Bringing Health Into Transport Planning: Unlocking The .

dietCancer (some)Diet, physical activityInjuriesRoad traffic

Collaborative project: econvaluationMain partners: WHO Regional Office for EuropeEcoplan (Switzerland) – economic aspectsRIVM (Netherlands) and contributors – epidemiological aspectsContributorsLars Bo Andersen, Norway; Fiona Bull, United Kingdom; Nick Cavill, United Kingdom; LuisCifuentes, Chile; Paul Fischer, Rob Jongeneel, Erna van Balen, Hannah van den Bogaard, theNetherlands; Christoph Lieb,Switzerland; Francesco Mitis, Pierpaolo Mudu, WHO RegionalOffice for Europe; Pekka Oja, Sweden; Larissa Roux, Canada¾ Advisory group of 18 experts from 10 countries and WHO¾ 3 external reviewers¾ Synergy with key related initiatives: OECD/EC VERHI projectTHE PEP/HEPA Europe project on quantification of health benefits of cyclingand walkingENHIS/WHO guidelines for HIA air pollution, noiseINTARESE¾ Supported by:

Health effects represent the largest partof the external costs of transportHealthrelated costs¾ The external costs oftransport are estimatedat ca 8 % of GDP inthe EU(*)¾ Savings from improvedhealth could be reinvested in othersocietal priorities;(*) Source: EEA indicators,http://themes.eea.europa.eu/Sectors and ndex html

Why should the transport and urbandevelopment sectors have an interest in health?Which Goals?Reduce emissions of:–air pollutants;–greenhouse gases;–noiseWhose Interest?EnvironmentHealthTransportUrban DevelopmentReduce congestionTransportReduce road traffic injuriesTransportHealthReduce investments in infrastructure to cater for more carsTransportImprove accessibility and quality of urban lifeComplement technological improvements to vehicles and fuelsTransportUrban developmentHealthTransportIncrease physical activityHealthFacilitate access to healthy dietsHealthPromote tourismCreation of new jobsTourism and leisure industry, urbandevelopmentEconomy, welfare, labour, urbandevelopment

Selected applications¾Czech Republic used HEAT for cycling used to calculate potential benefits from cycling inthe city of Pilsen USD 1.2million if 2% of population took up regular cycling¾Swedish Government adopted HEAT for cycling as part of official toolbox for theeconomic assessment of cycling infrastructure¾UK/England DfT: adopted HEAT for cycling as part of official toolbox for the economicassessment of cycling infrastructure¾UK/Scotland: HEAT used to estimate benefit from reaching cycling targets USD 1.5-3 billion per year if modal share goal of 13% reached Recommended that Scottish Transport Appraisal Guidance should include healthbenefits from cycling and walking¾New Zealand: University of Auckland used HEAT to value adding cycling and pedestrianfacilities to the Auckland Harbour Bridge 900.000USD per 1000 regular bike commuters¾United States: adaptation of tool for the US underway (by CDC)¾Austria: used HEAT for cycling to calculate current savings from cycling in Austria

Unlocking the value of cycling and walkingSonja Kahlmeier Nick Cavill Francesca Racioppi

HEAT approach¾ Effective public health: action outside as well as within the health sectoridentify leversworking upstreamefficient use of public resources¾ Recognises importance of economic analysis intransport: benefit-cost ratio is king¾ Evidence-based¾ Conservative¾ Transparent

Collaborative projectCore groupSonja Kahlmeier, Nick Cavill, Hywell Dinsdale, Harry Rutter,Thomas Götschi, Charlie Foster, Paul Kelly, Dushy Clarke,Pekka Oja, Richard Fordham, Dave Stone, Francesca RacioppiContributorsLars Bo Andersen, Andy Cope, Mark Fenton, Mark Hamer, Max Herry,I-Min Lee, Brian Martin, Markus Maybach / Christoph Schreyer, MarieMurphy, Gabe Rousseau, Candace Rutt / Tom Schmid, Elin Sandberg/Mulugeta Yilma, Daniel Sauter, Peter Schantz, Peter Schnohr,Christian Schweizer, Heini Sommer, Jan Sørensen, Gregor Starc,Wanda Wendel Vos, Paul WilkinsonFinancially supported by the European Union in the framework of the Health Programme2008-2013 (Grant agreement 2009 52 02). The views expressed herein can in no way betaken to reflect the official opinion of the European Union

