Public Health Promotion

Last week I attended a conference on public health promotion. A day later I was nearly killed. Let me explain how the two are related.

The public health event was positive in spirit but narrow in focus; ‘promoting health and healthy living’ in practice meant ‘promoting exercise and better diet in order to reduce obesity’. Thus method after program was rolled out to encourage children/families/employees to increase activity/healthy eating/exercise.

There is a weird paradox about encouraging exercise; we have spent decades of investment and inventiveness discouraging exercise in the name of efficiency, by engineering it out of our lives – through building cars, elevators and escalators; through buying household machines to lighten every single task; and by making nearly any act possible with a mere click on the internet. Public health promotors – and individuals who try to live healthy lives – thus find themselves faced with a desperate task: reversing this trend, fighting not only the tide, but 50 years of built environment. In hotels and offices, for example, I often cannot even find stairs, having to resort to an elevator instead – never mind ‘personal lifestyle choices’.

Not being able to design exercise back into the fabric of our lives, health promotors must encourage us to add it on. This takes time, commitment and difficult-to-achieve behaviour change, thus losing the efficiency we previously gained.

As a result I was more pleased than usual when I got out my bike the next day. I have found a way to beat the time’s curse: twice a day I spend 30 minutes cycling to work instead of 35 minutes on public transport. Thus I lose no time commuting (and save time otherwise spent in the gym), I save money (twice: once by saving the public transport fee and once by saving the gym fee), I get some exercise, improve my health, get some fresh(ish) air and increase my wellbeing. It’s a win-win-win for all!

Except that I nearly died. A bus overtook me so close and so fast that it only just missed me, its slipstream buffeting my bike, nearly dragging it into the bus.

Luckily I have a very stable bike. Luckily I am a big girl, cycling at considerable speed (which stabilises the bike even more). Luckily I have 20 years of daily cycling experience, and as a result, the cycling reflexes of a cat.

Luckily I have also developed almost complete immunity to fear and fright in traffic. For this was not the only near miss of the morning – just the closest. I was also cut off by a bus overtaking me when pulling into a bus stop; I got wedged between two buses in front of a traffic light (an extremely dangerous situation, but I had little choice as had to take a right turn); I was pushed out into the road by a bus pulling away from a bus stop, and I was nearly taken out by a taxi which was simultaneously overtaking me and taking a right turn. All in thirty minutes – and outside rush hour. If it had been rush hour, there would have been even more near-misses, and more of the problems would have been caused by cars. Overall, today’s trip was on the quiet side.

In principle, commuting by bike is – socially, ethically and environmentally – a quadruple edged sword. It gives you exercise, reduces air and noise pollution, has a low carbon footprint, and makes efficient use of the road (cyclists take up far less space than cars). In addition cycling is cheap, fast and time-efficient; I always beat public transport, average the same speed as cars in London, and can always get exactly where I want to be, when I want to be there.

In principle, getting people out on their bicycles could be the single best public health measure under the sun.

In practice, cycling in London is dangerous and terrifying. It requires superhuman amounts of courage, a delusional belief in one’s own skill and invulnerability, and incredible fitness and years of experience to have the reflexes and acceleration needed to be safe in traffic. I possess all these traits. But would I cycle when pregnant? No. Would I cycle with a child on my bike? No. Would I cycle when I approached middle age? No. Would I send family out on a bike? No.

Whereas, really, I should be able to do all these things. I could do them in a car in London (if I could afford one), but I should be able to do them on a bike – and in many other European capitals, I can.

And that is where the real link between my near-death and public health comes in. It is not that promoting cycling would be a good public health measure because it would encourage health; it is that my cycling experience this morning was a failure of public health – a failure of the state’s obligation to me, the citizen, to design a safe road.

In all our focus on diet, exercise and behaviour change, we forget that, once upon a time, public health was not about that. It was about design. It was about safety. And we forget that public health started not in the hand of doctors, but of engineers and regulators. Examples of public health measures are sewage systems and drinking water provisions to prevent disease outbreaks; road safety design; industrial emission regulation; and industrial and consumer good design safety. These did more for the health of the public than all health care combined. And, sadly, in many places in this world they are still lacking.

One of these places, it turns out, is London. When I go out on my bike, I go out into a hostile and unsafe environment that is the result of 50 years or more years of design, regulation and education – of road design and traffic rules that chose to and continue to facilitate motorised transport over cycling transport; road design and traffic rules that prioritises motorised transport efficiency over cycling safety; road users who have not been taught to check their inside mirrors for cyclists. It is not cycling that is inherently unsafe. It has been made unsafe by the way we designed our environments.

I should not have to put up with such an environment, and I should not have to put up with such risks – just as I should not have to put up with being exposed to asbestos in my workplace. Questioning what the government could do to promote exercise, takes attention away from the government’s failure to keep road users safe. Both are related to public health but the second, surely, should have priority.

PS – what does this mean in practice? Barclay’s cycle lanes are a nice effort (thanks Boris!), but laughable in terms of a safe cycling lane. If cycling is taken seriously, and decades of pro-car-bias to be corrected, London needs to close half its roads in the city centre to cars and sacrifice a lot of parking spaces , devote entire road lanes to safe (barrier-protected) cycle lanes, and have larger cycling boxes at the front of traffic lights that are accessible even when traffic starts piling up behind them. Cycling lanes should continue up to and through crossings, with cyclists going straight having priority over cars turning left. Crossing into a cycle lane or cycling box, and a taking a turn without looking should be a punishable (and enforced) offence.

This will, of course, severely hamper car traffic – but should we continue to favour car speed at the expense of cyclist’s safety, just because we did so for 50 years? Or should we equalise? For if we do, cycling will suddenly become safe and thereby attractive. I beat cars through London on a bike already. Make cycling safe and everyone will want to do the same – a public health double-whammy!

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