Intended for healthcare professionals

Opinion Dissecting Health

Scarlett McNally: Prioritising the health of our children by reducing road traffic deaths

BMJ 2022; 379 doi: (Published 30 November 2022) Cite this as: BMJ 2022;379:o2862
  1. Scarlett McNally, professor
  1. Eastbourne
  1. scarlettmcnally{at}
    Follow Scarlett on Twitter @scarlettmcnally

Last year, 27 450 people were killed or seriously injured on Britain’s roads.1 If these deaths or serious injury from road traffic crashes were a cancer, they’d represent the fifth leading new cancer diagnosis in the UK—with only prostate, lung, breast, and bowel cancer higher.2 This is a public health matter, and health inequalities play a big part. Children in the most deprived 20% of areas are six times more likely to be injured than those in the least deprived 20%, and 16 children are killed or seriously injured in road crashes every week on their way to or from school.3

We know how to prevent this: a combination of environmental and driver behavioural changes. The Highway Code changed in January to mandate safer driving behaviours around vulnerable road users, such as leaving at least 1.5 m (5 ft) when overtaking a cyclist,4 but 61% of drivers are unaware of the changes.5

Some real examples show what’s possible. In Edinburgh a change to 20 mph limits has reduced road traffic casualties by 40%.6 So, let’s bring in 20 mph limits in all urban areas. Oslo and Helsinki have reportedly eliminated pedestrian deaths with Vision Zero—an initiative including car-free zones around schools.7 And all types of fatal collisions fell by 49% when San Francisco introduced segregated cycle lanes.8

We should stop seeing the world through our windscreens. The government’s economic analysis of its £27bn (€31.3bn; $32.4bn) funding for major road traffic schemes focuses on a hypothetical reduction in traffic delays,9 without acknowledging the increased road travel and resulting incidents created by expensive, new, widened roads.

When local residents petition for a zebra crossing by their school, their project joins a list of at least 79 others, and funding goes only to the top three lucky projects—but we need to prioritise making our roads safer.10 Children make up 21% of the UK population.11 Only 76% of mothers with dependent children are in employment, compared with 92% of fathers.12 In a cost of living crisis, running a car is one of the biggest household expenses. But if children can cycle, walk, or scoot to school safely, the household may need only one car. Furthermore, walking or cycling has clear benefits for health by reducing sedentary lifestyles, as well as for the environment.

We’re in a vicious cycle where 34% of children are driven to school,13 62% of UK adults say that it’s too dangerous to cycle, and 59% of car journeys are under five miles.14 Only 5% of walking journeys are over two miles, so a modal shift from cars requires better infrastructure for cyclists and pedestrians, with better public transport. Electric cycles allow older people and people with disabilities to cycle more easily, especially on hills and for longer distances.

We should harness the health benefits of reduced car travel. Pollution from road traffic contributes to many health conditions15: 34% of men and 42% of women are not active enough for good health,16 and active travel can be one of the best ways of fitting in exercise into a busy day.

Let’s prioritise our health by making roads safer. We can’t afford not to if we want to look after our planet and the coming generations.


  • Competing interests: None.

  • Provenance and peer review: Commissioned; not peer reviewed.