Joining Forces to Tackle Obesity, 21-22 January 2002
Transcript : Preventing Obesity Through Physical Activity
Strategies
Adrian Davis
Consultant on Transport and Health
DR WILLIAM DIETZ: Our next speaker is Adrian
Davis, consultant on transport and health and his topic is Active
Transport Barriers and Opportunities. Thank you, Adrian.
ADRIAN DAVIS: Good afternoon. I’m glad to say
that so many faces out there I don’t actually know and the reason
that I’m glad about that is because I think and a very serious
point is we need to have far more intellectual dialogue across the
silo’s, these disciplinary boundaries, that the various previous
speakers have talked about.
As I’ll explain, in order to promote and sustain weight
management and general health, health concerns such as obesity and
overweight do not necessarily have to be issues at the forefront of
transport planning in order to achieve health benefits that may be
sought. It would help however if health professionals and people
here today, concerned with issues such as overweight and obesity,
if they were to better understand transport policy and the drivers
of transport policy in order that you can actually think about how
you can best tap into transport policy and to translate the values
that you have to promote physical activity and healthy lifestyles
into things that transport policy can deliver that they may not use
the term "health" at all in the way that they articulate their
programmes of work.
Now going back for a bit of a history lesson. I’m going to
canter through the first few slides. In transport planning one of
the great historical documents that we refer back to is the
Buchanan Report. In 1963 -- Colin Buchanan, who died just before
Christmas, he was a kind of icon in a way in the transport planning
world and he very much saw what was coming. "Traffic in Towns" was
a report which was later mirrored in many countries around Europe
and in fact also in North America in that it was a document which
asked questions from society about the way we wanted our society to
be structured. Did we want to rebuild our towns and cities to
favour the car more or did we want to try and control the car
before too many people got cars and it became very, very difficult?
And it was a political decision of course not his decision as a
civil servant - a political decision - to kind of choose, I think
unfortunately, a situation where we had tried to remodel our towns
and cities very much to make more room for the car and less
therefore for people to be able to be safely physically active, so
they’ve opted out of expending calories by walking and cycling
which on a particular note I suppose I’m focusing on here when I
talk about active transport.
So as other speakers’ of course have said, "We have mechanised
so much of our lives now from the electric toothbrush, that the car
has been one of the primary vehicles, to use a pun, for reducing
the amount of physical activity that we take". For example, in
terms of all road traffic, cycling comprised 37% of all road
traffic in 1949 but just 1% in 1995 and that involved a contraction
from 24 to 4.5 billion kilometres a year so there’s been an
absolutely massive decline in cycling. And I’m just going to, as I
say, canter through these figures and you’ll see them presented
more nicely in Nick Cavil’s presentation. I think he’s got some
nice coloured bar charts but anyway you can see, as though it came
to pass, what Buchanan was in a way suggesting was going to be the
case: the car was such a desirable item that people would chose it
and therefore they would reduce their calorie intake although I’m
sure no-one was thinking about that at the time in 1963 but we see
it very much declines in cycling and we see parallel declines in
walking.
So to make an apology to the Department of Health for
misappropriating a strap line that they use in their consultation
on physical activity in 1995, what we’ve had is a reverse of course
of what we want. We’ve got more cars, more active, more often
rather than more people, more active, more often. And just to quote
a few statistics at you: between 1989 and 1991 and 1998 to 2000 -
these are national travel surveys which the Department of Transport
undertake - the average length of shopping trips has increased by
26% and that’s just to reflect what Tim was saying earlier;
commuter trips have extended by 16% and education trips have
extended by 15% as parents scuttle across from one side of the town
or city to get their child to a school that they think is going to
do them best and so remove the option of course for walking and
cycling.
Therefore it is no surprise that the Commission for Integrated
Transport which was set up by the Labour administration when they
came to power in 1997, it produced a report at the end of last
year, one of its conclusions was that British people make more use
of cars than in any other European country, despite having below
average car ownership. I find that hard to believe sometimes when I
live in Bristol and all the residential streets around my home are
cluttered up with cars but we do have less cars than the European
average but we use them more intensively. We use them of course in
many ways - unnecessary ways - for short trips, so more short trips
are being made by car but also the average length of the trips that
we are making has become longer partly because there are land use
decisions about where you site your shopping centres and your
hospitals and all the key things that we need to access because the
prime function of transport is not transport per se, it’s about
access. It’s access to the goods and services and the things that
we need in order to carry out our daily tasks. So that’s really the
transport background. Let’s not loiter on that one any longer.
