Edinburgh’s Transport leaders have welcomed calls by more than 140 medical professionals to retain and expand upon measures introduced to support walking, wheeling and cycling during lockdown.
Doctors and health workers from across the city have published an open letter to the City of Edinburgh Council in support of the Travelling Safely programme, formerly Spaces for People.
The group cites the positive impacts of more active travel on health, inequality, air quality and in tackling the climate crisis, amongst other benefits.
In June, Transport and Environment Committee approved proposals to retain some of the schemes on an experimental basis, to remove others post-pandemic and to engage further with communities on options for a handful of measures.
Councillor Lesley Macinnes, Transport and Environment Convener said: “The collective voice of this wide range of medical and health professionals is incredibly welcome.
“We’ve been vocal about our commitment to encourage travel by foot, wheel or bike, and the benefits this brings, but to have the support of the medical profession demonstrates just how crucial investment in safe, protected routes is.
“Over the last year and a half we’ve introduced changes which have helped many people to feel newly confident about walking, cycling and wheeling safely. There are, of course, tens of thousands of people in Edinburgh who don’t have access to a car. We now have the opportunity to extend the lifespan of many of these measures and to improve upon them so that they work for as many people as possible.
“The evidence is clear and well expressed in this letter – there’s so much to gain from active travel, in terms of health, quality of life and in limiting our impact on the climate. We simply cannot return to the status quo, where private car journeys dominate the streets.
“By retaining the majority of schemes introduced through Spaces for People, we’re laying the foundations for a happier, healthier future for everyone here.
Councillor Karen Doran, Transport and Environment Vice Convener, said: “It’s indisputable that walking, wheeling or cycling, whether for leisure or commuting, has a positive impact on our health, our state of mind and our pockets, as well as the air we breathe. We wholeheartedly recognise and support these calls to retain and expand on the measures we’ve introduced during the pandemic.
“Temporary protected cycle lanes, widened pavements and quiet routes have helped families to walk safely to school, shoppers to spend time strolling through some of our iconic city centre streets and people trying out cycling for the first time.
“We really want to continue delivering these benefits, and we’ll be working hard to make sure the measures we have kept do just that.”
Read the full letter below:
Open letter to the City of Edinburgh Council
Dear Councillors,
We are a group of doctors and other health professionals, living or working in Edinburgh, and write to support the retention and extension of changes to travel infrastructure in Edinburgh and the Lothians, to improve public health and mitigate climate emergency. We hope that the points and evidence below will support the council to make decisions that will help to benefit, protect, and reduce inequalities in the health of the population of Edinburgh.
Climate crisis and health
One of the duties of a doctor as stated by the General Medical Council is “to protect and promote the health of patients and the public”1. As health professionals we have been reminded by our professional bodies of our responsibilities to raise the profile of the climate emergency, which is a public health emergency likely to have a much greater impact than COVID-192,3.
We have a responsibility to speak up for disadvantaged groups who are disproportionately vulnerable to the health and economic impacts of the climate crisis.
Health Inequality
Those living in areas of deprivation are less likely to drive but much more likely to be injured in a road traffic collision6. Rates of pedestrian casualties are twice as high in children as in adults, and pedestrians over 70 years of age have the highest fatality rate7.
Many of our patients do not have the financial means, health status, or abilities to access private car transport. Children, the frail elderly, and people with chronic illnesses or disabilities are disadvantaged in opportunities to access services and community by systems which prioritise private car transport.
Moves to promote safe active travel, including widening of pavements and provision of segregated paths, make the urban environment more accessible for people with disabilities and release road space for reliable and efficient public transport.
Measures to improve the urban environment and promote active travel in Edinburgh will differentially benefit the most disadvantaged members of our community and so help to reduce health inequalities in Edinburgh. We ask that councillors carefully consider the differential impact of decisions to prioritise private car transport on those for whom private car transport is not an option.
Air pollution and health
Air pollution is strongly associated with poor health outcomes. A joint Royal College of Physicians and Royal College of Paediatrics and Child Health report estimated that outdoor air pollution causes 40,000 deaths a year in the UK. Data from Scotland shows a particularly strong association between air pollution and respiratory disease and deaths. Transport – predominantly car transport – is the main source of air pollution in Scotland.
