The case for Healthy Streets

It is an exciting week for Healthy Streets. The first Healthy Streets Conference was held on Thursday and this Monday the consultation period closes for the draft London Mayor’s Transport Strategy which is framed around the Healthy Streets Approach.  It was therefore timely to use my keynote at the Healthy Streets conference to reflect on the evidence base for taking the Healthy Streets Approach.

In the article below, published in Local Transport Today in July 2017, I summarised the health evidence for London and the UK, needless to say a similar story can be told for most urban areas around the world.



Mayor of London Sadiq Khan has placed the Healthy Streets Approach at the heart of his 25-year Transport Strategy. This will require all transport decisions and investments to benefit health by improving the 10 Healthy Street Indicators. Making public health the driving force behind a transport strategy may seem a bold a step for a city to take, but a brief look at the circumstances in London show that this people-centred approach to transport planning is long overdue.

The levels of nitrogen dioxide (NO2) in London, while falling in recent years due to measures including cleaner vehicles and the Low Emission Zone, are still the highest in the UK.[i] This affects the health of every Londoner and contributes to shortening life expectancy for the most vulnerable people. Air pollution is not just a London problem; there are 37 zones across the UK that exceed the annual mean limit values for NO2.[ii] Small particulates in air pollution are within legal limits but there is no safe level from a health perspective and they account for nearly 5% of deaths in England.[iii]

Road danger and its health impacts

While air quality is considered by some to be a new health issue associated with transport, one issue we have been grappling with for decades – road danger – is still a major cause for concern. In 2015 over 2,000 people were killed or seriously injured on London’s streets.[iv] The national picture is also not good, with nearly 24,000 people killed or seriously injured on the roads in the same year.[v] It is shocking that violent life-changing events that ripple out to affect whole families and communities are an accepted part of our daily lives. This is a damning reflection of our priorities as a society.

The health impacts of road danger are more far reaching than injuries. In London it is estimated that 62% of journeys by motorised transport could be cycled. The majority of these are made by car[vi], but ‘too much traffic’ and ‘fear of being in a collision’ are the top reasons people give for not cycling.[vii] For their health, car owners desperately need safe, attractive streets for them to leave their vehicles at home more often. Car ownership in London is the strongest determinant of whether people are travelling actively each day, regardless of whether they live in the suburban fringes of outer London or the urban areas of inner London.[viii]

Active travel relieves the disease burden of inactivity

Across England 43% of adults do not manage to achieve the minimum recommended levels of activity each week (150 minutes in 10-minute periods). Even more shockingly, one in three adults do not manage even three 10-minute periods of walking or other ‘moderate intensity’ activity over the course of a week.[ix]

The easiest and most sustainable way for people to build physical activity into their lives and stick with it is through walking and cycling as part of their daily travel.[x] Research from the UK and mainland Europe shows that people who do any active travel in a day are likely to meet their physical activity requirements.[xi] This is why the public health community has championed active travel for so long. It really is seen as our best bet for reversing the huge burden of disease that has arisen over recent decades as a result of sedentary lifestyles.[xii]

While sport and leisure activities can greatly enhance individual lives and support communities, active travel is the affordable, sustainable and inclusive solution to ensuring everyone moves their body a bit every day of their lives.

Putting the most vulnerable first

Many of the ‘inactive’ population are older people. As people age, while they still need the same level of daily activity, they become more inactive.[xiii] Research with older people shows that they find it more challenging to walk even short distances to local shops and services due to uneven paving, lack of seating at regular intervals and intimidating crossing points.[xiv] Clearly, we need to raise our standards if we care about supporting our older population to remain active and independent in later life. And with the costs of health and social care spiralling upwards it is in everyone’s interests to act with urgency to ensure our communities are supportive environments for people who are living with complex needs and long-term conditions.

