Health impact assessment of cycling network expansions in European cities

Walkability and urban built environments-a systematic review of health impact assessments (HIA)

BACKGROUND

Urban environments are important determinants of human health. The term walkability summarizes features of the urban built environment that promote walking and other types of physical activity. While the beneficial effects of active and public transport have been well established, the health impact of other features of walkability are less well documented.

METHODS

We conducted a systematic review of health impact assessments (HIAs) of walkability. Studies were identified through PUBMED and Science Direct, from two German websites related to urban health and reference tracking. Finally, 40 studies were included in the present review. We applied qualitative thematic analysis to summarize the major results from these studies.

RESULTS

Most of the HIAs (n = 31) reported the improvement of health or health behaviour resulting from an investigated project or policy. However, three HIAs reported a lack of improvement or even a decrease of health status. In parallel, 13 HIAs reported a gain in economic value, whereas one reported a lack or loss of economic effects. Moreover, three HIAs reported on social effects and six HIAs gave additional recommendations for policies or the implementation of projects or HIAs.

CONCLUSIONS

Most HIAs investigate the impact of increasing active or public transport. Other features of walkability are less well studied. With few exceptions, HIAs document beneficial impacts of improving walkability on a variety of health outcomes, including reductions of mortality and non-communicable diseases.

Model Choice for Quantitative Health Impact Assessment and Modelling: An Expert Consultation and Narrative Literature Review

BACKGROUND

Health impact assessment (HIA) is a widely used process that aims to identify the health impacts, positive or negative, of a policy or intervention that is not necessarily placed in the health sector. Most HIAs are done prospectively and aim to forecast expected health impacts under assumed policy implementation. HIAs may quantitatively and/ or qualitatively assess health impacts, with this study focusing on the former. A variety of quantitative modelling methods exist that are used for forecasting health impacts, however, they differ in application area, data requirements, assumptions, risk modelling, complexities, limitations, strengths, and comprehensibility. We reviewed relevant models, so as to provide public health researchers with considerations for HIA model choice.

METHODS

Based on an HIA expert consultation, combined with a narrative literature review, we identified the most relevant models that can be used for health impact forecasting. We narratively and comparatively reviewed the models, according to their fields of application, their configuration and purposes, counterfactual scenarios, underlying assumptions, health risk modelling, limitations and strengths.

RESULTS

Seven relevant models for health impacts forecasting were identified, consisting of (i) comparative risk assessment (CRA), (ii) time series analysis (TSA), (iii) compartmental models (CMs), (iv) structural models (SMs), (v) agent-based models (ABMs), (vi) microsimulations (MS), and (vii) artificial intelligence (AI)/machine learning (ML). These models represent a variety in approaches and vary in the fields of HIA application, complexity and comprehensibility. We provide a set of criteria for HIA model choice. Researchers must consider that model input assumptions match the available data and parameter structures, the available resources, and that model outputs match the research question, meet expectations and are comprehensible to end-users.

CONCLUSION

The reviewed models have specific characteristics, related to available data and parameter structures, computational implementation, interpretation and comprehensibility, which the researcher should critically consider before HIA model choice.

Existence of the safety-in-numbers effect in the aspect of injury severity: A macroscopic analysis for bicyclists and pedestrians

OBJECTIVE

Several studies have confirmed the existence of a safety-in-numbers effect in relation to vulnerable road users. The safety-in-numbers effect refers to a phenomenon wherein the number of bicyclists/pedestrians on a road is higher, and consequently, the risk of each bicyclist/pedestrian being involved in a crash is lower. Nevertheless, the existence of the safety-in-numbers effect in the aspect of injury severity in traffic crashes has not yet been investigated. Thus, this study aimed to explore whether traffic injuries are more (less) severe with fewer (more) pedestrians/bicyclists at the county level.

METHOD

Using two fractional split multinomial logit models, the relationships between the number of bicyclists/pedestrians and the proportion of crashes involving bicyclists/pedestrians based on crash severity were investigated at the county level using crash data from Florida. In other words, we explored whether differing number of bicyclists/pedestrians could change the distribution of traffic injury severity levels.

RESULTS

The modeling results clearly revealed a lower proportion of severe injuries caused to bicyclists/pedestrians at a higher level of daily bicycle/pedestrian flows, indicating existence of the safety-in-numbers effect. Several variables (e.g., the percentage of people aged 65 years and older, the percentage of commuters using public transportation, and the proportion of recreational land use) were found to have a significant effect on the distribution of traffic injury severity among bicyclists/pedestrians.

CONCLUSION

This study proves that a safety-in-numbers effect exists in the aspect of injury severity among bicyclists and pedestrians.

PRACTICAL APPLICATIONS

These findings are expected to provide recommendations for promoting the use of active transportation, which will improve the safety of vulnerable road users in future.

Impact of electrically assisted bicycles on physical activity and traffic accident risk: a prospective observational study

Background

Electrically assisted bicycles (e-bikes) have become increasingly popular and may facilitate active commuting and recreational cycling.

Objective

To evaluate the physical activity levels and usage characteristics of e-bikers and conventional cyclists under real-world conditions.

Methods

We conducted a prospective observational study in Germany to examine the effects of e-biking compared with conventional cycling on reaching the World Health Organization (WHO) target for physical activity-at least 150 min of moderate-to-vigorous physical activity (MVPA) per week. Study participants (1250 e-bikers and 629 conventional bike users) were equipped with activity trackers to assess the time, distance and heart rate during cycling over four consecutive weeks. Questionnaires were used to assess any traffic accidents incurred over 12 months.

Results

The proportion of participants reaching 150 min of MVPA per week was higher for conventional bike users than for e-bike users (35.0% vs 22.4%, p<0.001). In a multiple regression model, the odds of reaching the physical activity target were lower for e-biking than for conventional biking (OR=0.56; 95% CI 0.43 to 0.72) with age, sex, comorbidities and bike usage patterns as confounding factors. No significant differences were observed between bike groups for traffic accidents, yet when controlled for cycling time and frequency of cycling e-bikers had a higher risk of a traffic accident (OR=1.63; 95% CI 1.02 to 2.58).

Conclusion

E-bikes are associated with a lower probability of reaching WHO targets for MVPA due to reduced duration and a reduced cardiovascular effort during riding. However, e-bikes might facilitate active transportation, particularly in older individuals or those with pre-existing conditions.

