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Integrated Assessment of Cycling Policies: Environmental, Health, and Safety Benefits, Notas de estudo de Cultura

The environmental, health, social, and equity benefits of shifting to active transport modes, specifically human-powered transport like bicycling and walking, for short commute trips. It also explores the safety implications of such a shift, including the safety in numbers effect and the impact of infrastructure on cycling numbers and crash rates. The document uses data from auckland, new zealand, to develop relationships between changes in population perception and changes in transport mode share.

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  • How does the safety in numbers effect impact cycling in Auckland?

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Environmental Health Perspectives
volume 122 | number 4 | April 2014
335
Research
All EHP content is accessi ble to individuals with di sabilities. A fully acce ssible (Section 508 –compliant)
HTML version of th is article is available a t http://dx.doi.org/10.1289/ehp.1307250.
The Societal Costs and Benefits of Commuter Bicycling: Simulating the
Effects of Specific Policies Using System Dynamics Modeling
Alexandra Macmillan,1 Jennie Connor,2 Karen Witten,3 Robin Kearns,4 David Rees,5 and Alistair Woodward1
1School of Population Health, University of Auckland, Auckland, New Zealand, 2Department of Preventive and Social Medicine, University
of Otago, Dunedin, New Zealand; 3Social and Health Outcomes Research and Evaluation (SHORE), Massey University, Auckland, New
Zealand; 4School of Environment, University of Auckland, Auckland, New Zealand; 5Synergia Ltd, Auckland, New Zealand
Background: Shifting to active modes of transport in the trip to work can achieve substantial
co-benefits for health, social equity, and climate change mitigation. Previous integrated modeling
of transport scenarios has assumed active transport mode share and has been unable to incorporate
acknowledged system feedbacks.
oBjectives: We compared the effects of policies to increase bicycle commuting in a car-dominated
city and explored the role of participatory modeling to support transport planning in the face
of complexity.
Methods: We used system dynamics modeling (SDM) to compare realistic policies, incorporating
feedback effects, nonlinear relationships, and time delays between variables. We developed a system
dynamics model of commuter bicycling through interviews and workshops with policy, community,
and academic stakeholders. We incorporated best available evidence to simulate five policy scenarios
over the next 40 years in Auckland, New Zealand. Injury, physical activity, fuel costs, air pollution,
and carbon emissions outcomes were simulated.
results: Using the simulation model, we demonstrated the kinds of policies that would likely be
needed to change a historical pattern of decline in cycling into a pattern of growth that would meet
policy goals. Our model projections suggest that transforming urban roads over the next 40 years,
using best practice physical separation on main roads and bicycle-friendly speed reduction on local
streets, would yield benefits 10–25 times greater than costs.
conclusions: To our knowledge, this is the first integrated simulation model of future specific
bicycling policies. Our projections provide practical evidence that may be used by health and
transport policy makers to optimize the benefits of transport bicycling while minimizing negative
consequences in a cost-effective manner. The modeling process enhanced understanding by a range
of stakeholders of cycling as a complex system. Participatory SDM can be a helpful method for
integrating health and environmental outcomes in transport and urban planning.
citation: Macmillan A, Connor J, Witten K, Kearns R, Rees D, Woodward A. 2014. The
societal costs and benefits of commuter bicycling: simulating the effects of specific poli-
cies using system dynamics modeling. Environ Health Perspect 122:335–344; http://dx.doi.
org/10.1289/ehp.1307250
Introduction
Car use is the dominant mode of transport
to work in many high-income cities. In
car-oriented cities, commuting by private
motor vehicle allows access to employment
and training (crucial social determinants of
health) while enabling households to man-
age competing responsibilities. However,
car-dependent commuting has significant
negative public health effects for commuters,
the wider community, and local and global
ecosystems. A mode shift to greater use of
active transport would bring environmental,
health, social, and equity benefits (de Nazelle
et al. 2011; Hosking et al. 2011). In high-
income cities, car commutes tend to be short,
habitual, solitary trips in congested traffic.
Consequently, they make a greater contribu-
tion to road traffic injury (Bhalla et al. 2007),
air pollution and transport greenhouse gas
emissions (André and Rapone 2009), noise
(Hänninen and Knol 2011), and stress
(Jansen et al. 2003) than other kinds of light
vehicle trips. Traffic congestion at peak com-
mute times is also a significant influence on
constructing new road capacity with land
use, environmental, and social costs (Coffin
2007; Fahrig 2003). In addition, the predict-
ability of car commuting routes may make
these trips amenable to a wider range of
policy alternatives.
Previous integrated health impact assess-
ments, based on existing evidence, suggest
that a shift to human-powered transport
modes (bicycling, walking, running, wheel-
chair, skating) for short commute trips
would be good for health, aside from the
risk of road traffic injury (Hosking et al.
2011; Woodcock et al. 2009). These trips
incur negligible greenhouse gas and air
pollution costs, incorporate physical activ-
ity into people’s daily lives, and cost little
(potentially increasing equitable access to
jobs) (Hosking et al. 2011). Although trans-
port policy is identified as a determinant of
the global noncommunicable disease (NCD)
crisis, transport interventions have not been
included in the United Nations’ priority
actions for NCDs because of poor evidence
of cost-effectiveness (Beaglehole et al. 2011).
Previous comparative risk assessments have
been undertaken for transport policy, climate
change, and health (e.g., Lindsay et al. 2011;
Rojas-Rueda et al. 2011; Woodcock et al.
2009). However, these assessments have been
unable to directly compare specific policies
seeking to increase active transport, and have
not incorporated recognized system feedbacks
(Woodcock et al. 2009).
The relationships between urban
planning and health are complex, and evi-
dence for them varies widely in source and
quality. Furthermore, policies may trade gains
made against some objectives at the expense
of others. However, a set of methodological
recom mendations is emerging in the literature
that might promote effective policy decisions
in such complex systems. They include a sys-
tems approach; transdisciplinarity (integrating
knowledge across policy, community, and the
academy); community participation in deci-
sion making; and a focus on social justice and
environmental sustainability (Charron 2012).
There have been recent calls for complex sys-
tems research to tackle deep-seated problems
such as physical inactivity (Kohl et al. 2012),
obesity (Swinburn et al. 2011), and improving
the contribution of urban planning to health
(Rydin et al. 2012).
We used the principles above to develop
a commuter cycling and public health model
integrating physical, social, and environmental
well-being. We used this model to identify
Address correspondence to A. Macmillan,
Department of Preventive and Social Medicine,
University of Otago, PO Box 56, Dunedin 9056,
New Zealand. Telephone: 64 3 479 7196. E-mail:
alex.macmillan@otago.ac.nz
Supplemental Material is available online (http://
dx.doi.org/10.1289/ehp.1307250).
We thank the organizations and individuals
who participated in the interviews and workshops;
S. Turner (Beca Infrastructure Ltd) and G. Koorey
(University of Canterbury) for peer reviewing
aspects of the simulation model; and J. Woodcock
(Centre for Diet and Activity Research, Cambridge
University) for his helpful comments on an earlier
draft of the manuscript.
This research was funded by the Health Research
Council of New Zealand. A.M. also received sup-
port from the NZ Transport Agency and the NZ
Ministry of Health. D.R. is employed by Synergia
Ltd, Auckland, New Zealand.
The authors declare they have no actual or potential
competing financial interests.
Received: 19 June 2013; Accepted: 3 February
2014; Advance Publication: 4 February 2014; Final
Publication: 1 April 2014.
pf3
pf4
pf5
pf8
pf9
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Environmental Health Perspectives • volume 122 |^ number 4 |^ April 2014 335