Edinburgh City Council has six Air Quality Management Areas, with concerning levels of air pollution related to vehicular traffic.
Decisive action from the council to promote active travel and reduce private car traffic in Edinburgh will help to reduce air pollution and associated harm to health.
Physical activity and health
Regular physical activity is associated with improved health outcomes at all ages13.
UK Chief Medical Officers recommend that children and young people should engage in moderate physical activity for at least one hour every day. For adults, 150 minutes of moderate activity per week is associated with a 40% reduction in risk of type 2 diabetes, 35% reduction in heart disease, 25% reduction in joint and back pain, and 20% reduction in bowel and breast cancer13.
National data indicates that in Scotland during 2019 only 66% of adults met this target, whilst in the same year fewer than 50% of journeys under two miles were made on foot14.
Segregated active travel infrastructure allows everyone to increase their physical activity levels through active travel; not only those who already enjoy regular physical activity.
We ask that the council considers the beneficial and protective health effects of physical activity when considering its decisions about travel infrastructure in Edinburgh.
Behaviour change for public health
Changing established patterns of behaviour is difficult. We understand that a move away from the current position of private car dependency can feel difficult.
Bold Scottish strategies have led to strikingly effective population shifts in behaviour for better health; tobacco smoking restrictions have saved many lives, and early data suggests that minimum alcohol unit pricing has reduced the amount of alcohol purchased by the heaviest alcohol consumers15,16. Both of these strategies met with initial resistance, but are now broadly supported.
Now, local government in Edinburgh has the potential to lead a bold and exemplary modal shift away from car-dependence which will benefit and protect the health of the people of Edinburgh.
Key Points
- As health professionals, we have a responsibility to protect and promote the health of the population. We have a responsibility to address inequalities and to advocate for the needs of the most deprived and disadvantaged members of the population we serve.
- We are concerned about the impact of the climate crisis on health, globally and locally.
- We are concerned about harms to health caused by air pollution in Edinburgh.
- Regular physical activity is associated with improved health outcomes at all ages.
- We support the retention, and further development and integration of infrastructures designed to support active travel and clean air for the whole population of Edinburgh, to mitigate inequalities in health, local mobility, and air quality.
- This includes quiet routes in the vicinity of schools to allow safe active travel for families, an integrated network of segregated safe paths for cycling, city-wide subsidised cycle hire programmes, and low-emission zones.
- We are concerned that suggested steps to reverse active travel measures introduced during the COVID-19 pandemic would be a retrograde and harmful step for the health of the population of Edinburgh.
Yours sincerely,
Dr Laura McWhirter, Consultant Neuropsychiatrist, Edinburgh
Neil Aitken, Physiotherapist, Neil Aitken Physiotherapy Ltd, Edinburgh
Dr Niall H. Anderson, Senior Lecturer in Medical Statistics, Usher Institute, University of Edinburgh
Dr Ross Archibald, Consultant in Emergency Medicine, NHS Lothian
