Valuing the health benefits of transport schemesGuidance for London
2 Valuingthehealthbenefitsoftransportschemes 3
Contents
4 Introduction8 –HEATandSARTaglance
11 Health Economic Assessment Tool (HEAT) 12 –HEATataglance14 –WhenshouldHEATnotbeused?16 –UsingtheHEATtool18 –HEATinputdata22 –HEAT–step-by-step36 –ReportingHEAToutputs38 –HowdoesHEATwork?43 –HEATcalculationexample44 –HEATinpractice–RoyalCollegeStreet
49 Sickness Absence Reduction Tool (SART)50 –SARTataglance52 –WhenshouldSARTnotbeused?54 –HowdoesSARTwork?56 –UsingtheSARTtool58 –SARTinputdata62 –ReportingSARTresults64 –SARTinpractice–RoyalCollegeStreet
67 Frequently asked questions 74 –Moreusefulinformation74 –HEATinputdatatemplate
Valuingthehealthbenefitsoftransportschemes 54 Introduction
Introduction
What is this guide for?
Thisguidewillhelpyoutomonetisethehealthbenefitsofschemesthatincreaseactivetravelusingtwotools:
• TheWorldHealthOrganization(WHO)HealthEconomicAssessmentToolforwalkingandcycling(HEAT)
• TheSicknessAbsenceReductionTool(SART)
Theguideincludesdetailson:
• Whatthetoolsare
• Whentousethetools
• Howtousethetools
• Examplesofthetoolsinaction
• Rulesofthumbforselectingyourinputdata
• Defendingtheresultsthatarisefromthe tools
• Howthetoolswork
Who should use this guide?Thisguideisaimedatanyoneinvolvedintheplanning,advocacyorassessmentoftransportschemes–TransportforLondon(TfL)staffandcontractors,localauthorityofficers,electedmembersorvoluntaryorganisations.Itshouldbeusefulforbothhealthandtransportplanners.
Context
Why is it important to monetise health benefits?Roadandpublicrealmschemesareincreasinglyfocusedonimprovingaccessandqualityoflife.However,transportbusinesscaseshavetraditionallyfocusedonthemovementofmotorvehicles,withmostbenefitsarisingfromjourneytimesavings.
Businesscasescanbestrengthenedbycapturingthewiderbenefitsofschemes.Themonetisedhealthbenefitsofsomepublictransportandpublicrealmschemescanbesubstantialandcanmakeasignificantcontributiontoapositivebenefittocostratio.ThisguideaimstosupportpractitionersinLondontoachievethis.
The main links between transport and health in London
are the main ways that Londoners keep active
+How is transport linked to health?Buildingactivityintopeople’severydaylivesisoneofthebiggestimpactsoftransporton health.LackofphysicalactivityiscurrentlyoneofthebiggestthreatstothehealthofLondoners.Beingphysicallyactivehelpspreventarangeofillnessesincludingheartdiseaseandstrokes,depression,type2diabetes,andbreastandcoloncancer.MostLondonersarecurrentlynotactiveenoughtostayhealthy.ItisestimatedthatintheCapital,42percentofadultsarenotachievingminimumlevelsofphysicalactivity.Adultsarerecommendedtospendaminimumof150minutesaweekdoingmoderatephysicalactivitytokeephealthy.Thisisequivalenttojustthree10-minute
walksfivedaysaweek.Evenmoreworryingisthatathirdofadultsarenotevenachieving30minutesactivityperweek.ActivetravelisthemainwayinwhichLondonersgettheirphysicalactivityandithasthebiggestpotentialforincreasingphysicalactivity.Itisestimatedthat60,000yearsofhealthylifecouldbegainedeveryyearifLondonersswapmotorisedtravelforactivetravelonshortjourneys.TheTfLhealthactionplanImprovingthehealthofLondonersclearlyoutlinestheimportanceofphysicallyactivetransporttohealthintheCapital.Thedocumentalsosetsoutotherlinksbetweentransportandhealth,includingairquality,roadtrafficcollisionsand accessibility.
Physical inactivity
Obesity
Lung disease
Mental health
Social isolation
Community breakdown
Injuries
Child development
Cancer
Heart disease
Diabetes
Air pollution Road traffic collisions
Poor accessibility
Valuingthehealthbenefitsoftransportschemes 76 Introduction
Which health outcomes can be monetised?Intheory,itwouldbepossibletomonetiseanyofthehealthimpactsarisingfromthelinksbetweentransportandhealth(physicalactivity,airquality,roadtrafficcollisions,pooraccess,noise).Outcomesthatcouldbemonetisedmightincluderiskofdeath,illnesscosts,healthcarecostsandproductivity.
However,currentlyonlyfourtoolsexisttomonetisethehealthbenefitsoftransportschemes.Twoofthesemonetisethehealthbenefitsfromincreasingphysicalactivitylevelsandtheothertwolookatthebenefitsofreducingroadtrafficinjuries.
AllareincludedintheDepartmentforTransport’s(DfT’s)Transportanalysisguidance(WebTAG)andtheTfLBusinessCaseDevelopmentManual(BCDM).
Thisguideexplainshowtousethetwotoolsrelatedtophysicalactivity–HEATandSART.
What tools monetise the health benefits from increased physical activity?Currently,twotoolsexisttomonetisetheimpactoftransportonphysicalactivity.BothtoolsarerecommendedinDfT’sTransportanalysisguidance(WebTAG)andtheTfLBusinessCaseDevelopmentManual(BCDM).Theyarethemostdevelopedandevidence-basedtoolsavailableforestimatingtheeconomicvalueofthehealthbenefitsofactivetravel.Theoutputsareimportantbecausetheyhelptoshowdecision-makersthevalueofmoneyspent.
Thesetoolsare:
• WHOHealthEconomicAssessmentToolforwalkingandcycling(HEAT)
• SicknessAbsenceReductionTool(SART)
What other tools are in development?Toolstomonetisetheimpactofincreasedphysicalactivityonillnessandhealthcarecostsareindevelopment.
Can we still include the other health benefits in business cases even if no tool exists to monetise them?Evenwhenhealthbenefitscannotbegivenaneconomicvaluetheyshouldstillbedescribedinbusinesscasestohelpmakeacomprehensivecaseforinvestment.
Forexample,youmightconsiderincludingnarrativeon:
• Improvementsinlong-termconditionsandmentalhealthrelatedtoactivetravel
• Reductionsinthedamagingeffectsofnoise,airpollutionandgreenhousegasemissionsfrommotorisedtraffic
• Reducingsocialisolationandstressthroughbetterconnectivity
TheTfLhealthactionplanImprovingthehealthofLondonersincludessummariesofrelevanthealthevidenceforyoutoincludeinbusinesscases.
How to increase active travel in a population
Thefollowingevidence-basedapproachesaretakenfromtheNationalInstituteforHealthandCareExcellence(NICE)guidelines–thegoldstandardnationalguidelinesonhealthandhealthcarebestpractice:
• Ensurepedestriansandcyclistsaregiventhehighestprioritywhendevelopingormaintainingstreetsandroads:reallocateroadspacetosupportactivetravelandrestrictmotorisedtransportaccessandspeed
• Planandprovideacomprehensivenetworkofroutesforwalkingandcycling.Theseroutesshouldoffereveryoneconvenient,safeandattractiveaccesstoworkplaces,homes,schoolsandotherpublicfacilities
HEAT Monetisesthebenefitfromthedeathspreventedinthepopulationasaresultofincreasesinphysicalactivity.
SART Monetisesthebenefitsfromlowerlevelsofsicknessabsencefromworkasaresultofincreasesinphysicalactivity.
Valuingthehealthbenefitsoftransportschemes 98 Introduction
HEATandSARTataglance
HEAT SARTWhatoutcomedoesthetoolmonetise?
Deathspreventedinthepopulationasaresultofincreasesinphysicalactivity.
Lowerlevelsofsicknessabsencefromworkasaresultofincreasesinphysicalactivity.
DoestheDfTorTfLendorsethetool?
YES–bothtoolsarerecommendedintheDfT’sTransportanalysisguidance(WebTAG)andtheTfLBusinessCaseDevelopmentManual(BCDM).
Howgoodistheunderlyingevidence?
Thetoolsarethemostdevelopedandevidence-basedavailableforestimatingtheeconomicvalueofthehealthbenefitsofactivetravel.
Whodevelopedthetools? WHO TfLArethereanylimitations onwhenIcan usethetool?
Cannotbeusedfor:
• One-offevents
• Calculatinghealthbenefitstoindividuals
• Schemesthatonlyaffectchildren
• Schemesthatonlyaffectpeoplewhoarealreadyveryfit
Cannotbeusedfor:
• Schemesthatonlyaffectpeoplewhoarenotinpaidemployment
• Schemesthatonlyaffectchildren
CanIuseitforwalkingandcycling?
YES–youjusthavetorunthetooltwice.
YES
Isthetoolcomputerised? YES–availablethroughtheWHOwebsite.
NO–thetoolissosimple;youcandoityourselfwithacalculator.
CanIusethesameinputdataforHEATandSART?
YES–TheinputdataforHEATandSARTisavailablefromexactlythesamedatacollectionmethods(egroadsidecounts,surveys,modelling).Thisisabenefitofusingbothtoolsatthesametime.
CantheoutputsofHEATandSARTbecombined?
YES–HEATandSARTvaluedifferenthealthbenefitsresultingfromwalkingandcycling.Thetwotoolscanbeusedtogetherwithnoriskofdoublecountingthebenefits.
In which situations can I use the tools?YoucanuseHEATandSARTinavarietyof scenarios:
How do I use the output from the tools?Theoutcomesofthesetwotoolsmaybeaddedtothebenefitcostratio(BCR)ofascheme,whichistheamountofbenefitexpectedtobeproducedcomparedtothecostofimplementingthescheme.
BCR =Totalmonetisedbenefit
Totalcostofscheme
1.Retrospectively–tovaluethehealthbenefits ofincreasedwalkingorcyclingafter aproject(egbenefitsrealisationaftercompletionofaproject)
2.Benefitsrightnow–tovaluethehealthbenefitsofallwalkingorcyclinginanarea rightnow
3. Prospectively–tovaluepredictedhealthbenefitsofplannedprojects(egoptionsappraisalforbusinesscase)
Improving the health of Londoners Transport action plan
Improving the health of Londoners: Transport action plan
Valuingthehealthbenefitsoftransportschemes 1110 HEAT
HealthEconomicAssessmentTool(HEAT)
12 HEAT at a glance
14 When should HEAT not be used?
16 Using the HEAT tool
18 HEAT input data
22 HEAT – step-by-step
22Stage1–enterdataforyourscheme
32Stage2–selectthestandardstatisticaldatatouseinyourcalculation
34Stage3–results
36 Reporting HEAT outputs
38 How does HEAT work?
43 HEAT calculation example
44 HEAT in practice – Royal College Street
Valuingthehealthbenefitsoftransportschemes 13
HEATataglance
12 HEAT
What is HEAT?
HEATisatooldevelopedbyWHOtovaluethedeathspreventedasaresultofincreasedlevelsofcyclingorwalking.HEATstandsforHealthEconomicAssessmentTool.
Tousethetoolandreadauserguide,gotoheatwalkingcycling.org
Why do we use HEAT?