Research

All EHP content is accessible to individuals with disabilities. A fully accessible (Section 508–compliant) HTML version of this article is available at http://dx.doi.org/10.1289/ehp..

The Societal Costs and Benefits of Commuter Bicycling: Simulating the

Effects of Specific Policies Using System Dynamics Modeling

Alexandra Macmillan,^1 Jennie Connor,^2 Karen Witten,^3 Robin Kearns,^4 David Rees,^5 and Alistair Woodward^1 (^1) School of Population Health, University of Auckland, Auckland, New Zealand, 2 Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand; 3 Social and Health Outcomes Research and Evaluation (SHORE), Massey University, Auckland, New Zealand; 4 School of Environment, University of Auckland, Auckland, New Zealand; 5 Synergia Ltd, Auckland, New Zealand B ackground : Shifting to active modes of transport in the trip to work can achieve substantial co-benefits for health, social equity, and climate change mitigation. Previous integrated modeling of transport scenarios has assumed active transport mode share and has been unable to incorporate acknowledged system feedbacks. oBjectives: We compared the effects of policies to increase bicycle commuting in a car-dominated city and explored the role of participatory modeling to support transport planning in the face of complexity. Methods: We used system dynamics modeling (SDM) to compare realistic policies, incorporating feedback effects, nonlinear relationships, and time delays between variables. We developed a system dynamics model of commuter bicycling through interviews and workshops with policy, community, and academic stakeholders. We incorporated best available evidence to simulate five policy scenarios over the next 40 years in Auckland, New Zealand. Injury, physical activity, fuel costs, air pollution, and carbon emissions outcomes were simulated. results : Using the simulation model, we demonstrated the kinds of policies that would likely be needed to change a historical pattern of decline in cycling into a pattern of growth that would meet policy goals. Our model projections suggest that transforming urban roads over the next 40 years, using best practice physical separation on main roads and bicycle-friendly speed reduction on local streets, would yield benefits 10–25 times greater than costs. conclusions : To our knowledge, this is the first integrated simulation model of future specific bicycling policies. Our projections provide practical evidence that may be used by health and transport policy makers to optimize the benefits of transport bicycling while minimizing negative consequences in a cost-effective manner. The modeling process enhanced understanding by a range of stakeholders of cycling as a complex system. Participatory SDM can be a helpful method for integrating health and environmental outcomes in transport and urban planning. citation : Macmillan A, Connor J, Witten K, Kearns R, Rees D, Woodward A. 2014. The societal costs and benefits of commuter bicycling: simulating the effects of specific poli- cies using system dynamics modeling. Environ Health Perspect 122:335–344; http://dx.doi. org/10.1289/ehp.