Dr Elika Aspinall, General Practitioner, NHS Lothian
Dr Katherine Atkins, Chancellor’s Fellow, Edinburgh Medical School, University of Edinburgh
Dr Paul Bailey, General Practitioner, NHS Lothian
Miss Emily Baird, Consultant, Children’s Orthopaedics, Royal Hospital for Children and Young People Edinburgh
Dr Kasia Banas, UG Talent Lead and Programme Director in Data-Driven Innovation for Health and Social Care, Usher Institute, University of Edinburgh
Dr Ravneet Batra, Consultant Liaison Psychiatrist, Regional Infectious Diseases Unit, Western General Hospital
Dr Roland Baumann, General Practitioner, Niddrie Medical Practice, Edinburgh
Dr Craig Beattie, Consultant Anaesthetist, Royal Infirmary of Edinburgh
Dr Monika Beatty, Consultant in Critical Care, Royal Infirmary of Edinburgh
Dr Sam Bennett, Foundation Doctor, Acute Medicine, Western General Hospital
Ms Katherine Bethell, Advanced Nurse Practitioner and Programme Manager, Chalmers Sexual Health Centre (Lothian) and Sandyford Centre (GGC)
Dr David Birrell, Emergency medicine trainee, Royal infirmary of Edinburgh; Honorary Clinical Fellow, University of Edinburgh
Professor James Boardman, Professor of Neonatal Medicine, University of Edinburgh
Dr Friederike Boellert, Respiratory Consultant, Western General Hospital, Edinburgh
Dr Kirsty Boyd, Reader in Palliative Care, Usher Institute, University of Edinburgh
Dr Tom Bloomfield, Consultant Anaesthetist, Royal Infirmary of Edinburgh
Mr Paul Brennan, Reader and Honorary Consultant Neurosurgeon, University of Edinburgh and NHS Lothian
Mr Iain Brown, Consultant Orthopaedic Surgeon, Royal Infirmary of Edinburgh
Dr John Budd, General Practitioner, Edinburgh Access Practice, and Co-ordinator of Lothian Deprivation Interest Group
Dr Rosamunde Burns, Consultant Anaesthetist, Royal Infirmary of Edinburgh
Dr Peter Cairns, General Practitioner, Wester Hailes Medical Practice
Professor Alan Carson, Consultant Neuropsychiatrist, University of Edinburgh
Dr Simon Chillingworth, Consultant Anaesthetist, Royal Infirmary of Edinburgh
Professor Richard Chin, Professor of Paediatric Neurology and Clinical Epidemiology, Honorary Consultant Paediatric Neurologist, University of Edinburgh and The Royal Hospital for Children and Young People
Dr Sarah Clay, Locum General Practitioner, Niddrie Medical Practice, and Specialty Doctor in Palliative Care
Dr Elizabeth Cole, Anaesthetics registrar, Royal Infirmary of Edinburgh
Dr Catherine Collinson, Consultant Anaesthetist, Department of Anaesthesia, Royal Infirmary of Edinburgh
Dr Claire Cooke-Jones, Trainee Anaesthetist, Royal Infirmary of Edinburgh
Dr Robert Cooke-Jones, Trainee General Practitioner, Inchpark Surgery, Edinburgh
Dr Nadine Cossette, Consultant Liaison Psychiatrist, Royal Infirmary of Edinburgh
Dr Helen Creedon, Clinical Fellow in Oncology, University of Edinburgh
Dr Julia Critchley, Consultant Anaesthetist, Royal Infirmary of Edinburgh
Dr Craig Davidson, Consultant in Emergency Medicine, NHS Lothian
Professor Adrian Davis, Professor of Transport & Health, Edinburgh Napier University
Dr Christopher Dickens, General Practitioner, Edinburgh
Ms Lynsey Downie, Anaesthesia Associate, Edinburgh Royal Infirmary
Mr Andrew Duckworth, Senior Lecturer and Consultant Orthopaedic Trauma Surgeon, Edinburgh Orthopaedics and University of Edinburgh
Mr Joseph Duncumb, Orthopaedic Surgery Registrar, Royal Infirmary of Edinburgh
Dr Tamasin Evans, Consultant Clinical Oncologist, Edinburgh Cancer Centre
Dr Alasdair Fitzgerald, Clinical Lead, Rehabilitation Services and Consultant in Neurorehabilitation, Astley Ainslie Hospital, Edinburgh