Day-to-day intrapersonal variability in mobility patterns and association with perceived stress: A cross-sectional study using GPS from 122 individuals in three European cities

Many aspects of our life are related to our mobility patterns and individuals can exhibit strong tendencies towards routine in their daily lives. Intrapersonal day-to-day variability in mobility patterns has been associated with mental health outcomes. The study aims were: (a) calculate intrapersonal day-to-day variability in mobility metrics for three cities; (b) explore interpersonal variability in mobility metrics by sex, season and city, and (c) describe intrapersonal variability in mobility and their association with perceived stress. Data came from the Physical Activity through Sustainable Transport Approaches (PASTA) project, 122 eligible adults wore location measurement devices over 7-consecutive days, on three occasions during 2015 (Antwerp: 41, Barcelona: 41, London: 40). Participants completed the Short Form Perceived Stress Scale (PSS-4). Day-to-day variability in mobility was explored via six mobility metrics using distance of GPS point from home (meters:m), distance travelled between consecutive GPS points (m) and energy expenditure (metabolic equivalents:METs) of each GPS point collected (n = 3,372,919). A Kruskal-Wallis H test determined whether the median daily mobility metrics differed by city, sex and season. Variance in correlation quantified day-to-day intrapersonal variability in mobility. Levene's tests or Kruskal-Wallis tests were applied to assess intrapersonal variability in mobility and perceived stress. There were differences in daily distance travelled, maximum distance from home and METS between individuals by sex, season and, for proportion of time at home also, by city. Intrapersonal variability across all mobility metrics were highly correlated; individuals had daily routines and largely stuck to them. We did not observe any association between stress and mobility. Individuals are habitual in their daily mobility patterns. This is useful for estimating environmental exposures and in fuelling simulation studies.

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.

Preliminary Results of a Bicycle Training Course on Adults' Environmental Perceptions and Their Mode of Commuting

This study was designed to analyze the effects of a bicycle training course on both adults’ environmental perceptions and their mode of commuting. Four bicycle training courses for adults were conducted in Granada, Spain in April 2015 and May 2016. The course program was focused on developing practical skills and attitudes on road. From the initial 65 adults who started the course, only 35 adults met the inclusion criteria and were included in the study. Participants completed twice (i.e., before and after the course) a questionnaire about their perceptions of the environment, usual mode of commuting to daily destinations, and sociodemographic characteristics. After finishing the initial questionnaire, the participants completed a bicycle training course based on the methodology “Bikeability” with a duration of 6 h. The results suggest that participants improved their safety perception in relation to the level of crime in the participants’ neighborhood after the bicycle training course. Cycling training courses should last longer in order to produce changes in the mode of commuting and in the environmental perceptions.

The Impacts of Car-Free Days and Events on the Environment and Human Health

Purpose of review

In this paper, we seek to elucidate the impact of car-free days and events on human health. Car-free days and events are often designed to alleviate the impact of transportation-related air pollution, noise, physical inactivity, traffic congestion, or other detrimental externalities of private motor vehicle travel. We reviewed existing peer-reviewed and gray literature to understand the variety of potential public health impacts that have been measured as a result of car-free days or events and associated changes in environmental exposures and lifestyles.

Recent findings

The impacts of car-free days and events are highly variable and seem to depend on the scope (frequency, duration, and geographic size) and goals of each car-free day and event. Most of the existing literature measures impacts in terms of air and noise pollution and some studies focus on physical activity metrics. In some cases, car-free days and events were successful in reducing the concentration of certain air pollutants but had little or adverse impacts on the concentration of others. Often, traffic is diverted from cordoned areas to surrounding streets, displacing traffic congestion and adverse environmental exposures to other areas of a city, with potential understudied implications to environmental justice.

Summary

Car-free days and events are often an attractive policy option; however, they require intensive planning to be successful. The organization and execution of car-free days and events, as well as public support and stakeholder engagement, greatly influence the level of success and the sustainability of such initiatives. Health benefits may be a palatable and convincing argument to the general public. However, very few studies focus on actual health impacts associated with car-free days and events. Future research could be most useful if it focused on measuring health outcomes associated with car-free days and events through longitudinal studies.

Fatal and Serious Injury Rates for Different Travel Modes in Victoria, Australia

While absolute injury numbers are widely used as a road safety indicator, they do not fully account for the likelihood of an injury given a certain level of exposure. Adjusting crash and injury rates for travel exposure can measure the magnitude of travel activity leading to crash outcomes and provide a more comprehensive indicator of safety. Fatal and serious injury (FSI) numbers were adjusted by three measures of travel exposure to estimate crash and injury rates across nine travel modes in the Australian state of Victoria. While car drivers accounted for the highest number of injuries across the three modes, their likelihood of being killed or seriously injured was substantially lower than that of motorcyclists across all exposure measures. Cyclists accounted for fewer injuries than car passengers and pedestrians but had a higher risk per exposure. The results varied by both injury severity and exposure measure. The results of this study will assist with high level transport planning by allowing for the investigation of the changes in travel-related FSI resulting from proposed travel mode shifts driven by safety, environmental reasons or other reasons as part of the holistic goal of transforming the transport system to full compliance with Safe System principles.

Potential health benefits of eliminating traffic emissions in urban areas

Traffic is one of the major contributors to PM2.5 in cities worldwide. Quantifying the role of traffic is an important step towards understanding the impact of transport policies on the possibilities to achieve cleaner air and accompanying health benefits. With the aim of estimating potential health benefits of eliminating traffic emissions, we carried out a meta-analysis using the World Health Organisation (WHO) database of source apportionment studies of PM2.5 concentrations. Specifically, we used a Bayesian meta-regression approach, modelling both overall and traffic-related (tailpipe and non-tailpipe) concentrations simultaneously. We obtained the distributions of expected PM2.5 concentrations (posterior densities) of different types for 117 cities worldwide. Using the non-linear Integrated Exposure Response (IER) function of PM2.5, we estimated percent reduction in different disease endpoints for a scenario with complete removal of traffic emissions. We found that eliminating traffic emissions results in achieving the WHO-recommended concentration of PM2.5 only for a handful of cities that already have low concentrations of pollution. The percentage reduction in premature mortality due to cardiovascular and respiratory diseases increases up to a point (30-40 ug/m3), and above this concentration, it flattens off. For diabetes-related mortality, the percentage reduction in mortality decreases with increasing concentrations-a trend that is opposite to other outcomes. For cities with high concentrations of pollution, the results highlight the need for multi-sectoral strategies to reduce pollution. The IER functions of PM2.5 result in diminishing returns of health benefits at high concentrations, and in case of diabetes, there are even negative returns. The results show the significant effect of the shape of IER functions on health benefits. Overall, despite the diminishing results, a significant burden of deaths can be prevented by policies that aim to reduce traffic emissions even at high concentrations of pollution.

