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

The 15-minute city concept: The case study within a neighbourhood of Thessaloniki

Cities, crucial cultural hubs, mould individual and group identities. The global urban expansion, with over half the population in urban areas, presents interconnected challenges such as pollution, poverty, inequality, ageing infrastructure, resource overconsumption, land use changes, biodiversity impact and climate change. Addressing these demands ambitious actions targeting political, social and economic systems for transformative change. The theoretical framework guiding city transformation centres on an interdisciplinary approach influenced by the Smart and Green Transition. The '15-minute city' concept, emphasizing human scale and urban experience, proposes that cities enable residents to meet daily needs within a short walk or bike ride. The aim of this study was the exploration of its implementation in Greek cities, particularly Thessaloniki, which reveals inherent characteristics supporting the 15-minute concept. Through an interdisciplinary approach rooted in the Smart and Green Transition framework, the research provides concrete guidance for policymakers in tailoring urban planning strategies, allocating resources effectively and crafting policies conducive to successful and sustainable urban transformations. Moreover, prioritizing public engagement highlights the significance of community involvement in shaping urban development plans, ensuring that proposed initiatives align with residents' needs and desires. In essence, this research contributes tangible insights and actionable recommendations for Greek cities, paving the way for more liveable, resilient and sustainable urban environments.

Mobility Infrastructures and Health: Scoping Review of studies in Europe

Objectives

Movement-friendly environments with infrastructure favouring active mobility are important for promoting physical activity. This scoping literature review aims at identifying the current evidence for links between mobility infrastructures and (a) behaviour regarding active mobility, (b) health outcomes and (c) co-benefits.

Method

This review was conducted in accordance with the PRISMA scoping review guidelines using PubMed and EMBASE databases. Studies included in this review were conducted in Europe, and published between 2000 and March 2023.

Results

146 scientific articles and grey literature reports were identified. Connectivity of sidewalks, walkability, and accessibility of shops, services and work are associated with walking. Cycling is positively associated with cycle-paths, separation of cycling from traffic and proximity to greenspaces, and negatively associated with traffic danger. Increased active transportation has a protective effect on cardiovascular and respiratory health, obesity, fitness, and quality of life. Co-benefits result from the reduction of individual motorized transportation including reduced environmental pollution and projected healthcare expenditure.

Conclusion

Mobility infrastructure combined with social and educational incentives are effective in promoting active travel and reducing future healthcare expenses. A shift to active transportation would increase both individual and community health and decrease greenhouse gas emissions.

Validating the Perceived Active School Travel Enablers and Barriers-Parent (PASTEB-P) Questionnaire to Support Intervention Programming and Research

A child's ability to participate in active school travel (AST) is complicated by several factors. Of particular note are parental controls, which are informed by their perceptions of the local built and social environments, assessments of their child's skills, and convenience preferences, among other considerations. However, there is currently a lack of AST-specific scales that include validated parental perception measures related to such notable barriers and enablers, or those that tend to frame their AST decision-making processes. Framed within the social-ecological model of health behaviour, the aims of the present paper were thus threefold, specifically to (1) outline and test the construct validity of measures delineating parental perceptions of barriers and enablers to AST, (2) evaluate the reliability and consistency of the developed measures, and (3) connect these measures to develop broader constructs for use in the Perceived Active School Travel Enablers and Barriers-Parent (PASTEB-P) questionnaire. To achieve these aims, a mixed-methods approach featuring cognitive interviews and surveys, along with qualitative (thematic analysis) and quantitative (Cohen's Kappa, McDonald's Omega, and confirmatory factor analysis) analyses, was applied across two studies. The validation processes of the two studies resulted in the development of fifteen items comprising seven distinct constructs (barriers: AST Skills, Convenience, Road Safety, Social Safety, and Equipment Storage; enablers: Supportive Environment and Safe Environment) related to parental perceptions of AST. The developed PASTEB-P questionnaire can be used to inform and evaluate AST intervention programming and can be applied for AST research purposes.

