Research tells us that the most effective way of increasing active travel will come from a mix of multi-disciplinary interventions that work together to1-4:

• recognise and address cultural and social factors, including reducing disparities in access to services
• make active travel safer and easier
• place appropriate limits on motorised vehicles

We would like to see transport policies (especially in cities) refocused so that they are based around efficient movement of people rather than vehicles. This would require road space reallocation away from motorised vehicles (especially parked cars) and towards space for public transport, cyclists, and pedestrians.

Our national recommendations

We welcome the recent funding announcement to boost transport in towns and rural areas by £104 million. Governments across the four nations should continue to provide long-term sustainable investments in public transport infrastructure, rather than short-term competitive funding or one-off payments, to enable independent mobility and promote active travel.

• All new urban roads, and any changes to existing roads, should be designed to prioritise the needs of pedestrians and cyclists. An increase in safe cycling and walking routes will also facilitate rural connectivity between villages. All segregated routes must be accessible to people living with disabilities, including those using wheelchairs or adapted bikes. Accessibility standards should ensure that people with mobility, cognitive, and sensory impairments are supported to access and use public transport.
• Cycling should be included in the national curriculum, and there must be safe spaces for children to learn to ride, with a change in the law allowing children and other vulnerable users to ride on the pavement.5
• The provision of bicycle spaces on trains should be expanded, and restrictions on bicycle carriage during peak travel times should be re-evaluated to promote multimodal, sustainable transport options. As seen in Wales, reducing speeds has shown to reduce road traffic collisions and can make the roads feel safer (for road users and pedestrians), improve air quality, community cohesion, and business viability.6, 7 The speed limit in built up areas should be reduced to 20mph.
• The Department for Transport (and other relevant bodies) should conduct rigorous health and equality impact assessments for new policies and reject or amend new policies if the assessment identifies risks.
• There is an urgent need to address climate change. Reducing the use of motorised vehicles and increasing active travel will play a key role in improving air quality and reducing carbon emissions. E-vehicles will be part of the solution and there must be a rapid expansion of the charging network, particularly in more deprived and densely populated areas (where home charging is less feasible), and linked to car sharing opportunities such as car clubs.
• Public transport in all UK cities should match London level – this is essential to move people out of cars.
• Devolving funding decisions to LAs on transport in towns and rural areas should not become a mechanism for national Government to offboard responsibility.

Our local recommendations

Public health should be central to planning policy to improve the population’s physical and mental wellbeing. All plans need to include extensive local engagement to support empowerment and build trust within communities.

Following the recent announcement, as transport funding decisions are devolved to LAs, it is important that LA public health teams and communities are consulted to ensure future interventions meet population need.

• Local public health authorities should be supported in implementing NICE Guidance NG90 on physical activity and the environment. This includes ensuring the provision and maintenance of adequate green spaces and community facilities within local areas (benches, toilets, etc) and improving transport accessibility.
• Introduction of low traffic neighbourhoods - effective at reducing car usage and increasing active travel.8, 9
• Good pavement maintenance is essential, as is ensuring that pavements are not blocked by parked cars or cluttered to allow mobility aids and prams to pass freely.
• Upgrading and maintaining roads, particularly in rural areas, is important to ensure safety when travelling and to facilitate connectivity and access to services.
• There should be segregation of cyclists from busy traffic, but shared space for cyclists and pedestrians needs to be used with caution. Unless the routes are wide enough to accommodate both sets of users, more experienced cyclists, those want to travel at a reasonable speed, or on a more direct route, may well choose not to use them. Shared cycling/pedestrian routes can feel unsafe and deter pedestrians, particularly older people, and disabled people. Having segregated routes is good but roads also need to be safe.
• Cycling and walking routes need to be properly lit as some of the off-road routes that make cycling more pleasant in the daytime can feel very unsafe after dark. Lighting these routes has been shown to increase walking and cycling numbers but needs to be done with care to avoid contributing to light pollution and its consequences for wildlife and biodiversity.10
• Cycle storage and security must be prioritised. Bicycle theft is a major deterrent to people cycling, and people need to have space to keep their bikes securely at home, at school/college, at work, and at venues/in town centres. This requires planning authorities to require suitable safe, accessible, storage to be provided in all developments.
• Bike sharing, cycle loan, and cycle to work schemes should be promoted. Shared bike programmes should be easily available and transcend local authority boundaries, particularly in cites to facilitate end-to-end journeys. However, this would require adequate regulations.

