Public health is, first and foremost, about ensuring that the widest range of policies work in ways that promote, rather than damage, population health. One set of policies that is critically important is transport. A society that is dependent on the car is fundamentally unhealthy. Cars pump out toxic fumes and greenhouse gases into the atmosphere. They cause injuries, either by driving over pedestrians, or by conveying their occupants at high speed into solid objects. They convey us from door to door so that we need never walk, and thereby use up some of the calories in the food that we used our cars to collect. The most extreme examples are seen in some American cities, where ubiquitous drive-thru banks, fast food outlets, shops, and almost everything else means that you never need to get out of your car…. ever. Some medieval Europeans believed that the Mongol raiders who appeared at the walls of their cities each spring were half-man and half-horse as they never saw the raiders dismounted. Similarly, a visitor from Mars could easily assume that people from Alabama were born with four wheels instead of legs.
Yet, for many people, cars are essential. They allow people to meet together and overcome social isolation. They support economic development, through their production, sale, and what they enable us to do, such as being tourists. The challenge is to find a way to use the car when we need to but use alternatives where this is possible. Yet this only becomes possible if there is a functioning public health system.
Sadly, this is not the case in England. It is possible to get a reasonably priced train fare but only if you book weeks in advance and are willing to travel at a time that is extremely inconvenient. The privatised train companies use financial incentives to encourage their ticket collectors to recoup as many penalty charges as possible, using highly inventive approaches – did someone use the word scams – to extract money from helpless people who have been mystified by the complexity of the fare schedules. Deregulation of buses has left many rural areas without any meaningful links. And despite some recent progress in places like London, we are years away from achieving an integrated transport system. Take the trip to Heathrow. The Heathrow express train, at £29 for a return ticket (even more if you buy it on the train) is the most expensive journey per passenger kilometre in the world. In fact expressed this way it is even more expensive than flying Concorde to New York was before it was retired. If there are two of you, it is much cheaper to take a minicab.
Against this background, it was a wonderful experience to spend the week before last in Switzerland. I had meetings in Lausanne, Berne, Basel, and Geneva, so I packed in a lot of travel. The trains were punctual, comfortable, and unlike many British trains, there were enough seats for everyone. However even my high expectations were exceeded when I arrived in Basel.

This beautiful old city on the Rhine has a remarkable tram system. Nowhere do you need to wait more than a few minutes for a tram and the very clear maps at every stop make it simple to find your way around. When you book into a Basel hotel you get a free transfer with your confirmation and, as soon as you check in, you get a ticket for unlimited travel covering the duration of your stay.
Unfortunately, it couldn’t last. I had to come back to London where a single journey on the tube costs £4 (€6) if you haven’t previously bought one of the prepaid Oyster card. This is nothing other than a legalised process of fleecing tourists.
Clearly, if we want people in the UK to use public transport, we need to emply a few Swiss transport advisers to sort our creaking system out.