��Ī - London School of Hygiene and Tropical Medicine (LSHTM)

A habitable planet for healthy humans

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��Ī Zero symposium gathers researchers to examine the connections between planetary and public health.

Carbon-omics and global health

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��Ī Zero to host two research symposia to discuss critical climate change challenges

UK modelling study finds case isolation and contact tracing vital to COVID-19 epidemic control

sc604 — Tue, 16 Jun 2020 22:30:00 +0000

Using social-contact data on more than 40,000 individuals from the BBC Pandemic database to simulate SARS-CoV-2 transmission in different settings and under different combinations of control measures, the researchers estimate that a high incidence of COVID-19 would require a considerable number of individuals to be quarantined to control infection. For example, a scenario in which 5,000 new symptomatic cases were diagnosed each day would likely require 150,000–200,000 contacts to be quarantined every day if no physical distancing was in place.

The study is the first time researchers have used social contact data to quantify the potential impact of control measures on reducing individual-level transmission of SARS-CoV-2 in specific settings. They aimed to identify not only what would theoretically control transmission, but what the practical implications of these measures would be in terms of numbers quarantined.

However, the authors note that the model is based on a series of assumptions about the effectiveness of testing, tracing, isolation, and quarantine—for example about the amount of time it takes to isolate cases with symptoms (average 2.6 days) and the likelihood that their contacts adhere to quarantine (90%)—which, although plausible, are optimistic.

“Our findings reinforce the growing body of evidence which suggests that we can’t rely on one single public health measure to achieve epidemic control,” said Dr Adam Kucharski from the London School of Hygiene & Tropical Medicine. “Successful strategies will likely include intensive testing and contact tracing supplemented with moderate forms of physical distancing, such as limiting the size of social gatherings and remote working, which can both reduce transmission and the number of contacts that need to be traced.”

He adds: “The huge scale of testing and contact tracing that is needed to reduce COVID-19 from spreading is resource intensive, and new app-based tracing, if adopted widely alongside traditional contact tracing, could enhance the effectiveness of identifying contacts, particularly those that would otherwise be missed.”

In the study, researchers analysed data on how 40,162 people moved about the UK and interacted with others prior to COVID-19 to simulate how combinations of different testing, isolation, tracing, and physical distancing scenarios—such as app-based tracing, remote working, limits on different sized gatherings, and mass population-based testing—might contribute to reducing secondary cases [3]. They also modelled the rate at which the virus is transmitted—known as the reproductive number (R), or the average number of people each individual with the virus is likely to infect at a given moment—under different strategies. To keep the COVID-19 epidemic declining, R needs to be less than 1.

In the model, the secondary attack rate (the probability that a close contact of a confirmed case will be infected) was assumed to be 20% among household contacts and 6% among other contacts. The researchers calculated that, had no control measures been implemented, R would be 2.6—meaning that one infected person would infect, on average, 2–3 more people.

The model suggested that mass testing alone, with 5% of the population undergoing random testing each week (i.e. 460,000 tests per day in UK), would lower R to just 2.5, because so many infections would either be missed or detected too late (table 3 and infographic).

Compared with no control measures, self-isolation of symptomatic cases (at home) alone reduced transmission by an estimated 29% (lowering R to 1.8); whilst combining self-isolation, household quarantine, and tracing strategies could potentially lower transmission by as much as 47% (R 1.4) when using app-based contact tracing (assuming the app is adopted by 53% of the population), and by 64% with manual tracing of all contacts (R 0.94).

Achieving such a thorough level of contact tracing may be impractical, but the new study suggests that a large reduction in transmission could also be achieved by supplementing with moderate physical distancing measures. For example, they estimate that, limiting daily contacts outside home, school, and work to four people (e.g. by restricting mass gatherings) along with manual tracing of acquaintances only (i.e. people they have met before) and app-based tracing, would have the greatest impact, reducing disease spread by 66%, and lowering R to 0.87. However, they note that the effectiveness of manual contact tracing strategies is highly dependent on how many contacts are successfully traced, with a high level of tracing required to ensure R is lower than 1, especially if it takes time to isolate symptomatic cases.

