Transport policies during the last half century have changed the model of transport, giving priority to motorised private transportation and nearly removing pedestrians from land use in urban areas. This fact generates serious negative adverse effects in the overall population, such as noise and environment pollution, traffic injuries, social isolation and lack of physical activity. It contributes to the burden of disease with increased mortality, obesity, cardiovascular disease, diabetes and some cancers. In addition, the impact of transport has an unequal distribution on society. Socially disadvantaged people experience the least benefits from motorisation and the most disbenefit from the model of motorised private transportation.1 A greater proportion do not own a car; have less access to services, healthcare, shops and leisure; and most deprived children have a higher risk of being killed as a pedestrian.2

There is a large amount of evidence that walking regularly provides many health benefits. It has been reported that it reduces the risk of heart disease, stroke, overweight and obesity, type 2 diabetes, colon cancer, breast cancer, falls in older people and depression, and improves musculoskeletal health and psychological well-being.3 Bassett et al found a consistent clear inverse relationship in different countries between active transportation and obesity.4 Among the possible exercise activities, walking is the better accepted, it is accessible for all ages and social groups as it has no economical cost, and it can be incorporated into everyday life.

Research in children and adolescents shows that physical activity during growing up is essential for musculoskeletal health, helps to control weight, improves self-image and autonomy, and may improve academic performance and alertness in youth.5 However great these benefits, the prevalence of walking is low and has decreased over the last decades. Active walking to school in the USA decreased from 42% in 1969 to 16% in 2001,5 and in the UK from 62% in 1989 to 52% in 2006.

Many factors have been reported as predictors of active commuting to school, including individual and family characteristics, school, and social and physical environments.6 Panter et al highlight in this issue that social support and environmental perceptions are associated with children’s active commuting behaviour (see page 40).7 Social support, particularly parental encouragement, is associated with active mobility to school. Parents can give social support and influence children’s walking to school by encouragement, but also by their own actions as models. Three pathways may be involved. First, parental encouragement and actions can modify the perceptions towards the safety environment. Second, it influences self-efficacy and therefore the feasibility of an active mode of transport. Self-efficacy can play a major role in how children envisage their own capabilities to walk or cycle to school. Third, it improves children’s self-esteem by the fact that parents trust their behaviour to walk to school. Social support for walking provides the framework to start walking and is also a pathway for social influence and social engagement, generating a never-ending cycle by reinforcing its effects. Active mobility allows sharing norms, values, behaviours, spaces, experiences with close relationships, increases the social networks and the feeling of belonging to a group, as well as tasting the experience of the physical benefits of walking or cycling and being physically active.

In addition to individual factors, macroenvironment determinants have a powerful influence on the likelihood that an individual will be physically active. These include socioeconomic, cultural and environmental conditions, built environment, land use patterns, availability of modes of transport and urban design. Policies to promote active mobility among children, as well as for the whole population, should focus on environmental determinants. These are modifiable and might have a greater impact if there is political will, leadership and intersectorial partnerships. Some possible actions include:

• To commit a budget to ensure safe walking and cycling lanes are accessible in all neighbourhoods.

• To implement traffic calming policies in residential areas, giving priority to pedestrians or cyclists rather than motor vehicles.

• To develop policies to reduce the use of private vehicles with charge schemes or expensive parking policies.

• To promote frequent, accessible and cheap public transportation to encourage people to be physically active. Companies have a key role in developing mobility plans with common and active transportation.

• To ensure an environment where children, youth, adults and elderly people can walk or cycle without fear of violence. Some studies have shown that neighbourhoods with less privileged socioeconomic conditions have higher rates of violence.8

• To assess the health impact of building new urban areas and to plan for mobility independent of private car use.

• To concentrate services where people live (ie, schools, healthcare services, work, etc). This would reduce motor commuting and increase walking. It would also contribute to a reduction in social inequalities, providing access for quality education and health care for all without dependence on private vehicles.

Although limited, there is evidence that there are two public health efforts that promote walking and cycling to school—Safe Routes to School and Walking School Bus6—which include in their design and implementation the participation of all stakeholders.