St. Martins Church, 232 Dalry Road, Edinburgh EH11 2JG 0131.313.2114 (answerphone) http://www.spokes.org.uk/
Web links PATF site www.show.scot.nhs.uk/sehd/PATF/index.htm
Contents A. Our main concerns/recommendations in relation to the report
B. Background, including the importance of active travel, and how to foster it
C. Detailed comments on the questions posed in the consultation response form
A. OUR MAIN CONCERNS / RECOMMENDATIONS
Spokes warmly welcomes the PATF consultation document: particularly its clear layout, its research base, its clear recognition in principle of the importance of active travel, and its emphasis on evidence-based action and on the need to ensure effective policy integration and at all levels. Nonetheless we highlight areas where the document needs considerable strengthening and/or new emphases.
We also strongly welcome the Executive's action in appointing a Scottish Physical Activity Coordinator at once, rather than waiting till after the consultation. Spokes was extremely disappointed that it took almost 2½ years from publication of the Public Health White Paper until the PATF was set up, and we wrote several times about the delay to the Health Department. We sincerely hope the early appointment of the coordinator indicates a genuine new sense of urgency in Executive attention to this critical issue. We hope it also presages Executive willingness to take the tough decisions needed to ensure effective policy integration.
Spokes has always been concerned to highlight the importance of everyday moderate physical activity - particularly cycling and walking - as a major potential contribution to public health. The second of our two objectives is "to publicise the benefits of cycling for the community and for individuals - like walking, it is cheap, efficient, enjoyable, healthy, non-polluting and intrinsically safe".
Spokes was therefore exceptionally disappointed to find that 1998 Scottish Public Health Green Paper made the disastrous and all-too-common implicit assumption that physical activity equals sport & leisure (i.e. generally physical activity for which personal time has to be set aside). At the same time, the Green Paper almost wholly neglected the more significant actual and potential role of everyday walking and cycling. Fortunately very many respondents to that consultation pointed out this major deficiency of the Green Paper, and as a result the 1999 Public Health White Paper placed as much emphasis on everyday moderate physical activity (exemplified in the White Paper solely by walking and cycling) as on sport and leisure, with one paragraph devoted to each type of physical activity [White Paper, paras 42, 43]. The White Paper also promised to set up the Physical Activity Task Force, allocate "additional resources to take forward the work of the Task Force and implement its recommendations", and it set some very challenging targets on adult physical activity [24-25 below].
Following the White Paper's publication, a big disappointment was that the Executive did not take up our suggestion, in letters to the Health Department and to the Transport and Health Ministers, that the PATF should include a transport professional. The PATF report reinforces our view. Certainly, the report does show a clear appreciation of the importance of active travel. However, whilst the presence of sports interests on the PATF has resulted in plenty coverage in that area (particularly school PE), the absence of a transport professional means that active travel, which is probably much more important to the overall health of the nation, is under-represented in examples, targets and recommendations. For example, in the entire 4-page discussion of school and college physical activity issues there are only two mentions of active travel, and not a single example of a relevant initiative. In the two-page bibliography there is only one reference to transport and health, with no mention of the BMA's Road Transport and Health and Cycling Towards Health and Safety, two Scottish Executive research publications on Safe Routes to School, the excellent Making T.H.E. Links (Transport, Health, Environment) from the Health Education Authority, or the publications from Sustrans's DoH-funded Active Travel project. Finally, the absence of a transport professional may lead to reduced credibility for the report amongst Transport Departments. We will continue to argue for fuller transport integration into the strategy and its implementation.
WHY ACTIVE TRAVEL IS SO VITAL IN A PHYSICAL ACTIVITY STRATEGY, AND HOW TO FOSTER IT
Most of the population, of most ages, spends significant amounts of time most days getting to places, whether for work, shopping, recreation, school, to visit friends, even to visit 'activity' centres, and for many other purposes. Since for many people time is very precious, it makes tremendous sense to foster the use of walking and/or cycling as the transport mode for as many of these journeys as possible. i.e. moderate physical activity is being used for existing personal needs, and so does not add a new personal time requirement. Note that lack of time is overwhelmingly the main stated barrier to being more physically active, for people between ages 16 and 54 [PATF report para 31]. This stated opinion also illustrates the fact that most people do not see physical activity as a part of everyday life, but as an extra, requiring time (and possibly money) to be spent. The PATF strategy should as a top priority seek to change this perception - but its current emphases may do the opposite!