Dr Nicholas Fletcher, Trainee General Practitioner, NHS Education Scotland
Professor Sue Fletcher-Watson, Chair in Developmental Psychology, Division of Psychiatry, University of Edinburgh
Mr Martin Gemmell, Principal Educational Psychologist, City of Edinburgh Council
Ms Paula Gardiner, Neurological Specialist Physiotherapist and Cognitive Behavioural Therapist, Edinburgh
Dr Cameron J Fairfield, Clinical Research Fellow, University of Edinburgh
Dr Gavin Francis, General Practitioner, Dalkeith Road Medical Practice, Edinburgh
Dr Allan Gordon, Retired Consultant Obstetrician and Gynaecologist, Edinburgh
Dr Claire Gordon, Consultant in Acute Medicine, Western General Hospital, Edinburgh
Dr Rebecca Gormley, Anaesthetic Core Trainee, Royal Infirmary of Edinburgh
Dr Peter S Hall, Honorary Consultant Medical Oncologist, Edinburgh Cancer Centre at St John’s Hospital and the Western General Hospital
Dr Helen Hare, Junior Doctor, Edinburgh Royal Infirmary
Dr Simon Heaney, Consultant Anaesthetist, Royal Infirmary of Edinburgh
Dr Ingrid Hoeritzauer, Consultant Neurologist and Acute Traumatic Brain Injury Rehabilitation, Royal Infirmary of Edinburgh
Dr Catriona Howes, Consultant Psychiatrist, Western General Hospital, Edinburgh
Dr Seán Keating, Consultant in Cardiothoracic Anaesthesia and Intensive Care Medicine, Royal Infirmary of Edinburgh
Dr Malik Jahangeer, Consultant Clinical Oncologist and Honorary Senior Clinical Lecturer, University of Edinburgh
Dr Marc Janssens, Consultant Anaesthetist, Royal Infirmary of Edinburgh
Mr Aimun Jamjoom, Speciality Neurosurgery Trainee, Edinburgh Royal Infirmary
Dr Michelle Jeffrey, Consultant Sports and Exercise Medicine, Sportscotland Institute of Sport, Oriam, Edinburgh
Dr Guy Johnson, General Practitioner (retired), Sighthill Health Centre
Professor John Keating, Consultant Orthopaedic Surgeon, Royal Infirmary of Edinburgh; Honorary Senior Lecturer, Edinburgh University
Dr Stephanie Kelly, Clinical Fellow in Intensive Care, Royal Infirmary of Edinburgh
Dr Dean Kerslake, Consultant, Royal Infirmary of Edinburgh
Dr Alice King, Trainee General Practitioner, Edinburgh
Dr Oliver Koch, Consultant & Honorary Senior Clinical Lecturer in Infectious Diseases, Regional Infectious Diseases Unit, Western General Hospital
Dr Rebecca Lawrence, Consultant Psychiatrist in Addictions, Royal Edinburgh Hospital
Mr Graham Lawson, Consultant Orthopaedic Surgeon, Royal Infirmary of Edinburgh
Yvonne Leavy, Lead Clinical Nurse Specialist (epilepsy) Department for Clinical Neurosciences, RHCYP, Royal Infirmary of Edinburgh
Dr Katharine Logan, Consultant Psychiatrist in Psychotherapy, Rivers Centre, Edinburgh
Dr Nazir Lone, Honorary Consultant and Senior Lecturer in Critical Care, Royal Infirmary of Edinburgh, NHS Lothian and University of Edinburgh
Dr Carey Lunan, General Practitioner, Craigmillar Medical GroupDr Saturnino Luz, Reader in Medical Informatics, Usher Institute, Medical School, The University of Edinburgh
Dr Saturnino Luz, Reader in Medical Informatics, Usher Institute, Medical School, The University of Edinburgh
Dr Sonia MacCallum, General Practitioner, Niddrie Medical Practice
Dr Claire Mackintosh, Consultant Infectious Disease Physician and Clinical Director, Regional Infectious Disease Unit, NHS Lothian
Dr Ivan Marples, Consultant in Pain Medicine and Anaesthesia, Leith Community Treatment Centre
Dr Katie Marwick, Clinical Lecturer in Psychiatry, University of Edinburgh
Dr Alexander von Maydell, Junior Doctor, Royal Infirmary of Edinburgh