The researchers also modelled the number of contacts that might need to be quarantined under different contact tracing strategies. They estimate that a scenario in which 1,000 new symptomatic cases were reported daily would likely require a minimum of 15,000 contacts quarantined every day (isolation plus app-based testing) and a maximum of 41,000 (isolation plus manual tracing all contacts). This could increase to an average of 150,000–200,000 contacts quarantined daily in a scenario where 5,000 new symptomatic cases were diagnosed each day (table 4).

“Our results highlight several characteristics of SARS-CoV-2 which make effective isolation and contact tracing challenging. The high rate of transmission, the short time between one person becoming infected and infecting another, and transmission that occurs without symptoms all make things difficult,” said co-author Dr Hannah Fry from University College London. “If there are a lot of symptomatic COVID-19 cases, then tracing, testing, and trying to quarantine a huge number of contacts will be a big challenge. How well we manage it will affect how and when it is possible to reduce transmission predominantly through targeted isolation and tracing measures or whether ongoing physical distancing measures will be required to control the epidemic.”

According to co-author Professor Julia Gog from ��Ī’s Department of Applied Mathematics and Theoretical Physics, “Planning for control based on isolation and contact tracing should consider the likely need for large numbers of cases to be tested and also a large number of contacts rapidly quarantined. Crucially, this work is able to quantify the scales of what is needed for a successful control strategy involving tracing and isolation by making use of the dataset from the BBC pandemic project. The BBC data gives a uniquely detailed picture of how people in the UK mix and the extent of contact tracing that will be necessary if we return to social mixing patterns as they were before the pandemic.”

The authors highlight several limitations to their study, including that it did not consider more detailed settings beyond home, school, work, or ‘other’ categories, or explicitly include imported infections, which may be detected at a different rate to local infections.

Writing in a linked Comment, Professor Raina MacIntyre (who was not involved in the study) from The University of New South Wales, Australia, says, “Whilst the study is specific to the UK, the findings are relevant to all countries. For countries which are opening up for business and resuming social activities, as social contacts increase, non-pharmaceutical interventions become even more critical. It may even be worthwhile for countries to invest in strategies to vastly improve the uptake of contact tracing apps to enable rapid response to resurgence of COVID-19. If you don’t trace, you leave a chain of transmission free to grow undetected and exponentially. With 80% of cases being mild, it may take several generations of silent epidemic growth before it is even recognised.”

Reference:
Adam J Kucharski et al. 'Effectiveness of isolation, testing, contact tracing, and physical distancing on reducing transmission of SARS-CoV-2 in different settings: a mathematical modelling study.' The Lancet Infectious Diseases (2020). DOI: 10.1016/ S1473-3099(20)30457-6

Adapted from a press release by The Lancet.

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In the absence of a vaccine or highly effective treatments for COVID-19, combining isolation and intensive contact tracing with physical distancing measures—such as limits on daily social or workplace contacts—might be the most effective and efficient way to achieve and maintain epidemic control, according to new modelling research published in The Lancet Infectious Diseases journal.

The BBC data gives a uniquely detailed picture of how people in the UK mix and the extent of contact tracing that will be necessary if we return to social mixing patterns as they were before the pandemic

Julia Gog

Tim Dennell

Coronavirus (COVID-19) Sheffield, UK

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Food and drinks industry uses non-profit organisation to campaign against public health policies, study finds

fpjl2 — Mon, 03 Jun 2019 08:07:13 +0000

The study, published today in the journal Globalization and Health, analysed over 17,000 pages of emails obtained through Freedom of Information requests made between 2015 and 2018. The documents captured exchanges between academics at US universities and senior figures at a non-profit organisation called the International Life Science Institute, or ILSI.

Comprising of 18 bodies, each of which covers a specific topic or part of the globe, ILSI has always maintained its independence and scientific rigour, despite being funded by multinational corporations such as Nestle, General Mills, Mars Inc, Monsanto, and Coca-Cola.

Founded by former Coca-Cola senior vice president Alex Malaspina in 1978, ILSI states on its website that none of its bodies “conduct lobbying activities or make policy recommendations”. As a non-profit organisation, ILSI is currently exempt from taxation under US Internal Revenue codes.

