Educating decision makers about the health benefits and safety aspects of cycling

VeloCity Milano, 1991

This paper will be focused on the need to educate transport and health practitioners and politicians about the relationship between the risk to health of not cycling and the risk of death or serious injury in a road accident when cycling.

Two facts emerge from examining public policy on cycling. First, it is viewed as a dangerous form of travel owing to the casualty rate among cyclists being many times higher than that among car or bus users. Second, as road safety policy is almost invariably aimed at lowering road accidents, it is then thought inadvisable to encourage more people to take up cycling. As a consequence, the extent of the health benefits of this unique means of maintaining physical and mental fitness, as well as the appropriateness of its primacy as a form of transport, are not adequately recognised. This leads to considerable under-investment of resources for cycling.

The paper will discuss the significance of evidence on the life-enhancing scope of cycling for the general population, and the distorting effect on policy of current statistics used to measure road safety.

Introduction
There is a general need for policy makers and practitioners to make their decisions on the basis of reliable evidence rather than that of their own judgement which is often derived from misconceptions. This can be seen in their attitudes to cycling which are based on a misunderstanding of the nature of road safety and a lack of information on the potentially much greater life-enhancing role that cycling could play.

It has been obvious for many years that, in theory, making wide-scale provision for cycling would contribute to such a range of goals of public policy as to strongly indicate that it should be given pride of place in the transport hierarchy, that is going well beyond simply treating it as mechanised mode of transport deserving some consideration in the allocation of public resources. There is growing appreciation of its virtues in terms of door-to-door convenience, speed and flexibility, its low environmental and energy impacts, its low costs both in provision and use, its scope for widespread availability for people of all ages, and its scope for the promotion of health and the general quality of life – truly a ‘green’ vehicle.

A major problem lies in the view of policy makers and practitioners in the transport field that, whilst there may be these wide-ranging justifications for encouraging cycling, they would be ill-advised to do so because of the associated risk of injury in road accidents. An increase in casualties would be inevitable. For this reason, whilst clearly being unable to make a law prohibiting cycling in order to contribute to the objective of reducing road casualties overall, they would prefer to see no significant transfer to cycling from other forms of travel – or certainly not until a safe and exclusive network could be provided for it.

This paper draws attention to three elemental paradoxes which it is essential to clarify in the process of formulating appropriate transport and health policies for the future of cycling.

The risks of cycling
The first paradox relates to how dangerous it is at present: the fear of the relatively high risk of injury when cycling is the most influential deterrent standing in the way of its wider take-up which would be so beneficial to both the individual and society at large. To some extent, that fear is justified.

In reflecting this, current policy is developed from examining the relative risk of travel by each travel method. Statistics are presented in such a way as to imply that, for instance, car travel is much safer than travel by bicycle. Comparison of the accident rate per kilometre travelled by cycle with most other forms of travel reveals cycling as a relatively dangerous mode: in the UK, less than one per cent of total mileage is made by bicycle, but cycling accounts for five per cent of all road fatalities. Indeed, the fatality rate per kilometre for travel by cycle is about seven times as high as that for travel by car. From this, it is generally inferred, and seems sensible to believe, that cars are a much safer form of transport.

An obvious interpretation of these figures from the perspective of any governments’ policy aimed at reducing road accidents is that people should be encouraged to make more of their journeys by the ‘safe’ modes – cars and public transport – and fewer of them by the ‘dangerous’ modes – foot and bicycle. Such a view is strengthened by reference to the claims of motor manufacturers of cars such as Volvo and Saab that, for instance, ‘the chassis is more able to resist collisions’ giving their drivers and passengers well above average survival rates.

It is clear, however, that any vehicle in use on the public highway poses some risk to road users other than its occupants. The form in which statistics are published only relates to the vehicle user under consideration. The obvious way of comparing the relative danger of travel by the different modes is not solely to ‘internalise’ it, but to ‘externalise’ it as well. Surely, the fatality rate per car kilometre should include the deaths of other road users, such as cyclists, together with as the people in the car.

Thus, transport policy makers should consider from whose viewpoint are cars relatively safe and cycling dangerous, and what can be done to improve the situation. Cars were not safer for cyclists about two-thirds of whose deaths conspicuously result year to year from an accident involving collision with a car. For these unfortunate people, cars were certainly not a ‘safe’ form of transport.

This leads to a significant change in perception of which are the more dangerous and safe travel methods. It allows a meaningful appreciation of the relationship between the risk per kilometre for each method in relation to each other method, that is the risk incorporating fatalities among all road users. In this way, policy makers are more pertinently informed of the real risk of death to all members of society of the different methods rather than the risk to the user of any particular method. This approach reveals the unsurprising correlation between the low rate for the largest and sturdiest vehicles and the high rate for unprotected road users. But, for every 100 persons killed in a heavy goods vehicle per kilometre travelled by that vehicle, 1200 other road users are killed. On the other hand, for every 100 cyclists killed per kilometre travelled by cycle, only 4 other road users are killed.

