The British Medical Association's hard-hitting new report on Transport and Health calls for traffic restraint, challenging walking and cycling targets, improved provision for walking and cycling, 20mph speed limits, and health sector action to promote active travel. Will the Government take note?
BMA calls for health, not the economy, to drive transport policy

The British Medical Association's report Healthy Transport = Healthy Lives [2] in many ways echoes what the BMA was calling for in its 1997 report on Road Transport and Health. This time though, they have put the spotlight firmly on the economic costs of car-dominated transport policies, and the huge economic benefits of a healthy and sustainable society.

To quote the report: “Much of UK policy to date can in part be attributed to the governmental focus on expanding the automotive industry, rather than prioritising the health of the nation.”  It also notes that, "Transport-related physical inactivity in England is estimated to cost £9.8 billion per year to the economy. This figure is in addition to the £2.5 billion in healthcare costs spent annually on treating obesity."

The report sets out the public health costs of roads-dominated transport policies in terms of physical inactivity, road injuries, air pollution, noise and climate change. It calls for a stronger focus on public transport to reduce these costs.

However it is the chapter on active travel which is most directly relevant for cycle advocates. It calls for many of the same measures that CTC also advocates: traffic restraint, ambitious targets for increased walking and cycling, 20mph speed limits, quality walking and cycling provision, and so on. It also urges the health sector to play its own part, by: ensuring that healthcare services are easily accessible by walking and cycling, working with local councils to “health-check” their transport and planning policies, and promoting active travel for their staff, patients and local communities alike.

The BMA report also includes a useful appendix summarising the findings of various NICE guidelines [3] which support the promotion of cycling, both through physical and promotional measures.

There are a few pieces of evidence we would like the BMA to have considered, had we known that this report was coming. One is a report on cycling, transport and health [4], commissioned from University College London by the Department for Transport (but so far ignored by them), whose conclusions entirely support those of the BMA report.  That reports said that “The key relationship is between car use and physical activity, In order to increase levels of physical activity, it is necessary to reduce the use of the car.”

It is also unfortunate that the BMA report cites an American study showing that a school-based initiative to promote cycling had no beneficial effect, claiming that this shows that behavioural interventions on their own are ineffective. We would entirely agree with the BMA that behavioural measures will work better if combined with improved cycling provision on the ground. However it does not make sense for the BMA to claim that behavioural measures in general are ineffective without environmental improvements, purely on the basis of a single study of one type of behavioural intervention in a US context. There is plenty of evidence that cycle training, and a host of other “smarter choices [5]” measures (whether in schools, workplaces or community settings, likewise those involving individualised or media-based awareness campaigns), can be effective without environmental improvements – even though it is doubtless true that the two approaches would work better still if combined.

Finally there is the BMA’s restatement of its support for cycle helmet laws. BMA does recognise the concern that these could reduce cycle use, and therefore would prefer voluntary helmet use to increase first before laws are introduced. However the BMA has not yet considered recent evidence [6] showing that even promotion campaigns are almost certain to be detrimental to public health. If the health benefits of cycling in Britain outweigh the risks involved by a factor of 20:1 (a figure now acknowledged by the UK Government), it follows that helmet promotion campaigns (let alone laws) would shorten more lives than they could possibly, even if they were 100% effective, if they caused more than a maximum reduction in cycle use of c2.4%.

The BMA report’s call for 20mph speed limits came out on the same day that the Government launched a consultation on new draft guidelines for setting local speed limits. [7] The new advice is only marginally more positive than the current guidelines, in that it invites (but doesn't exactly encourage) local authorities to consider 20mph limits on busy shopping streets and other people-dominated urban main roads, as well as residential streets.  A few days later, the Commons Transport Select Committee's report on its road safety inquiry highlighted the lack of Government leadership [8] on road safety (see commentary [9] from my colleague Chris Peck), while health magazine The Lancet [10] called for action on what it called a global "inactivity pandemic" [11].

With Directors of Public Health due to take up new roles within local authorities in April 2013 (under the Government’s health reforms), we are keen to seek dialogue with the BMA over the new evidence we’d like them to consider.  We very much look forward to forging closer links with them and other health sector bodies to promote cycling, both locally and nationally.