The Medical Women’s Federation is the largest body of women doctors in the UK. Our mission is to support women doctors and improve health for all. The majority of doctors qualifying are women. Every day, we consult with patients from all backgrounds and at all phases of life. We are committed to highlighting where health in general can be improved. The World Health Organization (W.H.O.) constitution states: "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity."
Transport is key to health. The air pollution from motor vehicle traffic is a major cause of ill-health – with exhaust fumes and particulate pollution (from brake and tyre wear) contributing to asthma, heart disease, cancer and mental ill-health. Physical inactivity is also a major cause of years spent living with poor health (Disability Adjusted Life Years, or DALYs). People taking up exercise can reduce their risk of common diseases and have fewer complications from established disease. This effect has been described as a ‘miracle cure’ and is better than many other treatments. A modal shift from car use to active travel (walking, cycling, electric-cycling, jogging, non-motorised scooter) or buses or trains will have massive benefits for the UK. Active travel is often the best way of fitting 150 minutes per week of exercise, as recommended by the World Health Organization and the UK Chief Medical Officers, into an adult’s schedule.
It seems as if government priority and travel funding is directed towards cars. The investment in roads is of a far greater magnitude than is spent on active travel. It would be better to prioritise other modes. Car drivers should not be prioritised because this removes focus from others who need transport.
• 19% of the UK population is over 65.
• 20% of population are children.
• 63% of working aged adults have dependent child in their household.
• 32% of UK children are driven to school.
• 19% of UK adults are living with a long-term health condition.
Women in general have different transport needs. Where children can go to and from school by walking, cycling or bus, this may free up their parents to be more available for employment. There is a gender pay gap in many professions, and a pay gap between mothers and women without children. These pay gaps would reduce if children’s access to school was prioritised. Women are more likely to trip-chain, linking journeys. We need secure cycle parking, including for cargo-bikes. 20mph default speed limits in populated areas reduce casualties and encourage active travel by improving perceived safety.
Far too many people are killed or seriously injured on Britain’s roads. Fewer cars would reduce this.
People do not cycle because it is perceived to be unsafe. Better infrastructure is urgently needed in many towns to ensure the uptake of active travel, especially cycling. This would be much cheaper than some road re-building projects.
Safety features around schools and pedestrian crossings should be funded. Thousands are requested, including residents submitting petitions, but are never progressed due to lack of funding.
Very few transport journeys over 1 mile are walked. For modal shift to occur, there should be viable alternative for journeys between 1 and 5 miles. Infrastructure for cycles, electric-cycles and buses are essential.
At every age group around half as many women cycle as men. Fear of injury is a major factor. Similarly, there are environments where women feel fearful to walk, run or jog.
Electric-cycles effectively flatten hills and make cycling pleasurable. People gain just as much fitness as in a conventional bicycle because they convert more car journeys to electric-cycle journeys. They allow people to travel actively and get exercise, even if unfit, with luggage, female or with disabilities.
Trains and buses should be prioritised and subsidised. This would reduce pollution from car use.
Many families experience poverty and running a car is a major expense. Where good alternatives exist, especially for getting children to school and for shopping and transport to work, many households would be able to manage with one car or none, reducing financial difficulties that contribute to ill-health.
References and further evidence on health, exercise, transport and traffic collisions:
https://www.bmj.com/content/379/bmj.o2862
https://www.bmj.com/content/379/bmj.o2538
https://www.bmj.com/content/382/bmj.p1739
https://www.bmj.com/content/380/bmj.p702
From consultation questions: https://committees.parliament.uk/work/7794/strategic-transportobjectives/
- What is your understanding of the Government’s strategic transport objectives? Are they the right ones, and if not, how should they be changed? The government’s strategic transport objectives offer worthy rhetoric about supporting a modal shift from car use to active travel. Unfortunately, funding is not currently attached to schemes for active travel. The funding for Active Travel England has been reduced. Without funding this strategy will never be effective.
- How well has the Government articulated the outcomes and objectives it seeks from the country’s transport network? How could this be improved, and what impact would better-defined objectives have on transport planning and investment? The government should make it clear that ALL transport has value, including that of children, women and people from marginalised groups. Funding and objectives should be set for active travel. The government should insist upon more active travel facilities and fund them.
- How well does the appraisal and decision-making process for new transport investment meet the Government’s strategic transport objectives? How should this be improved? It is not clear how this is undertaken. Decision-making needs to have a ‘health for all’ scoring
- How should wider economic, environmental and social impacts be appraised and valued, including when the gains will largely be felt in policy areas other than transport? A pilot may be needed to assess different options. It should be noted that a healthier population is more able to contribute to the economy. Exercise at the ‘dose’ of 150 minutes per week is easily achieved with active travel (eg a 15-minute journey commuted back and forth, five times per week) – this ‘dose’ reduces the risk of dementia, depression, heart disease and bowel cancer by 30% https://www.aomrc.org.uk/wp-content/uploads/2016/03/Exercise_the_Miracle_Cure_0215.pdf. The UK economy cannot afford the cost of ill-health or social care due to sedentary lifestyles.
- How can longer-term certainty in planning be achieved in order to promote greater private sector investment from a range of sources? At present, funding is often offered in a short bidding process, and only ‘shovel-ready’ schemes can benefit. Some change is needed to the planning and consultation process.
- How effectively is strategic transport planning and investment coordinated across and between transport modes, including with reference to achieving modal shift? This could be improved. Secure cycle-parking is needed at train stains and bus stations. Bus ‘Real Time Information Systems’ are making a difference, as is technology such as apps on smart phones detailing when the next bus service is, for example for young people and their families.
- How could planning for transport infrastructure across government and coordination of policy (for example, with policy on energy, digital or planning) be made more coherent and streamlined? Planning should have a ‘Health in All Policies focus: https://www.who.int/activities/promotinghealth-in-all-policies-and-intersectoral-action-capacities All public sector building should be required to meet standards (eg for access by foot, cycle or mobility scooter; planning; secure cycle storage; access to lockers and washing facilities for employees; access to subsidised cycle loan schemes and information on alternative travel arrangements).
- How effectively is strategic transport planning and investment coordinated between national, devolved, regional and local government and other public bodies? Do the current division and distribution of powers help or hinder. It seems that unitary authorities have had recent success achieving change. Tensions between parish, borough and county councils stymie progress and allow a few vociferous individuals to limit development to support active travel. Funding from central government with clear objectives may help this. Clear messages should be used for the public and local government, highlighting the health impacts of road traffic, the benefits of active travel and issues such as induced demand and the need to consider inequalities in health
Professor Scarlett McNally BSc MB BChir FRCS(Tr&Orth) MA MBA FAcadMEd President, Medical Women’s Federation
