Transcript Inactive lifestyles are contributing to an obesity

Active Travel: The Miracle Cure?
A guide for the NHS on raising physical activity levels
through your local transport plan
‘The potential benefits of physical activity to health are
huge. If a medication existed which had a similar effect, it
would be regarded as a “wonder drug” or “miracle cure”.’
Sir Liam Donaldson – Chief Medical Officer
(Annual Report of the Chief Medical Officer 2009, Department of Health,
March 2010)
With your local transport plan currently in development,
the NHS has a major the opportunity to ensure that local
transport policies maximise the health benefits that
walking and cycling can bring.
Local Transport Plans (LTP):
The Local Transport Plan Funding:
Your local authority is currently developing a
new LTP starting from March 2011, setting out
its investment priorities over the next five years.
Councils get an annual capital grant from DfT for
small-scale infrastructure and road maintenance,
but this is not ring-fenced for transport. They can
bid for additional funding from DfT for “major
schemes” costing over £5m.
Contributing to better safety, security and health
is one of the DfT’s five “goals” for transport,
including to “improve the health of individuals by
encouraging and enabling more physically
active travel”.
DfT expects local authorities to consider their
contribution to these goals as over-arching
priorities for their LTPs.
Most LTPs will cover the next 3 – 5 years, as
part of a 15-20 year strategy. Your authority
must publish its plan by 31 March 2011.
The NHS needs to be working now with local
Highway Authorities to get walking and
cycling prioritised in their areas.
Revenue support is included in the wider “formula
grant” from DCLG, but is not ring-fenced.
Consultation and Engagement:
Your authority is expected to consult on its LTP,
although it is worthwhile engaging as early as
possible in the process to shape thinking at the
outset - start talking to your transport team now.
In particular LTPs will need an Strategic
Environmental Assessment, which includes a
Health Impact Assessment. This is a major
opportunity for the health sector to challenge local
transport teams to do more on active travel.
Inactive lifestyles are contributing to an obesity
epidemic, a major public health crisis that is already
costing the economy and the NHS billions per year…
Physical Activity is critical to good health:
•
Reduces risk of CHD, Stroke, Type 2 Diabetes by
up to 50%, risk of premature death by 20-30%;
•
Improves well-being and mental health, particularly
beneficial for maintaining independence and good
health of older people.1
PCT
Annual Cost
Per 100k pop
Hastings &
Rother
£4,030,460
£2,357,587
But inactivity is a major public health problem:
•
Only one in three adults meet minimum
recommended level of physical activity; for older
people it is less than one in five. Two in three
adults are obese or overweight.2
Wakefield
£9,487,980
£2,848,354
Newcastle
£4,689,760
£1,811,705
Total cost of absenteeism, premature death and
treatment = £8bn - £10bn per year. £1bn - £1.8bn
of this is direct treatment costs - a serious drain on
NHS resources.1
Bath & NES
£2,776,750
£1,528,534
Norfolk
£13,267,480
£1,857,730
•
•
1
2
3
4
The cost to each PCT of treating the
effects of inactivity is significant: average
£5m a year:1
Major issue for NHS as an employer – healthy
workforces make for lower sickness rates, better
retention, improved patient satisfaction.3
Be Active, Be Healthy – A Plan for Getting the Nation Moving, DoH 2009
Health Survey for England 2008, DoH December 2009
NHS Health and Wellbeing – Final Report (Dr Steve Boorman / DoH 2009
Foresight (2007) Tackling Obesities: Future Choices – Project report, Govt
Office for Science
The forecasts are for inactivity to get
worse. If not addressed more than half of
adults could be obese by 2050.4
Treatment costs alone will be unaffordable,
regardless of the wider economic cost.
But there is a solution: most people could meet
recommended physical activity levels simply by
including more walking or cycling in their daily lives.
Chief Medical Officer’s recommendations for
health enhancing physical activity (minimum):
Children & young people: a total of 60mins of
moderate intensity physical activity a day;
Comparable European countries have higher
levels of walking and, in particular, cycling.
Adults: a total of 30mins a day of moderate
intensity physical activity five times a week.
Moderate intensity physical activity includes
cycling or brisk walking.
At Least Five A Week: evidence on the impact of
physical activity and its relationship to health. DoH 2004
Levels of walking and cycling have, however,
been in long term decline as car dependence
has grown, contributing to our obesity
problem.