Cycling through 360° Virtual Reality Tourism for Senior Citizens: Empirical Analysis of an Assistive Technology

In recent years, there has been a renewed interest in using virtual reality (VR) to (re)create different scenarios and environments with interactive and immersive experiences. Although VR has been popular in the tourism sector to reconfigure tourists' relationships with places and overcome mobility restrictions, its usage in senior cyclotourism has been understudied. VR is suggested to positively impact tourism promotion, cycling simulation, and active and healthy ageing due to physical and mental rehabilitation. The purpose of this study is to assess the senior citizens' perceived experience and attitudes toward a designed 360° VR cyclotouristic experiment, using a head-mounted display (HMD) setting within a laboratory context. A total of 76 participants aged between 50 and 97 years old were involved in convergent parallel mixed-method research, and data were collected using a questionnaire based on the technology acceptance model, as well as the researchers' field notes. Findings suggest that 360° VR with HMD can be an effective assistive technology to foster senior cyclotourism by promoting tourism sites, simulating the cycling pedaling effect, and improving senior citizens' general wellbeing and independence with physical and mental rehabilitation.

Developing Participatory Analytics Techniques to Inform the Prioritisation of Cycling Infrastructure

The planning of bicycle infrastructure across our cities remains a complex task involving many key stakeholders, including the community, who traditionally have had limited involvement in the planning process. This research develops an interactive bicycle prioritisation index tool which includes participatory spatial and textual citizen feedback. The research involves three components. Firstly, results of a survey of current cyclists in Sydney (n = 280), their current level of participation, priorities in investment in cycling and preferred locations for cycling infrastructure. This survey was undertaken between May and June 2020. Secondly, it documents the development of an interactive, digital bicycle planning tool which is informed through citizen feedback. Thirdly, it evaluates the approach in conversation with potential end-users, including government, planning practitioners, and advocacy group members. A clear preference for active participation mechanisms (86%) was articulated by current cyclists, as opposed to a reliance on the existing data available and passive data. The resulting tool was understood by interview participants and documented both existing utility and future work needed for practical implementation of similar systems. The research proposes the combination of multiple passive and active data traces with end-user evaluation to legitimise the citizen co-design of bicycle investment prioritisation initiatives. A case study approach was taken, focusing on the city of Sydney, Australia. The bicycle planning support system can be used by cities when engaging in cycle prioritisation initiatives, particularly with a focus on integrating citizen feedback and navigating the new and complex data landscapes introduced through recent, passively collected big data sets.

How might bicycle ownership/access and cycling expertise influence the design of cycling promotion interventions at the University of Johannesburg?

Objective: The present study examined potential barriers to cycle-based transport amongst undergraduate students, to inform the design of future cycling promotion interventions at the University of Johannesburg (UJ). Participants: A total of 606 first, second and third year UJ undergraduates took part. Methods: Sociodemographic and economic determinants of bicycle/car ownership, cycling competency and behavior were evaluated using data derived from a 9-item questionnaire, before and after adjustment for measured confounders. Results: While 70% of respondents knew how to cycle, only 26% owned/had access to a bicycle, and only 18% had last cycled for transport. Bicycle ownership and competency were far commoner amongst male and older participants, and those whose parents had the means to own a car. Conclusions: Interventions to promote cycle-based transport must address the many (predominantly female) students who: have limited cycling competency; do not own/have access to a bicycle; or have little/no experience of cycling for transport.

Planetary Health, Climate Change, and Lifestyle Medicine: Threats and Opportunities

Global environmental degradation and climate change threaten the foundation of human health and well-being. In a confluence of crises, the accelerating pace of climate change and other environmental disruptions pose an additional, preventable danger to a global population that is both aging and carrying a growing burden of noncommunicable diseases (NCDs). Climate change and environmental disruption function as "threat multipliers," especially for those with NCDs, worsening the potential health impacts on those with suboptimal health. At the same time, these environmental factors threaten the basic pillars of health and prevention, increasing the risk of developing chronic disease. In the face of these threats, the core competencies of lifestyle medicine (LM) present crucial opportunities to mitigate climate change and human health impacts while also allowing individuals and communities to build resilience. LM health professionals are uniquely positioned to coach patients toward climate-healthy behavior changes that heal both people and the planet.

Health, environmental and distributional impacts of cycling uptake: The model underlying the Propensity to Cycle tool for England and Wales

INTRODUCTION

The Propensity to Cycle Tool (PCT) is a widely used free, open source and publicly available tool for modelling cycling uptake and corresponding health and carbon impacts in England and Wales. In this paper we present the methods for our new individual-level modelling representing all commuters in England and Wales.

