Transport has an impact on health through transport-related accidents, active travel, public transport, air quality and access to a range of services. 

Transport can affect people by giving access to employment opportunities, education, leisure, healthcare and diverse food supplies. The development of an efficient transport network and vehicles has the potential to benefit health.

Increasing levels of motorised traffic have contributed to air pollution, noise, vibration, danger from vehicles and an increased fear of traffic. These issues particularly affect the most deprived and most vulnerable people in communities.

The rise in personal car use has meant liberation for people who are young and more affluent. More deprived, elderly and disabled people can become trapped in ‘residential islands’ surrounded by dense traffic, or without the means to access more distant facilities and services in out-of-town developments. This also applies to people in rural areas faced with dwindling local facilities and longer travel times.

Road traffic casualties are still one of the main public health challenges in the UK particularly for children and young adults.

The rise in personal car ownership levels has contributed to people being less active. This is a significant contributor to obesity, diabetes and cardiovascular disease.

This topic has links to the following JSNA topics:

Last updated: 2015-06-10 12:24:10
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1. What are the key issues?

Road Safety

In 2013, there were 266 collisions in Middlesbrough, resulting in 348 casualties. There were 5 fatalities, 35 serious casualties and 308 slight casualties.

Car occupants are the largest casualty group in Middlesbrough, contributing to 57% of all casualties (although approximately 96% of these car occupant casualties are slight injuries).

Approximately 41% of car occupants killed or seriously injured in Middlesbroughwere in the 17 to 34-year-olds age range.

In Middlesbrough, 19% of casualties were pedestrians. Pedestrians accounted for 53% of all people killed or seriously injured (KSI) due to their vulnerability. Children accounted for over one-third of pedestrian casualties and just under half of pedestrian KSIs.

In Middlesbrough, 14% of casualties were pedal cyclists (an increase of 14% from 2012).

In Middlesbrough, 4% of casualties were motorcyclists (a 56% decrease from 2012). Motorcyclists represent 13% of all people killed or seriously injured. Most of these collisions have tended to involve another vehicle.

The estimated cost of casualties in Middlesbrough in 2013 was £19.8 million.

Active Travel

From the Middlesbrough travel to work survey, conducted in 2012 it is apparent that only 10% of the working population travel actively.

In Middlesbrough (49.3%), significantly fewer people are active compared with England (56%). 

In Middlesbrough, an estimated 24% of adults are classed as obese.

In Middlesbrough, almost one in four children aged 11 years old are obese.

Last updated: 10/06/15

2. What commissioning priorities are recommended?


Realise funding opportunities to assist the implementation of capital infrastructure and revenue based schemes. This should be in line with the councils adopted walking and cycling 10-year infrastructure and strategy proposals. This will be measured via progress against the infrastructure implementation, and associated targets within these documents.


Work alongside Major Urban Regeneration to create a health and transportation impact assessment for any new development in Middlesbrough.


Establish greater joined up working practices across the Tees Valley between transport, leisure services and public health teams in order to minimise transport to heath, employment, education and leisure developments e.g. Middlesbrough Sports Village.  This will be measured through the physical activity partnership.


Establish promotional opportunities and raise the awareness of the impact of incorporating active travel (particularly students in years 6 and 11). This will be measured through the number of campaigns and initiatives rolled out.

Last updated: 12/06/15

3. Who is at risk and why?

Various factors influence the demand for transport as shown below.

Factors that affect transport demand (Litman, 2012):


Older (over 65-year-olds) and younger (18 to 20-year-olds) drivers are at particular risk of serious and fatal injuries on the roads.

Children are becoming less physically fit as they age. 


A higher percentage of boys than girls (aged 2-15 years) meet the Government’s recommendations for physical activity.

There is no current evidence suggesting gender plays a significant role in determining the prevalence of obesity in adults.  However, the NCMP shows that boys are significantly more likely to be obese than girls.