A brief bit of history about the links between transport and
health because I think for many, many years the Ministry of
Transport and Health have really been stuck in the bio-medical
model, which simply put is they’ve been stuck on focusing on road
traffic casualties which is very understandable. First road traffic
casualties were collected in 1927 and we’ve had a strong focus of
course on having to deal with the results of road traffic crashes
since then. Noise; which the Wilson Committee in England addressed
in 1963, that noise actually was a serious health issue and that
was reiterated in 1971 by an OECD report; and on air pollution
where we’ve had a kind of dip after the Clean Air Act in 1956,
there was less interest in air pollution and then in the 1980s
public health started to twig that actually motor traffic, all
these little engines running around, were actually going to cause
us increasing problems.
But from today’s perspective in terms of physical activity I
think that one of the key things is that it was only in 1996 when
the Department of Transport at the time launched a National Cycling
Strategy which had a number of targets not least to quadruple
cycling by 2012 from a 1996 baseline but also in the same year we
had a strategy statement on physical activity from the Department
of Health. And these, for the first time, actually started to look
over their own silos or their own fences and said, "Yes, we need to
link physical activity. We have to see that as a part of the
routine of daily living and transport is the important part of
that". Similarly, cycling - the National Cycling Strategy -
identified important health benefits to do with cycling but I think
it’s kind of quite important to dwell on the idea that it wasn’t
until 1996 that in public policy, in stated documents, we didn’t
really have that link made.
Now, healthy public policy. What is that you might say? Well I’m
just going to look at the health sector here and I’m thankful Tim
Lang made the point because I sometimes think, "Am I mad to put up
this quote from David Hunter?" although David Hunter is a fairly
senior, health figure. Just to remind people: yes, the health
service is a national sickness service. That’s what it spends most
of its time doing. It’s focused on GPs and hospital waiting times
and all the political pressure is at that end of the spectrum. It’s
done very little in fact in the past about health promotion because
all the political focus has been on dealing with the illness caused
by the things that happened largely outside of the health
sector.
To quote Nancy Millio, who is one of the people that really
developed the idea of healthy public policy, she said healthy
public policy can be defined as, "Health work must attend to the
policy sectors and organisational factors affecting conditions and
conduct that create health" and the thing is that these are very,
very largely outside the health sector. So we have to look at the
other areas of public policy to see what’s going on that’s making
us sick that’s then taken up our hospitals.
But equally healthy public policy is problematic because it
involves having to collaborate with people in other professions who
have different raison d’être; who’ve had different training with
different university degrees and all the rest of it; talking
different languages and it’s very difficult and they’ve different
budgetary constraints to ourselves’ and the history of public
policy is that it’s actually very difficult to do. The idea of
inter-sectoral collaboration is nice in theory but if you look at
the literature and the literature is fairly firm in saying that it
fails more often than it succeeds and that happens, even in
England, where we have close relationships between the health
sector and social services.
There was a report, an academic paper in 1999, which talked
about the idea of a Berlin Wall between social services and the
health sector and they historically have recognised the closed
connection between them. So if we think about the health sector and
transport it’s actually much, much harder to try and get
inter-sectoral collaboration to take place.
Now, nonetheless - that’s the kind of the down side of it - on
the positive side, at the end of the 20th century there
have been some examples now of inter-sectoral collaboration of work
on transport and health to try to promote healthy, active travel.
At the local level we have examples around the country of where
there have been the links made to try to promote walking and
cycling and of course the government - and Nick will reiterate -
that the government has recently issued a document on promoting
walking to work; trying to promote walking as active transport as
well as that you get the health benefits as well as accessing your
job.
So in terms of looking at the health sector I just want to
quickly look at health conscious transport planning. Is there such
a thing? What I’d like to say after many years of trying to con
myself that I think there is health conscious transport planning, I
think there isn’t largely but I don’t think that’s necessarily a
bad thing. The important point is that while health may not
necessarily be intrinsically a policy objective of transport
planning it is possible to build health into transport policy
objectives of the national and local level by looking, as I said at
the very beginning, at what are the policy drivers of transport
planning?
The second bullet point there comes from guidance from DTLR
which is issued every year for the local transport plans which is
the local level operationalisation for transport work in local
government and you see things like protecting the environment;
improved safety; efficiency; economy; accessibility and
integration. We can build health into there. You don’t necessarily
have to see the health label but there are ways that we can promote
health by grabbing hold of some of those ideas and working with
transport planners to actually get more active transport and get
more people being physically active as part of their routine.
