Select Committee on Transport, Local Government and the Regions Appendices to the Minutes of Evidence

Memorandum by Dr Adrian Davis (RTS 157)



  The Slower Speeds Initiative has submitted evidence both written and orally which has highlighted the negative impact of speed and inappropriate speed. One important impact is the supression of walking and cycling journeys. In public health terms this suppression has important consequences and this memorandum highlights the likely scale of the economic costs and so the need for actions across government to reduce road danger in order that people can choose to walk and cycle.

  A physically active lifestyle is now recognised to be an important element of a healthy lifestyle and one that reduces the risks of ill-health and premature deathi. Walking and cycling are both identified as ideal forms of physicial activity as they can be incorporated into daily routinesii. 44 per cent of all trips are under two miles in length and 70 per cent under five milesiii. This knowledge is set against a trend in declining levels of physical activity, found most starkly within western nations.

  Research in the last decade provides some indication of the costs to the economies of countries of physicial inactivity and helps to demostrate the economic value of devoting resources to halt and then reverse the trend of declining levels of physical activity including walking and cycling. Costs are generally divided between those directly associated with health care costs to the NHS, and indirect costs which can include a range of costs not attributable to the NHS, such as costs to employers from days lost through sick leave.

  Importantly, the largest contribution to mortality reduction arises from the group who are currently irregularly inactive. In that group increases in physical activity brings about the largest reduction in mortality because the group is large and because the difference in risk between being irregularly active and regularly active is also relatively large. Substantial contributions to mortality reduction also arise from the sedentary group, primarily because even low levels of physical activity reduce the risks of ill-health.


  Data from the Health Survey for Englandiv has demonstrated that, using a criterion of less than one 30 minute period of moderate activity a week, 23 per cent of men and 26 per cent of women are sedentary. Furthermore, around six out of ten men and seven out of ten women are not reaching recommended levels of physical activity. In the UK it is estimated that about 37 per cent of deaths from Coronary Heart Disease (CHD) are due to lack of physical activity and that 9 per cent of deaths from CHD could be avoided if people who are currently sedentary or have a light level of physical activity increased their level of physical activity to a moderate level. The direct annual health care costs of heart disease in the UK are £1.6 billionv. In addition, it has been acknowledged that health care costs for CHD substantially underestimate the costs:

    Looking only at the costs of CHD to the health care system grossly underestimates the total cost of CHD. CHD also costs the UK economy about £8,500 million because of the days lost due to death, illnes and informal care of people with disease. In total CHD costs the UK economy about £10,000 million a year.

  The costs to the NHS of other major diseases associated with physicial inactivity are also substantial and therefore there are economic savings to be made from avoidance. One example is that the costs of type 2 diabetes in the UK have been calculated to be £2 billion (2000 prices)vi. Physical activity has been demonstrated to be inversely related to the incidence of type 2 diabetes.vii Physical activity can contribute to the prevention, and following early detection, to the reversal and prevention or delay of complication in type 2 diabetes.

  The beneficial effects of moderate intensity physical activity are even more important to those sub-groups of the population who are at elevated risk of type 2 diabetes due to being overweight, having an elevated blood pressure, and a positive parental history of type 2 diabetesviii. Reducing physicial inactivity could also help reduce economic costs, for example, of colon cancer, osteoporosis, mental health problems, and falls among older people.


  It is widely believed that the significant increase world-wide is due to greater relative declines in physical activity than increases in energy intakeix. The National Audit Office has calculated that the known direct costs of treating obesity in England in 1998 was £9.4 million (at 1998 prices). By far the largest component of this cost was the 519,486 general practitioner consultations which cost £6.8 million although this is likely to be an underestimate as the latest figures for GP consultations was for 1991-92. Additionally, no data was available for consultations with practice nurses and dieticians in primary care.


  There is a strong association between physical inactivity and obesity and each is associated with direct health care costs. Public health researchers are increasingly recognising that afforts focused on improving the environment so that walking and cycling are more attractive to people may have a substantial impact in reducing physical inactivityx. Indeed, increasingly public health research is focusing on environmental factors in enabling people to build physical activity into their daily lifestylesxi, xii. Speed and inappropriate speed is a major deterrent to the use of these modes of transport.

  Environmental influences are also increasingly reflected in public policy statements. The 1999 Charter on Transport, Environment and Health, approved by Ministers of the Member States of the World Health Organisation, which included the UK, highlighted the key role of walking and cycling as transport modes in enhancing healthxiii. Across a range of public policy fields which include, health, environment, and transport there is widespread recognition that programmes focused on increasing levels of walking and cycling in meeting travel needs also:

    —  provide the greatest potential for improving health;

    —  reduce direct and indirect health care costs; and

    —  deliver a range of substantial benefits associated with less motorised transport including quality of lifexiv.

  Given that over 44 per cent of trips are under two miles in length and 70 per cent under five milesxv there is tremendous potential for increasing the amount of walking and cycling. Reducing road danger by enhanced speed management to reduce illegal and inappropriate speeds would be an important step forward.

Dr Adrian Davis

For the Slower Speeds Initiative, February 2002


  i  Department of Health, 1999 Saving lives; Our healthier nation, London: Stationary Office.

  ii  World Health Organisation/Federation of Sports Medicine, 1995 Exercise for Health:WHO/FIMS Committee on physical activity for health, Bulletin of the World Health Organisation, 73(2) pp. 135-136.

  iii  Department for Transport, Local Government and the Regions, 2000 National Travel Survey: 1997-99 Update, London: DTLR.

  iv  Department of Health, 1999 Health Survey for England: Cardiovascular Disease '98, London: Stationary Office.

  v  Britton, A McPherson, K 2000 Monitoring the Progress of the 2010 Target for Coronary Heart Disease Mortality: Estimated Consequences on CHD Incidence and Mortality from Changing Prevalance of Risk Factors. National Heart Forum: London.

  vi  Kings Fund et al, 2000 TARDIS: Type 2 diabetes. Accounting for a major resource demand in society in the UK.

  vii  Helmrich, S, Ragland, D, Leung, R and Paffenbarger, R. 1991 Physical activity and reduced occurance of Non-Insulin Dependent Diabetes Mellitus, New England Journal of Medicine, 325: pp. 147-152.

  viii  Lynch, J et al, 1996 Moderate intense physical activities and high levels of cardiorespiratory fitness reduce the risk of Non-Insulin Dependent Diabetes in middle aged men, Archives of Internal Medicine, 156: pp. 1307-1313.

  ix  Pescatello, L and Van Heest, J 2000 physical activity mediates a healthier body weight in the presence of obesity, British Journal of Sports Medicine, 34: pp. 86-93.

  x  Stevens, W, Hillsdon, M, Thorogood, M and McArdle, D 1998 British Journal of Sports Medicine, 32: pp. 236-241.

  xi  Oja, P,Vuori, I, and Paronen, O 1998 Daily walking and cycling to work: their utility as health enhancing physical ectivity, Patient Education and Counselling, 33: S87-94.

  xii  Owen, N, Leslie, E, Salmon, J and Fotheringham, M 2000 Environmental determinants of physicial activity and sedentary behaviour, Exercise and Sports Science Reviews, 28(4), pp. 153-158.

  xiii  World Health Organisation, 1999 Charter on transport, environment and health, Copenhagen: WHO.

  xiv  British Medical Association, 1997 Road Transport and health, London: BMA.

  xv  Department for Transport, Local Government and the Regions, 2000 National Travel Survey: 1997-99 Update, London: DTLR.

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