Results

Travel, injury and other data

The most recent year with full mortality, population, and transport data available is 1998; other years have been selected where they were the most recent quoted in reliable sources. The current Department of Transport (now DETR) report on Cycling in Great Britain, for example, was published in 1996.

Cycling and travel

38% of households overall, and 69% of those with two or more children, own at least one bicycle. Cycle ownership is linked to household income: about a quarter of households in the lowest 40% of incomes own a cycle, compared to nearly half in the remaining 60%.9

Bicycle usage has declined from 23.6 billion vehicle kilometres in 1949 to 4.0 billion in 1998; car use has increased from 20.3 billion vehicle kilometres to 375.9 billion in the same period.21 As a proportion of all road traffic, cycling has declined from 37% in 1949 to less than 1% in 1998; cycling accounts for 3.4% of journeys to work in England, but only 1.5% in Wales and Scotland.22 About a quarter of journeys travelled by bicycle are less than a mile, and another third between one and two miles; a quarter of car journeys are less than two miles.9

With 17.4% of residents cycling to work in 1991, Oxford has the third highest levels of cycle usage in the country, after Cambridge at 28.2% and York with 19.0%.9 The biannual census of pedestrian and vehicle flows into Oxford shows that the number of cyclists entering the city has increased slightly between 1996 and 2000, but remains steady around 15,500 per day. However, as the number of cars entering the census cordon points has decreased, the number of cycles as a proportion of total vehicles has increased from about 16% in 1996 to about 20% in 2000.23

A 1996 study of two Oxfordshire villages found a median car journey length of half a mile for people aged 30-59 travelling within their village; 25% of all journeys were four miles or less. It would have taken 25 minutes or less to walk (i.e. 10 minutes or less to cycle) rather than use the car for 40% of the journeys to work. The report states that 'for work journeys, the dominance of the car and acceptability of cycling to an office was explained in terms that indicated they were perceived as unalterable'; cars 'were recognised to marginalize other transport modes such as cycling and walking', and 66% of men and 71% of women supported reducing car use 'because of the associated health problems.' The study also found that the most affluent respondents had the highest levels of car ownership and car usage; the 10% of households using the most energy for travel was the most affluent group, and travelled ten times further than the 10% of households using the least energy, which was the poorest group.24

Casualty rates

3,421 people died on Great Britain's roads in 1998, and 322,000 were injured. National cyclist death rates have declined from 842 in 1949 to 158 in 1998; this is in the context of a large decrease in bicycle usage, and reflects an increase in the numbers of cyclists killed per distance travelled of about 10%. Cyclists make up 7.3% of road casualties in the UK, but cycling is, in absolute terms, a low risk activity; there is one cyclist death per 21 million kilometres cycled.21 Men average more than three times the annual cycle mileage of women, and male casualties outnumber female casualties by four to one overall and five to one for those aged under 20.22 A 1999 study of child pedestrian injuries in Britain, France and the Netherlands found that the injury risk on Britain's roads, matched for equivalent exposure, is significantly greater than in the other two countries.25

The numbers of cyclists killed on the roads in Oxfordshire are too small to discern trends, but ranged from one to five, with a mean of two, between 1994 and 1998. Despite the small numbers a standardised mortality ratio (SMR) for cycling deaths in Oxfordshire between 1994 and 1998 was calculated with a result of 131 (95% CI: 45-194). With cycle commuting rates in the county over five times the national average, and presumably other usage rates to match, even the upper limit of the 95% confidence interval for the SMR is less than half what one would anticipate given this level of cycling, suggesting that Oxfordshire is a relatively safe place to cycle.

Life years lost

Table 1 shows the numbers of life years lost through cyclist deaths in Oxfordshire 1994-98. The large year-to-year variation is a result of the inevitable random variations with small numbers of people of different ages dying. Life expectancies were calculated for each of the years 1994-98 from ONS population and mortality figures using standard formulae,26 and life years lost were then calculated by multiplying the number of deaths within each five-year age band by the life expectancy for that age band. The same calculations were also performed for CHD deaths both nationally and locally.

Table 1: Life years lost from cycling deaths and CHD deaths 1994-98

Activity levels

The 1998 Health Survey for England found that 63% of men and 75% of women exercise less than 30 minutes on most days; 20% of men and 24% of women reported less than 15 minutes of physical activity in the previous four weeks.27 A local survey of 2,056 people in 1997 found that 13% exercise three or more times a week, but 46% exercise less than once a month. Those in social class V are more than twice as likely to be sedentary as those in social class 1, and those in social class 1 are over three times as likely to exercise three or more times a week as those in social class V.28

Literature review

General points

There is a large body of evidence for the beneficial health effects of exercise on mortality and morbidity, especially from cardiovascular disease. Although different studies have taken a number of approaches to assessing and classifying activity levels, making comparison between studies difficult, it is nevertheless possible to draw broad conclusions about the activity levels required to benefit health.