Introduction

Car use is the dominant mode of transport to work in many high-income cities. In car-oriented cities, commuting by private motor vehicle allows access to employment and training (crucial social determinants of health) while enabling households to man- age competing responsibilities. However, car-dependent commuting has significant negative public health effects for commuters, the wider community, and local and global ecosystems. A mode shift to greater use of active transport would bring environmental, health, social, and equity benefits (de Nazelle et al. 2011; Hosking et al. 2011). In high- income cities, car commutes tend to be short, habitual, solitary trips in congested traffic. Consequently, they make a greater contribu- tion to road traffic injury (Bhalla et al. 2007), air pollution and transport greenhouse gas emissions (André and Rapone 2009), noise (Hänninen and Knol 2011), and stress (Jansen et al. 2003) than other kinds of light vehicle trips. Traffic congestion at peak com- mute times is also a significant influence on constructing new road capacity with land use, environmental, and social costs (Coffin 2007; Fahrig 2003). In addition, the predict- ability of car commuting routes may make these trips amenable to a wider range of policy alternatives. Previous integrated health impact assess- ments, based on existing evidence, suggest that a shift to human-powered transport modes (bicycling, walking, running, wheel- chair, skating) for short commute trips would be good for health, aside from the risk of road traffic injury (Hosking et al. 2011; Woodcock et al. 2009). These trips incur negligible greenhouse gas and air pollution costs, incorporate physical activ- ity into people’s daily lives, and cost little (potentially increasing equitable access to jobs) (Hosking et al. 2011). Although trans- port policy is identified as a determinant of the global noncommunicable disease (NCD) crisis, transport interventions have not been included in the United Nations’ priority actions for NCDs because of poor evidence of cost-effectiveness (Beaglehole et al. 2011). Previous comparative risk assessments have been undertaken for transport policy, climate change, and health (e.g., Lindsay et al. 2011; Rojas-Rueda et al. 2011; Woodcock et al. 2009). However, these assessments have been unable to directly compare specific policies seeking to increase active transport, and have not incorporated recognized system feedbacks (Woodcock et al. 2009). The relationships between urban planning and health are complex, and evi- dence for them varies widely in source and quality. Furthermore, policies may trade gains made against some objectives at the expense of others. However, a set of methodological recommendations is emerging in the literature that might promote effective policy decisions in such complex systems. They include a sys- tems approach; transdisciplinarity (integrating knowledge across policy, community, and the academy); community participation in deci- sion making; and a focus on social justice and environmental sustainability (Charron 2012). There have been recent calls for complex sys- tems research to tackle deep-seated problems such as physical inactivity (Kohl et al. 2012), obesity (Swinburn et al. 2011), and improving the contribution of urban planning to health (Rydin et al. 2012). We used the principles above to develop a commuter cycling and public health model integrating physical, social, and environmental well-being. We used this model to identify Address correspondence to A. Macmillan, Department of Preventive and Social Medicine, University of Otago, PO Box 56, Dunedin 9056, New Zealand. Telephone: 64 3 479 7196. E-mail: alex.macmillan@otago.ac.nz Supplemental Material is available online (http:// dx.doi.org/10.1289/ehp.1307250). We thank the organizations and individuals who participated in the interviews and workshops; S. Turner (Beca Infrastructure Ltd) and G. Koorey (University of Canterbury) for peer reviewing aspects of the simulation model; and J. Woodcock (Centre for Diet and Activity Research, Cambridge University) for his helpful comments on an earlier draft of the manuscript. This research was funded by the Health Research Council of New Zealand. A.M. also received sup- port from the NZ Transport Agency and the NZ Ministry of Health. D.R. is employed by Synergia Ltd, Auckland, New Zealand. The authors declare they have no actual or potential competing financial interests. Received: 19 June 2013; Accepted: 3 February 2014; Advance Publication: 4 February 2014; Final Publication: 1 April 2014.

Macmillan et al. 336 volume 122 |^ number 4 |^ April 2014 • Environmental Health Perspectives cost-effective transport policies for improving public health. Auckland, New Zealand’s largest and fastest growing city (population ~ 1.5 million), was the case study. A program of motorway development and low-density urban growth in Auckland has led to exponential growth in car owner- ship and use, with a collapse in use of public transport and bicycling as modes of transport (Mees 2010). Private motor vehicles are used for > 75% of commutes, and bicycles 1%. Recently, Auckland’s regional government has been promoting bicycling for transport to reduce motor vehicle use.

Study Design

We used participatory system dynamics modeling (SDM) to involve community, academic, and policy stakeholders in a process that explored the dynamic effects of realistic policies. SDM is based on the following principles (Richardson 2011):