We believe that the measurement and evaluation of integrated travel, and its benefits, should be strengthened using explicit SMART targets for the following:

• health improvement (in particular, in relation to reducing rates of physical inactivity) 
• impact on typically underserved groups, such as individuals facing economic hardships or health inequalities
• improvement in air quality (NOx and particulates) 
• reduction in greenhouse gas emissions
• modal shift away from motorised vehicles (including e-vehicles) and towards active / sustainable transport

Evaluating the health impact of transport interventions and integration will be important in aligning with the Government’s health mission and preventative health agenda. By assessing how integrated transport strategies affect physical and mental health, it will allow policymakers to measure progress against the shift from treatment to prevention.

We agree that decarbonising transport is essential, given that around a quarter of the UK’s carbon emissions are from transport. We note, however, that decarbonisation on its own will not bring the required improvement to air quality, and we would like to see an explicit reference to a modal shift to active and sustainable travel, with ambitious targets set for this. Our goal should be to reach Dutch/Danish levels of active travel by 2050 (or before) as part of the UK Net Zero strategy. We would also like to see shipping and aviation emissions included in decarbonisation plans.

Enhancing transport infrastructure and integration will be particularly important in rural areas, where improving rural connectivity can boost economic growth.11 Expanding infrastructure will not only facilitate access to employment and services but also encourages active travel which promotes a healthier lifestyle. Achieving a more active population will result in reduced sick leave, greater workforce productivity, and stronger local regeneration which will contribute to economic development.12,13 Additionally, a healthier population will ease the burden on the NHS, lowering healthcare costs, and reliance on public health services. 

Interventions to deliver transport integration should be assessed on how they contribute to the goal of ‘accessible, affordable, and reliable public transport and robust town planning that enables independent mobility and promotes active travel’.

We welcome the changes to the Green Book - allowing for placed-based business cases, supporting the assessment of long-term benefits, and moving away from a strong focus on benefit-cost-ratios and onto broader benefits to proposals. Our hope is that they will support the development of interventions needed to deliver transport integration through allowing broader thinking on what local areas need and broader, long-term benefits of proposals.

However, despite these changes, the Green Book still does not enable a clear assessment of how a policy will affect health. The Green Book provides guidance on quantifying and monetising health outcomes, but this is neither clear nor sufficiently directive, as explained in a BMJ article (written by the 2021-22 BMA President) on why prioritising population health is essential to prosperity.14

The Green Book should be updated and improved to include evaluation of the health impacts of transport policies.14

At a societal level, there needs to be recognition of the role that transport can play in reducing health, and other, inequalities and addressing the wider determinants of health. Secondly, at the individual level, it is important to recognise the physical and mental health consequences of different modes of travel. Active travel gives benefits to people’s physical health, mental health and wellbeing, congestion, productivity, and connection to nature and local communities.15-17

ADPH would like to make the following points:

