The British Medical Association responded to the consultation on Developing an integrated transport policy in November 1997. The Association's policy report entitled Road Transport and Health, published in September 1997 constituted our submission to the consultation. Whilst welcoming the review we drew attention to the need for health to be given a high priority in the development of future transport policies. In particular, the BMA report highlighted the many ways in which transport policy can affect health and made a number of recommendations regarding the development of a sustainable and health promoting transport policy.

  We are pleased to note that in preparing the Integrated Transport White Paper, the Government has taken account of the key recommendations made in our policy document. We have the following comments to make:

1. HEALTHY TRANSPORT POLICY

  Health considerations now feature centrally within the new framework of proposals in the White Paper. In particular, we note that the Government plans to establish a new independent body—the Commission for Integrated Transport (CfIT)—to provide independent advice to Government on the implementation of the integrated transport policy, to monitor developments across transport, health, environment, and other sectors and to review progress towards meeting the objectives. Such a body should help to ensure that health remains central to all future transport policy.

2. HEALTH IMPACT ASSESSMENT

  In our policy report Health and Environmental Impact Assessment, published in May this year, we recommended that health impact assessment should be carried out for all public policies and planning developments which have implications for human health. We are therefore pleased to note that arrangements are being made for health impact assessments of the Government's transport policy. In addition, environmental impacts, including the effects on people and their health will now be taken into account from the earliest stages of planning and designing new transport projects. In addition, we recommend that the Department of Health should also contribute to the development of a health audit to assess the health impact of new transport infrastructure. We note the plans to supplement the former DOE publication The Environmental Appraisal of Development Plans with a guide which will consider social, economic and environmental impacts. We believe that adequate guidance on health impacts should also be included within such a guide.

  The Association welcomes the development of a "new approach to the appraisal of different solutions to transport problems" proposed by the Government. This should greatly assist in the identification of alternative transport solutions, and will form an important source of information for those carrying out environmental and health impact assessments of transport projects.

3. DRINK DRIVING

  The BMA has long-standing policy for the reduction of permitted blood alcohol concentration (BAC) for driving to 50mg/100ml and responded to the Government consultation on this subject in February 1998. In addition, the Association has called for legislation at the European level to harmonise the permitted BACs to no more than 500mg/100ml. We also support the introduction of highly visible and well publicised roadside random breath testing. It is disappointing that these issues are not addressed within the White Paper, however, we will await, with interest, the Government's conclusions regarding its drink-driving policy, which are due to be announced later this year.

4. ROAD TRAFFIC REDUCTION

  Local traffic authorities are already required to set targets for traffic reduction in accordance with the Road Traffic Reduction Act 1997. The BMA has called for the establishment of a Traffic Reduction Unit, to co-ordinate action to achieve traffic reduction targets. The new CfIT could undertake this role since its remit specifically includes the setting of national road traffic and public transport targets and the identification and dissemination of best practice. However, we note that initially the Government plans to seek further advice from the CfIT in this area before setting national targets.

5. ROAD SAFETY

  In our policy document Road Transport and Health we called for improvements in road safety with the establishment of specific traffic danger reduction targets. We are pleased to note the planned publication of a new road safety target for Great Britain for 2010 later this year, together with a strategy and programme of measures for achieving this target. The BMA suggested that one possible indicator of the effectiveness of such measures could be the percentage of children travelling to school by foot and by bike, set against casualty rates (especially for 10 to 14-year-olds).

6. VEHICLE EMISSIONS AND AIR POLLUTION

  The BMA policy document drew attention to the need to establish stringent limits on emissions, particularly from diesel vehicles. We therefore welcome the Government's aim to reduce emissions of particulates and nitrogen oxides from existing vehicles and encourage the use of cleaner diesel technology and environmentally friendly fuels. Government measures will include incentives of up to £500 off Vehicle Excise Duty arrangements for lorries and buses producing very low particulate emissions, as well as other measures designed to reflect the environmental and health consequences of various fuels, such as charging higher duty on diesel than on petrol. However, the BMA believes that such measures do not go far enough and has recommended that the Treasury should consider the feasibility of the abolition of the Vehicle Excise Duty and transfer of all costs on to fuel duty and other taxes on cars, motoring and related activities, so as to discourage unnecessary car and heavy goods vehicle use. The adverse effects of such measures for the disabled or those in rural areas must also be considered.

7. PUBLIC TRANSPORT AND CYCLING

  The BMA has highlighted the need to halt the decline in public transport patronage and called for a number of improvements, particularly to pedestrian and cycling routes to public transport connections. We are pleased to see that these needs have been addressed within the White Paper. In particular, we support the Government's plans to improve facilities for all cyclists through better safety measures, improved traffic schemes, and the use of planning powers by local authorities to promote cycling via appropriate land use, layout and design of developments and by the provision of secure cycle parking facilities, e.g., at interchanges with public transport routes. We note the Government endorsement of the National Cycling Strategy's national target of doubling the amount of cycling within six years and of doubling it again by the year 2012. Such measures are in accordance with the 1992 BMA policy report Cycling Towards Health and Safety which drew attention to the significant health and fitness gains which may be achieved through cycling.

8. FREIGHT

  We welcome the Government's aims to encourage a modal shift to rail freight through the establishment of the Strategic Rail Authority. The Authority will support integrated transport initiatives and provide, for the first time, a clear focus for the promotion of rail freight. We also support the move to substantially increase funds available for freight grants, which are paid to tip the balance in favour of rail haulage. The Government intends to publish a strategy setting out initiatives to promote sustainable distribution. We believe that the Strategic Rail Authority should have a key role in the development of such a strategy in order to advise on railway capacity and continue to sustain development objectives.

9. RESIDENTIAL AREAS

  To improve the quality and safety of residential environments the BMA called for much greater use of, and funding for, 20 mph schemes. "20 mph zones" are most effective in streets where speeding traffic puts pedestrians, often children, and other vulnerable road users such as cyclists at risk. We therefore welcome the Government plans to encourage greater use of such schemes and to issue new guidance to local authorities.

10. COMMUNITY AND VOLUNTARY TRANSPORT

  The Government has recognised the importance of community and voluntary transport schemes and will be conducting a review in order to provide a better understanding of the role played by the voluntary sector. We believe this review will be important to inform the further development of policies at local or national level to enable voluntary sector services to operate most effectively.

  The Commission for Integrated Transport will have a key role in monitoring and reviewing the progress against the Government's targets and objectives, and in advising on the need to update or review the measures set out in the White Paper in the light of future developments. The White Paper represents an important step towards a truly integrated and health promoting transport policy for the UK.

M J Lowe

Deputy Secretary

23 September 1998