CANTERBURY SAFE ROUTES TO
SCHOOLS PROJECT SEMINAR
Canterbury Christ Church
University College, 29 May 1999
THE
IMPACT OF TRANSPORT POLICY ON CHILDREN’S
DEVELOPMENT:
Mayer
Hillman, Senior Fellow Emeritus, Policy Studies
Institute, London, UK
The purpose of
my contribution to today’s conference is to
place on the agenda an aspect of children’s
maturation into coping adults which to date has
been largely overlooked. It is aimed at
revealing how policies and practices in the
transport and related spheres have had damaging
affects on children. I conclude with an outline
of a strategy intended to return to children the
wide range of opportunities that they need for
their development outside the home which
previous generations of children enjoyed.
Some years ago, the government transport
minister at the time referred to the extent of
car ownership as a barometer of freedom.
What does that barometer show for children? Over
the last 30 years at least, owing to a concern
for their safety, this has been steadily
diminished by parental restrictions imposed on their
being out and about on their own. More and more
of them are escorted on their leisure and
school journeys - and up to an ever-later age in
their childhood. This may well be having a
detrimental effect on their social and emotional
development as well as, more obviously, on their
physical development. It is as if a malign
dictator intent on harming society by picking on
its most vulnerable and important members was
achieving his ends by promoting activities which
make the environment unsafe for children to be
out on their own; encouraging parents and their
children not only to be aware of the dangers but
to make them feel that they are more at risk
than they are in practice; and depriving them of
opportunities for improving their health and
acquiring these coping skills.
The loss of children’s
independence
When comparison is made with the lifestyle of
previous generations of children, it would seem
to be a cause for concern that such a high
proportion of parents should feel it necessary
to escort their children - nearly all
able-bodied - and to chauffeur them increasingly
in cars, with the result that they learn little
from exposure to the outside natural and
man-made world: our research has recorded that
whilst 80 per cent of 7 and 8 year olds went to
school on their own in the early 1970s, less
than one in ten were doing so two decades later
(Hillman, Adams and Whitelegg, 1991).
We also recorded that, whilst most children
own a bicycle, few are allowed to use it as a
means of transport. This seems regrettable
since, given safe provision for it, it is the
ideal means not only for their independent
mobility but also for promoting their fitness
and health (British Medical Association, 1992;
Hillman, 1993a). The effect of this restriction
is all the more unfortunate in terms of the size
of the world accessible to children with a
bicycle since, compared with walking, it has the
potential of extending a person’s geographical
catchment 10 to 15-fold.
Clearly, a considerable latent demand for
cycling exists, and this is borne out by the
evidence from the East Kent survey regarding
children’s high ownership of bicycles but
their very low use of them, even for the school
journey. Yet, at one Suffolk school where safe
facilities for cycling do exist, 60 per cent of
its children cycle to school and, in Denmark,
most children, even at the age of five, do so
(Danish Ministry of Transport, 1993).
Parental fears
The reasons given by parents for the
restrictions they impose on their children’s
independent mobility reflect a growing anxiety.
Increasingly, the outside world is seen as a
place where children are likely to be injured by
a motor vehicle or harmed by a bully or
stranger. The instinctive wish of parents to
avoid their children being exposed to risk has
been translated into them taking away from
children their freedom – for adults it would
be called a right - to get around on their own.
That freedom has been replaced by their time
being more and more under adult supervision and
structured by adults, with a rising and worrying
proportion of children’s waking hours being
spent indoors in front of the TV or in playing
computer games. This is a sad commentary on this
social change of the last few decades in that
its effects have largely gone unnoticed and that
fear is its inspiration.
Parents’ concerns regarding the risks of
road injury to their children if on their own
are justified. Analysis of transport statistics
on the volume and speed of traffic reveals that
in the last 20 years car traffic has almost
doubled and that of lorries has increased by a
half. And surveys show that vehicle speeds have
risen too: over two in three car drivers and one
in two lorry drivers now exceed the 30mph limit.
Vulnerable road users such as children are also
affected by the so-called ‘improved’
performance of motor vehicles enabling drivers
to accelerate to ever higher speeds in fewer
seconds. That then requires them to exercise
greater vigilance to avoid being knocked down.
Department of Transport road casualty
statistics during these 20 years record 200,000
children having been fatally or seriously
injured in this country, mainly through no fault
of their own - unless normal carelessness in
child behaviour is to be treated as blameworthy.
