ARTICLE FROM THE BOOK:
Cyclists & Cycling Around the World – Creating Liveable
andBikeable
CitiesCyclists& Cycling
Aroundthe World
Edited by Juan Carlos Dextre, Mike Hughes & Lotte Bech
Published by Fondo Editorial, Pontificia Universidad Católica del Perú, 2013
ISBN: 978-612-4146-55-8

Cycling and Health - Public health experts
recommend more cycling
By Philip Insall, Director, Health Sustrans, EnglandC

ycling is an active way of travelling. When you travel by bike you engage in physicalactivity. This directly benefits your health. Cycling is often grouped with walking
under the name ‘active travel’, and public health experts across the world are very
keen to see more people travelling actively more often.
The research evidence in favour of cycling is very strong, and each year it gets stronger.
Researchers on the Copenhagen Heart Study found that “even after adjustment for otherrisk factors ….., those who did not cycle to work experienced a 39% higher mortality rate thanthose who did”.

Start them young:children should beencouraged to cycle, tohelp them stay healthy
throughout life
Photo: J Bewley / Sustrans111Physical activity and healthPeople who lead active lifestyles, through walking and cycling, physical activity atwork, gardening, dance, or sport and active recreation, are healthier. However, in theUnited Kingdom, two-thirds of the adult population do not get even the minimum
recommended amount of physical activity. This is a critical issue for public health. In
2011, the Chief Medical Officers (CMOs) of the four UK countries jointly published areport on physical activity, saying, “regular physical activity can reduce the risk of many
chronic conditions including coronary heart disease, stroke, type 2 diabetes, cancer, obesity,mental health problems and musculoskeletal conditions” (see appendix).
Physical activity deficiency costs money: by 2050 almost 60% of the UK population could
be obese, costing the UK around £50 billion ($78 bn, €63 bn) per annum if strong action
is not taken. But cycling can also deliver cost savings from improved productivity in theworkplace, reduced congestion and pollution, and healthy development of children andyoung people.

112

Cyclists & Cycling Around the World

Health policy recommends cycling
The four CMOs state that “for most people, the easiest and most acceptable forms of physicalactivity are those that can be incorporated into everyday life. Examples include walking orcycling instead of travelling by car, bus or train”. This recognition of active travel is now
standard practice. Some other examples include:- the British Medical Association says “transport policy should ….. encourage a modal shift
away from private motor transport towards active forms of travel which benefit health”.
- the Toronto Charter on physical activity, now supported by over 100 countries, demands“transport policies and services that prioritise and fund walking, cycling and public transit
infrastructure”.

Long term healthcare cost savings
A really important argument for decision makers is that investment in physical activity,including cycling, saves money by preventing disease. Active people have lower
healthcare costs throughout their lives.
In 2012, a group of researchers writing in the medical journal “The Lancet” calculated thesavings achievable from growth in walking and cycling. They found that by increasing
active travel England and Wales could generate savings of £17 billion ($26 bn, €21 bn) tothe National Health Service over 20 years, and that thereafter the savings would continue
to mount up, year on year.

Potential for change in travel behaviour
In the UK over two-thirds of journeys 1 - 5 miles (1.6 – 8km) long are made by car, a distancethat can be cycled easily by most people. Sustrans’ own work for the UK Department forTransport has shown that in representative UK cities 47% of car trips could be replaced

Cycling is a way to remain active
and healthy into later life
Photo: J Thomsen / Sustrans113

by walking, cycling or public transport, without major intervention. This potential exists
in other highly motorised societies too. Of course, even greater potential exists where
significant investment is made in infrastructure to support these modes.
So from a public health point of view, massive health gains and healthcare cost savings
could be made very easily, simply by promoting changes in travel behaviour.

How to do it – a cross-governmental approach
Transport has a positive side: access to employment, education, services such as
healthcare, green space, social activities and so on is good for health, while physicalactivity from walking and cycling is health-promoting. But motor transport also hasmajor harmful effects – road danger, death and injury, air pollution, traffic noise and theseverance of communities by major roads. So the optimum – from the health point ofview – is the greatest possible range of access, always reachable by walking and cycling.
If you can access all the local destinations you need without ever having to drive, yourhealth will be better and so will the health of other people.

