Francesca Racioppi

Who owns the roads? How motorised traffic discourages walking and bicycling

Objective: To examine the impact of traffic on levels of walking and bicycling. Method: Review of the literature of medical, public health, city planning, public administration and traffic engineering. Results: The real and perceived danger and discomfort imposed by traffic discourage walking and bicycling. Accurately or not, pedestrians and bicyclists judge injury risk and respond accordingly. Although it can be difficult to measure these effects, observed behaviour provides good evidence for these effects, with the strongest association being an inverse correlation between volumes and speeds of traffic and levels of walking and cycling. Conclusion: Interventions to reduce traffic speed and volume are likely to promote walking and bicycling and thus result in public health gains.

Reducing inequalities from injuries in Europe

Injuries cause 9% of deaths and 14% of ill health in the WHO European Region. This problem is neglected; injuries are often seen as part of everyday life. However, although western Europe has good safety levels, death and disability from injury are rising in eastern Europe. People in low-to-middle-income countries in the Region are 3.6 times more likely to die from injuries than those in high-income countries. Economic and political change have led to unemployment, income inequalities, increased traffic, reduced restrictions on alcohol, and loss of social support. Risks such as movement of vulnerable populations and transfer of lifestyles and products between countries also need attention. In many countries, the public-health response has been inadequate, yet the cost is devastating to individuals and health-service budgets. More than half a million lives could be saved annually in the Region if recent knowledge could be used to prevent injuries and thus redress social injustice in this area.

Evidence-based physical activity promotion - HEPA Europe, the European Network for the Promotion of Health-Enhancing Physical Activity

There has been a world-wide increase in scientific interest in health-enhancing physical activity (HEPA). The importance of a physically active lifestyle has now been well established both on the individual and on the population level. At the same time, physical inactivity has become a global problem. While sports for all has a long history, only a few examples of long-term integrated physical activity promotion strategies have been in place in Europe until recently, namely in Finland, the Netherlands and England. A number of countries have now begun to develop their own activities. However, there has been a noticeable lack of a platform for sharing the development and implementation of evidence-based policies and strategies. In order to fill this gap, HEPA Europe, the European Network for the Promotion of Health-Enhancing Physical Activity, was founded in May 2005 in Gerlev, Denmark. The goal of the network is to strengthen and support efforts and actions that increase participation in physical activity and improve the conditions favourable to a healthy lifestyle, in particular with respect to HEPA. The Network is working closely with the WHO Regional Office for Europe (http://www.euro.who.int/hepa). The network focuses on population-based approaches for the promotion of HEPA, using the best-available scientific evidence, and is currently implementing its first projects. HEPA Europe has established collaboration with EU Commission projects and Agita Mundo. Priorities for future work have been defined, and interested organisations and institutions have the opportunity to join the network and participate in the process.

Including health in transport policy agendas: the role of health impact assessment analyses and procedures in the European experience

From the mid-1990s, research began to highlight the importance of a wide range of health impacts of transport policy decisions. The Third Ministerial Conference on Environment and Health adopted a Charter on Transport, Environment and Health based on four main components: bringing awareness of the nature, magnitude and costs of the health impacts of transport into intergovernmental processes; strengthening the arguments for integration of health into transport policies by developing in-depth analysis of the evidence; developing national case studies; and engaging ministries of environment, health and transport as well as intergovernmental and nongovernmental organizations. Negotiation of the Charter was based on two converging processes: the political process involved the interaction of stakeholders in transport, health and environment in Europe, which helped to frame the issues and the approaches to respond to them; the scientific process involved an international group of experts who produced state-of- the-art reviews of the health impacts resulting from transportation activities, identifying gaps in existing knowledge and methodological tools, specifying the policy implications of their findings, and suggesting possible targets for health improvements. Health arguments were used to strengthen environmental ones, clarify costs and benefits, and raise issues of health equity. The European experience shows that HIA can fulfil the need for simple procedures to be systematically applied to decisions regarding transport strategies at national, regional and local levels. Gaps were identified concerning models for quantifying health impacts and capacity building on how to use such tools.

