APPENDIX 60
Memorandum by The English Regions Cycling
Development Team (OB 49)
SUMMARY
The decline in physical activity is a key factor
that has contributed to the recent increases in obesity.
Cycling has declined significantly in recent
years, among adults and children.
Cycling is a healthy form of physical activity
with the potential to expend significant volumes of energy, hence
reducing the likelihood of obesity.
Cycling can be integrated into everyday life,
especially if a regular journey—such as to work or school—is
made by bike.
There is suppressed demand for cycling: there
are more than 20 million bikes in the UK, many of which are rarely
used.
Cycling is cost-effective: compared to cars,
bikes are cheap to buy and extremely cheap to run. Cycle infrastructure
is extremely cheap to provide compared to the road network.
The benefits of cycling are greater than the
risks: the British Medical Association (BMA) concluded that the
benefits of cycling are likely to outweigh the loss of life as
a result of crashes.
The Department of Health should give a higher
priority to policy and promotion of cycling.
Primary Care Trusts should be encouraged to
develop comprehensive approaches to increasing cycling in their
areas, in conjunction with local authority partners, through local
strategic partnerships.
ENGLISH REGIONS
CYCLING DEVELOPMENT
TEAM (ERCDT)—AN
OUTLINE
1. The English Regions Cycling Development
Team (ERCDT) was established in 2002 by the Department of Transport
and the National Cycling Strategy Board. The ERCDT has the task
of helping to deliver the National Cycling Strategy target of
quadrupling the number of trips made by bicycle from 1996 levels
to 2012.
2. In England, the National Cycling Strategy
(NCS) is overseen by the NCS Board, which has overall responsibility
for the recommendation of day-to-day policy, advice and guidance
to local authorities and Government Departments.
3. ERCDT members are employed by AEA Technology
and are located in each region in England. In addition there are
a number of co-ordinators with specific responsibilities and specialist
advisors on issues such as road safety and health promotion. Team
members have responsibilities for assessing the quality of strategy
and implementation for cycling in each region, and for identifying
priority actions to enhance the development of cycling in England.
4. Other witnesses will no doubt highlight
the important role of all types of regular physical activity in
helping to reduce the risk of obesity. This statement will focus
on the unique contribution which greater levels of cycling could
make to reducing the incidence of obesity in the population.
BACKGROUND
Physical activity and obesity
5. More than 50% of adults in the UK are
overwieght, putting them at increased risk of hypertension, coronary
heart disease, type 2 diabetes, and osteoarthritis. 1 Obesity
occurs when a person puts on weight to the point that it seriously
endangers health, and is defined as a body mass index (height/weight2)
of over 30. Levels of obesity have risen dramatically in the UK
in recent years: one in five adults is classed as obese, a trebling
of levels in the 1970s.
6. Obesity is an increasing problem in young
people: the Health Survey for England in 1997 found that 20% of
four year olds were overweight, and 8% were obese. Among 16 to
24 year olds, 23% of young men and 19% of young women were overweight
and a further 6% of young men and 8% of young women were obese.
3
7. Weight gain occurs when the energy taken
in as food exceeds the energy expended through physical activity.
Food surveys in the UK tend to show that the average energy intake
has either fallen or remained unchanged, which implies that declining
levels of physical activity are the main cause of the epidemic
of obesity. The authors of a review on this subject concluded:
"Evidence suggests that modern inactive
lifestyles are at least as important as diet in the aetiology
of obesity and possibly represent the dominant factor".4
8. The ERCDT's belief is that declining
levels of physical activity among adults and children are key
factors that have contributed to the recent increases in obesity.
More cycling could make a major contribution to increasing overall
physical activity, and reducing obesity.
Cycling and Obesity: Trends
9. Cycling has declined (along with many
other forms of physical activity) in recent years. Chart 14 shows
that annual cycle traffic fell substantially from the 24 billion
kilometres recorded in 1949. Having peaked again between 1982
and 1984, cycle traffic fell steadily again, to around five billion
kilometres per year since the 1990s.
