ArticlePDF Available

Dutch Cycling: Quantifying the Health and Related Economic Benefits

Authors:
Elliot Fishman at Institute for Sensible Transport
Elliot Fishman
  • Institute for Sensible Transport
Paul Schepers at Ministry of Infrastructure and the Environment
Paul Schepers
Carlijn Barbara
Carlijn Barbara
Carlijn Barbara
  • This person is not on ResearchGate, or hasn't claimed this research yet.
Maria Kamphuis
Maria Kamphuis
Maria Kamphuis
  • This person is not on ResearchGate, or hasn't claimed this research yet.
Download full-text PDF
Read full-text
Download citation

Abstract

The Netherlands are well-known for their high bicycle usage. The approach of the Health Economic Assessment Tool and life table calculations were used to quantify the population-level health benefits due to Dutch cycling levels. The results show that, due to cycling, about 6,500 deaths are prevented each year, Dutch people have half-a-year longer life expectancy, and that these health benefits translate in economic benefits corresponding to some 3% of Dutch GDP. Our study confirms that investments in bicycle-promoting policies (e.g. improved bicycle infrastructure and facilities) are likely to yield a high benefit-cost ratio in the long term.
Content uploaded by Paul Schepers
Author content
All content in this area was uploaded by Paul Schepers on Jul 24, 2015
Content may be subject to copyright.
Fishman, E., Schepers, P., Kamphuis, C.B.M. Dutch cycling: Quantifying the health and related economic
benefits, Am J Public Health. 2015;105(8):e13-e15.
Dutch cycling: Quantifying the health and related economic benefits
Elliot Fishman, PhD, Paul Schepers, PhD, and Carlijn Barbara Maria Kamphuis, PhD
This brief was accepted April 15, 2015.
ABSTRACT
The Netherlands are well-known for their high bicycle usage. The approach of the Health
Economic Assessment Tool and life table calculations were used to quantify the population-
level health benefits due to Dutch cycling levels. The results show that, due to cycling, about
6,500 deaths are prevented each year, Dutch people have half-a-year longer life expectancy,
and that these health benefits translate in economic benefits corresponding to some 3% of
Dutch GDP. Our study confirms that investments in bicycle-promoting policies (e.g.
improved bicycle infrastructure and facilities) are likely to yield a high benefit-cost ratio in
the long term.
INTRODUCTION
The Netherlands are well-known for their high cycling levels.1, 2 Currently, about 27% of all
trips in the Netherlands is made by bicycle.3 Investments in bicycle paths, bike parking, traffic
calming, and other policies contribute to these high cycling levels, and therefore, the Dutch
approach is internationally recognized as an example for other countries.1, 2 Although the
health benefits of cycling as a means to reduce the risk of sedentary lifestyle diseases and all-
cause mortality are well-known,4-6 no previous study has actually quantified the health
benefits and related economic benefits at a population level in the Netherlands, which has the
highest level of bicycle use in the world.1 Quantifying and monetizing these benefits is
important to inform policy makers in the field of transport.7 Therefore, this paper sets out to
examine the health benefits and health-related economic benefits of population cycling levels
in the Netherlands.
METHODS
Data on age group-specific cycling levels (i.e. average time spent cycling weekly per person),
population counts, and mortality rates in the Netherlands in 2010-2013 were retrieved from
Statistics Netherlands.3 Data about cycling levels had been collected by means of a travel
diary survey (National Travel Survey, or “Onderzoek Verplaatsingsgedrag in Nederland”)
among a nationally representative random sample of about 50,000 persons each year. All
types of travellers and households and all days of the year are proportionately represented.
