Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Excellent, but just one note of caution
- Harry Rutter (14 February 2003)
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Traffic congestion is traffic calming
- Helena Tunstall (15 February 2003)
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Never Underestimate Human Laziness.
- Mark P Durham (17 February 2003)
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A member of the 'walking class' replies
- Carole J Caldwell (18 February 2003)
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Is congestion charging good enough?
- Christian A Gericke (21 February 2003)
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The walking classes also need road-space reallocation
- Michael Joffe, Jennifer Mindell (28 February 2003)
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Harry Rutter, SpR Public Health South East Public Health Observatory, OX3 7LF
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I fully endorse this excellent paper; it is good to see the public health impact of traffic so well described. I would, however, urge just one note of caution. Although it is likely that 'less car travel will result in fewer crashes', if traffic levels drop enough to shorten journey times (which is one of Ken Livingstone's stated aims), the inevitable increase in speeds may in fact increase the danger from traffic. This is not in any to diminsh the rightness or importance of congestion charging, or other mechanisms for internalising the externalities of travel. But we should be aware of potential unintended consequences; awareness may help us to avoid them. Competing interests: None declared |
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Helena Tunstall, PhD student University of Bristol, School of Geographical Sciences, BS8 1SS
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I strongly agree with Ian Roberts’ view – that traffic can damage health and well being, particularly among those on lower incomes. However, I have concerns about the possible effects of congestion charging upon traffic speeds in London. Traffic congestion appears to have been a highly effective, if inadvertent, form of traffic calming in London and seems to have played an important role in reducing pedestrian fatalities in the city. My PhD analysis (recently completed and submitted) focused on the geography of child and teenage road accident fatalities in England & Wales. I found that deaths among child pedestrians aged 5-9 years and 10- 14 years declined faster between 1981-85 and 1991-95 in the Inner London Boroughs in comparison to other districts in England and Wales. The Inner London Boroughs, over this time period, have changed from having relatively high pedestrian death rates in comparison to other districts to relatively low death rates in these age groups. The sharp fall in child pedestrian death rates in Inner London have coincided with falls in traffic speeds (1, 2)and increasing congestion. The significant improvements in Inner London’s record on child pedestrian fatalities appear to have been lost in discussion of London’s growing traffic volumes. The beneficial role of congestion in reducing pedestrian fatalities is further suggested by the results of my analysis which finds that between 1981-85 and 1991-95 child pedestrian fatalities became relatively less concentrated in high population density urban wards in England and Wales. While the movements of children have been increasingly restricted as traffic volumes have increased (3), the importance of falling traffic speeds in reducing fatal pedestrian accidents is suggested by the falling risk of death per mile travelled by foot (4, 5). Falling traffic speeds also may also explain in part why overall numbers of traffic injuries in Britain have been stable in recent years but the proportion of fatalities has declined (2). Highly congested streets are clearly not the ideal environment for pedestrian journeys. However, the alternative option of fewer, faster moving vehicles offered by congestion charging in central London appears to produce obvious benefits for those travelling by car and bus in terms of reduced journey times, but the benefits are more ambiguous for those travelling by foot. There is a real risk that if congestion charging meets its objectives of reducing traffic volumes and increasing traffic speeds that there will be fewer traffic collisions but with a greater proportion of these collisions resulting in serious and fatal injuries. It is important therefore that the impact of congestion charging upon traffic speeds and the numbers of traffic injuries of different severities are carefully monitored. 1. Rowland M (1998) Traffic Speeds in Inner London: 1998, Department of the Environment, Transport and the Regions Statistical Bulletin (98), 22 2. Department for Transport (2003) Transport Statistics Great Britain: 2002 Edition; London: HMSO 3. Hillman M, Adams J and Whitelegg J (1990) One False Move: A Study of Children's Independent Mobility, London: Policy Studies Institute 4. DiGuiseppi C, Roberts I, Li L (1997) Influence of changing travel patterns on child death rates from injury: trend analysis, BMJ, Vol. 314, pp710-3 5. DiGuiseppi C, Li L and Roberts I (1998) Influence of travel patterns on mortality from injury among teenagers in England and Wales, 1985-95: trend analysis, BMJ, Vol. 316, 21 pp904-5 Competing interests: None declared |
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Mark P Durham, Paramedic Student University Of Hertfordshire
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As a worker for the London Ambulance Service, it could be said that i am biased in being against the congestion charge, in actual fact this is not the case, i merely cringe at one loophole which has been left in the congestion charge setup. The congestion charge in central London will not be levied on motorbikes, only cars - presumably because motorbikes are smaller, more manouverable, and therefore cause less congestion than cars. Fantasic, so far so logical, but i predict that the congestion charge will lead to a boom of bike sales, as all inner city workers rush to get bikes and get qualified to dodge the charge and still avoid having to expend energy in getting to work (i know i would if i could afford to). I am reliably informed that riding a motorbike is an acquired skill and requires good vision and road awareness all around because one is so vulnerable and much harder for others to see. Driving in London is an interesting experience at the moment, because a few (it only takes a few) people just do not THINK when behind the wheel, let alone pay adequate attention to the road, other road users etc. Imagine then, if you will, just some of these impatient and inconsiderate road users, applying their roadcraft and road attitudes to a motorbike which they aren't used to. Now i hope you see why i cringe. In my view the congestion charge could lead to a rise in motorbike RTAs, and a rise in mortality and traumatic injuries, especially cervical spine injuries because motorbikes offer so little protection in a crash. I can only hope i'm wrong. Competing interests: London Ambulance Service Worker |