Miss Julie McBirnie, Consultant Orthopaedic Surgeon, Spire Shawfair Park Hospital
Professor Alison McCallum, Centre for Population Health Sciences, Usher Institute, University of Edinburgh
Dr Dermot McKeown, Consultant Anaesthetist, Royal Infirmary of Edinburgh
Professor Andrew McIntosh, Professor of Biological Psychiatry and Honorary Consultant Psychiatrist, University of Edinburgh
Dr Christina McManus, Doctor, Western General Hospital
Dr Carinne McMurray, General Practitioner, Craigmillar Medical Group
Professor Stewart Mercer, Professor of Primary Care and Multimorbidity, Usher Institute, University of Edinburgh; General Practitioner, NHS Lothian
Dr Eve Miller-Hodges, Senior Clinical Lecturer & Honorary Consultant in Inherited Metabolic Disorders and Renal Medicine, Scottish Inherited Metabolic Disorders Service & University of Edinburgh
Dr Lyle Moncur, Consultant in Emergency Medicine, Royal Infirmary of Edinburgh
Mr Matthew Moran, Consultant Orthopaedic Surgeon, Royal Infirmary of Edinburgh
Dr Catriona Morton, General Practitioner, Craigmillar Medical Group
Dr Megan Mowbray, Consultant Dermatologist, Clinical Lead Dermatology, Skin Cancer Lead NHS Fife, Queen Margaret Hospital, Dunfermline (& resident of Edinburgh)
Mr Samuel Molyneux, Consultant in Trauma and Orthopaedic Surgery, Royal Infirmary of Edinburgh
Ms Mome Mukherjee, Senior Research Fellow, Usher Institute, University of Edinburgh
Dr Nóra Murray-Cavanagh, Clinical Lead General Practitioner, Wester Hailes Medical Practice
Dr Susan Nelson, General Practitioner, Mackenzie Medical Centre, Edinburgh
Dr Anna Noble, General Practitioner, Wester Hailes Medical Practice
David Obree, Archie Duncan Fellow in Medical Ethics and Fellow in Medical Education, Usher Institute, University of Edinburgh
Dr Richard O’Brien, Consultant Stroke Physician, Royal Infirmary of Edinburgh, Honorary Clinical Senior Lecturer, University of Edinburgh
Dr Laura O’Conaire, General Practitioner, Braefoot Medical Practice, Edinburgh
Dr Rory O’Conaire, General Practitioner, West End Medical Practice, Edinburgh
Dr Ailis Orr, Consultant Paediatrician, Royal Hospital for Children and Young People, Edinburgh
Mr James Patton, Clinical Director Orthopaedics, Consultant Orthopaedic Surgeon, Royal Infirmary Edinburgh
Dr. Meghan Perry, Consultant Physician and Honorary Senior Clinical Lecturer in Infectious Diseases and General Internal Medicine, Western General Hospital, Edinburgh
Dr Sharon Peoples, Consultant in Clinical Oncology, Edinburgh Cancer Centre
Professor Martyn Pickersgill, Co-Director of Research, Usher Institute, University of Edinburgh
Dr Evgeniya Plotnikova, Teaching Fellow, Master of Public Health Programme, University of Edinburgh
Dr S.G. Potts, Consultant in Transplant Psychiatry, Royal Infirmary of Edinburgh
Dr Michael Quinn, General Practitioner, Craigmillar Medical Group
Dr Martin Quirke, Research Fellow, Centre for Environment, Dementia and Ageing Research, University of Stirling (& resident of Edinburgh)
Dr Kristiina Rannikmäe, Consultant Neurologist and Clinical Research Fellow, Forth Valley Royal Hospital and University of Edinburgh
Ms Aїcha Reid, Registered Educational Psychologist, Edinburgh
Dr Helga Rhein, General Practitioner (retired), Edinburgh
Dr Helen Riches, General Practitioner, Restalrig Park Medical Centre, Edinburgh
Professor Craig Ritchie, Professor of Psychiatry of Ageing, University of Edinburgh; Director of Brain Health Scotland
Dr Alasdair Ruthven, Consultant Anaesthetist, Royal Infirmary of Edinburgh
