The new WHO Health Economic Assessment Tool

for Walking and Cycling

-

an introduction

Francesca Racioppi, WHO Regional Office for Europe

Sonja Kahlmeier, University of Zurich, EBPI, Physical Activity and Health Unit

Rutter H, Cavill N, Schweizer C, Goetschi T, Kelly P, Brand C, Rojas Rueda D, Woodcock J, Lieb

C/Sommer H, Oja P, Foster C

Health and environment challenges

in transport

Physical inactivity

A leading risk factor for health in Europe

• Diseases:

– Ischaemic heart disease

– Hypertension

– Diabetes type 2

– Cancer (e.g. breast and colon)

– Stress, anxiety, depression, loneliness

• Nearly 1 million deaths/year

• 40% of car trips in EU28 are < 5km long

The question

If x people walk/cycle an amount of y on most

days, what is the economic value of the health

benefits that occur as a result of the reduction

in mortality due to their physical activity?

The answer:

Health Economic Assessment Tool

(HEAT) for walking and cycling

www.euro.who.int/HEAT

What is the HEAT?

• Online tool www.heatwalkingcycling.org

• Designed for transport planners

• Economic assessment of health benefits

of walking or cycling

• Effects on mortality „only‟

www.pastaproject.eu

Why was HEAT developed?

• To help policy makers “see” that cycling and walking

deliver important societal (and economic) benefits

through health effects, which can be quantified;

• To make this contribution explicit in appraisals of

investments in transport and urban planning policies

and interventions;

• To support advocacy of cycling an walking

| 7

www.pastaproject.eu

For whom was HEAT originally developed?

53 Member States:

• Civil servants,• Staff supporting

policy makers,• Officers/experts

locally responsible for transport and urban planning

• Large differences in:• capacities• data availability

www.pastaproject.eu

HEAT “core principles”

• Scientific robustness

• Best available evidence

• Usability

• Minimal data input requirements

• Availability of default values

• Clarity of prompts/questions

• Design and flow of the tool

• Transparency

• Assumptions and approach

• Conservative

• Adaptable

• Modular

Harry Rutter, Francesca Racioppi, Sonja Kahlmeier, Thomas Götschi, Nick Cavill, Paul Kelly, Christian Brand, David Rojas Rueda,

James Woodcock, Christoph Lieb/Heini Sommer, Pekka Oja, Charlie Foster

Karim Abu-Omar, Lars Bo Andersen, Hugh Ross Anderson, Finn Berggren, Olivier Bode, Tegan Boehmer, Nils-Axel Braathen, Hana Bruhova-

Foltynova, Fiona Bull, Alberto Castro-Fernandez, Dushy Clarke, Andy Cope, Baas de Geus, Audrey de Nazelle, Ardine de Wit, Rune Elvik, Mark

Fenton, Jonas Finger, Francesco Forastiere, Richard Fordham, Virginia Fuse, Eszter Füzeki, Frank George, Regine Gerike, Eva Gleissenberger,

George Georgiadis, Anna Goodman, Maria Hagströmer, Mark Hamer, Thiago Herick de Sa, Max Herry, Marie-Eve Heroux, Gerard Hoek, Luc Int

Panis, Nicole Iroz-Elardo, Eva Heinen, Meleckidzedeck Khayesi, Michal Krzyzanowski, I-Min Lee, Christoph Lieb, Brian Martin, Markus Maybach, Irina

Mincheva Kovacheva, Hanns Mooshammer, Marie Murphy, Nanette Mutrie, Bhash Naidoo, Mark Nieuwenhuijsen, Åse Nossum, Laura Perez, Randy

Rzewnicki, Gabe Rousseau, David Rojas Rueda, Candace Rutt, Kjartan Saelensminde, Tom Schmid, Christian Schweizer, Elin Sandberg, Alexander

Santacreu, Lucinda Saunders, Daniel Sauter, Peter Schantz, Christoph Schreyer, Peter Schnohr, Joe Spadaro, Dave Stone, Jan Sørensen, Gregor