It is critical to appreciate that fostering the use of walking and cycling for such everyday journeys is far from being just a matter of exhortation of individuals. Of course, encouragement to individuals is important; but equally or more important are many other factors including...
In this section, the main numbering refers to the questions in the Consultation Response Form. The numbers in square brackets [] refer to paragraphs from the PATF report.
1-3 [PATF report, paras 39] Values agree - in part
Maybe add that work associated with the strategy should be consistent with and support environmental objectives.
4-6 [paras 40] Vision agree - in part
The present statement perhaps implies that the only benefits are to individuals. In fact the benefits are equally to the community/society at large, and the statement should reflect this.
7-9 [paras 41-43] Goal and Targets agree - in part
We agree with the target of 80% of children meeting minimum recommended PA levels by 2020.
We do not agree with the adult target of 50% by 2020. This target is too low.
We are very pleased that the PATF report explicitly stresses the need for effective policy integration at all levels. Spokes would like to see integration required to go further than just advice and information. For example, that relevant departments, including Scottish Executive as well as local levels, have objectives and targets which explicitly relate to health (and to environment).
10-12 [paras 72-74] National co-ordination framework agree - in part
This is an extremely important, and extremely challenging, priority. Departments or agencies set up for a specific purpose may pay lip service to other government objectives such as physical activity, but have no reason to take them seriously when it comes to priorities and resources.
We are also aware that there are similar arguments and problems in relation to integrating wider public health and environmental issues into departments and agencies which have their own existing primary objectives.
Therefore whilst we support the proposals in this section of the report, we are wary of the danger that the proposed Physical Activity Planning Team will be seen as the agency that deals with physical activity, thus allowing other departments and agencies to continue largely to neglect it.
A typical example is a recent re-organisation in Scottish Executive Transport Division 3, which significantly downgraded both the staff time for and the status of cycling and walking: the CWSS branch (cycling, walking, safer streets) had its head removed and was subsumed into the Road Safety branch. We suspect this happened with absolutely no thought to health-policy implications. In contrast, were there effective policy integration, with transport objectives and targets explicitly linked to public health (and environment), then we would perhaps see a new 'Healthy Travel' branch, aiming to maximise the public health (and environmental) elements of travel and access [Spokes 82]. Its targets could include improved local accessibility, modal shift to walking and cycling, reduced traffic pollution, and of course the traditional casualty-reduction targets.
Furthermore, the recent SE Transport Delivery Report, and other recent SE decisions, have very massively increased proposed expenditure on trunk-road construction and on 'big' public transport, whilst plans for walking, cycling and local access have remained completely static. This clearly reflects an absence of any serious consideration of public health issues in transport decision-making.
For any national coordination framework to be effective...
13-15 [paras 75-83] Local Coordination Framework agree - in part
The proposed Community Planning Partnership is welcomed in that it integrates discussion on public health, environmental and economic issues. However, it must have guidelines, and some participants with the appropriate knowledge, such that relevant national priorities like active travel can be adequately discussed and incorporated into local strategies. The annual Spokes survey of local authority expenditure on cycling shows clearly that even many local authorities will not follow national objectives without quite strong requirements and/or incentives.
As in 10-12 above, there will be a serious problem in ensuring that departments and local agencies see these issues as relevant to themselves, see the Partnership as significant to their own working, and do not remain geared solely to their specific objectives. It must be made clear by national funding agencies and by local political leaders that departmental priorities and targets must thus be widened.
We welcome particularly the following examples in para 82...
