Health impact assessment of cycling network expansions in European cities

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Jacob Lindsey
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1 Mueller et al. forthcoming Under Review in Preventive Medicine Health impact assessment of cycling network expansions in European cities Natalie Mueller a,b,c,*, David Rojas-Rueda a,b,c, Maëlle Salmon a,b,c, David Martinez a,b,c, AlbertAmbros a,b,c, Christian Brand d, Audrey de Nazelle e, Evi Dons f, Mailin Gaupp-Berghausen g, Regine Gerike h, Thomas Götschi i, Francesco Iacorossi j, Luc Int Panis f,k, Sonja Kahlmeier i, Elisabeth Raser g, Mark Nieuwenhuijsen a,b,c, on behalf of the PASTA consortium

The problem Car-centric mobility plans Physical inactivity Greenhouse gas emissions High levels of air pollution High levels of noise pollution Traffic

2 The problem Car-centric mobility plans Physical inactivity Greenhouse gas emissions High levels of air pollution High levels of noise pollution Traffic incidents with injury Space scarcity Disappearance of natural outdoor environments and eco-systems Economic issues Congestion costs Financing infrastructure

issues: Cycling can (1) provide transport, (2) increase physical activity (PA)

3 The solution?! Promoting a mode-shift to cycling Promising strategy to overcome aforementioned issues: Cycling can (1) provide transport, (2) increase physical activity (PA) levels and the bicycle is a (3) non-emitting mode of transport However, well designed and safe infrastructure is needed to promote a mode shift to cycling

Specific objectives To assess (1) the association between cycling network (km) and cycling mode share (%) (2) how an increase in cycling mode share might alter expected premature mortality in terms

4 Specific objectives To assess (1) the association between cycling network (km) and cycling mode share (%) (2) how an increase in cycling mode share might alter expected premature mortality in terms of changes in PA, exposure to air pollution and the risk of fatal traffic incidents (3) the cost-benefit tradeoff between cycling network expansions and economic benefits from avoided premature mortality

5 Cycling infrastructure cycling mode share Link between cycling infrastructure and cycling mode share (Buehler & Pucher 2012, Schoner & Levinson, 2014, Buehler & Dill 2015, Marqués et al. 2015, Schoner et al. 2015) Exposure-response relationship is unknown in European cities Cycling network (km) Cycling mode share (%)?

Data sources I Data on population size, cycling

cities located in 11 European countries (4 7 2 20

were the 7 PASTA cities (Antwerp, Barcelona,

cities were chosen based on 1) Geographic

Europe 2) Population size 100,000 people 3) Mode

6 Data sources I Data on population size, cycling mode share and cycling network length for 167 cities located in 11 European countries ( ) Amongst those 167 cities were the 7 PASTA cities (Antwerp, Barcelona, London, Rome, Örebro, Vienna, Zurich) Other 160 cities were chosen based on 1) Geographic representativeness of Northern, Central, Southern Europe 2) Population size 100,000 people 3) Mode share (%) 4) Spatial boundaries of administrative municipality area

Data sources II Mode share (%) European Platform

Labels of designated, non-shared cycling ways

7 Data sources II Mode share (%) European Platform on Mobility Management (EPOMM) Modal Split Tool (TEMS) Cycling network length (km) OpenStreetMap (OSM) Cycling network length for all 167 cities Labels of designated, non-shared cycling ways Street network length (km) for the seven PASTA cities

8 Gompertz growth model Non-linear least square regression to calculate corresponding cycling mode share (%) a is the asymptote (i.e. maximal cycling mode share associated with cycling network) b sets the displacement along the x-axis c sets the displacement along the y-axis (i.e. growth rate) t is the cycling network (km/ 100,000 persons)

9 Counterfactual scenarios Scenario analyses S1 10% increase in cycling network S2 50% increase in cycling network S3 100% increase in cycling network S4 all streets of city with cycling ways

10 HIA model 25% 75% Car Public transport Bicycle + 10 min walk Walking 5 km 13 km/h Physical activity Air pollution cyclist Traffic fatalities Mortality

11 Cost-benefit analysis Costs 2 million per km (reconstructing road mixed traffic) 4,000 per km/ year for maintenance (Scheepers et al. 2015) Benefits Avoided premature deaths Value of Statistical Life ( million) 5-year buildup of health benefits 5% discounting rate Time horizon 30 years

12 Association between cycling network and cycling mode share A cycling network of 315 km/ 100,000 persons was associated with maximal cycling mode share of 24.7% (99.9% of asymptotic value) PASTA City Population Car (%) PT (%) Bike (%) Walk (%) Cycling km (OSM) Km/ 100,000 persons Street km (OSM) Km/ 100,000 persons Antwerp 493, Barcelona 1,620, London 8,673, Örebro 138, Rome 2,869, Vienna 1,797, Zurich 410,