Public health guidance
recommends
improvements to cycling
infrastructure
Photo: D Martin / sustransPublic health policy and guidance call very clearly for two things to happen:- changes to the physical environment making it easier to walk and cycle, and restraining
private motor transport- a shift in public investment priorities from expensive road projects to smaller, bettervalue local schemes which facilitate walking and cycling.

114

Cyclists & Cycling Around the WorldIn the UK, the National Institute for Health and Clinical Excellence (NICE) bases its
public health guidance on intensive review of evidence from around the world. NICE
recommends radical changes to the environments where people live, in favour ofwalking and cycling. Its guidance on ‘Physical activity and environment’ recommends,
among other things, road space reallocation, traffic calming, road user charging andactive travel infrastructure improvements. Likewise, the British government’s Foresightreport on obesity, assembled by 200 senior academic experts, noted that “the top five
policy responses assessed as having the greatest average impact on levels of obesity [include]
increasing walkability / cyclability of the built environment”.
This is supported across the public health sector. The British Medical Association has
called for “growth targets for walking and cycling at national and regional levels, withincreased funding and resources proportional to target levels” (see appendix). This is inline with ‘Take action on active travel’, a joint policy call by a UK-wide group of over 100
transport and public health bodies in 2010, which says, “invest at a realistic level: commit
10% of transport budgets to walking and cycling immediately, and in future ensure thattransport funds are allocated proportionate to the new, ambitious target levels”.
The health sector is an opinion leader, a major employer and a powerful economicforce. Health professionals and health sector organisations should set a good example.
Walking and cycling should be encouraged as the ideal ways to travel to healthcare forstaff, visitors, and for the many patients who are able to travel actively. Health sector
managers should ensure high quality walking and cycling routes, cycle parking at
hospitals and health centres, and working practices to encourage active travel. And thechairman should no longer have a car parking space reserved at the main entrance!
Government as a whole should have a strategic plan to invest in cycling, so as to securelarge long-term healthcare cost (and other) savings. This plan should be developed atSetting a good example:cycle parking at theEuropean Commission
Photo: P Insall Sustrans115

Pont y Werin (The People’s Bridge) in Cardiff – high quality new walking and cycling
infrastructure enables people to change their travel habits
Photo: J Bewley / Sustransthe level of the national Treasury or Finance Ministry, and locally at the level of the city
Mayor or local government finance director. The financial allocation to transport should
set targets for travel behaviour change towards cycling.

ExamplesThe Active Travel (Wales) BillIn 2007, Sustrans Cymru (Wales), together with a range of Welsh organisations including
the British Medical Association, called on the Welsh Government for legislation to develop
and maintain a network of walking and cycling routes, to match their existing obligation
regarding roads.

116

Cyclists & Cycling Around the World

Sustrans “Bike It” school projects form part of Bristol’s strategic approach
Photo: J Bewley / SustransAmong the strongest arguments for the new legislation was the potential for publichealth. Sustrans therefore convened a group of influential public health organisations
and experts, which offered strong support to the proposals.
In July 2012, the Active Travel (Wales) Bill formed part of the Welsh Government’s
legislative programme announced. There has been a very positive response to the White
Paper, and it now seems likely that the Bill may become law, radically increasing levels ofwalking and cycling across Wales.
This legislative approach may be useful in other countries too. Further information canbe found on the Welsh Government website (see appendix).
Bristol
It may be difficult for professionals in transport to work together with those frompublic health. The two professions think differently, use different methods for policy
development or impact analysis, and even speak a different technical language. But it isimportant to make the effort, because each can help the other.