The approach of the Health Economic Assessment Tool (HEAT) developed by the World
Health Organization (WHO) was used8 to estimate the mortality rate reduction and number of
deaths prevented each year due to cycling. The tool estimates the value of reduced mortality
that results from specified amounts of cycling (or walking). Based on a recent meta-analysis
Fishman, E., Schepers, P., Kamphuis, C.B.M. Dutch cycling: Quantifying the health and related economic
benefits, Am J Public Health. 2015;105(8):e13-e15.
of studies about the impact of cycling on all-cause mortality,4 HEAT assumes a reduction in
mortality risk of 10% (95% confidence interval: 6 to 13%) for an exposure to cycling of 100
minutes per week. This risk reduction is controlled for other forms of physical activity, such
as leisure time or occupational physical activity, and other health behaviours like smoking.4
Negative side-effects due to increased exposure to road safety and air pollution risks are
controlled for because the meta-analysis was about all-cause mortality. HEAT only considers
ages between 20 and 65 years. Younger people are excluded because the evidence base for the
health effects of physical activity on young people is not as large as that for adults. Older age
groups are excluded because countries often lack mobility data for older age groups.8
However, since the underlying meta-analysis did provide information for ages of 65 and
over,4 The annual number of deaths prevented per age group, was calculated by the product of
the mortality rate reduction and the mortality rate (annual number of deaths per 100,000) for
that age group.
To calculate the economic health benefits of cycling, HEAT uses a standard value of a
statistical life (VSL) to monetize the number of deaths per year prevented by cycling
participation. Certain costs such as expenditures related to medical treatment are not reflected
in the VSL estimates but these are relatively small. HEAT applies a VSL of $3.6 million for
the EU-27 countries, but advises a locally agreed VSL where available.8 The Dutch VSL is
€2.8 million per death at the 2013 price level.3, 9
Lastly, Dutch hazard rates were entered in the open-access life-table calculations, IOMLIFET,
to estimate the life expectancy increases by age group in response to the reduced risk of
mortality as calculated by the HEAT approach.10
RESULTS
The weekly time spent cycling is about 74 minutes per week for Dutch adults of 20 to 90
years of age (Table 1). This level of cycling is fairly stable over adulthood and reaches its
peak around 65-70 years, in early days of retirement, and strongly drops after the age of 80
years. The mortality rate reduction, which is a direct result of the average time spent cycling
of a certain age group, is therefore also highest between 65 and 70 years. As a result of the
mortality reduction of all age groups together, about 6,500 deaths per year are prevented due
to cycling in the Netherlands. With a VSL of € 2.8 million per prevented death, the total
economic health benefits of cycling are estimated at € 19 billion per year. Life table
calculations suggested people in the Netherlands would die about half a year earlier without
cycling. More than half of this total life expectancy increase is achieved by cycling among
adults aged 65 and older.
Fishman, E., Schepers, P., Kamphuis, C.B.M. Dutch cycling: Quantifying the health and related economic
benefits, Am J Public Health. 2015;105(8):e13-e15.
TABLE 1. Health economic assessment based on time spent cycling and mortality rates of the
Dutch population between 20 and 90 years in 2010-2013
Input data
Outcome HEAT approach
Life table
calculation
Age
group
Average
weekly
minutes of
cycling p.p.
Popula-
tion
(x
1,000)
Average annual
mortality rate
per 100,000 pop.
Mortality
rate
reduction
(%)1
Annual benefit
of current
Dutch cycling
(billon €)3
Increase of
average life
expectancy4
20-30
73
2,058
31
7.3
0.1
0.01
30-40
69
2,087
53
6.9
0.2
0.02
40-50
69
2,573
135
6.9
0.7
0.03
50-60
79
2,320
390
7.9
2.0
0.08
60-65
89
1,071
757
8.9
2.0
0.07
65-70
94
872
1,232
9.4
2.8
0.09
70-75
88
652
1,963
8.8
3.2
0.10
75-80
73
507
3,422
7.3
3.6
0.09
80-85
36
369
6,328
3.6
2.4
0.05
85-90
24
216
11,663
2.4
1.7
0.03
Total /
Average
74
12,725
878
7.4
18.6
0.57
1 Based on an estimated mortality rate reduction of 10% per 100 minutes of cycling per week according to the meta-analysis.5,7 For instance,
for the age group of 20-30 years 73/100 = 7.3%
2 The product of the mortality rate reduction, population and mortality rate (per 100,000 population)/100,000
3 The product of the number of deaths multiplied by the standard value of a statistical life year (VSL) of 2.8 million euro.
4 Based on lifetable calculations using IOMLIFET with Dutch mortality rates between 2010 and 20133
DISCUSSION
Cycling levels in the Netherlands have great population level health benefits: about 6,500
deaths are prevented annually and Dutch people have half-a-year longer life expectancy.
