Health and greenhouse gas mitigation benefits of ambitious expansion of cycling, walking, and transit in California

Climate change and public health in California: A structured review of exposures, vulnerable populations, and adaptation measures

California faces several serious direct and indirect climate exposures that can adversely affect public health, some of which are already occurring. The public health burden now and in the future will depend on atmospheric greenhouse gas concentrations, underlying population vulnerabilities, and adaptation efforts. Here, we present a structured review of recent literature to examine the leading climate risks to public health in California, including extreme heat, extreme precipitation, wildfires, air pollution, and infectious diseases. Comparisons among different climate-health pathways are difficult due to inconsistencies in study design regarding spatial and temporal scales and health outcomes examined. We find, however, that the current public health burden likely affects thousands of Californians each year, depending on the exposure pathway and health outcome. Further, while more evidence exists for direct and indirect proximal health effects that are the focus of this review, distal pathways (e.g., impacts of drought on nutrition) are more uncertain but could add to this burden. We find that climate adaptation measures can provide significant health benefits, particularly in disadvantaged communities. We conclude with priority recommendations for future analyses and solution-driven policy actions.

Health Enhancing Physical Activity Policies in Poland: Findings from the HEPA PAT Survey

Insufficient physical activity (PA) is one of major risk factors for serious diseases and premature mortality worldwide. Public policies to enhance PA across society are recognized as an effective tool against the problem. This paper presents the results of a comprehensive assessment of national-level PA policy approach in Poland. A standardized survey of Word Health Organization named the Health-Enhancing Physical Activity Policy Audit Tool (HEPA PAT) was used for data collection. Content analysis and strengths, weaknesses, opportunities, and threats analysis (SWOT) were used to characterize various PA policy aspects, to appraise the current situation, and accommodate organizational and environmental factors that it is influenced by. The results show that the national PA policy approach has been constantly developing in Poland, but there is room for improvement in a number of areas. The most important weaknesses are the lack of clear leadership, no mechanisms in place to coordinate efforts undertaken at different levels, and lack of collaboration across different levels of government and across different sectors of economy. Providing an umbrella covering all PA promotion policies and activities is, therefore, a key issue to be addressed. The country should seize the opportunity coming from an increasing awareness of a healthy lifestyle among Polish society.

Do Safe Bike Lanes Really Slow Down Cars? A Simulation-Based Approach to Investigate the Effect of Retrofitting Safe Cycling Lanes on Vehicular Traffic

Cycling is a sustainable transportation mode that provides many health, economic and environmental benefits to society. Cities with high rates of cycling are better placed to address modern challenges of densification, carbon-neutral and connected 20-min neighbourhood goals. Despite the known benefits of cycling, participation rates in Australian cities are critically low and declining. Frequently, this low participation rate is attributed to the dangers of Australian cycle infrastructure that often necessitates the mixing of cyclists with car traffic. In addition, residents of car-dependent Australian suburbs can be resistant to the installation of cycle infrastructure where threats to traffic flow, or decreased on-street parking availability are perceived and the prohibitive cost of reconfiguration of other infrastructure maintained by the local councils to retrofit safe bike paths. This study investigates the effects on traffic behaviour of retrofitting safe, separate cycling lanes into existing residential streets in a Melbourne suburb suitable for accessing the primary neighbourhood destinations. We utilise only the widths available on the existing roadway of these streets, with minimal incursion on other facilities, such as the vehicle network and parking. Using only the existing roadway reflects the common need for municipal asset managers to minimise disruption and costs associated with street redesign. Using a traffic simulation approach, we modelled travel demand that suits suburban trips to services and shops, and we selectively applied separate cycling lanes to suitable residential streets and varied the effect of lowering speed limits. Simulations show that the selective inclusion of safe cycling lanes in some streets leads to a mere 7% increase in the average car travel times in the worst case, while requiring cyclists to increase their travel distance only marginally to avoid streets without dedicated cycling lanes. These results demonstrate that reasonable compromises are possible to make suburbs safer for cyclists and bring them closer to the 20-min neighbourhood goal. There is significant potential to enhance the result by including more street types and alternative designs. The results can inform councils in their cycle path infrastructure decisions and disprove assumptions about the influence of cyclists on car infrastructure.

Did air pollution continue to affect bike share usage in Seoul during the COVID-19 pandemic?

