Bikes with benefits: Cycling and population health

Michael Brauer UBC School of Population and Public Health
VeloVillage June 22, 2012 Saltspring Island

The Problem

Deaths attributed to 19 leading modifiable risk factors, by country income level, 2004

Globally, obesity responsible for • 44% of diabetes • 23% of ischemic heart disease • 7 - 41% of colon, uterine, postmenopausal breast cancer Physical inactivity responsible for • 27% of diabetes, • 30% of ischaemic heart disease, • 21 - 25% of breast and colon cancers.
Source: WHO

The Problem

Source: US CDC

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
Percentage at least moderately active in leisure time (Canada, 2001- 2010). Source CCHS


Canadian physical activity guidelines (adults 18-64 yrs): ≥ 150 mins. moderate- to vigorous-intensity aerobic physical activity per week, in bouts of 10 min. or more

Cycling to the rescue?

More problems…Cycling to the rescue?
• • • • Climate change Air pollution Peak oil …

Cycling to the rescue?

Cycling to the rescue?

Why cycling?
• ≥ 5kcal/minute…60 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 <2%, while rates as high as 30% are achievable (Denmark, Netherlands) • Utilitarian exercise more sustainable and as effective as structured physical activity

Cycling to the rescue?

Percentage of trips in urban areas made by walking and bicycling in North America and Europe, 1995.

Cycling & health

Cycling benefits
European Cyclists Federation, 2007

UBC Medical Journal, 2012

Cycling & health

Adult obesity and active transport in Australia, 13 countries in Europe and North America: 2000–2006.

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

Active commuting & cardiovascular disease

11% reduction in cardiovascular disease risk (13% women, 9% men) Prospective cohort studies Hamer and Chida, 2008

Cycling & health

• 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

• 71 healthy young/middle-age adults with lowmoderate 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 submaximal standard work – increase in HDL cholesterol.

Cycling & health

• 6 yr follow-up of 334 ~10 yr old children • Those switching to cycling were more fit, had better cholesterol/HDL ratio, better glucose metabolism, and a lower composite CVD risk factor score than those who did not cycle at start or end of study
Andersen et al, 2011

A negative value means that cyclists had a more favorable change.

Cycling & health

• 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

Steindorf et al, 2003; Hou et al, 2004

Cycling & health

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

• ~ 2% of traffic fatalities are bicyclists…of these: – 94% ≥ 16 years old

– 34% struck by a vehicle in darkness
– 19% struck by a heavy truck

• ~2/3 (all modes) fatal collisions and 1/3 of injury crashes occur on rural roads

Transport Canada, 2011

Cycling & health

Safety in numbers of urban trips by Percentage
walking and bicycling in North America and Europe, 1995. In American cities, per kilometer traveled, pedestrians and cyclists were 23X and 12X more likely to get killed than car occupants (2001), respectively

Pedestrian and bicycling fatality rates and nonfatal injury rates in the United States, Germany, and The Netherlands, 2000. Cyclist present much less risk to others than cars Pucher et al, 2003

Cycling & health


Source: Teschke et al, 2012 from Transport Canada

Cycling & health

• Improve survival for those involved in accidents, but… • ….Helmets do not prevents accidents from occurring… • Helmet laws discourage cycling so much that the reduced health benefits from less cycling are much greater than safety benefits of helmet laws • Helmets as an individual choice
Photo by Kyel,

Photo by Quimby,

Cycling & health

Individual and population risk
Nawrot et al, Lancet 2011

Risk Perception

Cycling & health

Additional risks
• Elevated air pollution EXPOSURES of cyclists

Putting it all together

Putting it all together
Risks Benefits

Authors Location
Grabow et al, 2012 Lindsay et al, 2010



Physical activity Reduced air pollution

Combined effect: 1,129 fewer deaths/ 31.9 million population = 35 fewer deaths/million population / year.

Midwest 50% shift of None USA, 11 car round trips evaluated metro areas of ≤ 8 km to cycling. New Zealand 5% shift in Traffic Vkmt for trips crashes < 7km, adults. Increased Traffic active crashes transportation : 2X walking & 8X cycling.

Physical activity Reduced air pollution

Benefit to risk ratio: no risks considered. Combined effect: 117 fewer deaths / 2.7 million population = 43 fewer deaths/million population/year.

Benefit to risk ratio ~ 24:1 (deaths)
WoodLondon, cock et England al., 2009 Physical activity

Reduced air pollution

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)
Combined effect: gain of 7 months of life per person = 583,333 years/million population over life course.

de Hartog et al., 2010 Rabl & de Nazelle, 2012

Netherlands 500,000 Traffic Physical activity adults switch crashes from car to Air pollution bicycle for trips < 7.5 km. Europe Driver who switches to 5 km of cycling for work commute 181,982 public bike share users, compared to car use. Traffic crashes Air pollution Traffic crashes Air pollution Physical activity Reduced air pollution (reduced noise and congestion) Physical activity Reduced air pollution

Benefit to risk ratio: ~ 9:1
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: ~ 19:1
Combined effect: 12.3 fewer deaths per year = 67 fewer deaths per million population per year.

RojasBarcelona, Rueda et Spain al., 2011

Benefit to risk ratio: ~ 96:1

Putting it all together

Cycling benefits outweigh risks
The Netherlands: Modal shift (Cars → Bikes), N=500,000 (short trips)1
– Physical activity: 14 – 90 life-day increase – Air pollution: 0.8 - 40 life-day decrease – Traffic accidents 5 - 9 life-day decrease

9:1 96:1

Barcelona Bicing bike share (181,982 users)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., 2011

Putting it all together

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

Putting it all together

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


Putting it all together

Putting it all together
Bike Lane Score

Hill Score

Destinations Score

Thank you!

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