The Health Economic Assessment Tool (HEAT) for walking and cycling - experiences from 10 years of application of a health impact assessment tool in policy and practice.

Introduction: In recent years, walking and cycling have moved into the focus as promising approaches to achieve public health, sustainable transport, climate goals and better urban resilience. However, they are only realistic transport and activity options for a large proportion of the population when they are safe, inclusive and convenient. One way to increase their recognition in transport policy is the inclusion of health impacts of walking and cycling into transport economic appraisals. Methods: The Health Economic Assessment Tool (HEAT) for walking and cycling calculates: if x people walk or cycle a distance of y on most days, what is the economic value of impacts on premature mortality, taking into account effects of physical activity, air pollution and road fatalities, as well as effects on carbon emissions. Different data sources were collated to examine how the HEAT in more than 10 years of existence, and to identify lessons learned and challenges. Results: Since its launch in 2009, the HEAT has gained wide recognition as a user friendly, yet robust, evidence-based tool usable by academics, policymakers, and practitioners. Originally designed for use in Europe, it has since been expanded for global use. Discussion: Challenges for a wider uptake of health-impact assessment (HIA) tools including active transport such as HEAT are the promotion and dissemination to local practitioners and policy makers also outside European and English-speaking regions and in low- and middle-income contexts, further increasing usability, and more generally the advancement of systematic data collection and impact quantification related to walking and cycling.

Integrated Impact Assessment of Active Travel: Expanding the Scope of the Health Economic Assessment Tool (HEAT) for Walking and Cycling.

The World Health Organization's Health Economic Assessment Tool (HEAT) for walking and cycling is a user-friendly web-based tool to assess the health impacts of active travel. HEAT, developed over 10 years ago, has been used by researchers, planners and policymakers alike in appraisals of walking and cycling policies at both national and more local scales. HEAT has undergone regular upgrades adopting the latest scientific evidence. This article presents the most recent upgrades of the tool. The health impacts of walking and/or cycling in a specified population are quantified in terms of premature deaths avoided (or caused). In addition to the calculation of benefits derived from physical activity, HEAT was recently expanded to include assessments of the burden associated with air pollution exposure and crash risks while walking or cycling. Further, the impacts on carbon emissions from mode shifts to active travel modes can now be assessed. The monetization of impacts using Value of Statistical Life and Social Costs of Carbon now uses country-specific values. As active travel inherently results in often substantial health benefits as well as not always negligible risks, assessments of active travel behavior or policies are incomplete without considering health implications. The recent developments of HEAT make it easier than ever to obtain ballpark estimates of health impacts and carbon emissions related to walking and cycling.

Transport mode choice and body mass index: Cross-sectional and longitudinal evidence from a European-wide study.

BACKGROUND: In the fight against rising overweight and obesity levels, and unhealthy urban environments, the renaissance of active mobility (cycling and walking as a transport mode) is encouraging. Transport mode has been shown to be associated to body mass index (BMI), yet there is limited longitudinal evidence demonstrating causality. We aimed to associate transport mode and BMI cross-sectionally, but also prospectively in the first ever European-wide longitudinal study on transport and health. METHODS: Data were from the PASTA project that recruited adults in seven European cities (Antwerp, Barcelona, London, Oerebro, Rome, Vienna, Zurich) to complete a series of questionnaires on travel behavior, physical activity levels, and BMI. To assess the association between transport mode and BMI as well as change in BMI we performed crude and adjusted linear mixed-effects modeling for cross-sectional (n = 7380) and longitudinal (n = 2316) data, respectively. RESULTS: Cross-sectionally, BMI was 0.027 kg/m2 (95%CI 0.015 to 0.040) higher per additional day of car use per month. Inversely, BMI was -0.010 kg/m2 (95%CI -0.020 to -0.0002) lower per additional day of cycling per month. Changes in BMI were smaller in the longitudinal within-person assessment, however still statistically significant. BMI decreased in occasional (less than once per week) and non-cyclists who increased cycling (-0.303 kg/m2, 95%CI -0.530 to -0.077), while frequent (at least once per week) cyclists who stopped cycling increased their BMI (0.417 kg/m2, 95%CI 0.033 to 0.802). CONCLUSIONS: Our analyses showed that people lower their BMI when starting or increasing cycling, demonstrating the health benefits of active mobility.

