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

Memorandum by the Health Development Agency (RTS 153)



  This briefing from the Health Development Agency (HDA) begins by looking at the impact of transport on health—accidents, physical activity and social interaction/quality of life—and considers what part speed plays. It also considers the implications for health inequalities. It then looks at the evidence of effectiveness of interventions. Finally, it highlights some common elements of approaches that have made progress in tackling the health impacts of transport and speed.


  Road traffic speed has a direct impact on health: it is a major cause of crashes, and the seriousness of accidents is related to speed.

  Speed has important indirect impacts on health:

    —  Perception of road danger discourages walking and cycling, two of the most important kinds of physical activity.

    —  This perception restricts social interactions (for example, by cutting people off from everyday facilities), affects the quality of life, and can induce feelings of stress, particularly among older people.

  Speeding is more common in less affluent areas. (There is a link between level of deprivation and child accident rates.)

  There is evidence that the following measures can reduce road traffic speed:

    —  Engineering changes to the built environment designed to reduce speed and calm traffic: 20 mph zones seem to be particularly effective in achieving injury reductions.

    —  Safer routes to school schemes, which can be effective in encouraging both walking and cycling.

    —  Targeting high-risk behaviours, particularly speeding and drinking, by combining public education, engineering changes and enforcement.

    —  Comprehensive local approaches to speed management that put pedestrians, people and mobility problems and cyclists at the top of the hierarchy of road users.

  Local strategic partnerships (LSPs) should lead comprehensive approaches, bringing partners together and linking health improvement and modernisation plans (HIMPs), local transport plans and community strategies.

  Also essential is joint action at Government Office level where public health teams should work closely with regional transport and planning officers.


  Three health impacts are significant in looking at transport and speed: casualties, reduced opportunities for physical activity and restriction of social interaction/quality of life. These are discussed briefly below.

3.1  Casualties

  The most visible heath impact of traffic speed is road casualties. In 2000, there were 320,283 casualties and 3,409 people killed in motor vehicle traffic accidents in Great Britain (DTLR 2001). This includes 42,033 pedestrian and 20,612 cyclist casualties and 857 and 127 pedestrian and cyclist deaths respectively. Beyond these, there is an uncertain level of ill health associated with the psychological effects of road crashes. A study estimated that of all those treated in a casualty department as a result of a traffic crash a third suffered from psychological consequences and 45 per cent reported major physical problems a year after the event (Mayou & Bryant 2001). The majority (61 per cent) of physical injuries were minor.

  It is generally accepted that speed is a major factor in road crashes, and particularly on the severity of the outcome (DETR 1999). Excessive and inappropriate speed is the major contributory factor in around a third of all road accidents (Carsten et al 1989). A review of the literature on the relationship between speed and accidents (Finch et al 1994) found a reduction in accidents of around 5 per cent for each 1 mph speed reduction.

  There is a dramatic variation in road casualties across socio-economic groups. The pedestrian death rate for children from families in social class V is five times that for those from social class I (Roberts & Power 1996), and there is a correlation between the level of deprivation of an area and child accident rates (Kendrick 1993). Speeding is more common in less affluent areas (MacGibbon 1999). The Acheson report (Acheson 1998) noted that there would be 600 fewer deaths annually among men aged 20-64 if all groups experienced death rates from motor vehicle traffic accidents now seen in social classes I and II combined (Acheson 1998).

3.2  Reduced opportunities for physical activity

  Physical inactivity is accepted to be a major risk factor for a range of health outcomes, including coronary heart disease, colon cancer, diabetes and overweight/obesity. The prevalence of inactivity in the population is substantial, with around 60 per cent of men and 70 per cent of women failing to reach the minimum recommendation of 30 minutes moderate activity at least five times a week. In population terms this means that inactivity has a significant impact. For instance, it is estimated that the population attributable risk of coronary heart disease from inactivity is 37 per cent (British Heart Foundation health promotion research group 2002). The British Heart Foundation estimates costs to the health care system from coronary heart disease of around £1,600 million (British Heart Foundation health promotion research group 2002) and the National Audit Office estimates direct costs of treating the outcomes of obesity as at least £0.5 billion a year (NAO 2001).