While the inactivity statistics for adults are dire nationwide, the statistics for children are almost unbelievable. Children need much more activity than adults to stay healthy, at least an hour a day. Currently only 22% are meeting that minimum standard.[xv] This used to be fairly easily achieved through ‘playing out’ and children travelling independently on foot or by bicycle for short neighbourhood journeys. Now this is a rare sight in many communities due to road danger and ‘stranger danger’. Both could be ameliorated by a shift in our street environments from being vehicle-dominated to ‘people places’, with the natural surveillance of eyes on the street.

The decisions made in local transport departments every day affect the health and prospects of communities today and for decades into the future. ‘Transport Strategy’ belies the great importance that a plan for changing the way that streets look and feel changes the trajectories of people’s lives. The evidence is clear that the challenges facing people in London hold for communities across the country. The root of many of the health and social challenges faced by our villages, towns and cities can only be addressed through transport strategies that put the needs of the most vulnerable people first. It is time to recognise the huge responsibility for health and wellbeing that lies with the transport planner. So, is it not time for the 10 Healthy Streets Indicators to be the goal for all our streets?



[i] Improving air quality in the UK: tackling nitrogen dioxide in our towns and cities Draft UK Air Quality Plan for tackling nitrogen dioxide (May 2017) DEFRA and DfT p.58 and p.31

[ii] Improving air quality in the UK: tackling nitrogen dioxide in our towns and cities Draft UK Air Quality Plan for tackling nitrogen dioxide (May 2017) DEFRA and DfT p.4

[iii] WHO Ambient (Outdoor) air quality and health (accessed July 2017) Fraction of mortality attributable to particulate air pollution (2015) in Public Health Outcomes Framework PHE (accessed July 2017)

[iv] Collisions and casualties on London’s roads: annual report 2015 (2016) Transport for London

[v] Reported road casualties in Great Britain: 2015 annual report (2016) Department for Transport

[vi] Analysis of Cycling Potential Policy Analysis Report March 2017 (2017) Transport for London

[vii] Attitudes towards cycling (2015) Transport for London

[viii] G. Fairnie, D. Wilby and L. Saunders (2016) Active travel in London: The role of travel survey data in describing population physical activity,” The Journal of Transport & Health, volume 3, issue 2 10.1016/j.jth.2016.02.003

[ix] Active People Survey (2015) in Public Health Outcomes Framework PHE (accessed July 2017)

[x] Everybody active every day: An evidence based approach to physical activity (2014) Public Heath England

[xi] E. Fishman, L. Bocker, M, Helbich (2015) Adult active transport in the Netherlands: An analysis of its contribution to physical activity requirements Plosone

Belanger et al (2011) Age related differences in physical activity profiles of English adults. Preventive Medicine

[xii] Everybody active every day: An evidence based approach to physical activity (2014) Public Heath England

[xiii] Health Survey for England (2015)Joint Health Surveys Unit of NatCen Social Research and the Research Department of Epidemiology and Public Health at UCL

[xiv] Older people’s perceptions of walking (2016) Transport for London

[xv] Health Survey for England (2015)Joint Health Surveys Unit of NatCen Social Research and the Research Department of Epidemiology and Public Health at UCL

Cars, streets and child health

Today Public Health England published new statistics on the link between children’s emotional wellbeing and physical activity.  They reminded us of the shocking statistic that only 1 in 5 children aged 5-15 achieve the minimum physical activity levels they need each day to stay healthy.

The strong focus on childhood obesity and the role of food and drink in driving that growing health crisis means that the important role of everyday activity is all too often overlooked.  Enabling children to walk, cycle, scoot, play and explore in the streets around where they live is so important for their happiness, resilience, independence and healthy growth.  My guest article in the UK Faculty of Public Health’s magazine Public Health Today set out why I think the Healthy Streets Approach is so desperately needed by our children……

The Healthy Streets approach delivers active children and healthy communities

Our efforts to tackle childhood obesity have focused on modifying diet, but the other side of the ‘energy in/energy out’ equation deserves careful consideration for the many co-benefits we can reap. A study by Mackett and Paskins (2004) assessed children’s energy expenditure during different activities and found that children burned the most calories when playing outdoors unsupervised or travelling actively. Neither activity is a routine use of time for the majority of children in the UK. Unlike past generations, most children in the U.K. do not spend several hours a day drifting around the streets looking for adventure and opportunity. Instead a car ride to organised activities, playing computer games and watching tv are more common.