Gesundheitsökonomisches bewertungsinstrument (HEAT) für gehen und für radfahren: methodik und benutzeranleitung für bewertungen der auswirkungen von körperlicher betätigung, luftverschmutzung, verletzungen und kohlenstoffemissionen

Die Förderung von Radfahren und Zufußgehen zum Zwecke täglicher körperlicher Betätigung kommt nicht nur der Gesundheit zugute, sondern kann sich auch positiv auf die Umwelt auswirken. In dieser Publikation werden die für die Erleichterung einer solchen Umstellung entwickelten Instrumente und Empfehlungen zusammengefasst: die Methodik für die ökonomische Bewertung der Verkehrsinfrastruktur und der Verkehrspolitik in Bezug auf die gesundheitlichen Effekte von Zufußgehen und Radfahren; systematische Sichtungen der ökonomischen und gesundheitsbezogenen Fachliteratur; und Empfehlungen für die Anwendung der gesundheitsökonomischen Bewertungsinstrumente und der ihnen zugrunde liegenden Prinzipien. Es handelt sich hierbei um eine aktualisierte Fassung, in der auch die Gesundheitsfolgen von Straßenverkehrsunfällen, Luftverschmutzung und CO2-Emissionen berücksichtigt werden. Mit dem Instrument lassen sich verschiedene Bewertungen durchführen, wie etwa: das aktuelle Verkehrsaufkommen mit dem Rad oder zu Fuß und der Stellenwert des Radfahrens oder Gehens in einer Stadt oder einem Land; die Veränderungen im Laufe der Zeit durch einen Vergleich von Vorher und Nachher oder von Szenario A mit Szenario B (wie etwa vor und nach einer Maßnahme); und die Auswertung neuer oder laufender Projekte und Bestimmung ihres Kosten-Nutzen-Verhältnisses. HEAT können allein oder gemeinsam mit anderen Instrumenten für eine umfassendere ökonomische Bewertung oder eine Abschätzung der Gesundheitsfolgen herangezogen werden. Dieses Methodik- und Benutzerhandbuch ist von wesentlichem Interesse für Fachkräfte auf nationaler wie kommunaler Ebene, d. h. Verkehrsplaner und Verkehrsingenieure sowie Interessengruppen in den Bereichen Verkehr, Zufußgehen, Radfahren oder Umwelt, aber auch Gesundheitsökonomen und Experten für Bewegung und Gesundheitsförderung.

Making THE (Transport, Health and Environment) link: Transport, Health and Environment Pan-European Programme and the Sustainable Development Goals

Transport plays an essential role in our societies and economies. It provides access to jobs, education, services, amenities and leisure, while contributing to economic growth, jobs and trade. At the same time, it has an impact on the environment and human health. Healthy and sustainable transport policies can make a major contribution to the attainment of many of the Sustainable Development Goals and fulfilment of the 2030 Agenda for Sustainable Development. Since 2002, the Transport, Health and Environment Pan-European Programme (THE PEP), jointly serviced by the WHO Regional Office for Europe and the United Nations Economic Commission for Europe, has provided a unique intersectoral policy platform for Member States, and other stakeholders active in the pan-European region, to collaborate to integrate environment and health considerations into transport policies, and improve the integration of transport and urban planning. This publication presents an analysis of how Member States, working through THE PEP, can advance the 2030 Agenda on multiple fronts; and provides examples of how THE PEP can help.

Outil d’évaluation économique des effets sanitaires (HEAT) liés à la pratique du vélo et de la marche : méthodologie et guide de l’utilisateur sur l’évaluation de l’activité physique, de la pollution atmosphérique, des traumatismes et de l’impact carbone

La promotion de la pratique du vélo et de la marche dans le cadre de l’activité physique quotidienne n’est pas seulement favorable à la santé, mais peut aussi s’avérer bénéfique pour l’environnement. Cette publication résume les outils élaborés afin de faciliter l’adoption de ces pratiques ainsi que les orientations dans ce domaine : méthodologie d’évaluation économique des infrastructures et politiques de transport en termes d’effets sanitaires de la bicyclette et de la marche ; revues systématiques de la littérature économique et sanitaire ; et conseils pour l’application des outils d’évaluation économique des effets sanitaires et principes à l’appui. Elle a été mise à jour afin de tenir compte des effets sanitaires des accidents de la route et de la pollution de l’air, ainsi que de l’impact sur les émissions de carbone. L’outil peut être utilisé pour plusieurs types d’évaluation, par exemple : l’évaluation des niveaux actuels (ou passés) de pratique du vélo ou de la marche, par exemple en montrant l’importance du vélo et de la marche dans une ville ou un pays donnés ; l’évaluation des changements au fil du temps, notamment en comparant les situations avant et après, ou le scénario A par rapport au scénario B (avec ou sans prise de mesures, par exemple) ; l’évaluation de projets nouveaux ou existants, notamment le calcul du rapport coûts-avantages. L’outil HEAT peut être utilisé de manière autonome, voire s’inscrire dans le cadre d’exercices plus complets d’évaluation économique ou d’une analyse prospective de l’impact sanitaire. Cette méthodologie et ce guide de l’utilisateur intéresseront principalement les professionnels aux niveaux national et local : les planificateurs des transports, les ingénieurs de la circulation, et les groupes d’intérêt spéciaux œuvrant dans le domaine du transport, de la marche, de la pratique du vélo ou de l’environnement, ainsi que les économistes de la santé et les experts en activité physique et en promotion de la santé.

