1. Highlighting the
costs and benefits
of cycling
Nick Cavill PhD
cavill ASSOCIATES
public health consultancy

7. Physical
inac+vity:
a
global
health
burden
Source: WHO (2009). Global health Risks. Mortality and burden of disease attributable to selected major risk. Geneva. WHO

8. Ac+vity
levels
in
England
100
100
90
%
ac+ve:
self
report
90
men
80
80
%
ac+ve:
objec+ve
women
70
70
60
60
50
50
42
40
40
31
30
30
20
20
10
6
10
4
0
0
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
men
women
Source: Health Survey for England 2008

9. Physical
ac+vity:
health
benefits
Children
and
adolescents
Adults
• improved
cardiorespiratory
• lower
risk
of
early
death
endurance
• heart
disease
&
stroke
• muscular
fitness
• type-­‐2
diabetes
• favorable
body
composi+on
• high
blood
pressure
• improved
bone
health
• adverse
blood
lipid
profiles
•
improved
cardiovascular
and
• metabolic
syndrome
metabolic
health
biomarkers
• colon
and
breast
cancers
• preven+on
of
weight
gain
• weight
loss
when
combined
with
diet
• improved
cardiorespiratory
and
muscular
fitness
• preven+on
of
falls
• reduced
depression
• cogni+ve
func+on
(older
adults).

10. Physical
ac+vity
and
health
Source: Dept of Health (2011) Start Active Stay Active. Adapted from US Dept of Health and Human Services (2008) Physical Activity Guidelines Advisory Committee Report

11. Physical
ac+vity
and
health
Source: Dept of Health (2011) Start Active Stay Active. Adapted from US Dept of Health and Human Services (2008) Physical Activity Guidelines Advisory Committee Report

12. Promo+ng
health
through
physical
ac+vity:
which
would
you
choose?

14. Cycling:
systema+c
review

15. Cycling:
systema+c
review

16. Broader
benefits
to
public
health
• Improved
air
quality
• Improved
social
cohesion
• Less
noise
• Reduced
traffic
danger
• Improved
environments
for
play
and
ac+vity

17. Cycling:
the
poten+al
risks
• Road
traffic
casual+es
• Air
quality
• Musculo-­‐skeletal
injury

18. Selected
causes
of
death:
2008
Deaths,
2008
35000
32647
30000
25000
20000
15000
10000
5000
2538
115
0
cyclists
killed
on
road*
All
road
users**
CHD
aributed
to
inac+vity***
Source: * **DfT Road Traffic Casualties 2009 *** BHF statistics 2010 edition; McPherson et al 2002.

19. Selected
causes
of
death:
2008
Deaths,
2008
35000
32647
30000
25000
20000
15000
10000
5000
2538
115
0
cyclists
killed
on
road*
All
road
users**
CHD
aributed
to
inac+vity***
Source: * **DfT Road Traffic Casualties 2009 *** BHF statistics 2010 edition; McPherson et al 2002.

20. Selected
causes
of
death:
2008
Deaths,
2008
35000
32647
30000
25000
20000
15000
10000
5000
2538
115
0
cyclists
killed
on
road*
All
road
users**
CHD
aributed
to
inac+vity***
Source: * **DfT Road Traffic Casualties 2009 *** BHF statistics 2010 edition; McPherson et al 2002.

21. Benefits
and
risks:
modelling
De Hartog et al, 2011

22. Benefits
and
risks:
modelling
• Physical activity ‘by far’ the most important
• “Concern about pollution exposure…is unfounded when
compared to the benefits of the cycling activity”
• Only includes mortality so total benefits likely to be much
higher

23. • There
exists
the
poten+al
of
a
modal
shi_
from
oil-­‐based
car
transport
to
food-­‐based
ac+ve
transport,
to
yield
important
health
benefits
for
car
users
and
wider
society,
through
reduc+ons
in
air
pollu+on,
physical
inac+vity,
and
opportunity
costs.
Future
research
should
quan+fy
these
effects
under
alterna+ve
scenarios.
• The
greatest
poten+al
for
health
gain
is
by
improving
the
walking
environment
and
suppor+ng
the
most
energy
efficient
form
of
transport—
the
bicycle.
• The
necessary
changes
are
achievable
and
affordable
and
essen+al
for
sustainable
development
across
sedngs.
Levels
of
cycling
can
be
used
as
a
measure
of
progress
towards
a
healthier
sustainable
future
in
both
the
developed
and
the
developing
world.
The
main
obstacles
to
progress
are
not
technological
but
poli+cal,
in
par+cular
the
financial
interests
of
stakeholders.

24. Benefits
and
risks:
HIA

25. Physical activity accounted for >70% of benefits

27. NICE
Guidance
Environment: published 2008
Walking and cycling: in press

28. NICE
economic
modelling

29. The comparison of physical activity with
other lifestyle interventions
18000
17000
16000
Cost/QALY
14000
12000
9515
10000
8000
6000
4000
2000
440
0
Physical
ac+vity
Sta+ns
smoking
cessa+on

30. Challenges
• Paradigm
shi_
in
transport
planning
• Culture
shi_
for
individuals
• Reaching
those
who
do
not
want
to
cycle
• Reaching
those
whose
health
would
benefit
the
most