Increasing walking and cycling

1. Increasing walking and cycling A briefing for Local Authority Directors of Public Health

2. Key messages: • Physical inactivity is a major public health issue • Walking and cycling for transport are the most appropriate physical activity options • Cycling and walking are safe • More cycling and walking achieves multiple public health objectives within the public health outcomes framework • More cycling and walking reduces health inequalities • We know what interventions are effective and cost-effective

3. Physical activity: a global health priority Source: WHO (2009). Global health Risks. Mortality and burden of disease attributable to selected major risk. Geneva. WHO

4. Inactivity: a major UK public health issue • Around 6/10 men and 7/10 women not active enough (from self report) • Accelerometer data shows this may be more like 9/10 • Impact on over 20 conditions including obesity; CVD; some cancers; diabetes Source: Health Survey for England 2008

5. Walking and cycling for transport are the most appropriate physical activity options • Sport: <10% participate regularly • Work: few active occupations exist • Leisure: infrequent participation in leisure pursuits • Active travel offers the potential for daily physical activity of sufficient frequency and intensity • Encouraging most inactive to walk has the greatest potential for health gain (see panel)

6. Walking and cycling are safe • Safety is improving • In 2006, the fatality rate for pedestrians was 54% lower than the 1980 level • for pedal cyclists it was 46% lower (DfT 2008) • The real risks are low • one death per 33 million km cycled (CE 2007) • More cycling and walking increases safety • Evidence of ‘safety in numbers’(Jacobsen 2003, Robinson 2005) • The benefits outweigh the risks • Multiple studies show physical activity benefits outweigh the risks by at least 10 to one • The real risk is being sedentary (see next slide)

7. The risk of physical inactivity compared to road casualties Source: * **DfT Road Traffic Casualties 2009 *** BHF statistics 2010 edition; McPherson et al 2002.

8. More cycling and walking achieves multiple public health objectives • Achieves physical activity objectives in the public health outcomes framework • Reduces obesity • Reduces road traffic casualties • Improves local air quality • Reduces CO2 emissions • Increases social interaction and builds social capital

9. More cycling and walking reduces health inequalities • Sport and active leisure have costs to the user • Walking is free; cycling is cheap • Improving the environment for walking and cycling reaches people from all socio-economic groups • ‘Shifting the curve’: increasing the average levels of activity across society

10. We know what interventions are effective and cost-effective • NICE guidance on environment and physical activity (NICE, 2008) • NICE guidance on walking and cycling (NICE 2012) • Cochrane reviews of physical activity (Baker et al 2011) • BMJ reviews on walking and cycling (Ogilvie et al 2007, Yang et al 2010) • Lancet series on physical activity (Woodcock et al 2007)

11. Ideas for action • Take a town/city-wide approach to creating environments for walking and cycling. • Implements NICE guidance on walking and cycling/physical activity • Work with the local authority transport planners to ensure cycling and walking are central to the local transport plan • Ensure physical activity is part of the joint strategic needs assessment (JSNA) • Influence local planning decisions in favour of active environments • Encourage staff to use the WHO HEAT tool. WHO provide free online training

12. Example • In Hereford, the Public Health team initiated ‘learning sets’ on walking and cycling, engaging the transport team • This coincided with funding for sustainable transport initiatives from the DfT’s Local Sustainable Transport Fund • The new Local Transport Plan now has a significantly enhanced focus on active travel

13. Example: • Across a town of 150,000 people, if everyone walked an extra 10 minutes a day, the HEAT model estimates: • 31 lives saved • Current value of £30m per year

