Select Committee on Environment, Transport and Regional Affairs Memoranda

Memorandum by the British Medical Association (WTC 14)


  Thank you for giving the British Medical Association an opportunity to submit evidence to the proposed inquiry by the Environment, Transport and Regional Affairs of the House of Commons on "Walking in Towns and Cities".

  The BMA welcomes the Government's initiative to promote walking and BMA policy supports the notion that whenever possible people should be encouraged and enabled to abandon motorised transport in favour of physically active forms of transport such as walking and cycling. In 1997 the British Medical Association commented on the Department of Transport's discussion paper, "Developing a strategy for walking" and noted that it should aim to complement the Government's cycling strategy.


  The BMA is concerned with the health risks and health benefits related to different transport policies. Policies that facilitate increasing levels of physical activity throughout the population will have significant benefits by influencing a number of conditions that are key contributors to morbidity and mortality. For example, increasing physical activity has a great potential for the prevention and management of cardiovascular disease and the retention of function in late middle age and beyond.1 The prevalence of clinical obesity in Britain is high, and evidence suggests that modern inactive lifestyles are at least as important as diet in the aetiology of obesity and possibly represent the dominant factor.2 An American study of men and women showed that reduction in death rates could be achieved by a brisk walk of 30-60 minutes per day—which could easily be incorporated into commuter or shopping journeys, for example.3 The ability to walk comfortably at a reasonable pace is also important for independence and quality of life. Older people, especially post-menopausal women, have a specific need to continue regular, rhythmic, weight-bearing exercise, to preserve bone mineral density in order to protect against osteoporosis, hypertension and stroke, and maintain the integrity of muscle function and physical confidence essential to the avoidance of falls and consequent hip fractures.4 Regular moderate activities such as brisk walking improve strength, flexibility, speed of muscle contraction, muscle endurance, gait and balance.5 The importance of facilitating and encouraging walking in terms of the population's health should therefore not be underestimated.


  The key factors in encouraging walking, and indeed cycling are, an overall reduction in motorised transportation and a reduction in the speed of remaining vehicles in urban areas. Cars have been increasingly used for very short journeys over past decades. In the late 1970s and 80s car use for journeys of less than half a mile increased from 3.8 per cent of all journeys to 6.9 per cent; for journeys between half a mile and a mile, the increase was from 14.7 per cent to 24.1 per cent. Although the average length of a journey made entirely on foot has remained constant at about 0.6 miles since 1975-76, only 29 per cent of journeys in Great Britain were made mainly on foot in 1994-966. There is obviously a great potential for transferring some of these journeys to healthier modes of transport such as walking and cycling, which may even be quicker when parking and traffic congestion considerations are taken into account.

Traffic calming and reduction

  With regard to lower speed limits, where these have been enforced through traffic calming, the most vulnerable groups tend to gain in terms of reduced casualties and also in increased independent mobility. Within the UK the introduction of 20 mph zones has been shown to be effective,7 and in Oxfordshire a 75 per cent reduction in pedestrian accidents has been achieved through traffic calming.8 Concerns have been raised that encouraging walking and cycling will lead to an increase in casualties and fatalities, however, this is not the case. In York, the policy of prioritising health promoting modes of transport, whilst restraining motor traffic has led to casualty reductions well above the national average, eg for pedestrian casualties in 1990-94 York saw a reduction of 36 per cent compared with a 15 per cent reduction for the UK as a whole.1 Local and central government should establish road user hierarchies which place pedestrians, people with mobility restrictions, and cyclists at the top and car-borne commuters at the bottom, as adopted in cities such as York and Oxford.1


  Children are an extremely important group to consider in terms of walking. More journeys are made on foot by young people aged 11-15, than by any other age group.6 However, between 1985-86 and 1994-96 the number of walking trips made by 11-15 year olds fell by 29 per cent, and by 17 per cent for those aged 5-10 years. The development of a physically active lifestyle is essential early in life and enabling children to walk safely to and from school is therefore one means by which to encourage active lifestyle habits and to remove reliance on the motor vehicle. In 1994-96 only 52 per cent of children aged 5-15 walked to school.6 It is of concern that the major cause of death in children is accidents and the UK has a poor record of road safety for children. In 1997 40 per cent of pedestrian casualties were children aged 0-15, although only 14 per cent of fatalities were in this group.6 Focusing on the needs of children in terms of improving safety in the road environment and enabling their independent mobility, will also benefit other sectors of the population in terms of road safety. A survey of determinants of car travel, on daily journeys to school in inner London showed that nine out of ten parents were worried about their child being abducted or hit by a car. The authors concluded that policies to encourage children to attend nearby schools and to address parental fears could increase the number of children walking to school and so reduce traffic congestion.9 Accordingly, initiatives to develop safe routes to schools should be particularly encouraged.