Fatality rates by vehicle user.

fatalities per 100,000 vehicle kilometres

Vehicle type vehicle user pedestrian other vehicles all other fatalities as prop. of all
Bicycle 4.9 0.1 0.1 5.1 4%
TWMV1 10.3 1.7 0.6 12.6 18%
Car 0.7 0.4 0.4 1.5 53%
Light goods 0.4 0.4 0.6 1.4 71%
Bus or coach 0.4 1.8 1.7 3.9 90%
Heavy lorry 0.2 0.5 1.9 2.6 93%

[1] Two-wheeled motor vehicle. Source: Department of Transport, Road Accidents Great Britain 1990: The Casualty Report, 1991, London, HMSO.

Thus, the paradox apparent in the question ‘How safe is any particular travel method?’ can only be clarified when the rider to this question is posed – ‘from whose perspective?’ An understanding of this paradox leads to an almost complete reversal of our appreciation of the relative danger and safety of travel by each method and therefore of the direction of policy on promoting road safety. It points to the need both to promote cycling as it is a form of travel that keeps the risk of death among other road users at a minimum. And it reinforces the case for making roads less dangerous by ‘taming’ motorised vehicles and providing safe and convenient networks for cyclists (and pedestrians).

The measure of road safety
The second paradox that requires clarification is very much related to a further misconception of politicians and practitioners about road safety policy. It stems from the incorrect way that safety or danger on the roads is measured in all countries around the world. This is based on the assumption that the only indicator of safety or danger needed to assess the success or failure of policy is the number of accidents. It apparently stands to reason: safe roads have few if any accidents on them whereas dangerous roads have many accidents on them.

The exclusive use of road accident data as the only necessary indicator of safety is well illustrated in the UK Department of Transport’s recent claim that “… over the last 25 years, our roads have become much safer”. This claim was seemingly substantiated with the statistics that followed it, namely that “… Road accidents have fallen by almost 20 per cent since the mid-1960s, and the number of deaths is down by one third. At the same time traffic has more than doubled.” Reliance on this indicator suggests that, far from traffic growth making roads more dangerous, it has the opposite effect, and it implies that further traffic growth will not make the road environment more dangerous.

But how could anyone knowing that traffic levels have more than doubled during this period (and knowing that traffic speeds generally have risen too) conclude that “our roads have become much safer”? Was there perhaps a subconscious resistance to thinking through this second apparent paradox, implying as it must a radical re-assessment of the tenet of faith of those responsible for road safety policy on which it has been based since time immemorial – like the Church in the 19th century finding it difficult to come to terms with Darwin’s theory of evolution?

As we showed in the PSI study of children’s independent mobility, published early this year, a major part of the explanation for the fact that both fatalities and the fatality rate have fallen in spite of the considerable increase in traffic is that parents have modified their children’s and their own behaviour in view of their logical perceptions of an increasingly unsafe environment. In the face of this, they have made two changes: first, they have progressively withdrawn their children from the risk of injury by limiting their children’s freedom to get around on foot and bicycle – a freedom which is incidentally cited as justification for welcoming the growth of car ownership and use. And second, they have had to take on the often tedious and time-consuming escort burden which is thereby necessitated. In neither case have these two major social changes been recognised by decision makers.

Clearly, a far more realistic measure of road safety is the volume and speed of traffic or indeed the proportion of say, eight year old children who are allowed by their parents to go to school on their own. Had such indicators been employed in the last 25 years, we would be pointing to the failure of road safety policy. The increasing danger with its attendant consequences, not least in terms of disincentives to cycling and children’s loss of independence, would have been registered. The success of policy would not be able to be claimed simply and exclusively by reference to the reduced number of casualties.

Health benefits of cycling
The third and related paradox is concerned with the loss of life in accidents involving cyclists which is seen by decision makers to be the overriding reason for not promoting cycling. This has had the effect of overlooking cycling’s considerable health and life-enhancing benefits.

Countries in the industrialised world have a history of increasing adoption of sedentary lifestyles in the wake of the mechanisation of society. This has been fed by an instinctive urge to minimise the physical effort required in meeting daily needs, for instance in work and for transport purposes. To combat the consequences of this, a very small proportion of the health-conscious population have sought an alternative route to maintaining fitness through sport, jogging or physically-oriented regimes.

For the great majority, such a route has not been followed and, as a result, the physical condition of the general population is poor. Surveys show that one in three adults in the United Kingdom are overweight and that the fitness of children is at an all-time low, and declining, no doubt partly because of the pressures on the school curriculum which allow less time for physical education and, as noted earlier, because of parental restrictions on their independent travel which almost by definition is mainly focused on their own two feet – walking and cycling.

It is widely acknowledged, however, that exercise could play a major preventive role as it is highly beneficial to health. People who exercise regularly are much fitter, enjoy improved strength and endurance, and the ability to perform everyday tasks with less fatigue. Exercise lowers blood pressure and weight, and promotes bone formation. As a consequence, it is associated with lower rates of cardiovascular disease and cancer. There is also a growing body of evidence that exercise contributes to mental well-being, being beneficial for depressive and anxiety states. It leads to a reduction of stress and to those positive elements – ‘a sense of achievement’, ‘feeling good’ and ‘feeling free’.

