Transport and Health

1. Introduction

The Joint Strategic Needs Assessment (JSNA) for transport provides an overview of the relationship between transport and health, a summary of the evidence base, identifies key issues within existing transport provision and outlines potential areas for action and change. The JSNA for transport supports decision makers to make informed choices about transport in Surrey to ensure that everyone can live a healthy life, with high standards of physical, mental, and social wellbeing.

Transport enables people to access education, employment, services, shops, leisure, the natural environment, and social and community connections. Transport should be reliable, affordable, safe, and accessible to all to make Surrey a healthy and attractive place to live. Sustainable transport enables people to make their journeys in a way that reduces carbon emissions and other pollutants, uses space efficiently and support physical and mental health.

Transport is an important wider determinant of health because it is part of everyone’s lives and everyday needs, regardless of age or social status. No single mode of transport is solely good or solely bad for health, and transport strategies need to use a place-based approach to provide a balance between community, retail, and development needs which facilitate healthy, cohesive, vibrant, and sustainable communities. By integrating health equity through the recommendations contained in the Surrey Health and Wellbeing Strategy - Health Equity into transport policy and planning as a system capability, it is possible to address the factors that cause poor health, improve health equity, and reduce pressures on health care and other systems.

1.1. The Surrey Health and Wellbeing Strategy

The Surrey Health and Wellbeing Strategy is a ten-year strategy between the NHS, Surrey County Council, district and borough councils and our wider partners, including the voluntary and community sector and the Police. Following the significant impacts of COVID-19, the Surrey Health and Wellbeing Strategy’s mission is to reduce health inequalities among its Priority Population (including the Key Neighbourhoods), so no-one is left behind.

Figure 1 shows the Index of Multiple Deprivation statistical release (IMD) for Surrey. Areas shaded in red are the areas that are in the most deprived 20% nationally and areas with deep orange shading are in the 30% most deprived nationally. Areas in green have lower overall levels of deprivation. Figure 1 also shows the 24 Key Neighbourhoods identified in the updated 2026 Surrey Health and Well-being Strategy. Following Local Government Reorganisation for Surrey, there will be 13 Key Neighbourhoods in West Surrey and 11 Key Neighbourhoods in East Surrey.

Figure 1: Map of Index of Multiple Deprivation for Surrey (2025) by Lower layer Super Output Areas (LSOAs) and Key Neighbourhoods in the Surrey Health and Wellbeing Strategy. Source: Healthy Surrey

The Surrey Health and Wellbeing Strategy has three priorities for reducing health inequalities amongst the Priority Populations. The Priority Populations include babies, children, young people, adults, and older adults who experience disadvantage that leads to poorer health outcomes.

• Priority 1: Supporting those of all ages in the Priority Populations to lead healthy lives by preventing physical ill health and promoting physical well-being. 

• Priority 2: Supporting those of all ages in the Priority Populations by preventing mental ill health and promoting emotional well-being. 

• Priority 3: Supporting those of all ages in the Priority Populations to reach their potential by addressing the wider determinants of health. The benefits of healthy environments should be valued and maximised, including through transport and land use planning.

1.2. The Local Transport Plan (LTP4) for Surrey

The fourth Local Transport Plan (LTP4) for Surrey was adopted in 2022 and sets out a plan to improve and transform the transport network to 2032 and beyond. LTP4 supports the delivery of Surrey’s priority objectives for transport, enhances Surrey’s economy and community, and seeks to improve the health and quality of life for our residents through transport.

Figure 2 shows the sustainable travel hierarchy for different modes of transport including walking, cycling, public transport, vehicles, and aviation. The sustainable travel hierarchy aims to shift journeys made by unsustainable modes of transport such as private vehicles to more sustainable, efficient, and environmentally friendly alternatives such as public transport, walking, and cycling. Whilst it is recognised that all modes of transport have their place in Surrey, the benefits of modal shift include increased physical activity, reduced greenhouse gas emissions, improved air quality less traffic congestion and improved retail activity for local businesses (Heart Foundation - Good for Business).

Figure 2: The sustainable travel hierarchy for active travel.

In the short term (2022-2025), measures in LTP4 focused upon a green and healthy recovery of transport choices after COVID-19 and the Avoid, Shift, Improve framework as shown in Figure 3. The Avoid-Shift-Improve framework focuses on reducing the need to travel and the length of trips where possible (avoid), making it easier to choose more sustainable modes of travel such as walking, cycling and public transport for everyday journeys (shift), and making remaining vehicle travel have a lower environmental impact (improve). This framework is a core model of transport demand management as it aims to reduce and redistribute travel demand across different times, routes, and modes of transport. Overall, this framework helps to manage congestion, reduce emissions, and alleviate pressure on road systems and public transport.

Figure 3: The "avoid, shift, improve" framework for sustainable travel.

Between 2022 and 2025, LTP4 strengthened transport links, increased interest in walking and cycling to start a shift away from car dependency, rebuilt trust in public transport and accelerated the uptake of electric vehicles. This built upon existing good practice, and the delivery of relevant and already planned schemes.

In the medium term (2025-2030), LTP4 will continue to support behaviour change towards carbon-neutral choices for their journeys, invest in improving places and communities, deliver higher impact but harder to deliver measures, increase the uptake of technology solutions and transition from traffic growth to traffic reduction. In the longer-term (post 2030), LTP4 focuses upon reducing car dependency, making sure places become people-focused not car focused.

There are nine policy areas in LTP4.

1. Planning for Place

2. Digital connectivity

3. Active travel and personal mobility

4. Public and shared transport policy

5. Demand management for cars

6. Demand management for goods vehicles

7. Efficient network management

8. Promoting Zero Emission Vehicles (ZEVs)

9. Supporting behaviour change

1.3 Healthy Streets for Surrey

Healthy Streets for Surrey provides developers and other professionals with a reference point for Surrey's design code and national and local guidance and policies. Healthy Streets for Surrey raises the standard of street design, creating streets which are safe, green, beautiful, and resilient in line with the ambitions of Community Vision for Surrey 2030.

The Healthy Streets design code aims to make Surrey a place where everyone has a great start to life, people live healthy and fulfilling lives, people are enabled to achieve their full potential and contribute to their community, and no one is left behind.

Figure 4: Healthy Streets requirements and design code. Source: Healthy Streets for Surrey.

1.4 The third Cycling and Walking Investment Strategy (CWIS3)

The third cycling and walking investment strategy (CWIS3) sets out the government’s long-term vision and objectives for walking and cycling to be the natural choice for shorter journeys. The strategy sets out how investment in active travel can save households money, improve public health, cut congestion, reduce carbon emissions, and support local economies. CWIS3 focuses on walking and cycling as modes of active travel, integrating active travel within the transport network, improving safety, and improving health. The strategy marks a new cross-government approach to active travel, bringing together transport, health and investment while giving local leaders a greater role in shaping delivery to meet the needs of their communities. 

CISW3 sets a national target for people to hit the pavement or pedals for 55% of short trips in towns and for 60% of children aged 5 to 16 to travel actively to school by 2035. 

CISW3 is underpinned by three strategic objectives:

1. Enable more people, particularly the least active, to benefit from physical activity through active travel

Walking, wheeling, and cycling are the most accessible and cost-effective ways to meet the chief medical officers' physical activity guidelines.

2. Make active travel the easy and integrated choice

Public transport and active travel are intrinsically linked: every public transport journey begins and ends with a walk, wheel, or cycle stage. This aligns with Better Connected, a wider strategy for integrated transport.

3. Improve safety for people walking, wheeling, and cycling

Safety remains the main barrier preventing more people from walking, wheeling, and cycling, especially for women and children. This strategy complements our road safety strategy (Road safety strategy - GOV.UK) which sets a target to reduce the number of people killed or seriously injured on roads in Great Britain by 65% by 2035, 70% for children under sixteen. Road and social safety, both perceived and actual are critical determinants of travel behaviour.

The government is projected to invest over £4.5 billion in active travel over the next 5 years and will work with Active Travel England and local authorities to deliver 5,000 new walking, wheeling, and cycling routes and 10,000 safer crossings to connect homes with schools, high streets, and local services by 2030. By 2030, people across England will see visible changes in their local area that make walking, wheeling, and cycling the safe, easy, and accessible choices for everyone.

Every mayoral strategic authority (MSA) and large local authority will have a funded, phased active travel network plan aligned to growth, housing, and health commitments. This will encourage people to walk or bike to public transport hubs such as train stations, create safe routes to schools, enable community programmes for walking and cycling, and allow future housing and development plans to include high-quality active travel provision from the outset. The increase in physical activity through CISW3 and its benefits for physical and mental health will have a measurable positive impact on the NHS, worth an estimated £10.5 billion in savings a year. Achieving the target set out in this strategy will result in an additional 5.3 million people being physically active in towns and cities by 2035, 45,000 years of life gained through reduced risk of premature death and prevent over four million sick days every year.

CWIS3 was published alongside Active Travel England’s Worth Every Step delivery plan which sets out a 4-year roadmap to how investment will be used to make walking and cycling the cheapest and easiest way to travel directly to local destinations. The delivery plan responds directly to the priorities in CISW3. The first four years of the delivery plan (2026 to 2030) focuses on enabling more children to walk, wheel and cycle to school alongside building the foundations of a national network to improve the consistency and quality of active travel infrastructure.

Evidence shows that the early consideration of active travel in planning and design has a lasting influence on travel behaviour, encouraging people to be physically active. High quality infrastructure such as smooth footways, protected junctions, quiet roads, segregated cycle lanes, and off-road routes helps these behaviour changes programmes to be more effective, increasing the number and distance of walking and cycling journeys. Increasing walking and cycling helps people to adopt healthier lifestyles.

1.5. Local Street Improvements (LSIs)

Local Street Improvements are schemes across Surrey which aim to improve local streets and the public realm to make our communities safer, healthier, and more attractive for people to live, work and visit. LSIs encourage people to travel by active travel modes such as walking or cycling when making local journeys. LSI measures typically include traffic calming, enhancement to the public realm, trees and greenery, seating, ornamental lighting, pedestrian links and crossing points. LSIs are not street maintenance works and are intended to target investment towards the viability of local level services and amenities.

1.6. Local Cycling and Walking Infrastructure plans (LCWIPs)

Surrey County Council aims to improve cycling by upgrading and maintaining a dense, integrated, and high-quality network of cycle routes across the county. At present, not all cycle infrastructure is of a good standard, and some areas lack cycling facilities overall. A good cycling network should be safe, coherent, direct, comfortable, and attractive and ensure that cyclists are protected from traffic whist cycling. This requires continuous and well-maintained cycling routes with secure bike storage, clear signage, and high-quality infrastructure to connect residential areas with schools, workplaces, and public transport.

Long term investment into cycling is managed by Local Cycling and Walking Infrastructure Plans (LCWIPs) which are ten plus year strategic plans for investing in walking and cycling within a defined area (such as a town, district, or borough). LCWIPs provide a strategic recommendation for where future improvements for walking and cycling could be prioritised and have the greatest impact, subject to further feasibility assessment, design development, engagement, and funding. LCWIPs support the delivery of Surrey’s Local Transport Plan and follows the Department for Transport’s guidance on planning walking and cycling networks (Planning local cycling and walking networks - GOV.UK) and Local Transport Note 1/20 Cycle Infrastructure Design.

LCWIPs focus on enabling longer walking and cycling journeys to help people to travel between and within towns, segregated from general traffic wherever possible. This helps create a safe, attractive, and high-quality walking and cycling network that directly serve the journeys that people want to make.