WeuseHEATbecause:
• HEAThasbeenapprovedbytheDfTandTfL.ItisincludedintheDfT’sTransport analysisguidance(WebTAG)andtheTfLBusinessCaseDevelopmentManual(BCDM)
• Thereisastrongevidencebasefortheeffectsofcyclingandwalkingonhealth.This ensuresHEAToutputfiguresarereliableandrobust
• OutputfiguresfromHEATareoftenlarge.ThismeanstheycanmakeasignificantpositivecontributiontoaBCRforascheme
• HEATisverystraightforwardandsimpleto use
What input data is needed?
Thereisadatatemplatetohelpyougatherallthenecessaryinputdatabeforeyouaccessthe HEATwebsite.SeeHEATinputdatatemplatesection.
Insummary,HEATasksfor:
Dataaboutyourscheme(yousupplythis):
• Typeofscheme(iebefore/afterorsinglepointintime)
• Realorprojecteddataforchangesinwalkingandcyclingforyourscheme:
– Numberofpeoplewalkingandcycling – Averageamountoftimespentwalkingandcycling
• Someassumptionsaboutyourdata
Standardstatisticaldata(youselectthesefromdrop-downmenustomakethecalculationrelevanttoaUKcontext):
• UKmortalityrate
• Valueofstatisticallife
• Discountingrate
SeeHEATinputdatasectionformoredetailonhowtoensurehigh-qualityinputdata.
What is the output?
HEATcalculates:
• Thenumberofdeathsperyearpreventedasaresultofascheme
• Themonetisedvalueofthischange
Valuingthehealthbenefitsoftransportschemes 1514 HEAT
WhenshouldHEATnotbeused?
ItisnotalwaysappropriatetousetheHEATtool.Thetoolcannotbeusedfor:
Situation Example Whycan’tyouuseHEAT?One-offevents Monetisingthe
healthbenefitsfromtheLondonSkyRide
HEATmeasuresthebenefitsofregularphysicalactivityoveraprolongedperiod.
Thetoolcannotbeappliedtoaone-offeventbecauseyoucannotassumethatallofthepeoplewhotakepartintheeventwillcontinuetowalk/cycleregularlyafterwards.
Individuals Monetisingthehealthbenefitthatsomeonewouldgetfromwalking/cyclingtoworkeveryday
HEATisbasedonevidencefromstudiesthatgathereddatafromthousandsofpeople.Thereductioninriskofdeathfromregularphysicalactivityvariesfrompersontoperson.HEATusestheaveragenumberofdeathspreventedacrossthelargestudypopulation.
SotheoutputfromaHEATcalculationwillnotbeaccurateforjustoneindividual.Generallyspeaking,thelargerthepopulationthatyouuseforyourcalculation,themoreaccuratetheresultswillbe.
Children Monetisingthehealthbenefitstochildrenfromawalktoschool project
Theevidencefortheeffectsofphysicalactivityonriskofdeathinchildreniscurrentlyinsufficientasmoststudieshavebeenconductedinadults.Wealsoknowthatfewerdeathsoccurinchildren,meaningtheriskofdeathfiguresusedinHEATdonotapplytothem.
Ifyourschemetargetschildrenbutmightalsohaveimpactsonadults(egadultstakingchildrentoschool),youcanruntheHEATtoolfortheimpactsonadultsonly.Describethebenefitstochildreninyouraccompanying narrative.
Peoplewhodoalotofexercise
Monetisingthehealthbenefitsfromaschemethattargetsprofessionalcyclists
HEATusesdatafromstudiesofpopulationswitharangeofphysicalactivitylevels.Peopledoinglittleexercisegainthelargesthealthbenefitsfromevensmallincreasesinactivity.Conversely,peoplewhoareveryactivealreadygainmuchsmallerhealthbenefitsfromincreasingphysicalactivitylevels.
HEATisnotappropriateforschemesthattargetpeoplealreadydoingmorethantwohoursofwalking/cyclingeachday.WeknowthatphysicalactivitylevelsinLondonarelowsothisisunlikelytobeaproblemifyouareapplyingthetooltoschemesforthegeneralpopulation.
Valuingthehealthbenefitsoftransportschemes 1716 HEAT
UsingtheHEATtool
How do I find the tool online?
• ThetoolislocatedontheWHOwebsite.Gotoheatwalkingcycling.org
Thewebsiteisveryeasytouse,particularlyifyougatherallyourinputdatatogetherbeforeyoustart.UsetheHEATinputdatatemplatesectiontogatherallyourinputdatainoneplacebeforestartingonline.
How long will it take to run the tool?
Thetooliseasytouseandtakesabout10minutestorunifyouhavegatheredallyourinputdatabeforeyoustart.
Itisgoodpracticetorunthetoolseveraltimesinordertotestyourassumptions(sensitivitytesting)andseehowsmallchangesinyourinputdatacanaffecttheoutputs.Thiswillmakeiteasiertodefendyourresults.
• Before/afterorasinglepointintime
• Selectthetypeofdatayoucollected
• Addsomeassumptionsaboutyourdata
• UKmortalityrate
• Valueofstatisticallife
• Discountingrate
• Deathsperyearpreventedasaresultofthescheme
• Monetisedvalueofthischangeinmortality
The three stages of the HEAT tool:
What are the stages of the HEAT tool?
Onthewebsite,youareguidedthroughaseriesofquestions,eachaskingforyourinputdataoraskingyoutoselectfromdrop-downmenus.Tohelpyouknowwhattoexpect,wehavedividedtheprocesshereintothreebasic stages.
Tips for using the HEAT website Useful links within the websiteOntheleftsideofthehomepage,thereisamenubarwithlinksto:
• Freeonlinetraining
• Auserguide
• Howtoselectwhethertorunthetoolforcyclingorwalking
Run the tool for either cycling or walking• Heatmonetisesthebenefitsfrombothwalkingandcycling,howeveritcannotcalculatewalkingandcyclingbenefitsatthesametime.Ifyourschemeaffectsbothwalkingandcycling,runthetooltwiceandaddyourmonetisedbenefitstogetherafterwards
Top tips• HEATgivesyoutipsasyougoalong.Lookintheboxontherightsideofthe screen
1. Enterdataforyourscheme 2.
Selectthestandardstatisticaldatatouseinthe calculation
3.Results
Valuingthehealthbenefitsoftransportschemes 1918 HEAT
HEATinputdataforstage1
HEATasksfordataaboutyourschemeaswellasaskingyoutoselecttheappropriatestandardstatisticaldatatomakethecalculationrelevanttoaUKcontext.
What data about my scheme does HEAT require?
HEATneedstwokeypiecesofresultsdatafromyourschemeforitscalculation:
Keyresultdata HowdoIcollectthisdata?
Numberofpeoplewalkingorcycling
• Roadsidecounts
• Populationsurveys
• Modelling/estimates
Averageamountoftimespentcycling/walkingperperson
• Routeusersurveys
• Modelling/estimates
• Roadsidecounts*
*Ifyourresultsarenotcollectedasanaveragetimespentwalking/cycling,HEATisabletocalculatethiskeyinformationusingeithertripcounts(providingyouenteradistanceforthetrip)oraveragedistancecycled(generallyfromsurveydata).
HEATassumesanaveragespeedof14km/hourforcyclingand4.8km/hourforwalking.Thetoolappliesthisspeedtoyourtripcountordistancedatatogetanaveragetimespentwalking/cycling.
HEATalsoasksforsomeassumptionsaboutyourdata.Whatthesearedependsonwhatdatacollectionmethodyouused.Forexampleitmightask:
• Doyouknowthenumberofpeoplewhotakecyclingtrips,ordoyouwishtoestimatethenumberofcyclistsbasedontheproportionofreturnjourneysofalltripsobserved?
• Whatproportionoftripsarereturnjourneys?
• Howmanydaysperyeardopeoplecycle?
• Howmanypeoplebenefit?
• Whatistheaveragetripdurationordistance?
• Whatisthetimeneededtoreachthefulllevelofcycling?
• Whatisthetimeperiodoverwhichbenefitsarecalculated?
• Whatproportionofcyclingdataisattributabletoyourintervention?
FortipsonhowtoanswerthesequestionsseeHEAT–step-by-stepsection.
What are the most common ways to obtain input data for HEAT?
How confident should I be of my input data?
Counts
Pedestrianorcyclecountsmeasurethenumberofpeopleusingaparticularroute.Thesecanbeautomaticcountsusingroadsidesensorsormanualcounts(whichtendtobemoreaccuratebutcostmore).
Route user surveys
Thesesurveyscanprovideinformationon:
• Theaverageamountofwalkingorcyclingdonebyusersofaparticular route
• Theaveragedistancewalked/cycled
• Theproportionoftripsthatarepartofareturnjourney
• Theagerangeofusers
• Previouslevelsofactivetravelandphysicalactivity
• Modeshift
• Routeshift
Population surveys
Thesecouldbebasedonarepresentativesampleofthepopulationoracensusofthewholepopulation.TfL’sLondonTravelDemandSurvey(LTDS)isagoodexample.
Modelled estimates
Ifyouwanttomonetisefuturehealthbenefitsfromaplannedinvestment,youwillneedtoestimatetheexpectedupliftinthenumberofpeoplewalkingorcyclingthatmightresult.
Thiscanbemodelledusingspecificsoftware.ThereisexpertisewithinTfLandsomelocalauthoritiestosupportthis.
Alternatively,youmaybeabletoestimateupliftbasedonchangestowalking/cyclinglevelsinpreviousschemesthataresimilar.
Counts
Youwillbeveryconfidentaboutsomeofyourinputdata(egtripcountfigures)butHEATwillalsoaskyoutomakesomeassumptionsaboutvariousaspectsofit.Wherepossible,wehaveprovidedrulesofthumbfortheseestimatesbasedonTfLdata.Youmayalsobeabletobaseyourassumptionsonsimilarschemes.
Itisimportanttorecordhowyoucametoanyassumptionssoyoucanjustifyyourresultsinthefinalbusinesscaseorreport.
Valuingthehealthbenefitsoftransportschemes 2120 HEAT
HEATinputdataforstage2
What standard statistical data does HEAT use?HEATasksyoutoselectUKvaluesforthreestandardstatisticalinputdatafromdrop-downmenus.ThisallowsHEATtomakeitscalculationbasedonaUKcontext.
Crude mortality rateCrudemortalityrateisalsocalledthedeathrate.Thisisthenumberofdeathsthatareexpectedtooccurinagivenpopulationwithinoneyear.
HEATusesage-specificcrudedeathratestakenfromtheWHOdatabase.Therateis‘age-specific’becausethetooldoesnotincludechildrenorolderpeople.HEATusesdifferentagecut-offsforwalkingandcyclingbecausethetoolassumesthatpeoplearemorelikelytocontinuetowalkatolderagesthantocycle:
• Forwalking,HEATuses20to74-year-olds(iecrudeUKmortalityrate=434deaths/100,000people)
• Forcycling,HEATuses20to64-year-olds(iecrudeUKmortalityrate=249deaths/100,000people)
UsetheUKcrudemortalityratewhichiseasilyselectedfromadrop-downmenu.HEATautomaticallyadjuststheagerangedependingonwhetheryouarerunningthetoolforwalkingorcycling.
Value of statistical life (VSL)Thevalueofstatisticallife(VSL)isthemonetaryvaluegiventoadeathbystatisticians.Thisallowsustovaluethedeathswepreventinmonetaryterms.HEATusesaVSLfigurefortheUKof£3,229,114.