What form of exercise could be undertaken regularly by people of all ages, and as a part of daily life? I would argue that there are no other practical means whereby the great majority of the population can keep fit than by cycling. If this sounds a somewhat provocative statement, let me try to justify it. What are the alternatives – running, jogging, brisk walking, sports, especially swimming?

But running and jogging place high stress on hips, knees, ankles and the Achilles tendons. Moreover, the evidence is that most people who adopt these leisure activities drop them after a few months or at most a few years. And whilst swimming has been identified as a better way of keeping fit as virtually all muscles are used in unstressed movements, is it realistic to think that most people could swim two or three times a week, summer and winter, throughout their lives? There are not only the constraints of time and costs of entry but also the problems of access and availability: in the United Kingdom, there is only one public swimming bath for every 50,000 people. Even if there were a massive construction programme to increase the number of baths ten-fold, it is clear that the daily congestion in the baths would rule out swimming as a realistic strategy for promoting the health of the nation.

On the other hand, there is little risk of cycling leading to overstrain of muscles, ligaments or to other injuries from ‘overuse’, particularly as the body is supported on a saddle with pressure and effort evenly distributed between hands, feet and backside. Cycling could be adopted by the majority of the population from childhood through to old age and can be easily tied in to the daily pattern of travel to school, to work, for leisure and so on. By this means, it has a functional role with less self-motivation required in order to adhere to what can otherwise develop into a boring routine. Indeed, cycling is particularly advantageous for children for whom the world is opened up once a bicycle can be used as an independent form of travel: it is their only independent form of mechanised travel, and it is highly desirable from a health viewpoint that they adopt such healthy practices in their early years which are then far more likely to be maintained throughout their lives.

Research has recorded a substantial difference in the attributes of health of those who keep fit and those who do not. They provide clear evidence that, even though the process is not wholly understood, exercise in moderation does contribute to reducing morbidity and mortality. Recent findings of a study conducted among college graduates in the United States over the last 30 years have shown an increase on longevity of one to two years among those who regularly exercised compared with those who did not. Another study in the United Kingdom found that the order of difference in the level of fitness in favour of those who sometimes cycled was equivalent to that enjoyed by being five years younger and that for those who regularly cycled, it was equivalent to that of being ten years younger.

From a public health perspective, therefore, it needs to be noted that, in spite of the life years lost in cycle accidents, far more life years are gained through the improved fitness of those who cycle regularly – even with the current low level of use. The ratio is considerable. There is also much scope for increasing the ratio by reducing the loss of life years by making safer provision for cycling and by much wider adoption of cycling for daily travel.

Conclusions
This leaves cycling in a unique position in being able to meet key public policy objectives of transport, energy, environment and health. From these perspectives, the evidence suggests that, far from it being irresponsible to encourage cycling because of the risks of injury attached to this vulnerable mode, it is irresponsible of decision-makers in the policy spheres of transport and health in particular not to promote it and, at the same time, irresponsible not to reduce these risks of injury by making proper provision for it.

It is clear that the policies of many government departments and other related institutions, including the medical establishment, have until now been deficient in terms of appreciating the major role that cycling can play in meeting their objectives, perhaps because of their concern about cyclists’ greater risk of injury – the promotion of healthy longevity, the enhancement of the quality of life, and a wide range of positive transport and other benefits.

Current misconceptions about the relative risk of accidents with different forms of travel, about the way in which road safety should be measured, and the lack of understanding of the preventive health role that cycling could play, have distorted the judgement of transport and health practitioners and politicians about the major role that cycling should be playing in public policy.

References
Department of Transport (1988) National Travel Survey: 1985/86 Report, Part 1, An Analysis of Personal Travel, London, HMSO.

Department of Transport (1990) Safety on the Move, London, HMSO.

Department of Transport (1991) Transport Statistics, Great Britain 1991, London, HMSO.

Department of Transport (1991) Road Accidents Great Britain 1990, London, HMSO.

Hillman, M. (1990), ‘Cycling and Health: A Policy Context’, in Cycling and the Healthy City, Papers from a one-day conference, Friends of the Earth.

Hillman, M., Adams, J., and Whitelegg, J. (1991), One False Move… a study of children’s independent mobility, London, Policy Studies Institute.

Hillman, M., and Cleary, J. (in press), ‘A Prominent Role for Walking and Cycling in Future Transport Policy’, in Roberts, J. et al. (eds.) A Green Transport Policy for Britain, London, Lawrence & Wishart.

Hillman, M. (in press), Cycling: towards health and safety, A Report for the British Medical Association, Oxford University Press.

Morris, J.N. et al. (1990), ‘Exercise in Leisure Time: coronary attack and death rates’, in British Heart Journal, 63, pp.325-334.

Plowden, S. and Hillman, M. (1984), Danger on the Road: the needless scourge, London, Policy Studies Institute.

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