Memorandum by the Faculty of Public Health
Medicine (RTS 04)
I am writing to you as President of the Faculty
of Public Health Medicine in response to the rules to increase
the visibility of speed cameras that were announced on 3 December.
We are concerned they appear to give the message that DTLR is
only concerned about excess traffic speed in the small number
of locations where there have been several deaths or serious injuries
from collisions. The emphasis on conspicuity could even give the
impression that motorists need only restrict their speed when
they are approaching a brightly coloured traffic camera.
We recognise that this is not the government's
intention, but it does reflect the commonly held view among some
members of the public, and especially among lobbying groups for
motorists, that traffic speed is only a problem if someone gets
killed or seriously injured. In contrast, we take the view that
excess traffic speed has many adverse health effects and that
a more holistic approach that promotes safer driving and reduces
the social acceptability of driving at excessive speed is needed.
There are two main public health arguments in
support of the latter approach. The first is the effect of traffic
speed on health inequalities; the second is based on the very
wide impact of traffic speed on patterns of daily living and social
These arguments are briefly summarised below,
and an appendix of background information with supporting references
Excessive speed is a major cause of deaths and
injuries, especially in children
Speeding is dangerous for the driver (for whom
it is a self-imposed risk), passengers and other motorists, but
it is especially dangerous for vulnerable road users such as cyclists
and pedestrians, particularly children and older people.
Trauma is the most common cause of death among
children, and road traffic injuries account for half of these.
Two thirds of deaths and serious injuries among children involve
child pedestrians injured in road crashes.
The death rate from road traffic injuries for
children in the UK is twice the European average. Most of these
injuries occur in urban areas, and excessive speed is the single
most important factor in such crashes.
Even apparently low levels of speeding pose
significant risks. For each 1 per cent increase in speed there
is a 5 per cent increase in mortality; in many urban and residential
situations travelling at the legal speed limit may be too fast.
Adverse health impacts of speeding are much more
than deaths and injuries
Road traffic injuries are, however, only one
manifestation of the health impacts of excessive speed. Fast traffic
on busy roads impairs pedestrian and cyclist access to goods and
services, and leads to community severance. Access is a particular
problem for those with impaired mobility, such as the elderly
and people with disabilities. These problems, which are associated
with marked social inequalities, may have an even greater impact
on health than traffic injuries. Social support networks have
a positive protective effect on both physical and mental health,
and low levels of social support are strongly associated with
excess premature mortality.
Excess speed, especially when associated with
late braking, increases local air pollution and noise levels with
potential adverse effects on respiratory, cardiac and mental health.
Physical inactivity is a major public health problem
Across the UK physical inactivity now has a
greater absolute effect on levels of coronary heart disease than
smoking, and the problem is increasing, with dramatic increases
in overweight and obesity; this is particularly worrying among
children. One of the main reasons for reduced activity levels
is the decline of walking and cycling resulting from perceptions
of danger from fast traffic.
Speeding contributes to some of the biggest health
inequalities in the UK, particularly in relating to child pedestrian
The Chief Medical Officer has highlighted health
inequalities as one of the main themes of his Annual Report. Tackling
the problems suffered by disadvantaged people as a result of excess
speed and traffic will make a major contribution to meeting the
inequalities targets and creating a more equitable society.
Children in social class V are four times more
likely to die from road crashes than those in social class I;
this gap is increasing.
People living in deprived areas are the most
likely to suffer the adverse health effects of traffic, such as
deaths and injuries, respiratory problems from air pollution,
stress from noise pollution, and community severance. These problems
are all made worse by excessive speed. People without access to
cars, especially children, mothers of young children, and those
who are unemployed, and older people, are particularly affected.
Focusing attention on a relatively small number
of locations with a poor crash record does nothing to address
the wider consequences of excessive speed; the implication that
speed is only a problem in certain places may in fact make them
worse. The reliability of crash data as an indicator of the level
of danger posed by a road is also highly questionable: it is well
recognised that people avoid walking and cycling on roads they
perceive as dangerous: both motorways and pedestrian precincts
both have low levels of pedestrian casualties, but clearly pose
very different levels of danger.
The inevitable conclusion drawn by many public
health professionals is that there is a very strong case for more
widespread introduction of lower speed limits, particularly in
deprived urban areas, allied to broader and stricter enforcement.
Increasing the visibility of speed cameras may work to discourage
illegal speeding in specific locations, but will do nothing to
reduce average speeds across the road network and make our towns,
villages and neighbourhoods safer.
Professor Sian Griffiths OBE
12 December 2001
Road traffic injuries account for 49 per cent
of all accidental deaths in children.
Almost two-thirds of the deaths plus serious injuries in children
occur in pedestrians.
There is a very sharp social gradient for both incidence of and
mortality from road traffic injuries in children. The death rate
fell in each social group between 1981 and 1991 but the decline
in social classes I and II (32 per cent and 37 per cent respectively)
was much larger than in social classes IV (21 per cent) and V
(2 per cent), thus increasing further the steep social class gradient,
which is now fourfold from social class I to V for all road traffic
deaths and fivefold for pedestrian deaths.1,2 This reflects a
number of factors which are all unequally distributed. Exposure
is greater for children in low income families, as they have less
access to other modes of transport. Risks are also higher per
kilometre walked. There is an exponential rise in risk to pedestrians
with increasing traffic speed.
