The price of precision: trade-offs between usability and validity in the World Health Organization Health Economic Assessment Tool for walking and cycling.

OBJECTIVES: The widely used World Health Organization (WHO) Health Economic Assessment Tool (HEAT) for walking and cycling quantifies health impacts in terms of premature deaths avoided or caused as a result of changes in active transport. This article attempts to assess the effect of incorporating 'life-years' as an impact measure to increase the precision of the model and assess the effect on the tool's usability. STUDY DESIGN: This article is a methods paper, using simulation to estimate the effect of a methodological change to the HEAT 4.2 physical activity module. METHODS: We use the widely used WHO HEAT for walking and cycling as a case study. HEAT currently quantifies health impacts in terms of premature deaths avoided or caused as a result of changes in active transport. We assess the effect of incorporating "duration of life gained" as an impact measure to increase the precision of the model without substantially affecting usability or increasing data requirements. RESULTS: Compared with the existing tool (HEAT version 4.2), which values premature deaths avoided, estimates derived by valuing life-years gained are more sensitive to the age of the population affected by an intervention, with results for older and younger age groups being markedly different between the two methods. This is likely to improve the precision of the tool, especially where it is applied to interventions that affect age groups differentially. The life-years method requires additional background data (obtained and used in this analysis) and minimal additional user inputs; however, this may also make the tool harder to explain to users. CONCLUSIONS: Methodological improvements in the precision of widely used tools, such as the HEAT, may also inadvertently reduce their practical usability. It is therefore important to consider the overall impact on the tool's value to stakeholders and explore ways of mitigating potential reductions in usability.

Sport promotion policies in the European Union: results of a contents analysis.

Although sport promotion may play an important role in achieving the recommended levels of physical activity for health, until now, there has been no comprehensive assessment of how sport policies in Europe address health. This article aimed at filling this gap by reviewing and analyzing recent national policy developments in the area of sport promotion, with a focus on synergies and discrepancies with the promotion of health-enhancing physical activity. By applying various search methods, 130 documents focusing on sport and physical activity were identified in the World Health Organization (WHO) European Region. An analysis grid covering key indicators was developed for a systematic content analysis of 25 documents, selected according to established criteria. Analysis showed that general recommendations for good policy making were followed, such as establishing general goals, specifying time frame and responsible body for implementation and addressing different target groups. Furthermore, all sport strategies addressed health on an overall level and recognized the importance of Sport for All. However, in several strategies, there was a lack of measurable targets, specified budgets, and evaluation plans. The analysis showed that there is a great opportunity for health and sport sectors to work more closely together in the future, and identified areas where this could take place.

Perceived environmental housing quality and wellbeing of movers.

STUDY OBJECTIVE: To examine whether changes in environmental housing quality influence the wellbeing of movers taking into account other dimensions of housing quality and sociodemographic factors. DESIGN: Cross sectional telephone survey. Associations between changes in satisfaction with 40 housing quality indicators (including environmental quality) and an improvement in self rated health (based on a standardised question) were analysed by multiple logistic regression adjusting for sociodemographic variables. Objective measures of wellbeing or environmental quality were not available. SETTING: North western region of Switzerland including the city of Basel. PARTICIPANTS: Random sample of 3870 subjects aged 18-70 who had moved in 1997, participation rate 55.7%. RESULTS: A gain in self rated health was most strongly predicted by an improved satisfaction with indicators related to the environmental housing quality measured as "location of building" (adjusted odds ratio (OR) =1.58, 95% confidence intervals (CI) =1.28, 1.96) and "perceived air quality" (OR=1.58, 95% CI=1.24, 2.01) and to the apartment itself, namely "suitability" (OR=1.77, 95% CI=1.41, 2.23), "relationship with neighbours" (OR=1.46, 95% CI=1.19, 1.80) and "noise from neighbours" (OR=1.32, 95% CI=1.07, 1.64). The destination of moving and the main reason to move modified some of the associations with environmental indicators. CONCLUSION: An improvement in perceived environmental housing quality was conducive to an increase in wellbeing of movers when other dimensions of housing quality and potential confounders were taken into account.