INTRODUCTION

The role of cycling has become more important in the urban transport system during the Covid-19 pandemic. As public transport passengers have tried to avoid crowded vehicles due to safety concerns, a rapid surge of cycling activities has been noted in many countries. This implies that more cyclists might be exposed to air pollution, potentially leading to health problems in cities like Seoul where the level of air pollution is high.

METHODS

We utilised three years of bike sharing programme (Ddareungi) data in Seoul and time series models to examine the changes in the relationship between particulate concentration (PM_2.5) and total daily cycling duration before and during the pandemic.

RESULTS

We find that cyclists reacted less to the PM_2.5 level during the pandemic, potentially due to the lack of covid-secure travel modes. Specifically, our results show significant negative associations between concentrations of PM_2.5 and total daily cycling duration before the pandemic (year 2018 and 2019). However, this association became insignificant in 2020.

CONCLUSIONS

Building comprehensive cycling infrastructure that can reduce air pollution exposure of cyclists and improving air quality alert systems could help build a more resilient city for the future.

Spatial variation in the joint effect of extreme heat events and ozone on respiratory hospitalizations in California

Extreme heat and ozone are co-occurring exposures that independently and synergistically increase the risk of respiratory disease. To our knowledge, no joint warning systems consider both risks; understanding their interactive effect can warrant use of comprehensive warning systems to reduce their burden. We examined heterogeneity in joint effects (on the additive scale) between heat and ozone at small geographical scales. A within-community matched design with a Bayesian hierarchical model was applied to study this association at the zip code level. Spatially varying relative risks due to interaction (RERI) were quantified to consider joint effects. Determinants of the spatial variability of effects were assessed using a random effects metaregression to consider the role of demographic/neighborhood characteristics that are known effect modifiers. A total of 817,354 unscheduled respiratory hospitalizations occurred in California from 2004 to 2013 in the May to September period. RERIs revealed no additive interaction when considering overall joint effects. However, when considering the zip code level, certain areas observed strong joint effects. A lower median income, higher percentage of unemployed residents, and exposure to other air pollutants within a zip code drove stronger joint effects; a higher percentage of commuters who walk/bicycle, a marker for neighborhood wealth, showed decreased effects. Results indicate the importance of going beyond average measures to consider spatial variation in the health burden of these exposures and predictors of joint effects. This information can be used to inform early warning systems that consider both heat and ozone to protect populations from these deleterious effects in identified areas.

Urban Design and Walkability: Lessons Learnt from Iranian Traditional Cities

Physical activity is connected to public health in many ways, and walking is its most popular form. Modern planning models have been applied to cities to manage rapid urban expansions. However, this practice has led to low level of walkability and strong car-dependency in today’s cities. Hence, this study aims to provide a review of the most promising urban design parameters affecting walkability, using Frank Lawrence’s theory of “Objectively Measured Urban Form” (density, connectivity and accessibility, and mixed-use development) as the basis of discussion. The second part of this paper takes a case study approach, through discussing the main design elements of traditional Iranian cities (mosques, bazaars, residential quarters, and alleyways) and analyses their impacts on promoting walkability. This study concludes that incorporating inherent values of traditional urban design elements will complement modern planning and design practices.

Transportation Physical Activity Earlier in Life and Areas of the Brain related to Dementia Later in Life

INTRODUCTION

Efforts to preserve brain function may be most effective when administered before there are changes in the brain, which may occur decades before the onset of Alzheimer's disease symptoms. White matter hyperintensities (WMH), a cardiovascular disease biomarker, are areas of hyperintense signals scattered in the white matter of the brain evident on magnetic resonance images. WMH increase with age and are associated with a higher risk of dementia. The purpose of this study was to determine if there was an association between different domains and intensities of physical activity earlier in life and lower risk of dementia later in life as indicated by less WMH.

METHODS

In this cross-sectional study, face-to-face interviews were conducted with the Lifetime Total Physical Activity Questionnaire. The metabolic equivalent of task (MET) hours/week/year of moderate (3.0-5.9 METs) and vigorous-intensity (≥6 METs) occupation, transportation, household and leisure-time physical activity was obtained across school-age (6-11), adolescence (12-18), young (19-39) and middle adulthood (40-64). WMH were calculated as the percent of intracranial volume in cognitively unimpaired middle (age 40-64) and older adults (age 65+). Simultaneous multiple linear regression determined associations between moderate and vigorous-intensity occupation, transportation, household and leisure-time physical activity across school-age, adolescence, young and middle adulthood with WMH.

