NICE ideas to make the UK a healthier place by encouraging cycling and walking

LCC campaigner Susie Morrow helped formulate new national guidelines to promote walking and cycling

During 2012, I was one of two ‘community members’ working with the National Institute for Health and Clinical Excellence (NICE) to produce its ‘Walking and Cycling’ guidance. This document calls on local authorities, the NHS, and anyone else involved in environment and transport planning, parks and LCC campaigner Susie Morrow helped formulate new national guidelines to promote walking and cycling leisure, and physical activity promotion to put in place policies that encourage walking and cycling to become the norm for short journeys across the UK.

NICE was formed in 1999 following concerns about the ‘postcode lottery’ in funding clinical treatments. Its remit was to ensure that evidence on the eff ectiveness and cost-effectiveness of medicines and clinical procedures was fed into health authorities’ funding decisions. In 2005 NICE’s role was broadened to encompass public health.

The publication of this guidance is very timely because on 1 April 2013 local councils will take over responsibility for public health in their areas. The shift in responsibility of public health to local councils is an attempt to address the public health crisis taking place in this country at present. ‘Crisis’ might sound melodramatic, but the nation is getting worryingly less healthy because of a long-term trend that’s seeing people doing less and less exercise.

Physical activity reduces the risk of coronary heart disease, stroke and type-2 diabetes, among other diseases, and is important for good mental health too. To many of us promoting walking and cycling is a no-brainer because these are obvious ways to increase most people’s levels of physical activity in low-cost, accessible ways. Having evidencebased guidance from NICE informs and strengthens our case.

NICE’s guidance recognises that encouraging walking and cycling are effective and economical ways to get more people active. It makes 10 recommendations to reverse the longterm decline in physical activity and its associated problems with public health. In particular, it considers three settings with great potential for promoting walking and cycling: schools, workplaces and the NHS.

Working at local level
I’m an active member of LCC in Wandsworth, though my role with NICE wasn’t to represent any particular organisation; rather it was to represent the views and concerns of those promoting walking and cycling in the broader sense, based on my experience with LCC and other organisations working to improve the public realm, such as Living Streets.

To develop the guidance we used a rigorous process, one built around ‘informal consensus’ including commissioning reviews and economic modelling, expert witness testimony, and consultation with stakeholders such as LCC members.

Stakeholders’ comments formed a useful ‘sanity check’ on the guidance as it developed, for example, strengthening it on cycle training and on ensuring people with impairments can benefit from local measures to promote walking and cycling.

The 10 detailed recommendations cover: local programmes; policy and planning; and schools, workplaces and the NHS. The measures proposed are highly cost-eff ective, representing excellent value for money. The guidance emphasises the need to address a range of issues, including “environmental, social, financial and personal factors” recognising that “other measures are needed to tackle the wider influences on walking or cycling. This includes measures to reduce road dangers and to reallocate roadspace to create a more supportive environment.” As well as guidance, gaps in evidence were identified and recommendations for future research given.

From a campaigner’s perspective, some parts of the guidance are especially useful. For instance, Section 4 (Implementation), gives suggestions for how the guidance can be used by local decision-makers. Key ‘targets’ for lobbying include the Director of Public Health, other relevant local authority directors, the Health and Wellbeing Board, Health Overview and Scrutiny Committee, Clinical Commissioning Group, Local HealthWatch, and other local community groups.

Within councils, local Health and Wellbeing Strategies are a major opportunity to ensure that cycling and walking become firmly embedded in local policy-making and planning. Tools to support the guidance’s implementation — a Costing Report & Template, and Baseline Assessment spreadsheet — are available, with a Local Government Public Health Briefing due shortly.

As a campaigner, I found my involvement with NICE refreshing because of the organisation’s openness and commitment to evidence based decision-making. I’d encourage all campaigners to make full use of the existing NICE guidance and to contribute to future guidance.


Document title: Walking and Cycling: Local measures to Promote Walking and Cycling as Forms of Travel or Recreation
Published: 28 November 2012
Find it at:

What’s the key message? Concerted action is needed to make walking and cycling become the norm for short journeys. Ten wide-reaching recommendations form the ‘core’ of the guidance and are based on the best available evidence of eff ectiveness and cost-eff ectiveness of local measures to promote walking and cycling.

Who’s it aimed at? Decision-makers at all levels within local authorities, the NHS and any other organisations in the public, private, voluntary and community sectors. In short, anyone involved in physical activity promotion, parks and leisure, and environment and transport planning.

More information: NICE guidance PH8 on physical activity and the environment, published in 2008. Implementation tools on NICE website; case studies of good practice are invited.

This article first appeared in the Feb-Mar 2013 issue of London Cyclist magazine, delivered free to LCC members every two months