courtesy of the Centers for Disease Control and Prevention, USA‌..

Obesity Trends Among U.S. Adults 1985

No Data

<10%

10%–14%

Source: Behavioral Risk Factor Surveillance System, CDC

Obesity Trends Among U.S. Adults 1986

No Data

<10%

10%–14%

Source: Behavioral Risk Factor Surveillance System, CDC

Obesity Trends Among U.S. Adults 1987

No Data

<10%

10%–14%

Source: Behavioral Risk Factor Surveillance System, CDC

Obesity Trends Among U.S. Adults 1988

No Data

<10%

10%–14%

Source: Behavioral Risk Factor Surveillance System, CDC

Obesity Trends Among U.S. Adults 1989

No Data

<10%

10%–14%

Source: Behavioral Risk Factor Surveillance System, CDC

Obesity Trends Among U.S. Adults 1990

No Data

<10%

10%–14%

Source: Behavioral Risk Factor Surveillance System, CDC

Obesity Trends Among U.S. Adults 1991

No Data

<10%

10%–14%

15%–19%

Source: Behavioral Risk Factor Surveillance System, CDC

Obesity Trends Among U.S. Adults 1992

No Data

<10%

10%–14%

15%–19%

Source: Behavioral Risk Factor Surveillance System, CDC

Obesity Trends Among U.S. Adults 1993

No Data

<10%

10%–14%

15%–19%

Source: Behavioral Risk Factor Surveillance System, CDC

Obesity Trends Among U.S. Adults 1994

No Data

<10%

10%–14%

15%–19%

Source: Behavioral Risk Factor Surveillance System, CDC

Obesity Trends Among U.S. Adults 1995

No Data

<10%

10%–14%

15%–19%

Source: Behavioral Risk Factor Surveillance System, CDC

Obesity Trends Among U.S. Adults 1996

No Data

<10%

10%–14%

15%–19%

Source: Behavioral Risk Factor Surveillance System, CDC

Obesity Trends Among U.S. Adults 1997

No Data

<10%

10%–14%

15%–19%

Source: Behavioral Risk Factor Surveillance System, CDC

20%-24%

Obesity Trends Among U.S. Adults 1998

No Data

<10%

10%–14%

15%–19%

Source: Behavioral Risk Factor Surveillance System, CDC

20%-24%

Obesity Trends Among U.S. Adults 1999

No Data

<10%

10%–14%

15%–19%

Source: Behavioral Risk Factor Surveillance System, CDC

20%-24%

Obesity Trends Among U.S. Adults 2000

No Data

<10%

10%–14%

15%–19%

Source: Behavioral Risk Factor Surveillance System, CDC

20%-24%

Obesity Trends Among U.S. Adults 2001

No Data

<10%

10%–14%

15%–19%

Source: Behavioral Risk Factor Surveillance System, CDC

20%-24%

≥25%

Obesity Trends Among U.S. Adults 2002 (*BMI ≥30, or ~ 30 lbs overweight for 5’4” person)

No Data

<10%

10%–14%

15%–19%

Source: Behavioral Risk Factor Surveillance System, CDC

20%-24%

≥25%

Obesity Trends Among U.S. Adults 2003

No Data

<10%

10%–14%

15%–19%

Source: Behavioral Risk Factor Surveillance System, CDC

20%-24%

≥25%

Predicted UK growth in obesityrelated disease by 2030 From “Our health, our care, our say� white paper 60%

+54%

50% 40% +28%

30% +18%

20% 10%

+12% +5%

0% Stroke

Angina

Heart Attack

Hypertension

Source: Living in Britain 2004: Results from the 2002 General Household Survey; National Food Survey 2000 Table B1

Type 2 diabetes

The UK obesity epidemic‌.. ‌.. is explained by <1.5 kg per annum weight gain

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….. ….. fell 110km over 20 years…..

….. equivalent to 1kg of fat gain, per annum 600 500 400 300 200 100

Walk miles

0 1975/6

1989/91

1995/7

Source: Fox / Hillsdon presentation to UK government Foresight policy development programme on obesity

Car miles x 10

We have made our environments “obesogenic�

Prevalence of overweight children (IOTF 2002)

15% 18% 11%

Sweden

Germany

UK

10%

Levels of cycling (DfT 1996)

Switzerland

15%

22%

2%

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 transport and healthy living “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

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 Daily mobility

On average, people make three trips per day, spending one hour travelling

Activities

Only one in five trips is work-related

Spatial orientation

Five out of six trips begin or end at home

Car trips

10% are not further than 1km, 30% are not further than 3km and 50% are not further than 5km

Potential for change What scale of travel behaviour change is possible?

Potential for sustainable travel modes % trips per person: Sustainable Travel Demonstration Towns Circumstances enforce car use

Actual usage (walking, bicycle, public transport)

9 35

Potential for sustainable travel modes % trips per person: Sustainable Travel Demonstration Towns Circumstances enforce car use

Actual usage (walking, bicycle, public transport)

9

No adequate alternative

35 27

Potential for sustainable travel modes % trips per person: Sustainable Travel Demonstration Towns Circumstances enforce car use

Actual usage (walking, bicycle, public transport)

9

No adequate alternative

35 27 29

Only subjective reasons against STM

Potential for sustainable travel modes without significant environmental modification

Environmental factors “enforce� private motorised modes

36 64 Immediate potential for walking, cycling & public transport

Potential for sustainable travel modes with environmental intervention

Motorised private modes

25

i t s i l a e d “I

t s i l a e r n u , c

d a r ic, 75

” . . … l a c i Walking, cycling & public transport

Idealistic, unrealistic, radical?

Mode choice in Basel, Switzerland % trips per person

Motorised private modes

25 75

Walking, cycling & public transport

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

Keep motor traffic out

Wien, Austria

Design for healthy, sustainable travel

Nordrhein-Westfalen, Germany

• 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

Significant, incremental, long-term London Congestion Charge

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

Composition of the Network

Quiet rural roads and lanes

Composition of the Network

Traffic-free greenways (30% of total)

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 Network 5,000 miles (8,000km) open in 2000

National Cycle Network 10,000 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

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