These large population level health benefits translate into economic benefits of €19 billion per
year, which represent more than 3% of the Dutch Gross Domestic Product (GDP) between
2010 and 2013.3
About 6,500 deaths that are saved annually due to cycling is a huge number, but becomes
even more impressive when compared to the population-health effects of other preventive
measures. An overview of Mackenbach et al (2013) showed that the 22 new preventive
interventions that have been introduced in the Netherlands between 1970 and 2010 (e.g.
tobacco control, population based screening for cancer, and road safety measures), altogether
avoid about 16,000 deaths per year.11
Still, our results are likely to be an underestimation of the true total health and economic
benefits. The benefits calculated are for health only (excluding, for instance, reduced traffic
congestion), and within the health category, only for mortality and not for prevented
morbidity. There is considerably uncertainty regarding the monetization of morbidity,5 which
is why it is not included in the WHO’s HEAT Model.8
Compared to the capital investments by all levels of Dutch government in road and parking
infrastructure for cycling of almost €0.5 billion per year over the last decades 12, the annual
benefits of €19 billion are much higher than the annual costs. We acknowledge that this
Fishman, E., Schepers, P., Kamphuis, C.B.M. Dutch cycling: Quantifying the health and related economic
benefits, Am J Public Health. 2015;105(8):e13-e15.
comparison excludes private spending on bicycles and savings on fuel costs if the same trips
would be covered by car. Moreover, next to safe and efficient cycling infrastructure and
facilities, also geographical factors, like the Dutch flat terrain, and mild climate, and cultural
factors are likely to contribute to high volumes of cycling.13 These are unrelated to capital
investment by governments. However, infrastructural and safety measures are important to
facilitate cycling.13 For instance, elderly, the group among whom the largest health and
economic benefits can be achieved, indicated to prefer separate bicycle paths.14 The Dutch
case shows it is likely that investments in bicycle-promoting policies (e.g. improved bicycle
infrastructure and facilities) yield a high benefit-cost ratio in the long term. We therefore
recommend investments in bicycle policies as suggested earlier by Pucher and Dijkstra.1, 2
REFERENCES
1. Pucher J, Buehler R. Cycling for Everyone: Lessons from Europe. Transport Res Rec.
2008;2074(1):58-65.
2. Pucher J, Dijkstra L. Promoting safe walking and cycling to improve public health:
lessons from The Netherlands and Germany. Am J Public Health. 2003;93(9):1509-1516.
3. Statistics Netherlands. Statline Available: http://statline.cbs.nl/Statweb/. Accessed
January 21, 2015.
4. Kelly P, Kahlmeier S, Gotschi T, Orsini N, Richards J, Roberts N, Scarborough, P,
Foster, C. Systematic review and meta-analysis of reduction in all-cause mortality from
walking and cycling and shape of dose response relationship. Int J Behav Nutr Phys Act.
2014;11(1):132.
5. Oja P, Titze S, Bauman A, de Geus B, Krenn P, Reger-Nash B., Kohlberger, T. Health
benefits of cycling: a systematic review. Scand J Med Sci Sports. 2011;21(4):496-509.
6. De Hartog JJ, Boogaard H, Nijland H, Hoek G. Do the health benefits of cycling
outweigh the risks? Environ Health Perspect. 2010;118(8):1109-1116.
7. Dora C, Racioppi F. Including health in transport policy agendas: the role of health
impact assessment analyses and procedures in the European experience. B World Health
Organ. 2003;81(6):399-403.
8. Kahlmeier S, Kelly P, Foster C, Götschi T, Cavill N, Dinsdale H, Woodcock, J,
Schweizer, C, Rutter, H, Lieb, C, Oja, P, Racioppi, F. Health economic assessment tools
(HEAT) for walking and for cycling; Methodology and user guide. World Health Organisation
2013.
9. De Blaeij AT. The value of a statistical life in road safety; Stated preference
methodologies and empirical estimates for the Netherlands. Amsterdam: VU University
Amsterdam, 2003.
10. Miller BG. IOMLIFET version 2013 Spreadsheets for life-table calculations.
Edinburgh:Institute of Occupational Medicine, 2013.