Nearly two-thirds of these injuries have been
caused when they were walking or cycling. The
figures reflect children’s particular
dependence on walking for their independent
travel and thus their disproportionate risk of
injury owing to the particular vulnerability of
pedestrians when hit by a motor vehicle. The
statistics on road injuries also reveal a
significantly higher rate among young teenagers
compared with younger children, and among older
teenagers compared with younger teenagers. This
is partly due to changes in the time of exposure
to traffic danger and to the use of forms of
travel associated with higher speeds and
therefore greater risk of injury when a
collision does take place.
The higher rates also reflect the years of
experience of acquiring road skills during
childhood. For instance, in previous
generations, children were far more likely to
have acquired them when cycling on relatively
safe roads. These could then apply at an older
age. It is perhaps unsurprising that the Royal
Society for the Prevention of Accidents (RoSPA)
has published a Code of Practice recommending a
minimum age of ten for children to cycle on
public roads. It is thought that, at a younger
age, they run the risk of it being beyond their
competence to manage riding a cycle whilst at
the same time coping with the prevailing traffic
conditions.
The other source of parents’ fears is far
less justified by the evidence. It stems from a
concern that their children may be assaulted or
molested by strangers - or murdered. A study in
the London Borough of Camden found that 90 per
cent of parents are ‘very’ or ‘quite
worried’ about the possible abduction or
molestation of their children, and 60 per cent
about the risk of them being bullied (DiGuiseppi
and Roberts, 1997). Recent MORI polls have
recorded that 40 per cent of 5-11 year old
children are not allowed to play outside their
homes and that 85 per cent of the population
think that the risk of being a victim of crime
has risen in the last ten years, three in ten
saying that, as a means of crime
protection, they always use a car rather than go
by public transport or on foot.
This risk needs to be put in perspective. An
extremely small number of the 12 million
children in the UK are murdered by strangers. It
is far more common for them to be murdered by a
person known to them. Indeed, it could be wryly
observed that far more are killed by strangers
behind the steering wheel of a motor vehicle
than are killed by strangers on foot. However,
excessive media coverage exaggerates their
incidence and thus the degree of risk.. For
instance, as a result of one unaccompanied child
mistakenly alighting from a coach at an earlier
stop, and therefore not being on the coach to be
met at his destination, an alarm was raised and
the local police force called in to investigate
the disappearance of the child. This led to
National Express making a ruling that no child
under the age of 16 years is allowed to travel
unaccompanied on its coaches.
Physical health
The circumscription of the lives of children,
with growing prohibitions on their independent
activity outside the home, is of course
well-intentioned. But its effect has damaged
children in ways additional to their loss of
freedom. A growing body of research suggests
that children’s fitness is declining and that
their obesity is increasing. This is in large
part attributable to the fact that they walk and
cycle far less (Armstrong and MacManus, 1994):
National Travel Survey data over the last 20
years show annual mileages on foot and cycle
among those of school age declining by over 25
and 40 per cent respectively (Department of
Transport, 1994). The latest of these surveys
shows that over 90 per cent of 5-10 year olds
and three-quarters of 11-15 year olds live
within three miles of their school, but only one
per cent and nine per cent respectively travel
by cycle which, as noted earlier, is an ideal
means of keeping fit, and has the further
distinct advantage that it can be tied in so
readily to the daily routine.
It is a disturbing reflection on the limited
public and political perceptions of children’s
needs that the link between their loss of
independent mobility and their declining fitness
has gone largely unnoticed over the last few
decades in the attempt both to accommodate the
growth of car-based patterns of activity - which
makes the outdoor environment so unsafe that
parents do not allow children out on their own -
and then to protect them from the consequent
dangers (Hillman, 1993b). It is salutary to note
too that when children do obtain the parental
‘licence’ to travel on their own, there are
fewer outdoor public spaces for their social and
recreational activity owing to the appropriation
of streets for traffic and parking. Moreover,
the quality of these spaces has declined sharply
not only because of the dangers posed by motor
vehicles but also the fouling of the air from
exhaust pipes and the interference with
comfortable communication induced by vehicle
engine noise.
