Director of Public Health Annual Report 2018: Healthy places

We travel for work and play, to get to school, shops and other services, but how we travel, and how far and for how long, has significant implications for our health, the health of others and society as a whole.

The mode of travel we choose matters. Active travel such as walking and cycling improves our health through promoting physical activity but also by reducing air and noise pollution, increasing social connections and making communities safer. It improves our mood, reduces stress and the risk of developing long term conditions or dying early. It is also the lowest carbon, cheapest and most reliable and sustainable form of transport. It reduces congestion, absenteeism and boosts economic productivity.

Adults who do regular physical activity are at lower risk of many chronic diseases such as heart disease, diabetes, stroke, some cancers, depression and dementia. Children and young people who are physically active have better cardio-respiratory health, better bone health and muscle strength, improved attention and better educational attainment, lower anxiety and stress and higher self-esteem. However, levels of physical activity are gradually declining and it is conservatively estimated that physical inactivity costs the NHS £1bn per year, with wider societal costs of more than £8bn per year.

Active travel can contribute significantly to helping people achieve the recommended levels of physical activity per week and areas that encourage people to walk or cycle to work, school or shops have healthier residents than those that don’t.

Walking improves our mood and reduces the risk of anxiety and depression as well as improving our physical health. Walkable neighbourhoods and towns are better for everyone. Areas where more people walk are more sociable, are safer and feel safer. Places that are designed to be more walkable increase the accessibility of public space for people of all ages, different mobility levels and backgrounds and reduces social isolation.

There are an increasing number of studies demonstrating the benefits of cycling. A recent British study found that people who commuted by bike had almost half the risk of developing and dying from heart disease and cancer. In addition, on average, cyclists take 15% fewer sick days compared to non-cyclists. Commuters who shift from private vehicle to public transport or active forms of travel have been shown to have a significant reduction in weight.

One of the main barriers for people switching to cycling is perceived safety with more people choosing to cycle if routes are physically separated from other traffic. 64% of people say they would cycle more if they had access to separated cycle routes. Areas where separated cycle routes have been introduced have seen an increase of up to 171% in bike lane usage. Increases are particularly seen among less experienced cyclists and those with lower levels of confidence including children, women and less active people. Separated cycle routes are also linked to real benefits to cyclist safety with reduced levels of collisions with motor vehicles. The health benefits of cycling outweigh the risk from injuries by about 20 to 1 and it has been estimated that for an average commute, the health benefits to society and the individual of each person shifting from car to bicycle is more than £1100 per year.

There are many opportunities for children to be active as part of their travel, often to and from school. Children who walk or cycle to school on average get about 20 extra minutes of physical activity per day compared to children that are driven and, switching from driving to school to walking has been estimated to save families £642 per year. It is estimated that approximately one in five cars on the road during peak hours in the morning are involved in school travel. For schools in residential areas, this can concentrate traffic in these areas, increasing pollution and the risk of road traffic injuries.

Active travel increases physical activity levels and reduces the number of cars on the road which reduces air pollution from road traffic all of which benefit health. Active travel is also good for the economy and people who walk or cycle to work tend to be more productive and take fewer sick days. The health and economic benefits of active travel have been found to outweigh the cost by up to 11 times with an average of £5.62 in benefits for every £1 spent on active travel in the UK.

People who live in environments that encourage people to walk or cycle rather than use the car have a stronger sense of community, better social connections and are more positive about the places they live than those who live in areas of heavy car use. They are more likely to know their neighbours, trust others and engage in community life.

Motorised transport has seen the distances people can travel for work, school and leisure increase and can bring many benefits. These include improved access to employment, reduced social isolation and better access to health care. These need to be balanced against the adverse consequences of this mode of travel for health and communities.

Neighbourhoods where housing and amenities are far apart, characterised by “urban sprawl”, have higher car use and higher levels of obesity and other health problems which taken together are equivalent to the population ageing 4 years.

In Bucks, the average commuter travels nearly 11 miles (17.7km) each way to work, longer than the average for England (9.3 miles, 15.0km) and the South East (10.3 miles, 16.6km).