Socioeconomic status

Children in the 10% most deprived wards in England are more than three times as likely to be pedestrian casualties as those in the 10% most affluent wards.

Although the most deprived areas produce the lowest levels of pollution, they are actually exposed to the highest levels of air pollution.

More people are active in households with higher income. 

The distribution of overweight and obesity has a significant social gradient, with prevalence among people who are socially and economically deprived.


Disabled people are most likely to suffer an injury due to a trip or fall and therefore, will require longer periods of medical care than other groups. 

Children and young people with a disability take part in physical activity and sport less frequently and their experiences are less positive than their non-disabled peers (Sport Scotland, 2006).


Injury rates are higher in black children when compared to their white and Asian peers.

People from minority ethnic groups tend to be less active compared to their white peers (The Information Centre, 2006).


People living within close proximity of motorised traffic can be affected as traffic vibration and noise cause stress, while congestion, traffic speeds and inconsiderate driving are a source of annoyance and fear for many.

Nationally in 2011, the majority (61%) of road collision related fatalities occurred on rural roads (40% on rural A roads and 21% on other rural roads).

While the evidence is varied, studies tend to show that cyclists and pedestrians are exposed to lower fine particulate matter and carbon dioxide concentrations when compared to those inside vehicles. The proximity to the pollution source(s) has a significant impact on the level of exposure levels experienced.


Nationally, whilst deaths peaked during the evening rush hour (and potentially dark nights), with a peak of 173 between 18:00 and 19:00 there were fatalities throughout the whole day.

Friday, Saturday and Sunday accounts for 50% of all deaths. Saturday and Sunday show evening peaks related to the periods following likely pub drinking and parties. On Sunday there are peaks following likely lunchtime drinking.

Last updated: 10/06/15

4. What is the level of need in the population?

The Tees Valley Transport Monitoring Report provides a wealth of statistical data for all modes of transport and monitors trends and changes over recent years. Several examples of tables within this document are shown below:

Traffic-related casualties

Tees Valley casualties by severity

Tees Valley casualties by age

Tees Valley transport casualties by age

Average vehicle speed

Tees Valley bus patronage

Tees Valley bus patronage trend


Last updated: 10/06/15

5. What services are currently provided?

Service delivered

By whom

Future issues

Capital Infrastructure improvements – Road Safety and sustainable transport initiatives, including Traffic calming, Local safety schemes and speed reduction (20mph zone) schemes

Local Authority/LEP

Reduction in funding reduces the opportunity to address maintenance, and infrastructure improvements for the future

Pedestrian training to primary school children

Local Authority/3rd sector

External funding is not confirmed beyond 2016

Middlesbrough Cycle Centre and Bike Academy; Offering support to cyclists in the area

3rd Sector/Local Authority

Future funding sources remain un confirmed

Road Safety promotion  including;  School based young person education, Road awareness education and events, Car Seat advice (U 4’s), Speed awareness courses, Driver improvements, National Driver Offender Rehabilitation, Motorcyclist training, Cleveland Safety Camera Partnership

Local Authority, Cleveland Police, Cleveland Fire Brigade, 3rd Sector

Funding for resources is limited, and future of service is unknown. Competition from providers to gain classroom time/mixed messaging

School Crossing Patrol

Local Authority

Risk assessment reviews my suggest that the service is not required, following engineering works on site basis

Independent Travel Training, working with identified individuals with disabilities to use sustainable transport modes

Local Authority

Partial external funding is only confirmed until 2016.

Subsidised bus services

Local Authority

Potential budget reductions could result in cessation of services

Shop Mobility, including community access initiatives

3rd Sector/Local Authority

Majority of funding to continue the service currently ceases in March 2015, with applications for continued support awaiting outcome. Failure to attract funds will cease the service in September 2015.