  The current advice on minimum levels of physical activity is for all adults to take at least 30 minutes of moderate activity on at least five days of the week. Incorporating activity into the normal routines of daily life is likely to be the most effective way of achieving this. Cycling and walking are examples of suitable moderately vigorous activities that have the potential to be included in daily activities.

  Independent travel by children, particularly to school, has declined dramatically over recent years. The percentage of primary school children walking to school has declined from 67 per cent to 53 per cent between 1985-86 and 1996-97, with a corresponding rise in those travelling by car from 22 per cent to 38 per cent. Cycling to secondary school has declined from 6 per cent to 2 per cent (DTLR 2002).

  The major deterrent to cycling expressed by non-cyclists is fear of motor traffic (Carnall 2000). Vehicle speed is a major factor in perceptions of the road environment as hostile by both cyclists and pedestrians.

  There is evidence of "suppressed demand" for cycling and walking. A survey by MORI for the Commission for Integrated Transport (CfIT 2001) found that 47 per cent of people said they would cycle more and 65 per cent would walk more if problems were addressed. Safety was a key issue in both groups: 32 per cent of cyclists identified better/safer cycling routes as a solution (the most common response) and 26 per cent of pedestrians identified safe walking routes (the most common response being fewer cracked pavements—32 per cent). Average distance travelled per year by foot has declined over recent years, from 244 miles in 1985-86 to 191 miles in 1997-99—a drop of 22 per cent (DTLR 2002).

  Physical activity levels vary with social class. However, the relationship is not straightforward. Overall, men in lower social classes tend to be more active than those in higher social classes, partly due to the effect of activity at work. There is no clear pattern by social class in women. Deprived groups, however, are twice as likely to be sedentary as the most affluent. The built environment, including road traffic density and speed, is a major influence on the quality of the experience of walking in urban environments (Bostock 2001)—an experience which can be stressful, potentially adding to the burden of ill health of those living in degraded environments. Increasingly, there is an acceptance that environmental considerations influence the level of physical activity (Brownson et al 2001; Sallis et al 1997).

3.3  Restriction of social interaction/quality of life

  Severance, whereby motor traffic reduces access to health promoting facilities for those on foot or travelling by bicycle, has important health effects. Access to a healthy diet, places for activity, employment and recreation can be restricted and feelings of insecurity, anxiety and stress increased, particularly among older people (Health Education Authority 2000). Traffic volume and speed influence the level of non-traffic activity on streets—for equivalent streets, the higher the volume of traffic the lower the pedestrian activity (Appleyard 1981). Perception of road danger is one of the key reasons for this decline. Traffic speed is frequently identified as a major concern in public consultations. For instance, 68 per cent of people in a consultation for Gloucester Safer City identified speeding as a concern (Gloucester Safer City 1998). In a MORI poll for the Local Government Association road safety/traffic speed was the most commonly cited aspect of the local neighbourhood in need of improving: road safety/traffic speed and facilities for young people/children were both cited by 30 per cent of respondents (


  The HDA review of effectiveness of interventions in preventing unintentional injury in children and adolescents (Towner et al 2001) looked at interventions in a number of different environments. In the road environment, the authors looked at general interventions, and those aimed at pedestrians, cyclists, car passengers and bus passengers. They found reasonable evidence for the effectiveness of area-wide engineering measures and good evidence for the effectiveness of 20 mph zones in achieving injury reductions. The evaluation of 20 mph zones (Webster & Mackie 1996) found reductions in accidents of about 60 per cent and vehicle speeds by over 9 mph. Public acceptability surveys of residents were generally in favour of the schemes. Child pedestrian injuries were reduced by around 70 per cent and child cyclist injuries by 48 per cent.