LCWIPS have six main objectives as shown in Figure 5.

Figure 5: The six objectives of LCWIPs.

LCWIPs identify routes and areas where investment into walking and cycling improvements has the greatest positive impact overall. Figure 6 shows the six principles that are used to prioritise LCWIP investment.

Figure 6: The 6 principles of LCWIPs.

LCWIPs should not be treated as confirmed infrastructure for delivery as they are strategic plans for high-quality and joined-up walking and cycling routes based on current levels of development. Completed LCWIPs are available for:

• Elmbridge Borough

• Farnham Town

• Mole Valley District

• Reigate and Banstead Borough

• Runnymede Borough

• Spelthorne Borough

• Waverley Borough

• Woking town

For further information about Local Cycling and Walking Infrastructure Plans (LCWIPs), see Surrey County Council’s Plans to improve walking and cycling.

2. Active travel for health

Active travel refers to all journeys made that involve physical activity, such as walking or cycling and any journeys made by walking and cycling to public transport. Increasing active travel is one of the most direct contributions that transport can make to the government’s 10 Year Health Plan for England.

Sedentary lifestyles are associated with several negative impacts on physical health, mental health, and wellbeing. A lack of regular physical activity is associated with shorter lifespans, worse health throughout the life course, an increased risk of developing various health conditions, and worse physical health outcomes. Regular exercise can support better mental health and wellbeing. Figure 7 shows examples of how physical inactivity impacts health.

Figure 7: Benefits of active travel for physical and mental health.

Active travel improves both physical and mental health by integrating regular physical activity into our everyday lives and activities. People who use active modes such as walking and cycling integrate regular physical exercise in their everyday lives, which helps them to maintains an active lifestyle that safeguards future health. Exercise also has mental health and wellbeing benefits including reduced stress, improved self-esteem, better management of depression and anxiety, better sleep and enhanced focus and motivation.

Active travel helps people make more informed choices about their health and is a highly accessible, cost-effective, and straightforward way for people to integrate regular exercise into their daily routine. People who currently live sedentary lifestyles characterised by prolonged sitting and low levels of physical activity would benefit from increasing their level of physical activity. The UK Chief Medical Officers’ Physical Activity Guidelines recommends that adults should aim to be physically active every day. The scientific evidence is clear that the benefits on health are measurable, even at low levels of physical activity. Regular physical activity can deliver cost savings for the health and care system and has wider social benefits for individuals and communities.

Active Travel England is sponsored by the Department for Transport and aims to increase the number of local journeys being walked, wheeled, or cycled by 2030. Active Travel England is doing this by:

• investing in and improving standards for active travel schemes across England.

• integrating active travel in the planning and development system.

• focusing on inclusivity and accessibility and giving people the opportunity to try active travel.

• helping councils to access data and analysis to use in active travel planning and design.

For further information on strategies to increase physical activity, see the Physical Activity Strategy ‘Movement for Change’ strategy and Active Surrey.

2.1. Active travel and reducing obesity

Tackling obesity is one of the greatest long-term health challenges currently faced in England. The 2022 Health Survey for England reported that around two-thirds (64%) of adults were overweight or facing obesity, and obesity-related ill health has significant impacts on workforce productivity and the National Health Service (NHS). The NHS in England typically spends £6.5 billion a year on treating obesity-related ill health and services (NHS England » One in eight toddlers and primary school aged children obese) despite facing significant long-term financial sustainability challenges.

Obesity is a significant risk factor for the early onset of several health conditions such as high cholesterol, high blood pressure, pre-diabetes, bone and joint problems and breathing difficulties. Obesity is also associated with reduced life expectancy and worse health outcomes for people with type 2 diabetes, cardiovascular disease, liver and respiratory disease and cancer. Obesity can also have a negative impact on mental health, as people living with obesity may feel depression, anxiety or low self-esteem related to their weight.

Table 1 shows obesity prevalence for adults (18+) by local authority area in Surrey. At a local authority level, the lowest level of obesity prevalence is in Waverley (50.05%), and the highest level of obesity prevalence is in Spelthorne (67.16%). The differences in obesity prevalence between areas can be attributed to many factors, including car-centric infrastructure and a lack of accessible recreation spaces for physical activity.

Table 1: Obesity prevalence for adults (18+, 2019-2020). Source: Surrey Context JSNA Population dashboard

There is a well-established relationship between low levels of physical activity and obesity which active travel can help to reduce by encouraging people to live a more physically active lifestyle to support weight loss. However, there are several factors that affect obesity prevalence which include lifestyle choices (such as diet, access to a variety of food options, sleep habits), environmental influences (including food access, community design, and socio-economic design) and socio-economic characteristics (including deprivation, inequality, and poverty).

Figure 8: Population Intervention Triangle. Adapted from: Public Health England's 'Place based approaches for reducing health inequalities'

Figure 8 shows a version of the Population Intervention Triangle which has been endorsed by the Surrey Health and Well-being Board. Being aware of place-based health inequalities (Place-based approaches for reducing health inequalities: main report - GOV.UK) and the need to act at a civic or system level, service-based level and community-led level is important to focus good transport on the people and places with the greatest need.

2.2. Barriers to participation in active travel

Not everyone has the same ability to take part in active travel due to a complex combination of socioeconomic, environmental, personal, and health-related barriers. These include unequal access to good infrastructure which supports active travel, a lack of time, physical limitations, and cultural factors. Some important factors (Health matters: getting every adult active every day - GOV.UK) and examples that prevent or reduce an individual’s ability to use active travel modes include:

• Time and Daily Demands: A lack of free time, often exacerbated by long working hours, commuting, and family or childcare commitments limits opportunities to make journeys through active travel modes as they may take more time.

• Socio-economic status: Walking and cycling is strongly linked to socio-economic status. People with a lower socio-economic status often have higher rates of walking, which is partially due to the costs associated with using public transport and vehicles. Areas with higher relative levels of deprivation may lack safe cycling routes, safe places to store bikes or find the upfront cost of a bike unaffordable.

• Environmental Barriers: Safe, accessible, and pleasant spaces for walking and cycling encourage more journeys to be made by active modes of travel. However, poor quality walking and cycling routes discourage active travel as a desirable and feasible options. Factors such as poor street lighting, a lack of green space, poorly maintained streets, and a lack of suitable pedestrian infrastructure such as safe crossing points discourage walking journeys. Cyclists may also avoid narrow roads and roads with heavy traffic due to personal safety concerns. Other environmental barriers to cycling include a lack of segregated cycling provision and topographic features such as hilly terrain.

• A lack of confidence in active travel modes: Unsafe environments and poor infrastructure discourage people from making active travel journeys.

• Disabilities and health issues: Disabled people and people with health conditions may find it impossible or difficult to make their journeys by active modes of travel. They may not be able to travel far or quickly when walking or cycling. People with disabilities also face challenges caused by unsafe or inaccessible infrastructure such as uneven pavements, a lack of dropped kerbs and antisocial pavement parking.

• Age: Physical activity typically declines with age, as aging is often connected with declining mobility and the development of health issues. Children and young people may also be unable to walk and cycle independently,

These factors show that for many people, making their journeys using active travel modes is not simply a matter of personal choice. Investment into infrastructure to support active travel is necessary to make walking and cycling more convenient, pleasant, and safe for everyone. Further information and details of how walking and cycling will be improved in the future can be found in the Surrey’s Local Transport Plan (LTP4).

• Improvements for pedestrians in our local transport plan

• Cycling improvements in our local transport plan

• Plans to improve walking and cycling

3. Road safety

Whilst the UK has one of the safest transport systems in the world, commitments to reduce harm on our road network remain important so people can travel safely and confidently. Road collisions resulting in death or injury have a devastating impact on victims, families, friends, and co-workers. As well as the pain, grief and suffering endured by those directly connected with road collisions, the wider community and the public are also affected. Many people are concerned about making roads safer through road safety strategies. Reducing the number of fatalities and injuries that happen on our roads is important to ensure that can people remain in good health.

In the annual 'Reported road casualties in Great Britain report for 2024', there were 1,602 fatalities and nearly 28,000 people were seriously injured on Britain’s roads, with vulnerable road users such as motorcyclists, pedestrians, and cyclists most affected per mile travelled. The national Road safety strategy sets out an ambitious plan to reduce deaths and serious injuries on Britain’s roads by 65% by 2035, with a higher target of 70% for children under sixteen.

3.1. Road casualty and injury statistics

Figure 9 shows the total number of fatal road casualties between 2000 and 2022. Whilst there was an ongoing reduction in the number of fatal collisions between 2000 until 2015, in recent years there has not been a continued reduction in fatal casualties.

Figure 9: Trend of total fatal road casualties (2000-2022). Source: Vision Zero' Road Safety Strategy

Figure 10 shows the recorded number of people who have sustained injuries on Surrey’s roads between 2000 and 2022. The location data is used to inform where junction improvements, appropriate speeds and other road safety measures should be implemented to keep people safe.

Figure 10: Trend of total road casualties (2000-2022). Data source: Vision Zero' Road Safety Strategy

3.2. Vision Zero Road Safety Strategy

Surrey County Council's Vision Zero Road Safety Strategy (2024-2025) aims to prevent all traffic fatalities and reduce the number of significant injuries whilst increasing safe, healthy, equitable mobility for all. The Vision Zero Road Safety Strategy revealed that Surrey has some of the highest numbers of pedestrian and cycling road casualties of any local authority in Great Britain. In 2022, 49% of all Surrey's road casualties were located on 30 mph speed limit roads (most of which are in urban areas). In addition to this 81% of pedestrian casualties took place on 30 mph speed limit roads, nearly all of which involved a motor vehicle. Similarly, 69% of cycling casualties took place on 30 mph speed limit roads, with 79% of these resulting from collisions with a motor vehicle. It is clear that road safety strategies should ensure the safety of pedestrians and cyclists where they may interact with motorised traffic.

4. Speed limits

Surrey County Council sets speed limits to ensure that the speed limit is appropriate for the main use of the road and to manage vehicle speeds. Speed limits are regularly reviewed and focus on the areas with the worst speeding and road casualty problems. The desire for lower speeds must be balanced against the need for reasonable journey times and the position of each road within the road network hierarchy.

For more information on how speed limits are set, see the Setting local speed limits policy.

4.1. Lower speed limits for improving road safety

Reviewing, implementing, and ensuring that people comply with existing and lower speed limits is necessary to reduce the number of people killed or injured on our roads. Vehicles travelling at lower speeds are more likely to be able to stop when reacting to hazards on the road ahead. Vehicles also have less kinetic energy to dissipate at low speeds which reduces the braking distance needed to stop. Figure 11 shows the typical stopping distances for a motor vehicle travelling at different speeds. These distances are a guide and depend on the driver paying attention to the road ahead, the road surface, weather conditions, vehicle type, and the condition of the vehicle.

Figure 11: Stopping distances (Rule 126 Highway Code) Source: Department for Transport: 'The Highway Code'

Lower traffic speeds reduce the severity of traffic collisions. People who only sustain minor injuries during a collision can recover quicker and are less likely to have resulting long term health issues or disabilities.

4.2. Lowering speed limits on rural roads

The national default speed limit on single carriageway rural roads without street lighting is 60 mph. This 60-mph default speed limit is inappropriate and dangerous for most rural roads as they often have narrow winding layouts, poor road surfaces, blind bends, limited visibility, and hidden hazards for drivers to react to.

All 60mph national speed limits on rural roads are currently under review to set a more appropriate and lower speed limit considering the use and nature of the road, as well as the speed that most drivers are travelling at. The first of these new speed limits was implemented in July 2023 and the new lower speed limits on these rural roads will be implemented by the end of 2028.