However, researchers from the ��Ī, London School of Hygiene and Tropical Medicine, University of Bocconi, and US Right to Know, found emails explicitly discussing tactics for countering public health policies around sugar reduction, as “[T]his threat to our business is serious”.

These include exchanges with an epidemiology professor at the University of Washington, as well as the US Centre for Disease Control’s then director of heart disease and stroke prevention, all strategising how best to approach the World Health Organisation’s then Director-General Dr Margaret Chan, to shift her position on sugar-sweetened products.

“It has been previously suggested that the International Life Sciences Institute is little more than a pseudo-scientific front group for some of the biggest multinational food and drink corporations globally,” said the study lead author Dr Sarah Steele, a researcher at ��Ī’s Department of Politics and International Studies.

“Our findings add to the evidence that this non-profit organisation has been used by its corporate backers for years to counter public health policies. We contend that the International Life Sciences Institute should be regarded as an industry group – a private body – and regulated as such, not as a body acting for the greater good.”

In one email, Malaspina, who also served as long-time president at ILSI, described new US guidelines bolstering child and adult education on limiting sugar intake as a “real disaster!”. He writes: “We have to consider how to become ready to mount a strong defence”. Suzanne Harris, then executive director of ILSI, was among the email’s recipients.

James Hill, then director of the Center for Human Nutrition at the University of Colorado, was involved in a separate exchange on the issue of defending industry from the health consequences of its products. Hill argues for greater funding for ILSI from industry as part of “dealing aggressively with this issue”. He writes that, if companies keep their heads down, “our opponents will win and we will all lose”.

The FOI emails also suggest ILSI constructs campaigns favourable to artificial sweeteners. Emails reveal Malaspina passing on praise from another former ILSI President to a former Coca-Cola employee and the Professor, describing both as “the architects to plan and execute the studies showing saccharine is not a carcinogen”, resulting in the reversal of many government bans.

The FOI responses suggest that ILSI operates strategically with other industry-funded entities, including IFIC, a science communication non-profit organisation. “IFIC is a kind of sister entity to ILSI,” writes Malaspina. “ILSI generates the scientific facts and IFIC communicates them to the media and public.”

“The emails suggest that both ILSI and IFIC act to counter unfavourable policies and positions, while promoting industry-favourable science under a disguised front, including to the media,” said Steele.

In fact, the emails suggest ILSI considers sanctioning its own regional subsidiaries when they fail to promote the agreed industry-favourable messaging. Correspondence reveals discussion of suspending ILSI’s Mexico branch from the parent organisation after soft drink taxation was debated at a conference it sponsored. Mexico has one of the highest adult obesity rates in the world.

Email conversations between Malaspina and the CDC’s Barbara Bowman are open about the need to get the WHO to “start working with ILSI again” and to take into account “lifestyle changes” as well as sugary foods when combatting obesity.

Further exchanges between Malaspina and Washington Professor Adam Drewnowski support ILSI’s role in this. Drewnowski writes of Dr Chan that “we ought to start with some issue where ILSI and WHO are in agreement” to help “get her to the table”.

In a further email, Malaspina points out that he had meetings with the two previous heads of the WHO, going back to the mid-90s, and that if they do not start a dialogue with Dr Chan “she will continue to blast us with significant negative consequences on a global basis”.

The tide has begun to turn against ILSI in recent years. The WHO quietly ended their “special relations” with ILSI in 2017, and ILSI’s links to the European Food Safety Authority were the subject of enquiry at the European Parliament. The CDC’s Bowman retired in 2016, in the wake of revelations about her close ties with ILSI. Last year, long-time ILSI funder Mars Inc. stopped supporting the organisation. Much of the study’s correspondence precedes these events.

“It becomes clear from the emails and forwards that ILSI is seen as central to pushing pro-industry content to international organisations to support approaches that uncouple sugary foods and obesity,” added Steele.

“Our analysis of ILSI serves as a caution to those involved in global health governance to be wary of putatively independent research groups, and to practice due diligence before relying upon their funded studies.”