New urban models for more sustainable, liveable and healthier cities post covid19; reducing air pollution, noise and heat island effects and increasing green space and physical activity

Cities are centres of innovation and wealth creation, but also hotspots of air pollution and noise, heat island effects and lack of green space, which are all detrimental to human health. They are also hotspots of COVID19. COVID19 has led to a rethink of urban public space. Therefore, is it time to re-think our urban models and reduce the health burden? We provide a narrative meta-review around a number of cutting edge and visionary urban models that that may affect health and that have been reported over the past few years. New urban concepts such as the Superblocks, the low traffic neighbourhood, 15 Minute city, Car free city or a mixture of these that may go some way in reducing the health burden related to current urban and transport practices. They will reduce air pollution and noise, heat island effects and increase green space and physical activity levels. What is still lacking though is a thorough evaluation of the effectiveness and acceptability of the schemes and the impacts on not only health, but also liveability and sustainability, although they are expected to be positive. Finally, the COVID19 pandemic may accelerate these developments and stimulus funding like the EU Next Generation funding should be used to make these changes.

Premature Mortality of 2050 High Bike Use Scenarios in 17 Countries

BACKGROUND

Biking plays a significant role in urban mobility and has been suggested as a tool to promote public health. A recent study has proposed 2050 global biking scenarios based on large shifts from motorized vehicles to bikes. No previous studies have estimated the health impacts of global cycling scenarios, either future car-bike shift substitutions.

OBJECTIVES

We aimed to quantify changes in premature mortality of 2050 global biking scenarios in urban populations from 17 countries.

METHODS

Through a quantitative Health Impact Assessment, the mortality risks and benefits of replacing car trips by bike (mechanica bike and electric bike) in urban populations from 17 countries were estimated. Multiple bike scenarios were created based on current transport trends or large shifts from car trips to bike trips. We quantified the estimated change in the number of premature deaths (reduced or increased) concerning road traffic fatalities, air pollution, and physical activity. This study focuses on urban populations between 20 and 64 y old.

RESULTS

We found that, among the urban populations (20-64 y old) of 17 countries, 205,424 annual premature deaths could be prevented if high bike-use scenarios are achieved by 2050 (assuming that 100% of bike trips replace car trips). If only 8% of bike trips replace car trips in a more conservative scenario, 18,589 annual premature deaths could be prevented by 2050 in the same population. In all the countries and scenarios, the mortality benefits related to bike use (rather than car use) outweighed the mortality risks.

DISCUSSION

We found that global biking policies may provide important mortality benefits in 2050. Current and future bike- vs. car-trip policies should be considered key public health interventions for a healthy urban design. https://doi.org/10.1289/EHP9073.

Cycle-network expansion plan in Oslo: Modeling cost-effectiveness analysis and health equity impact

Physical inactivity is the leading cause of non-communicable diseases, and further research on the cost-effectiveness of interventions that target inactivity is warranted. Socioeconomic status is vital in this process. We aim to evaluate the cost-effectiveness of a cycle-network expansion plan in Oslo compared to the status quo by income quintiles. We applied a Markov model using a public payer perspective. Health outcomes were measured by quality-adjusted life years (QALYs) gained from the prevention of coronary heart disease, stroke, type 2 diabetes, and cancer. We measured equity impact by the concentration index and social welfare using the achievement index. We conducted sensitivity analyses. The intervention was generally more costly and more effective than the status quo. Incremental cost per QALY falls with income quintile, ranging from $10,098 in the richest quintile to $23,053 per QALY gained in the poorest quintile. The base-case intervention increased health inequality. However, a scenario targeting low-income quintiles reduced inequality and increased social welfare. In conclusion, the cycle-network expansion is likely to be cost-effective, but with equity concerns. If decision makers care about health inequalities, the disadvantaged groups could be targeted to produce more equitable and socially desirable outcomes instead of a uniform intervention across income quintiles.

Tracking progress on health and climate change in Europe

Left unabated, climate change will have catastrophic effects on the health of present and future generations. Such effects are already seen in Europe, through more frequent and severe extreme weather events, alterations to water and food systems, and changes in the environmental suitability for infectious diseases. As one of the largest current and historical contributors to greenhouse gases and the largest provider of financing for climate change mitigation and adaptation, Europe's response is crucial, for both human health and the planet. To ensure that health and wellbeing are protected in this response it is essential to build the capacity to understand, monitor, and quantify health impacts of climate change and the health co-benefits of accelerated action. Responding to this need, the Lancet Countdown in Europe is established as a transdisciplinary research collaboration for monitoring progress on health and climate change in Europe. With the wealth of data and academic expertise available in Europe, the collaboration will develop region-specific indicators to address the main challenges and opportunities of Europe's response to climate change for health. The indicators produced by the collaboration will provide information to health and climate policy decision making, and will also contribute to the European Observatory on Climate and Health.

Heart healthy cities: genetics loads the gun but the environment pulls the trigger

The world's population is estimated to reach 10 billion by 2050 and 75% of this population will live in cities. Two-third of the European population already live in urban areas and this proportion continues to grow. Between 60% and 80% of the global energy use is consumed by urban areas, with 70% of the greenhouse gas emissions produced within urban areas. The World Health Organization states that city planning is now recognized as a critical part of a comprehensive solution to tackle adverse health outcomes. In the present review, we address non-communicable diseases with a focus on cardiovascular disease and the urbanization process in relation to environmental risk exposures including noise, air pollution, temperature, and outdoor light. The present review reports why heat islands develop in urban areas, and how greening of cities can improve public health, and address climate concerns, sustainability, and liveability. In addition, we discuss urban planning, transport interventions, and novel technologies to assess external environmental exposures, e.g. using digital technologies, to promote heart healthy cities in the future. Lastly, we highlight new paradigms of integrative thinking such as the exposome and planetary health, challenging the one-exposure-one-health-outcome association and expand our understanding of the totality of human environmental exposures.

Overall health impacts of a potential increase in cycle commuting in Stockholm, Sweden

AIMS

To estimate the overall health impact of transferring commuting trips from car to bicycle.

METHODS

In this study registry information on the location of home and work for residents in Stockholm County was used to obtain the shortest travel route on a network of bicycle paths and roads. Current modes of travel to work were based on travel survey data. The relation between duration of cycling and distance cycled was established as a basis for selecting the number of individuals that normally would drive a car to work, but have a distance to work that they could bicycle within 30 minutes. The change in traffic flows was estimated by a transport model (LuTrans) and effects on road traffic injuries and fatalities were estimated by using national hospital injury data. Effects on air pollution concentrations were modelled using dispersion models.

