The news this week that “social prescribing” will be enhanced by the introduction of 11 pilot schemes for GPs to prescribe walking or cycling is, pardon the pun, a step in the right direction for public health.
Physical activity is key to good physical and mental health and brings huge benefits to society and the environment. The World Health Organisation (WHO) now recommends 2.5 to five hours of exercise a week to stay in good health. The UK’s chief medical officers say that the minimum level of physical activity can be made “achievable within daily living; for example, walking, wheeling or cycling for daily travel is often the easiest way to get physically active”.
The evidence for the benefits of physical activity is overwhelming: keeping active can help to prevent or manage over 20 chronic conditions and diseases, reducing the risk of some cancers and dementia by almost a third, and heart disease, stroke, and type 2 diabetes by even more. It helps to prevent hip fractures and improves mental health problems, including depression and anxiety. Getting more people out of cars and cycling, walking and using public transport instead also brings the added benefits of less noise pollution, less injury and death on the roads, and cleaner air, reducing the number of severe asthma attacks.
The pandemic has adversely impacted mental health, obesity rates and health inequalities, strengthening the case for investing in active travel, alongside other policies to address the underlying causes of ill health. The British Medical Association (BMA) has long recognised the importance of active travel. In 2019, we called for the government budget for active travel to be increased from £6 to £20 per head, considerably more than proposed for these new pilot schemes.
Active travel policies need to be part of a comprehensive public health approach, with a reversal of the cuts to local authority public health and overall budgets over the past decade. The BMA has been vocal in calling for the public health grant in England to increase by £1.4bn (2020/21 prices) per year by 2024/25. These active travel pilots, which will provide funding for schemes such as adult cycle training, free bike loans and walking groups, alongside social prescribing, have the potential to build on and complement existing programmes, such as Local Cycling and Walking Infrastructure Plans.
But their impact will be minimal without a clear commitment to long-term funding and consideration of the wider context, such as protection for physical activity in the school curriculum, investment in nationwide active travel infrastructure, and ensuring access to open spaces and recreation facilities.
Without properly addressing resources and the capacity of GPs, this approach risks frustrating doctors as well as the public. These pilots are a good start. The initiative needs public health and primary care to have joined up policymaking and adequate funding, however, if prevention is to stay the course and deliver long-term health benefits, especially for the poorest.