Reference
Are industry-funded charities promoting “advocacy-led studies” or “evidence-based science”?: a case study of the International Life Sciences Institute. Globalization and Health; 3 June 2019; DOI: 10.1186/s12992-019-0478-6

A new study shows how a non-profit research organisation has been deployed by its backers from major food and beverage corporations to push industry-favourable positions to policymakers and international bodies under the guise of neutral scientific endeavour.

We contend that the International Life Sciences Institute should be regarded as an industry group – a private body – and regulated as such, not as a body acting for the greater good

Sarah Steele

Photo by Peter Bond on Unsplash

High-angle photography of grocery display

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Citizen science experiment predicts massive toll of flu pandemic on the UK

sc604 — Thu, 22 Mar 2018 16:03:31 +0000

The numbers are frightening, but even more daunting is the very real danger of a major flu pandemic emerging at any moment. Experts around the world agree that it’s a question of when not if the next deadly pandemic will strike, making it number one on the government civilian risk register in the UK.

When it happens the pandemic will almost certainly reach the UK and the government will be faced with a series of life-saving decisions. Should we close schools or public transport? Who should be given priority when the first doses of vaccine become available? How will we cope if there is a high mortality rate? Having the right answers to these and many other crucial pandemic response questions depends on mathematical models.

The model behind the results, designed by researchers at the ��Ī and the London School of Hygiene and Tropical Medicine, is based on data from nearly 30,000 volunteers and represents the largest and most comprehensive dataset of its kind. The results will be broadcast on Contagion! The BBC Four Pandemic, tonight (22 March) at 9pm on BBC Four, presented by Dr Hannah Fry and Dr Javid Abdelmoneim. The results are also published in the journal Epidemics.

“The value of predictions hinges completely on the quality of the model,” said Professor Julia Gog from ��Ī’s Department of Applied Mathematics and Theoretical Physics, who heads the disease dynamics group. “Up to now, the picture of how the population in the UK move around has been surprisingly limited, and existing studies use relatively small samples of the population. Getting a handle on how people move and interact day to day is vital to understanding how a virus will actually spread from person to person and place to place. The BBC Pandemic project has aimed to address this gap, with volunteers using an app to track movements and record who they encounter day to day, creating the biggest dataset for UK pandemic research ever collected.”

“BBC Pandemic experiment has been hugely successful in recruiting study participants,” said Dr Petra Klepac, the lead author of the paper. “The resulting dataset is incredibly rich and will become a new gold standard in modelling contact and movement patterns that shape the spread of infectious diseases. For the programme, we were able to create a detailed UK model based on data from almost 30,000 users.”

The BBC Four programme will show how a pandemic might spread in the UK, starting from Haslemere in Surrey, where the team modelled in detail an introduction starting from a hypothetical patient zero.

“We don’t know of any studies that join up the movement and survey data so comprehensively,” said Gog. “And this experiment is just huge already, an order of magnitude bigger than anything even similar. The BBC Pandemic experiment sets a new benchmark for other future studies around the world.”

The study remains open during all of 2018, and anyone in the UK can volunteer by using the app (available via App Store or Google Play). Once the project is complete, the anonymised dataset will be made available to all researchers, enabling more accurate prediction in future. “Our focus so far has been on a prospective influenza pandemic, but this dataset will be valuable in our efforts to understand and control a variety of infectious diseases, both in the UK and in extrapolating to other countries,” said Gog.

“While these preliminary results are eye-opening there’s a lot more this data can be used for,” said programme host Dr Hannah Fry. “Scientists around the country will be using it for years to come.”

The BBC Pandemic app was launched in September 2017. Once downloaded, app users enter some basic anonymous demographic information about themselves such as age and gender, and then are asked to be tracked via the GPS on their phone once an hour for 24 hours. The app also records the people they come into close contact with. This is the first time tracking, demographic and contact data have been combined, making it an unrivalled tool for pandemic research.

The headline results of the simulation shown in the programme are based on a moderately transmissible influenza pandemic virus with a high fatality rate, in accordance with a ‘reasonable worst case’. The details of assumptions and limitations are discussed in detail in the paper.