VSLhasbeenusedovermanyyearsbytransportplanners.Itiscalculatedbasedon
studiesthataskwhatpeoplewouldbewillingtopayforsmallreductionsintheriskofdeathinapopulationeachyear.
TheHEATfigureforVSLisdifferenttothefigureusedinroadtrafficinjurycalculations.However,thisvalueisendorsedbothbytheDfTandTfLforHEATcalculations.TheHEATvaluecomesfromalargeevidencereviewbytheOrganisationforEconomicCo-operationandDevelopment(OECD).Thereviewincludedstudiesfromaroundtheworldandderivescountry-specificfiguresforVSLbasedonincomelevels.
Discounting rateDiscountingisanadjustmentmadebyeconomiststoaccountforthefactthatpeoplegenerallyvaluebenefitsreceivedatthepresenttimehigherthantheyvaluethesamebenefitsreceivedinthefuture.
Anyfuturecostsorbenefitsrelatedtoaschemeorprojectneedtobereducedtoreflectthis.Thediscountingrateistheannualpercentagereductioninvaluethatappliestofuturecostsandbenefitsforeachyearthat passes.
In2003theUKTreasurysetanewdiscountratetobeappliedtothepublicsectorof3.5percent.ThisfigurecontinuestoberecommendedintheTfLBusinessCaseDevelopmentManual.ThisvaluecanbeenteredmanuallyintoyourHEATcalculation.
IfyouareusingTfL’sBusinessCaseAssistant(BCA)tool,enteradiscountrateofzero.TheBCAtoolappliesadiscountingratetoyourwholebusinesscasesoyouwillwanttoavoiddiscountinghealthbenefitstwice.
Tips for getting the most out of HEAT
Look for multiple impacts of a single schemeAlwaysconsiderifyourschemehasanimpactonbothwalkingandcyclinglevels.Schemesthattargetcyclingcanalsohaveanimpactonwalkinglevelsbyimprovingtheattractivenessofastreet,reducingtrafficflowetc.
Youcanincreasethehealthbenefitsmonetisedbyrunningthetooltwicetocapturebenefitsfromincreasedwalkingaswellascycling.
Conduct sensitivity testingManyinputsusedforHEATrelyonassumptionsandestimates.Tryrunningthetoolwithyourleastandmostoptimisticestimatesofyourinputdatatoseehowtheyaffectyouroutputs.Thiswillallowyoutomakebetterinformeddecisions.
Explainwhatyouhavedoneinyourbusinesscaseorreporttohelpjustifyyourresults.
Consider other impacts on cycling/walkingRememberthatcyclingandwalkinglevelsareinfluencedbythetimeofyearandbytheweatheronaparticularday.Ideally,countsshouldbetakenoveraperiodofseveralweeksandonlycomparedagainstthesametimeofyear.
Validate your count dataAutomaticcountersaregoodforcollectingdataonwalkingorcyclingoveralongperiodoftimebuttheymaynotbe100percentreliable.Ashortperiodofmanualcountingtocompareforaccuracyaddweighttoyourdata.
Valuingthehealthbenefitsoftransportschemes 2322 HEAT
HEAT–step-by-stepStage1–enterdataforyourscheme
WithinthefirststageofHEAT,youenterdataonyourschemeandareaskedtomakeassumptionsaboutit.Thissectionoftheguidegoesthrougheachquestionasked,givingrulesofthumbtohelpyoumakerobustassumptionsaboutyourdata.
ThisflowchartsetsoutthequestionsthatyouwillbeaskedbyHEAT,dependingonwhetheryourdataisfromasinglepointintimeorbefore/after.Youwillnoticethatthequestionsaskedaboutyourdataareexactlythesameforbothapproaches;youarejustaskedtwiceifchoosingbefore/after.
Flow chart of HEAT questions in Stage 1– enter data for your scheme
Q: Is your data from a single point in time or before/after?
Go to Stage 2 – Select the standard data to use in calculation
Q: Proportion of walking data attributable to your intervention?
Q: Time needed to reach full level of walking?
Q: What type of data did you collect?• Duration• Distance• Steps• Trips
Q: How many people benefit?Enter data
Review entered data
Single point in time
Before/after
Review entered data
Review entered data
Enter data
Enter data
Q: How many people benefit?
Q: How many people benefit?
Q: What type of pre-intervention data did you collect?• Duration• Distance• Steps• Trips
Q: What type of post-intervention data did you collect?• Duration• Distance• Steps• Trips
Stage 1– enter data for your scheme Stage 2 – selectthestandardstatisticaldatato useinyourcalculation Stage 3 – results
Valuingthehealthbenefitsoftransportschemes 2524 HEAT
HEAT–step-by-step
Initial questions
Is your data from a single point in time or before/after?HEATstartsbyaskingyouwhetheryourdataisfromasinglepointintimeorbefore/after.This determineswhetheryouthenneedtoenteroneortwosetsofwalking/cyclingdata.
1.Singlepointintime:ifyouarejustassessingthehealthbenefitscurrentlybeingdeliveredbyagivenlevelofwalkinginLondon,thenyouclick‘singlepointintime’.Youwillonlyneedtoenteronesetofwalking/cyclingdata
2.Before/after:ifyouareevaluatingtheresultofanintervention,oraretryingtoestimatetheimpactofaproposedscheme,youwillhave‘before’and‘after’data.Youwillneedtoentertwosetsofwalkingandcyclingdata
What type of data did you collect?Thisquestionwillbeaskedseparatelyforbothpreandpost-interventiondata.Youwillbegiventheoptiontoselectfrom:
1.Duration(mostlikelytobeavailablefromsurveydata)
2.Distance(mostlikelytobeavailablefromsurveydata)
3.Trips(mostlikelytobeavailablefromcycleorpedestriancountdata)
HEATwillaskdifferentquestionsafterthis pointdependingonthetypeofdatayou select.
What are all these questions about?HEATistryingtofindoutfromyouhowmanyminutesarespentbeingphysicallyactivebyhowmanypeople.Thisistheinformationneededtocalculatethehealthbenefit.
IfyoucanestimatethesetwonumbersandinputthisinformationdirectlyintoHEAT,youwilltakethemostdirectroutethroughthetoolandbeaskedfewerquestions.
Ifyoudonothavethenumbers,HEATwillaskyouseveralquestionstotrytomakeanestimatefromthedatathatyoudohave,takingyouonalongerroutethroughthetool.
How could you obtain the number of walkers/cyclists?• Routeusersurvey–askhowoftencyclistsusetheroute
• Populationsurvey(egLTDS)
• Estimatethenumberofreturnjourneysandapplythistoyourcycle counts
Entering your data
Youarenowaskedtoenteryourdata.Thequestionswillvarydependingonwhetheryouselectedduration,distanceortripsintheprecedingquestion.
Trips: average number of trips per person, or total number of trips?Youwillbegiventheoptiontoselectfrom:
1.Averageperadult
2.Totalnumberoftripsobserved
Youmayknowtheaveragenumberoftripsperpersonfromsurveydata.Ifyouonlyhaveatripscount,youmustchoose‘totalnumberoftripsobserved’.
Total number of trips?Enteratotalnumberoftripsbyaddingupnorthboundandsouthboundtripcounts.
What proportion of these are walking/cycling trips?Enterapercentage.Thiswillalwaysbe100percentifyouhaveusedpurepedestrianorpurecyclecounts.
Doyouknowthenumberofpeoplewhotakewalking/cyclingtrips,ordoyouwishtoestimatethenumberofcyclists/walkersbasedontheproportionofreturnjourneysoutofalltripsobserved?
Youwillbegiventheoptiontoselectfrom:
• Enterthenumberofindividuals walking/cycling
• Estimatethisbasedonreturnjourneys
HEATasksthisquestionbecauseitwantstoknowhowmanypeoplearewalkingandcycling.Whenahigherproportionofyourtripcountsarereturnjourneys,thisrepresentsfewerpeoplewalking/cyclingandwillreducetheoverallsizeofthehealthbenefit.
Youmaybeabletoobtaintheapproximatenumberofwalkers/cyclistsbyconductingarouteusersurveyorbyusingdatafrompopulationsurveyssuchastheLondonTravelDemandSurvey(LTDS).Withoutsurveydata,youcanestimatethenumberofwalkers/cyclistsbyestimatingtheproportionofreturnjourneysandapplyingthistoyourtrip counts.
Stage 1– enter data for your scheme Stage 2 – selectthestandardstatisticaldatato useinyourcalculation Stage 3 – results
Valuingthehealthbenefitsoftransportschemes 2726 HEAT
HEAT–step-by-step
What proportion of trips are return journeys?Enterapercentagehere.Ifyouhavenotcompletedarouteusersurveyyoucanmakeajudgementusingtheaccompanyingdatatables.
How many days per year do people cycle or walk?Enteranumberofdaysperyearthatpeoplecycleorwalk(maximum365).Youwillhavetomakeajudgement.
Estimating the number of days per year that people walk/cycle• Thinkaboutyourtargetpopulation.If youlookattheaccompanyingdata tablesitshowshowfrequencyofwalkingandcyclingvariesbetween groups
• HEATrecommendsaconservativeestimatethatpeoplecycle124daysperyear(basedonanexamplefrom Sweden)
How many people benefit?Enterthenumberofindividualsdoingtheamountofcyclingorwalkingthatyouenteredinpreviousquestions.
Ifyouareestimatingthenumberofpeoplebasedonreturntrips,thisiswhereyouadjustyourtripcountsaccordingtotheproportionofreturnjourneys.
How to calculate the number of people walking/cycling based on return journeys• Calculatethenumberofreturnwalkers/cyclists
=totaltripsxproportionofreturnjourneys/2
• Calculatethenumberofone-waywalkers/cyclists
=totaltrips–numberofreturnwalkers/cyclistscalculatedabove
• Addthemtogethertogetatotalnumberofwalkers/cyclists
What is the average trip duration or distance?Youwillbegiventheoptiontoselectfrom:
• Duration
• Distance
Youmayhavethedurationfromsurveydata.Otherwise,youcanestimatethedistance.Remember–thetoolisinterestedintheamountoftimepeoplearespendingexercising.Ifyouenterdistancedatathetoolwillconvertthisintodurationtomakeitscalculationsoifyoucan,calculateduration.
Estimating trip distance• Averyconservativeestimatewouldbetousethelengthofthestreetthatweknowtheycycled/walkedalong.ThisiseasytodousingGooglemapsbutitisnotveryrealistic
• Foramorerealisticestimate,workouttheaveragetripdistanceyoucanlookattheaccompanyingdatatableormakesomeassumptionsaboutwherepeoplearetravellingfromandto,using:
– Routeusersurveys
– Thelikelystartandfinishdestinations(egabusinessparkandatrainstation)
Stage 1– enter data for your scheme Stage 2 – selectthestandardstatisticaldatato useinyourcalculation Stage 3 – results
Valuingthehealthbenefitsoftransportschemes 2928 HEAT
HEAT–step-by-step
Extra questions for post-intervention data
Mostofthequestionsonyourpost-interventiondataareidenticaltothepre-interventionquestionsabove.Detailedbelowaretheadditionalquestionsthatyouwillbeaskedforbefore/afterstudies.
Time needed to reach the full level of cycling/walking?Selectatime(inyears)fromadrop-downmenu.Thisquestionisaskingyoutoestimatehowlongitwilltakeforyourschemetoreachfullcapacity.Youwillhavetomakeaninformed guess.