  • Complex systems include many interacting variables that change over time.
  • This pattern of interaction is a key driver of system behavior over time.
  • Interaction between variables is charac- terized by reinforcing (positive) loops, which amplify dynamic system patterns of behavior and balancing (negative) feedback loops, which dampen these patterns.
  • Complex systems are also characterized by the accumulation of “stocks” that could include people, information, or material resources.
  • Time is an important component of com- plex systems, and the pattern of cause-and- effect relationships may change variables at different rates over time, creating tensions between short- and long-term policy effects. A system dynamics simulation model con- sists of a set of integral equations whose solutions are approximated to demonstrate dynamic system behavior, enabling curves of trends over time in outcomes of interest to be explored and compared for future policy options. Participatory SDM has been success- fully used to improve decision making for a variety of difficult public health problems, including health system capacity to deal with chronic disease (Hirsch et al. 2010), infec- tious disease epidemiology (Atun et al. 2005), substance abuse prevention (Holder and Blose 1987), and obesity (Abdel-Hamid 2003). The method has also been used to consider the outcomes of transport policies on air quality (Stave 2002). As with most SDM efforts, these examples aimed to provide insights about the dynamic effects of policy alterna- tives by relating these back to the system structure, rather than attempting to make falsely precise absolute predictions about future outcomes in the context of complexity. For the present study, we used a combina- tion of primary and secondary data to develop a qualitative set of feedback loops. We used a purposive sampling strategy to identify 16 people who represented groups designing, influencing, or affected by trans- port policy, with the latter including groups likely to incur health inequities as a result of transport policies (see Supplemental Material, Table S1). We undertook semistructured interviews using cognitive mapping, a tech- nique designed to elicit the implicit causal theories of interviewees, linking perceptions and behaviors around a particular question, issue, or system (Eden and Ackermann 2004). We developed a preliminary set of feed- back loops from these interviews by piecing together the relationships identified in the individual interviews and triangulating the interview data with a multidisciplinary lit- erature review about transport and public health. The focus was on refuting or support- ing the dynamic causal theory emerging from the interviews. Although it was not within the scope of the study to undertake system- atic reviews for each relationship identified, we used the interview data together with an ecosystem health framework (Hancock 1993), describing the relationships among health, equity, and sustainability, to guide a wide search of the health, transport, social sciences, and geography literatures. The preliminary feedback loops were refined in two SDM workshops as well as in meetings with individuals and organizations involv- ing > 30 stakeholders. These workshops and meetings involved those already interviewed and other representatives of their group or organization. This resulted in a minimum set of feedback loops that represent a collective causal theory to explain trends over time for commuting in Auckland, including a causal loop diagram specific to commuter bicycling. This step was undertaken using Vensim PLE® modeling software (Ventana Systems UK, Salisbury, UK). We used the bicycling causal loops to develop a simulation model, populating the variables and relationships in the diagram with best available epidemiological evidence, administrative data, and expert opinion when no data were available. Data sets included regional subsets of national census and survey data and Auckland-specific travel surveys. We combined regional survey data about transport preferences with the qualitative data from the interviews and workshops to quantify relation- ships between factors that influence transport mode behavior in the trip to work, and the resulting commuting mode shares. It was beyond the scope of this study to undertake separate systematic reviews for each relation- ship identified. For the relationships between changes in commuting and changes in well- being outcomes, we used existing systematic reviews of the literature, as well as regionally relevant relationships previously developed from systematic reviews. In choosing between sources of data, we considered multiple dimen- sions including epidemiological quality, relevance to the population being modeled, and completeness and quality of survey and adminis trative data. We used STELLA® (http://www.iseesystems.com) to simulate the model. Outcomes simulated were commuter cyclist injury, regional air pollution mortality and morbidity, physical activity–related mor- tality, greenhouse gas emissions, and individual fuel savings. We incorporated expected trends in population growth, all-cause mortality, pub- lic transport improvement, light vehicle fleet composition, and fuel price. We triangulated the bicycling causal loop diagram with studies about the effectiveness of interventions to increase commuter bicy- cling to develop policy scenarios that might be most likely to alter the shape of trends in cycling over time. These were compared against a “business-as-usual” nonintervention scenario and the investment in cycling proposed in the region’s 30-year strategic transport plan (Auckland Regional Council 2010). We assessed the effectiveness of policy scenarios against strategic targets set out in the plan (Table 1). The model was run from 1991 through 2051. Historical simulations (1991–2012) were compared with the model simulations, validating the shape and magni- tude of simulated outputs against existing data. Implementation of interventions was Table 1. Transport strategic targets relevant to commuter bicycling from the Auckland Regional Land Transport Strategy 2010–2040 (Auckland Regional Council 2010). Strategic objective Current level Quantified target for 2040 Road traffic injury 2005–2007 average: 74 deaths and 537 serious injuries Reduction in road deaths to ≤ 40/year and serious injuries to ≤ 288/year Congestion on the road freight network 2006–2009 average delay: 0.53 min/km No increase Walking and bicycling mode share 2010: walking 14%, bicycling < 1% Combined walking and cycling mode share of 35% Perception of bicycling safety 2010: 19% of survey respondents considered bicycling to be “always or mostly” safe 80% of people consider bicycling “always or mostly” safe Transport greenhouse gas emissions 2007: 3.1 metric tons per capita from commuting Halve per capita emissions from domestic transport compared with 2007 Current levels were reported in the Strategy, except 2007 commuting greenhouse gas emissions, which were simulated using VEPM 5.0 (Auckland Regional Council 2011).

Macmillan et al. 338 volume 122 |^ number 4 |^ April 2014 • Environmental Health Perspectives during the incorporation of local data and validity testing. These are shown in dotted lines in Figure 1. In an alternative theory to B1, a “safety in numbers” loop is described in R3 (more people bicycling leads to a reduc- tion in the rate of cyclist injuries). There is ecological evidence for a safety in numbers effect for bicycling (Jacobsen 2003; Tin Tin et al. 2011; Vandenbulcke et al. 2009), but this very likely combines the impact of safer infrastructure on cycling numbers and a direct effect of cyclist numbers on crash rates (Bhatia and Wier 2011; Wegman et al. 2010). We tested this theory using longi- tudinal bicycling mode share (census) and bicycling injury data (NZ Transport Agency