4.3. 20mph speed limit zones

20mph speed limit zones are often used for urban areas, residential streets, near schools, town or village centres and other places where there is significant interaction between pedestrians, cyclists, and motor vehicles. 20mph speed limits are not a blanket approach and are instead a flexible and place-based approach to lower speed limits.

Surrey has among the highest number of pedestrian and cyclist road casualties of any local authority. 81% of pedestrian casualties took place on 30mph speed limit roads, with nearly all of these incidents involving collision with a motor vehicle. Similarly, 69% of cycling casualties took place on 30mph speed limit roads, with 79% of these resulting from collisions with a motor vehicle. In 2022, nearly half of all Surrey's road casualties (49%) were located on 30mph speed limit roads most of which are in built up areas.

20mph zones encourage people to make their journeys by modes of active travel such as walking and cycling. People are more confident to walk or cycle their journeys when vehicles travel at local speeds. This also improves the pedestrianisation, the patronage and visibility of community resources, amenities, and facilities. These benefits help to support more vibrant local communities for better social, mental, and physical health.

5. Transport poverty

Transport poverty is a term used to describe when someone does not have good transport options that are suitable for their needs. Transport poverty occurs when someone is excluded from full participation in economic and social life because they cannot afford travel, lack transport options, or face excessive journey times and physical barriers. Transport poverty is correlated with deprivation and poverty, and the impacts of transport poverty can contribute towards poor health outcomes for the dependants of transport users.

Figure 12 shows the five dimensions of transport poverty which are available, reliable, affordable, accessible, and safe.

Figure 12: The five criteria of transport poverty.

• Available: Transport availability can vary significantly between places, with rural and deprived areas often lacking public transport provision, or irregular services. Everyone should be able to make the journeys they need for employment, education, healthcare, leisure and more.

• Reliable: People should be able to travel with confidence and rely on the transport network to reach their destinations on time. The impacts of disruptions, cancellations, traffic congestion and planned maintenance work should be co-ordinated to minimise travel disruption.

• Affordable: Transport costs should be affordable for households and should not put excessive financial strain on people. Transport is the second highest household cost after housing (Family spending in the UK - Office for National Statistics) and in April 2023 to 2024 saw the largest real-term increase in average weekly household expenditure on goods and services. A recent Surrey Health Determinants Research Collaborative research report(Full Report Preventing and reducing poverty among priority populations in Surrey January 2026) found that amongst unemployed people and people with a learning disability and/or autism in Surrey, transport costs are a key factor in creating financial hardship. Specialist private transport for those with disabilities and their carers is often expensive. In terms of health equity, transport that is unaffordable limits access to health and care, education, training, employment, and social opportunities and exacerbates poverty. People from low-income households may find the initial costs associated with cycling (e.g. the cost of a bike, maintenance, and suitable cycling equipment) as a financial barrier to using cycling as a mode of transport (as per the Poverty Premium). People from low-income households may also be unable to afford the public transport fares. As a result, people from low-income households are more likely to walk, and could benefit from interventions such as free bikes and free or subsidised transport. Fares and ticketing should be simplified, and concessionary fares should provide reduced-cost or free public transport for eligible groups. 

• Accessible: Increasing the accessibility of transport and meeting people’s transport needs gives people real choice in how they travel. For example, many people with disabilities find that transport options do not meet their needs, particularly whilst using public transport options. This includes issues with infrastructure, design of vehicles, navigating stations, using bus stops, finding their way using signage and transitioning between modes of transport and facilities including toilets. These accessibility barriers can make journeys impossible to make or challenging and time consuming. Accessibility must be a core principle of designing transport and travel information should be straightforward and include practical considerations such as whether lifts are working and if there is step-free access. Poor accessibility limits people’s equal access to, and confidence in the transport network.

• Safe: Transport should keep and make people feel safe. This includes reducing the number of deaths and injuries on the network and violence against women and girls (VAWG) (Freedom from violence and abuse: a cross-government strategy - GOV.UK). 

When these five criteria for transport are not met, there are often significant health and social implications that arise when people feel isolated, socially excluded and cut off from opportunities. Specific interventions are needed to address the five criteria of transport poverty. Whilst some of the causes and impacts of transport poverty are beyond the direct influence of the transport system, identifying the places and groups of people who experience transport poverty to reduce health and social inequalities through transport improvements.

Figure 13 shows how transport poverty causes and influences health and health inequalities.

Figure 13: A model of transport poverty: the causes and influences on health and health inequalities. Source: Public Health Scotland

The Department for Transport has published Better Connected: a strategy for integrated transport which outlines the government's long-term strategy for safe, reliable, affordable, and accessible transport for people in England. This strategy will help transport to be more inclusive of people’s needs and will enable greater access employment, education, healthcare, and social activities and other parts of everyday life. This will be achieved through three principles: putting people at the heart of transport, using transport to create better connected places, and working in partnership with local leaders and experts.

The Better Connected Strategy sets out eight priorities,

1. simplify payments and information.

2. provide dependable and safe journeys.

3. make travel accessible and affordable.

4. create healthier communities.

5. align transport and development.

6. champion data and technology.

7. empower local leaders.

8. optimise decision-making and appraisal.

5.1 Transport poverty and mental health

People who experience transport poverty often feel isolated from the opportunities, services and aspects of daily life that support good physical health, mental health, and general wellbeing.

The Joint Strategic Needs Assessment (JSNA) for Loneliness and Social Isolation outlines how loneliness and social isolation are wider determinants of health and wellbeing for Surrey residents of all ages. Loneliness is complex and can be experienced by anyone at any time throughout the life course. The physical environment in which people live can encourage or discourage social connection. For example, well designed urban environments with good walking, cycling and public transport connectivity support social contact whilst people and places which experience transport poverty can feel lonely and socially isolated. The JSNA for Loneliness and Social Isolation identifies public transport and reducing transport poverty as a key structural enabler for tackling loneliness, encouraging social connection and enabling access to opportunities to tackle the prevalence of chronic loneliness and its negative association with health.

5.2. Digital inequality in transport

The digital divide in transport refers to the gap between the people who have access to and can use digital technology, and those that cannot when planning and using transport.

Transport systems increasingly rely on digital tools for travel planning, ticketing, information and accessing discounts and subsidies leaving behind individuals who have do not have digital skills, devices, or internet access. Digital tools include online ticket booking, route planning tools, timetables, and pre-travel information which is important to help people to plan and make their journeys. Timetables and route planning tools benefit from being online, as they can be updated during planned maintenance and disruption. These examples of data and digital connectivity are fundamental to the delivery of an integrated transport network that supports growth, enables safe journeys, and optimises the performance of the transport network. However, there is a risk that people will be left behind if they cannot or would prefer not to use digital tools for transport.

People commonly affected by the digital divide in transport include children, older adults, people with lower education levels, people with disabilities, and people in poverty. These groups may be less likely to be confident in using digital technology without assistance and may not have devices, data, or opportunities to practise digital skills. This limit to accessing and using digital technology when combined with a reduction in staffing across the public transport network, may leave passengers excluded at worst, and confused or unable to complete their journey at best. Passengers who do not receive assistance may use transport less in the future.

6. Transport for access

Access to education, training and employment is strongly associated with better physical and mental health. Connecting people and places has far-reaching wider impacts such as driving economic growth, closing economic disparities, and raising living standards by helping people access training, education, employment, health, care, and other services.

Transport for accessing education and employment is important for all, especially for children and young people and people who are Not in Education, Employment of Training (NEET). At the end of 2025, annual estimates from the Labour Force Survey of young people estimated that the age 18 to 24 NEET rate was 16.0% (783,100) in England. Good transport can reduce the number of people who cannot access the places they wish to go.

6.1. Transport to access employment

There is clear evidence that being in good work improves health and wellbeing across people’s lives and protects against social exclusion (Health matters: health and work - GOV.UK). Employment provides financial stability, structure, social connection, and a sense of purpose while reducing the risk of mortality and limiting long-term illness associated with unemployment.

Transport options which are low-cost, frequent, convenient, reliable and accessible can help people find and remain in employment. Good transport allows people to travel confidently to their place of work and increases the range of employment available to them.

Table 2 shows the average travel time to the nearest employment centre with 500 to 4999 jobs in minutes by local authority area. For all local authority areas, travelling by car is the quickest way to reach the nearest employment centre, followed by cycling and then public transport or walking. Whilst cars are the fastest way to increase the nearest employment centre, the average journey time for using public transport, cycling and walking is not significantly longer. This suggests that public transport, cycling and walking could replace some existing car journeys for commuting without increasing journey times.

Table 2: Average travel time to the nearest employment centre with 500 to 4999 jobs. Source: Surrey Context JSNA Chapter: Population Dashboard

Whilst average travel time to the nearest employment centre does not exceed 15 minutes, most people do not work in their nearest employment centre, and some people lack access to vehicles, cycling and public transport for commuting purposes. In addition to this, Table 2 only shows employment locations with 500 to 4999 jobs, which does not capture people who are self-employed or work in smaller locations with fewer employees. Some reasons why not everyone is able to, or may choose not to work at their nearest employment centre include:

• Local job availability: Some people may not have any suitable job vacancies in their local area for their skillset and competition for roles can be high. High skilled and high-income jobs are likely to be in major employment locations which cluster along good transport corridors or city centres, which can result in long and complex commutes for people outside of these areas.

• Limited access to modes of transport: People travelling to work should have reliable and affordable transport options which allow them to arrive at work prior to their start time and to return home at the end of the working day.

• Not everyone is able to work or faces significant barriers to securing employment: People with disabilities and long-term health conditions may not be able to work or may require specific accommodations and support to access employment. In addition to reasonable adjustments at work, transport plays a key role in enabling people to reach and remain in work (Reasonable adjustments for workers with disabilities or health conditions - GOV.UK).

• People have other commitments that prevent them from work: Many people have dependents that they need to support or care for, which affects their ability to work. These commitments often tie people to a specific area or constrain the times that people can work. Whilst flexible working arrangements do exist; these arrangements are not available to everyone. Shorter, more direct and affordable commuting options transport options can help some people to support their dependents and access to local employment.

6.2. Transport to access health services and care

Everyone should have access to high quality healthcare that gives them the medical help and attention they need. Transport plays a key role in helping people access to health services such as GP surgeries, hospitals, pharmacies, and preventative care.

Evidence is fairly limited on the relationship between transport provision and the utilisation of health services, but poor-quality transport and transport barriers are a contributory cause of missed and cancelled health appointments, delays in care and non-compliance with prescribed medication. This negatively affects the quality of the healthcare provision that a person receives, which in the long term reduces their likelihood of good health outcomes. Prevention and early interventions by healthcare systems improve individual health outcomes, ensures cost-effectiveness, leads to quicker treatment, and helps to develop a sustainable healthcare system.

Access to healthcare services is not geographically even in Surrey. This is partly due to where hospitals and pharmacies are located, but it also reflects existing transport provision. Factors such as distance, low frequency of public transport and a lack of healthcare facilities in a local area, and a person’s ability to use a mode of transport affect people who wish to visit a pharmacy, get long term condition management advice at a GP practice, or attend a hospital appointment.

6.3. Transport to access hospitals and walk-ins

Hospitals are a vital part of the healthcare system and support health by providing critical emergency care, inpatient and outpatient care, surgical treatment, diagnostic and imaging services, and other forms of healthcare. Hospitals operate 24 hours a day, 7 days a week, and 365 days a year. Inpatient wards, emergency departments (A&E), and intensive care units never close, and are continuously staffed.