Physical Activity through Sustainable Transport Approaches (PASTA): a study protocol for a multicentre project

Introduction Only one-third of the European population meets the minimum recommended levels of physical activity (PA). Physical inactivity is a major risk factor for non-communicable diseases. Walking and cycling for transport (active mobility, AM) are well suited to provide regular PA. The European research project Physical Activity through Sustainable Transport Approaches (PASTA) pursues the following aims: (1) to investigate correlates and interrelations of AM, PA, air pollution and crash risk; (2) to evaluate the effectiveness of selected interventions to promote AM; (3) to improve health impact assessment (HIA) of AM; (4) to foster the exchange between the disciplines of public health and transport planning, and between research and practice. Methods and analysis PASTA pursues a mixed-method and multilevel approach that is consistently applied in seven case study cities. Determinants of AM and the evaluation of measures to increase AM are investigated through a large scale longitudinal survey, with overall 14 000 respondents participating in Antwerp, Barcelona, London, Örebro, Rome, Vienna and Zurich. Contextual factors are systematically gathered in each city. PASTA generates empirical findings to improve HIA for AM, for example, with estimates of crash risks, factors on AM-PA substitution and carbon emissions savings from mode shifts. Findings from PASTA will inform WHOs online Health Economic Assessment Tool on the health benefits from cycling and/or walking. The studys wide scope, the combination of qualitative and quantitative methods and health and transport methods, the innovative survey design, the general and city-specific analyses, and the transdisciplinary composition of the consortium and the wider network of partners promise highly relevant insights for research and practice. Ethics and dissemination Ethics approval has been obtained by the local ethics committees in the countries where the work is being conducted, and sent to the European Commission before the start of the survey. The PASTA website (http://www.pastaproject.eu) is at the core of all communication and dissemination activities.

Health impact of motorised trips that could be replaced by walking

BACKGROUND We aimed to quantify the number of women and men, in Catalonia, among those not achieving physical activity recommendations, making short motorized trips which could have been made on foot, and to estimate the annual economic benefit due to reducing mortality as a result of replacing one short, daily, motorized journey with walking. METHODS Cross-sectional study. Mobility data came from individuals >17 years who reported, in the 2006 Daily Mobility Survey, having travelled on the referred working day (N = 80,552). The health economic assessment tool for walking (HEAT) from the World Health Organization (WHO) Regional Office for Europe was used to calculate the economic benefit. RESULTS Of those not meeting recommendations, 15.6% of men (95% CI 15.2-16.1) and 13.9% of women (95% CI 13.5-14.4) would go on to meet them if they were to replace at least one short motorized trip per day by walking. If applied to the entire population of Catalonia, this change would increase up to 326,557 men (95% CI 313 373-339,740) and up to 252,509 women (95% CI 240,855-264,163) who would achieve recommendations through walking rather than driving. According to HEAT estimations, this would suppose a saving of €124,216,000 (95% CI 120,182,000-128,250,000) in men and €84,927,000 (95% CI 81,774,000-88,079,000) in women, derived from the reduction in mortality gained from walking accumulated over one year. CONCLUSION This study demonstrates the potential of trips on foot as a source of physical activity. It also points out that both benefits for the health of the population and a huge economic benefit could have been gained through active transportation interventions.

Sport promotion policies in the European Union: results of a contents analysis

Although sport promotion may play an important role in achieving the recommended levels of physical activity for health, until now, there has been no comprehensive assessment of how sport policies in Europe address health. This article aimed at filling this gap by reviewing and analyzing recent national policy developments in the area of sport promotion, with a focus on synergies and discrepancies with the promotion of health‐enhancing physical activity. By applying various search methods, 130 documents focusing on sport and physical activity were identified in the World Health Organization (WHO) European Region. An analysis grid covering key indicators was developed for a systematic content analysis of 25 documents, selected according to established criteria. Analysis showed that general recommendations for good policy making were followed, such as establishing general goals, specifying time frame and responsible body for implementation and addressing different target groups. Furthermore, all sport strategies addressed health on an overall level and recognized the importance of Sport for All. However, in several strategies, there was a lack of measurable targets, specified budgets, and evaluation plans. The analysis showed that there is a great opportunity for health and sport sectors to work more closely together in the future, and identified areas where this could take place.