Edinburgh Council is also forward-looking in relation to the wider integration of health and transport. The second sentence of the Council's Local Transport Strategy vision begins "Edinburgh's transport system should contribute to better health, safety and quality of life ..." The LTS document includes two pages on policy links with health, including two paragraphs on physical activity and such advanced thinking as "There is enormous potential for linking transport policy and health so that exercise is not confined to the sports centre or swimming pool but is simply part of our daily business". There is a stated policy to work with Lothian Health to raise awareness of the relationship between transport and health, and to promote healthy travel choices. However, although targets are proposed on improved accessibility to key facilities by non-car modes and on increased walking and cycling, none of the targets are explicitly linked to public health issues (other than the traditional one of road casualty reduction). Finally, though not mentioned in the LTS, Edinburgh Council has also seconded a teacher full-time from the Education Department to Safe Routes to School work with the City Development Department Transport Section.
Stop Press: As we complete this response, we discover that several councils, including Edinburgh, are preparing strategies with 'physical activity' in their title [indeed Edinburgh's has an overarching objective that Edinburgh becomes Europe's most physically active city], but which are in fact largely strategies by the Recreation Department for the development of sport and physical recreation. In our view these should be termed "sport and physical recreation" strategies (as Glasgow has, correctly, done). If the PATF principles are to have any meaning, then a council PA strategy should be developed and implemented on a corporate basis, not through one interested department. It should be remembered that far more physical activity is and will continue to be undertaken through the actions of daily life than through organised sport. The sport and physical recreation strategy should then be a component of the full PA strategy - it is most certainly not the same thing! In turn, of course, the council's PA strategy would link into the proposed multi-agency Joint Health Improvement Plan [para 80].
16-21 [paras 84-98] Strategic objectives agree - in part
17 [paras 85-89] to develop and maintain long-lasting high-quality physical and social environments to support inactive people to become active
Maybe the wording should end "... to support people in being and in becoming active", as the strategy [in para 19] aims to maintain active lifestyles as well as to create them.
We agree that widespread effectiveness at local level throughout Scotland will depend on the lead from the Scottish Executive and its departments and agencies. Our example in 10-12 above on restructuring within SE Transport Division 3 shows this will require real determination by Ministers.
The example of the ring-fenced resources for cycling and walking is instructive in that it was introduced by a Minister who was very sympathetic to these objectives, but in the face of stiff opposition from COSLA who do not like ring-fenced resources. However, a survey by Spokes of local authority cycling officers found only one who objected to the ring-fencing, whilst 18 welcomed the scheme, and indeed several said it should be tightened to ensure that all councils did at least something for cyclists (the present arrangements do not ensure that). Secondly, the allocation was on a rising curve, and initially for a 3-year period. It will be interesting to see whether the ring-fenced allocation is continued, and whether the increasing trend continues, under new ministerial control!
Another specific area requiring national attention is setting up arrangements to ensure that qualified cycle-trainers are available for all adults, children and schools who require them (see 13-15 above), and that the arrangements are widely publicised, for example through national healthy-living campaigns.
18 [paras 90-91] to provide accurate and evidence-based advice to staff who are involved in government policy and service-delivery, and who work in the voluntary and private sectors
We agree with the points about educating transport and other professionals. However the converse is also true: transport professionals can assist in physical activity and public health discussions, leading to a fuller appreciation of options by public health professionals, as well as greater acceptability to transport professionals of the recommendations. This should be done in relation to PATF composition [A, 36c].
We strongly agree with the need to train 'even health-promotion, sport and recreation staff'. Frequently these staff will see their 'activity' as the all-important issue, not as a part of a public health strategy or in relation to the wider health needs of the individual. Thus staff will, without thought, organise classes at car-dependent locations. Health, sport and leisure centres are built with little consideration to walk and cycle access, and even if built more suitably they will rarely be operated in such a way as to encourage use of these modes - for example with car parking charges, discounts for users who walk or cycle, provision of local walk/cycle maps, and so on. PATF itself has commissioned research into reducing charges at such centres [para 34] - but surely it would be more appropriate to reduce charges for those who live locally (eg through a residents' card), or for those who don't arrive by car.