RESULTS

Within the scenario, 111,000 commuters would shift from car to bicycle. On average the increased physical activity reduced the one-year mortality risk by 12% among the additional bicyclists. Including the number of years lost due to morbidity, the total number of disability adjusted life-years gained was 696. The amount of disability adjusted life-years gained in the general population due to reduced air pollution exposure was 471. The number of disability adjusted life-years lost by traffic injuries was 176. Also including air pollution effects among bicyclists, the net benefit was 939 disability adjusted life-years per year.

CONCLUSIONS

Large health benefits were estimated by transferring commuting by car to bicycle.

Determinants of bicycle commuting and the effect of bicycle infrastructure investment in London: Evidence from UK census microdata

Worldwide, concern about physical inactivity and excessive car dependence has encouraged ambitious targets and policies to promote cycling. But policy making is hindered by limited knowledge about why cycling prevalence and trends vary greatly between different geographic areas (e.g. in London (UK) <1% cycle to work in Harrow compared to>15 % in Hackney) and individuals (e.g. by age or gender). The role of cycle infrastructure investment in explaining part of these patterns and trends is also unknown. We linked individual-level data on 317,117 London commuters (including 11,199 cyclists) in the 2001 and 2011 UK census to relevant geographic data, including on area-level cycling infrastructure investment during the period. Whilst cycle commuting increased over time on average, concentration curves and indices demonstrated that in contrast with England as a whole, cycling in London shifted from being dominated by commuters with lower socioeconomic status to commuters with higher socioeconomic status. In our first set of regression analyses, we showed that observed differences and time trends in cycling prevalence were partially explained by area-level differences in topography, greenspace, footpaths and crime levels and by differences and changes in population structures. In the second, we conducted a cost-effectiveness analysis which showed that expenditure on cycling infrastructure was associated with increased cycling at a marginal rate of £4915 per additional commuter cyclist, with some variation between groups: ethnic minorities were more responsive, and females, older people and those with lower socioeconomic status appeared less responsive. If planned increases in expenditure in England for the period 2020-25 were as cost-effective, and were sustained for the whole decade, our study suggests that commuter cycling prevalence could increase in England by 0.5 to 1.1 percentage points (this equates to a 16% to 34% increase in commuter cycling prevalence if compared to 2011 levels). More research is necessary to assess the impact on broader measures of cycling, active travel and overall physical activity, and to determine whether such expenditure constitutes good or equitable value for money.

Provisional COVID-19 infrastructure induces large, rapid increases in cycling

The bicycle is a low-cost means of transport linked to low risk of transmission of infectious disease. During the COVID-19 crisis, governments have therefore incentivized cycling by provisionally redistributing street space. We evaluate the impact of this new bicycle infrastructure on cycling traffic using a generalized difference in differences design. We scrape daily bicycle counts from 736 bicycle counters in 106 European cities. We combine these with data on announced and completed pop-up bike lane road work projects. Within 4 mo, an average of 11.5 km of provisional pop-up bike lanes have been built per city and the policy has increased cycling between 11 and 48% on average. We calculate that the new infrastructure will generate between $1 and $7 billion in health benefits per year if cycling habits are sticky.

Health Impacts of Urban Bicycling in Mexico

Background: Bicycling has been associated with health benefits. Local and national authorities have been promoting bicycling as a tool to improve public health and the environment. Mexico is one of the largest Latin American countries, with high levels of sedentarism and non-communicable diseases. No previous studies have estimated the health impacts of Mexico’s national bicycling scenarios. Aim: Quantify the health impacts of Mexico urban bicycling scenarios. Methodology: Quantitative Health Impact Assessment, estimating health risks and benefits of bicycling scenarios in 51,718,756 adult urban inhabitants in Mexico (between 20 and 64 years old). Five bike scenarios were created based on current bike trends in Mexico. The number of premature deaths (increased or reduced) was estimated in relation to physical activity, road traffic fatalities, and air pollution. Input data were collected from national publicly available data sources from transport, environment, health and population reports, and surveys, in addition to scientific literature. Results: We estimated that nine premature deaths are prevented each year among urban populations in Mexico on the current car-bike substitution and trip levels (1% of bike trips), with an annual health economic benefit of US $1,897,920. If Mexico achieves similar trip levels to those reported in The Netherlands (27% of bike trips), 217 premature deaths could be saved annually, with an economic impact of US $45,760,960. In all bicycling scenarios assessed in Mexico, physical activity’s health benefits outweighed the health risks related to traffic fatalities and air pollution exposure. Conclusion: The study found that bicycling promotion in Mexico would provide important health benefits. The benefits of physical activity outweigh the risk from traffic fatalities and air pollution exposure in bicyclists. At the national level, Mexico could consider using sustainable transport policies as a tool to promote public health. Specifically, the support of active transportation through bicycling and urban design improvements could encourage physical activity and its health co-benefits.

Evaluation of a New Urban Cycling Infrastructure in Caceres (Spain)

The purpose of the research is the evaluation of the impact of a new bike lane network built in Cáceres (Spain) in October 2019, a city with a weak tradition in the use of bicycles. Prior to the new project, the percentage of displacement by bicycle was under 0.2% (by contrast, private cars was 56%). The project has introduced a real network in 33 new streets and avenues, and 250 new parking places for bicycles. The impact has been evaluated by two online surveys, one conducted in November–December 2019 just after the inauguration, and the other conducted in January–February 2020. For that, the impact evolution after the first 3 months has also been evaluated. The result allows to analyze the citizens’ response to the new infrastructure; the main conclusion is that the effect of the built infrastructure is clearly positive in terms of new users, new potential users, and bike general image for the citizens. Moreover, this positive effect has grown after the first 3 months.

Assessing the Policy Environment for Active Mobility in Cities-Development and Feasibility of the PASTA Cycling and Walking Policy Environment Score

The importance of setting a policy focus on promoting cycling and walking as sustainable and healthy modes of transport is increasingly recognized. However, to date a science-driven scoring system to assess the policy environment for cycling and walking is lacking. In this study, spreadsheet-based scoring systems for cycling and walking were developed, including six dimensions (cycling/walking culture, social acceptance, perception of traffic safety, advocacy, politics and urban planning). Feasibility was tested using qualitative data from pre-specified sections of semi-standardized interview and workshop reports from a European research project in seven cities, assessed independently by two experts. Disagreements were resolved by discussions of no more than 75 minutes per city. On the dimension "perception of traffic safety", quantitative panel data were used. While the interrater agreement was fair, feasibility was confirmed in general. Validity testing against social norms towards active travel, modal split and network length was encouraging for the policy area of cycling. Rating the policy friendliness for cycling and walking separately was found to be appropriate, as different cities received the highest scores for each. Replicating this approach in a more standardized way would pave the way towards a transparent, evidence-based system for benchmarking policy approaches of cities towards cycling and walking.