Some hospital services such as outpatient clinics, elective (planned) surgeries, non-emergency diagnostic imaging, and other services are not open 24/7 and instead operate during standard business hours (e.g. Monday to Friday, 8am to 6pm). These services are important for diagnosing health conditions, providing follow-ups, treatment, and monitoring severe and chronic health conditions. As these appointments are scheduled, most people are expected to make their own way to and from their appointment. Hospital sites need to be connected by multiple modes of transport including walking, cycling, public transport (buses and trains) and private vehicles to allow people to attend their appointments, and for staff to reach their place of work.

In a medical emergency when someone is seriously ill or injured and their life is at risk, call 999 and ask for an ambulance to be taken to hospital. Calling 999 does not always mean an ambulance will be sent and you might be told it is safe for you to make your own way to A&E, or to be seen elsewhere.

Figure 14 shows the areas in Surrey where a person can access a hospital or walk in within an hour when using public transport. More urban areas in the West and East of the county can access these services within 30 minutes. Other areas, particularly in the south, central north have longer times of 30-60 minutes. Long journey times reduce the likelihood that a person can or will go to hospital when they need medical attention.

Figure 14: Map of hospital and walk-ins accessible within a 1-hour journey by public transport.

People in poor health are more likely to need regular or more frequent hospital appointments to manage their health concerns and conditions. People in poor health, and those with disabilities are less likely to be able to use active modes of travel and public transport.

Transport for hospitals needs to be designed in a way that allows most people to attend appointments independently, and for everyone to use modes of transport that suits them. In addition to good transport options to hospitals in Surrey, advancements in delivering care in community settings and digital appointments will make healthcare more accessible than ever before. From 2027, NHS Online will give people the option to receive planned care through the NHS App, including having online consultations and to get advice on managing their condition. Using NHS Online is optional and anyone who prefers face-to-face appointments will continue to use existing services as usual. This advancement in online health services will reduce the need for everyone to attend hospital appointments in-person, reducing overall travel demand. These aspirations are set out in the NHS 10 Year Health Plan for England: fit for the future.

6.4. Transport to access pharmacies

Pharmacies provide essential healthcare services, including dispensing prescription and offering medical advice for minor health conditions. Pharmacies play a crucial role in public health through preventative care such as vaccinations and health screenings, and by providing accessible care for minor illnesses. Their convenient locations and extended hours make them a vital and accessible part of the healthcare system. Pharmacies also function as an accessible information point for general health concerns which reduce pressure on GPs and other NHS services.

Figure 15 shows the distribution of local pharmacies that are accessible within a 20-minute walking distance in Surrey. The existing distribution of pharmacies does not allow most people to walk to a pharmacy from where they live, but many people may visit a pharmacy as part of other everyday journeys, such as shopping or going to work. Urban areas around major towns have more access to pharmacies, with more pharmacies found in the northern part of the county.

Figure 15: Map of pharmacies accessible within a 20-minute walk.

6.5. NHS transport services

Patients receiving NHS non-emergency healthcare are generally expected to make their own way to hospital using their own transport or the range of public, community, or voluntary transport available locally. People may find getting to hospital difficult and some patients may be eligible for assistance on the grounds of either health need or financial need:

Journeys to and from treatment often make a significant difference to patients’ wellbeing, and sometimes their safety and clinical condition. The NHS England offers free non-emergency patient transport services (NEPTS) which provides funded transport where a medical condition means that a patient would struggle to safely attend their treatment independently. This service provides over eleven million patient journeys every year and it often used to support outpatient appointments, dialysis, people over 65 and hospital discharges. NEPTS are subject to eligibility requirements (How to organise transport to and from hospital - NHS), are not available in all areas and requires confirmation from a GP or the healthcare professional who referred you to the hospital to use these services. Due to these barriers, people may not be aware that NEPTS exists as a transport service or may not meet the criteria to receive this support.

NEPTS is an important NHS transport service and can help people who would not be able to travel independently for treatment due to their health needs attend appointments and access timely care. NEPTS also facilitate timely discharges from hospitals, freeing up hospital beds for people who need them. NEPTS allow emergency ambulances to focus on urgent needs instead of non-critical cases.

Non-Emergency Patient Transport Services (NEPTS) costs the NHS an estimated £460 million a year (Final report of the non-emergency patient transport review), which is an average of £38 per journey. This represents about £1 in every £275 spent by the NHS, which is approximately the same as the total cost of radiotherapy. This is a significant financial cost to the NHS. Where possible, enabling people to make their own journeys by investing in broader transport improvements to hospitals, healthcare facilities and pharmacies can result in better health outcomes and fewer missed NHS appointments.

For further information on Non-Emergency Patient Transport Service and the Healthcare Travel Costs Scheme, see Hospital transport information. This Healthcare Travel Costs scheme provides financial assistance to those patients who do not have a medical need for ambulance transport, but who require assistance with their travel costs. This scheme is available for people on low incomes or receiving qualifying benefits or allowances to be reimbursed in part or in full for their travel expenses. The hospital transport information also provides passenger travel information and a list of direct bus services to hospital across Surrey to help people plan their journeys.

The NHS is committed to decarbonising its operations and working towards net-zero and sustainable transport through the NHS Net Zero travel and transport strategy. This strategy will tackle the twin challenges of climate change and air pollution which leads to direct and quantifiable impacts on health while also addressing health inequality.

7. Transport, pollution and air quality

Research into the effects of air pollutants, including those emitted from transport is extensive and provides a statistically significant association between various air pollutants and a wide range of health outcomes. An estimated 30,000 deaths are attributed to air pollution in 2025 (A breath of fresh air: Responding to the health challenges of modern air pollution), and the health impacts of air pollution were estimated to have an economic cost of £27 billion annually in the UK. In the short term, exposure to prominent levels of air pollution over a prolonged period can trigger increased numbers of hospital admissions, adding financial strain to health systems.

According to the Surrey Climate Commission, nearly half (47%) of Surrey’s carbon emissions come from road transport. This has a significant impact upon local air pollution, particularly in urban areas and areas adjacent to major roads where there are traffic and congestion. Surrey has a significant volume of vehicles travelling within and through Surrey on the strategic road network and some of the areas with poor air quality are in proximity to the M25, M3, M23 and A3.

The air pollutants commonly associated with transport include particulate matter (PM₁₀ and PM_2.5), nitrogen dioxide (NO₂), sulphur dioxide (SO₂), and ozone (O₃). These pollutants are linked to adverse health impacts including cardiovascular disease; respiratory conditions; dementia and neurological outcomes, such as Parkinson’s disease. For example, the short-term impacts of nitrogen dioxide include eye irritation, throat irritation, and an increase in the symptoms of respiratory conditions such as asthma and bronchitis. Air pollution also contributes towards premature mortality from cardiovascular disease, lung cancer, and respiratory diseases. Air pollution is harmful to everyone, but the health impacts are disproportionally felt by children, the elderly, pregnant women, and those with existing respiratory conditions.

Transport contributes to noise pollution which is the presence of excessive, unwanted, or harmful sounds in the environment. Examples include vehicle engine noise, tyres on the road surface, trains running on tracks, trains braking and planes passing overhead. Long term exposure to environmental noise can contribute to sleep disturbance, annoyance, and worse overall health.

Surrey County Council will deliver and promote an integrated, accessible, affordable, and reliable public and active (walking or cycling) transport system across the County, thereby reducing journeys made by less sustainable modes of transport and improving local air quality for improved health and wellbeing of our residents. For more information on the health impacts of poor air quality, see the Joint Strategic Needs Assessment for Air Quality and Air Quality by Healthy Surrey. For a list of Air Quality Management Areas (AQMAs) in Surrey where the main source of pollutants in road traffic and air quality modelling, see the Air quality strategy in the Local Transport Plan for Surrey.

7.1 Climate change strategies for transport

Climate change is already underway, and we are already seeing the impacts of higher average temperatures and unpredictable weather hazards and events on transport. Increasingly frequent and severe flooding, heatwaves, storms, and sea-level rise are damaging transport assets, disrupting services, and reducing reliability across transport modes. To enable people to travel with confidence and to reach their destination on time, we need a transport system that is responsive, reliable and operates safely in the face of growing climate risks.

The Climate Adaptation Strategy for Transport by the Department for Transport emphasises the climate crisis is growing more urgent, and the government is committed to decarbonising transport and accelerating progress towards net zero. This strategy sets the long-term strategic direction for adapting the transport sector to the impacts and risks associated with climate change.

Surrey's Climate Change Strategy (2020) identified the need to develop actions to increase Surrey's resilience to climate change. Even if net zero targets are met, Surrey will need to adapt to significant impacts from climate change that are already impacting infrastructure, services, communities, and ecosystems. The Surrey’s 2020 Climate Change Strategy set an interim target of a 60% reduction in transport emissions by 2035 relative to the business as usual.

Surrey's Climate Change Strategy (2020) was followed by Surrey’s Climate Change Adaptation and Resilience Strategy which helps Surrey County Council and its partners to manage climate impacts and risks in a more efficient and coordinated manner. In addition to reducing transport emissions to meet Net Zero aims, transport must continue to operate in extreme climatic conditions such as heatwaves. This strategy applies across all modes of transport, including walking, cycling, public transport and driving. All new infrastructure must be designed to reduce climate risks and be resilient to the impacts of climate change.

8. Transport for children and young people

Children and young people often depend on parents or carers to provide for their travel needs Common barriers that prevent children and young people face include poor infrastructure, inaccessible routes and limited public transport options. Parents and guardians may also feel uneasy about allowing children and young people to make their journeys independently, travel at certain times of the day and use certain routes due to actual and perceived concerns for their personal safety.

8.1. Sustainable Modes of Travel to School Strategy (SMOTTS)

Some of the most important and frequent journeys that children and young people make are to attend school. In Surrey, there are approximately 200,000 pupils across 511 schools, of which 299 are state primary schools, 61 are state secondary schools and 109 are independent schools. Ensuring that children and young people can access education is important because education helps provide the necessary foundation for people to be and remain in good health.

In the Local Transport Plan for Surrey, the Sustainable Modes of Travel to School Strategy (SMOTSS) aims to build children’s confidence in their ability to travel to school and sets out how sustainable modes of travel to school can encourage children and young people to build healthy habits for the future.

This strategy has three key themes:

1. Promotion: highlighting the benefits of sustainable travel

2. Skills and knowledge: providing training and education to improve children's and parent's confidence and ability to travel sustainably and safely.

3. Improving the journey: developing infrastructure and services in support of sustainable modes.

Regular school attendance is associated with longer life expectancy, better health outcomes, and reduced health inequalities through pathways for improved education, employment, and income opportunities. Improving school‑related travel also has wider benefits everyone’s health. Encouraging a modal shift from vehicles to active modes of travel reduces traffic congestion surrounding schools, improves local air quality and helps foster vibrant communities.

8.2. Journeys to primary schools

Access to primary school education helps children to develop the necessary social skills, communication, and independence to prepare for further education. According to the National Travel Survey (2023), 71% of journeys to primary school covering 1-2 miles are made by car even though 81% of people agree there is too much motor traffic around schools. To reduce the number of short journeys, decrease congestion and prevent parking issues around schools, alternatives such as active travel and public transport will need to make up a greater proportion of school-related journeys. This shift away from car dependency is dependent on children and young people, as well as their parents or guardians.