10. In terms of all road traffic, cycling
declined from 37% in 1949 to just 1% in 1995. Between 1985-86
and 1995-97 the average distance cycled per person has fallen
from 44 to 39 miles5.
11. Cycling to school has declined significantly.
Fewer than 2% of pupils aged 11-16 cycled to school in 1995-97,
compared to more than 6% in 1985-86. Correspondingly, the proportion
of five to 10 year olds being driven to school has increased from
22% in 1985-86 to 36% in 1998-2000.
12. The dramatic decline in cycling has
been matched by a stark increase in travel by car, which rose
from up from 388 billion passenger kilometres in 1980 in 624 billion
in 2001—an increase of 61%.
Cycling and Obesity: Relationships
13. The most stark decreases in cycling
(and walking) and increases in car travel have been in the last
20 years, the same timeframe over which obesity has tripled.
14. A recent study in China suggests that
this relationship between car travel and obesity is more than
coincidence. The study looked into vehicle ownership and obesity
levels among 4,741 Chinese adults aged 20 to 55 years. It found
that the odds of being obese were 80% higher for men and women
in households who owned a motorized vehicle compared with those
who did not own a vehicle. Men who acquired a vehicle experienced
a 1.8 kg greater weight gain and had two to one odds of becoming
obese compared to those who continued to rely on more active modes
of transportation6.
15. Experimental studies have shown the
potential for cycling to help control weight. A UK study of non-exercisers
who agreed to take-up cycling on at least four days a week found
that body fat was significantly reduced among most of those of
the volunteers who were overweight or obese at the outset (59%
of volunteers). The average fat loss was in the region of two
to three kilograms of fat mass over the period of the trial.7
Why is cycling such a strong option for increasing
levels of physical activity in the population?
It can be integrated into everyday life.
16. Cycling has great potential to be incorporated
into daily routines. Nearly ¾ of all journeys are under 5
miles, a large proportion of which could be done by bike. There
is also great potential to increase rates of cycling to work and
school. This would offer people a regular opportunity for physical
activity without having to set aside time for the gym or a swim.
Surveys show that only around 10% of people take part in regular
sport and exercise, citing "lack of time" as the main
barrier.8 Lack of accesible facilities for formal exercise is
also important. The situation with swimming illustrates this:
a Sport England survey in 1997 showed that there were fewer that
900 public swimming pools in the whole of the UK—one for
about every 60,000 people.9
It is a healthy form of physical activity
17. Cycling is an aerobic activity which
uses major muscle groups, expends significant volumes of energy,
and has the potential to raise the heart rate to an extent that
benefits cardiovascular health. However, the intensity of effort
is usually greater than walking. Cycling at only 10 miles per
hour (16 km per hour) expends 5.5 METS (MET stands for metabolic
equivalent, with one MET being the energy used at rest). Walking
would have to be done at a very brisk pace (faster than 4 mph
(6.4 kph)) to use the same amount of energy. 10 Also, cycling
uses periods of active work alternating with rest periods, which
allow recovery from high levels of activity in motion. These factors
make it a highly suitable activity to provide aerobic exercise
and thereby to improve physical fitness. 11
18. Cycling is also low weight bearing.
Many people cannot do certain sports (especially activities such
as running) because of the pressure it puts on their joints. Because
the bike takes the weight of the body, much less pressure is exerted
on the joints while cycling. This makes cycling a good form of
exercise for those with certain joint problems.
People want to cycle
19. Although there are more than 20 million
bikes in the UK, many are rarely used. Research suggests that
although many bicycles are purchased for leisure use, the majority
of cycle trips are for utility journeys. For example 37% of cycle
trips are to work and 15% for shopping, while 35% are for leisure.
