Physical activity and active travel

Strategic Review of Health Inequalities in
England post-2010
The role and impact of prevention -
Physical activity and active travel
Dr Charlie Foster
BHF Health Promotion Research Group
Department of Public Health
University of Oxford

Presentation Objectives
• To describe the case for physical activity and active travel
• To assess their relationship with inequalities
• To present examples of successful active travel
interventions

First clinical episodes* of CHD in male central
London bus drivers and conductors aged 35-
64, 1949-1950
No. of
cases
Age standardised Rate
per 1000 p.a.
Drivers 80 2.7
Conductors 31 1.9
*Angina, MI, CHD mortality
Morris et al, Lancet 1953

Physical
activity

Physical
activity

Physical
activity

Physical
activity

Leisure
Work
Physical
activity
Exercise & Sport
Active Travel
Household

61% of men and 71% of women do not meet the Chief Medical
Officer’s minimum recommendations for physical activity in adults
% active
Men
Women
Age

% active
Age

% active
Age

% active
Age

% active
Age

% active
Age

% active
Age

Physical activity, active travel and inequalities
• Physical activity choices are socially patterned

Hours per week
Mean hours per week of brisk/fast pace walking
in Scotland and England by social class
2.5
2.0
1.5
1.0
Scottish Women
Scottish Men
English Women
English Men
0.5
0.0
I & II III NonManual III Manual IV & V
Dr Melvyn Hillsdon – University of Exeter

Walking trips, for transport, per person per year
by household income
Lowest real
income
Second
level
Third
level
Fourth
level
Highest real
income
Walk 307 275 239 218 208
Car 224 325 458 537 602
National Travel Survey, 2006
Dr Melvyn Hillsdon – University of Exeter

Physical activity, active travel and inequalities
• Physical activity choices are socially patterned
• Individual approaches to promote physical activity have the
potential to increase inequalities
• Availability of physical activity facilities declines with level of
area deprivation

Availability of physical activity facilities declines with
level of area deprivation
The density of exercise
facilities by quintile of
deprivation for the
county of Kent in
Southeast England

Physical activity, active travel and inequalities
• Physical activity choices are socially patterned
• Individual approaches to promote physical activity have the
potential to increase inequalities
• Availability of physical activity facilities declines with level of
area deprivation
• Active travel interventions must contain environmental
supports to sustain individual choice (i.e. public transport)

Policies
Places
People

Bruno Taylor's Playful Spaces

Right-hand turn lanes

Right of way over motorists

Linked traffic light system

Priority of bicycle lanes

Using the environment to promote active living
• Successful active travel interventions blend changes to
places, people and policies
• European examples demonstrate what can be achieved
in the long term
• NICE Physical activity and Environment public health
guidance offers direction

The Cycling Demonstration
Towns programme
• First phase: October 2005 –
October 2008
• All towns funded at approx
£5 per head per year,
matched by the local
authority
• Comprehensive evaluation

Annual growth rates: European cities and CDTs
City
Annual
increase in
cycling flows
Darlington +14.2%
Exeter +9.9%
Brighton & Hove +9.0%
Strasbourg +7.0%
Lanc w Morecambe +6.2%
Vienna +6.4%
Graz +5.9%
Munich +5.5%
Hanover +5.4%
City
Annual
increase in
cycling flows
Nottingham +4.8%
Freiburg +4.4%
Munster +3.6%
Aylesbury +3.6%
Berlin +3.2%
Derby +2.5%
Zurich +2.3%
Delft +1.2%
Adapted from: Transport for London (2004) ‘Creating a chain reaction. The London Cycling Action Plan. February 2004.
(http://www.croydon-lcc.org.uk/downloads/2004_TfL_LondonCyclingActionPlan.pdf)

Summary
• Physical activity and active travel promotion are part of complex
system approaches not isolated as single dose solutions
• Synergies with economic regeneration, crime, welfare and climate
change
• We need high level strategic and political commitment, consistent
implementation of best practice and targeted investment

Strategic Review of Health Inequalities in England post-2010
Thanks
Nick Cavill – Cycle England
Dr Melvyn Hillsdon – University of Exeter
Dr Adrian Davis - Bristol City Council
Phil Insall - Sustrans
charlie.foster@dphpc.ox.ac.uk