Intended for healthcare professionals

Opinion Dissecting Health

Scarlett McNally: Enabling active travel can improve the UK’s health

BMJ 2024; 384 doi: (Published 06 March 2024) Cite this as: BMJ 2024;384:q522
  1. Scarlett McNally, professor
  1. Eastbourne, UK
  1. scarlettmcnally{at}
    Follow Scarlett on X @scarlettmcnally

There is an urgent need to improve the nation’s health, which worsened over the pandemic. There is an abundance of evidence and reports, including by me, claiming that exercise is a miracle cure that improves physical and mental health and reduces demands on NHS services and the need for social care.1234

The best forms of exercise are those that fit into everyday life. Active travel is a “best buy” for improving health. Commuting by cycling reduces incidence of, and mortality from, heart disease and cancer by over 30% in a dose dependent manner5 and reduces sick days and depression.6 People don’t swap from their car to active travel because cars are normalised and our infrastructure is built around them. This means that 71% of women (and 61% of men) say it is too dangerous to cycle on roads.7 Where there are segregated safe cycle routes, people use them, as has been demonstrated in Paris.8

Pavements need to be repaired9 and pedestrian junctions improved for the safety and accessibility of people walking or wheeling, including those with disabilities, children, and older people.910 Mobility equity11 won’t be achieved with so little money being spent on active travel.

In the UK, massive central funds are spent on major roads. Conversely, funds for infrastructure to support active travel are stuck in local council budgets, which are facing a £4bn spending gap.12 In East Sussex, £2m of allocated funds has allegedly been spent on design and consultation, with minimal resulting infrastructure.13

I have four suggestions to support active travel cheaply. Firstly, we should demand that the 2022 changes to the Highway Code are learnt by every driver: you must give priority to pedestrians at junctions, you must give 1.5 m clearance when overtaking a cyclist and not overtake on a bend or into oncoming traffic, and cyclists are encouraged to “take the lane” for their safety.14 I give talks where I lie down on the stage to show what 1.5 m looks like, urging drivers to wait behind a fellow citizen cycling or wheeling until the next traffic jam or safe passing spot.15 Surely, a bigger media campaign, a mandate requiring this education before insuring or using a vehicle for work, and carrying out enforcement would be more effective than my one person talk.15

Secondly, we should demand 20 mph limits in all areas where people are. People are rightly scared to walk, cycle, or wheel where traffic is faster—the horrific injuries I see in orthopaedic and fracture clinics get exponentially worse with every 1 mph increase in speed. In Oxfordshire, most parish councils have requested 20 mph limits.1617 This will require minimal cost—a few signs, a change of culture, and enforcement rather than expensive traffic calming measures.18

Thirdly, the NHS workforce should be role models. The BMA and the Health Foundation suggest the NHS should be an “anchor institution.”1920 The NHS is responsible for 5% of the UK’s total transport emissions—and 1.3 million staff commuting makes up the bulk of that.1921 A modal shift from driving to active travel needs focus, practical support, and some funding. We need pavements in all NHS sites, secure cycle parking, and lockers for wet gear. A few freebies might help, such as waterproof overtrousers for new staff and subsidised bus passes for NHS staff. Salisbury Hospital has five electric cycles that staff can try out free for two weeks, which has encouraged them to buy their own. This hugely successful scheme cost only around £15 000 and should be rolled out everywhere.22 People using an electric cycle get just as fit as those using a standard bike, because they ride further and convert more journeys from car driving.23

Fourthly, we need to link with other initiatives. Every NHS organisation is required to deliver a “green plan.”20 Active travel reduces pollution, which causes catastrophic ill health and harms the planet.24 Children getting to school under their own steam has huge benefits. Many families cannot afford a second car or live in transport poverty. People being able to get about safely reduces loneliness.

Let’s challenge the UK’s car dependency and enable active travel for everyone’s health.


  • Scarlett McNally is a consultant orthopaedic surgeon, deputy director of the Centre for Perioperative Care, and president of the Medical Women’s Federation.

  • Provenance and peer review: Commissioned, not externally peer reviewed.