1. Transport is a health issue Dr Harry Rutter South East Public Health Observatory www.sepho.org.uk

2. Health impacts on: Individuals Communities Environment

3. Individuals Physical activity Injuries Environment Access

4. Average distance travelled per year Miles per person per year 99/01 % change from 89-91 to 99/01 Walking189-20 Bicycle39-6 Car5,35411 Source: DfT Great Britain data http://www.transtat.dft.gov.uk/tables/tsgb02/1/download/10202.xls

5. Source: http://www.transtat.dft.gov.uk/tables/tsgb01/9/90101.htm

6. Journeys to school by mode and age group: 1985/86 to 1995/97 Source: DfT Personal Travel Factsheet 2 - June 1999 http://www.transtat.dft.gov.uk/facts/nts/pt2_99/school99.htm

7. Sedentary lifestyle In SE ~50% exercise < once a month Increasing obesity –20% of adults in England –Has trebled in last 20 years –Shortens life by average of 9 years –£0.5 billion direct costs to NHS –£2.0 billion impact on economy Sources: HSRU Healthy Lifestyles Survey and Tackling Obesity in England, National Audit Office, 2001

8. Cars and obesity 14% of Chinese households acquired a car between 1989 and 1997 Men who acquired a car –gained ~2kg –doubled their risk of obesity Source: Bell et al, Obesity Research 2002; 10: 277-83

9. Cardiovascular mortality 236,000 deaths a year from cardiovascular disease in UK –39% of deaths –36% of premature deaths in men, 28% in women –58% higher mortality in male manual than male non-manual workers Source British Heart Foundation Statistics Database 2002 - http://www.dphpc.ox.ac.uk/bhfhprg/stats/2000/2002/mortality.html

10. Health benefits of physical activity Heart disease High blood pressure Stroke Cancer Diabetes Mental health and well-being Cognitive function / independence

11. Physical activity and mortality >36% CHD deaths are attributable to sedentary lifestyle 1 14% of UK CHD deaths could be avoided by stepping up a level 2 28% reduction in mortality 3 Adds one to two+ years of healthy life 4 Dose-response relationship Sources:1) McPherson et al. Coronary heart disease: Estimating the impact of changes in risk factors. National Heart Forum, 2002 2) Britton et al, Monitoring the progress of the 2010 target for coronary heart disease mortality, National Heart Forum 2000 3) Andersen et al. All-cause mortality associated with physical activity during leisure time, work, sports, and cycling to work. Archives of Internal Medicine 2000, 160, 1621-1628. 4) Paffenbarger et al. Physical activity, all-cause mortality, and longevity of college alumni. NEJM 1986;314:605-13

12. Traffic injuries in UK In 2001 there were: –3,450 deaths –40,560 killed or seriously injured –313,000 injuries Cyclists –136 deaths (3.9% of total) –One death per 29,000,000 km cycled Sources http://www.transtat.dft.gov.uk/tables/tsgb02/4/download/41502.xls and http://www.transtat.dft.gov.uk/tables/tsgb02/4/download/40702.xls

13. Mortality: CHD v. traffic injury (UK 2001) Sources: http://www.dphpc.ox.ac.uk/bhfhprg/stats/2000/2002/mortality.html & http://www.transtat.dft.gov.uk/tables/tsgb02/4/download/41502.xls

14. Reduction in relative risk of death for cyclists cycling at 10mph 5 days a week Source: Paffenbarger et al. Physical activity, all-cause mortality, and longevity of college alumni. N Engl J Med 1986;314:605-13

15. Risk of injury per million kilometres (EU data) AgeDriversCyclists 12-14-16.8 15-17-18.2 18-2433.57.7 25-2917.08.2 30-399.77.0 40-499.79.2 50-595.917.2 60-6410.432.1 >6439.979.1 Total20.821.0 Source: Cycling: the way ahead for towns and cities. EU 1998

16. Health cost / benefit of cycling At least 20:1 life years gained:lost Costs of sedentary lifestyle much harder to visualise than cycling death or injury - risk communication issues Cycling is safer than driving Source: Hillman, M. Cycling and the Promotion of Health. Policy Studies 1993, 14, 49-58

17. Speed Injuries Noise Pollution Land use

18. Speeds on non-urban roads Cars –On motorways and dual carriageways >50% exceed 70 mph HGVs –On dual carriageways 88% exceed 50 mph limit 2001 data - Source: http://www.transtat.dft.gov.uk/tables/2002/vsgb/vsgb.htm

19. Speeds on urban roads Cars –On 30mph roads 2/3 exceed 30 mph 1/3 exceed 35 mph HGVs –On 30 mph roads 55% exceed 30mph 2001 data - Source: http://www.transtat.dft.gov.uk/tables/2002/vsgb/vsgb.htm

20. Access To health services (SEU report) To employment To goods and services To friends and relatives

21. Communities Social networks Community severance Health inequalities

22. Children / Elderly / Poor / Marginalised SE gradients for car and bike ownership SE gradient for activity levels Children in lowest SE group 5x more likely to die as pedestrians than in highest Sources: Abdalla I, Barker D, Raeside R. Road accident characteristics and socio-economic deprivation. Traff. Engin. Control 1997;38:672-6 and http://www.socialexclusionunit.gov.uk/transport/transport.htm

23. Environment Emissions Greenhouse gases Noise Visual Land take Construction and maintenance Energy

24. Transport and air pollution (GB data) 70% of CO emissions 48% of all nitrogen oxide emissions 22% of particulates Source: http://www.transtat.dft.gov.uk/tables/2002/tt/section8/section8.htm#8.6

25. Diesel and petrol engines Diesel produces NO x and particulates Petrol produces NO x, CO and VOCs Both produce carcinogens such as PAH, benzene and 1,3-butadiene Catalysts don’t help much for short journeys (ie most journeys in urban areas) as they need to warm up to work Source: http://www.doh.gov.uk/comeap/statementsreports/diesel.htm

26. Mortality due to air pollution Over 8,000 deaths/year from PM 10 3,500 deaths from SO 2 Others from CO and NO x Sources: http://www.doh.gov.uk/comeap/statementsreports/airpol7.htm and http://www.doh.gov.uk/comeap/statementsreports/transport.htm

27. Don’t forget other modes Air Rail Sea Inland waterways Freight – especially by road and air

28. Aviation Climate change Air pollution Noise Surface access Inequalities Communicable diseases and wider health protection Global public health issues

29. Road freight 576 killed in crashes involving a heavy goods vehicle in 1998 60 were occupants of the HGV 20% of fatalities were cyclists or pedestrians http://www.transtat.dft.gov.uk/facts/accident/hgv/hgv98.htm

30. Source: http://www.transtat.dft.gov.uk/tables/tsgb02/1/download/10702.xls

31. Source: http://www.transtat.dft.gov.uk/tables/tsgb02/1/download/11902.xls

32. Role of the NHS Service provider Employer Consumer Citizen

33. Healthy Travel Plans Requirement of the NHS Environmental Strategy Requirement of the DH Controls Assurance Risk Management process Requirement of the NSF for CHD

34. Benefits to employers Healthier employees Fitter and more productive workforce Less demand for car parking Sets a good example Achieves policy requirements Increases efficiency

35. Benefits to individuals Get healthier Feel healthier Send healthy message Save money

36. Benefits to public health Healthier population Reduced inequalities Fewer injuries Social and community benefits Environmental benefits

37. What can we in public health do? Awareness Knowledge Skills Partnership Action

38. Conclusions Transport is a health issue Personal, social and environmental costs of motorised transport Health, social and environmental benefits of active transport Role for public health in partnership with colleagues in other sectors