As Prof David Begg put it, many people see exercise as driving to a session of vigorous static cycling (probably followed by an over-sweet drink) when they could, perhaps at equal health benefit, cycle to an amusement centre for 30 minutes on a car simulator. This is not just a joke! - active travel for regular everyday journeys is likely to be more beneficial to health than driving to a centre once or twice a week for a burst of heavy physical activity.
Finally, advice alone is rarely sufficient. Advice to staff should be backed up by policies and targets which encourage all relevant staff to adopt the advice in their day-to-day work.
19 [paras 92-95] to raise awareness and develop knowledge and understanding about the benefits of physical activity and provide access to information
One particular area for awareness-raising is ensuring that people are aware not just of alternative transport choices but of alternative access choices - i.e. that they consider the blend of both transport-mode and destination-choice - see B above for more on this.
In terms of cycling, there should be far less public emphasis on danger and more on the benefits to personal and public health. Of course, road engineers should continue to improve safety through lower speed limits, well-designed cycle facilities, and accident investigation; and quality cycle-training should be widely available (13-15 above). However, there is evidence that highlighting the supposed dangers of cycling (for example, through emphasising a need for personal protection) results in significantly reduced levels of cycle use [Achieving the Aims of the National Cycle Strategy, Transport Research Lab, report 365]. This happened, for example in Australia and Nova Scotia, when cycle helmets were made compulsory, and there is even the suggestion that heavy promotion of voluntary helmet-wearing in some English authorities reduced cycle use. Yet years of life gained through regular cycle use greatly exceed those lost through crashes, possibly by a ratio of 20:1 [Road Transport and Health, BMA 1997, p20]. Finally, there is evidence that one of the best ways to increase cyclist safety is through increasing the number of cyclists on the roads [Spokes 80]. Thus the traditional road-safety strategy of trying to counter danger through public exhortation about self-protection may well reduce the numbers of cyclists, which in turn increases road-danger for remaining cyclists - a double whammy against overall public health.
20 [paras 96-98] to carry out research, monitoring and evaluation
We very much support this objective. However, what research has been done to convince PATF that the huge resources necessary to roughly double existing PE provision would be more effective in improving overall public health than devoting part of those resources to ensuring all schools provide high quality training in and promotion of active travel, particularly on school journeys? For the reasons stated in 22-23 below, we are not convinced. And yet there is already such publicity about the proposed 2-hour target that, regardless of any such possible research and evaluation, the resources may be effectively committed.
Although a voluntary organisation, Spokes has attempted to monitor certain of our projects, particularly one aimed at distributing cycle maps to people likely to make use of them. According to research for the Scottish Office, whilst many projects under the then Cycle Challenge Scheme may have increased cycle use, our map project was one of the few which could convincingly show that it had actually achieved this.
22-23 [para 99-132] Strategic priorities to support Children and Young People agree - in part
The importance of physical activity is highlighted by the fact that whilst child obesity is increasing, children actually consume less calories than in the past! [Scottish Chief medical officer's Annual Report for 2001]. Regrettably, the PATF proposals concentrate mainly on solutions which (implicitly) teach that physical activity is something to be undertaken in addition to everyday life rather than as part of it, and means being at a specialist location. It is therefore something difficult to continue in adult life when time becomes more precious, and indeed becomes the main perceived barrier to continuing physical activity [para 31].
In particular, this lengthy section of the PATF report pays far too little attention to active travel - with only two mentions and no examples. Yet in the real world there are some excellent case studies, such as Kesgrave School in Ipswich [www.kesgrave.suffolk.sch.uk/cycling.html and cycling2.html] - and there are Scottish examples, as revealed in Scottish Executive Safe Routes to School research, though none so advanced. Kesgrave came top in almost every local schools sports league - yet it did not even have a sports hall! The head put this down to the school's healthy-travel policies, which resulted in 60% of pupils cycling to school and most of the rest walking. The policies include significant restrictions on car access. [There is considerable evidence from the transport world, e.g. from workplace travel plans, that without parallel restrictions on car use the promotion of cycling and walking is much less successful].