Quickly moving on - I just need to explain this table a little
bit. The table is from an international comparative study I
finished a couple of years ago and I think the important point to
say is that it underlines the fact that ultimately the critical
factor is that environmentally led transport planning can deliver
health irrespective of whether the health sector is actually doing
something to support transport planning in itself. I mean, if we
look down the table we can see in the Netherlands, NT, that while
there is low support, (and this was a study looking at Health for
All and I think Health for All is a very good litmus test of seeing
whether the health sector and health and how promotion of public
health can influence transport planning because it has a social and
ecological model of health as well as a bio-medical focus) in the
Netherlands there was low support at the local level for Health for
All focusing on transport and there wasn’t a very high level of
support at a national level. But nonetheless as other people have
said because you’ve got an environmentally led transport policy in
the Netherlands you’ve got 30% of people regularly cycling as part
of their daily journey, you’re getting a health benefit out of it,
so you don’t necessarily have to have health as an up-front
statement. Environmentally led transport policies will help to
deliver health benefits nonetheless.
And you can see the same in Denmark. There again in Denmark
there was actually very strong support for Health for All at the
national government level and at the local level to support
transport work. And, like Tim, I kind of go to Copenhagen
occasionally and I think what a wonderful place and perhaps I
should actually move here because it’s so civilised. When I think
about bringing up my 20 month old child - I think if I want a safe
environment for my child to be able to be physically active, you
know to be able to get on a bicycle when she’s 3 or 4 and to know
she’s safe cycling on a local road she can do that in Denmark. She
would not be able to do that in Bristol and that in fact it is this
toxic environment that Ken was talking about that is very, very
much putting people off from making the healthy choices.
Now I’ll quickly go through this slide because it’s actually
"reasons to be cheerful". In a sense I think what it indicates is
that people do want to make the healthy choices. At the individual
level health is an important determinant of travel mode for a
minority of people and this DTLR chart - a Department of Transport
chart - derived from the ONS Omni Bus Survey in January 2001, shows
that some people, despite the current hostile traffic environments,
are changing their behaviour. In fact 38% of the sample reported
that they have switched some short car journeys to other modes in
the last 6 months. So some people, despite the environment, are
actually trying to do it. They know they should be doing it and
they actually are trying to do it.
So importantly I think one of the relevant points in this is
there is suppressed demand - a sort of jargon we use in transport
planning - there is suppressed demand for walking and cycling but
we need to think about how we can help to release that suppressed
demand.
So to move towards the end; the actions’ needed for more active
transport. There has been too much focus I think in the past within
health research and health planning on motivating the individual
and that’s been referred to by previous speakers and this has not
taken account of the wider environmental context within which
people have to make their choices.
There is a need for greater recognition of the transport
environment as generally the most powerful determinant of whether
we can walk and cycle, so largely behaviour changes have to be
infrastructure led so we have to change the environment. What you
might say is we need to cure the environment so that people can
make healthy choices and the critical example I think of this at
the moment is for example 20 mph zones in urban areas. There are
calls now for 20 mph zones across all of urban areas apart from a
few major arterial routes and in fact a House of Commons Select
Committee is just about to take evidence on speeding and
inappropriate speed and hopefully from the pressure groups that I
am involved with, like Transport 2000 and the Slower Speeds
initiative they will be arguing for much wider use of 20 mph zones
within built up areas so that we can encourage people, to make them
feel that it is a safer environment, to think about using the
healthy choices.
Related aspects to do with speed is that when people drive more
slowly they need less space to drive in and there comes the
opportunity for reallocation of road space. It was in the
government white paper on transport in 1998 and it’s one of the
things that we need to do; we need to reclaim some of the road
space to make protected space for cyclists and pedestrians so that
they feel they have some room and right to be there which in many
cases I think that they do not feel that they have that right.
And moving towards final words really is I think there is also a
need for public health, more generally the health sector, to engage
with transport. A prime example has to be that the NHS is the
largest employer in the UK and needs to show that it is addressing
the motor traffic that it generates; it generates millions of motor
traffic vehicle trips probably daily; 5% of the total motor traffic
flow in the UK is generated by the NHS.
Travel planning as has been mentioned in one of the workshops
yesterday is a milestone in fact in the national service framework
on coronary heart disease so that all NHS facilities should by
April this year have travel plans. Most of them, very much most of
them, will not so they need to make progress on that. But if we
could have more public health and allied professions pressing and
campaigning for the NHS to take travel planning more seriously,
that they should actually be champions in their local communities
rather than choking up their local communities’ residential streets
as a result of their own overspills of cars around NHS sites, that
would be a first important step I think.
Making the healthy choices the easy choices is certainly not
easy but if trends in overweight and obesity are to be halted and
reversed, part of the solution lies in travel options becoming far
more favourable to active transport. The added weight of the health
sector vociferously supporting, defending and arguing the case for
environmentally led transport planning would be one of the few
examples of where increasing weight leads to positive health. Thank
you very much.