1. Increasing walking and cycling A briefing for Local Authority Directors of Public Health

2. Key messages: Physical inactivity is a major public health issue Walking and cycling for transport are the most appropriate physical activity options Cycling and walking are safe More cycling and walking achieves multiple public health objectives within the public health outcomes framework More cycling and walking reduces health inequalities We know what interventions are effective and cost- effective

3. Source: WHO (2009). Global health Risks. Mortality and burden of disease attributable to selected major risk. Geneva. WHO Physical activity: a global health priority

4. Inactivity: a major UK public health issue Source: Health Survey for England 2008 Around 6/10 men and 7/10 women not active enough (from self report) Accelerometer data shows this may be more like 9/10 Impact on over 20 conditions including obesity; CVD; some cancers; diabetes

5. Walking and cycling for transport are the most appropriate physical activity options Sport: <10% participate regularly Work: few active occupations exist Leisure: infrequent participation in leisure pursuits Active travel offers the potential for daily physical activity of sufficient frequency and intensity Encouraging most inactive to walk has the greatest potential for health gain (see panel)

6. Walking and cycling are safe Safety is improving – In 2006, the fatality rate for pedestrians was 54% lower than the 1980 level – for pedal cyclists it was 46% lower (DfT 2008) The real risks are low – one death per 33 million km cycled (CE 2007) More cycling and walking increases safety – Evidence of ‘safety in numbers’ (Jacobsen 2003, Robinson 2005) The benefits outweigh the risks – Multiple studies show physical activity benefits outweigh the risks by at least 10 to one – The real risk is being sedentary (see next slide)

7. The risk of physical inactivity compared to road casualties Source: * **DfT Road Traffic Casualties 2009 *** BHF statistics 2010 edition; McPherson et al 2002.

8. More cycling and walking achieves multiple public health objectives Achieves physical activity objectives in the public health outcomes framework Reduces obesity Reduces road traffic casualties Improves local air quality Reduces CO2 emissions Increases social interaction and builds social capital

9. More cycling and walking reduces health inequalities Sport and active leisure have costs to the user Walking is free; cycling is cheap Improving the environment for walking and cycling reaches people from all socio-economic groups ‘Shifting the curve’: increasing the average levels of activity across society

10. We know what interventions are effective and cost-effective NICE guidance on environment and physical activity (NICE, 2008) NICE guidance on walking and cycling (NICE 2012) Cochrane reviews of physical activity (Baker et al 2011) BMJ reviews on walking and cycling (Ogilvie et al 2007, Yang et al 2010) Lancet series on physical activity (Woodcock et al 2007)

11. Ideas for action Take a town/city-wide approach to creating environments for walking and cycling. Implements NICE guidance on walking and cycling/physical activity Work with the local authority transport planners to ensure cycling and walking are central to the local transport plan Ensure physical activity is part of the joint strategic needs assessment (JSNA) Influence local planning decisions in favour of active environments Encourage staff to use the WHO HEAT tool. WHO provide free online training

12. Example In Hereford, the Public Health team initiated ‘learning sets’ on walking and cycling, engaging the transport team This coincided with funding for sustainable transport initiatives from the DfT’s Local Sustainable Transport Fund The new Local Transport Plan now has a significantly enhanced focus on active travel

13. Example: Across a town of 150,000 people, if everyone walked an extra 10 minutes a day, the HEAT model estimates: – 31 lives saved – Current value of £30m per year

