• Gareth Davies

The Lost Decades : Fin de Siècle (The 20th Century Ends). May 2020

Updated: Aug 31, 2021

In 1999 the Health Education Authority (HEA) published a report entitled ‘Making T.H.E. Links’. The report was the result of a research project commissioned by the HEA in collaboration with the Department of Health (DH) and the Department of Environment, Transport and the Regions (DETR). The report was a guide to integrating transport, health and environmental issues in local government and health policies.

Importantly, the report established a direct link between transport and health. The opening paragraph of section one made this perfectly clear: Transport policies and mobility choices in society have profound implications for the physical and mental health of individuals, for the health of communities and for the environment’.

The report went on to identify the effect of transport on individual and community health which included:

Air Pollution

‘Up to 24,000 vulnerable people are estimated to die prematurely each year, and similar numbers are admitted to hospital, because of exposure to air pollution and particulates, ozones and sulphur dioxide, much of which is related to road traffic.’

Road Safety

‘Road traffic accidents are a principal cause of accidental death and injury. Across the whole population in 1997, 3559 people were killed in road traffic accidents.’

Cycling and Walking

‘Conclusive evidence is available about the health benefits of cycling and walking in terms of reductions in mortality and morbidity (such as heart disease, stroke, osteoporosis, obesity, mental health and well-being.’

Transport Provision and Access to Services

These links are identified in the White Paper on integrated transport under ‘fairness and inclusiveness (DETR 1998); for example, the decrease in local shops and facilities for poor and less mobile people, the splitting of communities by streets with heavy traffic and lack of facilities for elderly or disabled people in public transport provision. Social isolation and community networks which affect mental health are influenced by transport provision and access to the transport network.

Fast Forward Two Decades

Air Pollution

In 2016 the Royal College of Physicians published a report ‘Every Breath We Take: The Lifelong Impact of Air Pollution’. The report starkly sets out the dangerous impact air pollution is having on the nation’s health leading to 40,000 premature deaths a year. The European Environment Agency gave a UK figure of 44,000 premature deaths in its report ’Health Impacts of Air Pollution’.

Road Safety

Government statistics indicate a steady improvement in road safety since 1999 with 1,870 people being killed in road accidents in 2019. However, road safety remains a concern as the 2019 figure shows a 4% rise in deaths to the highest level since 2011.

Transport Provision and Access to Services

In 2018 the Campaign for Better Transport report ‘Buses in Crisis’ identified a serious and growing problem with bus services in Britain. The findings indicated that between 2010 and 2018 funding for bus services declined by a staggering 45% whilst 3,425 bus services were withdrawn or severely reduced. The impact on the poor, the young and those less mobile has been dramatic. In rural areas it has led to large parts of the country becoming public transport deserts.

In summary, two decades have sailed past without any concerted effort to address the problems identified in the HEA report. The whole business of mobility, health and the environment have conveniently been left to the whims of market forces and the ‘I'm all right Jack’ attitude, insidiously instilled in the population since the 1980s and still in evidence today. It was only in 2019 that government, local and national awoke to the fact that there is a climate and health emergency.


This state of affairs has now been given a significant shaking by a global virus leading to the government decision to lockdown the country, the introduction of social distancing and a move to a work from home situation. The vulnerability of those with heart and lung problems directly related to poor air quality and environment has been brought into stark relief.

The effect of lockdown and social distancing, apart from the need to contain the virus, has been to accentuate the findings of the 1999 HEA report, especially the link between road traffic, air quality and the environment. There has been a sudden drop in road traffic and with it a significant improvement in air quality and the environment.

Whilst the containment of the virus is paramount, we need to look to the future and a post-lockdown situation. Such a situation should provide the scope and opportunity to develop a different and integrated transport policy that builds on addressing climate change, improving air quality, road safety and the environment.

Increased emphasis on walking and cycling is already taking place but the danger is that car use will increase in a social distancing scenario. Overcoming the dent of confidence in using buses and trains is going to be a major task. Maintaining and building on adequate and integrated levels of public transport service to allow for a comfortable journey is going to demand increased government and local authority financial support. This is the point at which environment and health needs come up against the ideological hard headedness of market force economics.

We may have been able to contain and hopefully defeat Covid 19 but the equally dangerous virus of deteriorating air quality, declining physical and mental health, poor environment and congestion will continue unabated unless we take action now. Let us hope that sense will prevail at a time when, post-Brexit, there is a glorious opportunity to create a healthy country worth living and working in.


Health Education Authority: Making the Links 1999

Royal College of Physicians: The Air We Breathe 2016

European Environment Agency: Health Impacts of Air Pollution 2016

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