1. Moving forward on transport and health: knowledge transfer and action
Dr Adrian Davis NHS Bristol/
Bristol City Council

2. A vision from the 1960s
“Television-sets and washing machines may for the time being take precedence in the hierarchy of domestic needs, but as a longer term objective it is questionable whether anything is so much desired as a family car.”
Ministry of Transport, 1963 Traffic in Towns p.10

3. Buchanan Report- Interpreted to say:
Car ownership and use would grow
This was a legitimate desire of most adults
More roads had to be built in towns to accommodate extra cars
‘Accidents’, noise and possibly air pollution were the negative health impacts

4. More space for motor vehicles =less for pedestrians/ cyclists
Inner Leeds 1963
In total 365 homes and 174 commercial buildings were raised to the ground. People who were living in the demolished houses were moved to new estates such as Little London.
The myth of progress
1990s

5. Ways in Which Transport Influences Health
Health Promoting Health Damaging
Enables access to: Injuries
physical activity Sedentary lifestyles
employment, shops, Pollution:
goods, education, particulates, carbon other services, monoxide and countryside nitrogen oxides
social (support) networks hydrocarbon and ozone, active travel carbon dioxide, lead, benzene
well-being Climate change
  Noise and vibration
Stress and anxiety Traffic danger Loss of land and planning blight Severance of communities by motor traffic

6. Road transport and health
British Medical Association Board of Science and Education, 1997

7. Official recognition of wider health impacts
The way we travel is making us a less healthy nation
Coronary heart disease is the biggest killer of adults in the country. Part of the blame is that we drive too much when we could walk or cycle.
DETR, 1998 A New Deal for Transport: Better for Everyone. London: TSO.

8. Physical activity: the best buy in public health
Those who think they have not time for bodily exercise will sooner or later have to find time for illness. Edward Stanley, Earl of Derby, in an address at Liverpool College, 20 December 1873
Physical activity must be one of the most undervalued interventions to improve public health
Donaldson, L Sport and exercise: the public health challenge, British Journal of Sports Medicine, 24:

9. Transport and health knowledge time-line
Traffic in Towns, 1963
‘Accidents’, air and noise – dominance of and aspirations for car use
Livable Streets, 1972
Road traffic volume and speed damage social support networks
Social and environmental context for health
Development of
new public health
from mid 1970s
BMA cycling
& health report, 1992
Health benefits outweigh the risks
Royal Commission on
Environmental Pollution, 1994
Traffic growth not environmentally or socially acceptable
BMA, Road transport
and Health, 1997
1st account of the myriad impacts of road transport on health
DfT, 1998 A New
Deal for Transport
‘The way we travel is making us a less healthy nation’ p.22
Half adult population in developed countries is sedentary or does minimal physical activity. Barriers to physical activity might have the greatest impact of all traffic-related health risks.
WHO, 2000
Development of peer
reviewed evidence base
of health impacts
Including studies linking obesity to sedentary travel
DfT - premature deaths from poor air quality likely to be double previous estimate
House of Commons
Environment Committee, 2010

10. The disease-burden from road transport
Adapted from: Cycling & Health – What’s the evidence? Cavill, N., Davis, A. 2007

11. Impact of car use on body weight
Time spent travelling by car has increased and walking declined by 23% between 1972 & 2005
Adults who bought private motorised transport to travel to work doubled their likelihood of becoming overweight in comparison to those where there was no mode change 1
Countries with highest levels of active travel generally have the lowest obesity rates 2
1. Bell, C., e, K., Popkin, B The road to obesity or the path to prevention: motorised transportation and obesity in China, Obesity Research, 10(4):
2 Bassett, D., Pucher, J., Buehler, R., Thompson, D., Crouter, S Walking, cycling, and obesity rates in Europe, North America and Australia, Journal of Physical Activity and Health, 5:

12. Health impact distributions

13. Social Support networks

14. Ending of South Yorkshire Fairs Freeze
Bus use rising from 1975 – against trends
Intervention – 1985 Transport Act % fare rise
62% and 60% reductions in bus use among unemployed and retired, 37% reduction for employed and 48% among children
Steep rise in requests for formal home help

15. Speeding
speeding traffic is rated as the greatest problem in local communities... Even when conducting analysis on the sub-groups, speeding traffic consistently came out as the antisocial behaviour perceived to be the greatest problem, whether respondents were male or female, young, middle aged, or old.
Poulter, D., McKenna, F Is speeding a “real” antisocial behaviour? A comparison with other antisocial behaviours, Accident Analysis and Prevention, 39: 384–389

16. NICE Physical Activity Guidance (2008)
94,172 possible papers:
54 studies were
included in the reviews.
Difficult to ascertain to what extent the interventions were responsible for the changes seen because:

17. The risk of bias – example from road safety education
Misplaced focused – importance of partnership working – confused with whether intervention delivered a safety benefit
Author bias, design bias etc…
Throughout the culture of road safety education there is an absence of evidence as a key guiding criterion.
McKenna, F The public health benefits of road safety education for teenagers. University of Reading.

18. Built Env/Healthy City
Public Health support within
Bristol City Council: planning for synergy
Transport Planning
Dr Adrian Davis
Active Bristol
Clare Lowman
Built Env/Healthy City
Marcus Grant/UWE
(0.1 fte)
Planning & Health
Stephen Hewitt
Climate & carbon
Dr Angela Raffle
(0.6 fte)
Health Policy
Liz McDougall
Cycling City
Simon Carpenter (0.4fte)

19. Relationship between Public Health and Local Government: the critical friend
The DPH is firmly independent of the executive leadership of
the authority and can speak with professional freedom.
Elston, T Health Appointments – 6 Models of Practice, In Hunter, D. (Ed) Perspectives on Joint Director of Public Health appointments, London: IdEA

21. What’s good for health is good for the Treasury

22. Joint Local Transport Plan 3
Joint Local Transport Plan 3
A Consultation response from the West of England Directors of Public Health
Dr Pamela Akerman, Director of Public Health Bath and North East Somerset
Dr Hugh Annett, Director of Public Health Bristol
Becky Pollard, Director of Public Health North Somerset
Dr Chris Payne, Director of Public Health South Gloucestershire.

25. Road Danger Reduction
Knowledge Transfer Partnership funded with Bristol City Council and UWE (ph) – 9 months
Investigate potential for shift from casualty reduction (ie to reduce danger at source)
Modelled on Vision Zero (SE) & Sustainable Safety (NT)
Key aspect:speed – 20mph for residential streets to reduce violence from traffic

26. Peak oil
Peak oil: the point in time when the maximum rate of global petroleum extraction is reached, after which the rate of production enters terminal decline.
Lloyds of London say:
“What it [the report] outlines, in stark detail, is that we have entered a period of deep uncertainty in how we will source energy for power, heat and mobility, and how much we will have to pay for it.”

27. Being there Informal opportunities to get health impacts included
Being a source of knowledge to hand (eg Joint Local Transport Plan3 and Local Sustainable Transport Fund bids)
Building trust
Windows of opportunity
Cost effective

28. Lessons learnt Leadership from Tier 1 is vital
Need for specialist with sufficient knowledge/training in both disciplines
Embedded post enables dialogue with all staff. Regular Tiers 2 & 3 briefings essential
Public health USPs - leverage in support of transport case for low carbon economy

29. The future Return to local government offers chance to:
embed public health across Councils to improve pop. health
break through ‘silo’ mentality
build trust and effectiveness/synergy
improve cost effectiveness