Time period over which benefits are calculated?Selectatime(inyears)fromthedrop-downmenu.Thetimeperiodshouldnotbelongerthanyoubelievetheenteredamountofwalking/cyclingwillbesustained.ThemaximumvaluethatHEATallowsis50years.Thetimeperiodoverwhichsavingsshouldbeexaminedisoftenstandardised;usethestandardforyourorganisation.
HEATcalculatesthetotalvalueofdeathspreventedoverthetimeperiodthatyouenterhere.Thelongerthetimeperiod,thegreaterthetotalmonetisedbenefitcalculated.ItisworthnotingthattheHEATresultspagealsogivestheaverageannualbenefitfromyourscheme(averagingtotalbenefitsoverthenumberofyearsthatyouenterforthisquestion).
Estimating how long it will take until your scheme reaches the full level of walking/cycling• Baseyourestimateondatafromsimilarschemes
• Thinkabout:
- Theprofileofthescheme.High-profileschemestendtohaveshortertimesuntilfulluseoftheinfrastructure,egCycleSuperhighways
- Thetypeofpersontargetedbythescheme.Isthetargetpopulationwellinformed?Willittakealotofpersuasionandinformationtogetthemtoparticipate?
- Thetypeofscheme.Anareawherewalkingandcyclinglevelsarealreadyhighwillhavefasteruptakethanwherethereislittleexistingactivetravel
• Youmaynotknowwhatthe‘fulllevel’willbeinthelong-term.Pickacertainlevelyouareexpectingbyacertainpointintimeandbaseyourresponsesonthatlevel.Youcanalwaysaddtoyournarrativethatthislevelcouldbeexceededanddeliverevenbiggerhealthbenefits
Estimating the time period over which benefits are calculated• Baseyourestimateondatafromsimilarschemes
• Thinkabouthowlongtheinfrastructurewilllast(providingcycling/walkinglevelsaresustainedforthistime)
• Usethestandardvalueforyourorganisation,ifavailable
Stage 1– enter data for your scheme Stage 2 – selectthestandardstatisticaldatato useinyourcalculation Stage 3 – results
Valuingthehealthbenefitsoftransportschemes 3130 HEAT
HEAT–step-by-step
Total number of trips?Thisiseasytoanswerifyouhavepreandpost-interventiondata.However,ifyouarerunningHEATprospectivelytocalculatebenefitsinthefuture,youwillneedtoestimatetheexpectedupliftinwalking/cyclingasaresultofyourscheme.
Estimating the expected uplift in walking for a prospective scheme• Wehavedevelopedaruleofthumbfromlookingatpreviousschemes.Upliftinpedestriancountscanbeestimatedtobelow(fivepercent),medium(15percent)orhigh(25percent),basedonthetypeofchangesthathavebeenmadeaspartofthescheme
Ourreviewofprojectsthathavereportedbaselineandfollow-uppedestriancountsfoundthat:
Schemeswithoneortwofeatures(excludingtheintroductionofanewroutethatdidn’tpreviouslyexist)deliverlowuplift(fivepercent)
Schemesdeliveringmorethantwofeatures(butstillnotincludingtheintroductionofanewroutethatdidn’tpreviouslyexist)delivermediumuplift(15percent)
Schemesthatconsistofanynumberofelementsincludingtheintroductionanewroutethatdidn’tpreviouslyexist,deliverhighuplift(25percent)regardlessofotheradditionalfeatures.
• Thisisthefulllistoffeaturesfromtheseschemes:
- Improvementstovisualappealofthestreet(egtrees,planters,colouredpaving)
- Increasedspacedesignatedforwalking(egwidenedpavementsbutnotanewroute)
- Improvedsecurityoftheroute(egbetterlighting,CCTV)
- Upgradedroutesignage(egLegibleLondonorlocalroutesigns)
- Improvedsurfacesforwalking(egrepaving,installingdroppedcurbs)
- Removingstreetclutterforpedestrians
- Trafficcalmingorrestrictions(egpedestrianisingastreet,reducingspeedlimits,installingspeedbumps,chicane)
- Theintroductionofanewroutethatpreviouslydidn’texist(eganewbridge,subway)
Proportion of cycling/walking data attributable to your intervention?Enterapercentage.Thisiswhereyouadjustfor routeshiftandmodeshift.Routeandmode shiftareonlyrelevanttobefore/afterHEATcalculations.
Routeshift:thisiswhenpeoplewhoarealreadywalking/cyclingswitchtoyourroutebecauseitismoreattractive.Sincetheyarealreadyactiveyouwillnotwanttoincludetheminyourcalculationsasanadditionalhealthbenefitofyourscheme,unlesstheyarespendingagreateramountoftimebeingactive.
Modeshift:thisiswhenpeopleswitchfromonetransportmodetoanother.HEATisinterestedinshiftfromsedentarymodes(egcar/bus/taxi)toactivemodes(egwalking/cycling).Youdonotgetahealthbenefitfrompeopleshiftingfromoneactivemodetoanotherunlesstheyspendmoretimebeingactive.
Estimating the proportion of cycling/walking data attributable to your intervention• Sensitivityanalysisiscriticaltotesttheimpactofdifferentestimatesonyourresults.Thevalueyouenterherehasalargeimpactonthesizeofyourresults
• Baseyourestimateondatafromsimilarschemes
• Estimaterouteshiftbyassessingotheralternativeroutes
• Estimaterouteshiftormodeshiftusingrouteusersurveys(askusersdirectlywhethertheyhavechangedmodeorroute)
5%
15%
25%
Stage 1– enter data for your scheme Stage 2 – selectthestandardstatisticaldatato useinyourcalculation Stage 3 – results
Valuingthehealthbenefitsoftransportschemes 3332 HEAT
HEAT–step-by-stepStage2–selectthestandardstatisticaldatatouseinyourcalculation
InthesecondstageoftheHEATtool,youwillbeaskedtoselectstandardinputdatafromdrop-downmenusortoenterstandardTfLvalues.ThisallowsHEATtomakeitscalculationbasedonaUKcontext.
Thethreestandardstatisticaldataitemsare:
• Crudemortalityrate
• Valueofstatisticallife(VSL)
• Discountingrate
ThesestatisticaldataareexplainedinmoredetailintheHEATinputdatasection.Seebelowfortipsonwhattoexpectwhenusingthewebsiteitself.
Mortality rate – please choose for which age range you wish to carry out your calculationYouwillbegiventheoptiontoselectfrom:
• Averagepopulation(about20to64yearsold)
• Youngeraveragepopulation(about20to44yearsold)
• Olderaveragepopulation(about45to64yearsold)
Youshouldalmostalwaysselectthefirstoption(averagepopulation)unlessyourschemewastargetedatanolderor youngergroupofadults.
Mortality rate – please enter a figure for mortality data either by selecting the value from the WHO mortality database, or by entering you own valueYouwillbegiventheoptionto:
• Selectfromadrop-downmenuofcountry-specificmortalityrates
• Enteryourownvaluemanually
Alwaysselect‘UnitedKingdom’.
Value of statistical life – select the country for which you want to carry out your assessment, and choose the currencyFirst,youwillbeaskedtoselectacountryfromadrop-downmenu.Alwaysselect‘UnitedKingdom’.
Next,youwillbeaskedtoselectacurrencyfromadrop-downmenu.Alwaysselect‘Britishpound(GBP)’.
Thisautomaticallypopulatesaboxwiththevalueofstatisticallife(£3,229,114fortheUK).
Discounting rate to apply for future benefits – please enter the rate by which you wish to discount future financial savingsYouwillbeaskedtoenteradiscountingrate manually.
IfyouarerunningHEATtogenerateavaluetoputintoTfL’sBusinessCaseAssistant(BCA)tool,enteradiscountingrateofzero.TheBCAtoolappliesadiscountingratetoyourwholebusinesscase.Otherwise,enteradiscountingrateof 3.5percent.ThisfigureisrecommendedbytheTreasuryandtheTfLBusinessCaseDevelopmentManual.
Stage 1– enter data for your scheme Stage 2 – selectthestandardstatisticaldatato useinyourcalculation Stage 3 – results
Valuingthehealthbenefitsoftransportschemes 3534 HEAT
HEAT–step-by-stepStage3–result
ThefinalstageoftheonlineHEATcalculationistheresultspage.Atfirstglance,thiswebpagecanbeconfusingasthereisalotoftext.Thekeypointstonoticefromtheresultspagearedetailedbelow.
You get a summary of your input data and assumptionsAsummaryofthekeyinputdataisfoundatthetopofthepage.Asummaryofyourassumptionsisfoundatthebottomofthepage(inagreybox).
Recordingthesevaluesisimportant.YoucandefendalargemonetisedbenefitandstrengthenyourbusinesscaseifyouareabletojustifytheinputsandassumptionsunderpinningyourHEATresult.Itisgoodpracticetotakeascreenshotoftheresultspageforyourrecords.Thisisparticularlyimportantwhenyourunthetoolseveraltimesusingdifferentinputdata(sensitivitytesting).
The main results to look for are:
Thenumberofdeathsperyearthatare prevented
Thisisthenumberofdeathsperyearpreventedbyyourscheme.Thisisgenerallyasmallnumber,althoughitgeneratesalargemonetarybenefitbecauseweputahighvalueonlife.
ThecurrentvalueofthetotalbenefitsaccumulatedoverXyears
Thisisthetotalmonetisedvalueofdeathspreventedoverthenumberofyearsyouenteredforthe‘timeperiodoverwhichbenefitsarecalculated’.HEAThasdiscountedthisvalueattherateyouenteredearlier.
Averageannualbenefit
HEATaveragesthetotalbenefits(ie‘currentvalueofthetotalbenefitsaccumulated’)overthenumberofyearsthatyouenteredforthe‘timeperiodoverwhichbenefitsarecalculated’.IfyouareusingtheHEATresultsasinputintotheTfLBusinessCaseAssistant(BCA),youneedtousethisaverageannualbenefitbecausetheBCAasksforannualcostsandbenefits.
Theincreaseinthenumberofindividualswalking/cyclingbetweenyourpreandpost-interventiondata
Theaverageamountofwalking/cyclingperpersonperyear
Thesevaluesshowwhetheryourhealthbenefitsarosemorefromanincreaseinthenumberofpeoplebeingactiveorfromanincreaseintheamountoftimeeachpersonspentbeingactive.Youwillseethegreatesthealthbenefitsfromschemesthatgeneratelargeincreasesinthenumberofpeoplebeingactive,eveniftheyareonlyactiveforasmallamountoftime.
Theseapplyonlytobefore/afterprojects.
Stage 1– enter data for your scheme Stage 2 – selectthestandardstatisticaldatato useinyourcalculation Stage 3 – results
Valuingthehealthbenefitsoftransportschemes 37
ReportingHEAToutputs
WriteashortreportonyourHEATproject.Thiswill:
• Enableyoutore-runyourcalculationseasilyifyouneedto
• Helpdecision-makersseeexactlywhatthefinalvaluesarebasedon
• Allowotherstolearnfromyourwork
• AllowspeopletocompareHEAToutputsfromdifferentschemes
Werecommendyouinclude:
An introduction• TheaimsandobjectivesoftheHEAT calculation
• Acleardescriptionoftheproject(egdetailsoftheinterventiontobeassessed)
InputsUsetheHEATinputdatatemplateasabasisforthissection.
