Review. Peter Walker: “The Miracle Pill”

The titles of Peter Walker’s books indicate that he thinks he has got big solutions to big problems. I said in my review of his first, How Cycling Can Save the Worldr/ that: “Those of us with a cynical mindset might be put off by such optimism and the extravagant claim of the title. But don’t be…”

So how about “The Miracle Pill”? Yet again Walker has addressed a massive problem – the quite enormous health disbenefits of not being physically active and presented solutions to it. Anybody interested in what is now called “Active Travel” (walking and cycling as forms of everyday transport) should read it.

What is this problem?

“In the UK, well over three in ten of the adult population lead lives so inactive that their long-term health could be harmed…nearly a third of all adults (globally), and four fifths of adolescents, currently move insufficiently in their lives.” You can read what the appalling effects on human health of this are in the numerous summaries of even larger numbers of research reports gathered here. What can be dry and off-putting epidemiology is clearly summarised by Guardian journalist Walker.

What we are talking about is how human life has changed with labour saving devices and moves away from manual labour in agriculture and industry:

“Regular, informal, unplanned exertion, an integral part of virtually every human life since the first Homo sapiens hunted and foraged, was designed out of existence, and with astonishing rapidity…” This is the first indication that we must look at is an essentially social problem:

“…the attention devoted to exercise rather than everyday movement has helped shift the public narrative towards one based on oversimplified notions of personal responsibility, as if declining activity levels were caused by nothing more than a mass outbreak of laziness.”

This should be ringing bells with the Active Travel (AT) community. We all know that although individual projects to support and “encourage” Active Travel may have some short term and local benefits, the issue is essentially systemic. Changes are needed throughout society  to provide the necessary support for Active Travel, including removing the incentives and support for sedentary car travel.

So, while Walker gives some indicators as to how inactivity has affected him and the measures he has taken, his book is: “Not a “how to” or a policy statement but: a guide through this often-unnoticed phenomenon (inactivity) and its many consequences.”

… and it’s a BIG problem

We learn: “…the standard metric is failing to reach at least 150 minutes a week of moderately intensive activity, or 75 minutes of vigorous activity, ideally spread out over five or so days and in bouts of at least ten minutes.” (p. 21). Doesn’t seem much, does it – but “The latest figures for England show that for adults, 66 per cent of men and 58 per cent of women meet these guidelines …31.1  per cent of people aged fifteen or older were insufficiently active. For those aged thirteen to fifteen, four in five across the world were not meeting the targets.”

A lot of this decline has happened quite quickly, in the UK a major project found that: “…overall activity levels had fallen 20 per cent in just over three decades, with the amount of exertion people undergo in their work dropping by almost half.”

As Active Travel professionals or campaigners you will know the list of health problems that are caused or exacerbated by inactivity, leading to cardio-respiratory diseases, stroke, cancers, obesity, diabetes…One medical expert says (p.89):

“It’s a tidal wave that’s engulfing the NHS.’ And (p.96):

“…unless things change, then the NHS as he knows it, universal and free at the point of use, will not survive. ‘We cannot stand still as things are,’ he explains. ‘And it’s not even about standing still. So what gives? The short answer is: the way things are at the moment, which is fragile anyway, cannot be maintained.”

The solution

As you might have guessed, the way forward is NOT sport (although that can have its benefits) but incorporating physical activity into everyday life. The good news is that: one of the most astonishing aspects of physical movement: for all the harm caused by its absence, more or less the very moment you start to use your body again, it feels the benefits… in terms of both amount and intensity, just about anything is better than nothing at all”.

And transport professionals know what has to change:  a massive shift from car usage to walking and cycling especially in urban areas where the shift can be easier. Chapter 5 features the work of Jan Gehl. Here’s another quote for us:

While no one is really suggesting that people do away with labour-saving appliances in the home, when it comes to the takeover of virtually all human-powered travel by the motor vehicle, it is a different story.

And there’s data backing up just how beneficial shifting to AT can be:

Biobank UK 2017: people who walked to work had almost a 30 per cent lower chance of suffering from heart disease in that time

those who commuted by bike had even lower odds of heart disease, with the risks cut by 50 per cent. The cyclists also saw the same reduction in risk for cancer, and had an overall 40 per cent lower chance of dying during the study period. In contrast, for people who commuted by foot, there was no measurable benefit with cancer or overall mortality rates.

one of the many amazing things about physical exertion is that the health dividends almost never stop – more is just about always even better.


Remember, this is not just about weight loss. Chapter 6 explores the evidence on activity, weight and the issues associated with obesity. The suggestion is that activity is the important thing to focus on – although the subject is complex and controversial, one approach is to forget the scales and just try to be regularly and frequently active.

Nor do you get a free pass from engaging in just one form of physical activity. The act of prolonged sitting has adverse effects on the shape of the spine and contributes, among other things, to chronic back pain. Have you ever done a long bicycle ride or walk and spent the evening slumped in front of the television? Well:

A UK study with a cohort of just over 13,000 people in Norfolk found that after the standard adjustments for other factors, each one-hour increase in average daily viewing time increased people’s overall chances of death during the study by 5 per cent, and the risk of cardiovascular disease by 8 per cent

The way forward

Walker is clear on this. Whatever the work of charities, health promotion campaigns (“people who are already active and well informed who pick up on the advice, and you just end up with widening health inequalities”), this comes down to governmental action. As one enlightened MP in the UK says: “The power is all in the car lobby. It’s not with the cycling lobby. Until we shift that, and you have ministers prepared to be bold and to ring-fence a sufficient amount of the transport budget to active travel, it’s never going to happen.”

There is lots of fascinating information in this book. And having the evidence on what is wrong and how others have solved public health problems associated with car use by having cycling and walking as major forms of everyday transport is crucial. But the key point is understanding what is key to remedy the problem in the UK: determined and genuinely committed action at governmental level. We have the evidence (and indeed have had a lot of it for some time), the point is to ACT on it.

“The Miracle Pill” is published by Simon and Schuster.


Robert Davis 14th February 2021

No book is without errors: I can pedantically mention that Adrian Davis is not Davies (it’s a thing with us Davis’s). Also in his excellent reference to my friend Mayer Hillman’s “One False Move” – the ground-breaking work showing how children have been pushed out of the street environment and away from independent mobility by motorisation – he could have mentioned the co-authors John Whitelegg and John Adams in the text as well as the references. But these are pretty small issues in a book covering such an enormous amount of evidence.

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