Conclusions

Sedentary lifestyle is a major threat to public health. Walking and cycling for transport are effective ways for people to engage in regular exercise with all its commensurate benefits for health. A modal shift towards these forms of transport should reduce car use, thus further improving road safety, and reducing the environmental damage caused by current travel patterns. There would also be positive social and community effects, with greater social cohesion, higher levels of social capital, and a stronger focus on local communities; all these factors are likely to have a positive influence on health.

Current volumes and speeds of traffic have serious adverse health impacts on individuals and communities. Traffic is disproportionately generated by the most affluent groups in society, but the greatest ill effects are borne by the most disadvantaged sectors: 'the poor are breathing the air that the rich pollute'.107 Current transport patterns are an important factor in health inequalities, and the dominance of the car over other forms of transport is a major factor in this. There are social class gradients for coronary heart disease and sedentary lifestyle, with the highest levels in social class V. Encouraging walking and cycling for transport, and reducing car use, are effective ways of reducing these health inequalities.

Motorists are entitled to take risks with their own lives, but not with the lives of others, and they should not expect society as a whole to bear the costs of their risk-taking behaviour. Speed limits, and other restrictions on traffic, should be based on a thorough consideration of the social, health, and other impacts of that traffic. This requires a new and more rational approach, both locally and nationally, to planning and enforcement. The complex interactions of traffic, individuals, and society are difficult to disentangle, but equity, social justice and the public's health demand that the effort is made. The rights of drivers must be balanced against those of people living in and around the streets they drive through and the needs of other road users, including pedestrians and cyclists.

There is no single approach that will work to encourage fewer people to drive and more to cycle. A range of approaches, adapted to individual and local circumstances, is needed. There are two central points to bear in mind. The first is that everyone will have their own set of concerns; the second is that the needs of a novice are different from those of an experienced cyclist. This has been evocatively expressed by Ampt: 'The first issue that the ordinary human being needs to focus on is 'shall I ride?', 'can I ride?', 'shall I buy a bike?', 'how much does it cost?', 'what if I buy it and don't like it?', 'what kind shall I buy?', 'what about theft?', 'what do I need to buy for it?', 'how will I get it home from the shop?', 'what, ride!!'. All of these things can be extraordinarily difficult….I think we need a gentle reminder now and then that there are other people out there, individuals with their own myriad of balancing acts, all of which need to be considered when we are telling them about the benefits of including cycling in their way of life.'108

The health sector has an important role to play in many aspects of transport policy, but it cannot work alone. As Marmot states: 'We can make it easier or harder for people to take exercise. We can create the conditions where it is easier for people to build exercise into their daily lives. You do not just say, 'Don't be a couch potato. Take exercise'. If cycling and walking are acceptable modes of transport, it is then easy for people to exercise.'109 The joint working required to achieve this is a challenge for all agencies concerned, but it is a vital part of any serious attempt to tackle the causes of ill health at their source.

The greatest health risks on the roads are carried by sedentary car drivers; they are also the source of the majority of the danger posed to others. Cycling is a safe and effective way of improving one's health without causing harm to other road users. A modal shift from car travel to walking and cycling would have enormous public health benefits to both individuals and communities, would help to reduce health inequalities, and should be strongly supported and encouraged by Oxfordshire Health Authority.

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