Integrated Impact Assessment of Active Travel: Expanding the Scope of the Health Economic Assessment Tool (HEAT) for Walking and Cycling.

The World Health Organization's Health Economic Assessment Tool (HEAT) for walking and cycling is a user-friendly web-based tool to assess the health impacts of active travel. HEAT, developed over 10 years ago, has been used by researchers, planners and policymakers alike in appraisals of walking and cycling policies at both national and more local scales. HEAT has undergone regular upgrades adopting the latest scientific evidence. This article presents the most recent upgrades of the tool. The health impacts of walking and/or cycling in a specified population are quantified in terms of premature deaths avoided (or caused). In addition to the calculation of benefits derived from physical activity, HEAT was recently expanded to include assessments of the burden associated with air pollution exposure and crash risks while walking or cycling. Further, the impacts on carbon emissions from mode shifts to active travel modes can now be assessed. The monetization of impacts using Value of Statistical Life and Social Costs of Carbon now uses country-specific values. As active travel inherently results in often substantial health benefits as well as not always negligible risks, assessments of active travel behavior or policies are incomplete without considering health implications. The recent developments of HEAT make it easier than ever to obtain ballpark estimates of health impacts and carbon emissions related to walking and cycling.

Gesundheitsökonomisches bewertungsinstrument (HEAT) für gehen und für radfahren: methodik und benutzeranleitung für bewertungen der auswirkungen von körperlicher betätigung, luftverschmutzung, verletzungen und kohlenstoffemissionen

Die Förderung von Radfahren und Zufußgehen zum Zwecke täglicher körperlicher Betätigung kommt nicht nur der Gesundheit zugute, sondern kann sich auch positiv auf die Umwelt auswirken. In dieser Publikation werden die für die Erleichterung einer solchen Umstellung entwickelten Instrumente und Empfehlungen zusammengefasst: die Methodik für die ökonomische Bewertung der Verkehrsinfrastruktur und der Verkehrspolitik in Bezug auf die gesundheitlichen Effekte von Zufußgehen und Radfahren; systematische Sichtungen der ökonomischen und gesundheitsbezogenen Fachliteratur; und Empfehlungen für die Anwendung der gesundheitsökonomischen Bewertungsinstrumente und der ihnen zugrunde liegenden Prinzipien. Es handelt sich hierbei um eine aktualisierte Fassung, in der auch die Gesundheitsfolgen von Straßenverkehrsunfällen, Luftverschmutzung und CO2-Emissionen berücksichtigt werden. Mit dem Instrument lassen sich verschiedene Bewertungen durchführen, wie etwa: das aktuelle Verkehrsaufkommen mit dem Rad oder zu Fuß und der Stellenwert des Radfahrens oder Gehens in einer Stadt oder einem Land; die Veränderungen im Laufe der Zeit durch einen Vergleich von Vorher und Nachher oder von Szenario A mit Szenario B (wie etwa vor und nach einer Maßnahme); und die Auswertung neuer oder laufender Projekte und Bestimmung ihres Kosten-Nutzen-Verhältnisses. HEAT können allein oder gemeinsam mit anderen Instrumenten für eine umfassendere ökonomische Bewertung oder eine Abschätzung der Gesundheitsfolgen herangezogen werden. Dieses Methodik- und Benutzerhandbuch ist von wesentlichem Interesse für Fachkräfte auf nationaler wie kommunaler Ebene, d. h. Verkehrsplaner und Verkehrsingenieure sowie Interessengruppen in den Bereichen Verkehr, Zufußgehen, Radfahren oder Umwelt, aber auch Gesundheitsökonomen und Experten für Bewegung und Gesundheitsförderung.

Outil d’évaluation économique des effets sanitaires (HEAT) liés à la pratique du vélo et de la marche : méthodologie et guide de l’utilisateur sur l’évaluation de l’activité physique, de la pollution atmosphérique, des traumatismes et de l’impact carbone

La promotion de la pratique du vélo et de la marche dans le cadre de l’activité physique quotidienne n’est pas seulement favorable à la santé, mais peut aussi s’avérer bénéfique pour l’environnement. Cette publication résume les outils élaborés afin de faciliter l’adoption de ces pratiques ainsi que les orientations dans ce domaine : méthodologie d’évaluation économique des infrastructures et politiques de transport en termes d’effets sanitaires de la bicyclette et de la marche ; revues systématiques de la littérature économique et sanitaire ; et conseils pour l’application des outils d’évaluation économique des effets sanitaires et principes à l’appui. Elle a été mise à jour afin de tenir compte des effets sanitaires des accidents de la route et de la pollution de l’air, ainsi que de l’impact sur les émissions de carbone. L’outil peut être utilisé pour plusieurs types d’évaluation, par exemple : l’évaluation des niveaux actuels (ou passés) de pratique du vélo ou de la marche, par exemple en montrant l’importance du vélo et de la marche dans une ville ou un pays donnés ; l’évaluation des changements au fil du temps, notamment en comparant les situations avant et après, ou le scénario A par rapport au scénario B (avec ou sans prise de mesures, par exemple) ; l’évaluation de projets nouveaux ou existants, notamment le calcul du rapport coûts-avantages. L’outil HEAT peut être utilisé de manière autonome, voire s’inscrire dans le cadre d’exercices plus complets d’évaluation économique ou d’une analyse prospective de l’impact sanitaire. Cette méthodologie et ce guide de l’utilisateur intéresseront principalement les professionnels aux niveaux national et local : les planificateurs des transports, les ingénieurs de la circulation, et les groupes d’intérêt spéciaux œuvrant dans le domaine du transport, de la marche, de la pratique du vélo ou de l’environnement, ainsi que les économistes de la santé et les experts en activité physique et en promotion de la santé.