117

Bristol is an English city with a population of close to 400,000. The city’s Director of
Public Health appointed urban planning, sustainable development, and transport
specialists into his team, and agreed with the city council to place these staff within therelevant council teams. They ensure physical activity, including cycling, is written into
city strategies and plans, give day-to-day advice and help, and over time the whole cityadministration becomes more expert in transport and health.
The strong public health arguments helped Bristol to win a major government grantcompetition, securing £11 million ($17 m, €14 m) for cycling improvements. The local
Member of Parliament Dawn Primarolo said, “For most people, a great way to keep healthy
is by building physical activity into everyday life, such as cycling to work or school”.
Bristol now publishes a useful series of evidence briefings on transport and health issues(see appendix).
Good for Business
A good example of a public health body leading a campaign for active travel is ‘Good
for Busine$$’, an initiative of the Heart Foundation, South Australia. This is a reviewof the evidence for the financial benefits to local businesses from more active travel.
Heart health bodies around the world recognise the health potential of cycling, and as
in this case they can take the lead in policy campaigning. Cycling groups should seek
to collaborate with them, and with other major disease-specific bodies in fields whereactive travel is protective, such as cancer, diabetes and mental health.

Road danger and health promotion: the balance of advantage
In some countries, such as the UK, it became accepted that people travelling by car
were more important than walkers and cyclists. Large volumes of fast-moving traffic
were invited into town centres, and rural roads re-engineered for higher speeds andvolumes of traffic. Streets and roads became more dangerous, and road safety policiesdiscouraged pedestrians and cyclists from making the trips they wanted to make.
Today, road safety professionals generally take a more sophisticated approach, which isoften called ‘road danger reduction’. This seeks to reduce the risks that motor vehicles
impose on other road users by reducing vehicle speeds, improving driver behaviour, andsometimes by reducing the volume of motor traffic.
However campaigners still sometimes call for legislation to make cycle helmets
compulsory. This is unfortunate: a more analytical approach to the question shows thatthe health impact of such legislation would be negative. It would save some life-years

118Cyclists & Cycling Around the World

More cyclist means safer cycling

The Belgian communes with highest levels of cycling have thelowest accident risk for cyclists(Vandenbulcke et al, Transport Policy, March 2009)

across the population by mitigating head injuries in some road crashes, but by raisingfears among existing and potential cyclists and deterring them from cycling it would costmany more, by dissuading physical activity.
Work done in the Netherlands in 2010 modelled what would happen if 500,000 Dutch
people changed their behaviour to become regular cyclists. Air pollution and roadcrashes might cost between 6 and 49 days of life per person, but the health gains fromthe increased physical activity would be much greater – between 3 and 14 months perperson (see appendix)!
It is also becoming clear that more people cycling makes cycling safer, an effect known as‘safety in numbers’. This is well illustrated by a Belgian study in 2009.

119Innovative cycle counter in Odense,
Denmark, motivates people to cycle
Photo: P Osborne / SustransMeasuring and valuing the benefits
Public health professionals all agree that cycling is important and valuable as a way of
promoting health. No tool has yet been developed which calculates the total healtheconomic benefit of cycling, because it generates gains in so many areas of health, but
the World Health Organisation has created a tool called Health Economic Assessment
Tool (HEAT), which uses values for reduction in mortality from three main forms ofdisease, arising from any increase in cycling. HEAT is easy to use, and available free on
the internet, at www.euro.who.int/HEAT.
A good illustration of the economic value of cycling can be seen with the UK NationalCycle Network, coordinated by Sustrans. Usage of the Network has increased every
year since 2000, showing how a long-term programme of infrastructure development
can encourage and support more people to cycle more often. Using HEAT, Sustranscalculated that the cycle journeys made on the Network in 2011 had a health value of£286 million ($445m, €360m) – this does not of course include the economic gains inother areas, such as road safety, carbon reduction and social gains.

120

Cyclists & Cycling Around the World

Further reading
Government Office South West, 2010 Value for Money: An Economic Assessment ofInvestment in Walking and Cycling
Transport, Health and Environment Pan-European Programme – see website fordocuments
Philip Insall
philip.insall@sustrans.org.uk

121