• Afulllistofallinputdata(includingdatasource)andjustificationofyourassumptions
• Detailsonmethodsofdatacollection,eg basedoncounts,surveys,estimates,or modelling
• Alistofallthevaluesusedforthestandardstatisticaldata(valueforstatisticallife,mortalityrate,discountingrate)
Outputs• Thenumberofpeoplewalkingandcycling(orthechangeinthenumberasaresultofyourscheme)
• Theamountofwalkingorcyclingperperson
• Thenumberofdeathsprevented
• Thetotalmonetisedbenefitoverastatedtimeframeand/ortheaverageannualmonetisedbenefit
• TheBCR(benefitcostratio)ifcalculatedforabusinesscaseorevaluation
Outcomes• Ifpossible,includeasummaryofanyimpactachievedsuchasabusinesscasebeingaccepted,publicityachievedortheinclusionoftheoutputsinanymajorpolicy
• IfHEATfigureswerechallengedbydecision-makers,itwouldalsobeusefultoincludeasummaryofthisandhowitwasdealtwith
36 HEAT
Valuingthehealthbenefitsoftransportschemes 39
HowdoesHEATwork?
ThebasicfunctionoftheHEATcalculationistoworkouthowmanydeathscanbepreventedperyearbyanincreaseinwalking/cycling.Eachdeathpreventedhasamonetaryvalue.HEATaddsupthetotalmonetaryvaluefromalldeathspreventedbyyourscheme.
Thenumberofdeathspreventedisrelatedtotheamountofwalking/cyclingdone–moretimeexercisingperpersonmeansabiggerreductionintheriskofdeath.Thisiswhyyouneedtoenterdataontheamountofexercisethatpeoplearedoing(time,distanceorduration)andnotjustthenumberofpeople.
How does HEAT give a monetary value to the number of deaths prevented?
HEATsimplymultipliesthenumberofdeathsprevented(calculatedabove)bythevalueofstatisticallife(VSL).VSListhemonetaryvaluegiventoeachdeathprevented.FormoreinformationonVSLseeHEATinputdata section.
38 HEAT
What is relative risk?
Relativeriskisacommonandsimplemeasureusedinmedicineandpublichealthtocomparetheriskthataspecifiedoutcomewilloccurinonegroupofpeoplecomparedwithanothergroup.
HEATcomparestherelativeriskofdyingfromanycauseinpeoplewhocycleorwalkcomparedwithpeoplewhodonotcycleorwalk.
A real example of relative riskStudieshaveshownthattheriskofdeath(fromallpossiblecauses)inregularcyclistsisninedeathsin10,000peopleperyear.Theriskofdeathinnon-cyclistsis10deathsin10,000peopleperyear.
Sopeoplewhocycleregularlyarelesslikelyto dieinanygivenyearthanpeoplewhodon’t cycle.
Therelativerisk(ratioofthetworisks)is:
Youcandescribethisratioinwords:
Relative risk is the ratio of the likelihood that a specific event will occur in one group compared with another group
9/10,00010/10,000=0.9=90%
How does HEAT estimate the number of deaths prevented?HEATdoesthisinthreestages:
1.HEATworksouthowmanydeathswouldbeexpectedinyourobservedwalkers/cyclistswithinoneyear,assumingtheyaresimilartoanaveragepopulation
Thetoolmultipliesthecrudemortalityrate(expectedannualdeathrateinanaveragepopulation)bythenumberofpeopleyouhaveobservedwalking/cycling
2.HEATthenworksouthowmanydeathsyouwouldexpectinthesewalkers/cyclists,given thatweknowthattheyhavebeenphysicallyactive
Weknowthatphysicalactivityreducestheriskofdeath.HEATisbasedonstudiesthat
haveshownthatforeveryminuteofwalking/cyclingthatpeopledo,thereisareductionintheirriskofdeath.HEATestimatesthenumberofminutesspentwalking/cyclingbasedonyourinputdata.Itcanthereforeapplytheappropriate‘relativeriskreduction’tothecrudemortalityratebasedonthetimethatyourobservedwalkers/cyclistshavebeenactive.Thisproducesanexpectedannualnumberofdeathsintheobservedwalkers/cyclists.Formoreinformationonrelativerisk,seebelow.
3.HEATcalculatesthenumberofdeathspreventedowingtowalking/cycling
Thisstepisverysimple:HEATsimplysubtractsthenumberofdeathsinStep2fromStep1 “Relative risk of death is
10 per cent lower in cyclists compared with non-cyclists”
Valuingthehealthbenefitsoftransportschemes 41
HowdoesHEATwork?
What is the evidence for the lower relative risk of death among people who regularly walk or cycle?
HEATisbasedonhigh-qualityevidencefromcohortstudiesthatfolloweduplargenumbersofpeople(acohort)overtime.TheoriginalevidenceforHEATcamefromaCopenhagen-basedcohortstudythatfollowedupparticipantsfor14.5years.Thestudycollecteddataonphysicalactivityhabitsaswellasmanyotherlifestylefactors.Subsequentstudieshavefoundsimilarrelationshipsbetweenphysicalexerciseandriskofdeath.HEATusesthecombinedresultsfromallthehighestquality studies:
• Cycling:evidenceshowsthatthereisa10percentreductioninriskofdeathinpeoplewhoregularlycycle100minutes/weekcomparedwithnon-cyclists
• Walking:evidenceshowsthatthereisan11percentreductioninriskofdeathinpeoplewhoregularlywalkfor168minutes/weekcomparedwithnon-walkers
Boththefiguresforwalkingandcyclingwereagreedbyaninternationaladvisorygroupbasedonasystematicreviewofallpublished studies.
What if people are cycling more or less than 100 minutes per week?
HEATincreasesordecreasestheriskpercentagesproportionallydependingontheaveragetimespentcycling/walkingthatyouputintothetool.
HEATcapsthehealthbenefitsat450minutesperweekforcyclingand300minutesperweekforwalking.Thisisbecauseyoudonotgetaninfinitereductioninriskofdeathfrominfinitephysicalactivity.
40 HEAT
How HEAT adjusts the risk of death according to how much people cycle
Time spent cycling
0 mins
0%
20%
45%
200 mins 450 mins 500 minsRedu
ctio
n in
risk
of d
eath
How do you know it was the physical activity that caused fewer deaths, rather than other factors?
Itisappropriatetoquestionwhetherthepeoplewhocycledmoreinthestudieswerealsomorelikelytoeathealthilyandsmokeless.Theymayalsohavebeenyoungerormoreofthemmale.Allthesealternativefactorsrelatedbothtothechancethatpeoplecycledandtotheirriskofdeatharecalled‘confoundingfactors’.Fortunately,statisticianscanadjustforconfoundingfactorsintheirstatisticalanalysis.Thisallowsthemtoisolatetheimpactonriskofdeaththatispurelyrelatedtowalkingorcycling.
ThestudieswhichHEATwasbasedoncollecteddataonalargenumberofdemographicandlifestylefactors(egdetaileddietaryhistory,smoking,age,gender,educationleveletc).WecanbeconfidentthattherelativeriskvaluesrelatedtowalkingandcyclingusedinHEATareindependentofanyotherfactors.
Valuingthehealthbenefitsoftransportschemes 43
HEATcalculationexample
Imagineaschemethatcreates2,000newcyclistseachspending100minutescyclingperweek.Weknowthatpeoplewhoregularlycyclefor100minutesinaweekare10percentlesslikelytodieperyearfromanycausecomparedwithnon-cyclists.
1. Calculate the expected deaths in the observed cyclists within one year, assuming they are similar to an average population
CrudeUKmortalityrate in20to64-year-olds =249deaths/100,000
Soin2,000averageadults youwouldexpectfivedeaths
=249/100,000x2,000=5deaths
2. Calculate how many deaths you would expect in these cyclists, given that we actually know that they have been physically active
Riskofdeathincyclistsis10percentlowerthannon-cyclists
Soin2,000cyclistsyouwouldexpect4.5deaths
=0.9x249/100,000x2,000 =4.5deaths
3. Calculate the number of deaths prevented that were due to cycling
=5–4.5=0.5deathspreventedinoneyear
4. Give a monetary value to the number of deaths prevented
Thevalueofeachdeathpreventedis£3,229,000
Sothetotalvalueofthescheme=£3,229,000×0.5=£1.6minoneyear
HEAT also calculates benefits over longer periods of timeThiscalculationwasbasedondeathspreventedinoneyear.HEATisabletocalculatethenumberofdeathspreventedandresultingmonetarybenefitoveralongerperiodoftime(thetimeperiodoverwhichyouthinkthebenefitswillberealised).Here,HEATismultiplyingtheannualbenefitabovebythenumberofyearsinyourtimeperiod.HEATalsoadjustsforthetimeitwilltakeforyourschemetoreachfullcapacity.
HEAT also applies a discounting rate to future benefitsHEATgivesyoutheoptiontodiscountfuturebenefits.Formoreinformationondiscounting,seeHEATinputdatasection.
42 HEAT
Valuingthehealthbenefitsoftransportschemes 4544 HEAT
HEATinpractice –RoyalCollegeStreetKey details about the scheme
RoyalCollegeStreetinCamdenwasacycleinfrastructureprojectthataimedtoimprovethepublicrealmandincreasethesafetyof cyclists.
Beforethescheme,therewasabi-directionalsegregatedcycletrackrunningononesideofthestreet.Thishadresultedinseveralcollisionswherecarsturningintotheroadhadnotnoticedcyclistscomingfromtheirleft.
Theinfrastructurechangesincluded:
• Puttingcycletrackonbothsidesoftheroad
• Installingarmadillostoseparatethecycletrackfromtheroad
Input data
ThissectionhasbeenwrittenusingtheformatoftheHEATinputdatatemplate.
Royal College Street
Photographs:ChristopherMartin,UrbanMovement
Before After
DataaboutyourschemeTypeofscheme Before/afterWhattypeofdatadidyoucollect? TripsBaselinedata Trips Numberofwalking/cycling
trips824perday
Averagetripdurationordistance
0.9miles(aconservativeestimatebasedonthelengthofthestreet)
Howmanypeoplebenefit? 453=numberofpeoplecyclingbasedon90percentbeingreturntrips:
Returncyclists:=(824x0.9)/2
=742/2=371
One-waycyclists=824–742
= 82
Totalpeople=371+82=453Post-interventiondata
Trips Numberofwalking/cyclingtrips
1,700perday
Averagetripdurationordistance
0.9miles(aconservativeestimatebasedonthelengthofthestreet)
Howmanypeoplebenefit? 935=numberofpeoplecyclingbasedon90percentbeingreturntrips:
Returncyclists=(1,700x0.9)/2
=1,530/2=765
One-waycyclists=1,700–1,530
= 170
Totalpeople=765+170=935
• Usingplantersaslanemarkers
• Resurfacingthecarriageway
• Plantingstreettrees
• Repavingpavements
Cyclingdatawasobtainedfrommanualandautomatictripcountsbeforeandaftertheintervention(2012and2015).
Thecostoftheschemewas£475,000.
Valuingthehealthbenefitsoftransportschemes 4746 HEAT
KeyassumptionsaboutyourdataBaselinedata Doyouknowthenumberofpeople
whotakecyclingtrips,ordoyouwishtoestimatethenumberofcyclistsbasedonreturnjourneys?
