Cycling and walking: a strengthening evidence-base of their co-benefits to health, environment an society Health benefits of sports; systematic review of observational and experimental studies Pekka Oja Side event of theSixth Ministerial Conference on Environment and Health Scaling up active mobility in Europe: THE PEP from Paris 2014 to Vienna 2019 13-15 June 2017 Ostrava, Czech Republic Pekka Oja, Sylvia Titze, Sami Kokko, Charlie Foster, Urho Kujala, Ari Heinonen, Pasi Koski, Paul Kelly HEPA Europe 21-23 October 2013 Helsinki

Physical activity and health outcomes mortality NCD morbidity hip fractures cognition cancer Source: St George et al. 2014

Domains of physical activity Occupation Domestic Transportation Leisure

1991 1998 1994

Nearly 20 years ago…….. While preparing for the Third Ministerial Conference on Environment and Health (London, 1999), Cycling and walking made their first entry as an important (positive) health dimension of transport policies UK LEADING THE WAY 1994: Transport and Health Research Group at the Open University 1995 Health at the crossroads : transport policy and urban health London School of Hygiene and Tropical Medicine edited by Tony Fletcher and Anthony J. McMichael

A rapidly developing evidence-base Risks Benefits Less congestion Less emissions of air pollutants and GHG More physical activity Less use of public space Exposure to air pollution Injuries

Domains of physical activity and all-cause mortality Domain of PA No of studies RR (95% CI) P-value %reduction in all-cause mortality Total physical activity 21 0.65 (0.60-0.71) <0.001 35% Occupation 6 0.83 (0.71-0.97) 17% Domestic 0.64 (0.55-0.75) 0.039 36% Transport 0.88 (0.79-0.98) 0.016 12% Leisure 41 0.74 (0.70-0.77) 0.018 26% Exercise and sports 13 0.66 (0.61-0.71) 0.046 34% Samitz et al. Int J Epidem 2011;1-19

Cycling for transport Relative risk = 0.90 (0.87-0.94) 7 studies, 187,000 individuals and 2.1 million person- years Mean age = 56; Mean follow-up = 14.2 years Exposure = 11.25 MET.hrs per week Risk of all-cause mortality reduced by 10% in the group that cycles compared to non-cyclists Kelly et al. IJBNPA 2014;11(1)

Walking for transport Relative risk = 0.90 (0.87-0,94) 7 studies, 187,000 participants, 21 milj. person-years Mean age =56; mean follow-up = 14.2 years Exposure = 11.25 MET-hours per week Risk of all-cause mortality rediced by 11% in the group that walks compared to non-walkers

Fig 1 Hazard ratio for all cause mortality, cardiovascular disease (CVD) incidence and mortality, and cancer incidence and mortality by commuting mode. Fig 1 Hazard ratio for all cause mortality, cardiovascular disease (CVD) incidence and mortality, and cancer incidence and mortality by commuting mode Carlos A Celis-Morales et al. BMJ 2017;357:bmj.j1456 ©2017 by British Medical Journal Publishing Group

Studies from different contexts indicate that the health benefits of active travel outweigh the risks Median benefit to risk ratio: 9:1 N. Mueller et al. / Preventive Medicine 76 (2015) 103–114 http://dx.doi.org/10.1016/j.ypmed.2015.04.010

Active transport may reduce health expenditures Total savings UK£ 17 billion Within 20 years, increased physical activity would lead to savings of roughly UK£17 billion (in 2010 prices) for the NHS, after adjustment for an increased risk of road traffic injuries. Further costs would be averted after 20 years

Active mobility can contribute to mitigate climate change Source: World Health Organization, 2011. Health co-benefits of climate change mitigation - Transport sector,

Exploring the job creation potential of active mobility Up to 435,000 cycling jobs created if 56 major cities achieved Copenhagen’s cycling modal share Strong correlation between cycling and the number of cycling-related jobs Cycling jobs are not only in cities – tourism jobs across wider geographical areas The indirect and induced jobs related to cycling can be significant Methodological issues remain, and need to be addressed through further research On average, the new cycling employment estimates were more than 150% higher for each sampled city, and up to 435,000 cycling jobs could be created if the same 56 major cities had the same cycling modal share as Copenhagen. As cycling increases, the higher number of cyclists will need more bicycles, more cycling accessories and more maintenance and repair services. The more bicycles there are in a city, the more cycling infrastructure will be needed, while an increase in the popularity of cycling will also encourage entrepreneurs to set up related businesses and to develop additional services. This was clearly demonstrated by the study in the city of Portland, Oregon in the USA. This showed an increase in the number of jobs over time as the of the modal share of cycling also increased. Another important finding through the analysis of data gathered from the cities and studies of wider geographical areas is that the there is a large cycling job potential outside of cities. Studies of wider geographical area (national or regional) concluded that tourism could make up a significant proportion of the total number of jobs associated with cycling. For example, the number of tourism related cycling jobs in Austria and France are estimated as 70% and 47%, respectively. What is more, we found that in some of the Serbian cities - including cities on the EuroVelo 6 along the River Danube – the number of jobs associated with tourism was at least 80% of the total number of cycling jobs. The studies reviewed and the data collected also revealed other insufficiently investigated aspects related to the possible creation of cycling-related jobs. Many jobs that might be considered to be associated with cycling tourism are indirect jobs, since they occur in other sectors of the economy, such as in the accommodation and food sectors. Such jobs are more difficult to associate with cycling and are therefore often not included in estimates of the number of cycling-related jobs, which tend to focus only on direct jobs. Other sectors might be contributing to jobs related to cycling that previous studies could not consider. In addition, the number of induced jobs created when the overall level of spending in the economy rises as a result of increased employment in cycling is also potentially important. Only one study, that for Austria, estimated the number of induced jobs; it concluded that these could account for 40% of the total number of jobs associated with cycling.

HEAT What is the economic value of the reduced all-cause mortality from a given volume of walking or cycling within a defined population?

Walking and cycling in transport Multiple and significant health benefits from AT conducive to public health gains Benefits of AT outweigh the risks AT can reduce health expenditures AT can mitigate climate change AT can create new jobs Economic value due to reduced mortality of AT manyfold compared to motor transport