Figure 16 shows the areas in Surrey where a primary school is located within a 20-minute walk. Primary schools tend to be in the urban and built-up areas of Surrey, and not all students will live within walking distance of their nearest primary school. Where possible, children of primary school age should be encouraged to walk to school, accompanied by their parents and guardians, as necessary.

Figure 16: Walking accessibility to primary schools.

Figure 17 shows travel time to the nearest primary school when cycling. Most people in Surrey can access their nearest primary school by cycling in under 20 minutes. However, many children do not cycle for reasons including a lack of safe routes, poor cycling skills, a lack of cycling infrastructure and a need for supervision from a parent or guardian.

Figure 17: Cycle accessibility for primary school pupils.

8.3. Journeys to secondary schools

Secondary school pupils are more capable of travelling independently to school than primary school pupils. Figure 18 shows the average journey time for secondary school students travelling to their nearest school when cycling. The red areas in Figure 18 show journey times between 30 and 40 minutes, and the areas without a coloured overlay show places where cycling times exceed 40 minutes.

Figure 18: Cycle accessibility for secondary school pupils.

There are several reasons why average journey times to secondary school are greater than the average journey times to primary schools. There are fewer secondary schools than primary schools, as secondary schools tend to have more students. Secondary school students are more likely to travel further distances to their nearest school, which increases the average journey time.

Physical barriers prevent secondary school students from taking the most direct route when making longer journeys. Students living adjacent to physical barriers such as major roads (e.g. M25, M3, A24), railway tracks and rivers need to travel around these physical barriers.

Reasons why secondary school pupils do not choose to cycle to school include concerns about their safety whilst cycling, a lack of suitable bike storage and challenging terrain such as hills. In places where walking and cycling to school is not desirable, student rely upon public transport (which can be expensive) or rely upon other people to drive them to school.

8.4. Journeys to Sixth Forms and Colleges

In England, students are legally required to stay in education or training until their 18^th birthday. Sixth forms and colleges support students aged 16–19 through teaching specialised qualifications (including A-levels and BTECs), career advice and university application support (UCAS).

Due to the lower number of sixth forms and colleges compared to the number of primary and secondary schools, students need to make further and more complex journeys to access post-sixteen education sites. Most students will use modes of active travel such as walking and cycling, or public transport to make the majority of their journeys as they cannot learn to drive until they are seventeen. If walking, cycling and public transport are not good transport options, post-16 students may rely upon other people to make their journey.

Figure 19 shows the cycle accessibility of colleges and sixth form schools across Surrey. In the southern parts of Surrey, cycling journeys often exceed 30 minutes, and students are significantly more likely to depend upon public transport services to reduce their journey time.

Figure 19: Cycle accessibility for colleges and sixth form colleges.

Figure 20 shows public transport accessibility for colleges and sixth form schools across Surrey. There are areas in Surrey where it takes more than an hour by public transport to reach the nearest college or sixth form. Accessibility to sixth forms and colleges in Surrey is limited by the lower number of educational sites and the availability of suitable public transport services.

Figure 20: Public transport accessibility for colleges and sixth form colleges

Journeys to colleges and sixth forms are affected by the availability, frequency, and timing of public transport services. Journeys which involve multiple trains and buses can take longer due to the time taken whilst transferring and waiting for services. These journeys can also be costly and unreliable, disrupting school attendance. Whilst it is possible to combine public transport with cycling, public transport often does not allow passengers to bring a bicycle onto services, which limits the opportunity of students using a bicycle to reduce their overall journey time.

Students may find it difficult to regularly attend college due to long journey times and the costs of using public transport. Six percent of 18–24-year-olds have turned down further education opportunities due to transport issues (Access to Transport and Life Opportunities). Young people seeking other forms of education such as university and employment opportunities (e.g. apprenticeships, part-time work, and full-time work) are likely to experience transport issues related to pursuing these opportunities. Students may also prefer not to attend their nearest college or sixth form and instead wish to attend a different educational facility due to the courses on offer and personal preferences. Students who cannot study a course they are interested in due to a lack of transport options to their preferred college or sixth form, or students who have excessively long and inconvenient journeys are likely to experience negative impacts on their wellbeing.

8.5. Reducing childhood obesity through active travel

Children and young people are becoming more sedentary on average, which is causing widespread concerns related to health including the rising rates of obesity and other non-communicable disease such as type II diabetes and the onset of chronic conditions such as high blood pressure, asthma, and joint pain. Obesity in children is also associated with poor psychological and emotional health as children may experience bullying linked to their weight. This bullying contributes towards low self-esteem, worse mental health, and lower school attendance amongst overweight and obese children. The negative effects of childhood obesity can continue into adulthood.

According to the National Travel Survey, in 2024 10% of journeys made to and from school under a mile made by children aged 5 to 16 were made by car (National Travel Survey - GOV.UK), increasing to 51% for stages of between one and two miles. This means that millions of children are losing out on the health benefits of active travel, and the number of vehicles on the road at peak times remains high.

The third walking and Investment strategy (CISW3) recognises the benefits of walking and cycling as active modes of travel that combats sedentary behaviour and can decrease the prevalence of obesity in children. This strategy focuses on enabling millions more children to walk, wheel and cycle to school by providing safe, coherent networks that connect schools, high streets, and homes. This gives children the freedom to walk, wheel and cycle in early life and supports children’s physical and cognitive development. Examples of the habits and health benefits of increasing physical activity in children include:

• Promoting good mental and physical wellbeing to reduce stress.

• Lowering the risk of developing non‑communicable diseases such as obesity.

• Improving sleep, concentration, and cognitive performance.

• Boosting energy levels and improve behaviour in lessons.

Table 3 shows the prevalence of childhood obesity at Reception age (4 to 5 years old) for Surrey. Children living in Runnymede are approximately twice as likely to be overweight or obese as children of the same age group in Elmbridge.

Table 3: Proportion of overweight and obese children aged 4-5 by local authority (Source – Tableau)

Obesity is not exclusively controlled by physical activity and other lifestyle choices such as diet, sleep habits, and environmental influences, such as food access, community design and socio-economic design affect the prevalence of obesity. There are also strong and direct links between deprivation and increased obesity prevalence.

8.6. Our Voice Matters Survey for Children and Young People

The Our Voice Matters Survey (2025) surveyed 435 young people aged 7-25 in Surrey and aimed to empower children and young people to be heard on the issues that matter to them, including transport.

Figure 21 shows how often survey respondents use public transport. Thirty-eight percent of respondents use buses less than once a month whilst 37% use buses at least once a week.

Figure 21: Frequency of public transport use amongst children and young people aged 7-25.

Figure 22 shows which factors that children and young people stated would encourage them to use public transport more often. The most popular reasons provided by both age groups was more affordable tickets and services running on time.

Figure 22: Reasons to use buses and trains.

Figure 23 shows the factors that children and young people (aged 7-25) felt would make cycling safer in Surrey. The most popular suggestion was more cycle lanes, followed by more places to lock and store bikes.

Figure 23: Survey responses for safe cycling (age 7-25)

8.7. Road safety education for children and young people

Keeping children and young people safe around roads is important to reduce the devastating impact of road accidents on children and young people. Children involved as pedestrians in road traffic accidents can incur serious injuries and permanent disabilities that continue to affect their lives in adulthoods.

Road safety education for children and young people is an essential part of the road safety strategy. Surrey County Council offers Feet First which is a walking training programme aimed at children in aged 7-8 (Year 3). This programme helps them develop road safety skills to better enable them to safely walk to and from school with their parents and carers and prepare them for independent travel. This includes teaching children to pay attention to traffic hazards, look before crossing the road, how to cycle safely and to ignore distractions such as mobile phones. The scheme also promotes the benefits of travelling actively to school for personal health and wellbeing, and how walking helps to replace car travel for short journeys.

The Bikeability scheme funded by Active Travel England is designed to equip people with cycling skills, build confidence whilst cycling and build sustainable habits for the future. Bikeability runs cycling lessons for children, teenagers and adults. Bikeability Level 2 is often taught at school for pupils in Year 5 or 6 when they are between 9 and 11 years old. It teaches students bicycle maintenance, how to start a journey and how to turn their bike safely whilst sharing a road with cars. Statistical models examining data between 2012 and 2022 found that there was a statistical association between level 2 Bikeability training and the number of children being seriously injured or killed whilst cycling (New analysis shows a reduction in cyclist KSIs linked to early safety training - Bikeability). This has helped ensure that cycling is more accessible to young people from all backgrounds as over 560,000 children in England got pedalling with Bikeability cycling training between April 2023 and March 2024 (5 million children equipped for happier, healthier and greener future).

As a public health intervention, Bikeability addresses childhood physical inactivity, equips them with vital life skills for enabling good mental health (such as independence, social skills, and a sense of wellbeing) and increased road safety whilst cycling. Both the walking and cycling programmes help children and young people build sustainable and healthy habits for the future as well as ensuring better safety.

9. Transport for older people

People are living longer and transport systems must adapt to better support older people and the travel difficulties they may face. Older people’s transport needs (65+ years) generally focus on maintaining their independence, safety, and access to essential services, particularly as mobility typically declines with age. Older people may struggle to walk long distances, especially in extreme cold or heat, manage stairs, stand for significant periods of time or travel by active modes of transport due to their declining mobility. Accessible infrastructure such as step-free access, maintained pavements, awnings, benches, and water fountains help to support older people making their journeys with or without the use mobility aids.

According to the Healthy Ageing: physical activity in an ageing society report, low levels of physical activity are a major driver of ill health in later life. Increasing movement, especially amongst the least active can prevent the leading causes of death amongst older people, including the onset of frailty, dementia, and disability. Whilst people remain in good health, active travel can delay the onset of poor health. However, transport options for older people must recognise that physically active travel can be unachievable and transport modes such as private vehicles and public transport are a more realistic mode of travel for people with mobility-related challenges and poor health.

Older people are less likely to be confident using digital technology, have a device or skills to access the internet to find real-time travel information, buy or book digital tickets and find accessibility information. Due to this, older people may rely on public transport staff for passenger assistance. Adequate information, alongside staff presence and assistance can help make passengers feel safer when travelling, as well as making journeys easier and more stress-free.

10. Transport for people with disabilities, impairments, and other health conditions

The Equality Act (2010) defines a person as having a disability if they have a physical or mental impairment which has a substantial and long-term adverse effect on their ability to carry out normal day-to-day activities. Disability is a broad term and includes people with a physical or sensory impairments (including mobility and vision impairment), neurodiverse people (including people who have a neurological or learning difference), and people living with chronic health conditions. Disabilities can also refer to physical and sensory conditions such as mobility difficulties, hearing or sight loss, non-visible disabilities such as autism, dementia and anxiety, learning disabilities, and physical and mental health conditions Tailored, flexible, inclusive, and customisable solutions are necessary for disabled people to travel safely and conveniently.

Disability-friendly transport infrastructure helps to enable people with disabilities to travel safely and independently. Common examples of disability-friendly transport physical infrastructure include step-free access, tactile paving, and accessible vehicles. Common examples of digital and sensory design for people with disabilities includes clear audio automated voice and visual displays for announcements, wayfinding tools for route planning, calm spaces, and sensory friendly options. These accessibility improvements not only remove barriers for disabled people but create a fairer and healthier community for all. For example, people using pushchairs, older people with mobility issues, people recovering from injuries, people carrying heavy bags and children all benefit from design choices which improve physical accessibility. Other examples such as better lighting, access to green space and readily available information improve the experience of transport, helping people to live healthier and happier lives.