Estimatebasedonreturnjourneys
Whatproportionofyourtripswillbeareturnjourney?
90% Reason:itisacommuterroutethereforeahighproportionarereturnjourneys
Howmanydaysperyeardopeople cycle?
100 Reason:thisisaconservativeestimatebasedontheSwedishexamplefromtheHEATwebsite
Post-interventiondata
Doyouknowthenumberofpeoplewhotakecyclingtrips,ordoyouwishtoestimatethenumberofcyclistsbasedonreturnjourneys?
Estimatebasedonreturnjourneys
Whatproportionofyourtripswillbeareturnjourney?
90% Reason:itisacommuterroutethereforeahighproportionarereturnjourneys
Howmanydaysperyeardopeople cycle?
100 Reason:thisisaconservativeestimatebasedontheSwedishexamplefromtheHEATwebsite
Timeneededtoreachfulllevelof cycling?
2years Reason:thisisbasedonotherschemes
Timeperiodoverwhichbenefitsare calculated?
10 years
Reason:thisisbasedonotherschemes
Proportionofcyclingdataattributabletoyourintervention?
75% Reason:thisisbasedonotherschemes.Differentvaluesweretestedhere(sensitivitytesting)
StandardstatisticaldataUKmortalityrate Chooseanagerangefromadrop-
downmenu
SelecttheUKfromadrop-downmenuofcountry-specificmortality rates
Averagepopulation
Valueofstatisticallife
SelecttheUKfromadrop-down menu
HEATstandardUKvalueis£3,229,114
Discountingrate IfyouarerunningHEATtogenerateinputsforTfL’sBusinessCaseAssistant(BCA)tool,enteradiscountrateofzero.TheBCAdiscountsallfiguresputintoitandwouldendupdiscountinghealthbenefitstwice
Forallotherprojects,enteradiscountrateof3.5percent
3.5%
HEAT results
• Therearenow482individualsregularlycyclingasaresultofthescheme
• Theaverageamountofcyclingperpersonhasnotchanged
• Thenumberofdeathsperyearpreventedbytheschemeis0.02
• Thecurrentvalueofthetotalbenefitsaccumulatedover10yearsis£347,000
• Theaverageannualbenefit,averagedover10years,is£44,000
Calculating a benefit cost ratio (BCR)
BCRistheratioofthemonetarybenefitsdividedbyprojectcosts:
Evenwithoutaddinganyotherbenefits,thisBCRhasalmostbrokeneven.YoucouldimprovetheratiofurtherbyrunningtheHEATtoolagainforwalkingandaddingthetwobenefitresultstogether.Youcouldestimatethelikelyoriginsanddestinationsofthecycliststoimproveyourtripdistancedata.YoucouldalsoaddintheresultsofaSARTcalculation(monetisingbenefitsfromreducedsicknessabsence–seethenextsectionofthisguide).
= £347,000£475,000=0.73:1
= monetarybenefits
projectcosts
= BCR
SicknessAbsenceReductionTool(SART)
50 SART at a glance
52 When should SART not be used?
54 How does SART work?
56 Using the SART tool
58 SART input data
62 Reporting SART results
64 SART in practice – Royal College Street
Valuingthehealthbenefitsoftransportschemes 4948 SART
Valuingthehealthbenefitsoftransportschemes 5150 SART
SARTataglance
What is SART?
SARTistheSicknessAbsenceReductionTool.
Itcalculatesthenumberofsickdayspreventedasaresultofpeopleshiftingfrombeinginactivetobeingactivebecauseofyourscheme.Thetoolcalculatesthemonetaryvalueofthischange.
Why do we use SART?
WeuseSARTbecause:
• SARThasbeenapprovedbytheDfTandTfL.ItisincludedintheDfT’sTransportanalysisguidance(WebTAG)andtheTfLBusinessCaseDevelopmentManual (BCDM)
• Itincreasesthescopeofhealthbenefitsincludedinabenefitcostratio(BCR)
• Thesavingscalculatedareadirectbenefittobusinesses.Thiscanbeattractivetodecision-makers
• Thereisgoodevidenceontheeffectsof cyclingandwalkingonreducingabsence levels
• SARTisverystraightforwardandsimpleto use
What input data is needed?
SARTissosimplethatyoucancalculatetheresultatyourdeskusingacalculator.Thetoolrequires:
Dataaboutyourscheme(suppliedbyyou)
• Thenumberofpeoplecyclingorwalking30minutesperweekasaresultofyourschemewhowerepreviouslynotwalkingorcyclingthisjourney.SeeSARTinputdatafortips onhowtoderivethisvaluefromyour data
Standardstatisticaldata(suppliedbythisguide)
• Theproportionofpeopleinyourtargetpopulationwhoareemployed
• Thenumberofsickdaysperyearpreventedbybeingphysicallyactive
• Theaveragecostofasickday
What is the output?
SARTcalculates:
• Thenumberofsickdayspreventedperyearasaresultofyourscheme
• Themonetaryvalueofsickdaysprevented
Valuingthehealthbenefitsoftransportschemes 5352 SART
WhenshouldSARTnotbeused?
ItisnotalwaysappropriatetouseSART.Thetoolcannotbeusedfor:
Situation Example Whycan’tyouuseSART?Peoplenotinpaidemployment
Monetisingthenumberofsickdayspreventedbyaschemethatsupportsretiredpeopletocyclemore.
ThefiguresusedinthetoolarebasedontheaverageUKadultpopulation,whichincludesbothemployedand unemployedpeople.Thetoolwouldnotbeapplicabletoschemesthattargetpeoplewhoarenotin paidemployment.
Children Monetisingthenumberofschoolsickdaysprevented.
Thetoolisbasedonstudieslookingatadultsonly.The figuresusedinthetoolarebasedonadultemploymentratesandwages.
Valuingthehealthbenefitsoftransportschemes 5554 SART
HowdoesSARTwork?
Onaverage,employeeswhoarephysicallyactivetake25percentfewersickdaysthaninactiveemployees.SARTaimstocapturetheeconomicbenefitstobusinessesfromstaffbeingmorephysicallyactiveandtakinglesstimeoffworksick.
SART calculates the number of people who shifted from being inactive to active by your schemeThesicknessabsencecalculationissimplerthanHEAT.UnlikeHEAT,SARTdoesnotaccountfortheexactamountofphysicalactivitybeingdonebyindividuals.Instead,SARTisconcernedwithwhetheraschemeisprovidingsignificantadditionalactivity.
SART assumes a fixed reduction in sickness absence for each newly active personSARTsimplyassumesaconsistent25percentreductioninsicknessabsenceinanyonewhoshiftsfrombeinginactivetoactivethroughyourscheme.Peopleareclassifiedasactiveiftheyengagein30minutesormoremoderatephysicalactivityperweek.Peoplewhoengageinfewerthan30minutesareclassedasinactive.
SART gives an economic value to each sick day prevented
SARTusesstandardinputdatatogiveafixedmonetaryvaluetoeachsickdayprevented.
How do SART results compare with HEAT results?
Themonetisedbenefitsfromreducedsicknessabsencearemuchsmallerthanthebenefitsfrompreventeddeath.EconomicevaluationoftheLondon-basedConnect2projectbySustransshowsthatthevalueofthebenefitsfromreducedabsenteeism(SARToutputs)areusuallymuchsmallerthanthosefrompreventeddeath(HEAToutputs)forthesamelevelsofcyclingorwalking.Intheseprojects,thevalueofsicknessabsencereductionwasaroundfivepercentofthevaluesfromHEAT.
SARToutputscanstillmakeavaluableadditiontothebenefitcostratio.
Can I use HEAT and SART together?AsHEATandSARTvaluedifferenthealthbenefitsofwalkingandcycling thetwotoolscanbeusedtogetherwithnoriskofdoublecountingbenefits.
Valuingthehealthbenefitsoftransportschemes 5756 SART
UsingtheSARTtool
How long will it take to run the tool?
Thetoolissosimplethatyoucancalculatetheresultatyourdeskusingacalculator.Ittakesjustafewminutes.
What are the stages of the SART tool?
SARTessentiallyhasfoursteps:
4.Applytheaveragecostofasickdayto
an employer**
*Thefirststagecanbebrokendownintofurtherstepsifyoudonothavesurveydatathatgivesthisnumberdirectly
**Stages2-4arebasedonstandardinputdata
1.Calculatethenumberofnewlyactive
peopleonyourroute*
2.Estimatetheproportionofthesepeoplewho
areemployed**
3.Multiplythenumberofsickdayspreventedby
physicalactivitybyeachperson**
Valuingthehealthbenefitsoftransportschemes 59
SARTinputdata
What data about my scheme does SART require?
SARTneedsjustonekeypieceofresultsdatafromyourscheme:
Keyresultdata HowdoIcollectthisdata?
Thenumberofpeoplewhoshiftedfrombeing‘inactive’to‘active’asaresultofyourscheme
Tousethistoolyouwillneedtodecidehowmanypeoplehaveshifted–orwillshift–frombeinginactive(lessthan30minutesofphysicalactivityperweek)toactive(regularlyachievingatleast30minutesofactivetravelperweek).
Ineffect,thisisthenumberofpeoplecyclingorwalking30minutesperweekasaresultofyourschemewhowerenotpreviouslywalkingorcyclingthisjourney.
Thisisavailablefrom:
• Roadsidecounts
• Populationsurveys
• Modelling/estimates
NBSARTinputdataisavailablefromexactlythesamedatacollectionmethodsasfortheHEATtool.Thisisabenefitofusingbothtoolsatthesametime.SeesectionHEATinputdatasectionformoredetailondatacollectionmethods.
How confident should I be of my input data?
Youmayknowtheexactnumberofpeoplewhohaveshiftedfrom‘inactive’to‘active’basedonsurveydata.Inmostcases,however,youwillhavetoestimatethisshiftfromtripcountsormodellingdata.
Seebelowfordetailonhowtoestimatethisvalue.Wherepossible,wehaveprovidedrulesofthumbfortheseestimatesbasedonTfLdata.Youmayalsobeabletobaseyourassumptionsonsimilarschemes.
Itisimportanttorecordhowyoucametoanyassumptionssoyoucanjustifyyourresultsinthefinalbusinesscaseorreport.
58 SART
1. Calculate the uplift in the number of people cycling or walking on your route
2. Calculate the proportion who are new active travellers
3. Calculate the proportion of these new active travellers who are cycling or walking for at least 30 minutes per week
Youcangetthisdatadirectlyfromrouteusersurveysormodelling.
Or you can calculate uplift from trip countsa.Calculateuplift(=aftertripcount–beforetripcount)
b.Estimatethenumberofwalkers/cyclistsbasedontheproportionofreturnjourneysoutofalltripsobserved.ThemethodusedisexactlythesameasfortheHEATtool(seeHEAT–step-by-stepsection)
If you have the data from route user surveys• Includeasnewactivetravellersanyonenowwalking/cyclingonyourroutewhowaspreviouslyusingacar,motorcycle,taxi/minicaborbus
If you need to estimate from trip counts YoucanusethefollowingrulesofthumbwhicharebasedonTfLcyclingdata:
a.Onlyincludepeoplewhoshiftedmode:thisautomaticallyexcludestheexistingwalkers/cyclistswhohavere-routedtoyourscheme.TfLcyclingdatashowsthat45-50percentofupliftincyclingwasduetomodeshift
b.Ofthese,onlyincludepeoplewhowerepreviouslyusing‘inactive’modes(car,motorcycle,taxi/minicab,bus):TfLdatashowsthat40-45percentofcurrentcyclistsinLondonhaveshiftedfromasedentarymodetocycling
Thesedataareforcycling.Currently,TfL doesnothavethesamedataforwalking.TocalculateSARTforwalkingconsiderpeople shiftingtopublictransportfrom‘inactivemodes’.