Reference
Petra Klepac, Stephen Kissler and Julia Gog. ‘Contagion! The BBC Four Pandemic – the model behind the documentary.’ Epidemics (2018). DOI: 10.1016/j.epidem.2018.03.003

How fast could a new flu epidemic spread? The results of the UK’s largest citizen science project of its kind ever attempted, carried out by thousands of volunteers, predict that 43 million people in the UK could be infected in an influenza pandemic, and with up to 886,000 of those infected expected to be fatalities.

We don’t know of any studies that join up the movement and survey data so comprehensively.

Julia Gog

Geographic patterns of spread of influenza pandemic

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App-based citizen science experiment could help researchers predict future pandemics

sc604 — Wed, 27 Sep 2017 14:17:21 +0000

The most likely and immediate threat to our species is a global pandemic of highly infectious flu. Such a pandemic could be so serious that it currently tops the UK Government’s Risk Register.

Scientists from the ��Ī and London School of Hygiene and Tropical Medicine are attempting to collect a gold standard data set that can be used to predict how the next pandemic flu would spread through this country - and what can be done to stop it. They need your help.

UK residents can take part in the BBC Pandemic experiment simply by downloading the Pandemic app onto your smartphone via App Store or Google Play from today.

The app and results will be featured in a documentary on BBC Four in 2018, to be presented by Dr Hannah Fry and Dr Javid Abdelmoneim.

Data gathered via the app could be key in preparing for the next pandemic outbreak. In order to better understand how an infectious disease like flu can spread, researchers need data about how we travel and interact.

Two experiments will be conducted through the app: the National Outbreak, which is open to anyone in the UK from 27th September 2017; and the Haslemere Outbreak, a closed local study that is only open to people in the town of Haslemere, Surrey, and runs for 72 hours starting on Thursday 19th October 2017.

In the National Outbreak, the app will track your approximate movement at regular intervals over a 24 hour period – all data will be anonymised, so the app will not know exactly where or who you are. The app will also ask some questions about your journeys and the people you spent time with during those 24 hours.

All data collected will be grouped to ensure anonymity, and a research team from the ��Ī and the London School of Hygiene and Tropical Medicine will use it to predict how a flu pandemic might spread across the country – and determine what can be done to stop it.

Professor Julia Gog, who specialises in the mathematics of infectious diseases, and her colleagues from ��Ī’s Department of Applied Mathematics and Theoretical Physics have helped design the experiment and will be processing the data, running statistical analyses, and building and running the pandemic models.

“This will give us a chance to explore a range of different scenarios,” said Professor Gog. “This could the best data set we’ve ever had on the movement of people in the UK, and could help support future research projects to control infectious diseases – for a researchers like us, this is incredibly exciting.”

There are flu outbreaks every year but in the last 100 years, there have been four pandemics of a particularly deadly flu, including the Spanish Influenza outbreak which hit in 1918, killing up to 100 million people worldwide. Nearly a century later, a catastrophic flu pandemic still tops the UK Government’s Risk Register of threats to this country. Key to the Government’s response plan are mathematical models which simulate how a highly contagious disease may spread. These models help to decide how best to direct NHS resources, like vaccines and protective clothing. But the models are only as good as the data that goes into them.

The more people of all ages that take part in BBC Pandemic, the better that data will be.

By identifying the human networks and behaviours that spread a deadly flu, the app will help to make these models more accurate and, in turn, help to stem the next pandemic.

This project has been commissioned by the BBC, and is being undertaken in collaboration with researchers at the ��Ī and the London School of Hygiene and Tropical Medicine.

More information is available at the BBC website.

A new app gives UK residents the chance to get involved in an ambitious, ground-breaking science experiment that could save lives.

This could the best data set we’ve ever had on the movement of people in the UK – for a researchers like us, this is incredibly exciting.

Julia Gog

BBC Pandemic

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IMF lending conditions curb healthcare investment in West Africa, study finds

fpjl2 — Wed, 11 Jan 2017 09:47:23 +0000

A new study suggests that lending conditions imposed by the International Monetary Fund in West Africa squeeze “fiscal space” in nations such as Sierra Leone – preventing government investment in health systems and, in some cases, contributing to an exodus of medical talent from countries that need it most.