There is good reason for this, over recent decades cars have filled our streets in ever increasing numbers. Now more affordable, convenient, comfortable and faster than ever their ubiquity means we don’t think to question their right to line our streets when parked and take precedence over other uses and users of the streets when they are moving. As a result many parents are reluctant for their child to walk with their friends to school, the park, the community centre or library and the sight of a child kicking a ball around in their street is rare. While many children living in urban areas live within walking distance of parks their ability to access them is constrained by the availability of an adult to accompany them. If we are to address inactivity amongst children then this is the issue we must face head on: how we will create street environments which are safe enough for children to travel on foot or by bike unsupervised.

Achieving this goal will deliver many wider health benefits. Streets in which car use is constrained (both in volume and speed) reduce road danger to all of us, improve air quality, reduce noise and are more accessible to the most vulnerable groups – older people, those living with illness and disabilities. These streets become welcoming spaces for everyone to walk, cycle and spend time helping us all to build some much needed activity into our daily routine and connect with our neighbours and communities. More eyes on the street helps reduce the fear of strangers that can further restrict children’s independent mobility.

I developed the Healthy Streets approach to deliver these outcomes. There are ten indicators of a Healthy Street, all are evidence-based to improve health, reduce inequalities and promote active travel. These indicators help to focus transport policy and decision making on what really matters: the human experience. The Healthy Streets approach moves us away from the passive acceptance of the dominance of motor traffic. We must consciously act to restrain motorised traffic through measures such as enforcing speed limits, ensuring pedestrian priority at crossings, reducing the convenience of driving short distances for trips that could be done on foot or by bicycle and installing cycling infrastructure that parents would be happy for their children to use unsupervised. Only through measures such as these, delivered at scale in villages, towns and cities across the country, can we provide an environment in which we can grow up and grow old healthy.

Healthy Streets in Seoul day and night

I have just returned from Seoul, a city that is showing the world how to entice people onto Healthy Streets around the clock.


My reason for visiting was to see the newly opened Seoullo 7017 – an urban motorway that has been converted into a pedestrian bridge connecting two parts of the city severed by railway lines and 16 (yes that’s right 16) lanes of highway. As well as tackling a major severance issue this project is remarkable because it has been delivered very quickly, at reasonably low cost, even with extensive stakeholder engagement. The original ‘bridge’ of Seoullo 7071 also has the potential to grow ‘tentacles’ out to connect other parts of the surrounding area.


Of course while in Seoul you cannot miss the Cheong-gye-cheon river which used to be hidden under a highway and now serves as a walking route east west across the city. It’s surprisingly peaceful, with herons fishing in the water and the breeze blowing through the trees it feels like a stroll along a rural stream, not a corridor for traversing the centre of a bustling global city. The length of it is probably what surprised me most. The Highline in New York is 2.33km, the Promenade Plantee in Paris is 4.7 km but the Cheong-gye-cheon river is 10.9 km long.



I was surprised to also come across a railway line that has been converted into a linear park that I have never heard of even though it opened in 2015 after several years of development. Gyeongui line park is even more impressive than the bridge or the river and I think you would need to go there to see why. It is the people that make the place and it has been designed so thoughtfully that it is a place where everyone feels welcome and the community comes together.



I found so many great streets in Seoul, here are some highlights showing well used public spaces both day and night across the city.






And if you’re wondering, yes all of these streets accommodate motorised vehicles as well as being welcoming places for people to spend time in and travel on foot.


Mayor of London’s Transport Strategy to deliver Healthy Streets

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This week the Mayor of London, Sadiq Khan, published his draft 25 year transport strategy for public consultation. By applying the Healthy Streets Approach, this ambitious plan reaches beyond the transport system to shape a global city and the lives of millions of people for the better.