Is cycle network expansion cost-effective? A health economic evaluation of cycling in Oslo

BACKGROUND

Expansion of designated cycling networks increases cycling for transport that, in turn, increases physical activity, contributing to improvement in public health. This paper aims to determine whether cycle-network construction in a large city is cost-effective when compared to the status-quo. We developed a cycle-network investment model (CIM) for Oslo and explored its impact on overall health and wellbeing resulting from the increased physical activity.

METHODS

First, we applied a regression technique on cycling data from 123 major European cities to model the effect of additional cycle-networks on the share of cyclists. Second, we used a Markov model to capture health benefits from increased cycling for people starting to ride cycle at the age of 30 over the next 25 years. All health gains were measured in quality-adjusted life years (QALYs). Costs were estimated in US dollars. Other data to populate the model were derived from a comprehensive literature search of epidemiological and economic evaluation studies. Uncertainty was assessed using deterministic and probabilistic sensitivity analyses.

RESULTS

Our regression analysis reveals that a 100 km new cycle network construction in Oslo city would increase cycling share by 3%. Under the base-case assumptions, where the benefits of the cycle-network investment relating to increased physical activity are sustained over 25 years, the predicted average increases in costs and QALYs per person are $416 and 0.019, respectively. Thus, the incremental costs are $22,350 per QALY gained. This is considered highly cost-effective in a Norwegian setting.

CONCLUSIONS

The results support the use of CIM as part of a public health program to improve physical activity and consequently avert morbidity and mortality. CIM is affordable and has a long-term effect on physical activity that in turn has a positive impact on health improvement.

Data-driven strategies for optimal bicycle network growth

Urban transportation networks, from pavements and bicycle paths to streets and railways, provide the backbone for movement and socioeconomic life in cities. To make urban transport sustainable, cities are increasingly investing to develop their bicycle networks. However, it is yet unclear how to extend them comprehensively and effectively given a limited budget. Here we investigate the structure of bicycle networks in cities around the world, and find that they consist of hundreds of disconnected patches, even in cycling-friendly cities like Copenhagen. To connect these patches, we develop and apply data-driven, algorithmic network growth strategies, showing that small but focused investments allow to significantly increase the connectedness and directness of urban bicycle networks. We introduce two greedy algorithms to add the most critical missing links in the bicycle network focusing on connectedness, and show that they outmatch both a random approach and a baseline minimum investment strategy. Our computational approach outlines novel pathways from car-centric towards sustainable cities by taking advantage of urban data available on a city-wide scale. It is a first step towards a quantitative consolidation of bicycle infrastructure development that can become valuable for urban planners and stakeholders.

The Profile of Bicycle Users, Their Perceived Difficulty to Cycle, and the Most Frequent Trip Origins and Destinations in Aracaju, Brazil

The objective of this study was to describe the profile of bicycle users, their perceived difficulty to cycle, and the most frequent trip origins and destinations in Aracaju, Northeast Brazil. Our cross-sectional study sampled 1001 participants and we collected information through structured interviews. Aged ≥15 years, participants were residents of all Aracaju’s neighborhoods and used a bicycle for commuting to work or for leisure. We observed that bicycle users in Aracaju are predominantly employed male subjects, aged between 18 and 40 years, and were the heads of their households. Most of the them reported “work” as the main reason for their bicycle trips and, “health” and “practicality” aspects as their main motivations for using bicycles. In general, the neighborhoods in the north and center of the city were identified as the most difficult for cycling, and the easiest trips occurred in places with cycle paths. As a conclusion of this study, we reaffirm the need for intersectoral actions that create favorable environments for active commuting and more sustainable cities.

Potential Effects on Travelers' Air Pollution Exposure and Associated Mortality Estimated for a Mode Shift from Car to Bicycle Commuting

This study aims to use dispersion-modeled concentrations of nitrogen oxides (NOx) and black carbon (BC) to estimate bicyclist exposures along a network of roads and bicycle paths. Such modeling was also performed in a scenario with increased bicycling. Accumulated concentrations between home and work were thereafter calculated for both bicyclists and drivers of cars. A transport model was used to estimate traffic volumes and current commuting preferences in Stockholm County. The study used individuals’ home and work addresses, their age, sex, and an empirical model estimate of their expected physical capacity in order to establish realistic bicycle travel distances. If car commuters with estimated physical capacity to bicycle to their workplace within 30 min changed their mode of transport to bicycle, >110,000 additional bicyclists would be achieved. Time-weighted mean concentrations along paths were, among current bicyclists, reduced from 25.8 to 24.2 μg/m³ for NOx and 1.14 to 1.08 μg/m³ for BC. Among the additional bicyclists, the yearly mean NOx dose from commuting increased from 0.08 to 1.03 μg/m³. This would be expected to yearly cause 0.10 fewer deaths for current bicycling levels and 1.7 more deaths for additional bicycling. This increased air pollution impact is much smaller than the decrease in the total population.

Exercising in the urban center: Inflammatory and cardiovascular effects of prolonged exercise under air pollution

The aim of this study was to investigate, in a well-controlled experimental environment, whether air pollution from an urban center would affect inflammatory and cardiorespiratory responses during prolonged moderate exercise (i.e., 90 min). Ten healthy men performed two experimental trials under filtered and polluted air, inside an environmental chamber located in Sao Paulo downtown, Brazil. Blood samples were obtained at rest, 30, 60, and 90 min of the exercise to determine the serum cytokines concentration, while arterial pressure was recorded immediately after the exercise. The serum cytokines were not altered until 60 min of exercise for both conditions (P > 0.05). Otherwise, at 90 min of exercise, the IL-6 (P = 0.047) and vascular endothelial growth factor (VEGF) (P = 0.026) were significantly higher and IL-10 tended to decrease (P = 0.061) in polluted air condition compared to filtered air condition. In addition, both systolic (P = 0.031) and diastolic (P = 0.009) arterial pressure were higher in polluted air condition than filtered air condition. These findings demonstrate that the exercise of longer duration (i.e., 90 min), but not of shorter duration (i.e., <60 min), performed in vehicular air pollution condition results in pronounced pro-inflammatory and increased arterial pressure responses.