It does not have to be this way. There is a
major opportunity to achieve public health
goals alongside transport objectives through
getting more people walking and cycling more
often.
Cycling levels in Britain are the lowest in
Europe
Estimated share of journeys (trips) made by bicycle
European Best Practice 2006 Update – Atkins 2006
Local transport plans are a major opportunity to
promote more active travel locally, but transport teams
cannot do this on their own…
We know what is needed to encourage more walking and cycling:
•
A supportive built environment where people can walk and cycle safely and in confidence, and where
key services and destinations are located and designed with pedestrians and cyclists in mind; and
•
Promotion and marketing measures to help people overcome their personal barriers to more walking
and cycling.
Successful active travel programmes do both: complementing better infrastructure with targeted
promotional activities
A number of English towns and
cities that have managed to halt
or reverse the decline in active
travel:
• 18% of trips in Cambridge are
cycled, in York it is 10%.
Your local transport team have
capital funding for
infrastructure like cycle lanes
& parking, traffic management
and home zones…
But do not have access to
revenue funds needed for travel
planning, marketing, training
(pictured) etc to complement
infrastructure..
• Cycling in London has doubled in
less than a decade; Darlington
achieved a 113% increase in just
three years.
• Walking in the DfT’s sustainable
travel towns increased by 10-13%
over three years.
Local transport teams have to balance a number of
competing priorities. It is important to make the case
that active travel can contribute to a broad range of
local objectives.
More walking and cycling can support a wide
range of local and national objectives,
including:
• Improving public health
• Reducing carbon emissions
• Improving air quality & the local environment
• Improving accessibility & reducing congestion
• Improving quality of life & better neighbourhoods
A relatively low-cost active travel programme
can make a significant contribution to your
local area agreement.
A starter for ten - what questions to ask your
transport team in the first instance:
• What percentage of trips made locally are less
than 2 miles, and 5 miles?
• What are current levels of walking and cycling?
• What is the ambition for growing this?
• How do they intend to deliver this?
• How will they monitor / review?
Who you should talk to:
Engagement at any level is worthwhile, but most
can be achieved by engaging at all levels to
embed Health priorities in the LTP.
Local Strategic Partnerships are a good starting
point, and Govt Offices can help make contacts.
NHS Chief Exec’s should engage early in the
process with their counterparts in the Highway
Authority, making the case for putting walking and
cycling at the heart of the LTP. You may find it
useful point to the contribution active travel can
make to Local Area Agreement indicators (see the
Active Travel Strategy for examples)
This should be followed by an ongoing dialogue
between the Director of Public Health and
Director of Transport to ensure that the benefits of
walking and cycling are fully realised in
implementation plans.
Most authorities also have a cycling and walking
officer who can advise on detailed plans and
schemes.
And there is robust evidence of the effectiveness and
value for money of active travel schemes to deliver a
range of benefits.
Evaluation of active travel schemes shows they can be
very effective in delivering health benefits:
• The health benefits alone of investing in cycling can be
more than 2.5 times the cost.
• The first 3 years of the DfT’s cycle towns programme saw
cycling increase by 27%, and proportion of adults who took
no exercise decreasing by 10%.1
• In DfT’s sustainable travel towns the proportion of people
who never walked or cycled fell by 11%, cycling rose by 2630% and walking by 10-13% in just 3 years.
• Rate of return on sustainable travel towns’ investment was
very high, with a benefit-cost ration of as much as 20:1.2
• Benefit-cost analysis of training schemes suggests that returns are of the
order of 7:1.
• The London Cycle Network has focussed on high density commuter
routes and is likely to lead to health, congestion and air quality benefits. A
recent benefit-cost analysis showed a return of approximately 4:1 for this
type of infrastructure investment
• The health benefits of cycling outweigh safety risks by a factor of more
than 20.3
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2
3
Cycling Demonstration Towns – Development of Benefit-Cost Ratios; DfT February 2010
The Effects of Smarter Choices Programmes in the Sustainable Travel Towns; DfT February 2010
Valuing the benefits of cycling – SQW / Cycling England (2007)
The National Institute for Health and Clinical Excellence
offers the first evidence-based recommendations on
improving the physical environment to encourage
physical activity.