The headline target is to reduce trips by car to 20% by 2041, down from 36% today, because ‘the success of London’s future transport system relies upon reducing Londoner’s dependency on cars’. Alongside this are targets to ensure that every Londoner walks or cycles 20 minutes each day, that no one will be killed or seriously injured on the roads and that public transport is affordable and accessible to all.

Reduction in car use on this scale is only possible with transformational change to a city’s streets and public transport provision plus ‘good growth’ i.e. higher standards for new developments.

The Healthy Streets Approach provides the framework for delivering this transformational change. The Mayor of London recognises that delivering improvements against the 10 Healthy Streets Indicators ‘will radically transform the day-to-day experience of living in London, helping fulfill this strategy’s overall aim of creating a better city for more people to live and work in’.

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This Healthy Streets plan will significantly enhance the quality of life in London. Streets will be cleaner and greener, less noisy and intimidating; everyone will feel welcome to walk, cycle and spend time in these public spaces which will be vibrant and no longer dominated by vehicles.

The public consultation is open until October 2nd 2017, to share your views visit the Mayor’s website


Taking Healthy Streets to North America


The last few weeks I have been sharing experiences with colleagues in North America.

I took part in the first joint podcast between the ITE in the USA and CIHT in the UK with Dale Bracewell, the transport manager for Vancouver, and Bernie Wagenblast, host of Transportation Radio.  We discussed the approaches we are taking in London and Vancouver to embed health in transport planning and the challenges we are overcoming.

I went to Boulder, Colorado to meet the team at Peopleforbikes who are leading The Big Jump project working with 10 US cities to reimagine their bike infrastructure and measure the impacts of improving streets for people.

I then headed to San Francisco and the Bay Area where I met with the San Francisco Municipal Transportation Agency and the team behind GroundPlay who are responsible for changing the look and feel of San Francisco streets like the one pictured above.

And finally I stopped off in Montreal where I met the City Council teams who have been working together to deliver an inspiring programme of public realm improvement projects. My reason for being there was to speak at the UITP Global Summit of Public Transport providers as part of their first ever session on transport and health.  There was a strong sense that transportation authorities are beginning to embrace their wider role in making cities great places to be.

Health benefits of streets quantified

This week Transport for London published the long-awaited Better Streets Delivered 2.  This beautifully presented report illustrates schemes across London that have been implemented over recent years, or are currently under construction, to improve the 10 Healthy Streets indicators.

Even just a flick through the ‘before’ and ‘after’ pictures show clearly how streets of all kinds have been made better for people:  Footways widened; direct crossings put in at the point where people want to cross the street; seating and planting; a range of measures to reduce the dominance of motorised vehicles on streets of all sizes.

It’s great to see such a variety of locations – town centres across outer London including Hornchurch, Bexley Heath, Southall and Harlesden; major junctions in central London including Holborn Circus, Euston Circus and Aldgate Gyratory; and local streets such as Bonnington Square in Lambeth and Royal College Street in Camden.  My favourite street in London, Van Gogh Walk, also features.


My favourite street in London: Van Gogh Walk (Image: TfL)

But what sets this report apart from its predecessor – Better Streets Delivered – is that the health benefit delivered by these street improvements has been calculated to show in £’s the human value of improving streets. For all the projects that I could get hold of some basic data on levels of people walking and cycling I applied the World Health Organisation’s Health Economic Assessment Tool for Walking & Cycling. This tool shows the monetised health benefit of people staying healthier and avoiding long term conditions because they were being more physically active.


Hornchurch town centre now delivers £500,000 in health benefits each year from increased footfall (Image: TfL)

You’ll see that the monetised health benefit varies depending on the levels of walking and cycling in each location. Some places in central London deliver £2-3m in health benefits each year but even more modest schemes in outer London deliver around £500,000 each year in health benefits.  Given that these calculations are conservative and (due to lack of data) often do not capture both the cycling and walking health benefits the reality is that these figures could probably be higher.

You can do these sums yourself, if you want to read more about how to calculate the monetised health benefits of transport projects, I have written this guidance.