11. Mackenbach JP, Lingsma HF, van Ravesteyn NT, Kamphuis, CB. The population and
high-risk approaches to prevention: quantitative estimates of their contribution to population
health in the Netherlands, 1970-2010. Eur J Public Health. 2013;23(6):909-915.
12. Ligtermoet D. Overheidsbestedingen aan fietsverkeer (Governmental spending on
bicycle traffic). Gouda: Ligtermoet & Partners, 2014.
Fishman, E., Schepers, P., Kamphuis, C.B.M. Dutch cycling: Quantifying the health and related economic
benefits, Am J Public Health. 2015;105(8):e13-e15.
13. Heinen E, van Wee B, Maat K. Commuting by bicycle: an overview of the literature.
Transport Rev. 2010;30(1):59-96.
14. Bernhoft IM, Carstensen G. Preferences and behaviour of pedestrians and cyclists by
age and gender. Transport Res F-Traf. 2008;11(2):83-95.
... While the public health benefits of cycling have already been assessed in a large variety of contexts, 11,12 national assessments based on representative mobility data are less common. 13 Moreover, few burden of disease studies have assessed its impact in terms of both mortality and morbidity or have estimated the associated direct medical and intangible costs avoided. 14,15 Such assessments can contribute meaningfully to intense debates currently ongoing about the future of mobility in a context of ambitious decarbonization targets and energy crises in many high-income Western countries such as France. ...
... 36 The French adult population reported cycling on average less than 10 minutes per week, which is low compared to the more than 70 minutes per week reported by the Dutch adult population. 13 Despite repeated calls to decrease motorized trips to help tackle climate change and physical inactivity, cycling mode share for France remained at about 2.7% of all trips in France between 2008, the year of the previous wave of travel survey, and 2019. The bike modal remained the same (2.7%) between the two waves. ...
... 37 In France, we estimate that cycling reduces the mortality risk by 0.6%, compared to 7.4% in the Netherlands. 13 We showed that currently, males are the main beneficiaries of cycling health benefits in France because they represent a large fraction of the cyclists. However, previous surveys have shown that females are equally represented in countries where cycling is normalized, providing an additional motivation for cycling promotion. ...
The untapped health and climate potential of cycling in France: a national assessment from individual travel data
Article
Full-text available
  • Mar 2024
Background Promoting active modes of transportation such as cycling may generate important public health, economic, and climate mitigation benefits. We aim to assess the mortality and morbidity impacts of cycling in a country with relatively low levels of cycling, France, along with associated monetary benefits. We further assess the potential additional benefits of shifting a portion of short trips from cars to bikes, including projected greenhouse gas emissions savings. Methods Using individual data from a nationally representative mobility survey, we described the French 2019 cycling levels by age and sex. We conducted a burden of disease analysis to assess the incidence of five chronic diseases (breast cancer, colon cancer, cardiovascular diseases, dementia, and type-2 diabetes) and the number of deaths prevented by cycling, based on national incidence and mortality data and dose–response relationships from meta-analyses. We assessed the corresponding direct medical cost savings and the intangible costs prevented based on the value of a statistical life year. Lastly, based on individual simulations, we assessed the likely additional benefits of shifting 25% of short (<5 km) car trips to cycling. Findings The French adult (20–89 years) population was estimated to cycle on average 1 min 17 sec pers⁻¹ day⁻¹ in 2019, with important heterogeneity across sex and age. This yielded benefits of 1,919 (uncertainty interval, UI: 1,101–2,736) premature deaths and 5,963 (UI: 3,178–8,749) chronic disease cases prevented, with males reaping nearly 75% of these benefits. Direct medical costs prevented were estimated at €191 million (UI: 98–285) annually, while the corresponding intangible costs were nearly 25 times higher (€4.8 billion, UI: 3.0–6.5). We estimated that on average, €1.02 (UI: 0.59–1.62) of intangible costs were prevented for every km cycled. Shifting 25% of short car trips to cycling would yield approximatively a 2-fold increase in deaths prevented, while also generating important CO2 emissions reductions (0.257 MtCO2e, UI: 0.231–0.288). Interpretation In a country with a low- to moderate-cycling culture, cycling already generates important public health and health-related economic benefits. Further development of active transportation would increase these benefits while also contributing to climate change mitigation targets. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
View
... In non-OECD countries, a 1% increase in biking correlates with a 148.4% decrease in emissions, highlighting cycling's effectiveness in lowering the environmental impact of transportation in these regions. The effectiveness of cycling in reducing transportation CO 2 emissions is supported by research from Fishman et al. [65], who found that promoting cycling in urban areas can lead to significant decreases in CO 2 emissions, especially in cities where the adoption of cycling is still growing and the potential for mode shift is high. ...