How to increase child physical activity
We emphasise that we do very much support greater child physical activity. However, we are concerned about the measures proposed to achieve this objective - namely, two hours a week of PE for each class. Clearly PE lessons in themselves give children activity, though only during term time. However...
Comments on specific paragraphs...
107 In relation to the stated priority to target teenage girls, note that cycling is the most common out-of-school physical activity for 8-11 year-old girls in Scotland [above], and so this is likely to be a productive avenue for early action. It reinforces our call for equal attention to school active travel as to doubling PE.
108-111 This section should not be called 'in the home', but perhaps 'with parents'. At present it totally excludes outdoor activities. This is extremely dangerous, as if children are to adopt an active lifestyle, and do so in mutual reinforcement with their parents, this should begin from the very earliest days. Being carried by parents for short journeys in a baby-rucksack or bike seat will assist very young children with motor skills, environmental stimulation, and the expectation of spending some of their time in the open air. Furthermore, a child is indoors all the time is likely to be 'entertained' by very unhealthy means - recent U.S. research on young children found that "a TV in the child's bedroom is the strongest indicator of increased risk of being overweight" [Guardian 5.6.02].
113 "The Scottish Executive Transport Division wants to increase the number of pupils who walk and cycle to school". This is not sufficient: indeed Transport Minister Lewis MacDonald has stated "All children should have the opportunity to walk to school safely" [SE News 02.05.2000]. Targets, explicitly linked to public health considerations, should be set for this and for on-road walk/cycle training/promotion at all schools. Funding for Safe Routes to Schools projects (including on- and off-road facilities, slow-speed zones, etc) should be enhanced.
130-132 Colleges and Universities are major employers, and their students are adults. They should be treated as such. These institutions of public education and research should be in the forefront of workplace active-travel policies [24-25 below], for both health and environmental reasons.
24-25 [para 133-151] Strategic priorities to support Adults of Working Age agree - in part
We welcome the extensive consideration to child physical activity (though we have serious concerns on the proposed method of delivery, as above). However, there should be equally extensive attention to adults, because...
Shortage of time is overwhelmingly the most important stated barrier to being more physically active for people between ages 16 and 54, and therefore active travel is of particular relevance. Methods of promoting this are covered in (B) above, with further comments below.
We support use of the workplace (including colleges, universities, etc) for initiatives [paras 147-151] - of which active travel should be a major element. This should include charging for car spaces, with the funds used to promote walking, cycling and public transport through interest-free loans, generous mileage allowances, free maps, season ticket discounts, etc. Recent government research shows that for Travel Plans to achieve significant success, restrictions on car use are essential (in parallel with promotion of walking, cycling and public transport). Furthermore, workplaces and other institutions should consider the annual £300-£500 per-space cost of land dedicated to car-parking [Dept for Transport, news release 5.8.02 - and it is not clear if this covers all costs, including construction, lost rent, etc]. However, unless there is a substantial charge for car spaces then clearly car users are being heavily subsided, and those who walk, cycle or use public transport are losing out.
Similarly, non-workplace car-attractants such as superstores and large leisure centres should be required to adopt green transport plans for customers. Again, for reasons of equity and social inclusion, note that due to the land-value of the car-parking areas, customers arriving by foot, walk or bus currently subsidise those who drive.
The government refused to include charging superstores and workplaces for car-park provision at the time of the last Transport Bill. This should be revisited. In particular, Robin Harper MSP achieved a promise that superstore charging would be reconsidered under planning legislation.
Another area ripe for initiatives, and which could tackle deprived areas as much as others, is in active school travel. Although this is covered in the child section above, it is potentially also highly effective for adults, in terms of how parents get their children to school, and provides strong mutual reinforcement between adult and child physical activity understanding and practice.
There should also be area-based (e.g. town-based) Scottish initiatives in the 'personalised' approach to encouraging use of active-travel modes, as developed in Australia and now being piloted in some English towns by Sustrans. These could include some deprived areas, in which additional resources could be included to help identify and rectify barriers to use of active-travel modes.
