important, so volunteer doctors, identified by specialty,
could be a valuable local resource.
The Advisory Group on Medical and Dental
Education, Training and Staffing (AGMETS) has estab-
lished a working group on refugee doctors, and the
opportunity now exists for the NHS as an institution to
address the needs of this group of doctors. Equally
important will be the contribution of individual
doctorswillingto actas mentorsorprovide
educational opportunities. With many small changes
there is the potential to change individual hardship
into healing for many.
Kate Adams senior house officer in psychiatry
City and Hackney Community Services, London N1 5SL
Edwin Borman consultant anaesthetist
Walsgrave Hospitals NHS Trust, Coventry CV2 2DX
(Accessed 5 Jan 2000.)
Home Office. Consultation paper on the integration of recognised refugees in
the UK. London: Home Office, 1999.
Roche B. Hansard Written answers 26 October 1999:p 837, col 95885.
fromHome Office. www.homeoffice.gov.uk/index.htm
4Home Office. Consultation document on the main regulations under part VI of
the Immigration and Asylum Act (1999). London: Home Office, 1999.
Berlin A, Gill P, Eversley J. Refugee doctors in Britain: a wasted resource.
Cycling and health promotion
A safer,slower urban road environment is the key
body is made to exercise, yet our increasingly
motorised existence means that we now walk an
average of eight miles less each day than our forebears
50 years ago.2Cycling has shown a similar decline: in
1949 34% of miles travelled using a mechanical mode
were by bicycle; today only 1-2% are.2
The car, weighing the best part of a ton and often
conveying only one person and a briefcase, is a highly
inefficient mode of transport. The fumes cars expel
cause appreciable mortality3and are a major contribu-
tor to greenhouse gas emissions. The excessive use of
motor vehicles severs communities and makes active
modes of transport such as walking and cycling more
difficult.Yet 70% of all trips made by car are less than five
miles long and eminently suitable for cycling or walking.
Regular exercise has worthwhile effects on several
cardiovascular risk factors, notably a reduction in
blood pressure of 10/8 mm Hg among hypertensive
patients4and of 3/3 mm Hg in normotensive people.5
Today 70% of British adults take exercise less than
once a month.6Although the risk factor changes seem
small from the perspective of the individual, across the
population they could reduce deaths from cardio-
vascular disease by a quarter.7
Building walking and cycling into daily life is much
more likely to be sustainable in the long term than gym
based exercise prescription schemes.8We own more
bicycles than ever—an estimated 27 million in the
United Kingdom—so why do we not use them? The
most important deterrent that non-cyclists express is
fear of motor traffic. The fear is exaggerated in
comparison with the statistical likelihood of injury,9but
lowering the speed limit in towns to 20 mph would be
a straightforward way of reducing it. Seventy per cent
of motorists currently exceed the 30 mph limit in free
flowing traffic. The government’s recent road safety
review passed responsibility for speed reductions to
local authorities10—with no extra resources to imple-
ment them. Compounding this was an announcement
by the Association of Chief Police Officers that it will
he consensus that regular physical exercise is a
vital part of maintaining health and wellbeing
has existed for at least a decade.1The human
standardise enforcement of the 30 mph limit at 37
mph. This may reflect the realpolitik of British roads,
but it is irrational.We know that the difference between
20 mph and 37 mph is quite literally life and death.11
Those with a clear sighted view of road safety issues will
continue to press this point.
But the best rule is self rule. Doctors have bought
the motor myth as hard as anyone, and it is time to
change. We doctors love our status as “essential car
users,” though whether such claims would stand close
scrutiny for the many who use their cars simply to
commute to work is questionable. The difficulties of a
return to utility cycling—that is, cycling for ordinary
journeys such as to work or for shopping—are easily
overstated, though neither is it a trivial step.12The BMJ
is holding a seminar on cycling and aerobic exercise on
14 May followed by a cycle ride (see advert in the clas-
sified section). We hope that this and other cycling
Medicine will inspire more than a few doctors to make
the change. After all, “do as I do” is more effective
advice than “do as I say.”
Millenium Festival of
Douglas Carnall associate editor,BMJ
DC is a volunteer for the London Cycling Campaign.
Hillman M. Cycling towards health and safety. London: BMA, 1994.
Anderson HR, de Leon AP, Bland JM, Bower JS, Strachan DP. Air pollu-
tion and daily mortality in London: 1987-92. BMJ 1996;312:665-9.
Fagard RH. Prescription and results of physical activity. J Cardiovasc
Kelley GA. Effects of aerobic exercise in normotensive adults: a brief
meta-analytic review of controlled clinical trials. South Med J 1995;
Hillsdon M, Thorogood M. A systematic review of exercise promotion
strategies. Br J Sports Med 1996;30:84-9.
Rose G.The strategy of preventative medicine.Oxford:Oxford Medical,1992.
Hillsdon M, Thorogood M, Anstiss T, Morris J. RCTs of physical activity
promotion in free living populations: a review. J Epidemiol Community
Powell KE, Heath GW, Kresnow M, Sacks JJ, Branche CM. Injury rates
from walking, gardening, weightlifting, outdoor bicycling, and aerobics.
Med Sci Sports Exerc 1998;30:1246-9.
10 Department of the Environment, Transport, and the Regions. Tomorrow’s
roads:safer for everyone. London: DETR, 2000.
11 Webster DC, Mackie AM. Review of traffic calming schemes in 20 mph zones.
Crowthorne, Berks: Transport Road Laboratory, 1996.
12 Forester J. Effective cycling.6th ed. Boston: MIT Press, 1996.
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