Cost-effectiveness of investing in sidewalks as a means of increasing physical activity: a RESIDE modelling study

Walkability and urban built environments-a systematic review of health impact assessments (HIA)

BACKGROUND

Urban environments are important determinants of human health. The term walkability summarizes features of the urban built environment that promote walking and other types of physical activity. While the beneficial effects of active and public transport have been well established, the health impact of other features of walkability are less well documented.

METHODS

We conducted a systematic review of health impact assessments (HIAs) of walkability. Studies were identified through PUBMED and Science Direct, from two German websites related to urban health and reference tracking. Finally, 40 studies were included in the present review. We applied qualitative thematic analysis to summarize the major results from these studies.

RESULTS

Most of the HIAs (n = 31) reported the improvement of health or health behaviour resulting from an investigated project or policy. However, three HIAs reported a lack of improvement or even a decrease of health status. In parallel, 13 HIAs reported a gain in economic value, whereas one reported a lack or loss of economic effects. Moreover, three HIAs reported on social effects and six HIAs gave additional recommendations for policies or the implementation of projects or HIAs.

CONCLUSIONS

Most HIAs investigate the impact of increasing active or public transport. Other features of walkability are less well studied. With few exceptions, HIAs document beneficial impacts of improving walkability on a variety of health outcomes, including reductions of mortality and non-communicable diseases.

Transport modes and road traffic mortality in the Americas: Deaths among pedestrian and motorcycle users through the lifespan

INTRODUCTION

In the Americas, almost half of road traffic deaths occur among motorcycle users and pedestrians (23% and 22%, respectively). Recent individual country trends show that nations are experiencing changes in deaths depending on the mode of transport used. While national trends are useful, analyses of disaggregated data by sex and age may provide more information about the impact of traffic crashes at different stages of the life course. Methods: We used mortality data from all land transport modes reported to PAHO/WHO (2000-2015) and included them in an ecological study to quantify temporal trends and estimate the association between mortality by mode, age group, sex, and selected socio-economic indicators. Results: Motorcycle and pedestrian mortality rates remain extremely high. Males younger less than 45 years have a higher burden of motorcycle-related mortality while older persons tend to die more as pedestrians. Discussion: Policies differentially aimed at addressing deaths by mode of transport and age are necessary because active living improves wellbeing especially among older individuals. For this to occur, safe environments must be created or maintained.

Physical activity-related health and economic benefits of building walkable neighbourhoods: a modelled comparison between brownfield and greenfield developments

BACKGROUND

A consensus is emerging in the literature that urban form can impact health by either facilitating or deterring physical activity (PA). However, there is a lack of evidence measuring population health and the economic benefits relating to alternative urban forms. We examined the issue of housing people within two distinct types of urban development forms: a medium-density brownfield development in an established area with existing amenities (e.g. daily living destinations, transit), and a low-density suburban greenfield development. We predicted the health and economic benefits of a brownfield development compared with a greenfield development through their influence on PA.

METHODS

We combined a new Walkability Planning Support System (Walkability PSS) with a quantitative health impact assessment model. We used the Walkability PSS to estimate the probability of residents' transport walking, based on their exposure to urban form in the brownfield and greenfield developments. We developed the underlying algorithms of the Walkability PSS using multi-level multivariate logistic regression analysis based on self-reported data for transport walking from the Victorian Integrated Survey of Transport and Activity 2009-10 and objectively measured urban form in the developments. We derived the difference in transport walking minutes per week based on the probability of transport walking in each of the developments and the average transport walking time per week among those who reported any transport walking. We then used the well-established method of the proportional multi-cohort multi-state life table model to translate the difference in transport walking minutes per week into health and economic benefits.

RESULTS

If adult residents living in the greenfield neighbourhood were instead exposed to the urban development form observed in a brownfield neighbourhood, the incidence and mortality of physical inactivity-related chronic diseases would decrease. Over the life course of the exposed population (21,000), we estimated 1600 health-adjusted life years gained and economic benefits of A$94 million.

DISCUSSION

Our findings indicate that planning policies that create walkable neighbourhoods with access to shops, services and public transport will lead to substantial health and economic benefits associated with reduced incidence of physical inactivity related diseases and premature death.

Obesity-related health impacts of active transport policies in Australia - a policy review and health impact modelling study

OBJECTIVE

To review Australian policies on active transport, defined as walking and cycling for utilitarian purposes. To estimate the potential health impact of achieving four active transport policy scenarios.

METHODS

A policy review was undertaken, using key words to search government websites. Potential health benefits were quantified using a cohort simulation Markov model to estimate obesity and transport injury-related health effects of an increase in active transport. Health adjusted life years (HALYs) gained and healthcare cost savings from diseases averted were estimated. Budget thresholds to achieve cost-effectiveness were estimated for each scenario.

RESULTS

There is broad recognition of the health-related benefits of active transport from all levels of Australian government. Modelling results suggest significant health-related benefits of achieving increased prevalence of active transport. Total HALYs saved assuming a one-year effect ranged from 565 (95%UI 173-985) to 12,105 (95%UI 4,970-19,707), with total healthcare costs averted ranging from $6.6M (95%UI $1.9M-11.3M) to $141.2M (95%UI $53.8M-227.8M).

CONCLUSION

Effective interventions that improve rates of active transport may result in substantial healthcare-related cost savings through a decrease in conditions related to obesity. Implications for public health: Significant potential exists for effective and cost-effective interventions that result in more walking and cycling.