Starc, Robert Thaler, Marko Tainio, Miles Tight, Sylvia Titze, Wanda Wendel Vos, Paul Wilkinson, Mulugeta Yilma

Software development and design: Tomasz Szreniawski, Alberto Castro Fernandez, Ali Abbas, Vicki Copley, Hywell Dinsdale, Duy Dao

A collaborative project

Epi / Public Health

Environmental Science

Air pollutionHealth

Economics

Transport Economics

Transport Planning

Policy makingPractice / Advocacy

Expertise involved:

2000

Initial thinking

(Barcelona)

2005

Nordic countries brainst. Seminar

(Magglingen)

2006

First Consensus

meeting

(Graz)

2007

HEAT for cycling

launched as Excel

sheet

2009

HEAT for cycling manual

2010 - 2011

Second Consensus

meeting

(Oxford)

Web-based HEAT for walking

launched

2013

Third Consensus

meeting

(Bonn)

2014

Fourth Consensus

meeting

(Bonn)

HEAT for cycling and

walking update

2015 – 2017

Fifth Consensus

meeting

(Copenhagen)

3 new modules

on air pollution, injuries carbon

Key milestones

Sneak preview!

Int. Cycling

Conference19-21 Sept 2017

Mannheim

Integration of health in transport planning

• Importance of economic analysis in transport planning

• Economic value of the health benefits of regular walking and cycling

-> easy-to-use tool needed

Health effects of walking and cycling:

integrated assessment 17 Health impact assessments (2015)

Müller N et al. (2015): Health impact assessment of active transportation: A systematic review, Preventive Medicine 76, July 2015: 103–114.

The question

If x people walk/cycle an amount of y on

most days, what is the economic value of

the health benefits that occur as a result of

the reduction in mortality due to their

physical activity?

Required user input

Basic functioning of previous HEAT

The question

If x people walk/cycle an amount of y on

most days, what is the economic value of

the health benefits that occur as a result of

the reduction in mortality due to their

physical activity?

! New HEAT options !

- How much do air pollution or crashes

affect these results?

- What are the carbon effects?

User inputs>

Basic functioning of the new HEAT 4.0

† RR = relative risk of death in underlyingstudies (walking: 0.89 and cycling: 0.90).

†† relative risk of death per 10 µg/m3 increasein PM2.5 in underlying studies (1.07)

§walking module work in progress

What do you want to assess? • Walking and/or cycling• Impacts (Physical activity, air

pollution, crash risk, carbon

emissions -> motorized modes)

• Time and spatial scale

Data inputs• Volumes of travel

Duration/distance/trips/stepsNew: Frequency / Mode share/shift

• Population size

Adjustment of data inputs • New vs. reassigned• Shifted from other modes (carbon)

• For transport or recreation (AP, carbon)

• In traffic vs. away from traffic (AP)

Reduced mortality/carbon emissionsAggregatedMode and pathway specific

Calculation parameters• Changeable default values

(Uptake period, trip/step length, speeds, mortality rate, air pollution level)

• Other background values

MonetizationValue of statistical life (VSL ) or Social costs of carbon. (SCC)

What can you use it for?

Sonja Kahlmeier, EBPI, University of Zurich

sonja.kahlmeierf@uzh.ch

• Project evaluation: new or old projects

– Value of health benefits of investements

• Assess current use

– What is walking/cycling worth now in my city, region,

country?

• Modeling projected future walking/cycling

– How much value walking/cycling can have…

… see how it works tomorrow

at THE PEP day!

Francesca Racioppi

World Health Organization

Regional Office for Europe

racioppif@who.int

Tel. +45 45 33 6822

Sonja Kahlmeier

University of Zurich

Switzerland

sonja.kahlmeier@uzh.ch

Tel. +41-(0) 44/ 634 43 71

This project has received funding from the European Union‟s Seventh

Framework Programme for research; technological development and

demonstration under grant agreement no 602624-2.