The popularity of the National Cycle Network has shown the great
potential for well-planned cycle routes, with some 100 million
journeys being cycled across the network. Much of this is "leisure
cycling" done on an occasional basis. A key challenge is
to transfer this to more frequent everyday journeys, by creating
an environment in which people feel safe to cycle on a daily basis.
Cycling is cost effective
20. Compared to cars, bikes are cheap to
buy and extremely cheap to run. This is an important issue for
reducing the effect of social exclusion which many people suffer
as a result of transport availability, limiting access to employment
leisure and recreation. 12
In addition, cycle infrastructure is extremely
cheap to provide compared to the road network.
Increasing cycling (and other forms of physical
activity) would also bring benefits in terms of reduced cost to
the NHS. A recent government report estimated that physical inactivity
costs the nation at least £2 billion per year. 13
More cycling would bring other benefits to public
health
21. Some of the reduction in activity levels
in recent years has come about because of an increasingly hostile
traffic environment, which has contributed especially to a strong
decline in child cycling. 14 In contrast, traffic environments
which are supportive of cycling, which control vehicle speeds
through cycle-friendly infrastructure such as traffic calming,
and include road space reallocation, can include space for children's
play. Research into children's play has concluded that:
"Children's needs for safe access to a diverse
outdoor environment on the front street and opportunities for
extending their free range mobility along footpath networks and
traffic calmed roads, needs to be incorporated in the estate design
and management process." 15
22. Perhaps more importantly however, high
traffic speeds diminishes the ability of young people to interact
properly with their environment learn about their surroundings
and develop an appreciation of risk and adventure. Streets with
speeding traffic do not make good playgrounds. As one BMJ correspondent
stated: "The sad reality is that most streets are now linear
car parks with a central race track." 16
23. By contrast, "liveable streets"
filled with people on foot or two wheels have cleaner air, less
noise, are safer, encourage social interaction and play, build
social capital and discourage opportunities for crime and diminish
the fear of crime. These broader benefits of (walking and) cycling
should not be underestimated.
The benefits are greater than the risks
24. Many people say that the risk of cycling
is one of the main barriers to more people getting "on their
bikes." However, the British Medical Association (BMA) has
concluded that the benefits of cycling are likely to outweigh
the loss of life as a result of crashes. 17
25. In 2000, a total of 125 adults and children
were killed in the UK while cycling. By contrast, 125,000 people
died in the same year from coronary heart disease (CHD) in the
UK, of which around 45,000 deaths can be attributed to lack of
activity.
26. Countries which have seen a modal shift
in favour of cycling have noted reductions in casualties as the
roads become safer—some times termed "critical mass".
For example, in the Netherlands and Denmark, there have been steady
increases in the amount of cycling in recent years, accompanied
by lower casualty rates per mile. This has been achieved by adopting
comprehensive measures to create better conditions for cycling
and because the more cyclists that there are, the more motorists
are aware of cyclists and consequently the better they are at
dealing with them and the more positive their attitude towards
them.
27. The ERCDT believes that encouraging
people to cycle should be accompanied by creating a safer environment
in which to cycle, and at the same time encouraging safe, responsible
and confident behaviour by both cyclists and drivers.
Cycling is growing in policy importance
28. The importance of cycling as a means
to achieve greater sustainability and improvements to public health
from transport was recognised in the Charter on Transport, Environment
and Health adopted by Member States of the European Region of
the WHO in 1999 at the 3rd Ministerial Conference on Environment
and Health. 18 WHO has concluded:
"there are major opportunities for achieving
large health gains for the European population by increasing levels
of routine physical activity. Walking and cycling as means of
daily transport can be a most effective strategy to achieve these
gains." 19
CONCLUSION
29. Cycling is not the universal answer
to society's problems. It does however offer a healthy, sustainable,
regular opportunity for people to achieve the recommended amounts
of physical activity necessary to prevent obesity. More cycling
would also bring a range of other benefits to society, notably
safer streets.