The Department for Transport has published guidance titled Inclusive Mobility: making transport accessible for passengers and pedestrians to set out how transport infrastructure can support people with disabilities, impairments, and other conditions in their day to day lives. Many, though not all, disabled people face barriers to movement in the environment, and this guidance provides solutions to make transport more accessible. This includes supporting people with mobility impairments, long‑term health conditions, sensory impairments, and decreased mobility to complete their journeys. These improvements are not restricted to public transport, and accessibility should extend to residential streets with well-maintained pavements, safe crossing points, benches, public toilets, and signage. Creating and maintaining an accessible and inclusive public realm along with transport systems is crucial for ensuring that disabled people are not excluded from playing a full role in society. Good transport options enable people with disabilities greater access to employment, healthcare, and social opportunities which can help these people to feel purpose, connection, and stability.

10.1. Experience of using transport as a person with disabilities, impairments, and other health conditions

People with disabilities, impairments and health conditions generally have fewer transport options that meet their needs and therefore have fewer options available for making their journeys. These people use active travel modes such as cycling, and public transport such as trains less than the rest of the population and often rely on other people, private vehicles, and taxis to make their journeys. Due to this, people with disabilities, impairments and other health conditions may only make journeys they consider essential or may not be able to make their journeys at all. Private cars may be the only viable mode of transport, and access to a usable vehicle often provides a significant amount of freedom and independence. Schemes that limit or remove car access and parking need to consider the negative impact this can have for people with a disabilities, impairments and other health conditions.

People with disabilities, impairments, and other health conditions are more likely to report negative and problematic journey experiences. Even when a journey is planned for, a lack of facilities, staff assistance, journey disruption and many other barriers cause anxiety, stress, and frustration.

Examples include:

• Using and moving between services and modes of transport can be difficult and time consuming. People with disabilities, impairments, and other health conditions often need to plan their journey in advance, find relevant information and book staff assistance. Travel disruption, such as late-notice cancellations, engineering works and replacement services, can increase journey times further and disrupt the preparations people have made in advance. Common concerns that reduce travel confidence and independent travel include being stranded during their journey or incurring high costs (e.g. taxis) to complete their journey.

• Reaching public transport and travelling on residential streets can be challenging due to pavement conditions, inaccessible pedestrian crossings and obstacles such as bins, gates, bus stops and benches. This limits short local journeys and access to public transport.

• Public transport can be a stressful experience for people with learning disabilities and autism. Loud noises and busy spaces such as transport interchanges can cause sensory overload and anxiety and travel disruption can feel overwhelming.

• People with cognitive impairments may struggle to make their journeys. Cognitive improvements include intellectual disabilities, learning disabilities, neurodegenerative disorders, and brain injuries. This can affect how people interpret and remember information. This can exacerbate feelings of stress in relation to travel.

• Delays in transport can leave people in significant pain, especially for people who rely upon medication and facilities such as disabled toilets. People may not be able to stand for long periods of time even when using mobility aids such as walking sticks and wheelchairs

For a more in-depth review of how disabilities, impairments and other health conditions affect people’s health in regard to transport, see the following sources of information.

• Access denied: rights versus reality in disabled people's access to transport provides an evidence-based review that finds that accessibility failings in transport are systematically ingrained across modes and have a significant negative impact on people’s lives. The evidence from disabled people shows that there is still a very substantial gap between the rights and obligations that exist in theory, and the daily experience of people who rely on pavements, buses, taxis, trains and planes to get to work, to access services or for leisure. This emphasises how failings are having a significant impact on the lives of disabled people.

• An evidence review of lived experience of disabled people in the UK was published in 2025 and established evidence published between 2010 and 2021 on the lived experience of disabled people in the UK. One of the thirteen themes identified was transport, and it was recommended that minimum standards and guidance on the accessibility of facilities and services along appropriate training, information, signage, and assistance would support independence and equal access to transportation.

• For more information on the relationship between disabilities and health, see the Joint Strategic Needs Assessment (JSNA) for People with learning disabilities and Joint Strategic Needs Assessment (JSNA) for Children and Young People with Additional Needs and Disabilities | Surrey-i

10.2 Improving transport for people who are blind or have visual impairments

Public transport is vital for people who are blind or have reduced vision as they are unable to drive and consequently tend to rely on public transport, taxis, and other people to make longer distance journeys. Shorter journeys can still benefit from accessible infrastructure such as pavements without obstacles, tactile paving, and signalised crossings.

People who are blind or have visual impairments often have difficulty in using public transport services and may use or rely on tools such as white canes, guide dogs, and GPS apps to help them navigate their environment. Even with these support tools, people who are blind or have visual impairments often require additional support to maintain their independence. This can include relying on passenger assistance services and carer support to make their journeys.

The Aira Explorer app offers blind and partially sighted people in Surrey tech-assisted and real-time navigation at key transport hubs, The app offers video calls with agents for guidance between bus stops and nearby train stations, reading timetables, and locating facilities at locations including rail stations at Caterham, Dorking, Oxted, Leatherhead, Epsom Station and Clocktower, Reigate and Horley, and bus stations in Guildford, Staines, Redhill, and Woking. This technology provides real-time support via a video call with a trained visual interpreter on speakerphone, complementing other assistive tools like screen readers (JAWS) for general digital access and specialized low-vision devices. All app usage at these locations is free of charge, provided by Surrey County Council using some of its allocation from the Government’s Bus Service Improvement Fund. This app aims to make travel more accessible for people with reduced sight and help people build travel confidence whilst using buses and trains.

11. Transport in rural areas

People who live in rural areas often need to travel further distances to reach employment centres, healthcare, shops, services, and leisure destinations as these popular destinations are not always close to where they live. Transport challenges and issues experienced by people living in rural areas can include a lack of or less frequent public transport provision, a lack of pavements on some rural roads and a lack of safe cycling infrastructure on rural roads. These issues reduce the number of people who are able to make their journeys by public transport or active modes of travel. People living in rural areas are more likely to depend on a personal vehicle for making these journeys due to a lack of suitable transport alternatives. Figure 24 shows the areas categorised as urban and rural areas in Surrey. Waverley is largely rural, Mole Valley and Tandridge are urban areas with significant rural areas, Surrey Heath, Reigate and Banstead and Guildford are urban areas with cities and towns, Elmbridge, Epsom and Ewell, Woking, Runnymede and Spelthorne are urban areas with major conurbations.

Figure 24: Rural-urban classification by ward. Source

Urban areas are more likely to have frequent public transport services as these services are more financially viable to operate. It is difficult to provide cost-effective and frequent transport solutions in rural areas due to low-density and dispersed populations.

For people living in rural areas, they may need to travel to other areas of Surrey, including urban areas to access key destinations including employment centres, healthcare, shops, services, and leisure destinations. Major destinations are also more likely to be in urban areas or other built-up areas. Section 6.5 in the JSNA for Multiple Disadvantage identifies that a lack or reliable and affordable transportation can be a significant barrier for people living in rural or underserved areas. For those who rely on public transport to attend appointments and to access services, they often find public transport options to be infrequent, indirect destination, unaffordable and unreliable.

12. Walking

Walking is often the simplest and most direct way for people to get to places in the local area. Walking is free and according to data from the Health Survey for England, is one of the main contributors to total physical activity across all age groups in the population. As walking is an active mode of travel, it can support better physical and mental health through the benefits gained from exercise. Walking can make you feel good, give you more energy, reduce stress and improve sleep quality.

Walking creates places where people want to spend time. Good walking routes should have safe road crossing points, continuous footways, well maintained surfaces, street furniture such as planters, awnings and benches, street lighting, and green/blue spaces. Missing or disconnected footpaths, limited crossing opportunities, fast traffic, and poor street amenities can make walking a less desirable option, particularly for children, older people, and people with disabilities.

13. Cycling

Cycling is a convenient and often the most-time efficient way to travel short and medium distances that cannot be walked quickly. Cycling is often a popular mode of transport in urban areas for short journeys and amongst people who do not have access to a private vehicle or good public transport.

Cycling supports health and wellbeing as it is an active mode of transport that allows people to integrate regular physical activity into their everyday journeys. Cycling is also an environmentally friendly mode of transport that can replace short trips made by car, reducing car-related impacts such as emissions and congestion on the road traffic network.

Maintaining and expanding cycling infrastructure through ongoing financial investment is important for the long-term success of cycling. Cycling networks must be easy to join, comfortable and safe and give attention to minimise road danger, delays, and detours. Achieving a functional network for cyclists in urban areas needs a willingness to prioritise cycle traffic, improving cyclist safety and focusing on high quality outcomes for long term value.

Investments in the cycling network need to be supported by facilities such as improved signposting, seating, and secure cycle parking. Supporting facilities can make cycling easier, more accessible, and more attractive. Key locations for improving cycling infrastructure include train stations, hospitals, town centres, near bus stops, retail centres, and near employment hubs and schools. These facilities support regular cycle journeys and increase the uptake of cycling. An effective strategy for increasing cycling includes integrating cycling into public and private transport journeys.

13.1 Common issues experienced by cyclists

Table 4: Summary of cyclist dangers.

13.2. Opportunities to increase cycling

• Electric bikes allow people to navigate hilly terrain and travel further distances with less physical effort than a standard non-electric bike. This increases the viability of longer journeys to be made by bike and helps people with lower levels of general fitness to cycle more often.

• Cycle to work schemes are a government-backed salary sacrifice incentive allowing UK employees to save money on bicycles and safety equipment for commuting. This is open to most employees and encourages active travel.

• Cycle training encourages people to feel more confident when cycling. Increasing the uptake of cycling across all age and population groups requires people to be and feel safe whilst cycling.

• Bike rental schemes allow people borrow a bike for free. The Department for Transport has partnerships with bike charities and companies like Halfords, Frog Bikes and Bike club. These partnerships give bikes to children who face financial barriers, live in rural areas where a bike is useful or live in a more deprived geographical area. In Surrey, Borrow Bike is a free service offered to library members that allow people aged 18+ to borrow a bike for up to 10 days. This scheme aims to increase accessibility to bicycles, reduce the need to use public transport, eliminate petrol expenses and to introduce people to cycling who may have not used a bike before. This service is currently offered at Ashford Library and Chertsey Library. All bikes are regularly maintained by a qualified bike mechanic and there are basic tools to repair bikes in the bike shelter.

13.3. Challenges for increasing cycling

• Cycle schemes can receive significant opposition from the general public. Some people do not want to see public money spend on cycle lanes due to scepticism about whether cyclists will use these cycle lanes, a generalised anti-cyclist attitude and the belief that investing in cycling is a “waste of money.” This discourages investment into cycling and can cause local authorities to hesitate or proceed cautiously with cycling infrastructure. This can result in the cycling network being poorly maintained or not expanded, decreasing overall levels of cycling.

• Some people do not have access to a bicycle. Whilst bikes have a lower upfront and maintenance costs than motorised vehicles, cycling has an entry cost that does not exist for walking. Not having access to a bike can be a major barrier for people who experience socio-economic disadvantage. However, the higher rate of cycle ownership than cycle use suggests affordability is not the only barrier to widespread cycling use.

• Not everyone has the same ability to travel by bicycle. Some people do not have the necessary level of physical fitness to use and cycle longer distances on a bike. Personal preferences, such as a reluctance to cycle at night limits the journeys that cycling trips can replace.

• Not everyone feels safe whilst cycling. Cycle infrastructure should be designed in a way that helps people feel safe and confident whilst cycling, regardless of age and cycling ability.

14. Public transport

Public transport is essential for economic growth, helps people access key destinations and makes longer distance journeys possible. Nearly a third of the adult population do not have personal car access and are reliant on public transport or other modes of transport such as walking and cycling. People with access to vehicles also use public transport for local journeys and to travel to places where vehicles and parking are restricted or limited.