  It is possible to increase levels of physical activity, and of walking in particular. The HDA guidance on prevention of coronary heart disease (Health Development Agency 2000a) and the forthcoming guidance on cancer prevention (Health Development Agency 2002) look at how physical activity can be encouraged. Characteristics of activities that have been found to encourage uptake are those that are easily included into an existing lifestyle, are enjoyable and do not depend on attendance at a facility. Walking is the exercise most likely to fulfil these criteria (Hilsdon et al 1995). The US Centers for Disease Control and Prevention report on community based physical activity (Centers for Disease Control and Prevention 2001) found sufficient evidence to recommend development of walking trails as an effective intervention. Promotion of cycling and walking to work or to school can also be effective. Safer routes to school, as part of school travel plans, frequently include measures to reduce motor traffic speed and provide space for other modes. These programmes can increase both cycling and walking to school. For instance:

    —  An increase of 30 per cent in walking to school following the introduction of walking buses in St Albans. Walking buses generally comprise two volunteer parents, one to "drive" and one to "conduct", a trolley to carry school bags, and a long line of children.

    —  61 per cent of children cycling to Kesgrave school (Suffolk) following development of safer walking and cycling routes. (School Travel Advisory Group 2000).

  Integrated interventions have been shown to be effective. Between 1989 and 1995 the State of Victoria in Australia identified a growing road death problem with deaths increasing at 5 per cent per month. The Victoria Solution, renamed Safety First (PACTS 1998) concentrated on high-risk behaviours, particularly speeding and alcohol. The strategy used a combination of education, engineering and enforcement (with evaluation added). Automated radar speed cameras checked two million drivers each month, and speeding was reduced from 23 per cent to a current rate of under 2 per cent. Evaluation identified:

    —  52 per cent reduction in road deaths.

    —  36 per cent reduction in serious injuries.

    —  22 per cent reduction in reported crashes.

    —  Over 100,000 hospital beds freed.

    —  Direct savings of over AU$980 million to TAC (Transport Accident Commission—the state monopoly third party insurer).

  The parties involved emphasise that "road safety is not something that the authorities DO to a community, it is something that a community does for itself in association with the authorities". Community involvement is necessary if hard-hitting advertising backed by effective technology-based traffic law enforcement is to be accepted and to make speeding and drink driving socially unacceptable.

  The Gloucester Safer City project was a city-wide demonstration project running from April 1996 to March 2001 (Gloucester Safer City 1998). Based on a comprehensive approach to speed management with the following key ingredients: working within the framework set by Gloucestershire's Sustainable Transport Plan; extensive education and awareness campaigning, consultation and partnership; analysis of traffic flows and speeds, crash casualty records for the entire city and existing land uses; and a new road hierarchy for the city. Work included area-wide traffic calming on mixed use and residential roads and high profile enforcement of speed limits. By July 1999 achievements included: 47 per cent reduction in personal injury casualties; 5 mph reduction in speed on treated main roads and 10 mph reduction on mixed use and residential roads; 15 per cent reduction in motor traffic on mixed use and residential roads; modal shift in journeys to work through cycling and use of public transport (including an element of walking): 60 per cent of those surveyed feeling safer than they did five years previously.

  In Germany a programme of establishing 30 kph zones has been shown to be effective in reducing speeds. In Buxtehude, one of the demonstration projects, establishment of 30 kph zones and a five-tier road hierarchy (pedestrian zones, residential streets, collector streets, main roads and limited access roads) has reduced traffic speed on all types of road. At the same time levels of pedestrian and cycle traffic have increased by 17 per cent and 27 per cent respectively (Davis 2001).

  The City of York has adopted a comprehensive transport policy based on a "hierarchy of road users". This priority list is applied in making and implementing land use and transport-related decisions and measures. The list is as follows (in order of priority):

    —  Pedestrians

    —  People with mobility problems

    —  Cyclists

    —  Public transport users, including taxis

    —  Commercial/business users

    —  Car-borne shoppers

    —  Coach-borne visitors

    —  Car-borne commuters and visitors.

  It takes a danger reduction approach to speed management that has helped it meet national casualty reduction targets well in advance of target dates. The Council recognises that "slowing traffic down is the best way to stop accidents and make the roads feel safer for all road users". Three road categories with target speeds and measures to achieve compliance have been defined. These are traffic routes, mixed priority routes and residential areas. The target speed in the last category is 20 mph.

