Health Impacts of Active Transportation in Europe

Abstract

Policies that stimulate active transportation (walking and bicycling) have been related to heath benefits. This study aims to assess the potential health risks and benefits of promoting active transportation for commuting populations (age groups 16-64) in six European cities. We conducted a health impact assessment using two scenarios: increased cycling and increased walking. The primary outcome measure was all-cause mortality related to changes in physical activity level, exposure to fine particulate matter air pollution with a diameter <2.5 μm, as well as traffic fatalities in the cities of Barcelona, Basel, Copenhagen, Paris, Prague, and Warsaw. All scenarios produced health benefits in the six cities. An increase in bicycle trips to 35% of all trips (as in Copenhagen) produced the highest benefits among the different scenarios analysed in Warsaw 113 (76-163) annual deaths avoided, Prague 61 (29-104), Barcelona 37 (24-56), Paris 37 (18-64) and Basel 5 (3-9). An increase in walking trips to 50% of all trips (as in Paris) resulted in 19 (3-42) deaths avoided annually in Warsaw, 11(3-21) in Prague, 6 (4-9) in Basel, 3 (2-6) in Copenhagen and 3 (2-4) in Barcelona. The scenarios would also reduce carbon dioxide emissions in the six cities by 1,139 to 26,423 (metric tonnes per year). Policies to promote active transportation may produce health benefits, but these depend of the existing characteristics of the cities. Increased collaboration between health practitioners, transport specialists and urban planners will help to introduce the health perspective in transport policies and promote active transportation.

Fig 1. Conceptual framework of active transportation and health.

Fig 2. Number of deaths and Number of deaths adjusted by 100,000 travellers who shifted modes per year, by heath exposure.

Scenarios. A: 35% of all trips by bicycle; B: 50% of all trips walking.

Fig 3. Sensitivity analysis. Number of deaths avoided or postponed per year by 100,000 travellers who shifted modes.

A: Cyclist increment; B: Pedestrians increment. “Linear RR for PA”: Using a linear relative risk function for physical activity (for cycling or walking) as reported by kahlmeier S, et al, 2011; “50% of the trips coming from car trips”: Assume that half of the trips substituted in each scenario come from car trips; “Safety in numbers”: Assuming a fatal accident reduction associated with the increment of the number of pedestrians or cyclist; “Fatal accident risk of the reference city”: Assuming a fatal accident risk similar to the reference city for the scenarios A (fatal accident risk of cyclist in Copenhagen) and B (fatal accident risk of pedestrians in Paris); “European RR function for PM2.5”: Using a relative risk function of PM2.5 and all cause mortality reported in ESCAPE project (Beelen R, et al, 2014); “Fivefold toxicity of PM2.5”: Assuming a fivefold toxicity of PM2.5 from the traffic sources.