  1. for Auckland as part of the model validity testing. From this testing, we con- sidered it unlikely that a “safety in numbers” effect occurs at Auckland’s low bicycling mode share, and that a threshold is likely for activation. Further positive feedback is pos- sible with a significant mode shift from cars to bicycles at commute time, because reduced vehicle numbers reduce the likelihood of collision as well as improving perception of safety (R4, “mode shift reduces collisions”). Alternatively, a balancing loop (B2) is pos- sible if a significant shift from cars to bicycles at peak times results in faster vehicles and increased real and perceived risk of bicycling injury, deterring cyclists. However, there is little evidence that this balancing loop applies on urban roads (Quddus et al. 2009). The causal loop diagram is helpful for identifying the likely determinants of dynamic system behavior (e.g., trends over time in cyclist numbers or injuries). Other factors, such as weather and topography, which do not take part in the commuter bicycling feedback loops, are considered to be “exogenous.” Although they may moder- ate the level of outcomes, they are unlikely to influence the shape of trends over time. This feedback understanding influenced the policies chosen for simulation. The simulation model. The simulation model incorporates the feedbacks described above. We developed mathematical relation- ships between variables from the best available data, and created nonfeedback structures to simulate exogenous outcomes such as physical activity. A brief summary of the assumptions and data sources for each sector is provided here. The full set of equations to develop the model is provided in Supplemental Material, Simulation Model Equations, pp. 20–44. Commuting population growth. We used national and regional census-based statistics, projections of population growth, and labor force statistics (Statistics New Zealand 2009), assuming that the number of commuters would continue to grow at the same rate as the whole population, growing 40% over the simulation period from a baseline of 400, people. Sex, age, and ethnicity distributions for the commuting population were assumed to be stable. Commuters excluded those not traveling to work on census day. The non- commuting proportion of the working popu- lation was assumed to continue to be the same as historical (0.85). Commute mode share. The New Zealand census includes a question about the main mode of travel used to get to work on census day. Analysis of data from the 1991 and sub- sequent censuses was used to populate baseline mode share levels for four main modes (light vehicle, bicycle, walking, and public transport) as well as helping to understand the effects of different influences over time. Because of the form of the census question, we assumed that commute trips are made by a single “main mode” and that the question asked on census day represents regular daily com- muting patterns in the population. Baseline commute mode shares were as follows: light vehicle, 0.85; cycling, 0.02; walking, 0.055; public transport, 0.075. The annual number of vehicle kilometers traveled (VKT) by com- muting via light vehicles is calculated from the light vehicle mode share, accounting for aver- age commuting vehicle occupancy (because a proportion of light vehicle commuters are passengers), annual trips (accounting for part and full time employment), and the median light vehicle commute trip length. Consistent with the qualitative interviews, workshops, and stated choice transport models (Louviere et al. 2000), we used a relative utility struc- ture to model the influences on mode share. We used a combination of the biennial local government transport mode rating surveys (Auckland Regional Council 2000–2010), census data about trip distance (Goodyear and Ralphs 2009), the stakeholder workshops, and qualitative studies about cycling (Daley et al. 2008; Kingham et al. 2011; Pooley et al. 2010; Pucher and Buehler 2008; Winters et al. 2010) to develop relationships between changes in population perception of differ- ent transport modes and changes in transport mode share. In doing so, we assumed that stated preference and revealed mode share were related and that there would be a delay (of 1 year on average) between a change in stated preference and a change in revealed mode share (Cantillo et al. 2007). We also assumed that trip distances of ≤ 6 km (50% of commute trips) were cycling range and trips of ≤ 2 km (27% of commute trips) were in walk- ing range. These proportions were assumed to remain stable over the simulation period. Bicycling injury. The structure simulat- ing cyclist injury was particularly important because actual and perceived bicycling safety was central to many of the proposed feedback loops. We simulated cyclist serious injuries and deaths caused by a collision with a light vehicle. Almost all serious bicycling injuries in New Zealand involve a motor vehicle (Turner et al. 2009), and those involving a light vehicle are amenable to changes in commuting patterns. Various denomina- tors are used in measures of cycling injury, and all have limitations depending on the research question (Halperin 1993). We chose a denominator that we postulated might reflect how individuals periodically consider the risk of bicycling to work in the area. Because we were considering changes in short commute trips from one mode to another, accounting for trip distance was less impor- tant. We therefore used a rate of injury per 1,000 cyclists. We used a simple simulation model to compare Auckland’s longitudinal cycling injury data with modeled data that included a safety-in-numbers effect in keep- ing with the power functions suggested by ecological studies (Jacobsen 2003; Robinson 2005; Tin Tin et al. 2011; Vandenbulcke et al. 2009). We found that simulations including a safety-in-numbers effect wors- ened the fit between modeled and historical data. Further, the longitudinal data suggested a reduction in the injury rate with declin- ing cyclist numbers. This is in keeping with a recent critical review that suggests a threshold is likely and that a significant proportion of the safety in numbers effect seen in ecological studies is a “numbers-in-safety effect” (more safety because of better infrastructure, leading to more bicycling) (Bhatia and Wier 2011). We therefore included a threshold for safety in numbers at a mode share of 0.025, fol- lowed by a safety-in-numbers effect half that of Jacobsen’s power function. Five steps were used to simulate fatal and serious cyclist injuries, adapted from the approach of Bhalla et al. (2007) and Elvik (2009):
  • Estimation of baseline proportions of vehicles and cyclists on local and main (arterial) roads, using Canadian evidence (Aultman- Hall et al. 1997) and local expert opinion;
  • Baseline annual collision and fatal or seri- ous injury rates at commute time in the working-age population were devel- oped through detailed analysis of the NZ Transport Agency Crash Analysis System, which includes information about timing, travel mode, demographics, injury cate- gorization (minor, serious, and fatal), and crash environment (NZ Transport Agency 2005). This included adjustment for known underreporting of serious bicycling injuries in New Zealand (Alsop and Langley 2001; Christchurch Cycle Safety Committee 1991; Turner et al. 2006);
  • Calculation of the number of annual cyclist–car collisions accounting for the nonlinear impact of light vehicle numbers

Integrated assessment of cycling policies using SDM Environmental Health Perspectives • volume 122 |^ number 4 |^ April 2014 339 on local and arterial road collisions (Turner et al. 2009) and our modified safety-in- numbers effect;

