Memorandum by the British Medical Association
WALKING IN TOWNS AND CITIES
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 daywhich 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 (http://www.communitytransport.com).
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. http://www.transtat.detr.gov.uk/personal/walkkey.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.