Bikes with Benefits: Cycling & Population Health

7/31/2019 Bikes with Benefits: Cycling & Population Health

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Bikes with benefits:

Cycling and population health

Michael Brauer

UBC School of Population and Public Health

VeloVillage

June 22, 2012 Saltspring Island


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Deaths attributed to 19 leading modifiable risk factors,

by country income level, 2004

The Problem

Globally, obesity responsible for

44% of diabetes

23% of ischemic heart disease

7 - 41% of colon, uterine, post-

menopausal breast cancer

Physical inactivity responsible for

27% of diabetes, 30% of ischaemic heart disease,

21 - 25% of breast and colon

cancers.

Source: WHO


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Estimated economic costs of physical inactivity/obesity in Canada

(2001): $5.3 billion (2.6% of all health care costs)/$4.3 billion

The Problem

Source: US CDC


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Percentage at least

moderately active in leisure

time (Canada, 2001- 2010).

Source CCHS

2010

Canadian physical activity

guidelines (adults 18-64 yrs):

150 mins. moderate- tovigorous-intensity aerobic

physical activity per week, in

bouts of 10 min. or more

The Problem


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More problemsCycling to the rescue?

Climate change

Air pollution

Peak oil

Cycling to the rescue?


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Why cycling?

5kcal/minute60 mins/day for weight control

Especially good physical activity for overweight

as 70% of load is borne by bike

Huge upside as rates in Canada and U.S. are

very low


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Percentage of trips in urban areas

made by walking and bicycling in

North America and Europe, 1995.



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Cycling benefits

Cycling & health

European Cyclists Federation, 2007

UBC Medical Journal, 2012 www.ubcmj.com


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Adult obesity and active transport in Australia, 13countries in Europe and North America: 20002006.

Share of workers commuting by

bicycle or foot and share of

adults with recommended(CDC) levels of physical activity:

50 US states and 47 of the 50

largest US cities, 2007.

Pucher et al, 2010

Cycling & health


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Active commuting & cardiovascular disease

11% reduction in cardiovascular disease risk (13% women, 9% men)

Hamer and Chida, 2008

Cycling & health

Prospective cohort studies


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13,000 women, 17,000 men in Copenhagen

14.5 year follow-up

After adjustment for other risk factors,including leisure time physical activity, those

who cycled to work (~3 hrs/week on average)

experienced a 39% lower mortality rate

Cycling & health


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Interventions

71 healthy young/middle-age adults with low-

moderate fitness. Previously commuted by

car/bus switched to cycling for 30 minutes one

way 10 week follow-up:

improved aerobic fitness (greater improvement

compared to walkers)

Decreased cardiovascular load in submaximalstandard work

increase in HDL cholesterol.

Cycling & health


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6 yr follow-up of 334~10 yr old children

Those switching tocycling were more fit,

had bettercholesterol/HDL ratio,better glucosemetabolism, and alower composite CVD

risk factor score thanthose who did notcycle at start or end ofstudy

A negative value means that cyclists

had a more favorable change.

Andersen et al, 2011

Cycling & health

l h l h


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Cancer

Germany: 360 breast cancer cases/886 controls.Increased cycling and decreased breast cancer.

34% risk reduction for women > 3 hours/week

moderate intensity cycling

Shanghai: 931 colon cancer cases/1552controls.

Lifetime cycle commuting protective

59/56% risk reduction for men/women cycled > 2

hours/day

Cycling & health

Steindorf et al, 2003; Hou et al, 2004

li & h l h


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Other (indirect) benefits

Improved air quality, but only with massive

shift (i.e. Netherlands, Denmark)

Greenhouse gas emissions even more indirect

Noise reduction

Cycling & health

C li & h l h


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Risks

~ 2% of traffic fatalities arebicyclistsof these:

94% 16 years old

34% struck by a vehicle indarkness

19% struck by a heavy truck

~2/3 (all modes) fatal collisionsand 1/3 of injury crashes occuron rural roads

Transport Canada, 2011

Cycling & health

C li & h lth S f i b


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Percentage of urban trips by

walking and bicycling in

North America and Europe,

1995.

Pedestrian and bicycling

fatality rates and nonfatal

injury rates in the UnitedStates, Germany, and The

Netherlands, 2000.