15. References • Cycling Embassy of Great Britain. 2012. Dutch Cycle Infrastructure. http://www.cycling-embassy.org.uk/wiki/dutch-cycle-infrastructure • Cycling England 2007. Cycling and Health: what’s the evidence? http://www.ecf.com/wp-content/uploads/2011/10/Cycling-and-health-Whats-the-evidence.pdf • De Hartog et al. 2011. Travel-time air pollution exposure, energy expenditure and health outcomes: use of new technologies. Epidemiology. 22:1 ppS76-S77 • Department for Transport. Road Casualties in Great Britain - Main Results 2007. London: Transport Statistics, 2008. • DfT 2007. Manual for Streets. London. Dept for Transport https://www.gov.uk/government/publications/manual-for-streets • DfT 2010 (b). Cycling Demonstration Towns. Development of Cost benefit ratios. • DfT 2010 (c). National Travel Survey. https://www.gov.uk/government/statistical-data-sets/nts06-age-gender-and-modal-breakdown • DfT 2010a. How People Travel. National Travel Survey 2010. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/8934/nts2010-03.pdf • Hansard 2007. Daily Hansard Written Answers. 29 March 2007. Column 169tW. http://www.publications.parliament.uk/pa/cm200607/cmhansrd/cm070329/text/70329w0010.htm • Jacobsen, P. (2003). Safety in numbers: more walkers and bicyclists, safer walking and bicycling, Injury Prevention, 9, pp.205-209 • Living Streets. Making the Case for investment in the walking environment. 2012 • Manton R, Clifford E. (2011) Cycling Ireland to work . http://www.etcproceedings.org/paper/cycling-ireland-to-work-sustainable-job-creation-in-the-tourism-sector-through • NICE 2008 Physical activity and the environment. http://publications.nice.org.uk/physical-activity-and-the-environment-ph8 • NICE 2012 Walking and cycling local government briefing - http://publications.nice.org.uk/walking-and-cycling-phb8 and the walking and cycling pathway http://pathways.nice.org.uk/pathways/walking-and-cycling • NICE 2012. Walking and cycling guidance. http://publications.nice.org.uk/walking-and-cycling-local-measures-to-promote-walking-and-cycling-as-forms-of-travel-or-recreation-ph41 • NICE 2012. walking and cycling pathway http://pathways.nice.org.uk/pathways/walking-and-cycling • Ogilvie D, Foster CE, Rothnie H, Cavill N, Hamilton V, Fitzsimons CF, et al. Interventions to promote walking: systematic review. BMJ 2007;334(7605):1204 • ONS 2007. ONS Omnibus Survey (Oct/Nov 2007) cited in DfT (2008) Public Attitudes To Congestion and Road Pricing. London. Dept for Transport • Rabl A, de Nazelle A. Benefits of shift from car to active transport. Transport Policy. 19 (2012) 121-131. • Robinson DL. 2005. Safety in Numbers in Australia. Health Promot J Austr. 2005 Apr;16(1):47-51. • Rojas-Rueda D, de Nazelle A, Tainio M, Nieuwenhuijsen MJ. The health risks and benefits of cycling in urban environments compared with car use: health impact assessment study. BMJ. 2011 Aug 4;343:d4521. • Sustrans 2013. http://www.sustrans.org.uk/resources/in-the-news/investment-in-smarter-travel-means-better-health-for-all • Sustrans 2013. http://www.sustrans.org.uk/resources/in-the-news/sweet-16-but-sustrans-has-no-intention-of-leaving-school • Tolley 2011. Good for business. The benefits of making streets more walking and cycling friendly. Heart Foundation. 2011. • WHO 2010. World Health Organization Regional Office for Europe. The Health Economic Assessment Tool (HEAT) for walking and cycling. www.heatwalkingcycling.org • Woodcock J, Banister D, Edwards P, Prentice AM, Roberts I. Energy and Health 3; Energy and Transport. The Lancet. 2007 Sep 22; 370(9592): 1078-88 • Yang L, Sahlqvist S, McMinn A, Griffin SJ, Ogilvie D. Interventions to promote cycling: systematic review. BMJ 2010;341:c5293. Further Reading • Cycling and Health. What’s the evidence? Cycling England 2007. http://www.ecf.com/wp-content/uploads/2011/10/Cycling-and-health-Whats-the-evidence.pdf • CfIT Sustainable Transport Choices and the Retail Sector (2006) http://webarchive.nationalarchives.gov.uk/20110304132839/http://cfit.independent.gov.uk/pubs/2006/stc/technical/pdf/stc-technical01.pdf • Take Action on Active Travel. Why a shift from car-dominated policy would benefit public health. Sustrans. 2010 • Living Streets. Making the Case for investment in the walking environment. 2012 • Other excellent information and help is available from organisations such as British Cycling, CTC, Living Streets, Ramblers, Sustrans, and others.

16. Acknowledgements • The slide sets were researched and written by Dr Nick Cavill, an independent public health consultant • Drafting was overseen by an ‘Active Travel and Health group’, which was a sub-group of the Cycling Forum. Members were: • Beelin Baxter, Department of Health • Tony Armstrong, Living Streets • Simon Barnett, Living Streets • Jackie Brennan, British Cycling • Hugo Crombie, National Institute for Health and Care Excellence • Phillp Darnton, Bicycle Association • Adrian Davis, Independent consultant • Des de Moor, Ramblers • Stephanie Dunkley, Leicester City NHS • Julia Ellis, Association of Directors of Public Health • Roger Geffen, CTC • Alison Hill, South East Public Health Observatory • Phillipa Hunt, Living Streets • Philip Insall, Sustrans • Patrick Lavery, Department for Transport • Carlton Reid, BikeBiz • Lynn Sloman, Transport for Quality of Life • Paul Stonebrook, Department of Health • Shane Snow, Department for Transport •  This presentation is part of a set of three, aimed at different target audiences in local authorities: • Directors of Public Health • Directors of Transport • Elected members • Two alternate versions of the presentation are available • Without logos, for you to customise • Without photos, on plain backgrounds • Contact nick@cavill.net for details. Draft 01 May 2013