1. Cycling and walking: a strengthening evidence-base of their co-benefits to health, environment an society
Health benefits of sports; systematic review of observational and experimental studies
Pekka Oja
Side event of theSixth Ministerial Conference on Environment and Health
Scaling up active mobility in Europe: THE PEP from Paris 2014 to Vienna 2019
13-15 June 2017
Ostrava, Czech Republic
Pekka Oja, Sylvia Titze, Sami Kokko, Charlie Foster, Urho Kujala, Ari Heinonen, Pasi Koski, Paul Kelly
HEPA Europe
21-23 October 2013
Helsinki

2. Physical activity and health outcomes
mortality
NCD morbidity
hip fractures
cognition
cancer
Source: St George et al. 2014

3. Domains of physical activity
Occupation
Domestic
Transportation
Leisure

4. 1991
1998
1994

5. Nearly 20 years ago……..
While preparing for the Third Ministerial Conference on Environment and Health (London, 1999), Cycling and walking made their first entry as an important (positive) health dimension of transport policies
UK LEADING THE WAY
1994: Transport and Health Research Group at the Open University
1995
Health at the crossroads : transport policy and urban health
London School of Hygiene and Tropical Medicine
edited by Tony Fletcher and Anthony J. McMichael

6. A rapidly developing evidence-base
Risks
Benefits
Less congestion
Less emissions of air pollutants and GHG
More physical activity
Less use of public space
Exposure to air pollution
Injuries

7. Domains of physical activity and all-cause mortality
Domain of PA
No of studies
RR (95% CI)
P-value
%reduction in all-cause mortality
Total physical activity 21
0.65 ( )
<0.001
35%
Occupation 6
0.83 ( )
17%
Domestic
0.64 ( )
0.039
36%
Transport
0.88 ( )
0.016
12%
Leisure 41
0.74 ( )
0.018
26%
Exercise and sports 13
0.66 ( )
0.046
34%
Samitz et al. Int J Epidem 2011;1-19

8. Cycling for transport Relative risk = 0.90 (0.87-0.94)
7 studies, 187,000 individuals and 2.1 million person- years
Mean age = 56; Mean follow-up = 14.2 years
Exposure = MET.hrs per week
Risk of all-cause mortality reduced by 10% in the group that cycles compared to non-cyclists
Kelly et al. IJBNPA 2014;11(1)

9. Walking for transport Relative risk = 0.90 (0.87-0,94)
7 studies, 187,000 participants, 21 milj. person-years
Mean age =56; mean follow-up = 14.2 years
Exposure = MET-hours per week
Risk of all-cause mortality rediced by 11% in the group that walks compared to non-walkers

10. Fig 1 Hazard ratio for all cause mortality, cardiovascular disease (CVD) incidence and mortality, and cancer incidence and mortality by commuting mode.
Fig 1 Hazard ratio for all cause mortality, cardiovascular disease (CVD) incidence and mortality, and cancer incidence and mortality by commuting mode
Carlos A Celis-Morales et al. BMJ 2017;357:bmj.j1456
©2017 by British Medical Journal Publishing Group

11. Studies from different contexts indicate that the health benefits of active travel outweigh the risks
Median benefit to risk ratio: 9:1
N. Mueller et al. / Preventive Medicine 76 (2015) 103–114

12. Active transport may reduce health expenditures
Total savings
UK£ 17 billion
Within 20 years, increased physical activity would lead to savings of roughly UK£17 billion (in 2010 prices) for the NHS, after adjustment for an increased risk of road traffic injuries. Further costs would be averted after 20 years

13. Active mobility can contribute to mitigate climate change
Source: World Health Organization, Health co-benefits of climate change mitigation - Transport sector,

14. Exploring the job creation potential of active mobility
Up to 435,000 cycling jobs created if 56 major cities achieved Copenhagen’s cycling modal share
Strong correlation between cycling and the number of cycling-related jobs
Cycling jobs are not only in cities – tourism jobs across wider geographical areas
The indirect and induced jobs related to cycling can be significant
Methodological issues remain, and need to be addressed through further research
On average, the new cycling employment estimates were more than 150% higher for each sampled city, and up to 435,000 cycling jobs could be created if the same 56 major cities had the same cycling modal share as Copenhagen.
As cycling increases, the higher number of cyclists will need more bicycles, more cycling accessories and more maintenance and repair services. The more bicycles there are in a city, the more cycling infrastructure will be needed, while an increase in the popularity of cycling will also encourage entrepreneurs to set up related businesses and to develop additional services. This was clearly demonstrated by the study in the city of Portland, Oregon in the USA. This showed an increase in the number of jobs over time as the of the modal share of cycling also increased.
Another important finding through the analysis of data gathered from the cities and studies of wider geographical areas is that the there is a large cycling job potential outside of cities. Studies of wider geographical area (national or regional) concluded that tourism could make up a significant proportion of the total number of jobs associated with cycling. For example, the number of tourism related cycling jobs in Austria and France are estimated as 70% and 47%, respectively. What is more, we found that in some of the Serbian cities - including cities on the EuroVelo 6 along the River Danube – the number of jobs associated with tourism was at least 80% of the total number of cycling jobs.
The studies reviewed and the data collected also revealed other insufficiently investigated aspects related to the possible creation of cycling-related jobs. Many jobs that might be considered to be associated with cycling tourism are indirect jobs, since they occur in other sectors of the economy, such as in the accommodation and food sectors. Such jobs are more difficult to associate with cycling and are therefore often not included in estimates of the number of cycling-related jobs, which tend to focus only on direct jobs. Other sectors might be contributing to jobs related to cycling that previous studies could not consider. In addition, the number of induced jobs created when the overall level of spending in the economy rises as a result of increased employment in cycling is also potentially important. Only one study, that for Austria, estimated the number of induced jobs; it concluded that these could account for 40% of the total number of jobs associated with cycling.

15. HEAT What is the economic value of the reduced all-cause mortality from a given volume of walking or cycling within a defined population?

16. Walking and cycling in transport
Multiple and significant health benefits from AT conducive to public health gains
Benefits of AT outweigh the risks
AT can reduce health expenditures
AT can mitigate climate change
AT can create new jobs
Economic value due to reduced mortality of AT manyfold compared to motor transport