Researchers from the Universities of ��Ī, Oxford and the London School of Hygiene & Tropical Medicine analysed the IMF’s own primary documents to evaluate the relationship between IMF-mandated policy reforms – the conditions of loans – and government health spending in West African countries.

The team collected archival material, including IMF staff reports and government policy memoranda, to identify policy reforms in loan agreements between 1995 and 2014, extracting 8,344 reforms across 16 countries.

They found that for every additional IMF condition that is ‘binding’ – i.e. failure to implement means automatic loan suspension – government health expenditure per capita in the region is reduced by around 0.25%.

A typical IMF programme contains 25 such reforms per year, amounting to a 6.2% reduction in health spending for the average West African country annually.

The researchers say that this is often the result of a policy focus on budget deficit reduction over healthcare, or the funnelling of finance back into international reserves – all macroeconomic targets set by IMF conditions.

The authors of the new study, published in the journal Social Science and Medicine, say their findings show that the IMF “impedes progress toward the attainment of universal health coverage”, and that – under direct IMF tutelage – West African countries underfunded their health systems.

“The IMF proclaims it strengthens health systems as part of its lending programs,” said lead author Thomas Stubbs, from ��Ī’s Department of Sociology, who conducted the study with Prof Lawrence King. “Yet, inappropriate policy design in IMF programmes has impeded the development of public health systems in the region over the past two decades.”

A growing number of IMF loans to West Africa now include social spending targets to ensure that spending on health, education and other priorities are protected. These are not binding, however, and the study found that fewer than half are actually met.

“Stringent IMF-mandated austerity measures explain part of this trend,” said Stubbs. “As countries engage in fiscal belt-tightening to meet the IMF’s macroeconomic targets, few funds are left for maintaining health spending at adequate levels.”

The study also shows that the 16 West African countries experienced a combined total of 211 years with IMF conditions between 1995 and 2014. Some 45% of these included conditions stipulating layoffs or caps on public-sector recruitment and limits to the wage bill.

The researchers uncovered correspondence from national governments to the IMF arguing that imposed conditions are hindering recruitment of healthcare staff, something they found was often borne out by World Health Organisation (WHO) data. For example:

In 2004, Cabo Verde told the IMF that meeting their fiscal targets would interrupt recruitment of new doctors. The country later reported to the WHO a 48% reduction in physician numbers between 2004 and 2006.
In 2005, a series of IMF conditions aimed to reduce Ghana’s public sector wage bill. The Ghanaian Minister of Finance wrote to the IMF that “at the current level of remuneration, the civil service is losing highly productive employees, particularly in the health sector”. Wage ceilings remained until late-2006, and the number of physicians in Ghana halved.

“IMF-supported reforms have stopped many African countries hiring, retaining or paying healthcare staff properly,” said co-author Alexander Kentikelenis, based at the University of Oxford.

“Macroeconomic targets set by the IMF – for example, on budget deficit reduction – crowd out health concerns, so governments do not adequately invest in health.”

The IMF’s extended presence in West Africa – on average 13 out of 20 years per country – has caused considerable controversy among public health practitioners, say the researchers.

“While critics stress inappropriate or dogmatic policy design that undermines health system development, the IMF has argued its reforms bolster health policy,” said Stubbs.

“We show that the IMF has undermined health systems – a legacy of neglect that affects West Africa’s progress towards achieving universal health coverage, a key objective of the United Nation’s Sustainable Development Goals.”

Research shows budget reduction targets and public sector caps, insisted on by the IMF as loan conditions, result in reduced health spending and medical ‘brain drain’ in developing West African nations.

We show that the IMF has undermined health systems – a legacy of neglect that affects West Africa’s progress towards achieving universal health coverage

Thomas Stubbs

DFID

Sierra Leonean Junior Doctor, Marina Kamara, follows up on a suspected kidney infection.

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High-quality traffic-free routes encourage more walking and cycling

jfp40 — Thu, 17 Jul 2014 20:03:01 +0000

The provision of new, high-quality, traffic-free cycling and walking routes in local communities has encouraged more people to get about by foot and by bike, according to a new study published today in the American Journal of Public Health.