Notallthenewlyactivepeopleidentifiedabovewillbedoing30minutesofphysicalactivityperweek.Youneedtoexcludethosewhoarestillnotreaching30minutesperweek.
Work out who to exclude using the following rules of thumb• Ifyourschemedeliversanaveragetriptaking
lessthan10minutestowalk/cycle,onlyincluderegularcommuters(astheydothetripregularlyenoughtoreach30minutes/week)
• Ifyourschemedeliversanaveragetripof10 minutesormore,includeallnewactive travellers
How do I work out how many people shifted from being inactive to active?
Youcanestimatethisshiftbybreakingdownthequestionintothreestages:
Valuingthehealthbenefitsoftransportschemes 61
SARTinputdata
Breakdown of the uplift in cycling to identify newly active travellers
What standard statistical data does SART use?
TheSARTcalculationusesthreestandardinputfigures.AllareapprovedbyTfL.TheyarebasedonrecentUKandLondon-specificdata.
Manypeoplemakeshortwalkstagesaspartoflongertripsonpublictransport.Tosetacommonandmeaningfulbenchmark,TfLdefinesa‘substantial’walkstageasbeinggreaterthanfiveminutesinduration.
DatafromTravelinLondon6showsthatwalkstagesofmorethanfiveminutesaremorelikelytobemadeaspartofamainmodepublictransporttrip,ratherthanaspartofatripbyprivatemotorvehicle.
• Activemodes:Mosttripsmadeusingrail,UndergroundorDLRservicesincludedawalkstageofmorethan5minutes(83percent).
Thesetransportmodescanbeclassedas‘active’asthevastmajorityoftravellerswillwalkatleastfiveminutesaspartoftheirjourney.
• Sedentarymodes:Car,taxiorbusjourneysareclassedassedentarymodesbecauseamuchsmallerproportionoftravellersareobservedtowalkformorethanfiveminutesaspartoftheirjourney.57percentofbustripsinvolvedwalkstageofmorethan5minutes.Onlyfivepercentofcarjourneysinvolvedawalkstageofmorethan5minutes.
How do we know whether a transport mode should be classed as sedentary or active?
60 SART
Uplift in cycling
Uplift in cycling
Number of cyclists on this route before the intervention
Number of cyclists on this route after the intervention
New cyclists who shifted from another mode Existing cyclists
who shifted route?
Previously bus/car/taxi
(sedentary modes)Previously
walking/Tube/train (active modes)
Before
After
40-45%55-60%
45-50%50-55%
Active for more than 30 minutes/week
Active for less than 30 minutes/week
New journeys on this route but we are unsure what these people were doing before
This is the figure to use in SART
Percentage of walkers/cyclists who are employed
SARTusesastandardemploymentrateof65percent.
ThisisanestimatebasedondatafromtheLondonTravelDemandSurvey.
Reduction in sick days per year for each newly active person
SARTusesastandardfigureof1.3sickdayspreventedpernewlyactivepersonperyear.
Thisisanestimatebasedon:
• A25percentreductioninsicknessabsenceresultingfromashiftfrominactivetoactive
• ThecurrentaveragenumberofsickdaystakenbyadultsintheUK(5.3days)
ThisdatacomesfromtheNationalInstituteforHealthandCareExcellenceandvariousothersources
Monetary value for each sick day prevented
SARTusesastandardvalueof£133.68persickdayprevented
ThisisanestimatebasedonmediandailypayinLondon(OfficeforNationalStatistics)
Valuingthehealthbenefitsoftransportschemes 63
ReportingSARTresults
JustlikeforHEAT,itisrecommendedthatyouwriteupandshareashortreportonyourSARTproject.ThiscanbeusedwithintheorganisationforhelpwithfutureprojectsandincludedinabusinesscasethathasusedHEAT.
Werecommendyouinclude:
An introduction• TheaimsandobjectivesoftheSARTcalculation
• Acleardescriptionoftheproject(egdetailsoftheinterventiontobeassessed)
Inputs• Afulllistofallinputdata(includingdatasource)andjustificationofyourassumptions
• Detailsonmethodsofdatacollection,eg basedoncounts,surveys,estimates,or modelling
• Alistallthevaluesusedforthestandardstatisticaldata
Outputs• Thenumberofsickdaysprevented
• Theannualsavingstobusinessesfrompreventedsickdays(youmightalsodiscountthisvalueandtotalitoveralongertimeframe)
• TheBCR(benefitcostratio)ifcalculatedforabusinesscaseorevaluation
Outcomes• Ifpossible,includeasummaryofanyimpactachievedsuchasabusinesscasebeingaccepted,publicityachievedortheinclusionoftheoutputsinanymajorpolicyetc
• IfSARTfigureswerechallengedbydecision-makers,itwouldalsobeusefultoincludeasummaryofthisandhowitwasdealtwith
62 SART
Valuingthehealthbenefitsoftransportschemes 65
SARTinpractice –RoyalCollegeStreetKey details about the scheme
RoyalCollegeStreetinCamdenwasacycleinfrastructureprojectthataimedtoimprovethepublicrealmandincreasethesafetyofcyclists.
Beforethescheme,therewasabi-directionalsegregatedcycletrackrunningononesideofthestreet.Thishadresultedinseveralcollisionswherecarsturningintotheroadhadnotnoticedcyclistscomingfromtheirleft.
Theinfrastructurechangesincluded:
• Puttingcycletrackonbothsidesoftheroad
• Installingarmadillostoseparatethecycletrackfromtheroad
• Usingplantersaslanemarkers
• Resurfacingtheroad
• Plantingstreettrees
• Repavingpavements
The calculation
1. Calculate the number of newly active people on your route Calculate the uplift in the number of people cycling or walking on your route
Upliftincycling=1,000–499 =501people
Calculate the proportion who are new active travellersOnlyincludepeoplewhoshiftedmode:TfLcyclingdatashowsthat45-50percentofupliftincyclingwasowingtomodeshiftfromanothertransportmode
=501x0.45=225people
Ofthese,onlyincludepeoplewhowerepreviouslyusingsedentarymodes:TfLdatashows40–45percentofcurrentLondoncyclistshaveshiftedfromasedentarymodeto cycling
=225x0.40=90people
Calculate the proportion of these new active travellers who are cycling or walking for at least 30 minutes per week Workoutwhotoexcludeusingthefollowingrulesofthumb:
• Ifyourschemedeliversanaveragetriptakinglessthan10minutestowalk/cycle,onlyincluderegularcommuters
• Ifyourschemedeliversanaveragetripof10 minutesormore,includeallnewactive travellers
MostcyclistsonRoyalCollegeStreetwerecommutersthereforeallcanbeincluded.
2. Estimate the proportion of these walkers/cyclists who are employed
=90peoplex65percent=59people
3. Multiply by the number of sick days prevented by physical activity per person
=59peoplex1.3days=76days
4. Apply to the average cost of a sick day to an employer
=76daysx£133.68=£10,187annualsavingstobusinesses
Youcandiscountthisvalueandtotalitover10 years:
£10,187annualsavingsdiscounted(at3.5percent)andtotalledover10years=£93,932
YoucanaddittotheHEAToutputwithinthe BCR:
64 SART
DataaboutyourschemeThenumberofnewlyactivepeopleonmyroute
Seecalculationright
StandardinputdataProportionofpeopleinyourtargetpopulationwhoareemployed
65%
Numberofsickdaysperyearpreventedbybeingphysicallyactive
1.3dayspernewlyactivepersonperyear
Averagecostofasick day
£133.68perday
= £347,000+£93,932=0.93:1£475,000
Cyclingdatawasobtainedfrommanualandautomatictripcountsbeforeandaftertheintervention(2012and2015).
Thecostoftheschemewas£475,000.
Royal College Street
Photographs:ChristopherMartin,UrbanMovement
Before After
68 Using HEAT
71 Using SART
72 Using the outputs of HEAT and SART
74 More useful information
Valuingthehealthbenefitsoftransportschemes 67
Frequentlyaskedquestions
66 Frequentlyaskedquestions
Valuingthehealthbenefitsoftransportschemes 6968 Frequentlyaskedquestions
UsingHEAT
What happens if I have not collected my results as an average amount of time spent walking/cycling per person (which is what HEAT uses)?
Thisisnotaproblem.HEATisabletocalculatetimespentcyclingandwalkingusingeithertripcounts(providingyouenteradistanceforthetrip)oraveragedistancecycled(generallyfromsurveydata).
HEATassumesanaveragespeedof14km/hourforcyclingand4.8km/hourforwalking.Thetoolappliesthisspeedtoyourtripcountanddistancedatatogetanaveragetimespentwalking/cycling.
I only collected the number of cycling and walking trips for my project. HEAT needs the number of people walking/cycling. What do I do?
Werecommendcollectinginformationonthenumberofpeopleimpactedwhereverpossibleviasurveys.However,thisisnotalwayspossible.Youcanestimatethenumberofpeoplewalking/cyclingfromtripcounts,basedontheproportionoftripsthatwerereturnjourneys.See HEAT–step-by-stepsection.
Does the physical activity need to be of a minimum trip duration or length to have an impact and be included in HEAT?
No.AnyamountofwalkingorcyclingthatresultsfromyourschemewillbringabenefitrecognisedbyHEAT.HEATisbasedon:
• Thenumberofpeoplewalkingandcycling
• Theaveragetimespentperpersonwalkingandcycling
My project is targeted at children. Can I still use HEAT?
HEATcannotbeusedformonetisinghealthbenefitsinchildrenbecausetheevidencebaseinchildrenisnotcurrentlystrongenough.However,HEATisstillusefulforschemestargetingchildrenbecauseyoucanrunthetooltomonetisethebenefitstoadultswalkingasaresultoftheintervention(egadultswalkingwithchildrentoschool/teacherswalkingtoschool).
Youshouldcapturethehealthbenefitstochildreninthenarrativesectionofyourbusinesscase.
Automatic counts might include children. Would that artificially inflate the HEAT and SART outcomes?
ThecountingofchildrenbyautomaticsensorsisunlikelytobeaproblemforcyclecountsasweknowthatonlyasmallproportionofcyclistsonLondonroadsareunder16years.
Ifarouteusersurveyisavailable,thiswillgiveinformationontheproportionofwalkersorcyclistswhoarechildren.Overallcountscanbereducedaccordingly.
HEAT caps the health benefits of cycling and walking at 450 and 460 minutes respectively. How do we know if our trip counts are including lots of people that are already doing that much activity through other means (eg sports/exercise classes)?
HEATshouldnotbeusedforpopulationswithveryhighphysicalactivitylevelsasitisknownthattheygetonlylimitedadditionalhealthbenefitfromanyincreaseinexercise.However,thisisnotaproblemforanyschemetargetingthegeneralpopulationinLondon.AveragephysicalactivitylevelsinLondonarelowandonlyasmallproportionofpeopleinthegeneralpublicwillbedoingmorethan450minutescyclingor460minutesofwalkingper week.