Public health grants

The public health grants aim to encourage communities to improve their health and wellbeing and sustain positive health-related behavioural change. Communities are offered the opportunity to access grant funding to help develop new activities or expand existing ones that have a particular emphasis on healthy eating and physical activity (

The Local Transport Plan(LTP)

Middlesbrough’ Local Transport Plan provides allocation of capital infrastructure projects that will assist in improving transport opportunities and reduce accidents recorded on the local transport network.

Last updated: 12/06/15

6. What is the projected level of need?

Middlesbrough households with no car ownership are set to fall from 41% in 2001 to 21% by 2021. This will increase the dependence and use of cars to travel to work further. With more vehicles being depended upon, there will be fewer active travel journeys, and an increased risk of accidents due to increased numbers of vehicles.

Last updated: 10/06/15

7. What needs might be unmet?

Although the current service needs are met, there is little room for error or extension of deliverability due to reduced resources. A small reduction in funding or resource would likely have a large impact upon deliverability, and meeting the existing service requirements due to this fine balance.

The existing Middlesbrough Council Local Sustainable Transport Fund ceases in April 2015. However, the Tees Valley Local Sustainable Transport Fund bid commences as of April 2015 for 1 year. There are provisions within this funding bid to directly fund certain elements of the transportation needs of the town with this funding.

If the funding of projects is not continued, gaps in transportation provision are likely to reduce or abolish the following:

  • Child pedestrian and cycle training, this will result in a lack of safety training, which could increase the number of accidents;
  • The support given to Middlesbrough Cycle Centre and Bike Academy. This may reduce facilities supporting cycle journeys that currently upskill vulnerable residents;
  • The walking and cycling infrastructure. This may remove physical measures to improve the network that encourages more active travel journeys;
  • The education and promotion service by the safe and active travel team;
  • Community access audit reduction, which currently reduces the impact of the physical environment;
  • Subsidised bus service provision, where commercial cases cannot be made to continue service;
  • Support toward Shop Mobility, who reducing the support toward people with mobility issues; and
  • The Independent Travel Training service, removing the opportunity for people with special educational needs to travel independently.

Casualty reduction

The current economic climate has placed severe pressures upon levels of investment in transport infrastructure. Traditional traffic engineering interventions on the road network are capital intensive and becoming increasingly difficult to fund.

Major reductions in the capital budget mean that fewer schemes can be delivered.

Most accidents recorded in Middlesbrough are as a result of human error, so investing within a programme aimed at addressing this is critical.

Active travel/casualty reduction

There are missing links in the Middlesbrough cycle route infrastructure. There also remain some significant barriers which separate communities and restrict active travel.

The policy is for all year 3 and year 4 pupils to have access to pedestrian training. This is currently funded, however due to budget restrictions; the longevity of this provision is questionable.

Cyclist training for year 5 and year 6 children is well covered and taken up by the Council’s training provision, and funded from the Department for Transport’s allocation for Bikeability (cycle proficiency for the 21st Century, using live carriageways and real life situations) levels 1 and 2. Level 3 training is offered to secondary school children, however attracting participants can prove difficult as schools will not allow participation during school hours. Incentives have worked well in order to attract participants, however this proves costly, with funding available offering a ‘one off’ injection. This is likely to cease, and with it, the opportunity to engage pupils of this age.

The Pool Bike scheme and Middlesbrough Bike Academy project has shown that there is demand for adult cycle training (both road safety and maintenance based). Funding reduction will see the end of pool bike scheme, and subsequent adult road safety training.

The Government’s local transport white Paper, Cutting Carbon, Creating Growth: Making Sustainable Local Transport Happen DfT 2011 sets out the Government’s vision for a sustainable local transport system that supports the economy and reduces carbon emissions. The principal focus for action will be at local level. The key points in the paper are reducing the number of grant-making schemes and decentralising decision-making powers to local authorities, local economic partnerships (LEPs) and voluntary community and social enterprises (VCSEs). The main concern is that the Local Sustainable Transport Fund is unlikely to meet the reductions in local authority budgets.