Speeding is more common in less affluent areas.2 Children from
low income families cross more roads,
are more likely to be unaccompanied,2 and may have less understanding
of road safety.2
Fear of injury is a well-founded concern. Rates
of serious injuries and fatalities from road traffic collisions
are highest in the young and the old.
Children who walk or cycle in Britain have twice the European
average risk of death from a road traffic collision.
Community severance was shown by Appleyard and
Lintell in their classic study in San Francisco.
They studied three parallel streets in an area with a homogeneous
population in terms of social class, income, education and mix
of ethnic origin. Traffic volumes had increased considerably in
two of the streets 10 years previously, so by the time of the
study, the three streets carried light, moderate or heavy traffic.
Both the number of friends and of acquaintances of residents were
inversely proportional to the volume of traffic in their street.
Use of the street for social activities, predominantly meeting
places and conversation by older residents and teenagers and play
by children and teenagers, was common in the light traffic street
and almost absent in the heavy traffic street, with the moderate
traffic street being in between. The street with little traffic
promoted a rich social climate and a strong sense of community,
whereas the heavy traffic street was used solely as a corridor
and there was no feeling of community. This was also borne out
by the area considered as "home territory" by the residents.
Those living on the light traffic street included at least their
whole building and often the whole street. Those on the heavily
trafficked street often felt even part of their own flat was not
home territory because of the intrusion of traffic noise, making
them live just in the back part of their home. Families with young
children had mostly moved out of the street with heavy traffic,
because of the adverse effects on quality of life. The elderly
and those too poor to move became isolated within their own homes
in the heavy traffic street. Deterrents to use of the street for
social areas were not only perceived danger from speeding traffic
but also hassling by strangers, even though inside passing cars.7
The loss of social networks, as described in this study, has a
significant impact on health.
A 1992 report for the Transport Research Laboratory
commented on the threat to pedestrians of narrow pavements; speeding
traffic; vehicles ignoring red traffic lights, rarely stopping
at pedestrian crossings, and going onto the pavement; and of the
hazard to cyclists of speeding traffic. In the three areas of
London studied, between one-third and a half of comments by respondents
concerned perceived risk, particularly for children and the elderly.
Another TRL study demonstrated that every 1 per cent increase
in speed produces a 5 per cent increase in deaths and serious
A British national survey in the early 1970s
found that outdoor noise and fumes was the second commonest complaint
after pedestrian danger, followed by traffic noise penetrating
Twenty years later, people were disturbed outdoors by smoke, fumes
and odour from traffic-derived air pollution not only because
of the smell and soiling but also out of concern for their effects
on health. Indoors, noise was a greater problem, although soiling
was also a nuisance.
Traffic noise in San Francisco interfered with sleep, conversation
or watching television for more than a third of respondents and
with eating or working in one-fifth. Perception of noise and vibration
correlated strongly with traffic volume (r=0.46). Almost one-third
(29 per cent) lived in the back of the house to reduce this, except
on the light street.11 In Huddersfield, traffic noise interfered
with relaxation and sleeping for 20 per cent and home-based leisure
activities for 10 per cent of respondents. Such noise, fear of
traffic injuries, and dirt and fumes from traffic were considered
very important quality of life issues by around one-quarter of
1 Roberts I, Diguiseppi C, Ward H. Childhood injuries:
extent of the problem, epidemiological trends, and costs. Injury
Prevention, 1998; 4:S10-S16. Back
MacGibbon B. 13b Inequalities in health related to transport.
In Gordon D, Shaw M, Dorling D and Davey Smith G (eds) Inequalities
in health: the evidence, Bristol: Policy Press, 1999, pp.
McCarthy M. 7 Transport and health. In Marmot M and Wilkinson
RG (eds) Social determinants of health, Oxford: Oxford
University Press, 1999, pp 132-54. Back
Davis A. 13a Inequalities of health: road transport and pollution.
In Gordon D, Shaw M, Dorling D, and Davey Smith G (eds) Inequalities
in health McCarthy M. 7 Transport and health. In Marmot M
and Wilkinson RG (eds) Social determinants of health, Oxford:
Oxford University Press, 1999, pp 132-54. Back
Powell G and Taylor S. Health of the Nation, accidents and deprivation
in Kensington & Chelsea, and Westminster, London: K &
C and W Health Authority, 1997, 6-31. Back
Jarvis S, Clarke M, Cryer C, Davidson L, Evans S, Sheriff C,
Stone D, Ward H and Yates D. Injury prevention, London:
British Medical Association, 2001. Back
Appleyard D, Lintell M. The environmental quality of city streets:
The residents' viewpoint. American Institute of Planners Journal,
1972; 38:84-101. Back
Berkman LF, Syme SL Social networks, host resistance and mortality:
A nine-year follow-up study of Alameda County residents. American
Journal of Epidemiology 1979 109:186-204. Back
Smith JD, Gurney A. Community effects of traffic congestion:
A review of the London Assessment Study Data, Crowthorne,
Berkshire: Transport Research Laboratory, 1992. Back
Finch D, Kompfner P, Maycock G. Speed limits and accidents. Crowthorne,
Berkshire: Transport Research Laboratory, 1994. Back
Appleyard D, Gerson MS, Lintell M. Livable Streets, Berkeley:
University of California Press, 1981. Back
Williams ID, McCrae IS. Road traffic nuisance in residential
and commercial areas. Science of the Total Environment,
1995; 169:75-82. Back
Jones S, Kingham S, Briggs D. Kirklees case study, Huddersfield:
Environment Unit, Kirklees Metropolitan Council, 1997. Back