Feature

Nothing to lose but your chains

The Royal Commission on Environmental Pollution recommends a ‘sustainable transport policy’, and the government wants people to take more exercise. So why not have a sensible cycling policy, asks Adrian Davis

The news that cycling is good for you is hardly front page material. But when the British Medical Association gave their unequivocal support to the promotion of cycling in a 1992 report, the national media sat up and took notice. The headlines at the time made clear the reason for such uncharacteristic attention to health promotion. The Times headline declared ‘BMA back-pedals on cycling risks’, highlighting how the report had originated from a BMA working group which had set out with the view that cycling was a dangerous activity. From this starting point, the conclusions of the report indicate a remarkable about turn in policy.

In considering the risks of injury and death — approximately 200 cyclists are killed annually in Great Britain — the BMA concluded that ‘even in the current hostile traffic environment, the benefits from regular cycling are likely to outweigh the loss of life through cycle accidents for the current population of regular cyclists’. In typically forthright manner the report’s author, Dr Mayer Hillman, has since calculated that years of life gained outweigh those lost by twenty to one.

A bicycle user is seriously injured only once every 300,000 cycling kilometres and a cycling death occurs only once every 17 million kilometres. Such statistics suggest that the risks of cycling have been over-played in the past, deterring potential cyclists from an activity which has benefits for the health of the community as well as the individual.

Public health has been undermined as a result of undue stress on the risks of cycling, especially given that the main alternative is car travel. A growing body of research links vehicle emissions with the worsening of respiratory and cardiac diseases. The increasingly sedentary lifestyles being led by a large proportion of the adult population, which the 1992 Allied Dunbar National Fitness Survey revealed, implies that encouraging cycling as a means of promoting physical activity would improve the health of many adults.

But while one in three adults owns a bike and 93 per cent of adults can ride, according to a Mintel survey, only 27 per cent of bicycles are used in a typical week. This is despite the fact that 72 per cent of all journeys are under five miles long and that bicycle sales have rivalled and even outstripped car sales since the early 1980s.

The health benefits of cycling are considerable. The National Forum for Coronary Heart Disease Prevention has noted that regular cyclists often enjoy levels of fitness more typical of people ten years younger than they are. The eminent epidemiologist Professor Jerry Morris has reported that cycling at least twenty miles a week reduces the risk of coronary heart disease to less than half that of the population as a whole. There are further benefits in terms of improved lung and respiratory function, avoidance of obesity and osteoporosis, and even improved mental health and well-being. Morris has concluded that ‘among the common physical activities, cycling comes nearest to an ideal form of exercise’.

The BMA report was a particularly important milestone in the battle which cycling groups, environmentalists and enlightened town planners have been waging over several decades with transport policy makers and politicians. But what has happened since 1992 to broaden support among such groups as doctors, public health researchers, health promoters and health pressure groups? An initiative which followed directly from the publication of the report was the production of a leaflet (enclosed in this issue of healthmatters), funded by the industry’s Bicycle Association and produced in partnership with the BMA and the Cyclists’ Touring Club, the largest of the cycling campaign groups. The leaflet, which was distributed to all GP surgeries in Britain, summarises the health benefits of cycling and the BMA’s prescription for greater cycle use.

Other initiatives, such as encouraging health authority staff to cycle and lobbying for provision for cyclists by local highway authorities were stimulated by the report’s publication. The work of the health promotion unit in Chichester, West Sussex, is a good example. A consultation document published by the highway authority in July 1994 proposed a cycling strategy for the county. The BMA report was cited in justifying the health benefits of cycling, which are integral to the strategy. Importantly, the health promotion unit had used the report as a vehicle which could be used to put the case to planners, engineers and elected members that cycling should be promoted for its significant health benefits.

Given that there are many forms of physical activity which would provide considerable health gain, why single out cycling? One might argue that swimming is an even better form of physical activity. The reasons in favour of cycling are persuasive. Taking swimming as an alternative, even if as many people could swim as can cycle there are difficulties with regards to access to a pool — which may generate extra journeys, often made by car. And despite significant investment in new pools, the average public swimming pool serves a population of over 45,000, conjuring up scenes of chaos if just 5 per cent of the population were to swim regularly.

While bicycles cost money to buy, the running costs are low. And perhaps most importantly, cycling has a useful transport function in going about daily activities. As a Cyclists’ Touring Club report notes: ‘...cycling could easily be incorporated into the daily routine as a trip to and from work, and would be representative of a significant proportion of work trips in terms of distance.’ In short, cycling is a form of useful, as well as beneficial, physical activity available to the majority of the population on a regular basis.

The issue of children and cycling should not be ignored. As with adults, widespread ownership of bicycles by children is not matched by use. For example, many journeys to school are potentially cycleable if considered by trip length. Yet perceived and real traffic dangers commonly result in children being driven to school, creating a spiral of car dependency. Yet — as the practice of including non-car ownership when assessing levels of deprivation fails to acknowledge — there are health benefits from a greater reliance on muscle power, especially as recent research has shown that car occupants are exposed to higher levels of pollution than those outside, especially in urban traffic conditions.

The way to resolve the problem is not to restrict children’s independent mobility, nor to discourage a health promoting activity. The solution must be to tackle the cause: too much traffic, often travelling too fast. Traffic calming and safe routes to school projects are health issues in the broadest sense, allowing physical safety and independent mobility, promoting well-being and a sense of achievement in learning how to cope with the environment.

To further encourage cycling as a useful and enjoyable form of preventive medicine, the Bicycle Association and the Cyclists’ Public Affairs Group (a forum of cycle campaign groups) have initiated the Bike For Your Lifeproject. In the short term the project’s focus is on the work of the Health of the NationPhysical Activity Task Force and the consultation exercise on how to promote increased levels of physical activity in the population. Cycling could play a substantial role if it is taken seriously by the task force. The question is whether the task force recommendations to the Health of the Nation Cabinet committee will recognise this or whether current transport policy will once again see the potential of cycling denied.

Encouragingly, the former minister for roads and traffic, Robert Key, accepted the validity of local authorities establishing targets for increasing the proportion of trips made by bike when he made the first significant government statement on cycling for over a decade. He also recognised that ‘definable health benefits’ could be derived from cycling, so reversing the previous government position on cycling as that of an accident problem.

Aside from focusing on the Physical Activity Task Force, the project will seek to undertake projects with specific organisations and health sector professionals in raising the profile of cycling as preventive medicine. This will involve briefing materials and workshops towards the end of the first year. Bike For Your Life is also seeking examples of best practice in encouraging cycling in the health sector and in influencing local (and hopefully national) transport policies. The author would be grateful to receive such examples which will be included in a good practice guide.

Promoting links between health and transport professionals, breaking down traditional sectoral barriers and encouraging intersectoral collaboration in the spirit of Health For All has, to date, been notable mainly for its absence. It is the intention that Bike For Your Life will act as a catalyst to ensure that the links between cycling and health gain are made. In seeking to move away from understanding of NHS health facilities as ‘illness centres’ health professionals can actively promote health in their own working environments by promoting the cause of cycling as preventive medicine. Ultimately, Bike For Your Life is working towards the time when the slogan (proffered by Fiona Godlee of the British Medical Journal) reflects daily experience on the highway: ‘Think first, most doctors go by bike.’

Bike For Your Life, c/o 40 Jodrell Street, Nuneaton, CV11 5EG. Tel: 0203 386 248.