Two years after new routes were developed by charity Sustrans with local authority partners, people living nearby increased their total levels of physical activity, compared to those living further away.

People living 1km (0.6 miles) from the new routes had increased their time spent walking and cycling by an average of 45 minutes per week more than those living 4km (2.5 miles) away.

This could make a substantial contribution to helping people achieve the two and a half hours of physical activity per week recommended by health experts.

Independent research led by the MRC Epidemiology Unit at the ��Ī, on behalf of the iConnect consortium, surveyed adults living in three communities before and after they benefited from a national initiative led by the sustainable transport charity Sustrans, and funded by the Big Lottery Fund, to build or improve walking and cycling routes at 84 towns, cities and villages around the UK.

Crucially, there was no evidence that the gains in walking and cycling were offset by reductions in other forms of physical activity. This suggests that the new routes have encouraged local people to become more active overall. The benefits were equally spread between men and women and between adults of different ages and social groups. However, people without access to a car were more likely to increase their activity levels than those who had a car.

Dr Anna Goodman, lecturer at the London School of Hygiene and Tropical Medicine and lead author of the paper, said: “These findings support the case for changing the environment to promote physical activity by making walking and cycling safer, more convenient and more attractive. The fact that we showed an increase in overall levels of physical activity is very important, and shows that interventions of this sort can play a part in wider public health efforts to prevent diabetes, heart disease and other chronic conditions.”

Dr David Ogilvie of the MRC Epidemiology Unit at the ��Ī, who led the study, added: “Although it may seem intuitive that improving facilities for walking and cycling will help make the population more active, this has rarely been tested in practice, and most of the existing studies have been done in other parts of the world. This is one of the first studies to show that changing the environment to support walking and cycling in the UK can have measurable benefits for public health. It is also notable that we did not see a significant effect on activity until two-year follow-up. It can take time for the benefits of this sort of investment to be fully realised.”

Malcolm Shepherd, Chief Executive of charity Sustrans who implemented the three projects with support from the Big Lottery Fund, said: “It’s clear that when good quality infrastructure exists people use it. Our experience from co-ordinating the National Cycle Network, which saw an amazing three quarters of a billion (748 million) journeys in 2013, 7% more than the year before, has shown us this over and over again.

“With a physical inactivity crisis and traffic jams clogging our towns and cities the case has never been stronger for governments to guarantee dedicated funding for quality walking and cycling routes for everyone.”

Peter Ainsworth, Chair of the Big Lottery Fund added: “In 2007, Sustrans’ Connect2 project won the public TV vote to bring £50 million from the Big Lottery Fund to communities across the UK to create networks for everyday journeys for people travelling by foot or bike. The study released today showcases brilliantly the long lasting benefits that this transformational funding is achieving in creating greener, healthier, fitter and safer communities.”

The three communities studied were in Cardiff, where the centrepiece of the project was a new traffic-free bridge across Cardiff Bay; Kenilworth in Warwickshire, where a new traffic-free bridge was built across a busy trunk road to link the town to a rural greenway; and Southampton, where a new boardwalk was built along the shore of the tidal River Itchen. All of these new crossings then linked into extensive networks of routes.

New study finds overall physical activity is increased by proximity to routes.

This is one of the first studies to show that changing the environment to support walking and cycling in the UK can have measurable benefits for public health

David Ogilvie

Eifion

Cycle path, Colwyn Bay, Wales

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�������������Ī - London School of Hygiene and Tropical Medicine (LSHTM)

A habitable planet for healthy humans

Carbon-omics and global health

UK modelling study finds case isolation and contact tracing vital to COVID-19 epidemic control

How you can support �������������Ī's COVID-19 research effort

Food and drinks industry uses non-profit organisation to campaign against public health policies, study finds

Citizen science experiment predicts massive toll of flu pandemic on the UK

App-based citizen science experiment could help researchers predict future pandemics

IMF lending conditions curb healthcare investment in West Africa, study finds

High-quality traffic-free routes encourage more walking and cycling

��Ī - London School of Hygiene and Tropical Medicine (LSHTM)

How you can support ��Ī's COVID-19 research effort