15. References Cycling Embassy of Great Britain. 2012. Dutch Cycle Infrastructure. http://www.cycling-embassy.org.uk/wiki/dutch-cycle-infrastructurehttp://www.cycling-embassy.org.uk/wiki/dutch-cycle-infrastructure Cycling England 2007. Cycling and Health: what’s the evidence? http://www.ecf.com/wp-content/uploads/2011/10/Cycling-and-health-Whats-the-evidence.pdfhttp://www.ecf.com/wp-content/uploads/2011/10/Cycling-and-health-Whats-the-evidence.pdf De Hartog et al. 2011. Travel-time air pollution exposure, energy expenditure and health outcomes: use of new technologies. Epidemiology. 22:1 ppS76-S77 Department for Transport. Road Casualties in Great Britain - Main Results 2007. London: Transport Statistics, 2008. DfT 2007. Manual for Streets. London. Dept for Transport https://www.gov.uk/government/publications/manual-for-streetshttps://www.gov.uk/government/publications/manual-for-streets DfT 2010 (b). Cycling Demonstration Towns. Development of Cost benefit ratios. DfT 2010 (c). National Travel Survey. https://www.gov.uk/government/statistical-data-sets/nts06-age-gender-and-modal-breakdownhttps://www.gov.uk/government/statistical-data-sets/nts06-age-gender-and-modal-breakdown DfT 2010a. How People Travel. National Travel Survey 2010. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/8934/nts2010-03.pdfhttps://www.gov.uk/government/uploads/system/uploads/attachment_data/file/8934/nts2010-03.pdf Hansard 2007. Daily Hansard Written Answers. 29 March 2007. Column 169tW. http://www.publications.parliament.uk/pa/cm200607/cmhansrd/cm070329/text/70329w0010.htm http://www.publications.parliament.uk/pa/cm200607/cmhansrd/cm070329/text/70329w0010.htm Jacobsen, P. (2003). Safety in numbers: more walkers and bicyclists, safer walking and bicycling, Injury Prevention, 9, pp.205-209 Living Streets. Making the Case for investment in the walking environment. 2012 Manton R, Clifford E. (2011) Cycling Ireland to work. http://www.etcproceedings.org/paper/cycling-ireland-to-work-sustainable-job-creation-in-the-tourism-sector- throughhttp://www.etcproceedings.org/paper/cycling-ireland-to-work-sustainable-job-creation-in-the-tourism-sector- through NICE 2008 Physical activity and the environment. http://publications.nice.org.uk/physical-activity-and-the-environment-ph8http://publications.nice.org.uk/physical-activity-and-the-environment-ph8 NICE 2012 Walking and cycling local government briefing - http://publications.nice.org.uk/walking-and-cycling-phb8 and the walking and cycling pathway http://pathways.nice.org.uk/pathways/walking-and-cyclinghttp://publications.nice.org.uk/walking-and-cycling-phb8 and the walking and cycling pathway http://pathways.nice.org.uk/pathways/walking-and-cycling NICE 2012. Walking and cycling guidance. http://publications.nice.org.uk/walking-and-cycling-local-measures-to-promote-walking-and-cycling-as-forms-of-travel-or- recreation-ph41http://publications.nice.org.uk/walking-and-cycling-local-measures-to-promote-walking-and-cycling-as-forms-of-travel-or- recreation-ph41 NICE 2012. walking and cycling pathway http://pathways.nice.org.uk/pathways/walking-and-cyclinghttp://pathways.nice.org.uk/pathways/walking-and-cycling Ogilvie D, Foster CE, Rothnie H, Cavill N, Hamilton V, Fitzsimons CF, et al. Interventions to promote walking: systematic review. BMJ 2007;334(7605):1204 ONS 2007. ONS Omnibus Survey (Oct/Nov 2007) cited in DfT (2008) Public Attitudes To Congestion and Road Pricing. London. Dept for Transport Rabl A, de Nazelle A. Benefits of shift from car to active transport. Transport Policy. 19 (2012) 121-131. Robinson DL. 2005. Safety in Numbers in Australia. Health Promot J Austr. 2005 Apr;16(1):47-51. Rojas-Rueda D, de Nazelle A, Tainio M, Nieuwenhuijsen MJ. The health risks and benefits of cycling in urban environments compared with car use: health impact assessment study. BMJ. 2011 Aug 4;343:d4521. Sustrans 2013. http://www.sustrans.org.uk/resources/in-the-news/investment-in-smarter-travel-means-better-health-for-allhttp://www.sustrans.org.uk/resources/in-the-news/investment-in-smarter-travel-means-better-health-for-all Sustrans 2013. http://www.sustrans.org.uk/resources/in-the-news/sweet-16-but-sustrans-has-no-intention-of-leaving-schoolhttp://www.sustrans.org.uk/resources/in-the-news/sweet-16-but-sustrans-has-no-intention-of-leaving-school Tolley 2011. Good for business. The benefits of making streets more walking and cycling friendly. Heart Foundation. 2011. WHO 2010. World Health Organization Regional Office for Europe. The Health Economic Assessment Tool (HEAT) for walking and cycling. www.heatwalkingcycling.org www.heatwalkingcycling.org Woodcock J, Banister D, Edwards P, Prentice AM, Roberts I. Energy and Health 3; Energy and Transport. The Lancet. 2007 Sep 22; 370(9592): 1078-88 Yang L, Sahlqvist S, McMinn A, Griffin SJ, Ogilvie D. Interventions to promote cycling: systematic review. BMJ 2010;341:c5293. Further Reading Cycling and Health. What’s the evidence? Cycling England 2007. http://www.ecf.com/wp-content/uploads/2011/10/Cycling-and-health-Whats-the-evidence.pdfhttp://www.ecf.com/wp-content/uploads/2011/10/Cycling-and-health-Whats-the-evidence.pdf CfIT Sustainable Transport Choices and the Retail Sector (2006) http://webarchive.nationalarchives.gov.uk/20110304132839/http://cfit.independent.gov.uk/pubs/2006/stc/technical/pdf/stc-technical01.pdf http://webarchive.nationalarchives.gov.uk/20110304132839/http://cfit.independent.gov.uk/pubs/2006/stc/technical/pdf/stc-technical01.pdf Take Action on Active Travel. Why a shift from car-dominated policy would benefit public health. Sustrans. 2010 Living Streets. Making the Case for investment in the walking environment. 2012 Other excellent information and help is available from organisations such as British Cycling, CTC, Living Streets, Ramblers, Sustrans, and others.

16. Acknowledgements The slide sets were researched and written by Dr Nick Cavill, an independent public health consultant Drafting was overseen by an ‘Active Travel and Health group’, which was a sub-group of the Cycling Forum. Members were: – Beelin Baxter, Department of Health – Tony Armstrong, Living Streets – Simon Barnett, Living Streets – Jackie Brennan, British Cycling – Hugo Crombie, National Institute for Health and Care Excellence – Phillp Darnton, Bicycle Association – Adrian Davis, Independent consultant – Des de Moor, Ramblers – Stephanie Dunkley, Leicester City NHS – Julia Ellis, Association of Directors of Public Health – Roger Geffen, CTC – Alison Hill, South East Public Health Observatory – Phillipa Hunt, Living Streets – Philip Insall, Sustrans – Patrick Lavery, Department for Transport – Carlton Reid, BikeBiz – Lynn Sloman, Transport for Quality of Life – Paul Stonebrook, Department of Health – Shane Snow, Department for Transport This presentation is part of a set of three, aimed at different target audiences in local authorities: – Directors of Public Health – Directors of Transport – Elected members Two alternate versions of the presentation are available – Without logos, for you to customise – Without photos, on plain backgrounds – Contact nick@cavill.net for details.nick@cavill.net Draft 01 May 2013