In American cities, per kilometer

traveled, pedestrians and cyclists

were 23X and 12X more likely to get

killed than car occupants (2001),

respectively

Pucher et al, 2003

Cyclist present

much less risk to

others than cars

Cycling & health Safety in numbers

C li & h lth


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TRENDS

Cycling & health

Source: Teschke et al, 2012 from Transport Canada

C li & h lth


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Helmets

Improve survival for those involvedin accidents, but

.Helmets do not prevents

accidents from occurring Helmet laws discourage cycling so

much that the reduced healthbenefits from less cycling are much

greater than safety benefits ofhelmet laws

Helmets as an individual choice

Cycling & health

Photo by Quimby, Flickr.com

Photo by Kyel, Flickr.com

C cling & health


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Nawrot et al, Lancet 2011

Individual and population risk

Cycling & health

Risk Perception

RISK = HAZARD + OUTRAGE

Cycling & health


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Additional risks

Elevated air pollution EXPOSURES of cyclists

Cycling & health

Putting it all together


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Risks Benefits


A h L i Ch Ri k B fi B l


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Authors Location Change Risk Benefit BalanceGrabow

et al,

2012

Midwest

USA, 11

metro areas

50% shift of

car round trips

of 8 km to

cycling.

None

evaluated

Physical activity

Reduced air pollution

Combined effect: 1,129 fewer deaths/ 31.9

million population

= 35 fewer deaths/million population / year.

Benefit to risk ratio: no risks considered.Lindsay

et al,2010

New

Zealand

5% shift in

Vkmt for trips< 7km, adults.

Traffic

crashes

Physical activity


Combined effect: 117 fewer deaths / 2.7 million

population = 43 fewer deaths/millionpopulation/year.

Benefit to risk ratio ~ 24:1 (deaths)

Wood-

cock et

al., 2009

London,

England

Increased

active

transportation

: 2X walking &

8X cycling.

Traffic

crashes

Physical activity


Combined effect: 530 fewer premature deaths

and 7,332 more disability-adjusted life-years per

million population per year.

Benefit to risk ratio: ~ 49:1 (deaths); ~ 15:1

(DALYs)de

Hartog

et al.,

2010

Netherlands 500,000

adults switch

from car to

bicycle for

trips < 7.5 km.

Traffic

crashes

Air pollution

Physical activity Combined effect: gain of 7 months of life per

person

= 583,333 years/million population over life

course.

Benefit to risk ratio: ~ 9:1Rabl &

de

Nazelle,

2012

Europe Driver who

switches to 5

km of cycling

for work

commute

Traffic

crashes

Air

pollution

Physical activity


(reduced noise and

congestion)

Combined effect: gain of 1,271 Euros/yr per car

driver who switches to cycling

= 1.3 billion Euros/yr per million car drivers who

switch.

Benefit to risk ratio: ~ 19:1Rojas-

Rueda et

al., 2011

Barcelona,

Spain

181,982 public

bike share

users,

compared to

car use.

Traffic

crashes

Air

pollution

Physical activity


Combined effect: 12.3 fewer deaths per year

= 67 fewer deaths per million population per

year.

Benefit to risk ratio: ~ 96:1



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Cycling benefits outweigh risks

The Netherlands: Modal shift(Cars Bikes), N=500,000 (short trips)1

Physical activity: 14 90 life-dayincrease

Air pollution: 0.8 - 40 life-day decrease

Traffic accidents 5 - 9 life-day decrease

Barcelona Bicingbike share (181,982users)2

Physical activity: 12 deaths avoided

Air pollution: 0.13 increased deaths Traffic accidents: 0.03 increased deaths

1 De Hartog et al. 2010, 2 Rojas-Rueda et al., 2011Gett Ima es


9:1

96:1



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Infrastructure to reduce risks

Further reducing risks - and PERCEIVED risks

reduce motor vehicles speeds on shared roadways

physical separation of cyclists from motor vehicle

traffic

Reduced health costs will far exceed costs of

infrastructure




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Rural opportunities &

challenges Lower traffic levels/ lower (perceived) traffic injury

risk

Parents more likely to let kids bike

Seniors may be more comfortable

Older communities may be more cycle-friendly

Low air pollution

Fewer space constraints for new infrastructure

Conversion of existing infrastructure (rails to trails)

Cycle tourism

Climate

Distances Infrastructure

Wayfinding

End-of-trip facilities

Integration with transit


Challenges



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www.cyclevancouver.ubc.caPutting it all together



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Bike Lane Score

Hill Score

Destinations Score


www.walkscore.com/bike


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Thank you!

michael brauer@ubc ca

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Bikes with Benefits: Cycling & Population Health

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