  • Calculation of the number of fatal and seri- ous injuries accounting for the nonlinear effect of changing mean car speeds on each type of road, using Auckland measurements of mean speeds (Beca Infrastructure Ltd 2011; Charlton et al. 2010). We adjusted accepted cumulative frequency curves [Organisation for Economic Co-operation and Development (OECD) and European Conference of Ministers of Transport 2006; Rosén et al. 2011] to differences between impact and mean speeds, and calibrated to Auckland speed and cyclist injury rates;
  • A combined serious and fatal injury rate per 1,000 cyclists was then calculated accounting for changes in the number of bicycle commuters. To complete the feedback loops (R1, R2, and B1), we simulated a nonlinear impact of fatal and serious cyclist injury numbers on bicycling sense of safety supported by evi- dence from qualitative studies in bicycling environments similar to Auckland (Daley et al. 2008; Kingham et al. 2011; Pooley et al. 2010; Winters et al. 2010), using expert opin- ion to develop the shape of the curve relating media-reported deaths to perception of safety and calibrating it to Auckland fatal injury and transport mode rating surveys (Auckland Regional Council 2000–2010). Air pollution, fuel cost savings, and greenhouse gas emission outcomes. Region- and source-specific estimates of air pollution mortality and morbidity are available from the Health and Air Pollution in New Zealand (HAPiNZ) (Fisher et al. 2007; Kuschel and Mahon 2010) models, which combine sur- rogate estimates of exposure from vehicle kilometers traveled, meteorological data, and spatial mapping (Kingham et al. 2007) with the effect estimates from international cohort studies. Outcomes in adults > 30 years of age estimated include deaths, cardiovascular and respiratory hospitalizations due to fine par- ticulates (particulate matter ≤ 10 μm; PM 10 ) and carbon monoxide, COPD hospitaliza- tions due to PM 10 , cancer incidence due to benzene, and restricted activity days due to PM 10. Baseline (1991) burden of disease metrics were adjusted for population, VKT (Ministry of Transport 2011), and vehicle fleet emissions changes over time. Auckland’s Vehicle Emissions Prediction Model (VEPM 5.0) (Auckland Regional Council 2011) and longitudinal emissions measurements (Bluett et al. 2011) were used to develop business- as-usual trends in PM 10 and carbon monox- ide. Dynamic air pollution burden of disease attributable to commuting was then simu- lated, accounting for changes to mode share, population, and light vehicle fleet emissions. By using the HAPiNZ modeling to calculate the burden of disease attributable to com- muting, we have assumed that removing commuting light vehicles has an effect on air pollution equivalent to removing any light vehicle over a 24-hr period. The VEPM 5. model assumes that the New Zealand light vehicle fleet will follow European patterns of fuel efficiency and technical improvements, with a 10-year lag. We have also assumed that the health effects for commuters themselves of shifting travel mode are minimal because of the healthy worker effect, despite possible changes in exposure (de Hartog et al. 2010; Kaur et al. 2007). A similar approach was taken to estimat- ing the per VKT greenhouse gas emissions. VEPM 5.0 includes historical and projected carbon dioxide and carbon monoxide (also a potent greenhouse gas) vehicle emissions, accounting for changes in fuel consump- tions, fuel composition, and vehicle technical improvements. Per VKT metrics were also esti- mated for methane and nitrous oxide using New Zealand’s Greenhouse Gas Inventory (Ministry for the Environment 2011). All these gases were converted to carbon diox- ide equivalents (CO2eq) using the Fourth Intergovernmental Panel on Climate Change report (Forster et al. 2007). The model there- fore simulates CO2eq from the commuting fleet, accounting for trends in light vehicle emissions, population, and VKT. These are then converted to commuting CO2eq and per capita emissions for the region’s population. The direct fuel savings for average light vehicle commute trips averted were also calculated using VKT, accounting for fuel consumption and fleet composition trends (VEPM 5.0) and historical and forecast “at the pump” fuel costs for petrol and diesel (Donovan et al. 2009; Energy Information and Modelling Group 2009, 2011). Mortality due to physical inactivity. We used two international prospective cohort studies of commuter bicycling (Andersen et al. 2000; Matthews et al. 2007) to develop a relative risk estimate for all-cause mortal- ity of 0.72 for regular commuter cyclists. We assumed that the question about commute mode on census day represented the regular mode used for commuting, and that trips of ≤ 6 km in Auckland are equivalent to the levels of physical activity reported for com- muter bicycling in the cohort studies. We also assumed a linear dose–response relationship for the range of commuter bicycling trips undertaken in Auckland. Lead time has not been specifically studied, and expert judgment has previously been used (Kahlmeier et al. 2011). We assumed a 2-year lead time for the accrual of physical activity benefits fol- lowing a mode shift, and the same time for benefits to return to baseline with a reduction in commuter bicycling. To simulate all-cause mortality savings from any increase in com- muter bicycling, we stratified the commut- ing population by age, ethnicity, and sex and projected and developed standardized baseline estimates of all-cause mortality in these groups from national mortality statistics. We used historical rates of declining all-cause mortality and projected these to develop an adjustment for the widespread trend in mortality. We simulated a “business-as-usual” all-cause mor- tality scenario, and then simulated all-cause mortality rates in response to any changes in commute mode share to calculate lives lost or saved due to changes in bicycle commuting. Policy simulations. We investigated five policy scenarios (Table 1). The first scenario acted as a baseline (no investment in cycling), the second was drawn from present policy, and three further scenarios were developed by analyzing Auckland’s road network (Auckland Transport 2011; Charlton et al. 2010; Wallace 2008) against international bicycling infrastructure design standards for different road types from the Netherlands (CROW 2007) and the United Kingdom (Transport for London 2005). Equations were developed to simulate the effects of the four intervention policies, based on quantitative and qualitative research and local data sources. In particular, we relied on existing systematic (Elvik et al. 2009; Reynolds et al. 2009) and nonsystem- atic (CROW 2007) reviews of the published and unpublished literature, supplemented by more recently published studies. We consid- ered epidemiological quality and relevance to Auckland to develop point estimates. We also used the lowest and highest confidence limits of all the studies to develop best- and worst-case scenarios and for sensitivity testing. For collision relative risks, we developed region-wide effects based on the propor- tion of roads treated. The policies are briefly described below, and the effects simulated are summarized in Table 2. Regional Cycle Network (RCN). The regional council’s 30-year transport strategy (Auckland Regional Council 2010) includes a commitment to develop a partial network of mixed cycling infrastructure, further details of which were sought directly from the coun- cil. Planned infrastructure included on-road marked lanes with no physical segregation on 46% of main roads, an increase from 10 to 25 km of off-road shared footpaths per 100,000 population, and a small number of new shared bus and bicycle lanes (0.04% of the main road network treated). The RCN was simulated to affect cyclists’ risk of colli- sion with a motor vehicle, the proportion of the population considering bicycling to be always or mostly safe, and the proportion of the population considering bicycling to be a good way to get to work.