Systematic review and quality assessment of economic evaluation studies of injury prevention

OBJECTIVE To review and assess the quality of economic evaluation studies on injury prevention measures. DESIGN Systematic review. DATA SOURCES Electronic databases searched included Medline (Pubmed), EMBASE, Web of Science, PsycINFO, and Safetylit. INCLUSION CRITERIA Empirical studies published in English in international peer-reviewed journals in the period 1998-2009. The subject of the study was economic evaluation of prevention of unintentional injury. Cost-effectiveness (CEA), cost-benefit (CBA) and cost utility (CUA) analyses were included. METHODS Methodological details, study designs, and analysis and interpretation of results of the included articles were reviewed and extracted into summary tables. Study quality was judged using the criteria recommended by the Panel on cost-effectiveness in health and medicine and the British Medical Journal (BMJ) checklist for economic evaluations. RESULTS Forty-eight studies met the inclusion criteria of our review. Interventions assessed most frequently were hip protectors and exercise programs for the elderly. A wide variety of methodological approaches was found, including differences in type of economic evaluation, perspective, time horizon, study design, cost categories, effect outcomes, and adjustments for timing and uncertainty used. The majority of studies performed a cost-effectiveness analysis from a societal perspective with a time horizon of one to five years, in which the effect was expressed in terms of injuries prevented and only direct health care costs were included. Most studies deviated from one or more of the Panel recommendations or BMJ guidelines; e.g. not adopting the societal perspective, not including all relevant costs, no incremental analysis. CONCLUSIONS This review has shown that approaches to economic evaluation of injury prevention vary widely and most studies do not fulfill methodological rigour. Improving quality and harmonization of economic evaluation studies in the field of injury prevention is needed. One way of achieving this would be to establish international guidelines on economic evaluation for injury prevention interventions, based on established economic evaluation checklists, to assist researchers in the design and reporting of economic evaluations.

On the way to Parma: understanding and addressing the influence that social inequities have on environmental health

On 10–12 March 2010, ministers of environment and health of the 53 countries in the WHO European Region (and a number of international governmental and non-governmental organizations) will meet in Parma, Italy, on the occasion of the Fifth Ministerial Conference on Environment and Health. One major item in their agenda is going to be the increasing challenge of inequities in exposure to environmental hazards. These inequities emerge both between and within countries, and are significantly influenced by social conditions.1 The recent economic crisis has further exposed the potential exacerbating effect that social factors may have on inequities and their consequences for health.2 To support its Member States in developing more informed policies on the environmental dimension of health inequities, WHO commissioned evidence reviews on the occurrence and extent of social inequities in exposure to selected environmental risk factors with a specific focus on inequities affecting children.3 Social factors considered in these reviews were socioeconomic status (income, education, employment), age, gender, ethnicity, or being part of a minority group. Summaries of the reviews on social inequities in housing4, waste management5, air pollution6 and childrens environment7 are published in this issue of the EJPH. The compiled evidence was reviewed by 40 experts from 20 countries at a consultation meeting convened by WHO in Bonn on 9–10 September, 2009, resulting in a set of policy recommendations on possible measures to be undertaken to alleviate the inequities and their health burden. …

Developing a national policy for injury and violence prevention

As injuries can happen in any setting, to anyone and at any time, the preventive responses required need to be comprehensive. Accordingly, this requires the involvement of many stakeholders from different sectors and disciplines (Krug, Dahlberg, Mercy, Zwi & Lozano, 2002; Peden et al., 2004). The development and implementation of national policies are rational ways of obtaining commitment and coordinating the efforts, roles, responsibilities and resources of the many actors involved (Schopper, Lormand & Waxweiler, 2006). The lack of such coordination may lead to an incomplete or fragmented response and to duplication or divergence of efforts. A policy has essential elements that include a vision, with targets, actions, resources and actors required to successfully implement it over a defined time scale in a coordinated way. In addition to providing evidence on the burden and on what works for prevention, WHO’s world reports on violence and health and road traffic injury prevention promote the development of national prevention policies (Krug et al., 2002; Peden et al., 2004). This paper draws upon WHO’s Developing policies to prevent injuries and violence: guidelines for policy-makers and planners (Schopper et al., 2006).