RESULTS

Greater moderate-intensity transportation physical activity during young (b= -.09, p=.008) and middle adulthood (b= -.14, p=.013) was associated with lower WMH in middle and older adulthood, explaining 28% (p=.003) to 29% (p=.002) of the variance in WMH (n=54).

CONCLUSIONS

Changes to the physical environment that encourage walking, running or biking, such as sidewalks and bike paths, may be strategies to mitigate the age-related increases in WMH, areas of the brain associated with higher risk of dementia.

Will the Consequences of Covid-19 Trigger a Redefining of the Role of Transport in the Development of Sustainable Tourism?

As there are very marked relationships between tourism and transport, integrated knowledge of these processes is essential if destinations and tourism enterprises are to be developed, an effective tourism policy pursued, and emerging local and global issues and conflicts surrounding tourism resolved. Beyond this, in an era of huge change reflecting the consequences of the COVID-19 viral pandemic, the importance of sustainable transport in tourism’s sustainable development appears to be of critical importance. Adopting this kind of perspective, this paper seeks to achieve a critical overview of conceptual dimensions of sustainability that link up with tourism and transport. To this end, ideas based on the literature and previous discussions are extended to include certain new propositions arising out of a (hopefully) post-COVID-19 world. Proceeding first with a systematic literature review (SLR), this article discusses the importance of transport to the development of tourism, dealing critically with modes of transport and their changing roles in sustainable development under COVID and post-COVID circumstances. The author summarises likely new way(s) of thinking in the aftermath of the pandemic, with the need for this/these to be far more sustainable and responsible, and characterised by a reorientation of behaviour in a “green” direction. It is further concluded that three aspects of transport–tourism relations will prove crucial to more sustainable utilisation—i.e., proximity, slower and less energy-intensive travel, and green transport.

Built Environment Correlates of the Propensity of Walking and Cycling

Walking and cycling are not only frequently-used modes of transport but also popular physical activities. They are beneficial to traffic congestion mitigation, air pollution reduction, and public health promotion. Hence, examining and comparing the built environment correlates of the propensity of walking and cycling is of great interest to urban practitioners and decision-makers and has attracted extensive research attention. However, existing studies mainly look into the two modes separately or consider them as an integral (i.e., active travel), and few compare built environment correlates of their propensity in a single study, especially in the developing world context. Thus, this study, taking Xiamen, China, as a case, examines the built environment correlates of the propensity of walking and cycling simultaneously and compares the results wherever feasible. It found (1) built environment correlates of the propensity of walking and cycling differ with each other largely in direction and magnitude; (2) land use mix, intersection density, and bus stop density are positively associated with walking propensity, while the distance to the CBD (Central Business District) is a negative correlate; (3) as for cycling propensity, only distance to CBD is a positive correlate, and job density, intersection density, and bus stop density are all negative correlates. The findings of this study have rich policy implications for walking and cycling promotion interventions.

Potential of active transport to improve health, reduce healthcare costs, and reduce greenhouse gas emissions: A modelling study

Background

Physical inactivity contributes substantively to disease burden, especially in highly car dependent countries such as New Zealand (NZ). We aimed to quantify the future health gain, health-sector cost-savings, and change in greenhouse gas emissions that could be achieved by switching short vehicle trips to walking and cycling in New Zealand.

Methods

We used unit-level survey data to estimate changes in physical activity, distance travelled by mode, and air pollution for: (a) switching car trips under 1km to walking and (b) switching car trips under 5km to a mix of walking and cycling. We modelled uptake levels of 25%, 50%, and 100%, and assumed changes in transport behaviour were permanent. We then used multi-state life table modelling to quantify health impacts as quality adjusted life years (QALYs) gained and changes in health system costs over the rest of the life course of the NZ population alive in 2011 (n = 4.4 million), with 3% discounting.

Findings

The modelled scenarios resulted in health gains between 1.61 (95% uncertainty interval (UI) 1.35 to 1.89) and 25.43 (UI 20.20 to 30.58) QALYs/1000 people, with total QALYs up to 112,020 (UI 88,969 to 134,725) over the remaining lifespan. Healthcare cost savings ranged between NZ$127million (UI $101m to 157m) and NZ$2.1billion (UI $1.6b to 2.6b). Greenhouse gas emissions were reduced by up to 194kgCO₂e/year, though changes in emissions were not significant under the walking scenario.

