Variations in the health benefit valuations of active transport modes by age and ethnicity: A case study from New Zealand

doi:10.1016/j.jth.2020.100953

Journal of Transport & Health

Volume 19, December 2020, 100953

https://doi.org/10.1016/j.jth.2020.100953 Get rights and content

Highlights

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Older people and Māori had greater potential health benefits from active transport.
•
Using population averages masks substantial variation in health benefits.
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Active transport funding could be more equitable if this variation was considered.
•
More targeted active transport projects could be more economically efficient.
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Detailed government statistical reporting would support benefit value calculation.

Abstract:

Introduction

Economic valuation of the health benefits of active transport modes (such as walking and cycling) is an important means of incentivising changes in transport and land-use policy that better support human health. However, existing valuation methods do not adequately examine how these benefits might vary within a population. Using data from New Zealand, we investigate the extent to which active transport health benefit valuations vary by age and ethnicity.

Methods

We extended a health benefit valuation method used by the New Zealand Transport Agency (NZTA) to value the health benefits of walking and cycling, stratified by age and ethnicity.

Results

Walking was estimated to have a health benefit of $1.00 per kilometre (New Zealand dollars) for those aged 15–64 years but a benefit of $5.79/km for those aged 65–74 years old. For cycling the health benefits were $0.50/km and $2.90/km respectively. Among people aged 15–64 years, the health benefits of walking were $1.75/km for Māori (New Zealand's indigenous people) and $0.88/km for non-Māori. The equivalent values for cycling were $0.87/km and $0.44/km respectively. There was a greater difference in health benefit by age for Māori ($1.75/km vs $15.12/km of walking for the 15–64 and 65–74 age groups respectively) than for non-Māori ($0.88/km vs $5.11/km of walking for the 15–64 and 65–74 age groups respectively).

Conclusions

The estimated health benefits of active transport are not evenly distributed within the New Zealand population but vary by age and ethnicity. Improvements to the efficiency and equity of active transport investment could potentially be made by taking account of variations in health status within the population.

Introduction

It is well-established that higher levels of physical activity are associated with reduced incidence of many non-communicable diseases (NCDs). These include cardiovascular disease (Boone-Heinonen et al., 2009, Celis-Morales et al., 2017), some cancers (Celis-Morales et al., 2017) and type 2 diabetes (Jeon et al., 2007) as well as a reduction in all-cause mortality (Leitzmann et al., 2007; Andersen et al., 2000). Regular walking and cycling offer the opportunity to integrate physical activity into daily life. Regular use of active transport for travel to work has been associated with health gains including reduced body mass index (Martin et al., 2015) and lower mortality (Andersen et al., 2000). The financial benefit of active transport's protective effect on health has also been recognised (Cavill et al., 2008; Boarnet et al., 2008; Sælensminde, 2004) and tools for transport planners to estimate the magnitude of health benefits have been developed by the World Health Organization (WHO) (Kahlmeier et al., 2017) as well as several national governments (Transport Analysis Guidance Unit, 2010; Genter et al., 2008). These tools are important for quantitatively representing the health benefits of active transport infrastructure in the cost-benefit calculations that are frequently used to prioritise projects. As such, health benefit valuations represent an important avenue for the advancement of the public health goal of ‘health in all policies’ (Ollila, 2011).

NCD rates increase steeply with age, and can also vary substantially by ethnicity. For example, in New Zealand, cardiovascular mortality rates in 2001–4 for Māori (indigenous New Zealanders) were 61, 605 and 1910 per 100,000 for the age groups 25–44, 45–64 and 65–74, respectively. The overall cardiovascular mortality rate for Māori aged 1–74 was 250 per 100,000, but the rate for the European/Other group was only one-third as high, at 83.7 per 100,000 (Blakely et al., 2007). Consideration of Māori health status is especially important from a policy perspective given the special status of Māori under Te Tiriti o Waitangi (a treaty that is widely seen as New Zealand's founding document) and the widely acknowledged and inequitable disparities in health outcomes and life expectancy between Māori and non-Māori (Ministry of Health, 2015).

These differences in mortality rates suggest that the benefits of physical activity, and therefore active transport, could be much greater in some age and ethnic groups than others. If the size of the health benefit varies by age and ethnicity, an equity-focused approach would also take account of differences in monetary valuations of health benefits by age and ethnicity.

