The document discusses how transport policy has negatively impacted public health by contributing to issues like climate change, air pollution, obesity, and road danger. It notes that global climate change poses significant health risks and that many countries, especially the US, are experiencing obesity epidemics due to inactive lifestyles. The document argues that environments can be made more "obesogenic" and that physical activity should be incorporated into everyday activities like walking and cycling instead of driving. It provides examples from places like the UK, Switzerland, Germany, and Denmark that have successfully increased active transport through measures like reallocating road space, building bike infrastructure networks, and restricting car traffic.

2. Healthy and sustainable: why
walking and cycling are central
to public health policy
Philip Insall
Director, Active Travel, Sustrans

3. Transport policy has damaged public
health
• climate change
emissions
• local air pollution
• obesity epidemic
• road danger
• difficulties of access
• quality of life

4. Global climate change
Climate change is also a public
health issue
006,
e in 2 n*
eopl atio
000 p rganis
150, h O
killed Healt
h ange World
ate c to the
Clim ing
d
a ccor
*www.who.int/globalchange/climate

5. Polluted urban air
EU urban population
exposed to air pollution
above EC limits, %, 1999
ozone nitrogen oxides PM10 particulates
Source: European Environment
Agency

6. Road casualties
Europe, 2005:
41,000 dead
1.9 million injured
The roads ARE
dangerous

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

8. 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)

9. A worldwide epidemic of obesity
We eat too We are not
much, and active
choose enough,
unhealthy including in
foods our travel
choices

10. Who leads the world in obesity?
Who do you think?
….. the following slides are courtesy of the
Centers for Disease Control and Prevention,
USA…..

11. Obesity Trends Among U.S. Adults
1985
No Data <10% 10%–14%
Source: Behavioral Risk Factor Surveillance System, CDC

12. Obesity Trends Among U.S. Adults
1986
No Data <10% 10%–14%
Source: Behavioral Risk Factor Surveillance System, CDC

13. Obesity Trends Among U.S. Adults
1987
No Data <10% 10%–14%
Source: Behavioral Risk Factor Surveillance System, CDC

14. Obesity Trends Among U.S. Adults
1988
No Data <10% 10%–14%
Source: Behavioral Risk Factor Surveillance System, CDC

15. Obesity Trends Among U.S. Adults
1989
No Data <10% 10%–14%
Source: Behavioral Risk Factor Surveillance System, CDC

16. Obesity Trends Among U.S. Adults
1990
No Data <10% 10%–14%
Source: Behavioral Risk Factor Surveillance System, CDC

17. Obesity Trends Among U.S. Adults
1991
No Data <10% 10%–14% 15%–19%
Source: Behavioral Risk Factor Surveillance System, CDC

18. Obesity Trends Among U.S. Adults
1992
No Data <10% 10%–14% 15%–19%
Source: Behavioral Risk Factor Surveillance System, CDC

19. Obesity Trends Among U.S. Adults
1993
No Data <10% 10%–14% 15%–19%
Source: Behavioral Risk Factor Surveillance System, CDC

20. Obesity Trends Among U.S. Adults
1994
No Data <10% 10%–14% 15%–19%
Source: Behavioral Risk Factor Surveillance System, CDC

21. Obesity Trends Among U.S. Adults
1995
No Data <10% 10%–14% 15%–19%
Source: Behavioral Risk Factor Surveillance System, CDC

22. Obesity Trends Among U.S. Adults
1996
No Data <10% 10%–14% 15%–19%
Source: Behavioral Risk Factor Surveillance System, CDC

23. Obesity Trends Among U.S. Adults
1997
No Data <10% 10%–14% 15%–19% 20%-24%
Source: Behavioral Risk Factor Surveillance System, CDC

24. Obesity Trends Among U.S. Adults
1998
No Data <10% 10%–14% 15%–19% 20%-24%
Source: Behavioral Risk Factor Surveillance System, CDC

25. Obesity Trends Among U.S. Adults
1999
No Data <10% 10%–14% 15%–19% 20%-24%
Source: Behavioral Risk Factor Surveillance System, CDC

26. Obesity Trends Among U.S. Adults
2000
No Data <10% 10%–14% 15%–19% 20%-24%
Source: Behavioral Risk Factor Surveillance System, CDC

27. Obesity Trends Among U.S. Adults
2001
No Data <10% 10%–14% 15%–19% 20%-24% 225%
Source: Behavioral Risk Factor Surveillance System, CDC

