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
• 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
Tel. +45 45 33 6822
Sonja Kahlmeier
University of Zurich
Switzerland
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.
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