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 (lucysaunders@tfl.gov.uk)

© Transport for London WindsorHouse 42–50VictoriaStreet LondonSW1H0TL

November 2015

tfl.gov.uk FL15_131