Greater confinement to the home and more of
their journeys being made by car are factors
which are, of course, associated with children’s
increasingly sedentary lifestyle. That does not
bode well for their future health for it is
unrealistic to think that PE and games on school
days only – that is half the days of the year
- can compensate for the loss of the medically
recommended minimum of a daily dose of 20
to 30 minutes’ physical exercise of some sort
or another. We may have a time bomb on our hands
which will explode in 20 or 30 years as the
incidence of heart disease could rise sharply
owing to the insufficiency of daily exercise
during the critical years of childhood.
Mental health
The damage of confinement is not limited to
curbing children’s physical development. It
also has other closely-linked adverse
consequences. The effect of steadily and almost
insidiously diminishing children’s access to a
safe environment in parents’ narrow but
understandable pursuit of aiming to protect them
from harm may be incurring psychological costs.
These are fairly intangible and therefore
difficult to measure. However, a recent Mental
Health Foundation survey recorded one in five
children suffering from some degree of mental
stress, some of which is likely to be
attributable to confinement to the home with
relationships with adults limited to one or two
parents.
Though the outdoor environment contains
within it experience, learning opportunities and
stimuli that are crucial to children’s
understanding of the real world, it is now out
of bounds to them until they reach an
increasingly advanced age in their childhood.
Whilst they do not enjoy similar levels of
security to the home in the local neighbourhood,
and the reassurance stemming from that, it does
provide another learning environment which can
contribute to their maturation, namely
opportunities for giving rein to instinctive
desires not only to enlarge their geographical
boundaries and develop their physical and
practical skills but also their social and
emotional skills – and build on all of these.
In this neighbourhood, they can do so,
gaining experience from making their own
decisions without adult supervision, learning
how to act responsibly and how to assess the
motives of those they do not know. They can have
adventures in what are to them relatively
dangerous situations, be mischievous, set
just-attainable challenges that give pleasure
from meeting them, take risks, be adventurous
and make mistakes and suffer the consequences,
gain self-esteem and self-confidence by being
successful, reliable and punctual, and
contribute to family and community life by
shopping, visiting or running errands. These are
all basic elements of growing up best acquired
through exposure in daily life situations when
on their own and at an earlier, rather than a
later age. The ‘information’ they gain in
the process can then be placed in the ‘memory
bank’ to call upon when making decisions in
more demanding situations, such as when faced
with a bully. It is worth recalling that, when
accompanied by an older person such as a parent,
a child’s instinct is to leave decisions to
that person in the same way that, when abroad,
we tend to leave conversation in a foreign
language if we can to someone fluent in that
language - but, in that way, lose the
opportunity of improving our language skills
through practice. Indeed, the local
neighbourhood - just outside the home for young
children, and further and further afield as they
grow older - represents a unique locus for
relating knowledge, information and social
behaviour learned at school and in the home to
real life situations- unsupervised.
There is a further psychological dimension to
be added to the damaging effects of limiting
children’s exposure to the outside world
unless they are accompanied by an adult. Not
allowing them out on their own takes some of the
excitement and adventure out of children’s
lives - witness the thrill they enjoy when first
allowed to do things on their own. It is
interesting to note from experiments on primates
that damage to the development of their social
behaviour by depriving them of the rough and
tumble of their early years cannot be restored:
survival rises with the extent of experience of
risk taking.
Children’s detention in their homes
inculcates in their impressionable minds a
grossly misleading perception of the world
outside as hostile – a world in which we, as
experienced and responsible adults, consider
that people one does not know could well be up
to no good and that their locality may contain
within it elements of danger to which they
should not be exposed.
Increasingly, one can observe urban children
being dropped off so that they can make the last
few yards on their way to school, hurrying and,
in some instances, looking only straight ahead.
The impression one gains from this behaviour is
that they have had the message of stranger/danger
very effectively instilled in them. Indeed, a Guardian
article last year recommended parents to tell
their children to avoid eye contact with
strangers.
The apparently worthy initiatives of the Walking
Bus for children on their way to school –
as if going through a minefield, Safe Houses
where children are told they can find help if
they feel threatened, the ParentWatch
schemes in which parents volunteer to supervise
parks and play areas, and the Stranger/Danger
campaigns such as that of Kidscape which advises
parents to tell their children to Yell, Run
and Tell if approached by a stranger, all
contribute to a siege mentality in children’s
minds. The effect of all of them is to promote
paranoia among parents that they are not acting
responsibly unless they are always with their
children outside the home and to make them feel
irresponsible if they are unable to do so or to
delegate someone to act in their place. For all
these reasons, we should be somewhat wary about
assuming that children’s views are a reliable
source of information unless these are
interpreted from the perspective of the limits
of their experience and possibly an exaggerated
concern about risk reflecting the influence of
their parents’ over-protective instincts.