Urban and transport planning pathways to carbon neutral, liveable and healthy cities; A review of the current evidence

INTRODUCTION

Half the world population lives in cities and this is likely to increase to 70% over the next 20 years. Suboptimal urban and transport planning has led to e.g. high levels of air pollution and noise, heat island effects and lack of green space and physical activity and thereby an increase in morbidity and premature mortality. How can better urban and transport planning improve public health?

METHODS

A narrative meta-review around a number of cutting edge and visionary studies and practices on how to improve public health through better urban and transport planning reported in the literature and from meetings over the past few years.

RESULTS

We describe the latest quantitative evidence of how cities can become healthier through better urban and transport planning. It focuses and provides evidence for important interventions, policies and actions that can improve public health, including the need for land use changes, reduce car dependency and move towards public and active transportation, greening of cities, visioning, citizen involvement, collaboration, leadership and investment and systemic approaches. Health impact assessment studies have recently provided new powerful quantitative evidence on how to make cities healthier and will be used as examples. At the same time these measures make also our cities more sustainable (i.e. carbon neutral) and liveable creating multiple benefits.

CONCLUSION

Better urban and transport planning can lead to carbon neutral, more liveable and healthier cities, particularly through land use changes, a move from private motorised transportation to public and active transportation and greening of cities.

Cyclist crash rates and risk factors in a prospective cohort in seven European cities

Increased cycling uptake can improve population health, but barriers include real and perceived risks. Crash risk factors are important to understand in order to improve safety and increase cycling uptake. Many studies of cycling crash risk are based on combining diverse sources of crash and exposure data, such as police databases (crashes) and travel surveys (exposure), based on shared geography and time. When conflating crash and exposure data from different sources, the risk factors that can be quantified are only those variables common to both datasets, which tend to be limited to geography (e.g. countries, provinces, municipalities) and a few general road user characteristics (e.g. gender and age strata). The Physical Activity through Sustainable Transport Approaches (PASTA) project was a prospective cohort study that collected both crash and exposure data from seven European cities (Antwerp, Barcelona, London, Örebro, Rome, Vienna and Zürich). The goal of this research was to use data from the PASTA project to quantify exposure-adjusted crash rates and model adjusted crash risk factors, including detailed sociodemographic characteristics, attitudes about transportation, neighbourhood built environment features and location by city. We used negative binomial regression to model the influence of risk factors independent of exposure. Of the 4,180 cyclists, 10.2 % reported 535 crashes. We found that overall crash rates were 6.7 times higher in London, the city with the highest crash rate, relative to Örebro, the city with the lowest rate. Differences in overall crash rates between cities are driven largely by crashes that did not require medical treatment and that involved motor-vehicles. In a parsimonious crash risk model, we found higher crash risks for less frequent cyclists, men, those who perceive cycling to not be well regarded in their neighbourhood, and those who live in areas of very high building density. Longitudinal collection of crash and exposure data can provide important insights into individual differences in crash risk. Substantial differences in crash risks between cities, neighbourhoods and population groups suggest there is great potential for improvement in cycling safety.

Road lighting density and brightness linked with increased cycling rates after-dark

Cycling has a range of benefits as is recognised by national and international policies aiming to increase cycling rates. Darkness acts as a barrier to people cycling, with fewer people cycling after-dark when seasonal and time-of-day factors are accounted for. This paper explores whether road lighting can reduce the negative impact of darkness on cycling rates. Changes in cycling rates between daylight and after-dark were quantified for 48 locations in Birmingham, United Kingdom, by calculating an odds ratio. These odds ratios were compared against two measures of road lighting at each location: 1) Density of road lighting lanterns; 2) Relative brightness as estimated from night-time aerial images. Locations with no road lighting showed a significantly greater reduction in cycling after-dark compared with locations that had some lighting. A nonlinear relationship was found between relative brightness at a location at night and the reduction in cyclists after-dark. Small initial increases in brightness resulted in large reductions in the difference between cyclist numbers in daylight and after-dark, but this effect reached a plateau as brightness increased. These results suggest only a minimal amount of lighting can promote cycling after-dark, making it an attractive mode of transport year-round.

Evaluating Cyclists’ Route Preferences with Respect to Infrastructure

Providing a sufficiently appropriate route environment is crucial to ensuring fair and safe biking, thus encouraging cycling as a sustainable mode of transport. At the same time, better understanding of cyclists’ preferences regarding the features of their routes and their infrastructure requirements is fundamental to evaluating improvement of the current infrastructure or the development of new infrastructure. The present study has two objectives. The first is to investigate cyclists’ route preferences by means of a choice experiment based on a stated preference survey. Subsequently, the second objective is to compare cyclist preferences in two countries with different cycling characteristics (both in infrastructure as well as cyclists’ behavior). For this purpose, a graphical online stated preferences survey was conducted in Greece and Germany. Within the framework of statistical analyses, multinomial mixed logit discrete choice models were developed that allow us to quantify the trade-offs of interest, while distinguishing between the preferences of different user groups. In addition, user requirements in Greece, as a country with a low cycling share and very little dedicated bike infrastructure, were compared to the requirements in Germany, where cycling is popular and the infrastructure is well developed. The results over the whole sample indicate that subgroups value infrastructure differently according to their specific needs. When looking at country specifics, users from Greece are significantly more willing to accept longer travel times in return for higher-quality facilities. The utility of low speed limits in mixed traffic is also different. In Germany, low speed limits offset the disturbance caused by motorized traffic, but in Greece they do not. Consequently, the results help to asses which types of infrastructure are most sustainable from a user perspective and help to set priorities when the aim is to adapt the road infrastructure efficiently in a stable strategy.

Is a liveable city a healthy city? Health impacts of urban and transport planning in Vienna, Austria

Each year, The Economist Intelligence Unit (EIU) computes the Global Liveability Index and determines the most liveable cities around the world. Vienna, Austria, was ranked by the EIU as the most liveable city worldwide in 2018 and 2019. However, the relationship between a liveable as well as healthy and environmentally-just city has not been previously explored. To explore whether the most liveable city is also a healthy and environmentally-just one, we estimated the premature mortality burden related to non-compliance with international exposure level recommendations for physical activity (PA), air pollution (PM_2.5 and NO₂), road traffic noise, green space and heat for Vienna, as well as its distribution by socioeconomic status (SES). We applied the Urban and TranspOrt Planning Health Impact Assessment (UTOPHIA) methodology and estimated the annual mortality, life expectancy (LE) and economic impact of non-compliance with exposure guidelines for the Viennese adult population ≥ 20 years. We compared current with recommended exposure levels, quantified the association between exposures and mortality and calculated attributable health impact fractions. Eight percent of premature mortality (i.e. 1239 deaths, 95% CI: 679-1784) was estimated to be attributable to non-compliance with the recommended exposure levels. Seventy-six percent of the attributable premature mortality was due to PM_2.5 exposure and insufficient PA. Non-compliance also resulted in an average of 199 days of LE lost for the adult population (95% CI: 111-280) and an economic impact of 4.6 (95% CI: 2.5-6.7) billion 2015€ annually. Overall, residents of lower SES neighbourhoods faced higher risk of premature mortality due to higher exposure to NO₂, road traffic noise, heat and less green space. Despite high liveability standards according to EIU definition, a considerable premature mortality burden was attributable to non-compliance with exposure recommendations, and socioeconomic inequalities were estimated. Although the exposure attributable mortality burden was lower than in other European cities and local Viennese policies favour the reduction of motorized traffic, alongside the promotion of active and public transport and urban greening, there is room for further alignment of liveability, environmental health and justice objectives.