NICE PH8 (2008) “Promoting and creating built or natural environments that encourage and support
physical activity” includes a number of recommendations you can use when as a checklist when
reviewing LTP or development proposals.
The Recommendations can be summarised as:
• Strategies, Policies & Plans: New developments always prioritise the need for people (including those
whose mobility is impaired) to be physically active as a routine part of their daily life, local facilities and
services are easily accessible on foot, by bicycle.
• Transport: Pedestrians & cyclists given highest priority when developing or maintaining streets and roads.
• Transport: Plan and provide a comprehensive network of routes for walking and cycling, offering
convenient, safe and attractive access to workplaces, homes, schools and other public facilities.
• Public Open Spaces: and public paths can be reached on foot, by bicycle and accessible by public
transport. They are maintained to a high standard, safe, attractive and welcoming to everyone.
• Buildings: Different parts of Campus sites (hospitals, universities) are linked by appropriate walking and
cycling routes; new workplaces are linked to walking and cycling networks, where possible, improving the
existing walking and cycling infrastructure by creating new, through routes.
• Buildings: Staircases are designed and positioned to encourage people to use them, and are clearly
signposted and attractive to use (e.g. well-lit and well-decorated).
• Schools: School playgrounds are designed to encourage varied, physically active play. Primary schools
should create areas to promote individual and group physical activities.
www.nice.org.uk/Guidance/PH8
There are many ways that the NHS can contribute to
local walking and cycling plans…
PCTs can directly support LTP objectives to
get more walking and cycling in a number of
ways:
• 78% of people consult their GP at least once
during the year: many will not be active enough.
It’s an opportunity to directly engage with people
to encourage more active travel in their daily
lives.
• NHS staff, contractors and patients generate a
lot of local trips. Making NHS sites easy for
cyclists and pedestrians to access can help
people rely less on their cars and get more
active.
• PCTs can help Identify neighbourhoods or
groups with high levels of physical inactivity
where intervention would bring most health
benefits.
• PCTs can complement capital investment in
active-travel infrastructure, such as a new cycle
route, with revenue-based measures to promote
take-up and maximise benefits.
Useful sources of information:
The Active Travel Strategy was published by DH
and DfT setting out the Govt’s plans to increase
walking and cycling.
Be Active, Be Healthy sets out the estimated
health-care costs of physical inactivity.
At Least Five A Week established the Chief
Medical Officer’s recommendations for healthenhancing Physical Activity.
NICE PH8 provides evidence-based guidance
on how to improve the physical environment to
encourage active travel.
Cycling England have published evidence on the
health benefits of cycling and an evaluation of
cycling towns.
DfT have published evaluation of the impacts of
the sustainable travel town programme.
The NHS Operating Framework 2010/11
encourages PCTs to work with councils to
promote better health and more physical activity.
And places around the country where health and
transport sectors are realising the benefits of working
together
Liverpool
Liverpool City Council and PCT have signed an
agreement to make it a “Cycling City” to improve
quality of life and create a healthy low-carbon city.
London
NHS Camden and Walk England have produced
easy to follow walking maps to explore their local
area and get fit at the same time.
The Active Steps programme in Sutton is a
groundbreaking initiative to increase physical
activity and reduce car trips. It is linked to local
NHS checks to identify those at greater risk of
cardio-vascular disease. 97% of users said they
became more active, 85% felt healthier, 46% lost
weight.
A number of PCTs are already funding “Bike
It” Officers to promote cycling in schools:
The agreement sets out to generate a 10% increase
in cycling trips by March 2011.
And to make access to health services easier on
foot, a network of new treatment centres are being
sited across the city within 15 minutes walk of every
residential address.
“We aim to encourage Active Travel as an
essential component of a healthy lifestyle for all
ages, and Bike It is a proven intervention to help
children develop that habit of healthy travel.”
Adrian Dawson, Director of Public Health at
Bournemouth and Poole PCT.
But don’t just take our word for it…
“For most people, the easiest and most acceptable forms of physical activity are
those that can be incorporated into everyday life. Examples include walking or
cycling instead of travelling by car…..”
At Least Five A Week: the Chief Medical Officer’s report on physical activity, 2004
“The top five policy responses assessed as having the greatest average impact
on levels of obesity [include] increasing walkability / cyclability of the built
environment…..”
Foresight Tackling Obesities report, Government Office for Science 2007