View
... Evidence shows that well-designed cycling infrastructure can have health, transportation, and environmental benefits, and support equity by improving access to cycling across different demographic groups (Buehler & Pucher, 2021;Doran et al., 2021;Fishman et al., 2015;Mitra & Nash, 2019). The presence and quality of cycling infrastructure influences who cycles, how much they cycle, and how far they go. ...
All Ages and Abilities': exploring the language of municipal cycling policies
Article
Full-text available
  • Sep 2023
As cities work to support greater uptake and equity in cycling, the terminology ‘All Ages and Abilities’ (or AAA) is increasingly common in cycling research and practice vernacular. However, it is unclear the values that underlie this. We undertook a policy scan of Canadian municipal and regional policy documents to understand: the language used to describe ‘All Ages and Abilities’; the infrastructure specified; how municipalities and regions define a cycling network; and how equity and priority populations are incorporated into these plans. Of 35 plans, 25 mentioned ‘All Ages and Abilities’. Fourteen mentioned specific ‘All Ages and Abilities’ infrastructure, with cycle tracks, local street bikeways, and multi-use paths most frequent. Reference to the idea of a network was common (32 plans), with some defining this as a minimum grid. Within plans that used ‘All Ages and Abilities’ language, children and older adults were the most common populations mentioned (e.g. ‘Ages’), but there was more ambiguity around who was being referred to with ‘Abilities’. As use of this terminology continues, clarity is needed on the meaning and values that underpin it. A lack of specificity in design standards and whom this infrastructure serves is a barrier to concrete, consistent implementation.
View
... A report by Fishman and coworkers (93), used HEAT to estimate the economic health benefits of cycling in the Dutch population. Based on age-specific weekly cycling times (average of 74 min per week across the age range from 20 to 90 years) and mortality rates it was estimated that current levels of cycling prevented 6,657 deaths per year in the Netherlands, resulting in a 0.57 year increase in life expectancy and an annual economic benefit of €18.6 billion, assuming a value of a statistical life of €2.8 million per prevented death. ...
Benefits, risks, barriers, and facilitators to cycling: a narrative review
Article
Full-text available
  • Sep 2023
There is large potential to increase cycling participation worldwide. Participation in cycling is associated with lower risk of mortality from any cause, and incidence of cardiovascular disease and type 2 diabetes, as well as positive mental health and well-being. The largest potential for health gains likely to come from increasing participation amongst those who do not currently cycle regularly, rather than encouraging those who already cycle regularly to cycle more. Replacing car journeys with cycling can lead to reductions in air pollution emissions and lower pollutant exposure to the general population. Important gaps and uncertainties in the existing evidence base include: the extent to which the health benefits associated with cycling participation are fully causal due to the observational nature of much of the existing evidence base; the real-world economic cost-benefits of pragmatic interventions to increase cycling participation; and the most effective (combination of) approaches to increase cycling participation. To address these uncertainties, large-scale, long-term randomised controlled trials are needed to: evaluate the effectiveness, and cost-effectiveness, of (combinations of) intervention approaches to induce sustained long-term increases in cycling participation in terms of increases in numbers of people cycling regularly and number of cycling journeys undertaken, across a range of population demographic groups; establish the effects of such interventions on relevant outcomes related to health and wellbeing, economic productivity and wider societal impacts; and provide more robust quantification of potential harms of increasing cycling participation, such as collision risks.
