Background

Public health importance

Health and transport are inextricably linked. Current levels of motorised transport have major consequences for public health, both in terms of the health impact of sedentary lifestyles, and the environmental and social effects of traffic.5 6 7

Policy context

The World Health Organisation Transport, Environment and Health programme has stated that 'sedentary lifestyle, one of the two most important risk factors for non-communicable disease and early mortality in Western populations is associated with the use of motor vehicles. There is a need to promote healthy and sustainable transport alternatives as a way to prevent the negative impacts of transport systems on human health. One important way to do this is to ensure that health issues are clearly on the agenda when transport decisions are being made and policies formulated. This requires…a change in the current strategies towards full consideration of transport policy implications for development, the environment, and health'.8

In the UK there have been many recent national and local policy initiatives encouraging exercise in general and cycling in particular. The National Cycling Strategy 9 was produced by the Conservative government in 1996, with targets to double cycling from 1996 levels by 2002, and quadruple them by 2012. The Department of the Environment, Transport and Regions' (DETR) Transport 2010: The 10 Year Plan 10 contains a commitment to providing safer cycling and walking routes, and more 20mph areas and Home Zones, particularly around schools. The Government's road safety strategy has set casualty reduction targets for 2010 of a 40% reduction in the number of people killed or seriously injured in road accidents, a 50% reduction in the number of children killed or seriously injured, and a 10% reduction in the slight casualty rate. It also acknowledges the importance of road safety for broader health, environmental and social inclusion issues.9

Several recent initiatives from central government are also highly relevant. Our Healthier Nation included a commitment to reduce the death rate from CHD, stroke and related diseases in people aged under 75 by at least 40% by 2010; it also set a target of reducing accidental deaths by 20% and serious injuries by 40%, and made a commitment to 'improve conditions and give greater priority to pedestrians and cyclists.'11 The Department of Health National Priorities Guidance 2000/01 - 20002/3 states that 'all health authorities [are] to develop and implement local prevention policies on CHD and stroke by March 2001'.12

The National Service Framework (NSF) for coronary heart disease, has among its targets a requirement that the NHS should 'develop, implement and monitor policies that reduce the prevalence of coronary risk factors in the population, and reduce inequalities in risks of developing heart disease.' It also states that by April 2001 'health authorities, local authorities, PCGs/PCTs, and NHS trusts will have agreed and be contributing to the delivery of the local programme of effective policies on…increasing physical activity' in order to reduce the incidence of CHD. The first of the four principles underpinning the NSF is that 'reducing the burden of CHD is not just the responsibility of the NHS. It requires action right across society'; it also states that 'publicly funded bodies will work together to tackle the broad determinants of health, including…transport. They will help children and adults have the opportunity to lead healthy lives, for example by increasing the opportunities for regular physical activity…'13

Current transport patterns are a major source of health inequalities. The Independent Inquiry into Inequalities in Health recommended 'further measures to encourage walking and cycling as forms of transport and to ensure the safe separation of pedestrians and cyclists from motor vehicles', and 'further steps to reduce the usage of motor vehicles to cut the mortality and morbidity associated with motor vehicle emissions', along with 'further measures to reduce traffic speed, by environmental design and modification of roads, lower speed limits in built up areas, and stricter enforcement of speed limits.'14

The foreword to the Oxfordshire Health Improvement Programme (HImP) for 2000-2003 identifies transport as one of the two key issues to be tackled. The programme supports the importance of physical activity in the prevention of CHD and diabetes, and contains local targets for reducing death and serious injury from accidents for both adults and children. It sets out several relevant objectives, such as those to promote healthy lifestyles to reduce the incidence of CHD and stroke, to develop transport policies that will benefit health, to reduce traffic and transport problems generated by the health care sector, and to improve local collection of accident data.15

Oxfordshire County Council produced cycling 16 and walking 17 strategies in 1999, along with a corporate travel plan.18 The cycling strategy contains a target to increase the proportion of cycle trips to work from 9.2% in 1991 to 10% in 2001, and 20% in 2011, and in 1993 Oxford City Council set itself a target to increase cycle use by 50% by 2001.

Current situation in Oxfordshire

Oxfordshire County Council is the highway authority for the county, although it has devolved certain powers, notably in the form of an agency agreement with Oxford City Council, which has responsibility for the majority of highways within its boundaries.

Oxford has in the last 18 months seen major changes to its traffic system as a result of the Oxford Transport Strategy (OTS); these have generated significant controversy. The strategy was first conceived by the City and County councils in the 1970s as a response to the increasing traffic flows within the city, and developed over the subsequent two decades with the aim of maintaining traffic levels at those at the time of its inception. The first phase of the OTS was implemented on 1 June 1999 with the closure of the High Street to through traffic and the pedestrianisation of Cornmarket, a major central shopping street which until that time had been a major bus thoroughfare.

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