Quantification of
Health Benefits for
Cycling and
Walking: The
Health Economic
Assessment Tool
Candace Rutt, Ph.D.
Often Urban Environments
Favor Motorized
Transportation…..
….and Hinder Walking and Cycling
However, there are Places that are
Conducive to Active
Transportation
Why Assess Health Consequences?
Source: American Public Health Association, “The Hidden Health Costs of Transportation” Report prepared by Urban Design
4Health, Inc. February 10,2010, pg.2
Chronic Disease
and
Risk Factors
7 out of 10 deaths in the U.S. are
from chronic diseases such as
heart disease, cancer and stroke
 These chronic diseases are
primarily related to four risk
behaviors
- lack of physical activity
- poor nutrition
- tobacco use
- excessive alcohol consumption

Source: http://www.cdc.gov/chronicdisease/overview/index.htm
Current Health Care Spending
$2.2 Trillion
Prevention, 4%
Behaviors &
Environment
70%
Medical Services
96%
Genetics
20%
Medical Care, 10%
Factors Influencing
Health
SOURCE: Centers for Disease Control and Prevention, Blue Sky Initiative,
University of California at San Francisco, Institute of the Future, 2000
National Health
Expenditures
“Get more exercise”...
Source: Wernham, A. Health Impact Project. http://www.healthimpactproject.org/resources#presentations_webinars
Transportation, Land Use and Obesity
Source of slide: Meehan, L.A from the Nashville Area Metropolitan Planning Organization. Incorporating Health in
Regional Transportation Planning. Healthy Communities and Transportation Webinar, American Public Health
Association, January 18, 2011.
Why Walking and Cycling?
Perfect win-win option
 Reduce inactivity
 Reduce congestion
 Improve road safety
 Improve air quality
and noise
 Reduce energy
consumption and CO2
 More livable
communities
Why Guidance on Economic
Assessment?



Economic evaluation is
a standard tool of
transport planners so
it can help the health
sector to speak “their”
language
Public health benefits
are likely to be great,
esp. if inactive
persons can be
reached
Need for a transparent
robust methodology
HEAT
Developed by the WHO with international
experts
 Economic tool to estimate reductions in
mortality due to cycling (transportation)
and walking (recreaction and
transportation)
 Very conservative and does not include
morbidity
 Currently for adults only

HEAT

Can be used for planning new
infrascructure, evaluate current or future
levels of walking and cycling or even for
Health Impact Assessments
HEAT

Data imputs for the model:
– Average amount of time spent walking
or cycling
 Number of people walking and cycling and
average distance of trips
HEAT

How to get the
need inputs
– Route user
surveys
– Travel surveys
– Destination
based surveys
– Traffic counts
– Pedometers
Copenhagen Study – Effect
Estimate for Transport Cycling






6,954 regular cycle commuters
N = 30,640
Followed for 14.5 years
Mean journey time of 3 hours
per week
RR = 0.72 (0.57-0.91)
Adjusted for age, sex,
educational status, leisure time
physical activity, body mass
index, blood lipid levels,
smoking and blood pressure
Effect Estimate for Walking
9 studies were found that accounted for
OTHER types of leisure-time PA
 A meta-analysis weighted by sample size
found a RR of .78 (.64 - .98) for walking
29 minutes a day 7 days a week
 Model is still being modified

HEAT

Outputs of the model
– Number of lives saved
– Annual benefit in SVL which is $5.8
million per person in the U.S.
Uses in Other Countries

Austria: USD: $570 million per year

Pilsen, Czech Republic: $1.2 million if 2% of
population took up regular cycling

UK/Scotland: $1.5-3 billion per year if modal
share goal of 13% reached

New Zealand: adding cycling and pedestrian
facilities to the Auckland Harbour Bridge for a
savings of $900,000 per 1000 regular bike
commuters
Challenges to Adapting to U.S.
US Is much larger and
heterogeneous
 Travel data only
collected nationally
every 5 years
 Very few local regions
collect transport related
data
 Hard to find good data
on bike lanes and
sidewalks