Some published analyses do allow for variations by age or ethnicity. The WHO HEAT tool for estimating the health economic benefits of transport projects allows for stratification by age (Kahlmeier et al., 2017), and a review of health economic analyses identified two reports that allowed for age variations (Cavill et al., 2008). In addition, Lindsay et al. calculated monetary valuations of distance travelled by cycling that were ethnicity-specific (Lindsay et al., 2011). The norm, however, is to use non-stratified approaches (Cavill et al., 2008). We are not aware of any analyses investigating variations by age and ethnicity within the same population.

Using data from New Zealand, a country with an average life expectancy at birth of 83.2 years for females and 79.5 years for males (Statistics New Zealand, 2015), we examine the extent to which health benefits from active transport are likely to vary by age and ethnicity, and the implications of those variations for health economic valuation of transport projects.

Section snippets

Material and methods

The New Zealand Transport Agency (NZTA) has developed a health benefit valuation framework used for cycling and walking infrastructure projects. The health benefit valuations contribute to a Benefit Cost Ratio (BCR) which is one of the inputs into decisions on whether a project will be built. This health valuation method is published in the NZTA Economic Evaluation Manual (New Zealand Transport Agency, 2018), which is considered the industry standard for economic evaluation for the New Zealand

Results

Our analyses identified higher estimated health benefit valuations from active travel for Māori compared with non-Māori (Table 1). This applied to walking among 15–64 year olds ($1.75/km for Māori and $0.88/km for non-Māori) and 65–74 age group ($15.12/km and $5.11/km respectively). Similar patterns were seen for cycling in the 15–64 age group ($0.87/km and $0.44/km) and 65–74 age group ($7.56/km and $2.56/km).

There was also a higher health benefit valuation for the 65–74 population than the

Methods

In this study, we explored how stratification by age and ethnicity affected the economic valuation of health benefits, by adapting the methodology used by a national transport agency. Aside from this stratification, we did not attempt to make further improvements to that model, as that was beyond the scope of our study. However, we did note several important methodological limitations to be taken into account.

The availability and precision of national statistical data by population sub-groups

Conclusion

This study demonstrates the potential differences in health benefits attributable to active transport use between different ethnic and age groups by adapting a current health economic valuation method.

Current health benefit methodologies may be allocating scarce active transport infrastructure expenditure away from the groups that would benefit most. Health benefit valuations that are specific to key ethnic and age groups (and other axes of variation) could lead to transport investment

Funding

This work was supported by a University of Auckland Summer Research Scholarship. The Authors did not receive any other specific funding for this work.

Declaration of competing interest

The authors have no relevant interests to declare.

Acknowledgements

None.

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View full text

Variations in the health benefit valuations of active transport modes by age and ethnicity: A case study from New Zealand

Highlights

Abstract:

Introduction

Methods

Results

Conclusions

Introduction

Section snippets

Material and methods

Results

Methods

Conclusion

Funding

Declaration of competing interest

Acknowledgements

Lancet

Transport Pol.

Aust. N. Z. J. Publ. Health

Transport. Res. Pol. Pract.

J. Transp. Health

Walking for prevention of cardiovascular disease in men and women: a systematic review of observational studies

Obes. Rev.

All-cause mortality associated with physical activity during leisure time, work, sports, and cycling to work

Arch. Intern. Med.

Tracking Disparity: Trends in Ethnic and Socioeconomic Inequalities in Mortality, 1981-2004

Walking, urban design, and health: toward a cost-benefit analysis framework

J. Plann. Educ. Res.

Association between active commuting and incident cardiovascular disease, cancer, and mortality: prospective cohort study

BMJ

Recommended Values for Active Mode Health Benefits (Ref: B1074157) [Unpublished File Note]

Valuing the Health Benefits of Active Transport Modes

Physical activity of moderate intensity and risk of type 2 diabetes: a systematic review

Diabetes Care

Health Economic Assessment Tool (HEAT) for Walking and for Cycling. Methods and User Guide on Physical Activity, Air Pollution, Injuries and Carbon Impact Assessments (2017)

Physical activity recommendations and decreased risk of mortality

Arch. Intern. Med.