Transport and Health in London: Trends, evidence and trend breaches

1. Transport and Health in London: Trends, evidence and trend breaches 19th May 2009 Dr Adrian Davis Transport and Health Consultant JMP Consultants

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3. Sample text page On current trends 60% of adults will be obese by 2050

4. Our current trajectory for 2050 What would 60% of the London adult population being obese mean for the functioning of the City’s transport system? What role would cycling fulfil?

5. Drivers of weight gain: subtle and chronic “Low levels of physical activity prevalent in Britain must play an important, perhaps dominant, role in the development of obesity by greatly reducing energy needs from food.” Prentice, A., and Jebb, S., (1995) Obesity in Britain: gluttony or sloth, BMJ, 311: 437-439 A) “Total energy intake actually fell by approximately 20% between 1974 and 2004” B) “Total energy intake rose by approximately 20% between 1974 and 2004” C) “Total energy intake rose approximately 46% between 1974 and 2004” Information Centre (2006) Statistics on obesity, physical activity and diet: England 2006

6. Energy expenditure recommendations for health and weight management Chief Medical Officer: minimum of 5 x 30 minutes of moderate physical activity is required per week for population health 65% of adults do not achieve this “It is likely that for many people, 45-60 minutes of moderate intensity physical activity a day is necessary to prevent obesity.” DH, 2004 At Least Five a Week.

7. The best ‘buy’ but most undervalued Physical activity is the best buy in public health1 Physical activity must be one of the most undervalued interventions to improve public health2 …Major communication challenge 1. Morris J., 1994 The role of exercise in the prevention of coronary heart disease: today’s best buy in public health. Medicine Science Sports Exercise, 26:807–13. 2. Donaldson, L. 2000 Sport and exercise: the public health challenge, British Journal of Sports Medicine, 24: 409-410.

8. Routine physical activity • “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 driving…” • DH, 2004 At Least Five a Week. • Chief Medical Officer

9. Car ownership/landuse physical activity relationship • Rising car ownership accompanied by changing land-use patterns to accommodate increased car use… are closely inter-related. Between them they have a profound effect on physical activity levels. Frank, L., Andersen, M., Schmid, T. (2004) Obesity relationships with community design, physical activity, and time spent in cars, American Journal of Preventive Medicine, 27(2): 87-96.

10. The Evidence Base • Countries with highest levels of active travel generally have the lowest obesity rates 1 • Mixed use developments, high density, good connectivity for walking and cycling significantly affects body weight and reduce risk of weight gain 2 • Time spent in cars is positively associated with obesity 3 • Purchase of motor vehicles to travel to work has been reported as doubling the likelihood of becoming overweight, in comparison to those that make no change in their travel mode 4 • Significant association with commuting to work by car and overweight or obesity compared with active travel modes and use of public transport 5 1 Bassett, D., Pucher, J., Buehler, R., Thompson, D., Crouter, S. 2008 Walking, cycling, and obesity rates in Europe, North America and Australia, Journal of Physical Activity and Health, 5: 795-814. 2 Frank, L., Andresen, M., Schmid, T. 2004 Obesity relationships with community design, physical activity, and time spent in cars, American Journal of Preventive Medicine, 27(2): 87-96. 3 Ibid. 4 Bell, C., Ge, K., Popkin, B. 2002 The road to obesity or the path to prevention: Motorised transportation and obesity in China, Obesity Research, 10(4): 277-283. 5 Wen, L., Orr, N., Millett, C., Rissel, C. 2006 Driving to work and overweight and obesity: findings from the 2003 New South Wales Health Survey, Australia, International Journal of Obesity, 30(5): 782-786.

11. Out on the streets… • The car - it’s not very responsible though. People are just lazy pigs these days, I include myself in this category. I’ve got loads of pals who have increased in weight two fold when they passed their driving test. • That’s part of the reason why I don’t want to learn to drive because I’ve seen the weight that my husband has put on. • (I cycle) because of the exercise really. With the moped I was starting to put on weight. It’s just best to keep that off before it gets a good hold of you really. Keeping in shape is important to me. Not so much fit, just so long as I don’t look bad. • If I was to become a bit overweight, wanted to lose weight then that’s obviously what I would do (start walking or cycling), I wouldn’t just starve myself, I carry on doing what I was doing and then burn more on top of it, but at the moment I’m lucky enough not to need it.

12. Intersectoral collaboration for health gain • Health is largely‘won’ and ‘lost’ outside of the health sector • Transport is substantially implicated in making us an unhealthy nation • Close working with public health should be the rule – not the exception • Joint appointments of DPHs with local authorities provide major opportunities • Public health secondments into transport planning • Making NICE Guidance ‘stick’

13. Thank you