METHODS

Scenario commuter cycling potential in the PCT is modelled as a function of route distance and hilliness between home and work. Our new individual-level approach has allowed us to create an additional "Near Market" scenario where age, gender, ethnicity, car ownership and area level deprivation also affect an individual's likelihood of switching to cycling. For this and other scenarios, we calculate the carbon benefits of cycling uptake based on the trip distance and previous mode, while health benefits are additionally affected by hilliness and baseline average mortality risk. This allows the estimation of how health and carbon benefits differ by demographic group as well as by scenario.

RESULTS

While cycle commuting in England and Wales is demographically skewed towards men and white people, women and people from ethnic minorities have greater cycling potential based on route distance and hilliness. Benefits from cycling uptake are distributed differently again. For example, while increasing female cycling mode share is good for equity, each additional female cyclist generates a smaller average health and carbon benefit than a male cyclist. This is based on women's lower baseline mortality risk, shorter commute travel distances, and lower propensity to commute by car than men.

CONCLUSION

We have demonstrated a new approach to modelling that allows for more sophisticated and nuanced assessment of cycling uptake and subsequent benefits, under different scenarios. Health and carbon are increasingly incorporated into appraisal of active travel schemes, valuing important outcomes. However, especially with better representation of demographic factors, this can act as a barrier to equity goals.

Impact of E-Bikes on Cycling in Hilly Areas: Participants’ Experience of Electrically-Assisted Cycling in a UK Study

Electrically-assisted cycling can make a major contribution to sustainable mobility. For some people, hills are a barrier for cycling. This paper focuses on how and why electrically-assisted bikes make a difference to cycling in hilly contexts, and can thus be an important element of sustainable mobility in hilly geographies. It makes a novel contribution in being able to draw on recorded sensor data of the actual use of assistance in relation to the specific geography of the route cycled (GPS data), and interview/survey material. It shows that e-bikes extend the range, nature and scope of journeys manageable by bike, and therefore the general viability of e-bikes as alternative to other modes. It highlights that the benefits of using e-bikes are often also psychological, since they can change the overall enjoyability of the cycling experience in hilly areas. Resulting policy recommendations, that could lead to significant CO2 savings through the uptake of e-cycling in hilly contexts, include ‘try before you buy’ schemes, training for e-bike users and investing in relevant cycling infrastructure.

An economic analysis of the health-related benefits associated with bicycle infrastructure investment in three Canadian cities

Objectives

Decision-makers are increasingly requesting economic analyses on transportation-related interventions, but health is often excluded as a determinant of value. We assess the health-related economic impact of bicycle infrastructure investments in three Canadian cities (Victoria, Kelowna and Halifax), comparing a baseline reference year (2016) with the future infrastructure build-out (2020).

Methods

The World Health Organization’s Health Economic Assessment Tool (HEAT; version 4.2) was used to quantify the economic value of health benefits associated with increased bicycling, using a 10-year time horizon. Outputs comprise premature deaths prevented, carbon emissions avoided, and a benefit:cost ratio. For 2016–2020, we derived cost estimates for bicycle infrastructure investments (including verification from city partners) and modelled three scenarios for changes in bicycling mode share: ‘no change’, ‘moderate change’ (a 2% increase), and ‘major change’ (a 5% increase). Further sensitivity analyses (32 per city) examined how robust the moderate scenario findings were to variation in parameter inputs.

Results

Planned bicycle infrastructure investments between 2016 and 2020 ranged from $28–69 million (CAD; in 2016 prices). The moderate scenario benefit:cost ratios were between 1.7:1 (Victoria) and 2.1:1 (Halifax), with the benefit estimate incorporating 9–18 premature deaths prevented and a reduction of 87–142 thousand tonnes of carbon over the 10-year time horizon. The major scenario benefit:cost ratios were between 3.9:1 (Victoria) and 4.9:1 (Halifax), with 19–43 premature deaths prevented and 209–349 thousand tonnes of carbon averted. Sensitivity analyses showed the ratio estimates to be sensitive to the time horizon, investment cost and value of a statistical life inputs.

Conclusion

Within the assessment framework permitted by HEAT, the dollar value of health-related benefits exceeded the cost of planned infrastructure investments in bicycling in the three study cities. Depending on the decision problem, complementary analyses may be required to address broader questions relevant to decision makers in the public sector.

The public health implications of the Paris Agreement: a modelling study

BACKGROUND

nationally determined contributions (NDCs) serve to meet the goals of the Paris Agreement of staying "well below 2°C", which could also yield substantial health co-benefits in the process. However, existing NDC commitments are inadequate to achieve this goal. Placing health as a key focus of the NDCs could present an opportunity to increase ambition and realise health co-benefits. We modelled scenarios to analyse the health co-benefits of NDCs for the year 2040 for nine representative countries (ie, Brazil, China, Germany, India, Indonesia, Nigeria, South Africa, the UK, and the USA) that were selected for their contribution to global greenhouse gas emissions and their global or regional influence.