U.S. Uses

Paper by Götschi (2012) examined cycling in
Portland
– By 2040, investments in the range of $138 to $605
million will result in health care cost savings of $388
to $594 million, fuel savings of $143to $218 million,
and savings in value of statistical lives of $7 to $12
billion.
– The cost-benefit ratios for healthcare and fuel
savings are between 3.8 and 1.2 to 1
Nonmotorized Transportation Pilot
Project

FHWA allocated $100 million dollars to 4 pilot
communities
–
–
–
–


Marin County, CA
Minneapolis, MN
Columbia, MO
Sheboygan County, WI
The communities were selected by congress with
input from bike and pedestrain advocates as well as
communnity leaders.
Several factors were used to pick the communities
including demographics, level of readiness and level
of urbanization.
Nonmotorized Transportation
Pilot Project


As of 2013 the communities spent $88.5 million
dollars with 78.9 million for infrastructure, 7.5
million in outreach education and marketing and
1.3 million in bicycle parking.
They were also able to leverage 59 million dollars
in other Federal State local and private funds.
Increases in Walking and
Cycling





85.1 million Vehicle Miles Traveled
were averted.
Walking mode share increased 15.8%
and cycling mode share increased
44%.
At individual project sites trip counts
increased 56% for pedestrian trips
and 115% for cycling trips.
¼ mile network cycling access was
expanded to 240,00 people, 160,00
housing units and 102,000 jobs.
Over 70% of projects connected to
activity centers.
Economic Savings
The number of lives saved per year is expected to be 9
for Minneapolis, 2 for Colombia, 8 for Marin County,
and 0 for Sheboygan County.
 The investments in Minneapolis are projected to
return $21,642,000 per year, Columbia will save
$5,396,000, and Marin County will save $18,776,000.
With the small decrease in cycling in Sheboygan
County, they are expected to lose $153,000.

Discussion


Criticism of HEAT- cycling is that it uses a RR from
Copenhagen
However, similar RR were also found in Shanghai
Discussion

Other outputs could be used:
– QALY
– DALY
– Morbidity by disease (cost of illness)
Next Steps





Adding morbidity into
both models
Modifying input and
output parameters
Inform and train
potential users
Examine injury and
exposure to air
pollution
Develop a model for
children
WHO Guidance and Tool
Download the guidance document and user
guide from
www.euro.who.int/transport/policy/20070503_1
HEAT Tool - Minneapolis

Q1: Your data: amount of cycling from a single point in
time, or before and after an intervention
– Single point in time
– Before and after

Q2: Enter your pre-intervention cycling data
– Duration
– Distance
– Trips

Q6.1: Trips: average number of trips per person, or total
number of trips?:
– Average per adult
– Total number of trips observed
HEAT Tool- Minneapolis

Q6.3: Total number of trips
– Enter the number of trips observed per day:
– 11,241 trips
– What proportion of these trips are cycling trips?
– 100% percent

Q6.4: Do you know the number of people who take cycling
trips, or do you wish to estimate the number of cyclists
based on the proportion of return journeys out of all trips
observed?
– Enter the number of individuals cycling
– Estimate this based on return journeys
HEAT Tool - Minneapolis

Q6.5: How many individuals contributed to the cycling trips
entered?
– Study population
– 294,729
– How many days per year do people cycle?
– 365 days per year
– The default is 124 days per year but this was based on
modeling the VOLPE and DOT used to calculate daily
averages

Q6.7: Enter the average trip duration or distance
– Duration
– Distance
HEAT Tool - Minneapolis

Q6.9: Average trip length
– Average trip length
– 2.26 miles
– This is the national average of cycling trip length NHTS
data

Q7: How many people benefit?
– Persons
– 294,729
– In some cases this figure will be the number of cyclers in
your study area, city or country or cycling data may be
based on a representative sample of a larger population.
In this case, you may wish to apply the findings to the
whole population.
HEAT Tool - Minneapolis