New Spring Features

In Spring 2017 there’s been a flurry of events and new articles on Healthy Streets.


In February the Sustrans Street Talk was led by Val Shawcross (London Deputy Mayor for Transport) and Will Norman (the Mayor’s new Walking and Cycling Commissioner) introducing Healthy Streets – you can watch their presentations here

In March Transport for London held a conference on Healthy Streets and making London a better city for walking. Speakers included Val Shawcross, Janette Sadik-Khan (Former Commissioner of New York City Dept of Transportation),Christophe Najdovski (Deputy Mayor for Paris) and TV doctor Dr Xand Van Tulleken. This was followed by the Living Streets Walking Summit, videos from the Summit are available here

At the second Sustrans Street Talk in April Lucy joined a panel including the Guardian’s Peter Walker and Laura Laker to discuss the challenges of building cycle infrastructure and engaging communities in changing public realm. Lucy emphasised the benefit of the Healthy Streets Approach in engaging communities to imagine how their streets could be different and better by focusing on the 10 Indicators of a Healthy Street.

New articles

The Spring 2017 edition of  Urban Design Group Journal focused on health and urban design with an article by Lucy on Healthy Streets

In April 2017, in anticipation of the forthcoming London Mayor’s Transport Strategy Nick Sanderson discusses the opportunities and challenges of implementing the Healthy Streets Approach in his Environment Journal blog.

In March 2017 Lucy posted a guest blog for the Urban Transport Group on the value of embedding health considerations into city transport planning.

For International Women’s Day Lucy featured amongst esteemed company in the Environment Journal 5 inspiring women working to change the way we travel.

What’s next?

And there’s more to look forward to in the coming weeks with some high profile conference appearances, Public Health Today featuring Healthy Streets in its forthcoming Spring edition, a podcast in the pipeline and of course the draft Mayor’s Transport Strategy for London

Healthy Streets for London


This week Transport for London published Healthy Streets for London. This is a bold statement of intent by one of the world’s largest transport authorities to put people, and their health, at the heart of decision making and project delivery.

The Healthy Streets Approach will be delivered through activity at three levels of planning:

  • Street Level – designing and maintaining high quality street environments that are welcoming to everyone and no longer dominated by motorised traffic.
  • Network level – planning and managing the public transport and road networks so that street space can be fairly allocated to sustainable travel.
  • Strategic level – ensuring London’s growth enables more people to live in healthy environments where walking and cycling are easy and convenient for shorter trips and public transport is an attractive option for longer trips.

The overall objective is to deliver the 10 Healthy Streets Indicators “to create a healthier city, in which all people are included and can live well, and where inequalities are reduced”.

10 Healthy Streets Indicators


TfL has committed to investing £2.1bn to deliver a Healthy Streets Portfolio of street improvements. However the document makes clear that this is only one part of delivering Healthy Streets and that partnership working with public, private and community sector organisations is essential. To support this the Healthy Streets Approach will be embedded in all the Mayor of London’s statutory strategies.

More details of how the Healthy Streets Approach will be delivered in London is promised in the forthcoming Mayor’s Transport Strategy and TfL’s second Health Action Plan.

Back to the start

On February 22nd Deputy Mayor for Transport,Valerie Shawcross and Walking & Cycling Commissioner, Will Norman will be talking about Healthy Streets at the first Street Talk of 2017.

To see how far we have come then why not head right back to the start of Street Talks and this presentation on Healthy Streets from 2012.

Welcome to the Healthy Streets website

This is the website for Lucy Saunders, who created the Healthy Streets Approach in 2011 to enable strategic and local planning, placemaking and urban design to deliver the best results for people. You can find out more about Lucy here.

You can find an overview of Healthy Streets, its evidence base and application here.

Healthy Streets has been adopted policy at Transport for London since their 2014 Health Action Plan.  Under Mayor Sadiq Khan this approach is becoming more deeply embedded in transport and planning policy in London.  You can follow the latest Healthy Streets policy developments here.

You can find links to all Lucy’s publications on transport and health here.