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Carole J Caldwell, Consultant Histopathologist Farnborough Hospital, BR6 8ND
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Editor : At last, you have sounded a note of sanity amidst the hysteria which has characterised the debate on congestion charging ('Congestion charging and the walking classes', BMJ 15 February). As a member of the 'walking (and cycling) class' who gave up her car 10 years ago in London I can wholly endorse your observation that it is the poor (or car-less in my case) who face the greatest risk on the roads. As a consequence our children have become virtual prisoners in their own homes and our streets belong to the muggers. I am not a great fan of Ken Livingstone but I do think he has shown true guts in introducing this charge and only wish the government had a fraction of his courage. The congestion charge is an example of social justice and, as you point out, a major public health reform. As such, the medical profession should welcome it with open arms. I hope it does. Competing interests: Member of Friends of the Earth. |
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Christian A Gericke, specialist registrar in public health medicine Witham, Braintree and Halstead Care Trust & Institute of Public Health, University of Cambridge, CB2
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EDITOR – I definitely agree with Ian Roberts 1 that congestion charging is a good idea, but much more is needed to tackle road danger at its source in the UK. When I first came to this country I was shocked by the lack of respect for pedestrians and cyclists in the UK traffic infrastructure compared to other European countries of similar wealth like Germany, France or the Netherlands. This is evident in many aspects of the daily traffic experience: Dysfunctional traffic lights
Insufficient inner city speed limits
Defaults in infrastructure for pedestrians and cyclists
Car-centred traffic legislation
Adding to these the shortcomings in quality and infrastructure of public transport, all these points add to the impression that the UK Government is much less concerned about road safety of pedestrians and cyclists than other governments in Europe. A nationwide audit of current traffic control practices and rapid implementation of improvement measures is urgently needed to protect the most vulnerable groups of the traffic system – children and the elderly. ‘Tinkering around the edges of the problem’ 1 is as much needed as a big bang policy restricted to London’s inner city. 1. Roberts I. Congestion charging and the walking classes. BMJ 2003;326:345-6. Competing interests: None declared |
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Michael Joffe, Reader & Consultant in Epidemiology & Public Health Imperial College, Dept of Epidemiology & Public Health, Norfolk Place, London W2 1PG, Jennifer Mindell
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Dear Sir Congestion charging and the walking classes We very much welcome Ian Roberts' editorial, making the case for the new London Congestion Charge on health grounds (1), particularly as the revenue is legally required to be spent on transport improvements. We agree that the likely result is an increase in physically active transport such as walking and cycling. It is important that this be monitored adequately, with attention given to prior activity levels and broken down by socio-demographic groups, to assess the impacts on health and inequalities. There are other potential effects of congestion charging, for example that it is likely to improve access for emergency vehicles, but not all are positive; the impact of the policy will depend on which complementary measures are introduced at the same time. One statement with which we disagree is, "Less car travel will result in fewer crashes". This is one aspect of the charge where the impacts are more difficult to predict.(2) If Transport for London’s predictions are correct that shorter journey times will occur primarily due to reductions in time spent queuing at junctions, i.e. that shorter journey times will ensue without concomitant increases in travelling speed, then he is probably correct. If traffic reduction is greater than predicted, then travel speeds may become substantially faster. While shorter journey times could reduce people's exposure to the risk of collisions, higher speeds could increase the risk by a greater amount.(3) Congestion charging without other transport improvements could also have an adverse impact on equity: road space vacated by people who are deterred by the charge could be occupied by those who are less price- sensitive, who are likely to have higher disposable income (3), reinforcing the benefits of access for wealthy drivers and the adverse effects of others’ car use for the less well-off. Both of these potentially adverse effects can be effectively combated by the simultaneous introduction of road-space reallocation measures, giving priority to buses, preferential access to disabled drivers, and effective protection to cyclists and pedestrians.(3) This is largely true of the London Congestion Charge, but it is important to consider when other towns and cities follow suit. Even London has thus far been timid about pedestrianising road space – Soho and Covent Garden would seem like ideal candidates. Experience has shows that whereas such schemes tend to be initially opposed by shopkeepers and other local businesses, once the schemes are implemented, they benefit economically. Yours sincerely Michael Joffe
1. Roberts I. Congestion charging and the walking classes. BMJ 2003; 326: 345-46. 2. Mindell J. Quantification of health impacts of air quality management in Kensington & Chelsea and Westminster. PhD thesis submitted to University of London. 3. Joffe M, Garnett T, Mindell J. Mapping the links - Project evidence base for Health Impact Assessments. http://155.198.41.240/projects/mapthelinks/mapthelinks.htm (accessed 27 February 2003). Competing interests: None declared |
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