People with disabilities

  When considering planning and improvements to enable walking, the needs of those with disabilities must be taken into account. Some of the measures that can be undertaken to encourage pedestrianisation may sometimes act as a barrier to those with disabilities. For example, cobbled surfaces, raised kerbs and bollards that differentiate pedestrian areas from roads may cause difficulty to those in wheelchairs, or those who use crutches or sticks to walk. The Royal National Institute for the Blind has put forward proposals for improving facilities for the visually impaired10 and the needs of others with disabilities have been addressed by the Community Transport Association (

  Strategies for walking and cycling should work together as provision needs to be made for both these groups of vulnerable road users. The separation of vulnerable road users from road traffic is obviously one means of improving safety, and divided pathways for cyclists and pedestrians can be of benefit. However, a survey by CTC found that such shared pathways may not be suitable for some vulnerable groups such as blind people,11 and hence, where such shared facilities are necessary, it is important that they are to the highest standard.


  The role of employers also needs to be addressed. In 1994-96, men with company cars walked only about half the average distance of all men.6 Examples of important action which employers can take to reduce the need for motorised forms of transport include: the location of offices that are accessible by public transport, walking and cycling; reconsidering the use of company cars and restricting the provision of car parking; assessing the need for transport between offices; increasing use of home working and giving staff incentives to walk or cycle.


  One issue that needs to be highlighted further is the responsibility of all members of society to consider the forms of transport that they use. A national campaign to increase awareness of unnecessary car journeys, would provide a useful backdrop for the development of a National Strategy on Walking.

  In commenting on the earlier discussion document "Developing a Strategy for Walking" the Association expressed disappointment that no mention was made of setting targets for increasing the percentage of all journeys made by foot. The establishment of health derived targets for increases in walking, according to age group would lead the way for local targets to be set and act as a benchmark by which to measure success. Targets could also be set for reductions in car journeys of under two miles to reverse the current trend whereby car usage on short journeys is increasing.


  Exposure to air pollution may also act as a significant deterrent to walking in cities. A recent report on London transport concluded: "air pollution related health impacts from transport may be equivalent to, if not greater than transport accidents in London".12 The health effects of air pollution must be taking into consideration in the development of a Walking Strategy. The Department of Health should continue to research and monitor the medical effects of air pollution and other health effects of transport policies.

Professor V H Nathanson

Head of Professional, Research and Resources Group


  1 British Medical Association, Road Transport and Health, London: BMA 1997.

  2 Prentice A M, Jebb S A. Obesity in Britain: gluttony or sloth? BMJ 1995;311:437-9.

  3 Blair S N, Kohl H W, Paffenbarger R S et al. Physical fitness and all-cause mortality: a prospective study of healthy men and women. JAMA 1989;262:2395-2401.

  4 Young A, Dinan S. ABC of sports medicine. Fitness for older people. British Medical Journal 1994;309:331-334.

  5 Brown M, Holloszy J. Effects of walking, jogging and cycling on strength, flexibility, speed and balance in 60 to 72 year olds. Ageing Clinical and Experimental Research 1993;5:427-434.

  6 Department of the Environment, Transport and the Regions. Transport Statistics: Walking in Great Britain.—key.htm, 21 June 2000.

  7 Transport Research Laboratory. Review of traffic calming schemes in 20 mph zones. Report 215. Crowthorne: Transport Research Laboratory, 1996.

  8 Local Transport Today, 25 November 1993:13.

  9 DiGuiseppi C Roberts I Li L Allen D. Determinants of car travel on daily journeys to school: cross sectional survey of primary school children. BMJ 1998:316;1426-8.

  10 RNIB. Transport and mobility for visually impaired people in the UK. Campaign Report 9. London: RNIB 1999.

  11 CTC. Press Release: Make the roads safe to cycle, say walkers. 11 July 2000


  12 NHS Executive. On the move: Informing transport health impact assessment in London. London: NHSE. October 2000.

January 2001

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