  Walking is an important form of transport in York with 24 per cent (double the national average) of journeys to work made on foot. The City Council adopted a Pedestrian Strategy in 1992 to promote and encourage more walking. This identified a 120 km route network, which will be improved to provide a safer and more pleasant pedestrian environment.

  Cycling is also an important form of transport in York. 20 per cent of journeys to work are made by bicycle. The national average is less than a quarter of this. A Cycle Strategy identified 80 km of cycle route of which about half has now been implemented. Advanced stop lines and signalised crossings are being installed to make cycling safer, and already there has been a reduction of 28 per cent in the number of cycle accidents, in the context of an increase in cyclist and walkers—against the national trend.


  Many of the interventions required to address the adverse impacts of speed are outside the direct control of the Department of Health and the NHS. However, evidence of successful action in transport and health has shown the benefit of combined action to achieve joint or overlapping goals.

  The Social Exclusion Unit (SEU) is currently examining transport and social exclusion and is considering proposals for targeted action to reduce child pedestrian injuries in deprived areas. If introduced, these could focus on speed and ensure all local agencies work together to address this issue.

  A number of elements seem to be common in achieving progress in tackling the health impacts of transport and speed. These are:

    —  Adopt a comprehensive approach as part of broader neighbourhood renewal strategies and community strategies. Effective policies tend not to focus on single problem sites or issues but try to address broader problems. Similarly, they are not restricted to single professional groups but include partners from across professions as well as engaging with the community.

    —  Joint action at regional level is key, with Government Offices' new public health teams working closely with regional transport and planning officers.

    —  There is a role for health professionals to act as "champions" for the health benefits of changes in transport policy and activity locally and to support the development of local information systems to identify and provide the necessary intelligence to support action (such as the road accident database developed in Cambridge). Such systems would include linking data between local government, police and health services to inform action on accidents; undertaking community health needs assessment in relation to physical activity, safety and access; and developing health impact assessment of transport policy.

    —  Changes in the built environment (such as traffic calming) are likely to be significant but are not the only element of effective schemes. The Victoria experience emphasised the importance of education and enforcement as well as environmental changes, combined with ensuring community "buy-in" to the proposed interventions. This requires joint work across local services, led by the local strategic partnership (LSP). Health improvement and modernisation plans (HIMPs) need to link to local transport plans, set out a joint approach and feed into the community strategy.

    —  Specific projects (such as workplace travel plans) to promote physical activity through transport can be effective. These will be more effective if they include action to address barriers such as perception of risk, the need to carry and store bags and so on.

    —  Local practitioners frequently mention that ensuring that guidance from different government departments is integrated is a key element in facilitating local action.

    —  Local flexibilities—enhanced by the Health Act (1999), the power of local authorities to promote and improve well being and the production of local community strategies—provide an ideal opportunity to develop comprehensive local action. Use of joint funding and pooled budgets will be key to tackling issues like speed. Some early examples (including funding of speed cameras) are set out in the Appendix, and this type of work should be actively encouraged.

    —  Local public service agreements (LPSAs) could be a key lever, linking to Best Value and the NHS performance framework. LSPs could identify joint targets.

  Hugo Crombie is Public Health Adviser, Physical Activity at the HDA.


  Acheson, D ed 1998, Independent inquiry into inequalities in health, The Stationery Office, London.

  Appleyard, D 1981, Livable streets, University of California Press, Berkeley.

  Bostock, L 2001, "Pathways of disadvantage? Walking as a mode of transport among low-income mothers", Health Soc Care Community, vol 9, no 1, pp 11-18.

  British Heart Foundation health promotion research group 2002, Coronary heart disease statistics, British Heart Foundation, London.

  Brownson, R C, Baker, E A, Housemann, R A, Brennan, L K, & Bacak, S J 2001, "Environmental and policy determinants of physical activity in the United States", American Journal of Public Health, vol 91, no 12, pp 1995-2003.

  Carnall, D 2000, "Cycling and health promotion. A safer, slower urban road environment is the key", BMJ, vol 320, no 7239, p 888.

  Carsten, O J M, Tight, M R, Southwell, M T, & Plows, B 1989, Urban accidents: Why do they happen? AA Foundation for Road Safety Research, Basingstoke.

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