Integrated assessment of cycling policies using SDM Environmental Health Perspectives • volume 122 |^ number 4 |^ April 2014 341 All the intervention scenarios achieve sav- ings in all-cause mortality through an increase in population levels of physical activity. The savings range from tens of lives per year (RCN and SER) to hundreds of lives per year (ASBL and combined best practice). There are projected fuel cost savings under all scenarios (including slight savings even with no intervention), which will increase over time if rising fuel prices outstrip improvements in light vehicle fuel efficiency. According to our simulations, the RCN and SER scenar- ios would achieve annual fuel cost savings in hundreds of millions of $NZ due to increased commuter bicycling, while the ASBL and com- bined best practice scenarios would achieve annual savings in billions of dollars (Table 3). Table 3 illustrates the estimated cumu- lative costs and benefits to 2051 of the four policy interventions compared with the business-as-usual simulation. All interven- tions exhibit positive benefit–cost ratios, ranging from $NZ6 to > $NZ20 saved for every dollar spent on bicycling infrastruc- ture. The largest savings come from reduc- tions in all-cause mortality due to physical inactivity. However, the distribution and magnitude of costs and savings vary widely between scenarios. Although the RCN is cheap to build (~ $NZ45 million), it achieves only a small shift in mode share accompa- nied by a large injury burden, resulting in net benefits in the hundreds of millions of dol- lars. Yet the combined best practice scenario, although considerably more expensive to build (approximately $NZ630 million), achieves a much larger mode shift with a similar num- ber of bicycling injuries and a cumulative net benefit in tens of billions of dollars, as shown in Table 3. In this scenario, bicycling fatalities are offset by the reduction in other motor vehicle injuries. Because a major effect of the SER intervention is to reduce vehicle use by making it less convenient (Charlton et al. 2010), rather than to directly increase bicycling, further effects of the SER scenario will accrue through increases in all non- car transport modes (including walking and Figure 2. Dynamic model outputs 1991–2051. (A) Commuter bicycling mode share. (B) Annual serious and fatal injuries to commuter cyclists due to collisions with light vehicles. (C) Commuter cyclist injury rate per 1,000 cyclists. (D) Mortality due to air pollution from the commuting light vehicle fleet. 1991 2006 2021 2036 2051 0

1 2 3 1 2 3 1 2 1 2 3 3 4 4 4 4 5 5 5 5 1991 2006 2021 2036 2051 0 500 1000 1 2 1 2 1 1 2 2 3 3 3 3 4 4 4 4 5 5 5 5 1991 2006 2021 2036 2051 0 5 10 1 1 1 1 2 3 2 3 2 2 (^33) 4 4 (^4 ) 5 5 (^5 ) 2021 Year Year 1991 2006 2036 2051 0 10 20 1 1 (^1 ) 2 2 2 2 3 3 3 3 4 4 4 4 5 5 5 5 Bicycle mode share Cyclist serious injuries and deaths Cyclist serious injury and death rate (per 1,000 cyclists) Annual air pollution mortality 1, Baseline 2, RCN 3, ASBL 4, SER 5, ASBL + SER Table 3. Cumulative outcomes projected from the simulation of active policy scenarios compared with the business-as-usual scenario. Outcome RCN (monetized) ASBL (monetized) SER (monetized) ASBL + SER (monetized) Cycling mode share by 2051 (%) 5 20 5 40 LV mode share by 2051 (%) 75 65 55 40 Proportion of people considering cycling always/mostly safe by 2040 0.4 0.7 0.3 0. LVKT (billion km) –3.5 –7 –10 –18. Cyclist injuries Fatalities 200 (620) 360 (1,100) 85 (250) 250 (850) Serious injuries 4,000 (1,300) 7,000 (2,300) 1,600 (500) 5,000 (1,600) Car crashes Car occupant fatalities –70 (–220) –120 (–370) –170 (–527) –340 (–1,000) Air pollution Mortality –10 (–7.5) –20 (–15) –40 (–30) –80 (–60) Hospitalizations –5 (–0.02) –15 (–0.04) –20 (–0.06) –40 (–0.12) COPD incidence –10 (–0.75) –30 (–2.25) –55 (–4) –90 (–6.75) Restricted activity days –12,500 (–1) –37,200 (–4) –57,700 (–6) –112,200 (–11) Air pollution total (–9) (–21) (–40) (–78) All-cause mortality –650 (–2,000) –1,850 (–5,700) –650 (–2,000) –4,000 (–12,400) Greenhouse gas emissions (megatons) –3 (–120) –8 (–360) –13 (–520) –26 (–1040) Fuel cost ($NZ million) (–600) (–1,800) (–600) (–3,900) Infrastructure cost ($NZ million) (45) (250) (380) (630) Net benefit ($NZ million) –770 –2,550 –1,780 –13, Benefit–cost ratio 18 18 6 24 Abbreviations: LV, light vehicle; LVKT, light vehicle kilometers travelled. Numbers with a negative sign represent savings. Monetized figures are given in parentheses and are in millions of New Zealand dollars. Benefit–cost ratios are calculated from the net public health benefits and infrastructure costs shown.