Urban health: an example of a "health in all policies" approach in the context of SDGs implementation

BACKGROUND

Cities are an important driving force to implement the Sustainable Development Goals (SDGs) and the New Urban Agenda. The SDGs provide an operational framework to consider urbanization globally, while providing local mechanisms for action and careful attention to closing the gaps in the distribution of health gains. While health and well-being are explicitly addressed in SDG 3, health is also present as a pre condition of SDG 11, that aims at inclusive, safe, resilient and sustainable cities. Health in All Policies (HiAP) is an approach to public policy across sectors that systematically takes into account the health implications of decisions, seeks synergies, and avoids harmful health impacts in order to improve population health and health equity. HiAP is key for local decision-making processes in the context of urban policies to promote public health interventions aimed at achieving SDG targets. HiAPs relies heavily on the use of scientific evidence and evaluation tools, such as health impact assessments (HIAs). HIAs may include city-level quantitative burden of disease, health economic assessments, and citizen and other stakeholders' involvement to inform the integration of health recommendations in urban policies. The Barcelona Institute for Global Health (ISGlobal)'s Urban Planning, Environment and Health Initiative provides an example of a successful model of translating scientific evidence into policy and practice with regards to sustainable and healthy urban development. The experiences collected through ISGlobal's participation implementing HIAs in several cities worldwide as a way to promote HiAP are the basis for this analysis.

AIM

The aim of this article is threefold: to understand the links between social determinants of health, environmental exposures, behaviour, health outcomes and urban policies within the SDGs, following a HiAP rationale; to review and analyze the key elements of a HiAP approach as an accelerator of the SDGs in the context of urban and transport planning; and to describe lessons learnt from practical implementation of HIAs in cities across Europe, Africa and Latin-America.

METHODS

We create a comprehensive, urban health related SDGs conceptual framework, by linking already described urban health dimensions to existing SDGs, targets and indicators. We discuss, taking into account the necessary conditions and steps to conduct HiAP, the main barriers and opportunities within the SDGs framework. We conclude by reviewing HIAs in a number of cities worldwide (based on the experiences collected by co-authors of this publication), including city-level quantitative burden of disease and health economic assessments, as practical tools to inform the integration of health recommendations in urban policies.

RESULTS

A conceptual framework linking SDGs and urban and transportplanning, environmental exposures, behaviour and health outcomes, following a HiAP rationale, is designed. We found at least 38 SDG targets relevant to urban health, corresponding to 15 SDGs, while 4 important aspects contained in our proposed framework were not present in the SDGs (physical activity, noise, quality of life or social capital). Thus, a more comprehensive HiAP vision within the SDGs could be beneficial. Our analysis confirmed that the SDGs framework provides an opportunity to formulate and implement policies with a HiAP approach. Three important aspects are highlighted: 1) the importance of the intersectoral work and health equity as a cross-cutting issue in sustainable development endeavors; 2) policy coherence, health governance, and stakeholders' participation as key issues; and 3) the need for high quality data. HIAs are a practical tool to implement HiAP. Opportunities and barriers related to the political, legal and health governance context, the capacity to inform policies in other sectors, the involvement of different stakeholders, and the availability of quality data are discussed based on our experience. Quantitative assessments can provide powerful data such as: estimates of annual preventable morbidity and disability-adjusted life-years (DALYs) under compliance with international exposure recommendations for physical activity, exposure to air pollution, noise, heat, and access to green spaces; the associated economic impacts in health care costs per year; and the number of preventable premature deaths when improvements in urban and transport planning are implemented. This information has been used to support the design of policies that promote cycling, walking, public, zero and low-emitting modes of transport, and the provision of urban greening or healthy public open spaces in Barcelona (e.g. Urban Mobility, Green Infrastructure and Biodiversity Plans, or the Superblocks's model), the Bus Rapid Transit and Open Streets initiatives in several Latin American cities or targeted SDGs assessments in Morocco.

CONCLUSIONS

By applying tools such as HIA, HiAP can be implemented to inform and improve transport and urban planning to achieve the 2030 SDG Agenda. Such a framework could be potentially used in cities worldwide, including those of less developed regions or countries. Data availability, taking into account equity issues, strenghtening the communication between experts, decision makers and citizens, and the involvement of all major stakeholders are crucial elements for the HiAP approach to translate knowledge into SDG implementation.

Safety-in-numbers: An updated meta-analysis of estimates

Safety-in-numbers denotes the tendency for the number of accidents to increase less than in proportion to traffic volume. This paper updates a meta-analysis of estimates of safety-in-numbers published in 2017 (Elvik and Bjørnskau, Safety Science, 92, 274-282). Nearly all studies find safety-in-numbers, but the numerical estimates vary considerably. As virtually all studies are cross-sectional, it is not possible to determine if safety-in-numbers represents a causal relationship. Meta-regression analysis was performed to identify factors which may explain the large heterogeneity of estimates of safety-in-numbers. It was found that safety-in-numbers tends to be stronger for pedestrians than for cyclists, and stronger at the macro-level (e.g. citywide) than at the micro-level (e.g. in junctions). Recent studies find a stronger tendency towards safety-in-numbers than older studies.

Transforming Our Cities: Best Practices Towards Clean Air and Active Transportation

PURPOSE OF REVIEW

By 2050, 70% of the global population will live in urban areas, exposing a greater number of people to specific city-related health risks that will only be exacerbated by climate change. Two prominent health risks are poor air quality and physical inactivity. We aim to review the literature and state the best practices for clean air and active transportation in urban areas.