METHODS

Modelling the energy, food and agriculture, and transport sectors, and mortality related to risk factors of air pollution, diet, and physical activity, we analysed the health co-benefits of existing NDCs and related policies (ie, the current pathways scenario) for 2040 in nine countries around the world. We compared these health co-benefits with two alternative scenarios, one consistent with the goal of the Paris Agreement and the Sustainable Development Goals (ie, the sustainable pathways scenario), and one in line with the sustainable pathways scenario, but also placing health as a central focus of the policies (ie, the health in all climate policies scenario).

FINDINGS

Compared with the current pathways scenario, the sustainable pathways scenario resulted in an annual reduction of 1·18 million air pollution-related deaths, 5·86 million diet-related deaths, and 1·15 million deaths due to physical inactivity, across the nine countries, by 2040. Adopting the more ambitious health in all climate policies scenario would result in a further reduction of 462 000 annual deaths attributable to air pollution, 572 000 annual deaths attributable to diet, and 943 000 annual deaths attributable to physical inactivity. These benefits were attributable to the mitigation of direct greenhouse gas emissions and the commensurate actions that reduce exposure to harmful pollutants, as well as improved diets and safe physical activity.

INTERPRETATION

A greater consideration of health in the NDCs and climate change mitigation policies has the potential to yield considerable health benefits as well as achieve the "well below 2°C" commitment across a range of regional and economic contexts.

FUNDING

This work was in part funded through an unrestricted grant from the Wellcome Trust (award number 209734/Z/17/Z) and supported by an Engineering and Physical Sciences Research Council grant (grant number EP/R035288/1).

Climate Change Mitigation Policies and Co-Impacts on Indigenous Health: A Scoping Review

Climate change mitigation policies can either facilitate or hinder progress towards health equity, and can have particular implications for Indigenous health. We sought to summarize current knowledge about the potential impacts (co-benefits and co-harms) of climate mitigation policies and interventions on Indigenous health. Using a Kaupapa Māori theoretical positioning, we adapted a validated search strategy to identify studies for this scoping review. Our review included empirical and modeling studies that examined a range of climate change mitigation measures, with health-related outcomes analyzed by ethnicity or socioeconomic status. Data were extracted from published reports and summarized. We identified 36 studies that examined a diverse set of policy instruments, with the majority located in high-income countries. Most studies employed conventional Western research methodologies, and few examined potential impacts of particular relevance to Indigenous peoples. The existing body of knowledge is limited in the extent to which it can provide definitive evidence about co-benefits and co-harms for Indigenous health, with impacts highly dependent on individual policy characteristics and contextual factors. Improving the quality of evidence will require research partnerships with Indigenous communities and study designs that centralize Indigenous knowledges, values, realities and priorities.

Health benefits of policies to reduce carbon emissions

James Milner and colleagues argue that carefully considered policies to lower carbon emissions can also improve health, and we should use these benefits to push for strong climate action

[Current trends and injuries in cycling: faster, further, e-bike?]

During the past decade, technical innovations (e.g., carbon as a new material, disk brakes, hydraulic shock absorbers, electric transmissions) and lifestyle changes have significantly influenced recreational and professional cycling. In contrast to the past, where ambitious leisure cyclists were primarily interested in the recreational value of nature and landscape, cyclists of all ages are nowadays increasingly focused on performance and self-optimization. Simultaneously, manufacturers have adapted to differing customer requirements: besides the traditional extremities of road and mountain bikes, many specialized models have been designed for special applications: trekking, cyclocross, gravel, full-suspension, single-track, hardtail, downhill, fatbike, etc. For biking fans who are no longer able to meet their own demands due to individual physical restrictions or defined health problems, electric-assist bikes (pedelecs or "e-bikes") were recently introduced. While these are becoming increasingly popular, they have also increased the number of accidents and injuries. The current work provides an update on relevant sport medical and orthopaedic challenges brought on by these developments in cycling.

Climate change and health: Moving from theory to practice

In an Editorial discussing the Special Issue on Climate Change and Health, guest editors Jonathan Patz and Madeleine Thompson summarize key issues in the field and describe the significance of research studies included in the issue.