28. Obesity Trends Among U.S. Adults
2002 (*BMI ≥30, or ~ 30 lbs overweight for 5’4” person)
No Data <10% 10%–14% 15%–19% 20%-24% 225%
Source: Behavioral Risk Factor Surveillance System, CDC

29. Obesity Trends Among U.S. Adults
2003
No Data <10% 10%–14% 15%–19% 20%-24% 225%
Source: Behavioral Risk Factor Surveillance System, CDC

30. Predicted UK growth in obesity-
related disease by 2030
From “Our health, our care, our say” white paper
60%
+54%
50%
40%
+28%
30%
+18%
20%
+12%
10% +5%
0%
Stroke Angina Heart Attack Hypertension Type 2 diabetes
Source: Living in Britain 2004: Results from the 2002 General Household Survey; National Food
Survey 2000 Table B1

31. 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

32. 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
C ar miles x 10
1975/6 1989/91 1995/7
Source: Fox / Hillsdon presentation to UK government Foresight policy
development programme on obesity

33. We have made our
environments “obesogenic”

34. Prevalence of overweight children (IOTF 2002)
15% 16%
18%
15%
22%
10% 11%
Switzerland
Germany
2%
Sweden
UK
Levels of cycling (DfT 1996)

35. 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

36. A cross-sector issue
With cross-sector solutions

37. Transport policy can now contribute to
healthy, low-carbon lifestyles

38. 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

39. 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

40. 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

41. Mobility….. or accessibility?

42. Mobility….. or accessibility?
• Transport policy has prioritised mobility :
the ability to travel – sometimes long distances

43. Mobility….. or accessibility?
• Accessibility : access to the goods and
services people need
• the ideal is maximum accessibility with
minimum mobility

44. Potential for change
Analysis of travel behaviour shows very
significant potential for change to more
active modes

45. Constants in travel behaviour
On average, people make three trips per day,
Daily mobility
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
10% are not further than 1km, 30% are not further
Car trips
than 3km and 50% are not further than 5km

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

47. Potential for sustainable travel modes
% trips per person: Sustainable Travel Demonstration Towns
Circumstances
enforce car use
Actual usage
(walking, bicycle,
9 public transport)
35

48. Potential for sustainable travel modes
% trips per person: Sustainable Travel Demonstration Towns
Circumstances
enforce car use
Actual usage
(walking, bicycle,
No adequate
9 public transport)
alternative 35
27

49. Potential for sustainable travel modes
% trips per person: Sustainable Travel Demonstration Towns
Circumstances
enforce car use
Actual usage
(walking, bicycle,
No adequate
9 public transport)
alternative 35
27
29
Only subjective reasons against
STM

50. Potential for sustainable travel modes
without significant environmental modification
Environmental
factors “enforce”
private motorised
modes
36
64
Immediate potential
for walking, cycling
& public transport

51. Potential for sustainable travel modes
with environmental intervention
Motorised private
modes
25 l… ..”
rad ica
alis tic,
u nre 75
tic,
Walking, cycling &
alis
public transport
“Id e

52. Idealistic, unrealistic, radical?

53. Mode choice in Basel, Switzerland
% trips per person
Motorised private
modes
25
75 Walking, cycling &
public transport

54. Examples of intervention
What should we do to make urban
transport systems better?

55. Re-allocate road space
Take space from motor
traffic and return it to
walking and cycling
Bristol, UK

56. Keep motor
traffic out
Wien, Austria

57. Design for healthy, Nordrhein-Westfalen,
sustainable travel 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

58. Significant,
incremental,
long-term
London
Congestion
Charge

59. Show leadership

60. Case study: Odense

61. 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

62. 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…..

63. Case study: National Cycle Network

64. Composition of the Network
Traffic-calmed urban roads

65. Composition of the Network
Quiet rural roads and lanes

66. Composition of the Network
Traffic-free greenways (30% of
total)

67. Designed for multiple trip purposes
leisure and recreation…

68. …shopping and personal business...

69. …commuting to work...

70. …school travel

71. … attractive traffic-free
routes...

72. …without gaps or
obstacles...

73. …with iconic,
memorable structures...

74. Art and the travelling landscape

75. Development of the Network

76. National Cycle Network
1995: plans for 2,500 miles (4,000km)

77. National Cycle Network
5,000 miles (8,000km) open in 2000

78. National Cycle Network
10,000 miles (16,000km) in 2005

79. ….. and construction continues…..

80. 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

81. 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