1. Presentation Objectives To briefly define what are the economic values of physical activity To outline the HEAT cycling economic tool To present real cost effective cycling interventions

2. What are the economic values of physical activity? Cost of physical inactivity – Direct Health service costs – Indirect economic and social costs Costs of interventions – Physical activity health care – Environmental interventions Cost of doing nothing Cost of doing something

3. Presentation Objectives To briefly define what are the economic values of physical activity To outline the HEAT cycling economic tool To present real cost effective cycling interventions

4. HEAT approach Effective public health: – action outside as well as within the health sector – identify levers – working upstream – efficient use of public resources recognises importance of economic analysis in transport: benefit:cost ratio is king evidence-based transparent adaptable ‘do once and share’

5. Collaborative project Core group Harry Rutter, Nick Cavill, 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 In collaboration with: HEPA Europe network for the promotion of health-enhancing physical activity Acknowledgements Austrian Federal Ministry of Agriculture, Forestry, Environment and Water Management The Swedish Expertise Fund / Karolinska Institute, Sweden National Institute for Health and Clinical Excellence (NICE) University of Graz, Austria

6. Overview of the HEAT approach Use economic levers to influence transport appraisal Identify best format/inputs for transport planners Review the evidence Generate a tool based on the evidence Test with wide range of experts and refine Disseminate; evaluate; review

8. Issues Which health benefits? Mortality or morbidity or both? Physical activity and health relationship: linear or threshold? Activity substitution Costs applied Time periods

9. Relative risk of all cause mortality for regular cycle commuters 6,171 men and 783 women including 2,291 deaths RR 0.72 (95% CI: 0.57-0.91) adjusted for age, sex, educ. level, BP, BMI, leisure time physical activity, cholesterol and smoking Data from Copenhagen Male study and Glostrup Population Studies Results consistent with other cycling studies and literature on physical activity eg Matthews, Paffenbarger Cycling to work RR: all cause mortality Andersen, L B, Schnohr, P, Schroll, M, Hein, H O, (2000) All-Cause Mortality Associated With Physical Activity During Leisure Time, Work, Sports, and Cycling to Work, Archives of Internal Medicine, Vol. 160, pp1621-1628

10.  Excel Tool to assess the economic effect of cycling  Based on reduced all-cause mortality Foto: Günter Havlena / pixelio.de  HEAT tool for assessment of a city/region (cycling share) assessment of a cycle path (cycling infrastructure) cost-benefit-analysis  HEAT tool for transport planner traffic engineers health economists policy maker If x people cycle y distance on most days, what is the value of the improvements in their overall mortality rate? HEAT for Cycling

11. Step 1: enter your data  number of cycle trips per day traffic count estimation for a new infrastructure  mean trip length traffic census default value (2.0 km) Foto: Michael Praschl HEAT for Cycling Three simple steps

12. Step 2: check the parameters (default values)  mean number of days cycled per year  proportion of ‘round trips’  proportion of new cyclists  mortality data working age population  value of statistical life  discount rate  check timeframes for build up of benefits build up for uptake calculation of mean annual benefit Foto: Michael Praschl HEAT for Cycling Three simple steps

13. Step 3: read economic savings  present value of mean annual benefit (Euros per years)  savings per km, cyclist, trip  ‘saved lifes’ per year HEAT for Cycling available www.euro.who.int/transport (english version) www.radfahren.klimaaktiv.at (german version) Foto: www.pd-f.de / Pressedienst Fahrrad HEAT for Cycling Three simple steps

14. HEAT for Cycling

16. Presentation Objectives To briefly define what are the economic values of physical activity To outline the HEAT cycling economic tool To present real cost effective cycling interventions

17. The Cycling Demonstration Towns programme  First phase: October 2005 – October 2008  Now in the second phase, funded to 2011  This presentation focuses on results from the first phase of work  All towns funded at approx €6 per head per year, matched by the local authority  All towns ‘medium-sized’; larger ones focussed effort on part of their population 245,000 248,000 65,000

18. The Cycling Demonstration Towns programme

19. Benefit: Cost Ratio For every £1 spent in the cycling towns, the value of reduced mortality is £2.50

22. Scotland: HEAT used to estimate benefit from reaching cycling targets – 2-4 billion GBP per year if it reached 27% – Recommended that Scottish Transport Appraisal Guidance should include health benefits from cycling and walking Swedish Government adopted HEAT for cycling as part of official toolbox for the economic assessment of cycling infrastructure Czech Republic used HEAT for cycling used to calculate potential benefits from cycling in the city of Pilsen – USD 1.2million if 2% of population took up regular cycling New Zealand: Transport Authority of Auckland used HEAT to value adding cycling and pedestrian facilities to the Auckland Harbour Bridge Impact beyond England

23. HEAT for Walking “if x people walk y distance on most days, what is the economic value of the improvements in their mortality rate?” systematic review of epidemiological literature: aggregate risk for all-cause mortality of 0.77 (CI 0.63-0.95) 28 minutes per day Complex inputs needed for walking

24. Distance StepsDuration Trips How many people do these data apply to? Average speed Average step length Average trip duration Average trip distance Repeat these questions if pre and post measures are available How would you like to input your walking data? HEAT walking: work in progress

25. Conclusions: HEAT Identifies a major public health issue and uses effective lever to promote it Works outside traditional health care paradigm to achieve health gain Uses language of the target sector, not health Highly influential Cheap and sustainable Effective demonstration of using evidence to drive practice

26. Thanks Dr Nick Cavill & Dr Harry Rutter