Supporting Active Mobility and Green Jobs through the Promotion of Cycling.

This article is a summary of the main findings of the study "Riding towards the green economy: cycling and green jobs", which was developed in the context of the Transport, Health and Environment pan-European Programme (THE PEP). It builds on previous work under THE PEP, which demonstrated the job creation potential of cycling and of green and healthy transport more generally. The report summarized in this article collected data on jobs associated with cycling directly from city authorities and analysed these to re-assess previous estimates of the job creation potential of cycling. It concluded that the number of cycling-related jobs in the pan-European Region could increase by 435,000 in selected major cities if they increased their cycling share to that of the Danish capital Copenhagen. The implications and potential role of municipal and sub-national authorities in facilitating cycling while supporting economic development are then discussed. These findings indicate that investment in policies that promote cycling could deliver not only important benefits for health, the environment and the quality of urban life, but could also contribute to a sizable creation of job opportunities. Authorities need to be proactive in promoting cycling in order to deliver these benefits.

Environment and health for European cities in the 21st century: making a difference

With more than 80% of the European population expected to live in urban areas by 2030, cities play a pivotal role in steering the transition towards a low-carbon society as well as in promoting and protecting health and well-being, and preventing and mitigating socioeconomic inequalities among urban dwellers. This publication reviews the key drivers for change in the European urban environment, highlights the burden of disease in European cities, and discusses opportunities and barriers to action. Taking into account the responsibilities of cities in relation to several policy areas that have a direct impact on health and the environment, it also proposes possible ways forward to strengthen support for cities that are committed to addressing environment and health challenges in their communities. Such support will be channelled through the development of new partnerships, facilitating the dialogue and exchange of knowledge between subnational and local authorities, national governments and international actors, while building on existing strategic partnerships and initiatives at all levels of governance.

Health economic assessment tool (HEAT) for walking and for cycling: methods and user guide on physical activity, air pollution, injuries and carbon impact assessments

The promotion of cycling and walking for everyday physical activity not only promotes health but can also have positive effects on the environment. This publication summarizes the tools and guidance developed to facilitate this shift: the methodology for the economic assessment of transport infrastructure and policies in relation to the health effects of walking and cycling; systematic reviews of the economic and health literature; and guidance on applying the health economic assessment tools and the principles underlying it. It has been updated to consider the health effects of road crashes and air pollution and the effects on carbon emissions. The tool can be used for several types of assessment, for example: assessing current (or past) levels of cycling or walking, such as showing the value of cycling or walking in a city or country; assessing changes over time, such as comparing before-and-after situations or scenario A versus scenario B (such as with or without measures taken); and evaluating new or existing projects, including calculating benefit–cost ratios. HEAT can be used as a stand-alone tool or to provide input into more comprehensive economic appraisal exercises or prospective health impact assessment.

Physical Activity through Sustainable Transport Approaches (PASTA): a study protocol for a multicentre project.

INTRODUCTION: Only one-third of the European population meets the minimum recommended levels of physical activity (PA). Physical inactivity is a major risk factor for non-communicable diseases. Walking and cycling for transport (active mobility, AM) are well suited to provide regular PA. The European research project Physical Activity through Sustainable Transport Approaches (PASTA) pursues the following aims: (1) to investigate correlates and interrelations of AM, PA, air pollution and crash risk; (2) to evaluate the effectiveness of selected interventions to promote AM; (3) to improve health impact assessment (HIA) of AM; (4) to foster the exchange between the disciplines of public health and transport planning, and between research and practice. METHODS AND ANALYSIS: PASTA pursues a mixed-method and multilevel approach that is consistently applied in seven case study cities. Determinants of AM and the evaluation of measures to increase AM are investigated through a large scale longitudinal survey, with overall 14,000 respondents participating in Antwerp, Barcelona, London, Örebro, Rome, Vienna and Zurich. Contextual factors are systematically gathered in each city. PASTA generates empirical findings to improve HIA for AM, for example, with estimates of crash risks, factors on AM-PA substitution and carbon emissions savings from mode shifts. Findings from PASTA will inform WHO's online Health Economic Assessment Tool on the health benefits from cycling and/or walking. The study's wide scope, the combination of qualitative and quantitative methods and health and transport methods, the innovative survey design, the general and city-specific analyses, and the transdisciplinary composition of the consortium and the wider network of partners promise highly relevant insights for research and practice. ETHICS AND DISSEMINATION: Ethics approval has been obtained by the local ethics committees in the countries where the work is being conducted, and sent to the European Commission before the start of the survey. The PASTA website (http://www.pastaproject.eu) is at the core of all communication and dissemination activities.