Last updated: 12/06/15

8. What evidence is there for effective intervention?

A wide range of evidence on the scale of impact on health in Middlesbrough and the effectiveness of interventions are available:

Benefits of Investing in Cycling – British Cycling (2014)

Statement of Transport Ambition – Tees Valley Unlimited (2011)

Tees Valley Monitoring Report – Tees Valley Unlimited (2013)

NICE - Walking and cycling: local measures to promote walking and cycling as forms of travel or recreation

NICE – Promoting Physical Activity for Children and Young People

Last updated: 10/06/15

9. What do people say?

The main findings from surveys and consultation exercises have been largely positive.  Participants and stakeholders acknowledge that a lot of consultation had taken place to further improve services.  A recent survey/audit of the road safety service was undertaken to ascertain gaps in service provision.  Pedestrian and cycle training were specifically mentioned.

Road safety satisfaction survey

From road safety satisfaction surveys conducted in 2012:

  • 100% of respondents suggested that pedestrian and cycle training were valued;
  • 100% of responding primary schools answered a pedestrian steps and skills survey with either ‘Good’, or ‘Excellent’ for all questions relating to the services received; and
  • 100% customer satisfaction for road safety services delivered to schools.

Walk Middlesbrough

For the Walk Middlesbrough initiative, feedback stated that 90% of respondents thought the initiative was positive and stated that they would like to see additional healthy walks created (with varying levels of difficulty identified for different service users).  Common themes that have emerged throughout feedback, is that the lack of connectivity is the main barrier to engaging in sustainable/active travel.


The Shopmobility service is highly rated by the customers who use the service and their network.  Customer satisfaction surveys have the service at:

  • 99.7% positive for the customer service;
  • 98.9% positive for assistance; and
  • 97.5% positive for advice. 

20mph zones

A public consultation was carried out in 2011 involving the 11 Councils covering the ‘high priority’ areas identified within the council’s area-wide 20 mph speed limit programme.  This exercise revealed a high level of support for the programme, with all 11 Councils voting in favour of the proposed scheme.

Active People Survey

The Active People Survey (2014) suggests that 33.5% of Middlesbrough population participates in sport at least once per week. Of this, cycling is identified as the 3rd most popular sport participated in.


The DfT commissioned a research study which has evaluated the impact and perceptions of cycle training, with a specific focus on Bikeability, and found positive results.  The research, undertaken by Ipsos MORI, has now been made public. It shows that Bikeability schemes enjoy a very high degree of customer satisfaction.

  • 98% of parents surveyed said they were satisfied with the Bikeability scheme;
  • 76% of these were very satisfied;
  • 93% of parents feel that it has had a positive impact on their child’s safety when cycling on the road;
  • 93% of children feel more confident about riding their bike generally; and
  • 86% of children feel more confident about riding their bike on the road.

When the children were asked what the main thing that they learnt from taking part in Bikeability:

  • 68% said ‘to ride my bike more safely’;
  • 53% said ‘to ride my bike safely on the road’; and
  • 36% said ‘to ride my bike with confidence’.
Last updated: 10/06/15

10. What additional needs assessment is required?

With reducing budgets and higher demand, it is necessary for all partners to explore and invest in preventative measures and early intervention programmes, ensuring that the return on the capital employed is greater than the initial investment.

Community engagement and participation is critical for any project, and the profile needs of the community are required to set priorities.  An effective engagement network with robust guidance will be required.

Partners/stakeholders need to have greater involvement in budget setting, and also community consultation regarding what funding is available to address needs.

A better understanding is needed of the links (and barriers) between leisure and commuter cycling.

Last updated: 10/06/15

Key contact: Chris Orr

Job title: Cycling Officer

Phone: 01642 728196




Internal Council documents/information

Middlesbrough Travel to work survey, 2012

Road Safety satisfaction surveys, 2012 (and on-going)

Steps and Skills Survey (on-going)

Shop Mobility  customer satisfaction survey

Cycle count data

Casualty data