Transcript Transport and health

Transport and Health in London:
Trends, evidence and trend
breaches
19th May 2009
Dr Adrian Davis
Transport and Health Consultant
JMP Consultants
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On current trends
60% of adults will
be obese by 2050
Our current trajectory for 2050
What would 60% of the London adult
population being obese mean for the
functioning of the City’s transport
system?
What role would cycling fulfil?
Drivers of weight gain:
subtle and chronic
“Low levels of physical activity prevalent in Britain must play an
important, perhaps dominant, role in the development of obesity
by greatly reducing energy needs from food.”
Prentice, A., and Jebb, S., (1995) Obesity in Britain: gluttony or sloth, BMJ, 311: 437-439
A) “Total energy intake actually fell by approximately 20% between
1974 and 2004”
B) “Total energy intake rose by approximately 20% between 1974
and 2004”
C) “Total energy intake rose approximately 46% between 1974 and
2004”
Information Centre (2006) Statistics on obesity, physical activity and diet: England 2006
Energy expenditure
recommendations for
health and weight
Chief
Medical Officer: minimum of 5 x 30 minutes
management
of moderate physical activity is required per week
for population health
65% of adults do not achieve this
“It is likely that for many people, 45-60 minutes of
moderate intensity physical activity a day is
necessary to prevent obesity.”
DH, 2004 At Least Five a Week.
The best ‘buy’ but most
undervalued
Physical activity is the best buy in public health
Physical activity must be one of the most
undervalued interventions to improve public
health
1
2
…Major communication challenge
1. Morris J., 1994 The role of exercise in the prevention of coronary heart disease: today’s best buy
in public health. Medicine Science Sports Exercise, 26:807–13.
2. Donaldson, L. 2000 Sport and exercise: the public health challenge, British Journal of Sports
Medicine, 24: 409-410.
Routine physical activity
“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 driving…”
DH, 2004 At Least Five a Week.
Chief Medical Officer
Car ownership/landuse physical activity
relationship
 Rising car ownership accompanied by changing
land-use patterns to accommodate increased car
use… are closely inter-related. Between them
they have a profound effect on physical activity
levels.
Frank, L., Andersen, M., Schmid, T. (2004) Obesity relationships with community
design, physical activity, and time spent in cars, American Journal of Preventive
Medicine, 27(2): 87-96.
The Evidence Base
 Countries with highest levels of active travel generally have the
lowest obesity rates 1
 Mixed use developments, high density, good connectivity for walking
and cycling significantly affects body weight and reduce risk of
weight gain 2
 Time spent in cars is positively associated with obesity 3
 Purchase of motor vehicles to travel to work has been reported as
doubling the likelihood of becoming overweight, in comparison to
those that make no change in their travel mode 4
 Significant association with commuting to work by car and
overweight or obesity compared with active travel modes and use of
public transport 5
1 Bassett, D., Pucher, J., Buehler, R., Thompson, D., Crouter, S. 2008 Walking, cycling, and obesity rates in Europe, North America and
Australia, Journal of Physical Activity and Health, 5: 795-814.
2 Frank, L., Andresen, M., Schmid, T. 2004 Obesity relationships with community design, physical activity, and time spent in cars, American
Journal of Preventive Medicine, 27(2): 87-96.
3 Ibid.
4 Bell, C., Ge, K., Popkin, B. 2002 The road to obesity or the path to prevention: Motorised transportation and obesity in China, Obesity
Research, 10(4): 277-283.
5 Wen, L., Orr, N., Millett, C., Rissel, C. 2006 Driving to work and overweight and obesity: findings from the 2003 New South Wales Health
Survey, Australia, International Journal of Obesity, 30(5): 782-786.
Out on the streets…
 The car - it’s not very responsible though. People are just lazy
pigs these days, I include myself in this category. I’ve got loads of
pals who have increased in weight two fold when they passed
their driving test.
 That’s part of the reason why I don’t want to learn to drive
because I’ve seen the weight that my husband has put on.
 (I cycle) because of the exercise really. With the moped I was
starting to put on weight. It’s just best to keep that off before it
gets a good hold of you really. Keeping in shape is important to
me. Not so much fit, just so long as I don’t look bad.
 If I was to become a bit overweight, wanted to lose weight then
that’s obviously what I would do (start walking or cycling), I
wouldn’t just starve myself, I carry on doing what I was doing and
then burn more on top of it, but at the moment I’m lucky enough
not to need it.
Intersectoral collaboration for health gain
 Health is largely ‘won’ and ‘lost’
outside of the health sector
Transport is substantially implicated
in making us an unhealthy nation
 Close working with public health
should be the rule – not the exception
 Joint appointments of DPHs with
local authorities provide major
opportunities
 Public health secondments into
transport planning
Making NICE Guidance ‘stick’
Thank you