A fascinating take on the congestion charge in the British Medical Journal this week: the “charge tackles road danger at its source” instead of using the typical “blame the victim” approach of lecturing at pedestrians. It’s worth quoting at length:

Two hundred years ago London was a cesspit. Its streets were awash with sewage and infectious disease was a deadly scourge of the urban poor. The man credited for cleaning up the mess was a tenacious London politician called Edwin Chadwick. His 1842 report Survey into the Sanitary Conditions of the Labouring Classes was a landmark in public health with its graphic descriptions of how filthy living conditions were a key factor in the spread of infectious disease. Chadwick battled hard for sanitary reform, waging political war against those opposed to central government intervention in public health matters. His opponents argued that people were clever enough to manage their own affairs, claiming there was “insanity in sanity.” But Chadwick won through and is now acclaimed as the instigator of the most important public health reform of the 19th century.

The sewage has long gone, but now the streets of London are in gridlock and traffic is the deadly scourge. Each year in inner London there are some 4000 pedestrian and 2000 cycle casualties, air pollution is a serious health threat, and much of inner London is a noisy dirty mess… The [charging] scheme is based on the simple economic premise that if people have to pay more for car travel they will buy less of it. Schemes in Singapore and Norway have resulted in substantial reduction in traffic. Less car travel will result in fewer crashes, reduced emissions, and may encourage drivers to use healthier transportation options such as walking and cycling. If the revenues from charges and fines are ploughed back into other healthy transport initiatives then the scene is set for a major advance in public health.

One hundred years later it is still the poor who face the greatest risk on the roads. Children from families without a car, because they walk more than children from car owning families, have substantially higher pedestrian death rates… With increasing traffic volume, walking has become more hazardous, leading to a vicious cycle of more car use leading to increased road danger leading to more car use… A survey of parents in two inner London primary schools found that 85% were worried about traffic danger on the journey to school…

Congestion charging tackles road danger at its source and is a refreshing change from the usual efforts to influence the behaviour of the potential victims of road traffic crashes. The scheme will no doubt meet with fierce opposition from the usual line up of vested interests but if it reduces deaths and injuries of pedestrians and cyclists, encourages walking, and reduces car use, then it will be a major public health reform, and Ken Livingstone will be to the walking classes what Edwin Chadwick was to the working classes.

Ian Roberts, professor of epidemiology and public health. Public Health Intervention Research Unit, London School of Hygiene and Tropical Medicine.

Full cite: British Medical Journal 2003;326:345-346 ( 15 February ).