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Active Travel: The Miracle Cure? A guide for the NHS on raising physical activity levels through your local transport plan
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A guide for the NHS on raising physical activity levels through your local transport plan
‘The potential benefits of physical activity to health are huge. If a medication existed which had a similar effect, it would be regarded as a “wonder drug” or “miracle cure”.’
Sir Liam Donaldson – Chief Medical Officer (Annual Report of the Chief Medical Officer 2009, Department of Health, March 2010)
With your local transport plan currently in development, the NHS has a major the opportunity to ensure that local transport policies maximise the health benefits that walking and cycling can bring.
Local Transport Plans (LTP):
Your local authority is currently developing a new LTP starting from March 2011, setting out its investment priorities over the next five years.
Contributing to better safety, security and health is one of the DfT’s five “goals” for transport, including to “improve the health of individuals by encouraging and enabling more physically active travel”.
DfT expects local authorities to consider their contribution to these goals as over-arching priorities for their LTPs.
Most LTPs will cover the next 3 – 5 years, as part of a 15-20 year strategy. Your authority must publish its plan by 31 March 2011.
The NHS needs to be working now with local Highway Authorities to get walking and cycling prioritised in their areas.
The Local Transport Plan Funding:
Councils get an annual capital grant from DfT for small-scale infrastructure and road maintenance, but this is not ring-fenced for transport. They can bid for additional funding from DfT for “major schemes” costing over £5m.
Revenuesupport is included in the wider “formula grant” from DCLG, but is not ring-fenced.
Consultation and Engagement:
Your authority is expected to consult on its LTP, although it is worthwhile engaging as early as possible in the process to shape thinking at the outset - start talking to your transport team now.
In particular LTPs will need an Strategic Environmental Assessment, which includes a Health Impact Assessment. This is a major opportunity for the health sector to challenge local transport teams to do more on active travel.
Inactive lifestyles are contributing to an obesity epidemic, a major public health crisis that is already costing the economy and the NHS billions per year…
The cost to each PCT of treating the effects of inactivity is significant: average £5m a year:1
Physical Activity is critical to good health:
But inactivity is a major public health problem:
The forecasts are for inactivity to get worse. If not addressed more than half of adults could be obese by 2050.4
Treatment costs alone will be unaffordable, regardless of the wider economic cost.
But there is a solution: most people could meet recommended physical activity levels simply by including more walking or cycling in their daily lives.
Chief Medical Officer’s recommendations for health enhancing physical activity (minimum):
Children & young people: a total of 60mins of moderate intensity physical activity a day;
Adults: a total of 30mins a day of moderate intensity physical activity five times a week.
Moderate intensity physical activity includes cycling or brisk walking.
Comparable European countries have higher levels of walking and, in particular, cycling.
At Least Five A Week: evidence on the impact of physical activity and its relationship to health. DoH 2004
Levels of walking and cycling have, however, been in long term decline as car dependence has grown, contributing to our obesity problem.
It does not have to be this way. There is a major opportunity to achieve public health goals alongside transport objectives through getting more people walking and cycling more often.
Cycling levels in Britain are the lowest in Europe
Estimated share of journeys (trips) made by bicycle
European Best Practice 2006 Update – Atkins 2006
We know what is needed to encourage more walking and cycling:
Successful active travel programmes do both: complementing better infrastructure with targeted promotional activities
A number of English towns and cities that have managed to halt or reverse the decline in active travel:
Your local transport team have capital funding for infrastructure like cycle lanes & parking, traffic management and home zones…
But do not have access to revenue funds needed for travel planning, marketing, training (pictured) etc to complement infrastructure..
Local transport teams have to balance a number of competing priorities. It is important to make the case that active travel can contribute to a broad range of local objectives.
More walking and cycling can support a wide range of local and national objectives, including:
A relatively low-cost active travel programme can make a significant contribution to your local area agreement.
Who you should talk to:
Engagement at any level is worthwhile, but most can be achieved by engaging at all levels to embed Health priorities in the LTP.
Local Strategic Partnerships are a good starting point, and Govt Offices can help make contacts.
NHS Chief Exec’s should engage early in the process with their counterparts in the Highway Authority, making the case for putting walking and cycling at the heart of the LTP. You may find it useful point to the contribution active travel can make to Local Area Agreement indicators (see the Active Travel Strategy for examples)
This should be followed by an ongoing dialogue between the Director of Public Health and Director of Transport to ensure that the benefits of walking and cycling are fully realised in implementation plans.
Most authorities also have a cycling and walking officer who can advise on detailed plans and schemes.
A starter for ten - what questions to ask your transport team in the first instance:
Evaluation of active travel schemes shows they can be very effective in delivering health benefits:
Benefit-cost analysis of training schemes suggests that returns are of the order of 7:1.
The London Cycle Network has focussed on high density commuter routes and is likely to lead to health, congestion and air quality benefits. A recent benefit-cost analysis showed a return of approximately 4:1 for this type of infrastructure investment
The health benefits of cycling outweigh safety risks by a factor of more than 20.3
1 Cycling Demonstration Towns – Development of Benefit-Cost Ratios; DfT February 2010
The National Institute for Health and Clinical Excellence offers the first evidence-based recommendations on improving the physical environment to encourage physical activity.
NICE PH8 (2008) “Promoting and creating built or natural environments that encourage and support physical activity” includes a number of recommendations you can use when as a checklist when reviewing LTP or development proposals.
The Recommendations can be summarised as:
PCTs can directly support LTP objectives to get more walking and cycling in a number of ways:
Useful sources of information:
The Active Travel Strategywas published by DH and DfT setting out the Govt’s plans to increase walking and cycling.
Be Active, Be Healthysets out the estimated health-care costs of physical inactivity.
At Least Five A Week established the Chief Medical Officer’s recommendations for health-enhancing Physical Activity.
NICE PH8provides evidence-based guidance on how to improve the physical environment to encourage active travel.
Cycling England have published evidence on the health benefits of cyclingand an evaluation of cycling towns.
DfT have published evaluation of the impacts of the sustainable travel townprogramme.
The NHS Operating Framework 2010/11encourages PCTs to work with councils to promote better health and more physical activity.
NHS Camden and Walk Englandhave produced easy to follow walking maps to explore their local area and get fit at the same time.
The Active Stepsprogramme in Sutton is a groundbreaking initiative to increase physical activity and reduce car trips. It is linked to local NHS checks to identify those at greater risk of cardio-vascular disease. 97% of users said they became more active, 85% felt healthier, 46% lost weight.
Liverpool City Council and PCThave signed an agreement to make it a “Cycling City” to improve quality of life and create a healthy low-carbon city.
The agreement sets out to generate a 10% increase in cycling trips by March 2011.
And to make access to health services easier on foot, a network of new treatment centres are being sited across the city within 15 minutes walk of every residential address.
A number of PCTs are already funding “Bike It” Officers to promote cycling in schools:
“We aim to encourage Active Travel as an essential component of a healthy lifestyle for all ages, and Bike It is a proven intervention to help children develop that habit of healthy travel.”
Adrian Dawson, Director of Public Health at Bournemouth and Poole PCT.
“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
“The top five policy responses assessed as having the greatest average impact on levels of obesity [include] increasing walkability / cyclability of the built environment…..”
Foresight Tackling Obesities report, Government Office for Science 2007