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      Health Impacts of Active Transportation in Europe

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          Abstract

          Policies that stimulate active transportation (walking and bicycling) have been related to heath benefits. This study aims to assess the potential health risks and benefits of promoting active transportation for commuting populations (age groups 16–64) in six European cities. We conducted a health impact assessment using two scenarios: increased cycling and increased walking. The primary outcome measure was all-cause mortality related to changes in physical activity level, exposure to fine particulate matter air pollution with a diameter <2.5 μm, as well as traffic fatalities in the cities of Barcelona, Basel, Copenhagen, Paris, Prague, and Warsaw. All scenarios produced health benefits in the six cities. An increase in bicycle trips to 35% of all trips (as in Copenhagen) produced the highest benefits among the different scenarios analysed in Warsaw 113 (76–163) annual deaths avoided, Prague 61 (29–104), Barcelona 37 (24–56), Paris 37 (18–64) and Basel 5 (3–9). An increase in walking trips to 50% of all trips (as in Paris) resulted in 19 (3–42) deaths avoided annually in Warsaw, 11(3–21) in Prague, 6 (4–9) in Basel, 3 (2–6) in Copenhagen and 3 (2–4) in Barcelona. The scenarios would also reduce carbon dioxide emissions in the six cities by 1,139 to 26,423 (metric tonnes per year). Policies to promote active transportation may produce health benefits, but these depend of the existing characteristics of the cities. Increased collaboration between health practitioners, transport specialists and urban planners will help to introduce the health perspective in transport policies and promote active transportation.

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          Most cited references11

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          A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010

          The Lancet, 380(9859), 2224-2260
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            Dose response between physical activity and risk of coronary heart disease: a meta-analysis.

            No reviews have quantified the specific amounts of physical activity required for lower risks of coronary heart disease when assessing the dose-response relation. Instead, previous reviews have used qualitative estimates such as low, moderate, and high physical activity. We performed an aggregate data meta-analysis of epidemiological studies investigating physical activity and primary prevention of CHD. We included prospective cohort studies published in English since 1995. After reviewing 3194 abstracts, we included 33 studies. We used random-effects generalized least squares spline models for trend estimation to derive pooled dose-response estimates. Among the 33 studies, 9 allowed quantitative estimates of leisure-time physical activity. Individuals who engaged in the equivalent of 150 min/wk of moderate-intensity leisure-time physical activity (minimum amount, 2008 U.S. federal guidelines) had a 14% lower coronary heart disease risk (relative risk, 0.86; 95% confidence interval, 0.77 to 0.96) compared with those reporting no leisure-time physical activity. Those engaging in the equivalent of 300 min/wk of moderate-intensity leisure-time physical activity (2008 U.S. federal guidelines for additional benefits) had a 20% (relative risk, 0.80; 95% confidence interval, 0.74 to 0.88) lower risk. At higher levels of physical activity, relative risks were modestly lower. People who were physically active at levels lower than the minimum recommended amount also had significantly lower risk of coronary heart disease. There was a significant interaction by sex (P=0.03); the association was stronger among women than men. These findings provide quantitative data supporting US physical activity guidelines that stipulate that "some physical activity is better than none" and "additional benefits occur with more physical activity."
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              Public health benefits of strategies to reduce greenhouse-gas emissions: urban land transport.