As a direct consequence of this form of
indoctrination we, the strangers, are less
inclined to engage in conversation with children
we do not know - a perfectly healthy instinct -
lest our motives be misconstrued. It also has
the insidious effect of relieving us of our
societal responsibilities for keeping an eye on
other people’s children and intervening when
we judge it necessary. It all runs counter to
promoting confidence-building in children and
generating desirable behaviour such as
conviviality within the community.
One of the few aspects of children’s lives
outside school that has received attention
during the last few years has stemmed from a
concern about more and more children being
escorted to and from school, albeit that its
origins appear to lie in the contribution that
this has been making to road congestion,
particularly in the morning rush hour. This has
led to some initiatives, such as the Safe
Routes to School projects, aimed at
reversing this trend. Laudable though these are,
they reflect the conventional but false view
that children’s lives are, in the main,
school-oriented and thus that the proper
response to the greater danger to which children
are now exposed from traffic lies in making the
school journey safer. It is as if the school
journey is the only one requiring a safe
environment in which to travel, overlooking the
fact that children make many more journeys to
destinations in their free time than they do to
and from school and that 90 per cent of their
fatalities occur on these other journeys
(Hillman, Adams and Whitelegg, 1991). Why not Safe
Routes for Children?
The exercise of parental choice with regard
to the school that their child attends is
another policy initiative which appears both
desirable and democratic. On the face of it, it
runs with the tide of extending personal
freedoms as it enables parents to advance their
children’s academic prospects. However, it
usually leads to the selection of a more distant
school, making chauffeuring by car rather than
independent travel on foot or cycle a more
likely outcome. This harms the health of people
along the route then taken twice daily as it
adds to the noise, pollution and danger from
traffic (Whitelegg, Gatrell, and Naumann, 1993).
It also results in the loss of a place in the
chosen school for a child living nearby who may
then have to travel further as a consequence.
Dependence on car travel also tends to limit
participation in extra-curricular activity.
Friendship patterns are more likely to be
geographically-spread and to be more formally
arranged - a very different character to the
more spontaneous ones that can thrive when
children are free to casually drop in on each
other. In addition, it promotes the culture of
self-interest in that parents are encouraged to
seek the safest means for their children
to get to and from their destinations – not
just for school (the ordinary car if the Range
Rover cannot be afforded) - without regard to
the effects of that decision on the safety of
other children and other road users as these
vehicles are so dangerous for pedestrians and
cyclists.
Most recently, a policy change instituted by
the Home Office under last year’s Crime and
Disorder Act (Home Office, 1998) can have the
effect, where it is introduced, of limiting
children’s quality of life still further.
Owing to the problems of criminal activity among
some young children in some urban areas, local
authorities have been given powers to impose a
ban on those under the age of ten being out of
doors, unsupervised in a public place, from as
early as 9pm. That may be an appropriate penalty
but only for particular ‘offending’
children.
However, the restriction on how they spend
their time out of doors can have a range of
undesirable outcomes: first and foremost, it
takes away from children a basic right by
imposing a blanket limit on all members of this
group in society because some of its members
commit crimes. Adults would almost certainly
oppose such legislation, other than if it were
introduced as a wartime curfew or in the face of
extreme incidents of terrorist activity. Second,
such a ban inculcates a view that responsible
parents do not allow their children out of
sight. Third, and allied to this, it effectively
requires parents in the areas in which the ban
is imposed to enforce it. Otherwise the police
and social services will come to their homes to
require them to do so or to take the necessary
measures to make the ban effective. Such
legislation reflects a view running counter to
the progressive approach of giving children more
and more licence as they grow older. It is
surely for parents to decide at what age their
children can be out and about on their own in
the evening.