RECENT FINDINGS

Cities have been targeting reductions in air pollution and physical inactivity to improve population health. Oslo, Paris, and Madrid plan on banning cars from their city centers to mitigate climate change, reduce vehicle emissions, and increase walking and cycling. Urban streets are being redesigned to accommodate and integrate various modes of transportation to ensure individuals can become actively mobile and healthy. Investments in pedestrian, cycling, and public transport infrastructure and services can both improve air quality and support active transportation. Emerging technologies like electric and autonomous vehicles are being developed and may reduce air pollution but have limited impact on physical activity. Green spaces too can mitigate air pollution and encourage physical activity. Clean air and active transportation overlap considerably as they are both functions of mobility. The best practices of clean air and active transportation have produced impressive results, which are improved when enacted simultaneously in integrated policy packages. Further research is needed in middle- and low-income countries, using measurements from real-world interventions, tracing air pollution back to the sources responsible, and holistically addressing the entire spectrum of exposures and health outcomes related to transportation.

Neighborhood Socioeconomic Status and Health Care Costs: A Population-Wide Study in the Netherlands

Objectives. To identify disparities in several types of insured health care costs in the Netherlands across neighborhoods with different socioeconomic statuses and to assess the room for improvement. Methods. We used 2015 Dutch whole-population registry data to estimate the age- and gender-specific cost structure by neighborhood for total, specialist, pharmaceutical, and mental health care. Classifying neighborhoods by the quintile of their neighborhood socioeconomic status (NSES), we determined differences in observed and expected health care costs for several scenarios of NSES improvement. Results. From low to high NSES, we found a clear downward gradient in health care costs. Total health care costs would drop by 7.3% if each neighborhood's cost structure was equal to that of the most affluent neighborhoods. The potential for cost reduction appeared highest for females, for age groups between 40 and 60 years, and for pharmaceutical care. Conclusions. Low NSES is associated with relatively high health care costs, and represents considerable potential for cost savings in health care. Public Health Implications. Our research suggests that policies aimed at improving the socioeconomic determinants of health locally may be pivotal in containing health care costs.

Building Healthy Community Environments: A Public Health Approach

Environmental quality has a profound effect on health and the burden of disease. In the United States, the environment-related burden of disease is increasingly dominated by chronic diseases. At the local level, public health practitioners realize that many policy decisions affecting environmental quality and health transcend the authorities of traditional health department programs. Healthy decisions about the built environment, including housing, transportation, and energy, require broad collaborative efforts. Environmental health professionals have an opportunity to address the shift in public health burden toward chronic diseases and play an important role in the design of healthy communities by bringing data and tools to decision makers. This article provides a guide for community leaders to consider the public health effects of decisions about the built environment. We present a conceptual framework that represents a shift from compartmentalized solutions toward an inclusive systems approach that encourages partnership across disciplines and sectors. We discuss practical tools to assist with environmental decision making, such as Health Impact Assessments, environmental public health tracking, and cumulative risk assessment. We also identify priorities in research, practice, and education to advance the role of public health in decision making to improve health, such as the Health Impact Assessment, as a core competency for environmental health practitioners. We encourage cross-disciplinary communication, research, and education that bring the fields of planning, transportation, and energy in closer collaboration with public health to jointly advance the systems approach to today's environmental challenges.

The sharing economy promotes sustainable societies

A simultaneous improvement in both ecological and economic efficiency is necessary to achieve the Sustainable Development Goals (SDGs). The new sharing economy has potential to promote the needed shifts in collective consumption behaviour, but better governance models are urgently required.

Sharing activities are under wide debate regarding the environmental impacts. Here the authors reviewed their benefits and problems and suggested that a simultaneous improvement of both ecological and economic efficiency is necessary to achieve the Sustainable Development Goals (SDGs).

Physical activity-related health and economic benefits of building walkable neighbourhoods: a modelled comparison between brownfield and greenfield developments

BACKGROUND

A consensus is emerging in the literature that urban form can impact health by either facilitating or deterring physical activity (PA). However, there is a lack of evidence measuring population health and the economic benefits relating to alternative urban forms. We examined the issue of housing people within two distinct types of urban development forms: a medium-density brownfield development in an established area with existing amenities (e.g. daily living destinations, transit), and a low-density suburban greenfield development. We predicted the health and economic benefits of a brownfield development compared with a greenfield development through their influence on PA.

METHODS

We combined a new Walkability Planning Support System (Walkability PSS) with a quantitative health impact assessment model. We used the Walkability PSS to estimate the probability of residents' transport walking, based on their exposure to urban form in the brownfield and greenfield developments. We developed the underlying algorithms of the Walkability PSS using multi-level multivariate logistic regression analysis based on self-reported data for transport walking from the Victorian Integrated Survey of Transport and Activity 2009-10 and objectively measured urban form in the developments. We derived the difference in transport walking minutes per week based on the probability of transport walking in each of the developments and the average transport walking time per week among those who reported any transport walking. We then used the well-established method of the proportional multi-cohort multi-state life table model to translate the difference in transport walking minutes per week into health and economic benefits.

RESULTS

If adult residents living in the greenfield neighbourhood were instead exposed to the urban development form observed in a brownfield neighbourhood, the incidence and mortality of physical inactivity-related chronic diseases would decrease. Over the life course of the exposed population (21,000), we estimated 1600 health-adjusted life years gained and economic benefits of A$94 million.

DISCUSSION

Our findings indicate that planning policies that create walkable neighbourhoods with access to shops, services and public transport will lead to substantial health and economic benefits associated with reduced incidence of physical inactivity related diseases and premature death.

Health Benefits of Physical Activity Related to an Urban Riverside Regeneration

The promotion of physical activity through better urban design is one pathway by which health and well-being improvements can be achieved. This study aimed to quantify health and health-related economic impacts associated with physical activity in an urban riverside park regeneration project in Barcelona, Spain. We used data from Barcelona local authorities and meta-analysis assessing physical activity and health outcomes to develop and apply the “Blue Active Tool”. We estimated park user health impacts in terms of all-cause mortality, morbidity (ischemic heart disease; ischemic stroke; type 2 diabetes; cancers of the colon and breast; and dementia), disability-adjusted life years (DALYs) and health-related economic impacts. We estimated that 5753 adult users visited the riverside park daily and performed different types of physical activity (walking for leisure or to/from work, cycling, and running). Related to the physical activity conducted on the riverside park, we estimated an annual reduction of 7.3 deaths (95% CI: 5.4; 10.2), and 6.2 cases of diseases (95% CI: 2.0; 11.6). This corresponds to 11.9 DALYs (95% CI: 3.4; 20.5) and an annual health-economic impact of 23.4 million euros (95% CI: 17.2 million; 32.8 million). The urban regeneration intervention of this riverside park provides health and health-related economic benefits to the population using the infrastructure.

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.