Professor Rustam Al-Shahi Salman, Professor of Clinical Neurology at the University of Edinburgh; Honorary consultant neurologist in NHS Lothian
Dr Euan Sandilands, Consultant Toxicologist and Director National Poisons Information Service (Edinburgh); Honorary Clinical Senior Lecturer, University of Edinburgh
Ms Chloe Scott, Consultant Trauma and Orthopaedic Surgeon, Royal Infirmary of Edinburgh
Dr Ann Sergeant, Consultant Dermatologist, NHS Fife (Edinburgh resident)
Dr Anthony Simon, General Practitioner, Craigmillar Medical Group
Dr Chris Smith, Foundation Doctor, Western General Hospital, Edinburgh
Dr Nick Spencer, Anaesthetic Trainee, Western General Hospital, Edinburgh
Dr Andrew Stanfield, Senior Clinical Research Fellow and Honorary Consultant Psychiatrist, University of Edinburgh
Dr Elizabeth Steel, Consultant Anaesthetist, Royal infirmary Edinburgh
Professor Jon Stone, Consultant Neurologist, Edinburgh Royal Infirmary and University of Edinburgh
Professor Cathie Sudlow, Professor of Neurology and Clinical Epidemiology and Head of the Centre for Medical Informatics, Usher Institute, University of Edinburgh
Dr Digby Thomas, General Practitioner to the homeless 2001-2021, Edinburgh Homeless/Access Practice
Dr Sarah Thompson, Consultant Anaesthetist, Royal Infirmary of Edinburgh
Professor Lindsay Thomson, Professor of Forensic Psychiatry, University of Edinburgh; Medical Director of the State Hospitals Board for Scotland and the Forensic Mental Health Managed Care Network
Dr Fionn Toolis, General Practitioner, Wester Hailes Medical Practice, Edinburgh
Professor Neil Turner, Professor of Nephrology, University of Edinburgh; Honorary Consultant, Royal Infirmary of Edinburgh
Dr Stefan Unger, Consultant Respiratory Paediatrician, Royal Hospital for Children and Young People
Dr Helen Usher, Consultant Anaesthetist, Royal Infirmary of Edinburgh
Dr Anna te Water Naudé, Acute Medicine Core Trainee, Royal Infirmary of Edinburgh
Stephen Walls, Senior Charge Nurse, General Intensive Care, Royal Infirmary of Edinburgh
Dr Charles Wallis, Consultant Anaesthetist and Chair of Bicycle Users Group, Western General Hospital
Dr Andrew Watson, Associate Medical Director for Psychiatry, NHS Lothian
Ms Abby White, Psychiatric Nurse, Edinburgh
Mr T.O. White, Consultant Orthopaedic Trauma Surgeon (Clinical Lead for Trauma), Royal Infirmary Edinburgh, and Honorary Lecturer, University of Edinburgh
Dr William Whiteley, Reader in Neurology, University of Edinburgh; Honorary Consultant Neurologist, NHS Lothian
Dr E.B. Wilson, Emergency Department Consultant, Emergency Department, Royal Infirmary of Edinburgh
Dr Hilary Young, General Practitioner, Mackenzie Medical Centre / University of Edinburgh
Post-publication supporters: (added after 6th September 2021):
Dr Anna Gaskell, General Practitioner, Newbattle Medical Practice
Dr Andrew Grant, Consultant Anaesthetist, Royal Infirmary of Edinburgh
Lydia Howells, Lead Nurse for Quality & Standards, NHS Lothian
Dr Catriona McLean, Clinical Director and Consultant Clinical Oncologist – Lower GI Cancer, Edinburgh Cancer Centre
Professor Gillian Mead, Chair of Stroke and Elderly Medicine, University of Edinburgh
Dr David Noble, Consultant Clinical Oncologist, Edinburgh Cancer Centre
Dr Faye Robertson, Oncology Registrar, Edinburgh Cancer Centre
Professor Roy Robertson, Chair of Addiction Medicine, University of Edinburgh, and General Practitioner, Edinburgh
Louise Starkey, Practice Nurse, Slateford Medical Practice, Edinburgh
Dr Lucy Wall, Consultant Medical Oncologist, Edinburgh Cancer Centre
Find out more about the Travelling Safely programme on the Council website.