Encouraging active travel through the NHS for better planetary and public health

UK Health Alliance on Climate Change Webinar

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Contact: Chris Billington, Public Health Strategist, Association of Directors of Public Health (ADPH) London

chris.billington@adphLondon.org.uk

APRIL 2023

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Aim and contents

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Contents

1. London policy context
2. Making the case for active travel
3. How can the NHS increase active travel?

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Aim: Increase the proportion of NHS staff and patients achieving 20 minutes (140 minutes/ week) of walking or cycling per day to improve both public and planetary health.

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London policy context

Policy context: Active, efficient and sustainable travel and Londoners’ health are key to the Mayor’s policies

Figure 2. Proportion of London residents aged 20+ who achieve at least 20 minutes of active travel per day, LTDS, 2008/09-2022/23.

MTS Policy 1:

80 per cent of all trips in London to be made on foot, by cycle or using public transport by 2041

MTS Policy 2:

By 2041, all (70% as proxy) Londoners do at least the 20 minutes of active travel they need to stay healthy each day

Figure 1. Active, efficient and sustainable trip-based mode share, 2010-2030.

2041 target

2041 target

Making the case for active travel

Greenhouse gas emissions by sector, 2020, by proportion (BEIS, 2022)

Benefits of encouraging active transport

• Transport is the largest emitting sector of GHG emissions, producing 24% of the UK's total emissions in 2020.

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• Approximately 3.5% (9.5 billion miles) of all road travel in England relates to trips associated with the NHS, contributing around 14% of the NHS system’s total emissions.

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In 2021, around 49% of trips in towns and cities in England were under 5 miles, with around a quarter of all car trips in England less than 2 miles (DfT, 2022) demonstrating the potential for feasible change…

All you need to know about transport and health...

The health impacts of the transport system in London relate mostly to motorised road transport

Physical Activity

Injuries

Severance

Climate Change

Noise

Air Quality

Top 15 risk factors for death, Greater London, 2019*

Physical activity strongly influences numerous risk factors highlighted in green

*Global Burden of Disease Study 2019 (This is the latest data which is Pre Covid-19)

Imagine a drug that could achieve this:

We would all be taking it...

1/3 adults in England do not achieve minimum Chief Medical Officer’s physical activity guidelines: large and growing inequalities exist

Levels of activity in adults : Active: at least 150 minutes a week, by social status

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19.9pp difference - A large and growing gap

16.2pp difference

Active travel is the main source of physical activity in the UK

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If every Londoner walked or cycled for 20 minutes a day...

Active travel is an equitable type of physical activity.

Proportion of Londoners reporting 20 minutes of active travel by social status

2041 target

The co-benefit of encouraging public transport, walking & cycling

Using public transport, walking and cycling all count as active modes of transport

Air Quality

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Despite recent improvements, toxic air pollution is still the biggest environmental risk to the health of all Londoners. 

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In London, road transport accounts for:

• 44 per cent NOX emissions
• 31 per cent PM2.5 emissions
• 28 per cent CO2 emissions

In 2019 toxic air contributed to around 4,000 premature deaths in London.

Air Quality and health inequalities in London

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• Communities with higher levels of deprivation, or a higher proportion of people from a non-white ethnic background, are more likely to be exposed to higher levels of air pollution.
• Every hospital and medical centre in London is located in areas which do not meet World Health Organization guideline limits for toxic air pollution

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Vulnerable communities and people with underlying health conditions are disproportionately impacted by poor air quality.

How can the NHS increase active travel?

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The NHS can encourage active travel through...

NHS Policy

Creating Sustainable and Healthy Environments

NHS Patients

NHS Staff

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The NHS is embedding active travel in relevant policies and strategies

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New Net Zero Travel and Transport Strategy will guide future NHS Green Plans:

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• Net Zero Travel and Transport (NZTT) strategy is in development by the National Net Zero Travel and Transport team. The NZTT Strategy will set out trajectories for decarbonising the NHS’ travel and transport.
1. Modal shift
2. Business travel
3. Primary, secondary and community care fleet.

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NHS Policy

Regional Travel and transport deliverables (in draft) for 23/24:

• Increase collaboration with local authorities and their initiatives
• Low emission fleets
• Staff travel surveys
• Salary sacrifice cycle-to-work scheme in place for staff; as well as facilities available to encourage staff and visitors to cycle-to-work where appropriate
• Modal shift – to implement interventions such as shuttle buses between sites, cycle training, subsidise public transport costs

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Creating Healthy and Sustainable Environments

We need to change transport infrastructure to encourage active travel

Case study– North Middlesex Hospital Cycle Route

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What does good look like for a healthcare setting?

Enfield Council are in the process of delivering an active travel route this is funded by Transport for London (TfL).

The Healthy Streets Approach underpins the work we do in London

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NHS can encourage patients to travel actively

• 1 in 4 say they would be more active if it was recommended by a healthcare professional.

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• Opportunities to further promote active travel include: OHID’s national ‘Moving Healthcare Professionals Programme’; Physical Activity Clinical Champions, NHS Health checks, and undergraduate curriculum represent potential opportunities to promote active travel

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• Following a workshop with medical students on active travel at Imperial University; 95% reported they would be more likely to promote active travel to patients in the future.

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NHS Patients

The Greater London Authority (GLA) produced a toolkit to help healthcare staff encourage more walking and cycling.

NHS Patients

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Key evidence from TfL’s Active People Debrief showed:

• Exercise was perceived as something patients had to make time for (such as going to the gym).

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• Participants found the 20 minute per day active travel challenge was an accessible and enjoyable way of achieving physical activity recommendations.

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NHS Staff

• Highlighting the benefits of building active travel into the everyday routine e.g. as part of public transport trips

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• Promotion of offers. For example, in London NHS staff get 50% discount on annual Santander Cycle hire membership.

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• Providing information on maps and wayfinding, apps and routes.

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• Advocating for active travel hubs at healthcare facilities – availability of cycle parking, showers, bike tools and lockers etc.

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The NHS can encourage staff to act as role models and travel actively through:

Case study: Embedding Active Travel in Physical Activity Training

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GLA & TfL worked with OHID to add active travel to the national training slide pack used by ‘Physical Activity Clinical Champions’ to deliver training on physical activity to health professionals:

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NHS Staff

Case Study - Central London Community Trust – implementation of e-bikes

Key take home messages

Recap - 5 key messages in today's presentation:

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1. Transport is the largest contributor to greenhouse gas emissions in the United Kingdom.
2. Physical inactivity and poor air quality is leading to premature deaths.
3. Active travel can help tackle air pollution and represents an equitable form of physical activity that can be built into the everyday routine.
4. Encouraging everyone to do just 20 minutes of active travel per day would have huge health benefits and help to reduce pressure on the NHS.
5. The NHS can help to boost active travel through influencing and delivering relevant NHS policy, becoming advocates for healthy and sustainable environments and promoting behaviour change amongst staff and patients.