A remedial strategy
What form would a strategy take to create an
environment in which children can enjoy both
freedom and the benefit to their physical and
mental health from being able to spend more time
on their own outside the home? Four components
could be suggested:
- At the transport level, the attractions of
motorised travel generally need to be
reduced, environmental standards raised, and
cycling and walking given pride of place in
the transport hierarchy through the creation
of safe networks for them so that they are
no longer seen as dangerous (Hillman and
Cleary, 1992). The East Kent surveys not
only show the high levels of cycle ownership
among children but the extent to which
children would wish to use them as a form of
transport. Moreover, a significant
proportion of the children in the survey
have indicated that they would like to
improve their fitness and, as noted earlier,
the bicycle is an ideal means for them to do
so.
Other measures, such as traffic calming, are
called for, with traffic only minimally
intruding: a recent study has shown that, after
such measures were introduced, 50 per cent more
children were allowed to go to school on their
own. Much lower speed limits – say 15 to
20mph-must be adopted and enforced. A more
equitable balance also needs to be struck
between teaching children skills to cope with
traffic danger to minimise their risk of injury
on the roads through changes which reflect the
fact that just because they are likely to be
more careless and inexperienced, they are not
necessarily culpable in an increasingly
dangerous traffic environment which is not of
their making.
- At the planning level, schools need to be
encouraged to adopt a catchment policy
favouring children living locally; at the
same time, the adoption of longer distance
patterns of travel for all purposes should
be discouraged, and local activity promoted
both to reduce the need for motorised
travel, repopulate the streets with people
on foot, and improve the amenity of the
pedestrian environment to reflect the fact
that the street also has a social function.
Far more could be done to enable children to
‘reclaim the streets’ as a locus
for their outdoor activity (Tranter and
Doyle, 1996).
- At the institutional level, considerable
scope exists for central and local
government to demonstrate that they are
truly committed to improving children’s
quality of life outside the home. At
present, there is a lack of interaction
across professional and departmental
boundaries, particularly those of health,
social services, education, sport, transport
and environment, with the result that, for
instance, giving primacy to cycling and
walking in transport policy is not seen as a
unique means of realising many common public
policy objectives, especially those of
health. Rather than the blanket ban on all
children being out and unsupervised after
9pm, the limited resources available to
police and social services may well be
deployed in liaising with the parent(s) of
children who have been causing trouble. And,
given the close link between proximity and
levels of participation in leisure
activities (Hillman and Whalley, 1977), far
more recognition needs to be given to local
provision – smaller, more numerous and
therefore more easily accessible facilities
rather than larger, better equipped ones
which are then more likely to require
motorised travel to reach them.
- Most importantly, at the level of cultural
values and public attitudes, the
conventional view about children’s rights
to a relatively safe environment needs to be
reviewed and a reappraisal made of their
claim to it and of its role in terms of
their development. Taking away these rights
needs perhaps to be seen as a form of abuse.
Perceptions of car use as being anti-social
–after all, 85 per cent of pedestrian
deaths and serious injuries on the roads
result from collision with a car - need to
be heightened. In this regard, as teachers
often act as role models for schoolchildren,
schools, as well as local authorities could
adopt green commuter plans, the effect of
which would be to encourage their staff to
use alternatives to the car to get to work.
Attitudes to the nurturing of community life
need to be promoted, for instance, by
explicitly planning to enable more of
children’s time to be spent free of overt
adult supervision. Social interaction
between children and adults should be
encouraged so that children learn and gain
confidence from communicating with strangers
and do not treat them as potential
molesters. And we - the ‘strangers’ -
should see one of our public duties as
keeping an eye on other people’s
children, creating a climate of confidence
as they do far more on the Continent by
intervening where behaviour appears to be
verging on the dangerous or too
anti-social. Claire Rayner recently quoted
an African proverb that it takes a whole
village to rear a child. Finally, owing to
the paranoia and fear that they can
inculcate, the media must act more
responsibly so that the incidence of the
rare instances of child murder and
molestation is not exaggerated in the public
mind through over-reporting.
Conclusions
In our wish to do the best for our children
we have unwittingly cast them in the role of
second-class citizens through an oversight of
the role of their personal autonomy in the
outdoor world. One could draw an analogy here
between the battery-reared childhood of today
and our own relatively free-range childhoods.
The situation is far more serious than I think
is realised: remarkably, society – central and
local government, the educational system and, we
ourselves – have all connived as active agents
in the process of infringing children’s civil
liberties and, in the process, have damaged
their physical, social and emotional
development. Sadly, the age at which most
children are allowed to get around on their own
has been steadily raised.
