Research and practice methods
Economic Impact of Reduced Mortality Due to Increased Cycling

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Abstract

Increasing regular physical activity is a key public health goal. One strategy is to change the physical environment to encourage walking and cycling, requiring partnerships with the transport and urban planning sectors. Economic evaluation is an important factor in the decision to fund any new transport scheme, but techniques for assessing the economic value of the health benefits of cycling and walking have tended to be less sophisticated than the approaches used for assessing other benefits. This study aimed to produce a practical tool for estimating the economic impact of reduced mortality due to increased cycling. The tool was intended to be transparent, easy to use, reliable, and based on conservative assumptions and default values, which can be used in the absence of local data. It addressed the question: For a given volume of cycling within a defined population, what is the economic value of the health benefits?

The authors used published estimates of relative risk of all-cause mortality among regular cyclists and applied these to levels of cycling defined by the user to produce an estimate of the number of deaths potentially averted because of regular cycling. The tool then calculates the economic value of the deaths averted using the “value of a statistical life.” The outputs of the tool support decision making on cycle infrastructure or policies, or can be used as part of an integrated economic appraisal. The tool's unique contribution is that it takes a public health approach to a transport problem, addresses it in epidemiologic terms, and places the results back into the transport context. Examples of its use include its adoption by the English and Swedish departments of transport as the recommended methodologic approach for estimating the health impact of walking and cycling.

Introduction

Regular physical activity is a major contributor to physical and mental health, and reduces the risks of many chronic diseases.1, 2 However, opportunities for regular physical activity within everyday life have inexorably declined over recent decades, with serious consequences for public health.3 One strategy for increasing physical activity is to change the physical environment to encourage and support walking and cycling, which provide an opportunity for many people to achieve recommended levels of physical activity within their daily routines.4, 5 There is growing evidence for the effectiveness of interventions to promote a shift from cars to cycling and walking.6

Economic evaluation, usually in the form of cost–benefit analysis, is an important factor in the decision to fund any new transport scheme, program, or policy: new infrastructure generally will be built only if its projected benefits outweigh its costs.7 Techniques for assessing the economic value of the health benefits of cycling and walking historically have been much less sophisticated than the approaches used for assessing the other benefits and costs of new infrastructure.8 Cycling and walking interventions produce extremely high benefit–cost ratios,7, 9 so lowering the barriers to this kind of assessment could have a major impact on decision-making relating to transport infrastructure.

This paper describes the development of a practical tool for estimating the economic impact of reduced mortality due to increased cycling. It focuses on only the reduced mortality arising from increased physical activity through cycling, and does not include any benefits arising from reductions in morbidity. It specifically does not include the negative health impacts of cycling, such as injuries and the consequences of exposure to air pollution, as these routinely are addressed elsewhere within transport appraisal, although methods for estimation of the health benefits remain relatively crude.10

To inform the development of the economic assessment tool, the authors conducted a systematic review of economic analyses of cycling and walking projects.7 Sixteen studies were found that showed the costs of the health benefits of cycling and walking, and only three of the studies were of high quality. The benefits primarily arose from reductions in mortality due to conditions such as cardiovascular disease and cancer as a result of increased physical activity.

The systematic review7 identified a number of issues to be addressed in the development of any new approach. These included deciding whether to take a mortality-based or disease-based approach; accounting for the nature of the dose–response relationship between the level of cycling and the resulting health benefits; identifying the appropriate economic values for use within the transport sector; estimating the time needed for health benefits to accrue; and applying discounting to future benefits.11 More-recent analyses have applied more-sophisticated approaches to comparing costs and benefits,12, 13 but they take an academic approach rather than providing straightforward tools to be used by transport planners in their practice.

Section snippets

Methods

The tool is intended to be applicable in a number of situations, ranging from specific interventions to strategic assessments of transport infrastructure, program, or policy development. For instance:

  • modeling the economic impact of various levels of cycling when planning new infrastructure;

  • estimating the economic value of reduced mortality that results from current levels of cycling, such as to a specific workplace, across a city or in a country;

  • providing input into more-comprehensive

Results

The model was named the Health Economic Assessment Tool (HEAT) for cycling and walking and was published initially as a Microsoft Excel spreadsheet on the WHO Regional Office for Europe website (www.euro.who.int/HEAT) in 2007. It has been used widely: in New Zealand, the Czech Republic, Scotland, Sweden, Austria, and elsewhere. Applications include conducting prospective assessments of cycling and pedestrian facilities on a major road bridge, valuation of projected increases in levels of

Discussion

This tool uses a conservative set of assumptions to provide a lower-level estimate of the likely economic benefit of regular cycling, designed for economic appraisal of transport interventions. The reference study controlled for leisure-time physical activity and other lifestyle factors, which addresses the concern that cyclists may have reduced mortality because of generally healthy lifestyles. In addition, as all causes of mortality were considered, the observed effects incorporate the

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