View
Let’s walk! The fallacy of urban first- and last-mile public transport
Article
Full-text available
  • Jun 2024
  • TRANSPORTATION
In recent years, there has been an upsurge in intelligent mobility solutions that provide door-to-door services. Although these services offer convenience to certain individuals, it is frequently overlooked that they can lead to welfare losses when accounting for the reduced health benefits that result from reduced physical activity. In this paper, we derive a welfare function of introducing first- and last-mile public transport services. By comparing possible health gains from walking with corresponding accessibility losses, we identify the distance boundaries under which the service fails to be socially beneficial. The results are based on a simulation study and draw on further insights from a recent agent-based model from Copenhagen focusing on first- and last-mile public transport. Although the model is intentionally stylized and may not apply universally to all scenarios featuring diverse population densities, demographic profiles, or transport network layouts, the fundamental conclusion presented in the paper is that first-mile services have minimal welfare impact for average trip distances below 1 km, appears robust even under conservative assumptions. In this case, the probability of failure is almost 100% for any realistic parametrization. This finding implies that planners and researchers should focus on the design of main transit networks and the access and egress of active modes to and from the stations. In particular, door-to-door services covering shorter distances should not be the priority of public funding unless in particular situations or contexts.
View
View
Safety and Comfort Evaluation of High-Speed Cycling on Urban Asphalt Pavement
Article
  • Dec 2023
Cycling is a healthy and sustainable means of urban travel. In this research, cycling tests and questionnaires were used to evaluate the impact of vibration intensity on the cycling experience. The standard deviation of vibration acceleration ( AStd) generated in cycling test was collected and vibration comfort and vibration perception were scored. Then, the simulation method was used to quantitatively analyze the influence of the macrostructure of the pavement on the cycling vibration. Moreover, through the simulation analysis of the most unfavorable situation of high-speed riding, the minimum British pendulum number (BPN) value that meets the skid resistance requirements is obtained. According to the results of regression analysis, the prediction equations of pavement structure parameters and AStd/BPN are obtained. After comprehensively considering cycling safety and comfort, the evaluation process of bicycle-specific pavement is given. This research hopes to provide a reference for the sustainable development of urban green travel.
View
View
View
View
View
Systematic review and meta-analysis of reduction in all-cause mortality from walking and cycling and shape of dose response relationship
Article
Full-text available
  • Oct 2014
  • INT J BEHAV NUTR PHY
Background and objective Walking and cycling have shown beneficial effects on population risk of all-cause mortality (ACM). This paper aims to review the evidence and quantify these effects, adjusted for other physical activity (PA). Data sources We conducted a systematic review to identify relevant studies. Searches were conducted in November 2013 using the following health databases of publications: Embase (OvidSP); Medline (OvidSP); Web of Knowledge; CINAHL; SCOPUS; SPORTDiscus. We also searched reference lists of relevant texts and reviews. Study eligibility criteria and participants Eligible studies were prospective cohort design and reporting walking or cycling exposure and mortality as an outcome. Only cohorts of individuals healthy at baseline were considered eligible. Study appraisal and synthesis methods Extracted data included study population and location, sample size, population characteristics (age and sex), follow-up in years, walking or cycling exposure, mortality outcome, and adjustment for other co-variables. We used random-effects meta-analyses to investigate the beneficial effects of regular walking and cycling. Results Walking (18 results from 14 studies) and cycling (8 results from 7 studies) were shown to reduce the risk of all-cause mortality, adjusted for other PA. For a standardised dose of 11.25 MET.hours per week (or 675 MET.minutes per week), the reduction in risk for ACM was 11% (95% CI =4 to 17%) for walking and 10% (95% CI =6 to 13%) for cycling. The estimates for walking are based on 280,000 participants and 2.6 million person-years and for cycling they are based on 187,000 individuals and 2.1 million person-years. The shape of the dose-response relationship was modelled through meta-analysis of pooled relative risks within three exposure intervals. The dose¿response analysis showed that walking or cycling had the greatest effect on risk for ACM in the first (lowest) exposure interval. Conclusions and implications The analysis shows that walking and cycling have population-level health benefits even after adjustment for other PA. Public health approaches would have the biggest impact if they are able to increase walking and cycling levels in the groups that have the lowest levels of these activities. Review registration The review protocol was registered with Prospero (International database of prospectively registered systematic reviews in health and social care) PROSPERO 2013: CRD42013004266.