RECOMMENDATIONS
1. The Department of Health should give
a higher priority to policy and promotion of cycling. We note
for example.
— The NHS Priorities And Planning Framework
for 2002-03 contains a programme of action in smoking and a healthy
diet but nothing on encouraging physical activity including cycling.
— Only one of the nine Local Exercise
Action Pilots recently funded by the DH mentioned included cycling
in its list of activites.
— Milestones relevant to cycling have
been misssed: the National Service Framework for Coronary Heart
Disease included a milestone for the production of travel plans
within the NHS by April 2002. These are plans for NHS premises
which include measures to encourage sustainable transport including
cycling. Few NHS trusts achieved this milestone.
— Department of Health involvement
in the National Cycle Strategy and in promotions such as National
Bike Week has been low.
— There was no DH financial contribution
to the Department for Transport's Cycle Projects fund. This could
have been used to increase the amount of projects funded with
an objective of improving public health through cycling.
2. Primary Care Trusts should be encouraged
to develop comprehensive approaches to increasing cycling in their
areas, in conjunction with local authority partners, through local
strategic partnerships. Areas for action include:
— Strenghtening the connections between
the Health Improvement and Modernisation Programme and the Local
Transport Plan.
— Including cycling as part of approaches
to the prevention of coronary heart disease and cancer.
— Learning from and replicating some
of the examples of good practice such as Stockport PCT's "Health
on Wheels" scheme which offers cycling to patients undergoing
cardiac rehabilitation.
— Developing travel plans for NHS premises
which provide incentives—such as bike mileage allowances—for
changing from car to bike for certain journeys.
Nick Cavill
Specialist Advisor—Health Promotion
English Regions Cycling Development Team
CASE STUDIES
Personalised Travel Plans—Queens Medical
Centre (Nottingham) 20
Nottingham Travelwise Centre offers staff at
Queens an individualised travel plan. After looking at an individual's
route to work by car, realistic alternatives are suggested by
bike, train or bus. Initial take-up has been high with many staff
switching from the car to bike. The Trust also installed new cycle
parking facilities with CCTV, showers and lockers.
Addenbrookes Hospital Cambridge21
This busy hospital site sees 18,000 vehicle
visits per day, and has been working to reduce car use since 1993.
A range of initiatives have been put in place including interest
free staff loans for bikes, high car parking charges and bike
parking facilities.
In 1993 74% of staff travelled to work by car,
in 2001 it was 59%. More than 1,300 employees regularly cycle
to work.
Second-chance cycling
In Stockport PCT, cycling is being offered to
patients recovering from a heart attack as part of an innovative
approach to cardiac rehabilitation. As well as being offered access
to gyms and "healthwalks", people recovering from a
heart attack are being offered weekly bike rides led by an experienced
cycle leader. One group of men were so keen on cycling after their
course that they formed a new cycling club—the "Second
Chance Cycling Club" and continue to ride together every
week.
Cycling in the NHS—Bristol
The Physical Activity Advisor for Bristol South
and West PCT has been given responsibility within the Trust and
also in partnership with Bristol North PCT to work with NHS sites
across Bristol to improve conditions for cycling among staff,
whether for the journey to work or during the course of work.
New secure cycle parking has been installed within some buildings,
interest free loans for purchasing a bicycle, 50p a mile when
cycling during the course of work, and better changing facilities
developed. The work also involves close collaboration with Bristol
City Council in promoting travel plans at the NHS sites. The Council
offers to analyse travel surveys free of charge.
Cycle Lifestyle—Cycling Project for the
North West
This project offers activities to young people
aged 13-19 who are at risk of social exclusion in Manchester.
Young people can take part in activities like skill development
sessions, off road cycle sessions and bike recycling.
The project has reported a range of positive
outcomes among the young people attending the activities, including
increased self-esteem, improvements in health and fitness, and
more positive relationships.
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