• Transport can be integral to improving equality by increasing access to jobs, education, and services. Policies that improve the accessibility and affordability of transport can therefore help promote equality, social cohesion, and reduced isolation.
• If transport costs are too high people cannot afford to make the journeys they need to get into work or move into education and training that could improve their prospects. Lack of travel options can result in people, particularly individuals who rely on accessible transport, spending a high proportion of their income on car travel as the only way to access employment and services.
• Some groups can be at higher risk of poverty and transport poverty. People from ethnic minority backgrounds, young people not in education, employment or training, students, older people, and women are particularly at risk of transport poverty. The impacts of transport poverty are worst for poorer people in rural (and small urban) areas.
• Limited transport options reduce access to healthcare. Getting to hospitals is particularly difficult for people without a car or who are living in places with inadequate public transport options. This lack of access can lead to missed health appointments and associated delays in medical intervention.18
• There is an urgent need for policies to recognise the important social value of transport more explicitly. Public transport service limitations, combined with largely unregulated land-use development are driving a mobility culture that most advantages already highly mobile and affluent sections of the population, while worsening the mobility and accessibility opportunities of the most socially disadvantaged in the UK.
• Active travel can contribute significantly to children’s activity levels and help make children more independent.19, 20 It also helps to maintain physical activity and health in older adults.21 It is cheap and convenient, allowing people to go where they want, when they want, and can be built into the normal day, using time that would otherwise be spent on a sedentary journey. Cyclists and walkers are the happiest commuters and studies from the Netherlands and the UK have found cyclists also take less sick leave and are less likely to be overweight22- 25.
• Air pollution causes even more harm to children than to adults, and their peak exposure occurs during the school run.26-28 Using active travel for the journey to school not only gives children a good start to the day, with evidence of improved health and educational outcomes, among children who are more physically active, but also reduces the number of cars on the road, thereby improving air quality for all as well as reducing carbon emissions and road traffic collisions involving children.28-30

At present the UK appears to have a bias towards car-centric planning which privileges the needs of automobiles and their drivers over other modes of transport. This often results in environments that are undesirable for active travel, for example:

• unlit streets
• poor quality pavements
• absence of dropped kerbs
• limited crossings/prioritisation of vehicles at crossings
• absence of cycling infrastructure such as dedicated cycle lanes and secure cycle storage
• insufficient or unsafe public transport

This prioritisation of private motor vehicles during the planning and design of transit infrastructures and urban space means that vehicle ownership is built into living and accessing certain spaces. This marginalises some groups, particularly those on lower incomes, people with disabilities, women, and older people and limits their employment, educational, and social opportunities leading to transport-related social exclusion. Additionally, some people are forced into car ownership despite the significant financial implications of this. Forced car ownership often leads to deprivation in other areas of life, for example, fuel poverty, food poverty, and social poverty.

As mentioned above, we would like to see transport policies, particularly in cities, refocused so that they are based around efficient movement of people rather than vehicles. Although, it should be noted that the option to walk or cycle may be restricted in rural area, and the integration of public transport in these areas may be difficult or unfeasible to achieve, it remains essential that rural communities are not left behind in efforts to improve transport infrastructure.

Integrated transport modes should link seamlessly to offer a convenient and easy travel experience for users which is accessible and affordable, however, for this to happen key actors with a responsibility for transport, such as national and local government, and transport authorities, must work in collaboration.

Integration will not automatically improve accessibility, and it is important to intentionally build this into transport proposals. There are many barriers currently experienced by people with disabilities on public transport such as badly designed and cluttered streets, unreliable step-free access, poor staff assistance, lack of safe and free spaces to rest, and poor navigation and information within stations.33 Policy and interventions must be designed for all groups. While shared bike programmes have improved urban transportation, the disorderly parking of dockless bikes can create hazards for pedestrians, particularly the most vulnerable.34

It is these types of obstacles which often causes people with disabilities and long-term health conditions to travel less and avoid spontaneous or unfamiliar journeys which limits their freedom and independence. To ensure public transport is more inclusive, accessible, and reliable, there should be34:

1. A ring-fenced investment to ensure they are a feasible option for people with disabilities, including:
• Increased access to step-free stations
• Readily accessible travel information
• Increased amount of mobility aid spaces onboard transport modes
2. Inclusion of people with disabilities in research, co-production of interventions, decision-making processes and implementation. Involving individuals with lived experiences can help identify and eliminate potential issues as they arise and ultimately produce a safe and inclusive mode of transport.