Q2: Enter your post-intervention cycling data
– Duration
– Distance
– Trips

Q6.1: Trips: average number of trips per person, or total
number of trips?
– Average per adult
– Total number of trips observed

Q6.3: Total number of trips
– Enter the number of trips observed per day:
– 17,986 Trips
– What proportion of these trips are cycling trips?
– 100 percent
HEAT Tool - Minneapolis

Q6.4: Do you know the number of people who take cycling
trips, or do you wish to estimate the number of cyclists
based on the proportion of return journeys out of all trips
observed?
– Enter the number of individuals cycling
– Estimate this based on return journeys

Q6.5: How many individuals contributed to the cycling trips
entered?
– Study population
– 326,085
– How many days per year do people cycle?
– 365 days per year
HEAT Tool - Minneapolis

Q6.7: Enter the average trip duration or distance
– Duration
– Distance

Q6.9: Average trip length
– Average trip length:
– 2.26 Miles

Q7: How many people benefit?
– Number of cyclists:
– 326,085 persons
HEAT Tool - Minneapolis

Q9: Proportion of cycling data attributable to your
intervention
– Estimate the proportion of cycling which you would like
to attribute to the intervention.
– It is prudent to assume that not all the cycling, or
increase in cycling is due to the intervention.
– Please enter a proportion between 0-100%
– 60 percent

Q10: Time needed to reach full level of cycling
– Please select the time period before maximum uptake is
achieved:
– 5 years
– This is the default value
HEAT Tool - Minneapolis

Q11: Mortality rate
– It is recommended to use the local crude mortality rate
for the population aged 20-64 years.
– HEAT is not appropriate for populations consisting
mainly of children, very young adults, or older people,
– 793.8 deaths per 100,000 population

Q12: Value of statistical life
– The value of a statistical life is derived with a
methodology called “willingness to pay” to avoid death
in relation to the years this person can expect to live
according to the statistical life expectancy.
– 5,800,000 dollars
HEAT Tool - Minneapolis

Q13: Time period over which benefits are calculated
– Please select the time period over which you wish
average benefits to be calculated
– 25 years

Q14: Costs to include a benefit–cost ratio in the HEAT
calculation
– Yes
– No

Q16: Discount rate to apply to future benefits
– Please enter the rate by which you wish to discount
future financial savings
– 5 percent
HEAT Tool - Results




There are an additional 31,356 individuals
regularly cycling compared to baseline
The number of deaths averted per year is 9.15
The average annual benefit is $21,642,000
The benefits accumulated over 25 years in
$541,051,000
Additional Resources

Report to the U.S. Congress on the Outcomes of the
Nonmotorized Transportation Pilot Program SAFETEALU Section 1807:
http://www.fhwa.dot.gov/environment/bicycle_pedes
trian/ntpp/2012_report/final_report_april_2012.pdfQu
antification of health benefits of cyling and walking

Transport, Health and Environment Pan European
Programme (THE PEP) www.thepep.org

HEPA Europe (European network for promotion of
health-enhancing physical activity)
www.euro.who.int/hepa
Multidisciplinary Team
Core Group:
Nick Cavill, Harry Rutter, Sonja
Kahlmeier, Hywell Dinsdale,
Francesca Racioppi, Pekka Oja
Contributors:
Lars Bo Andersen, Finn Berggren,
Hana Bruhova-Foltynova, Fiona
Bull, Andy Cope, Maria Hagströmer
/ Michael Sjöström, Eva
Gleissenberger / Robert Thaler,
Brian Martin, Irina Mincheva
Kovacheva, Hanns Moshammer,
Bhash Naidoo, Kjartan
Saelensminde, Peter Schantz,
Thomas Schmid, Heini Sommer,
Jan Sørensen, Sylvia Titze, Ardine
de Wit / Wanda Wendel Vos,
Mulugeta Yilma
Contact
Candace Rutt
awr8@cdc.gov
770-488-6015