We need to rethink policy for our children so
that it embraces the full spectrum of their
lives, including its quality, its coverage of
their activity in the evenings, at weekends and
during holidays, and the role that this activity
plays in the maturation process. At the heart of
the problem lie two complementary aspects which
reflect society’s careless attitude to
children. The first is the relentless pursuit of
minimising even the slightest risk of them being
harmed. It has led to taking away the rights of
literally millions of children to a safe
environment outside the home. Some argue that
children today are better-off: they have far
more access to people and places – albeit, in
the company of a parent or under other adult
supervision - than we did as children. However,
insofar as this is true, it has had the effect
of requiring a condoning of the conventional
practice of withdrawing children from danger
rather than withdrawing danger from children. We
have ignored the effects of this practice on
children’s development. Indeed, it could be
argued that, through this oversight, we have
been breeding a generation of ‘battery-reared’
as compared with our generation of ‘free-range’
children, with all the generalised implications
such an analogy has for their health and quality
of life.
The second is that formal education in
school, important though that is, is seen to be
so significant to children’s learning that
other less formal environments in which children
are able to practice practical, physical and
social skills can be largely ignored. These
skills needed for the transition from the
limited capabilities of childhood to the widely
embracing competence and prospective
independence of adulthood are by no means solely
gained in school. The home is of course where
many are acquired through interaction with
parents, siblings and the extended family during
the period of over three-quarters of
their waking hours (holidays included) spent
outside school, but the area in which they live
has the potential for serving as the informal locus
for their maturation as responsible, fit and
healthy members of society.
It is widely acknowledged that the quality of
a school’s environment has a considerable
influence on children’s academic attainment
(National Commission on Education, 1995). It
stands to reason that the quality of the out-of-school
environment, particularly in terms of its
safety, and the street as a milieu for
social and recreational activity, should also be
seen as relevant to children’s attainment in
this complementary sphere of their development.
As they grow older, they should have the freedom
to plan, put into practice and gain experience
from acting on their own ideas without overt
adult supervision.
Children are individuals whose inalienable
rights are of no less value than those of
adults. Now that we have evidence of the
deleterious effects of growing restrictions on
their independence outside the home, it is
difficult to believe that a civilised society
will not wish to reverse the process which has
brought that about.
REFERENCES
Armstrong, N. and McManus, A. (1994), ‘Children's
Fitness and Physical Activity - A Challenge for
Physical Education’, The British Journal
of Physical Education, Spring, p.25.
British Medical Association (written by
Hillman, M.) (1992), Cycling: Towards
Health and Safety, Oxford University
Press.
Danish Ministry of Transport (1993), The
Bicycle in Denmark: Present Use and Future
Potential.
Department of Transport (1994), Transport
Statistics Report, National Travel Survey:
1991/93, HMSO.
DiGuiseppi, C. and Roberts, I. (1997), The
Daily Journey to School: A Survey of Primary
School Children in Camden, Camden
Accident Prevention Alliance.
Hillman, M. (1993a), ‘Cycling and the
Promotion of Health’, Policy Studies,
Vol.14, no.2, 1993, pp.49-58.
Hillman, M. ed. (1993b), Children,
Transport and the Quality of Life,
Policy Studies Institute.
Hillman, M., Adams, J. and Whitelegg, J.
(1991), One False Move... a study of
children's independent mobility, Policy
Studies Institute.
Hillman, M. and Cleary J. (1992), ‘A
Prominent Role for Walking and Cycling in Future
Transport Policy’, in Roberts, J. et al
(eds.), The Need for a Sustainable
Transport Policy for Britain, Lawrence
and Wishart.
Hillman, M. and Whalley, A. (1977), Fair
Play for All: a study of access for sports and
informal recreation, Political and
Economic Planning.
Home Office (1998), Crime and Disorder
Act (clauses enabling local authorities
in England and Wales to impose curfews on
children).
National Commission on Education (1995) Success
Against the Odds, Routledge.
Tranter, P.J. and Doyle, J.W. (1996), ‘Reclaiming
the residential street as play space’, International
Play Journal, 4, pp.81-97.
Whitelegg, J., Gatrell, A. and Naumann, P.
(1993), Traffic and Health, A
report for Greenpeace Environmental Trust.