Development of HEAT¾ Use economic levers to influencetransport appraisal¾ Find best format for transport planners¾ International advisory group includingtransport; health; economics; practice¾ Review the evidence¾ Generate a tool based on the evidence¾ Test with range of experts and refine¾ Disseminate; evaluate; develop further

Key steps1. Literature reviews (economics; health)

Key steps1. Literature reviews (economics; health)2. Issues and draft tool

Issues¾ Which health benefits: mortality, morbidityor both?¾ Physical activity and health relationship:linear or non-linear? Threshold?¾ Unique effects of cycling /walking vs. otherforms or physical activity?Activity substitution?¾ Costs applied

Key steps1. Literature reviews (economics; health)2. Issues and draft tool3. Consensus event – cycling4. Develop HEAT cycling (Excel)5. Literature reviews6. Issues and draft tool

Risk reduction for all-cause mortalityfor regular cycle commutersRR: all-cause mortality1.2¾ Data from 3 populationstudies in Copenhagencombined1¾ 6,171 men and 783 womenincluding 2,291 deaths0.80.6¾ RR 0.72 (95% CI: 0.57-0.91)0.4¾ Adjusted for age, sex, educ.level, blood pressure, weight,leisure time physical activity,cholesterol and smoking0.20NoYes¾ Results consistent with othercycling studies and literatureCycling to workon physical activity egMatthews, PaffenbargerAndersen, L B, Schnohr, P, Schroll, M, Hein, H O, (2000) All-Cause Mortality Associated With Physical Activity During Leisure Time,Work, Sports, and Cycling to Work, Archives of Internal Medicine, Vol. 160, pp1621-1628

ApplicationsProject website visited over 6000 times,products downloaded over 600 times

HEAT walkingSystematic review¾ PubMed search for keywords ‘Walking’ and‘Relative risk’ in studies that specified walking as an independent behavior reported a relative risk for mortality or morbidity¾ Meta-analysis of 9 studies(controlled for leisure time physical activity)¾ RR 0.78 (0.64-0.98) for all-cause mortalityfrom walking 29 mins per day on 7 days/week

HEAT walkingEconomic studies¾ Updated systematic review of economicstudies¾ 8 studies included; 5 good quality¾ Few methodological advances¾ Showed HEAT approach remained validfor walking

What’s new?¾ Step-by-step online tool¾ Assessment of walking data with a brand-newHEAT walking¾ More data entry options: (before: cycling trips only) New:––––TripsDistanceDurationSteps (for walking)¾ More explanations, tips and hints on every step

Conclusions¾ Identifies a major public health issue anduses effective lever to promote it¾ Works outside traditional health careparadigm to achieve health gain¾ Uses language of the target sector, nothealth¾ Highly influential¾ Cheap and sustainable¾ Efftidt tifiidt

Reported riskMean age and reported riskMean age

Benefits outweigh the risksDe Hartog et al, 2011

Why cycling and walking?Francesca Racioppi1Sonja Kahlmeier2Carlos Dora, Tim Armstrong, Vanessa Candeias3WHO Regional Office for Europe, European Centre for Environment and HealthInstitute of Social and Preventive Medicine, University of Zurich, SwitzerlandWorld Health Organization Headquarters, Department of Chronic Diseases and HealthPromotion123

In this presentation:¾ Physical activity and health: what dowe know?¾ WHO Global Recommendations onPhysical activity for Health¾ Why cycling and walking?¾ Health dividends from Green GrowthStrategies

Physical activity andhealth:what do we know?

Physical inactivity is a leading risk factor for health inEurope, associated to nearly 1 million deaths/yearDisability adjusted life yearslost due to risk factors in

10% shorter than 1km, 30% shorter than 3km and 50% shorter than 5km Shifting some of these trips to walking and cycling can help to Reduce congestion Reduce energy consumption and CO2 emissions Improve road safety, air quality and noise Reduce need for more infrastructure for cars Improved accessibility and quality of .