Разработка национальных планов действий в области транспорта, охраны здоровья и окружающей среды: пошаговое пособие для лиц, формирующих политику и осуществляющих планирование

Национальный план действий в области транспорта, охраны здоровья и окружающей среды (НПДТОСОЗ) является ключевым механизмом для развития экологически устойчивого и здорового транспорта в стране. В нем представлен всеобъемлющий межотраслевой метод планирования и осуществления действий в области транспорта, окружающей среды и здоровья на национальном уровне. НПДТОСОЗ также стимулирует работу по всем секторам и действия, которые могут способствовать сокращению неравенств в отношении здоровья, внося вклад в достижение целей таких важнейших европейских мер политики и стратегий, как: Здоровье-2020, основы Европейской политики в поддержку здоровья и благополучия; Пармская декларация по окружающей среде и охране здоровья 2010 г.; План действий по реализации Европейской стратегии по профилактике и борьбе с неинфекционными заболеваниями, 2012–2016 гг. Данное пособие предназначено для помощи в разработке НПДТОСОЗ в странах. В нем предлагаются четыре этапа: планирование, разработка, реализация и оценка. В пособии не представлены конкретные рекомендации по организации процесса выработки общих стратегий и мер политики в отношении экологически устойчивого и здорового транспорта, то есть того процесса, который обычно предшествует разработке НПДТОСОЗ. Пособие содержит практические рекомендации по каждому из четырех этапов (и шаги в рамках каждого этапа) НПДТОСОЗ, а также представляет примеры эффективной практики из стран Европейского региона.

Effect of neighbourhood motorization rates on walking levels.

BACKGROUND: Motorized traffic may discourage people walking. This study analyses the influence of motorization on pedestrian mobility in the neighbourhoods of a European city, controlling for environmental, sociodemographic, mobility and road safety characteristics of the neighbourhood in which each trip was made. METHODS: Cross-sectional ecological study using the 38 neighbourhoods of Barcelona as the unit of analysis. Mobility information was obtained from the 2006 Daily Mobility Survey. Walking rates were calculated for 32.343 men and women who made walking trips, per 1000 men and women who made trips in the 38 neighbourhoods. Data were aggregated to calculate the total number of motorized trips made in each neighbourhood. ß coefficients and their confidence intervals were calculated using Poisson regression, in order to study the relationship between walking and motorization, in the different tertiles of motorization and adjusting for contextual factors and their corresponding interactions with motorization. RESULTS: Levels of motorization in the neighbourhood negatively influence walking, even when environmental variables of the neighbourhood are considered. In men we observe a gradient whereby walking rates fall as motorization rises (ß = -0.248; P < 0.001 and ß = -0.363; P < 0.001 in the second and third quartiles of motorization, respectively). In the case of women we find that only high levels of motorization have a negative influence on the rates of women who walk. (ß = -0.256; P < 0.001). CONCLUSION: Motorized traffic discourages people walking. Motorization is a modifiable environment-related factor which should be taken into account when designing policies to promote safe active travel.

Health economic assessment tools (HEAT) for walking and for cycling: methodology and user guide: economic assessment of transport infrastructure and policies

The promotion of cycling and walking for everyday physical activity not only promotes health but can also have positive effects on the environment. This booklet summarizes the tools and guidance developed to facilitate this shift: the methodology for the economic assessment of transport infrastructure and policies in relation to the health effects of walking and cycling; systematic reviews of the economic and health literature; and guidance on applying the health economic assessment tools and the principles underlying it. This methodology and user guide will be of key interest to professionals at both national and local levels: transport planners, traffic engineers, and special interest groups working on transport, walking, cycling or the environment, as well as health economists, physical activity experts and health promotion experts.

Developing national action plans on transport, health and environment: a step-by-step manual for policy-makers and planners

A national transport, health and environment action plan (NTHEAP) is a key tool and mechanism for developing sustainable and healthy transport in a country. NTHEAPs provide a comprehensive and intersectoral way of planning and implementing transport, environment and health action at the national level. They also call for working across sectors, and action can result in reducing health inequalities, thus contributing to Health 2020, the European policy for health and well-being; the Parma Declaration on Environment and Health; and the action plan for implementation of the European Strategy for the Prevention and Control of Noncommunicable Diseases 2012–2016. This manual was developed to guide NTHEAP development at the country level. It proposes four phases: planning, development, implementation and evaluation. It does not provide specifics on how to establish the general policies or strategies on sustainable and healthy transport, an activity that usually precedes the development of action plans. The manual provides practical advice for each of the phases and steps and highlights good practices from the European Region.