Macmillan et al. 342 volume 122 |^ number 4 |^ April 2014 • Environmental Health Perspectives public transport). Therefore, counting only the benefits and costs due to an increase in commuter bicycling reflects only part of the benefits and costs of this intervention. Policy sensitivity analysis. The results of the policy parameter testing are summarized in the Supplemental Material, Tables S4–S and Figures S1–S6. Realistic changes to pol- icy assumptions did not change the shape of outcome behaviors over time. However, injury outcomes were sensitive to safety-in- numbers assumptions. In particular, simulat- ing the no-threshold power function proposed by Jacobsen (2003) altered the shape of change over time of injury outcomes for all scenarios, but worsened the validity against historical data. The Monte Carlo analysis demonstrated order-of-magnitude variability in mode share outcomes only for the SER policy. Overlap in the mode share effects of some policies was evi- dent, but the model continued to distinguish among the RCN, ASBL, and combined best practice policies (see Supplemental Material, Table S7 and Figure S6). Simulating the reported range of effects of commuter cycling on all-cause mortality altered the order of mag- nitude of savings, and the model was not able to distinguish between scenarios because of overlapping effects. Plausible variation in lead times for physical activity benefits led to order- of-magnitude differences in outcomes, while retaining the ability to distinguish between the RCN and combined best practice scenarios. Even under a best-case scenario, the RCN would result in an increase in the cyclist injury rate (Figure 2C; see also Supplemental Material, Figure S1) because the infrastructure components have the potential to make cycling more dangerous, while failing to achieve the mode shift necessary to reduce vehicle growth or reach the safety in numbers threshold. On the other hand, policies 4 (SER) and 5 (ASBL

  • SER) reduce the cycling injury rate even under worst-case scenario testing.

Discussion

Principal findings. Under our primary model assumptions, the benefits of all the interven- tion policies outweighed the harms, between 6 and 24 times. However, there were order- of-magnitude differences in estimated net benefits among policies. A universal approach to bicycle-friendly infrastructure will likely be required to achieve sufficient growth in bicycle commuting to meet strategic goals. Our findings suggest that the most effective approach would involve physical segregation on arterial roads (with intersection treatments) and low speed, bicycle-friendly local streets. We estimate that these changes would bring large benefits to public health over the coming decades, in the tens of dollars for every dollar spent on infrastructure. The greatest benefits accrue from reduced all-cause mortality due to population-level physical inactivity. The modeling enabled discussions about the forces behind bicycling trends between policy and nongovernment actors, based on a shared structural understanding. By develop- ing a more consistent, shared, structure-based understanding, we expect this participatory modeling process to reduce conflict among policy stakeholders and successfully support policy change. Simulating the model delivered further insights, identifying feedback loops that were inactive and enabling comparison between plausible policies to demonstrate how strategic targets could be met. Conflicting, mismatched, and unrealistic targets were also identified. For example, meeting the postulated bicycling mode share target was possible through sev- eral of the policies simulated. However, none met the perception of safety target. Except for the combined best practice policy, increases in cycling mode share conflicted with targets to reduce road traffic deaths and injuries. The dynamic output graphs suggest that the planned RCN is unlikely to meet regional tar- gets and fails to address the projected business- as-usual increase in the bicycling injury rate. Through the integrated modeling of benefits we were able to show that a more ambitious approach would be cost-effective. Strengths and weaknesses. To our knowl- edge, this is the first integrated assessment of specific alternative active transport policies, and one of the first uses of SDM to integrate health, social, and environmental outcomes of urban policies. The study builds on previous inte- grated assessments of transport policies (e.g., Lindsay et al. 2011; Rojas-Rueda et al. 2011; Woodcock et al. 2009). The model improves our understanding of active transport policy impacts by circumventing the limitations of both small-scale, rigorous interventions (Ogilvie et al. 2004) and larger ecological com- parisons (Buehler and Pucher 2011). By com- bining local stakeholder knowledge, regional data, and epidemiological evidence using SDM, we were able to combine the structural and the social influences on cycling uptake with evidence-based and context-specific emphasis given to each. The method allowed us to model bicycling collisions and injuries with greater sophistica- tion, including a more nuanced approach to safety in numbers and a more sophisticated model of the effects of traffic speed than previ- ous studies. It also enabled us to account for expected dynamic changes in all-cause mortal- ity and the light vehicle fleet, and to undertake a deeper analysis of structural and parametric uncertainty. However, we were able to include only bicycling injuries occurring as a result of a collision with a light vehicle. Collisions with heavy vehicles, other cyclists, and pedestrians and cyclist-only injuries were not included. Although collisions with motor vehicles account for > 90% of the serious injuries and fatalities reported in New Zealand’s crash analysis, other kinds of cyclist injuries are also likely to increase with increasing bicycle mode share. The relative risks from bicycling cohort studies used in our model may overestimate the mortality benefit of commuter bicycling. These relative risks are larger than expected from meta-analyses of physical activity (Löllgen et al. 2009; Woodcock et al. 2011). Conversely, there are likely benefits not yet able to be counted because of a lack of quan- tified evidence. These include reductions in inactivity-related morbidity, increased social connection, and local economic benefits. The development of a useful SDM requires a balance between parsimony and accuracy. Consistent with most SDM endeavors, our goal was to develop a reflective model for enhancing communication and understanding of system structure and behavior. Although the assumptions meant it was not possible to make point predictions of policy effects, robust policy insights can to be drawn despite mixed quality data. Implications for policy and practice. In high-income, car-dependent cities such as Auckland, particular bicycle-friendly interven- tions will be crucial to turn patterns of declin- ing commuter cycling into sustained growth that would meet climate and health goals. Although our findings suggest that Auckland’s existing plan to develop a regional cycle net- work would likely have benefits, the simulation modeling suggests that it would not reverse the predicted business-as-usual increased rate of cycling injury. In contrast, a gradual trans- formation of all roads using best practice arte- rial and local street interventions could make a major contribution to regional transport targets. Our projections suggest that, assuming our assumptions are valid, this transition would be cost-effective, returning tens of dollars in benefits for every dollar spent. Participatory SDM represents a methodo- logical step forward for health impact assess- ment. As well as being applicable to other transport and land use policies, it could assist with intervening in the wider interdependent systems driving obesity, physical inactivity, and climate change. Implications for future research. The sen- sitivity analysis identified important assump- tions, and therefore future research directions. The model was most sensitive to assumptions about safety in numbers, highlighting the need for longitudinal studies of cycling inju- ries accounting for both infrastructure and cyclist numbers. Although the causal loop diagram is context specific, we find it a useful basis for

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