Journal of Public Health | Vol. 33, No. 2, p. 172 | doi:10.
1093/pubmed/fdr036
Commentary
Healthy lives, healthy transport
Yvonne Doyle
NHS Southeast Coast, Horley, RH6 7DE, UK
Public health is travelling through an interesting time in its
history. The profound—though not fully clear—implications
of the world economic crisis have brought an international
wave of political change, a mood of austerity and much
public reflection as to what went wrong and who was to
blame. The future still seems uncertain, as is the long-term
impact of this period on population health. The economic
crisis also led to some acute behavioural changes—fewer
cars were sold in 2008 and particularly in 2009 than in pre-
vious years, although this recovered subsequently.1
Behaviour can change very rapidly when borne out of
urgent necessity. But what happens when people have more
discretion? We know that many people know they should do
more for their health and aspire to lose weight, take more
exercise, drink less or give up tobacco products. How con-
sistent are these people in following through on their aspira-
tions? In the case of leaving their cars for more active
transport, Douglas and colleagues in this issue show evi-
dence that what people say and do is inconsistent.2 An inter-
esting aspect of current discourse about how to change
health behaviours in the UK is the emergence in popular
awareness of libertarian paternalism—or ‘nudge’ ideology.3
This combines individual freedom of choice with gentle
interventions to guide people into their ultimately desired
(and desirable) behaviours. Would this work to turn the tide
on our national reticence to take modest amounts of exer-
cise, reduce our fast growing obesity or even nudge us out
of our cars to walk for short journeys? Changing habits in
relation to car use is not going to be easy. In western
172 # The Author 2011, Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved.
societies, our lives and environments have now grown to
accommodate regular car use. In low- and middle-income
countries there is an additional burden of disease from high
road traffic injury due to increasing car use.4 Those addres-
sing the population health impact of car use will need a
sophisticated appreciation of how personal behaviour is con-
nected with, and a consequence of the wider influences on
health. Douglas and colleagues pose a renewed challenge to
those in public health to be brave and advocate a more
rounded approach to complex modern challenges to health.
Frequently, the popular tide is moving in the opposite direc-
tion and it can be an intimidating climate, fuelled by vested
interests behind the scenes who have become adept at exer-
cising leverage at some distance. To advocate for health in
these circumstances requires leaders of exceptional skill and
courage at every level, supported by imaginative partnerships
that perceive the future. That is the challenge we face in
public health in the coming decades.
References
1 http://www.am-online.com/NewCarSalesFigures/ (4 March 2011,
date last accessed).
2 Douglas MJ, Watkins SJ, Gorman DR, Higgins M. Are cars the new
tobacco? Journal of Public Health 2011; in press.
3 Thaler RH, Sunstein CS (eds). Nudge. Improving Decision About Health,
Wealth and Happiness. London: Penguin, 2009.
4 Stevenson M. Measuring the global burden of road traffic injury:
implications for low-income and middle-income countries. Inj Prev
2009;15(1):1 –2.
Yvonne Doyle, Regional Director of Public Health