Again, widespread cycle training opportunities for adults as well as children should be available throughout Scotland (13-15 above).
There should be revised priorities and massively increased funding to make walking and cycling safer, more pleasant, and a more prominent option. Spokes is very disturbed [10-12 above] at the downgrading of status and staffing for these modes at the Scottish Executive, and their almost complete absence in recent Executive decisions on major transport expenditure increases.
Finally [36b below], there should be indicators on active travel and on adult physical activity, to measure progress towards PATF goals, in the same way that PATF is proposing indicators for pupils and schools.
26-27 [para 152-168] Strategic priorities to support Adults in Later Life agree - in part
Whilst it is the case that there are relatively few active older people in Scotland at present, any initiatives should be careful to avoid suggesting that decreased activity is a 'normal' result of ageing. On the other hand, the number of necessary journeys is less, with no children at home and no journeys to work. Therefore, although there is far more time to undertake walking, cycling and other everyday activity, there is in a sense less necessity to do so. Older people should be made aware explicitly of such issues. Also, by encouraging opportunities for part-time and voluntary work an important byproduct will be to maintain the need for everyday activity.
In terms of recreation, we liked this story from a holidaymaker in the Netherlands [On Your Bike, Summer 98] "We could hear a faint noise in the quiet forest. We realised it was talking and laughing, getting closer ... Then another cyclepath crossed ours ... A matronly figure jumped off her ancient roadster and brandished a pole with a red disc - clearly a signal to stop. Then a convoy of around 50 elderly cyclists came into view, chatting loudly. This was clearly a Dutch old folks outing!"
There is no reason why many older people in Britain should not return to cycling, and cycle training opportunities to instill confidence as well as skills may be particularly necessary.
29-34 [Annex C] National Priority for Education no. 5 'Pupils are equipped with the necessary foundation skills, attitudes and expectations to prosper in a changing society and to encourage creativity and ambition'
29-31 Indicator: percentage of pupils achieving health-related level of physical activity - target 80% of pupils agree - in part
32-34 Indicator: percentage of schools delivering two hours a week of physical education to each class - target all schools disagree
As explained in 22-23 above, training in and promotion of active travel could well be more successful than PE lessons in developing sustainable physical activity; and it would do more to provide 'the necessary foundation skills, attitudes and expectations' necessary for a healthy life. We certainly do not oppose increased levels of PE, particularly when this is feasible without excessive disruption within a school. However, given that time and finance is limited, and that resources (such as cycle training) for active travel are almost non-existent, active travel training and promotion should be a higher priority. Possibly it could be included as part of the 2-hourly target.
We accept the indicator labelled 29-31 above. However, the second indicator (32-34) should be replaced by targets to provide on-road cycle and walking training at all schools and to provide safe routes from main catchment areas to all schools - see the Transport Minister's statement in 22-23 above, re. para 113. However if, as seems likely to happen, the 2-hour PE indicator is retained, then there should be additional indicators of equal weight covering active travel, as in the previous sentence.
35 The role of our organisation in relation to the strategy
Bearing in mind that we are a voluntary organisation with no staff, we will as far as possible...
a. "We can learn from..."
The report makes extensive use of examples of existing Scottish initiatives on physical activity. Whilst there is much to be said for this approach, it also has weaknesses, which may impact on the resulting recommendations.
Two targets are set by the strategy [7-9 above], but there are only two indicators to measure progress towards the targets. Both these relate to schools and pupils [29-34 and 22-23 above]. Apart from our criticism of one of these child indicators, there should also be indicators relating to active travel, and indicators relating to adults.
In devising indicators, there should be close working with other relevant departments and policies. For example, the Executive is setting indicators for Sustainable Development [Meeting the Needs, April 2002], including...
Finally, there should be attention to existing non-integrated national indicators/targets which are inimical to public health and/or environmental considerations. For example, according to a review of the recent book Rising Tides by R.Spowers, "economic indicators increase every time we drive to the shops rather than walk" [Herald 15.6.02].
c. Enhancing the credibility of the strategy