Health economic assessment tool (HEAT) for walking and for cycling: methods and user guide on physical activity, air pollution, injuries and carbon impact assessments

The promotion of cycling and walking for everyday physical activity not only promotes health but can also have positive effects on the environment. This publication summarizes the tools and guidance developed to facilitate this shift: the methodology for the economic assessment of transport infrastructure and policies in relation to the health effects of walking and cycling; systematic reviews of the economic and health literature; and guidance on applying the health economic assessment tools and the principles underlying it. It has been updated to consider the health effects of road crashes and air pollution and the effects on carbon emissions. The tool can be used for several types of assessment, for example: assessing current (or past) levels of cycling or walking, such as showing the value of cycling or walking in a city or country; assessing changes over time, such as comparing before-and-after situations or scenario A versus scenario B (such as with or without measures taken); and evaluating new or existing projects, including calculating benefit–cost ratios. HEAT can be used as a stand-alone tool or to provide input into more comprehensive economic appraisal exercises or prospective health impact assessment.

Years of life lost and morbidity cases attributable to transportation noise and air pollution: A comparative health risk assessment for Switzerland in 2010.

BACKGROUND: There is growing evidence that chronic exposure to transportation related noise and air pollution affects human health. However, health burden to a country of these two pollutants have been rarely compared. AIMS: As an input for external cost quantification, we estimated the cardiorespiratory health burden from transportation related noise and air pollution in Switzerland, incorporating the most recent findings related to the health effects of noise. METHODS: Spatially resolved noise and air pollution models for the year 2010 were derived for road, rail and aircraft sources. Average day-evening-night sound level (Lden) and particulate matter (PM10) were selected as indicators, and population-weighted exposures derived by transportation source. Cause-specific exposure-response functions were derived from a meta-analysis for noise and literature review for PM10. Years of life lost (YLL) were calculated using life table methods; population attributable fraction was used for deriving attributable cases for hospitalisations, respiratory illnesses, visits to general practitioners and restricted activity days. RESULTS: The mean population weighted exposure above a threshold of 48dB(A) was 8.74dB(A), 1.89dB(A) and 0.37dB(A) for road, rail and aircraft noise. Corresponding mean exposure contributions were 4.4, 0.54, 0.12µg/m(3) for PM10. We estimated that in 2010 in Switzerland transportation caused 6000 and 14,000 YLL from noise and air pollution exposure, respectively. While there were a total of 8700 cardiorespiratory hospital days attributed to air pollution exposure, estimated burden due to noise alone amounted to 22,500 hospital days. CONCLUSIONS: YLL due to transportation related pollution in Switzerland is dominated by air pollution from road traffic, whereas consequences for morbidity and indicators of quality of life are dominated by noise. In terms of total external costs the burden of noise equals that of air pollution.

Health economic assessment tools (HEAT) for walking and for cycling: methodology and user guide: economic assessment of transport infrastructure and policies

The promotion of cycling and walking for everyday physical activity not only promotes health but can also have positive effects on the environment. This booklet summarizes the tools and guidance developed to facilitate this shift: the methodology for the economic assessment of transport infrastructure and policies in relation to the health effects of walking and cycling; systematic reviews of the economic and health literature; and guidance on applying the health economic assessment tools and the principles underlying it. This methodology and user guide will be of key interest to professionals at both national and local levels: transport planners, traffic engineers, and special interest groups working on transport, walking, cycling or the environment, as well as health economists, physical activity experts and health promotion experts.

Direct health costs of environmental tobacco smoke exposure and indirect health benefits due to smoking ban introduction.

BACKGROUND: Introducing comprehensive smoke-free policies to public places is expected to reduce health costs. This includes prevented health damages by avoiding environmental tobacco smoke (ETS) exposure as well as indirect health benefits from reduced tobacco consumption. METHODS: The aim of this study was to estimate direct health costs of ETS exposure in public places and indirect health benefits from reduced tobacco consumption. We calculated attributable hospital days and years of life lost (YLL), based on the observed passive smoking and disease rates in Switzerland. The exposure-response associations of all relevant health outcomes were derived by meta-analysis from prospective cohort studies in order to calculate the direct health costs. To assess the indirect health benefits, a meta-analysis of smoking ban studies on hospital admissions for acute myocardial infarction was conducted. RESULTS: ETS exposure in public places in Switzerland causes 32,000 preventable hospital days (95% CI: 10,000-61,000), 3000 YLL (95% CI: 1000-5000), corresponding to health costs of 330 Mio CHF. The number of hospital days for ischaemic heart disease attributable to passive smoking is much larger if derived from smoking ban studies (41,000) than from prospective cohort studies (3200), resulting in additional health costs of 89 Mio CHF, which are attributed to the indirect health benefits of a smoking ban introduction. CONCLUSION: The example of smoking ban studies on ischaemic heart disease hospitalization rates suggests that total health costs that can be prevented with smoking bans are considerably larger than the costs arising from the direct health impact of ETS exposure in public places.