Public transport reduces traffic congestion by reducing the number of other vehicles on the strategic road network, lowers household transportation costs, and promotes healthier lifestyles through increased physical activity from walking or cycling to bus stops and train stations. Public transport also enables sustainable development and employment opportunities.

Improvements to public transport include improving the frequency of services, improving journey time reliability, simplifying ticketing and fares, ensuring affordability, improving accessibility and other improvements which improve the quality of people’s journeys.

14.1 Buses

Regular bus services connect residential areas and local towns, enabling people to make longer journeys to access employment opportunities, education, healthcare, shops, services, and social networks which are important for supporting health and wellbeing. Buses support good health by providing affordable and reliable access to places, and many bus journeys include a rail or walking component, which increases public transport use and active travel. Overall, affordable fares and high-quality bus networks reduce the use of less sustainable modes of transport and buses are useful for making local journeys.

The Access to Transport and Life Opportunities study prepared for the Department for Transport in 2019 identified which population groups are more likely to travel by bus. Bus usage is summarised in Figure 21.

Figure 25: Bus usage by population group. Source: National Centre for Social Research (NatCen)

25% of the adult population in the UK uses a bus at least once a week. Buses are used most frequently amongst people with no personal car access (54%), people of working age and not in employment (44%) and young adults ages 16 – 24 (41%). Only 15% of people with mobility impairments use a bus at least once a week which is lower than the UK average of 25%.

The Surrey Bus Service Improvement Plan (BSIP) aims to increase bus use by increasing average journey speed, improving reliability, increasing passenger numbers, and increasing average passenger satisfaction. The BSIP includes new services (on evenings, weekends, Sundays, and overnight), more frequent services, new or extended bus routes, fare caps, and plans for zero emission vehicles to support the goal to decarbonise transport. These improvements help to reduce transport poverty, and affordable and subsidised bus fares significantly improve transport connection amongst lower-income groups.

14.2 Trains and railways

Rail supports health by encouraging people to make longer journeys through public transport and active travel modes (e.g. walking and cycling to their nearest station) instead of private vehicles. Railway stations facilitate longer journeys, especially amongst people who cannot, or do not have access to cars. Rail services provide non-driving populations with scheduled services for making longer distance journeys, as well as enabling better access to healthcare, employment and leisure which are important wider determinants of health.

Improving rail transport is important for health as it encourage daily movement and connects people with essential medical and social services. Rail transport should be designed to be inclusive and comfortable to allow as many people as possible to use this mode of transport. This includes ensuring that the design of stations and trains are optimised for passenger accessibility and comfort, so that services run efficiently and match passenger demand to avoid overcrowding on services.

The Surrey Rail Strategy (2021) sets out how rail can contribute to a greener future, a more sustainable economy, empower communities and tackle health inequalities. The strategy sets out the baseline position of rail use in Surrey in terms of the network, stations, operators, and services. The strategy also outlines engagement with key stakeholders in business, user groups across districts and boroughs, organisations representing disabled people and relevant bodies such as Transport for the South East and Network Rail.

The Surrey Rail Strategy sets out five long-term strategic aims which the rail network can assist in delivering over the next 30 years.

1. Achieving transport decarbonisation

2. Responding to change in the rail sector

3. Encouraging good growth and a sustainable economy

4. Increasing access for all

5. Developing an attractive, high quality rail network by developing the case, influencing stakeholders, directly supporting schemes and monitoring delivery.

In addition to these longer-term objectives, the Long-Term Rail Strategy from the Department of Transport sets out five strategic priorities for the long-term planning of railways. These five objectives have been tested with stakeholders, including through extensive engagement in 2022, to ensure they will be resilient and useful in the long-term strategic planning of our railways.

1. Meeting customers’ needs

2. Financial sustainability

3. Long-term economic growth

4. Reducing regional and national inequality

5. Environmental sustainability

On 5th November 2025, the Railways Bill was introduced before Parliament. This landmark legislation will enable the creation of publicly owned Great British Railways (GBR). This programme will transfer rail services into public ownership and establish GBR as the body responsible for passenger services and infrastructure as a first step towards wider rail reform. Instead of having to navigate fourteen separate train operators, passengers will once again to use the railway as one system, by travelling on GBR trains, running on GBR tracks, and working to a GBR timetable. The railway will be run by a single body which will result in fewer delays, a better transport experience and a timetable that serves people’s needs. Some planned upgrades include new trains, increased capacity, extra services, reduced ticket prices, and investment into technology.

GBR is expected to be operational around 12 months after the bill receives Royal Assent. Once operational, it will take on responsibility for coordinating the entire rail system, marking a fundamental shift away from the fragmented model introduced during privatisation. The renationalisation of passenger services is expected in 2027.

15. Airports and aviation

Living near an airport can have positive and negative effects on health and overall quality of life. Surrey is located between Heathrow Airport in the London Borough of Hillingdon and Gatwick Airport near Crawley in West Sussex which are two of the world’s busiest international airports. Many Surrey residents are employed in jobs linked to the airports and international transport accessibility is important for Surrey's economy and prosperity. Airports are highly significant economic centres and attract important global business investment.

The Parliamentary Office of Science and Technology (POST) published the health impacts of airports on local residents in May 2026. The main adverse effects of living near an airport on health are poorer air quality and exposure to aircraft noise. Globally, 16,000 premature deaths per year can be attributed to civil aviation-related air pollution, with one third of these deaths occurring in people living within twenty kilometres of airports.

There is strong evidence that noise associated with airports impacts health. This includes:

• annoyance (such as disturbance, irritation, and nuisance).

• mental health (such as depression and anxiety).

• sleep disturbance.

• cardiovascular diseases, including heart disease, stroke, and heart attacks.

• metabolic conditions, including type 2 diabetes.

• premature mortality.

Airports generate air pollution from several sources, including the aircraft themselves, on-site energy consumption, equipment, on-site vehicles, and airport-related traffic on surrounding roads from staff, passengers and freight movement. Residents may also be exposed to continuous air and noise pollution from airports and associated infrastructure. Air pollution and noise pollution can both have significant impacts upon health whether experienced in the short or long-term.

There is a need to engage proactively on future airport capacity to ensure impacts within the county are considered and addressed. The Department for Transport is responsible for setting national policies and long-term plans for aviation. The primary focus of Surrey County Council will continue to focus to be on the need for investment in infrastructure to precede any development as well as effective mitigation of the detrimental effects of expansion on Surrey residents and local businesses. Further information on aviation in Surrey can be found at Aviation and airports in and around Surrey.

16. Multimodal journeys

Multimodal journeys are when a person uses more than one mode of transport such as walking, cycling and public transport to complete their journey. The most common type of multimodal journey combines active travel and public transport, such as when people walk and cycle as part of a longer journey that involves travelling by train.

Multimodal journeys support healthier and more sustainable journeys, however improving multimodal journeys come with several challenges. Multimodal journeys rely upon a person being confident in using different types of transport modes, transport networks need to be connected, and transport information such as signage, schedules and ticketing need to be easy to understand.

Multimodal journeys can be increased by ensuring that stations and other interchange hubs are linked by safe, high‑quality walking and cycling infrastructure to help people make door‑to‑door journeys. Clear information, reliable timetables, and accessible journey‑planning tools also help people to plan and make complex multimodal journeys. Where possible, increasing the frequency of public transport services and ensuring that timetables align (to prevent long waiting and transferring times) makes journey more seamless. Making multimodal journeys more convenient, attractive, and affordable can lead to improved physical and mental health, reduced traffic congestion, and lower transport‑related emissions.

For a research and analysis of the factors affecting people’s decision to use combined public transport and their views on changes that could make these trips more appealing see Factors influencing multi-modal public transport use.

17. Cars and other vehicles

Cars and other vehicles offer a convenient way for people to travel further distances and connect their users to various amenities, services, employment, recreation spaces, and social networks. Private vehicles are often the most convenient and fastest way to make many door-to-door journeys and are a popular mode of travel for journeys not well served by other modes of transport. The popularity of car use has resulted in many people making their journeys by car as their default and preferred mode of travel, which has led to people living more sedentary lifestyles, which evidence links to poorer health outcomes.

Car use is associated with physical, social, and ecological harms. Prioritising the convenience of car use has had several further negative impacts for Surrey in terms of carbon emissions, local air quality, the environment quality of public spaces, physical fitness and health, and equality of access to opportunities and amenities for those without a car. Motorised transport is associated with air pollution, noise pollution, greenhouse gas emissions, injuries, physical inactivity, stress, and cross-community routes, all of which negatively impact health. Due to this, the UK government is taking steps to phase out widespread car usage and invest in alternatives healthier modes of transport.

17.1. Car dependency

Car dependency occurs when journeys cannot be reasonably accommodated by other modes of transport or when car use is perceived as the best and most convenient ways for people to make their journeys. This can include the ability to make journeys directly and quickly, to travel in comfort (e.g. avoiding poor weather, travelling in the dark and the comfort a private vehicle offers).

People who have convenient access to a private vehicle will often choose to make the majority of journeys by car, even when their journeys only cover short distances or where good public transport and active travel options exist as alternatives. Many people would argue their car is an essential component of their lives that they would be reluctant to live without. This is underpinned by a wider car culture in which car use is perceived to be the default way to travel for all journeys.

Reducing car dependence involves transitioning travellers from private vehicle use to sustainable alternatives like public transport, cycling, and walking to reduce emissions and congestion. People can be encouraged to use their cars less by using local shops and facilities, walking, and cycling shorter journeys, combining short trips into longer journeys, and altering the timing and frequency of journeys to avoid traffic congestion. The negative impacts of widespread car use can also be reduced by encouraging people to share vehicles, use smaller vehicles, use electric or hybrid vehicles and parking further away from their destination, and completing their journey by walking. Reducing car use supports active travel, reduces congestion, improves air quality by through reduced vehicle emissions, and reduces the casualties and injuries associated with road traffic.

It is likely to be necessary to increase the costs of car travel through effective strategies such as parking restrictions and improve the quality and affordability of other modes of transport. Recognising the wider negative impacts of cars helps support meeting the objectives of the Local Transport Plan for Surrey (LTP4). For more information about decreasing car dependency see the demand management for cars policy area.

17.2. Household car access

People who do not have access to a vehicle in their household may find it difficult and time consuming to reach many destinations such as out-of-town shopping centres if these places are not as well served by other modes of transport. A lack of household car access does not always affect health negatively, as making journeys by public transport and active travel can have several positive impacts on health.

Figure 26 shows that every district and borough in Surrey has a higher level of household access to a can or van that the Southeast and England average. Spelthorne and Woking have the highest percentage of households with no car or van availability (14.7%) and Surrey Health had the lowest percentage of households with no car or van availability (9.9%). For an interactive map version of Figure 26, see car or van availability from the 2021 Census.

Figure 26: Households with no car or van availability (2021) Surrey-i: Car or van availability from the 2021 Census

Figure 27 shows that there is significant variation in household access to cars within boroughs and districts across Surrey. The percentage of households without access to a car or van ranges from 1.2% to 48.2%.

Figure 27 also shows the priority neighbourhoods identified in Surrey’s Health and Wellbeing Strategy (2022-2026). The Strategy’s Key (priority) Neighbourhoods are the electoral wards that encompass the most deprived Lower Super Output Areas (LSOAs) in Surrey (deciles 2 and 3 of the Index of Multiple Deprivation, 2019, since updated). The priority neighbourhoods geographically overlap with lower levels of household car availability, which could indicate a need for improved transport in these areas to reduce levels of deprivation.