13 Antwerp, Belgium

14 Barcelona, Spain

15 London, UK

16 Örebro, Sweden

17 Rome, Italy

18 Vienna, Austria

19 Zurich, Switzerland

20 Results Gompertz growth model

21 Antwerp Barcelona London Örebro Rome Vienna Zurich Premature mortality impacts Scenario Physical activity Air pollution Traffic fatalities Total deaths Total deaths (100,000) S1 10% 0 (0;0) 0 (0;0) 0 (0;0) 0 (0;0) 0 (0;0) S2 50% 0 (0;0) 0 (0;0) 0 (0;0) 0 (0;0) 0 (0;0) S3 100% -3 (-1;-4) 1 (0;1) 0 (-1;1) -2 (-1;-4) 0 (0;-1) S4 all streets -5 (-3;-6) 1 (1;1) 0 (-1;-2) -4 (-1;-6) -1 (0;-1) S1 10% -10 (-7;-13) 1 (1;2) 1 (-3;4) -8 (-3;-12) 0 (0;-1) S2 50% -15 (-11;-21) 2 (1;3) 1 (-4;6) -12 (-7;-19) -1 (0;-2) S3 100% -24 (-17;-32) 3 (2;4) 1 (-6;9) -20 (-12;-29) -1 (-1;-3) S4 all streets -152 (-112;-209) 20 (12;25) 8 (-40;57) -124 (-55;-192) -8 (1;-16) S1 10% -12 (-9;-17) 2 (1;2) 1 (-3;5) -9 (-4;-15) 0 (0;0) S2 50% -43 (-31;-59) 6 (4;8) 3 (-11;17) -34 (-14;-53) 0 (0;-1) S3 100% -84 (-62;-116) 12 (7;16) 6 (-21;33) -66 (-27;-105) -1 (0;-3) S4 all streets -806 (-594;-1116) 117 (68;149) 56 (-205;317) -633 (-262;-1004) -7 (13;-28) S1 10% 0 (0;0) 0 (0;0) 0 (0;0) 0 (0;0) 0 (0;0) S2 50% 0 (0;0) 0 (0;0) 0 (0;0) 0 (0;0) 0 (0;0) S3 100% 0 (0;0) 0 (0;0) 0 (0;0) 0 (0;0) 0 (0;0) S4 all streets 0 (0;0) 0 (0;0) 0 (0;0) 0 (0;0) 0 (0;0) S1 10% -14 (-11;-20) 3 (2;3) 1 (-4;5) -11 (-4; -18) 0 (0;-1) S2 50% -17 (-13;-24) 3 (2;4) 1 (-5;6) -13 (-5; -21) 0 (0;-1) S3 100% -21 (-16;-29) 4 (2;5) 1 (-6;8) -16 (-7;-26) -1 (0;-1) S4 all streets -292 (-215;-404) 55 (32;70) 12 (-82;106) -225 (-90;-360) -8 (5;-21) S1 10% -23 (-17;-32) 5 (3;6) 1 (-7;8) -17 (-7;-28) -1 (0;-2) S2 50% -43 (-31;-60) 9 (5;11) 1 (-13;15) -33 (-13;-53) -2 (1;-4) S3 100% -64 (-47;-89) 13 (8;17) 2 (-19;23) -49 (-19;-79) -3 (1;-6) S4 all streets -106 (-78;-148) 22 (13;28) 3 (-32;38) -81 (-32;-131) -5 (1;-11) S1 10% -5 (-4;-7) 1 (0;1) 0 (-1;2) -4 (-2;-7) -1 (0;-2) S2 50% -10 (-7;-13) 2 (1;2) 1 (-3;4) -7 (-3;-12) -2 (-1;-3) S3 100% -15 (-11;-21) 2 (1;3) 1 (-4;6) -12 (-5;-19) -3 (-1;-5) S4 all streets -34 (-25;-48) 5 (3;7) 2 (-9;13) -27 (-11;-43) -6 (-2;-11)

22 Rapid HIA for all 167 cities If all 167 cities with a total population of 75.2 million people, achieved a cycling mode share of 24.7% each year 14,500 premature deaths (95% CI: 5,316; 23,684) could be avoided WHO study estimated 10,000 premature deaths preventable in 50 European cities under assumption that Copenhagen cycling mode share (=26%) was achieved (WHO 2014)

Results cost-benefit analysis Cost-effective Largest cost-benefit ratios were found for 10% increase Non-linearity of exposure response relationship Rome 37:1 Zurich 28:1 Barcelona 18:1

23 Results cost-benefit analysis Cost-effective Largest cost-benefit ratios were found for 10% increase Non-linearity of exposure response relationship Rome 37:1 Zurich 28:1 Barcelona 18:1 Vienna 13:1 London 4:1 Antwerp Örebro S4 all streets: Cost-benefit ratios smaller Large amount of additional infrastructure Horizon of 30 years almost not being enough time to compensate

expansions promising policy Cycling network cycling

24 Conclusions PA benefits outweigh risks of traffic incidents and air pollution Cycling network expansions promising policy Cycling network cycling mode share Increase in cycling net health and economic benefits

25 Thank you!

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