View
Promoting Safe Walking and Cycling to Improve Public Health: Lessons From The Netherlands and Germany
Article
Full-text available
  • Oct 2003
  • AM J PUBLIC HEALTH
We examined the public health consequences of unsafe and inconvenient walking and bicycling conditions in American cities to suggest improvements based on successful policies in The Netherlands and Germany. Secondary data from national travel and crash surveys were used to compute fatality trends from 1975 to 2001 and fatality and injury rates for pedestrians and cyclists in The Netherlands, Germany, and the United States in 2000. American pedestrians and cyclists were much more likely to be killed or injured than were Dutch and German pedestrians and cyclists, both on a per-trip and on a per-kilometer basis. A wide range of measures are available to improve the safety of walking and cycling in American cities, both to reduce fatalities and injuries and to encourage walking and cycling.
View
Cycling for Everyone: Lessons from Europe
Article
Full-text available
  • Dec 2008
This paper investigates how bicycling can be promoted as a safe and feasible means of transport for everyone and for all trip purposes. The policies and programs needed to encourage a broad spectrum of social groups to cycle are the same policies and programs that encourage high overall levels of cycling: extensive systems of separate cycling facilities, intersection modifications and priority bicycle traffic signals, traffic calming of neighborhoods, safe and convenient bike parking, coordination and integration of cycling with public transport, traffic education and training for both cyclists and motorists, and trafik laws that favor cyclists and pedestrians. To show how this multifaceted, coordinated approach actually works, the paper focuses on cycling trends and policies in the Netherlands, Denmark, and Germany. The national-level comparative analysis is supplemented with case studies of large and small cities in each country.
View
The population and high-risk approaches to prevention: Quantitative estimates of their contribution to population health in the Netherlands, 1970-2010
Article
Full-text available
  • Aug 2012
  • EUR J PUBLIC HEALTH
Background: To compare the contribution of 'population' and 'high-risk' approaches to prevention, with regard to their impact on population health in the Netherlands between 1970 and 2010. Methods: Preventive interventions that have had an impact on mortality and morbidity rates were identified using published evaluation studies and routinely collected mortality and morbidity data. These interventions were then classified into population versus high-risk approaches, depending on whether they were targeted to groups identified on the basis of their risk of disease. Results: In the period 1970-2010, 22 new preventive interventions were introduced, which altogether avoided about 16 000 deaths and several hundred thousand disease cases per year in the Netherlands. Tobacco control and road safety measures had the largest impact. Preventive interventions based on a high-risk approach, such as hypertension detection and control and cancer screening, accounted for approximately one quarter of the total health gain. Conclusions: In the period 1970-2010, considerably larger health gains have been achieved with the population approach than with the high-risk approach to prevention. National prevention policies should make judicious use of these complementary approaches to maximize health gain.
View
View
View
View
Commuting by Bicycle: An Overview of the Literature
Article
  • Jan 2010
  • TRANSPORT REV
Commuting by bicycle has advantages over other modes of transport, both for the commuter and for society. Although cycling is an option for many commuters, a considerable number of them choose to use other forms of transport. In order to underpin policies that promote commuting by bicycle, this paper investigates the determinants for commuting to work. As many bicycle commuters do not cycle every day, we also examine people’s daily choices, in terms of frequency. We conducted a survey of the current literature in order to identify the determinants for commuting by bicycle. We found many determinants, not all of which are addressed by conventional mode choice studies and models. This suggests that predicting and influencing bicycle use needs to be grounded in other kinds of knowledge than those currently available for motorized forms of transport.
View
Preferences and behaviour of pedestrians and cyclists by age and gender
Article
  • Mar 2008
  • TRANSPORT RES F-TRAF
Preferences and behaviour of older pedestrians and cyclists (women and men, 70 years and above) in cities were studied by means of a questionnaire, and was compared to a group of people aged 40–49. The older respondents appreciate pedestrian crossings, signalized intersections and cycle paths significantly more than the younger respondents do. To a larger extent they feel that it is dangerous to cross the road where these facilities are missing. The older pedestrians also find the presence of a pavement very important on their route, whereas the younger pedestrians more often focus on a fast passage. Differences in preferences and behaviour within the group of older respondents can be related to differences in health and physical abilities rather than to differences in age and gender. The older road users seem to be more influenced by the fact that an action is illegal than the younger road users are. In several instances they more often give this reason for refraining from an act than the younger respondents. They also more often use the argument that they act in a specific way, because it makes them feel safer. And finally they more often express doubts about their own abilities.
View