Physical activity and mortality

A major review article in 1995 stated that approximately 12% of deaths in the United States are attributable to lack of physical activity, and concluded that every adult should engage in at least 30 minutes of moderate exercise on most, preferably all, days of the week. It defined moderate activity as that which expends 4-7 kcal/minute, such as brisk walking, or cycling for leisure or transport.29 A review that categorised the population as sedentary, irregularly active, regularly active, or vigorously active found that the greatest health benefits would accrue from increasing the exercise levels of the irregularly active group.30 A meta-analysis of physical activity in the prevention of CHD supported a dose-response relationship between exercise and protection from CHD.31

A prospective study of over 13,000 men and women found that those in the least fit quintile had relative risks of all-cause mortality of 1.58 (95% CI: 1.32, 1.89) for men, and 1.94 (95% CI: 1.30, 2.88) for women, compared with those in the most fit quintile, with a strong and graded association between physical fitness and mortality.32 In a study of 10,269 Harvard alumni those who were previously sedentary but took up moderate physical activity during the course of the study had a 41% lower risk of death from CHD than those who remained sedentary, and added 0.72 years of life (95% CI:0.14, 1.29).33 An earlier study of 16,936 Harvard alumni found that those expending less than 2000 kcal/week had a relative risk of fatal heart attack of 2.01 compared to those expending over 2000 kcal/week (p=0.001).34 A follow-up to this study found that death rates declined steadily as energy expenditure increased from below 500 kcal/week to 3500 kcal/week, with rates 25-33% lower in those expending over 2000 kcal/week compared to those expending less than this. By the age of 80 the amount of additional life attributable to adequate regular exercise, as opposed to sedentary lifestyle, ranged from one to over two years.35 There has until recently been a dearth of good evidence for the benefits of activity in women, but this situation has now been redressed with several large, high-quality studies showing equivalent benefits to those found in men.36 37 38

Physical activity and morbidity

In addition to the effects on cardiovascular morbidity discussed above, regular exercise has been shown to be beneficial in many conditions4 including diabetes 39 40 and insulin sensitivity,41 42 hypertension,43 44 stroke,45 elevated blood lipids,46 47 obesity,42 and cancer.48

There is evidence to support a relationship between physical activity and psychological well-being 49 50 and a recent review shows that low to moderate physical activity has beneficial effects on depression, stress,51 mood, self-esteem and premenstrual syndrome.52 Physical activity has been shown to improve cognitive function in the elderly,53 and reduce falls.54 Regular exercise allows elderly people to maintain a reasonable degree of fitness for activities of daily living,55 and a review of the relationship between physical activity and hip fractures found a protective effect of the order of a 50% reduction in the more physically active subjects.56

Stakeholder views

Interviewees live across the county, some in urban and some in rural areas, although the majority of them live in or near Oxford. Only one respondent does not cycle at all, and about half cycle regularly.

Those who lived in urban areas were more likely to cycle further and more frequently than those in rural areas, with long distances and high speed traffic on narrow roads cited by the latter group as disincentives. Experienced and higher mileage cyclists were more likely to cycle on the carriageway, and were less likely to be put off cycling by bad weather, traffic or other factors.

Fear of traffic danger was overwhelmingly the greatest disincentive to cycling. Segregation from vehicles, lower traffic speeds, and continuous cycle lanes were felt to be the most important mechanisms to counter the threat of traffic. There was broad agreement on this from the majority of respondents, with less experienced cyclists especially keen. Large vehicles, especially buses, were felt to be the most threatening.

The interviewees were broadly supportive of the projects and facilities currently in place for cyclists, and there was general agreement that they should be taken further; discontinuities in cycle lanes in particular were seen as a problem, especially by less experienced cyclists. Bicycle theft is a major concern, and greater provision of secure cycle parking was felt to be essential.

Many of the interviewees felt that employers should provide facilities such as secure cycle parking, lockers, and showers at work. There was also support for financial incentives, such as subsidies for cycle and equipment purchase, and generous mileage allowances. There was widespread criticism of the health sector for apparently failing to get its own house in order, and not leading the way with its own staff.

Several respondents stated that a process of cultural change was required to encourage more people to cycle, especially in relation to their employment. It was felt that while certain workplaces were very supportive of cycling, in others where it was not culturally accepted there would be greater obstacles to those who did want to cycle. The need to look smart at work was cited several times as a reason for people not to cycle, including by regular cyclists, as were difficulties carrying bulky items.

There was strong support for effective joint working, and public consultation, but problems were identified with both these activities. While members of all agencies were keen to work closely with their counterparts elsewhere, many respondents felt that current arrangements were ineffective, and the City Council / County Council split in Oxford was felt to be a particular barrier. Many reasons were cited for these problems, including a lack of appreciation of one another's perspectives, differing agendas, and budgetary constraints. There is little money available for public consultation, which is expensive and time consuming, and several interviewees reported practical difficulties in obtaining the views of the general public.

Many other points were raised, including:

• Widespread criticism of poor and/or illegal behaviour by cyclists
• Local Authorities across the country have a standardised system for collecting transport and accident data, allowing comparison between authorities; no such system exists for health data
• It is important to recognise the different needs of town and country dwellers. In rural areas roads tend to be narrower with higher speed traffic, and journeys made over greater distances. As a result safe, comfortable off-road routes, as have been created by Sustrans for the National Cycle Network,57 were felt to be necessary outside the major towns
• The Oxford City cycling map was very popular, and felt to be an excellent encouragement to leisure cycling

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