Figure 27: Surrey household access to a car or van.

There are many factors that affect household access to cars, but there is a clear trend for car access to be lower in urban areas and significantly higher in rural areas. Lack of personal car access is more common amongst young adults, those with mobility impairments, unemployed people, and those with low incomes (Access to Transport and Life Opportunities).

17.3. Parking

There is an expectation amongst the general public that parking should be located as near to amenities, services, employment, recreation spaces, and other destinations as possible. Historically, the design of our towns and cities have focused on car access, which has resulted in significant space being dedicated to the road network and parking. Continuing to prioritise infrastructure for cars and other vehicles will increase the proportion of journeys made by car, which can decrease the quality of the public realm and reduce the number of journeys made by active travel modes.

In the annual National Travel Attitudes Survey, 70% of people polled were in favour of reducing motor vehicle use in urban areas for the sake of public health. Reducing the use of cars and supporting a modal shift towards active travel and public transport could be achieved through measures such as reducing parking availability, implementing parking restrictions, permitting development without dedicated parking spaces, and charging for parking, congestion charges and creating limited traffic zones.

One common approach to managing parking and vehicle access in urban and built-up areas is to relocate parking away from central areas to discourage car journeys in the busiest places, and to invest in public transport and active travel in its place. However. initiatives that reduce people’s ability to park and drive where they want to are often politically unpopular or are perceived as unfair to existing car users. Removal of parking can be contentious, especially when located close to businesses, services, and residential areas, and in places where parking demand exceeds limited availability. Local businesses may also reject plans and express their concerns about any parking removal near retail premises as this could affect trade whilst residents wish to park near to where they live.

Some parking does need to remain as not everyone has the ability to use other forms of transport. Parking supports longer journeys, people who cannot use other modes of transport and people with disabilities. Parking is therefore needed in a variety of place including residential areas, healthcare facilities, supermarkets, shops, and other services.

Evidence suggests that in appropriate circumstances, removing parking and increasing pedestrianisation is good for business and can result in people staying longer and spending more at a local level. People are more likely to get sufficient physical activity if they live in walkable communities, and reducing the dependency on vehicles has several health benefits.

It remains a question of whether vehicle and parking initiatives like these are strong enough to change existing car use behaviour and discourage people from buying and using cars as they do at present. Any alteration or removal of parking should be carefully considered and justified to meet the objectives contained in Surrey’s Local Transport Plan.

17.4. Impact of vehicles on spatial planning

Economic development and spatial planning decisions influence the location of employment opportunities, schools, nurseries, shops, hospitals and health centres, parks, amenities, and services relative to places of residence. All of these destinations need to be served by appropriate transport options.

Historic approaches to spatial planning, transport and urban design have caused high levels of vehicle use and car dependency by making car use more convenient and attractive over other considerations for several decades, at the expense of other transport modes. This desire to use private vehicles has resulted in vehicles dominating all roads, making them less attractive for other uses such as walking, cycling, and socialising. Widespread car use and demand have also resulted in a significant amount of space in urban areas to be allocated to parked cars, which disrupts the use of central public space for other uses.

Transport, housing and wider land use planning are often considered in isolation, leading to developments that lack good public transport and safe walking, wheeling, and cycling routes. Widespread car usage has also affected the location and design of common destinations such as places of employment, education sites, retail parks, and leisure facilities to be located at out-of-town locations, away from where people live. These sites were originally selected due to lower land values in out-of-town locations, and the availability of larger sites for development. People have to travel further and longer to access these destinations, increasing journeys made by car. People who cannot, or do not have a vehicle may find it difficult to reach their destination, which reinforces car dependency and creates barriers for achieving a sustainable modal shift away from cars. Overall, historic approaches to spatial planning have fostered a car culture which has long-term negative health and wellbeing implications.

Figure 28 shows the cycle of how spatial planning decisions for transport which prioritise car use have a negative impact upon the viability of other modes of transport and the public realm. This cycle is difficult to break, and remaining in this cycle reduces opportunities to improve public transport and active travel in existing communities.

Figure 28: Spatial planning impacts of prioritising vehicle use cycle.

A joined-up approach between transport and development is necessary to unlock the full potential of places. Transport supports a vision-led approach to planning, including building at higher densities around public transport, and ensuring connectivity across transport systems. When this densification is combined with high-quality walking and cycling infrastructure, places and infrastructure can support healthier lifestyles.

17.5 Electric vehicles

The Surrey Electric Vehicle Strategy identifies opportunities for the deployment, implementation and integration of electric vehicle infrastructure to increase the usage of electric vehicles. Surrey County Council will work with partners to deliver the necessary infrastructure that supports the transition from internal combustion engine (ICE) vehicles to zero-emission vehicles (ZEVs) or electric vehicles (EVs). This strategy includes providing convenient access to both rapid and slower charging infrastructure in residential areas, retail centres, leisure spaces and transport interchanges such as stations and mobility hubs. This ensures that users of electric vehicles have efficient, convenient and affordable charging options. Since 2019, Surrey County Council has been rolling out public charging points across the county to enable EV ownership, particularly in areas with limited off-street parking. In 2020 there were only 6 on-street charge point sockets across Surrey. By October 2024, there were over 200 EV charge points sockets installed on behalf of Surrey County Council.

Electric vehicles offer many of the same conveniences as other petrol and diesel vehicles and allow their users to make their journeys in a similar way to which they may currently use motorised vehicles. However, electric vehicles do not produce exhaust emissions and make less noise than motorised vehicles. This leads to significant improvements in some aspects of local air quality and reduces noise pollution, improving local street environments and the health and well-being of residents.

A rapid uptake of electric vehicles in Surrey is needed to meet carbon reduction targets, improve local air quality, and reduce noise pollution. Much of the change will depend on action at a national level (critically the government's petrol and diesel new car and van sales ban in 2030 and the automobile industry's response). Petrol and diesel vehicles will remain on the roads during the 2040s and beyond despite the UK government’s commitment to phase out the sale of petrol and diesel cars by 2030. Electric vehicles do not solve many problems associated with car use including congestion, road safety, and the social inequality implications of lack of accessibility for those unable to use or afford cars.

Surrey County Council will continue to support widespread electric vehicle charging infrastructure and accelerate the uptake of electric and zero emission vehicles whilst working towards other objectives in the Local Transport Plan for Surrey (LTP4). More information on how electric vehicles fit into the Local Transport Plan (LTP4) is available in the Promoting ZEVs policy area.

18. Local Government Reorganisation (LGR)

The government has confirmed Local Government Reorganisation (LGR) in Surrey, with two new unitary councils – East Surrey Council and West Surrey Council; replacing the current twelve councils (Surrey County Council and eleven district or borough councils) from April 2027.

• An East Surrey unitary authority will replace the current areas covered by Elmbridge, Epsom and Ewell, Mole Valley, Reigate, and Banstead, and Tandridge councils.

• A West Surrey unitary authority will take over the areas of Guildford, Runnymede, Spelthorne, Surrey Heath, Waverley, and Woking.

Figure 29 shows how Surrey will be divided into the new unitary councils of East Surrey and West Surrey which combine county and district or borough services into a single level of government.

Figure 29: Map of East and West Surrey

For up-to-date information on devolution and Local Government Reorganisation (LGR) in Surrey, visit the Future Surrey website.

19. Recommendations

Transport and health have complex interactions and an appreciation of their connected nature, combined with a Health Equity in All Policies approach to transport decision-making, will aid in the development and delivery of a more coordinated approach to transport planning, and health. The Local Transport Plan (LTP4) for Surrey sets out the long-term plan to create a safer, accessible, and better-connected transport system, to empower thriving communities, reduce health inequalities and ensure no-one is left behind. 

Transport can significantly influence health and wellbeing by:

• Improving access and accessibility to the places where people need to go to thrive, including education, employment, services, retail, leisure facilities, social networks, housing, and homes, especially for those experiencing socio-economic disadvantage and health inequalities.

• Influencing the quality of the built urban environment and supporting healthy placemaking.

• Addressing the social and economic determinants of health through improved connectivity for all communities.

• Encouraging healthier travel options and increasing physical activity levels through active travel.

• Addressing environmental determinants of health through climate change mitigation, noise reduction, and improved air quality.

The Joint Strategic Needs Assessment (JSNA) for transport has five key areas for improving health and wellbeing outcomes and reducing health inequalities through transport and transport planning.

1. Encourage Active Travel

• Expand walking, wheeling, and cycling infrastructure through Local Cycling and Walking Infrastructure Plans (LCWIPs) to make active travel safer and more convenient, especially in places where people have poorer health outcomes.

• Integrate active travel into planning related activities by prioritising walkable and bikeable communities and reducing car dependency for short trips.

• Embed health into transport planning to support alignment and coordination of transport planning and the Surrey Health and Wellbeing Strategy.

• Deliver public campaigns and travel planning tools to highlight the mental and physical health benefits of active travel and to encourage daily active travel for adults, children, and young people.

• Encourage daily active travel for children and young people to support concentration, behaviour, and long-term healthy habits.

• Develop methods to monitor and evaluate the health impacts of active travel to create a cost-benefit evidence base.

2. Use transport planning to improve connectivity for communities as part of a whole-system approach to healthy place-making

• Improve the integration of walking, cycling and public transport networks to support and simplify complex multimodal journeys to reduce excessive journey times, and ensure that key destinations such as education, employment, retail, community services, and healthcare are reachable within a reasonable time to reduce reliance on cars.

• Address transport poverty by ensuring that transport options are available, reliable, affordable, accessible, and safe to prevent social exclusion and improve quality of life.

• Improve the accessibility of public transport (step-free access, seating, clear signage, for example) and ensure that transport options are flexible and customisable for people with long-term health conditions, physical disabilities, or sensory impairments.

• Follow the Department for Transport’s roadmap to an accessible railway to deliver improvements including more step-free stations, improved passenger assistance, clearer travel information, a simpler and fairer ticketing system, and stronger performance monitoring. Accessibility is an important part of supporting passengers to travel independently, safely and with dignity.

• Increase supply and improve the quality of demand-responsive transport and community transport schemes to improve access to amenities and services, reduce loneliness and social isolation, and improve health outcomes for rural communities. 

• Address the impact of transport costs on people in poverty by considering subsidised fares or targeted discounts and by integrating the Foundation Framework for Enabling a Whole System Approach to Poverty into transport planning.

3. Reduce harmful emissions and improve air quality

• Implement measures to reduce private car usage, such as promoting local shopping, car trip consolidation, and school active travel.

• Accelerate the transition to electric vehicles (EVs) by expanding charging infrastructure and supporting zero-emission fleets, while acknowledging EVs do not solve congestion or accessibility issues.

• Align transport planning with Surrey’s Climate Change Strategy, Surrey Air Alliance objectives and NHS net zero strategies to mitigate against the harmful impacts on health and health inequalities of a changing climate.

4. Address car culture and enhance road safety

• Align transport decision-making with Healthy Streets for Surrey policy and guidance.

• Reduce risks to pedestrians and cyclists by collaborating with road safety teams to target drivers with road safety awareness.

• Reduce risks for children and young people near roads through infrastructure improvements around schools and road safety awareness. 

5. Collaborate with communities

• Build relationships with communities to understand travel-related attitudes, experiences, and behaviours.

• Co-produce with priority populations tailored interventions to improve access to public transport, promote active travel, and encourage local communities to support sustainable transport options.

• Consistently apply behaviour change principles and health psychology to community interventions to reduce reliance on car use.