My scheme is only going to increase cycling among existing cyclists. Can I still use HEAT in my business case?
Yes.Therewillbeahealthbenefitaslongasthetargetpopulationisnotalreadydoingmorethan450minutesofcyclingonaverageacrossthewholepopulation(itdoesn’tmatterifsomeindividualsaredoingmorethan450minutes).
Whetherornotexistingcyclistswillgetamonetisedbenefit,youwillalsowanttoconsiderthepotentialfornewcycliststobenefitinfuture.Ifyouthinkthismighthappen,youcanaddthisbenefittothenarrativesectionofyourbusinesscase.
Can I use HEAT even though I don’t know whether those who increase their active travel aren’t just reducing other types of activity?
Yes.Anyotherphysicalactivitythatpeoplearedoing,ornotdoing,isirrelevant.HEATisbasedonlong-termstudiesusingverylargepopulations.Somepeopleinthesepopulationswouldhavebeentakingexercisealreadyandsomewouldnothave;somewouldhavetakenupnewactivityandsomewouldhavestoppedexistingactivity.HEATisbasedontheaveragereducedriskofdeathfromcycling/walkingregardlessofallotheractivitycarriedoutbypeopleinthepopulation.
How do we know that it is the cycling and walking that is making people healthier? What if the reduced risk of death is just because the cyclists and walkers are already healthy (eg eating healthily, not smoking)?
HEATisbasedonstudieswhichcollecteddataonalargenumberofdemographicandlifestylefactors(egdetaileddietaryhistory,smoking,age,gender,educationleveletc).Statisticiansadjustedforalltheseother‘confoundingfactors’intheirstatisticalanalysis.WecanbeconfidentthatthereductioninriskofdeathrelatedtowalkingandcyclingusedbyHEATisindependentofanyotherfactors.
Does HEAT account for the intensity of walking and cycling? For example, can HEAT capture if a new cycle trip was an intense 10 minutes while an old journey included a slow 10-minute walk?
HEATdoesnotaccountforintensityofphysicalactivity.However,wewouldexpectdifferencesintheintensityofwalking/cyclingtoaverageoutoverthewholepopulationofcyclists/walkers.
ThisiswhyitisimportanttorunHEATonapopulationlevelandnotforverysmallgroupsorindividuals.
Valuingthehealthbenefitsoftransportschemes 7170 Frequentlyaskedquestions
UsingSART
Do people really achieve health benefits from only 30 minutes per week of physical activity?
Evidenceshowsthatmovingpeoplefrombeinginactive(lessthan30minutesexerciseperweek)toactive(morethan30minutesperweek)bringsthebiggesthealthbenefit.
Gettingpeopletogofromdoingnothingtocycling/walkingfor30minuteseachweekcanbeabigachievementforthemandlikelytoenablethemtomovetomuchhealthierlifestyles.
Are there any other costs associated with sick leave other than just wages? If so, can we add these into our SART calculation?
Yes.Othercostscouldinclude:
• Pensioncontributions
• NationalInsuranceContributions
• Thecostsofcoveringfortheabsentstaff member
• Lostproductivity(fewergoodssold/servicestandardsdecline)
Youcantryandestimatetheseandaddthemintothecostofasickdaybutyouwouldneedtofindareliableevidencesourcetojustifyyourcostings.Experiencehasshownthatthesevaluestendtobemuchsmallerthantheimpactofsalary.Itmaynotbeworthaddingthemin.
Valuingthehealthbenefitsoftransportschemes 7372 Frequentlyaskedquestions
UsingtheoutputsofHEATandSART
How can I convince people to believe the figure that comes out of the HEAT calculation? It seems far too big.
• AssurethemthatHEATisendorsedbytheDfTandTfL
• Conductsensitivitytestingusingveryconservativeassumptionstoseehowtheresultsvaryandtobuildyourconfidenceintheresult
• Chooseveryconservativeassumptionsto produceafigurethatisplausibletoyour audience
• LookatHEATataglancesectionfordetailonthesourceofthetoolanditslegitimacy
Will I be double counting health benefits if I use HEAT and SART together?
No.AsHEATandSARTvaluedifferenthealthbenefitsofwalkingandcyclingthetwotoolscanbeusedtogetherwithnopotentialfordoublecountingofbenefits.
Who will receive the benefits that are valued by HEAT? Is it just the health sector?
HEATproducesamonetaryvaluefordeathsprevented,butthisisnotrealsavedmoneythatgoestoanyonesector.Instead,itthevaluethatpeopleputonthedeathsthatdidnothappenasaresultofyourscheme.
Itisimportanttovaluethedeathspreventedbyactivetravelbecause:
• Businesscasesshoulddemonstratetheglobalbenefitsdeliveredbyascheme–itdoesnotmatterwhothebenefitsgoto
• HealthisaTfLpriorityandweneedevidencetoshowthatweareworkingtoimproveit
• Localauthoritieshavestatutoryresponsibilitiesforimprovingpublichealthandmustdemonstratewhattheyaredoingtoimproveit
HEAT and SART only value prevented death and prevented sickness absence. What about the other health benefits from physical activity?
Thereareotherbenefitsofincreasingphysicalactivitywhichcanbemonetisedsuchasthereducedriskofillnessandthereducedcostsofhealthcare.Currentlywedonothavetoolsforcalculatingthesemonetarybenefitsbutyoucandescribetheminyournarrative.
Inbusinesscasesitisalsoimportanttosetoutthewiderhealthbenefitsbeyondthoseincludedinthebenefitcostration.AlltheinformationyouneedtodothisisintheTfL healthactionplanImprovingthehealthof Londoners.
Don’t the harms of air pollution and accidents outweigh the physical activity benefits?
No.Thehealthbenefitsofphysicalactivityfaroutweightheriskofroadtrafficinjuryandairpollution(by63to1).Seepage27oftheTfL healthactionplanImprovingthehealthof LondonersandtheGreaterLondonAuthorityreportTransportandhealthinLondon.
HEATmeasuresthehealthbenefitsachievedafteraccountingforotherrisks.Therelativeriskofdeathbyanycausealreadyincludestheimpactsofroadtrafficcollisionsandair pollution.
Improving health is not a specific objective for my project so should I assume there is no point in capturing health benefits in the business case?
No.Businesscasesshouldnotonlyreflecttheobjectivesoftheproject,butshouldalsocapturetheglobalbenefitstheprojectisexpectedtodeliver.
Youcanusethesehealthbenefitcalculationsinanumberofways:
• Todemonstratethewiderbenefitsofwhatyourprojectcandeliver
• ToimprovetheBCRofyourbusinesscase
• TodemonstratehowTfLhasmadeprogressagainstitsprioritytoimprovethehealthof Londoners
Valuingthehealthbenefitsoftransportschemes 7574 Frequentlyaskedquestions
Moreusefulinformation
HEAT input data template
DataaboutyourschemeTypeofscheme Singlepointintime
(youcanskipallsectionsaskingforpost-interventiondata)Before/after
Whattypeofdatadidyoucollect? DurationDistanceTrips
Baselinedata
*youonlyneedtocompleteoneofthesesections(duration/distance/trips)
Duration Numberofwalking/cyclingtripsAveragetripdurationordistance
Distance Numberofwalking/cyclingtripsAveragetripdurationordistance
Trips Numberofwalking/cyclingtripsAveragetripdurationordistanceHowmanypeoplebenefit?(Completethisbasedonyourassumptionsdetailedonthenextpage)
Post–interventiondata
*youonlyneedtocompleteoneofthesesections(duration/distance/trips)
Duration Numberofwalking/cyclingtrips
Averagetripdurationordistance
Distance Numberofwalking/cyclingtrips
Averagetripdurationordistance
Trips Numberofwalking/cyclingtrips
Averagetripdurationordistance
Howmanypeoplebenefit?(Completethisbasedonyourassumptionsdetailedonthenextpage)
KeyassumptionsaboutyourdataBaselinedata
Onlycompletethissectionifyourinputdatausestripcounts
Doyouknowthenumberofpeoplewhotakewalking/cyclingtrips,ordoyouwishtoestimatethenumberbasedonreturnjourneys?
Iknowthenumberofpeople(youcanskipthenextquestion)
EstimatebasedonreturnjourneysWhatproportionofyourtripswillbeareturnjourney?
Entervalue
Reason:
Howmanydaysperyeardopeople cycle?
Entervalue
Reason:
Post–interventiondata
Onlycompletethissectionifyourinputdatausestripcounts
Doyouknowthenumberofpeoplewhotakewalking/cyclingtrips,ordoyouwishtoestimatethenumberbasedonreturnjourneys?
Iknowthenumberofpeople(youcanskipthenextquestion)
EstimatebasedonreturnjourneysWhatproportionofyourtripswillbeareturnjourney?
Entervalue
Reason:
Howmanydaysperyeardopeople walk/cycle?
Entervalue
Reason:
Timeneededtoreachfulllevelof walking/cycling?
Entervalue
Reason:
Timeperiodoverwhichbenefitsare calculated?
Entervalue
Reason:
Proportionofwalking/cyclingdata attributabletoyourintervention?
Entervalue
Reason:
Valuingthehealthbenefitsoftransportschemes 7776 Frequentlyaskedquestions
Documents
HEAT methodology and user guide (2014 update)
Improving the health of Londoners: Transport action plan
Travel in London reports
NICE guidelines: Physical activity and the environment
Cycling is good for health and the economy, Glasgow Centre for Population Health3
Websites
HEAT websiteheatwalkingcycling.org
Department for Transport WebTAGwww.gov.uk/guidance/transport-analysis-guidance-webtag
Sustrans, national charity enabling people to travel by foot, bike or public transport www.sustrans.org.uk/
Living Streets, the UK charity for everyday walkingwww.livingstreets.org.uk/
Transport for London tfl.gov.uk
ECONOMIC ASSESSMENT OF TRANSPORT INFRASTRUCTURE AND POLICIES
Health economic assessment tools (HEAT) for walking and for cycling
Methods and user guide, 2014 update
Improving the health of Londoners Transport action plan
Travel in London Report 7
PhPhysical activity and the enysical activity and the environmentvironment
Public health guideline
Published: 23 January 2008nice.org.uk/guidance/ph8
© NICE 2008. All rights reserved.
Cycling is good for healthand the economy
BRIEFING PAPER 37 FINDINGS SERIES
May 2013
StandardstatisticaldataUKmortalityrate Chooseanagerangefromthedrop-
downmenu
SelecttheUKfromthedrop-downmenuofcountry-specificmortality rates
Averagepopulation
Youngeraveragepopulation
Olderaveragepopulation
Valueofstatisticallife
SelecttheUKfromthedrop-down menu
HEATstandardUKvalueis£3,229,114
Discountingrate IfyouarerunningHEATtogenerateinputsforTfL’sBusinessCaseAssistant(BCA)tool,enteradiscountrateofzero.TheBCAdiscountsallfiguresputintoitandwouldendupdiscountinghealthbenefitstwice
Forallotherprojects,enteradiscountrateof3.5percent
If I get really stuck using these tools, what should I do?
• ReadtheWHOmanualontheHEATwebsite
• SignuptoaWHOonlinetrainingsession
• ContactLucySaunders ([email protected])
© Transport for London WindsorHouse 42–50VictoriaStreet LondonSW1H0TL
November 2015
tfl.gov.uk FL15_131
