The National Institute for Health and Care Excellence (NICE) has produced two pieces of guidance that are particularly relevant to the transport system: ^{1 2}

• PH41 – Physical activity: walking and cycling (2012)
• PH31 – Unintentional injuries on the road: interventions for under 15s (2010).

A summary of the main recommendations from this guidance is provided in Table 3 and Table 4. NICE guidance on physical activity and the environment, promoting physical activity in the workplace, promoting physical activity for children and young people and prevention of cardiovascular disease also contain recommendations for effective measures relevant to a healthy transport system. ^{3 4 5 6}

NICE is also currently consulting on guidance on air pollution, which is scheduled for publication in 2017. ⁷ Draft recommendations include:

• including air quality considerations in Local Plans (local authority development planning guidelines)
• introducing clear air zones (this could include measures such as restricting polluting vehicles, encouraging less polluting forms of travel, improving driver behaviour and implementing congestion charging zones)
• ensuring that public sector transport services and fleet vehicles contribute to reduced emissions (this could include measures such as improving driver behaviour and building in reduced emissions as a factor in procurement of vehicles)
• encouraging smooth driving and speed reduction using highway engineering techniques and technology (e.g. displays of current and average speed)
• considering the positioning of cycle routes (on less polluted roads if possible)
• awareness raising about the health effects and ways to reduce air pollution with the general public, businesses and at-risk groups (including children, older people and those with chronic health conditions).

There is currently no NICE guidance on noise pollution, although this is something that is incidentally reduced by increasing active travel and measures to reduce injury.

Table 3:  Active travel and the environment – evidence-based recommendations ⁸

Broad area	Summary of recommendations
Public realm	Re-allocate road space for active modes of transport. Address infrastructure issues that may discourage  walking. Implement policies to discourage private car use. Introduce a default 20mph speed limit for streets where people live, work and shop. Ensure public transport is accessible for all and integrated with other transport modes. Ensure that people can easily access local services on foot or bicycle via safe and attractive walking/cycling networks. Ensure that new developments prioritise physically active lives, including walking and cycling. Health impact assessment is recommended for relevant transport and land-use decisions. sure adequate cycle parking provision, including at schools.
Strategy and investment	Set ambitious targets for increases in walking/cycling and publish a strategy to meet them. Invert the current traffic hierarchy so that walking and cycling are at the top and private car use is at the bottom. Invest at a realistic level – £5 to £10 per person per year is generally accepted as the minimum required to increase cycling. Build in routine data collection and subsequent evaluation to any approach that is not of proven value or effectiveness. Ensure inclusive school travel plans are developed which encourage children to walk or cycle to school.
Training and communications	Tackle bad driving through training and awareness campaigns. Ensure cycle training is available and accessible for all and that pupils at schools can access road safety training. Publicise available facilities (such as walking and cycling routes) and include information that people with impairments will require (e.g. location of dropped kerbs, location and design of barriers at access points to cycle paths). Map safe routes to school and local play and leisure facilities and consult with the local community, including people with expertise in accessibility issues. Ensure signage is available to aid walking by giving details of distance and/or walking time between transport facilities and key destinations.
Programmes and initiatives	Develop targeted programmes to encourage walking and cycling. Provide support for personalised travel planning. Introduce regular ‘walking buses’ and projects such as ‘walk once a week’ in schools. Develop or promote workplace schemes to promote cycling. Develop walking and cycling programmes using an evidence-based theoretical model of behaviour change.

Table 4: Preventing unintentional injuries on the road in under 15s – evidence-based recommendations ⁹

Broad area	Summary of recommendations
Health advocacy and engagement	Ensure senior public health leadership to engage the health sector in injury prevention and risk reduction. Support and promote changes to the road environment as part of a broader strategy to prevent injuries and the risk of injuries. Support coordinated work between health professionals and local highways authorities to promote changes to the road environment.
Measures to reduce speed	Introduce engineering measures to reduce speed in streets that are primarily residential or where pedestrian and cyclist movements are high (e.g. traffic calming on single streets or 20 mph zones across wider areas). Implement city or town-wide 20 mph limits and zones on appropriate roads (based on traffic volume, speed and function).
Safer routes for children and young people	Consider opportunities to provide safer routes commonly used by children and young people, including to school and other destinations (such as parks, colleges and recreational sites). Include school governors and head teachers in discussions about changes relating to school travel.

In addition to NICE guidance, TfL has produced a Streets Toolkit to aid those involved in the design of streets to create high quality spaces.¹⁰ This includes guidance on making bus stops accessible, and streetscape guidance to ensure attractive environments for active travel, and references the London Cycling Design Standards to ensure cycle friendly infrastructure, streets and parking.

TfL’s transport action plan, ‘Improving the health of Londoners’, brings together a range of evidence on health and transport and includes recommendations on how to make the transport system healthier. ¹¹ Recommendations relevant to local authorities include implementing speed limits of 20 mph on borough-controlled roads, ensuring accessibility to healthcare facilities and increasing joint working between public health and transport colleagues. The action plan also describes 10 ‘healthy street’ indicators for guiding local transport planning (see Box 3).

Box 3: TfL’s ‘healthy street’ indicators ¹²

TfL has proposed the following key principles to deliver ‘healthy streets’ for everyone: Pedestrians from all walks of life People choose to walk and cycle Clean air People feel safe Not too noisy Easy to cross Shade and shelter Places to stop Things to see and do People to feel relaxed

 

1. National Institute for Health and Care Excellence (NICE), “Public health guideline 41, Physical activity: walking and cycling,” 2012.
2. National Institute for Health and Care Excellence (NICE), “Public health guideline 31, Unintentional injuries on the road: interventions for under 15s,” 2010.
3. National Institute for Health and Clinical Excellence (NICE), “Physical activity and the environment (PH8),” 2008.
4. National Institute for Health and Care Excellence (NICE), “Physical activity in the workplace (PH13),” 2008.
5. National Institute for Health and Care Excellence (NICE), “Physical activity for children and young people (PH17),” 2009.
6. National Institute for Health and Care Excellence (NICE), “Cardiovascular disease prevention (PH25),” 2010.
7. National Institute for Health and Care Excellence (NICE), “Air pollution: outdoor air quality and health (draft for consulation),” 2016.
8. National Institute for Health and Care Excellence (NICE), “Public health guideline 41, Physical activity: walking and cycling,” 2012.
9. National Institute for Health and Care Excellence (NICE), “Public health guideline 31, Unintentional injuries on the road: interventions for under 15s,” 2010.
10. https://tfl.gov.uk/corporate/publications-and-reports/streets-toolkit
11. Transport for London, “Improving the health of Londoners: Transport action plan,” 2014.
12. Transport for London, “Improving the health of Londoners: Transport action plan,” 2014.