Long commutes are increasingly being recognised as having a detrimental effect on our health and wellbeing. They have been linked with higher levels of stress and anxiety and higher blood pressure.

In addition, long commute times reduce the amount of free time people have for recreational activities, cooking and sleeping and participating in community life with consequent adverse impact on their health.

As the distance commuted increases, people’s health suffers, with lower levels of physical activity and fitness, higher body weight and cholesterol, waist circumference and risk of diabetes and cardiovascular disease. Studies have shown that driving more than 10 miles one way to and from work five days a week was associated with an increased risk of developing high blood sugar and cholesterol and commuting more than 30 miles a day was associated with high blood pressure, stress and heart disease.

Statistics show the longer we drive the less happy we are and that happiness decreases with every mile of commute. Workers with longer commutes are 33% more likely to suffer from depression and 12% more likely to report stress at work. They are also 46% less likely to get the recommended minimum of seven hours of sleep each night. Studies have shown that, to have the same level of satisfaction as someone who walks, a commuter travelling for more than one hour per day has to earn 40% more money.

Changing from a long commute to a short walk to work has the same impact on happiness as a single person finding a new partner.

A recent report looking at congestion in towns and cities shows that commuters in Aylesbury spend on average 32 hours stuck in congestion each year. Out of 111 towns and cities in the UK that were assessed, commuters in Aylesbury spent the 6th highest amount of time in congestion.

Road traffic accidents can also contribute to harm. Speed is the main cause of premature deaths and injuries in road accidents, 9 in every 10 pedestrians survive if hit by vehicle travelling at 20mph, 5 out of 10 die if hit by vehicle travelling at 30 mph and 9 in 10 die if hit by vehicle at 40 mph.

Nationally, whilst the majority of road traffic injuries (all casualties) arise on 30mph built up roads (58%), less than one in three deaths on the roads occur on 30mph built up roads. In comparison, 60mph roads account for less than one in every six casualties, but more than one in every three deaths nationally (36%).

Traffic calming measures have been found to reduce the number of accidents by 40% whilst also reducing the severity of the accidents. Speed bumps and chicanes in the road are the most effective ways of reducing vehicle speed. However, speed bumps need to be effectively designed to minimise the potential impact on air quality due to extra braking and fuel consumption.

Motorised vehicles are a major contributor to air and noise pollution, accounting for approximately a third of air pollution from particulate matter. However, the impact of air pollution from road traffic is greater in built up areas where concentrations of vehicles are high. As a result, road traffic is responsible for a large proportion of air quality management areas due to Nitrogen Dioxide (96%) and particulate matter (76%) in the UK. The cost of ill health due to air pollution from road traffic is estimated to be between £4.5-10bn to the UK economy each year.

The design of our transport network and roads influence how we choose to travel from place to place but also about how we interact with each other. Roads, especially large or busy roads can act as a significant barrier and can have a negative impact on health. ‘Community severance’, where busy roads reduce access to goods, services or people can isolate communities and neighbourhoods increasing the difficulty in accessing important facilities such as schools, doctors’ surgeries and shopping centres. This is especially important for children and older people. Community severance creates a self-perpetuating cycle, whereby the presence of a busy road causes individuals to rely more on cars to move around, thus causing higher congestion on the roads and greater severance. Living on a road with heavy traffic can reduce the opportunity for social interaction with neighbours. Residents living on streets with light car traffic volumes have three times more friends and twice as many acquaintances than those living on streets with high car traffic.

Travelling by public transport compared with driving a car has a number of benefits for both mental and physical health and wellbeing. Using public transport increases amount of time being physically active by between 8-33 minutes on average. On average, residents living in areas served by a good public transport network or where there is “mixed land use” (where houses, jobs and amenities are close to each other) own significantly fewer cars, drive significantly less and use active and public modes of transport for a higher proportion of their travel.

In addition to boosting levels of physical activity, using good quality public transport is associated with lower levels of stress compared to driving and can reduce exposure to air pollution as car users have higher exposure to air pollutants that people on buses and trains.