Conclusions

Substantial health gains and healthcare cost savings could be achieved by switching short car trips to walking and cycling. Implementing infrastructural improvements and interventions to encourage walking and cycling is likely to be a cost-effective way to improve population health, and may also reduce greenhouse gas emissions.

Routine Assessment of Health Impacts of Local Transportation Plans: A Case Study From the City of Los Angeles

OBJECTIVES

To determine the health impacts of three future scenarios of travel behavior by mode for the City of Los Angeles, California, and to provide specific recommendations for how to conduct health impact assessments of local transportation plans on a more routine basis.

METHODS

We used the Integrated Transportation and Health Impact Model to assess the health impacts of the Los Angeles Mobility Plan 2035 by using environmental impact report data on miles traveled by mode under alternative implementation scenarios as inputs. The Integrated Transportation and Health Impact Model links region-wide changes in travel behavior to population exposures to physical activity, air pollution, and traffic collisions and associated health outcomes and costs.

RESULTS

The largest impacts were on cardiovascular disease through increases in physical activity. Reductions in air pollution-related illnesses were more modest. Traffic injuries and deaths increased across all scenarios but were greatly reduced through targeted roadway safety enhancements accounted for outside the model.

CONCLUSIONS

By establishing miles travelled as the metric for transportation impacts of statewide and regional plans, states can leverage existing data sources to more routinely consider health impacts as part of environmental impact reports. While not insurmountable, challenges remain regarding the incorporation of land use and roadway safety strategies into health impact estimates.

Development of the Impacts of Cycling Tool (ICT): A modelling study and web tool for evaluating health and environmental impacts of cycling uptake

BACKGROUND

A modal shift to cycling has the potential to reduce greenhouse gas emissions and provide health co-benefits. Methods, models, and tools are needed to estimate the potential for cycling uptake and communicate to policy makers the range of impacts this would have.

METHODS AND FINDINGS

The Impacts of Cycling Tool (ICT) is an open source model with a web interface for visualising travel patterns and comparing the impacts of different scenarios of cycling uptake. It is currently applied to England. The ICT allows users to visualise individual and trip-level data from the English National Travel Survey (NTS), 2004-2014 sample, 132,000 adults. It models scenarios in which there is an increase in the proportion of the population who cycle regularly, using a distance-based propensity approach to model which trips would be cycled. From this, the model estimates likely impact on travel patterns, health, and greenhouse gas emissions. Estimates of nonoccupational physical activity are generated by fusing the NTS with the English Active People Survey (APS, 2013-2014, 559,515 adults) to create a synthetic population. Under 'equity' scenarios, we investigate what would happen if cycling levels increased equally among all age and gender categories, as opposed to in proportion to the profile of current cyclists. Under electric assist bike (pedelecs or 'e-bike') scenarios, the probability of cycling longer trips increases, based on the e-bike data from the Netherlands, 2013-2014 Dutch Travel Survey (50,868 adults).Outcomes are presented across domains including transport (trip duration and trips by mode), health (physical activity levels, years of life lost), and car transport-related CO2 emissions. Results can be visualised for the whole population and various subpopulations (region, age, gender, and ethnicity). The tool is available at www.pct.bike/ict. If the proportion of the English population who cycle regularly increased from 4.8% to 25%, then there would be notable reductions in car miles and passenger related CO2 emissions (2.2%) and health benefits (2.1% reduction in years of life lost due to premature mortality). If the new cyclists had access to e-bikes, then mortality reductions would be similar, while the reduction in car miles and CO2 emissions would be larger (2.7%). If take-up of cycling occurred equally by gender and age (under 80 years), then health benefits would be marginally greater (2.2%) but reduction in CO2 slightly smaller (1.8%). The study is limited by the quality and comparability of the input data (including reliance on self-report behaviours). As with all modelling studies, many assumptions are required and potentially important pathways excluded (e.g. injury, air pollution, and noise pollution).

CONCLUSION

This study demonstrates a generalisable approach for using travel survey data to model scenarios of cycling uptake that can be applied to a wide range of settings. The use of individual-level data allows investigation of a wide range of outcomes, and variation across subgroups. Future work should investigate the sensitivity of results to assumptions and omissions, and if this varies across setting.