20mph: A Litmus Test of Public Health Outdoors

Road injuries hurt an estimated 1% of people a year and its rising. Tackling road risk is key to public health improvement outdoors for all ages. Community-wide 20mph limits confer huge health economic returns in casualties avoided and in active travel exercise gains.  

194,477 people were recorded road injured in 2014 (a 6% increase over 2013). Including unreported casualties 700,000 (1%) of Britons are estimated road injured yearly. The vast majority involved motorists hitting people. Adding those too frightened to play out, walk or cycle and underactive makes a staggering illness burden from predictable and preventable road risks.  The Department for Transport (2011) estimated that including incidents unreported to the police the value of preventing road crashes was £34.8 billion per year[1] - a whopping £540 per head pa.

With residential 20mph limits Warrington reported a First Year Rate of Return of 800% - the capital costs were recovered in reduced casualty value in just 7 weeks. 20mph limits are a once off cost of approx. £2-3 per head and typically avoid 20% of casualties for years to come. 

Wide 20mph limits are best practice according to the World Health Organisation, NICE, Association of Directors of Public Health, Faculty of Public Health, UK Public Health Association, Royal College of Paediatrics & Child Health and National Children's Bureau[2]. 20mph is an evidence-based, cost effective policy whose lower risk and fitness benefits far exceed its costs.  Bristol estimated a £24 per £1 spent benefit to cost ratio on increased walking and over £7 on raised cycling[3].  Implementation is typically £0.5m per 200,000 population and discounted across future years.   

For children, the elderly and health equality for age groups, Britain’s top outdoor public health priority is tightly monitored road danger reduction plans with targets and tight recording (like workplace injuries) with careful reflective learning and application of evidence-based danger mitigation measures.  Proven prevention policies include 20mph limits for built up areas (each 1mph less reduces crashes and casualties 6%), low alcohol tolerance levels, speed enforcement, hidden cameras, in vehicle speed limiters, presumed liability, no texting whilst driving and a Vision Zero (no deaths) goal. We know the solutions. What we need is the multi-agency working, finance and political will to apply them.

20mph limits are the litmus test of public health outdoors. If your authority isn’t already committed to wide area 20mph limits then why not?  14 million people live where road danger from excessive speed is no longer tolerated. Directors of Public Health have funded 20mph in Liverpool, Birmingham, Calderdale and Manchester. Implementing 20mph limits costs very little and confers so many wins in transforming built-up streets to healthier, pleasant places.  This environmental change hits many agendas: injury prevention; child protection; equalities; coronary heart disease; obesity; active lifestyles; asthma and mental health/isolation.  Air quality improves from less wasteful acceleration.

20's Plenty for Us ask authorities to integrate public health in transport planning, state a vision for healthier roads, implement wide 20mph limits in built up areas and for the Government to plan a transition to Total 20 by 2020.

Anna Semlyen (MSc Health Econ) Campaign Manager, 20’s Plenty for Us said:- “Healthy places are 20mph. Public Health Directors have convincing evidence that 20mph is the right default urban speed limit.  Like immunisation, limits raise herd immunity against road danger. Lower speed is an affordable change benefiting us all. 20mph tackles not just road risks but also the inactivity time-bomb. Prof Danny Dorling said that in public health terms road casualties are the “open sewers of the 21st Century”[4]. We can reap substantial health economic gains by making this small change in the way we share and use roads in our communities.”




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