              We used Comparative Risk Assessment methods to estimate the health effects of alternative urban land transport scenarios for two settings-London, UK, and Delhi, India. For each setting, we compared a business-as-usual 2030 projection (without policies for reduction of greenhouse gases) with alternative scenarios-lower-carbon-emission motor vehicles, increased active travel, and a combination of the two. We developed separate models that linked transport scenarios with physical activity, air pollution, and risk of road traffic injury. In both cities, we noted that reduction in carbon dioxide emissions through an increase in active travel and less use of motor vehicles had larger health benefits per million population (7332 disability-adjusted life-years [DALYs] in London, and 12 516 in Delhi in 1 year) than from the increased use of lower-emission motor vehicles (160 DALYs in London, and 1696 in Delhi). However, combination of active travel and lower-emission motor vehicles would give the largest benefits (7439 DALYs in London, 12 995 in Delhi), notably from a reduction in the number of years of life lost from ischaemic heart disease (10-19% in London, 11-25% in Delhi). Although uncertainties remain, climate change mitigation in transport should benefit public health substantially. Policies to increase the acceptability, appeal, and safety of active urban travel, and discourage travel in private motor vehicles would provide larger health benefits than would policies that focus solely on lower-emission motor vehicles.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                1 March 2016
                2016
                : 11
                : 3
                : e0149990
                Affiliations
                [1 ]ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
                [2 ]Municipal Institute of Medical Research (IMIM-Hospital del Mar), Barcelona, Spain
                [3 ]Departament de Ciències Experimentals i de la Salut, Barcelona, Universitat Pompeu Fabra (UPF), Barcelona, Spain
                [4 ]CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
                [5 ]Imperial College London, London, United Kingdom
                [6 ]Center for Epidemiology and Screening, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
                [7 ]Swiss Tropical and Public Health Institute (SwissTPH), Basel, Switzerland
                [8 ]University of Basel, Basel, Switzerland
                [9 ]Kolin Institute of Technology (KIT), Kolin, Czech Republic
                [10 ]Agency for Environment and Energy Management (ADEME), Paris, France
                [11 ]Université de Versailles-Saint-Quentin-en-Yvelines, Versailles, France
                [12 ]The Systems Research Institute (SRI), Warsaw, Poland
                [13 ]UKCRC Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
                University of Washington, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: AN DR-R MJN. Performed the experiments: DR-R AN ZJA CB-F JB HB-F HD CP MSR MT MJN. Analyzed the data: DR-R AN MJN. Contributed reagents/materials/analysis tools: DR-R AN ZJA CB-F JB HB-F HD CP MSR MT MJN. Wrote the paper: DR-R AN ZJA CB-F JB HB-F HD CP MSR MT MJN.

                Article
                PONE-D-15-44310
                10.1371/journal.pone.0149990
                4773008
                26930213
                5d5f9022-13fe-44ec-80f8-b4e17b4d5c77
                © 2016 Rojas-Rueda et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 8 October 2015
                : 7 February 2016
                Page count
                Figures: 3, Tables: 3, Pages: 14
                Funding
                This work is part of the European-wide project Transportation Air pollution and Physical Activities: an integrated health risk assessment progamme of climate change and urban policies (TAPAS), which has partners in Barcelona, Basel, Copenhagen, Paris, Prague, and Warsaw. TAPAS is a four year project funded by the Coca-Cola Foundation, AGAUR, and CREAL ( http://www.tapas-program.org/). The work was also undertaken by the Centre for Diet and Activity Research (CEDAR), a UKCRC Public Health Research Centre of Excellence. Funding from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the National Institute for Health Research, and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged. The sponsors have had no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.
                Categories
                Research Article
                Engineering and Technology
                Environmental Engineering
                Pollution
                Air Pollution
                Engineering and Technology
                Transportation
                Medicine and Health Sciences
                Health Care
                Health Care Policy
                People and Places
                Demography
                Death Rates
                Biology and Life Sciences
                Population Biology
                Population Metrics
                Death Rates
                Engineering and Technology
                Civil Engineering
                Transportation Infrastructure
                Roads
                Engineering and Technology
                Transportation
                Transportation Infrastructure
                Roads
                Physical Sciences
                Chemistry
                Chemical Compounds
                Carbon Dioxide
                Biology and Life Sciences
                Toxicology
                Toxicity
                Medicine and Health Sciences
                Pathology and Laboratory Medicine
                Toxicology
                Toxicity
                Medicine and Health Sciences
                Public and Occupational Health
                Behavioral and Social Aspects of Health
                Custom metadata
                All relevant data are within the paper and its Supporting Information files.

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