Examples of applications of the health economic assessment tool (HEAT) for cycling

HEAT has been used to support the evaluation and planning of walking and cycling in several countries within and outside the European Region.


The modal share of cycling in Austria is currently 5%, with an average trip length of 2 km. Calculations made with the HEAT for cycling tool estimated that this level of cycling saves 412 lives every year owing to regular physical activity. The corresponding average annual savings for Austria from this reduced mortality were estimated to amount to €405 million.

Czech Republic

The level of cycling in the city of Pilsen is low, but a study by the Czech Charles University Environment Centre showed that 2% of participants would be ready to take up regular cycling if the infrastructure were improved. Assuming an average of 2 cycling trips per day, the mortality savings from such an increase in cycling would result in discounted annual savings of €882 000.


The Pärnu city government used HEAT to estimate the value of future projected levels of cycling.

Manual counting and questionnaires were used to estimate the number of people currently cycling, duration and distance cycled. This was then used to estimate the future number of cyclists following infrastructure improvements. Assuming that 230 cyclists per day would use a proposed new route, and that 50% of these would be additional new cyclists, avoidable deaths would be reduced by 0.17 per year.

Using a country-specific value of statistical life of €1 430 000, this leads to a current value of the average annual benefit, averaged across 6 years, of €112 000 per year.

The HEAT-derived results were used as one of the tools to secure funding to build a new 4 km pathway to connect downtown and residential areas. The results are also being used to support the development of a master plan for Pärnu and a strategic environmental assessment.


Kuopio city authorities used HEAT to estimate the value of existing levels of cycling among city employees.

Estimates of the annual number of deaths prevented varied between 0.29 and 5.66 and the current value of the average annual benefit averaged across 10 years varied between €396 000 and €7 604 000 respectively.

The HEAT results were used to help secure agreement for the promotion of cycling commuting. Future uses of HEAT include a project to promote cycling among employees of large employers situated close to an existing cycle route perceived to be dangerous.


  • The University of Florence used HEAT to estimate the value of existing and future projected levels of walking and cycling to work or to school. The project was designed in collaboration with the Department of Prevention, Florence Local Health Authority and the Municipality of Florence, based on 2001 Italian population census data (ISTAT).
    Results showed that lives saved each year amount to 16.75 for walking and 5.26 for cycling. The corresponding average annual health savings were estimated to be €20.3 million for walking and €6.4 million for cycling. The scenario analysis of future cycling estimated between 6689 and 15 343 additional individuals cycling regularly; with between 3.91 and 9.64 preventable deaths per year and discounted annual savings of between €3 341 000 and €8 235 000.
    These results were used to provide local decision-makers with quantitative evidence that a modal shift toward cycling among students and workers improves health, is economically convenient and may help reduce health inequalities. The results are also being used to raise public awareness of cycling as a means of urban transportation and a valid, healthy and green option to cars and motorcycles.
  • The city of Modena used HEAT to estimate the value of existing levels of cycling, increases in cycling, future projected levels of cycling and the health benefits produced by the use of a new cycling path which connects the main hospital/university with the city centre.
    Results showed an anticipated increase of 1091 in the number of cyclists and an associated number of avoidable deaths of 0.35 per year. Average mortality risk was expected to decrease by 5.13%. The current value of the annual benefit averaged across 10 years was €414 000. The results were used to help secure agreement for the new cycling path.


The Swedish Road Administration adopted HEAT for cycling as part of their official toolbox for the economic assessment of cycling infrastructure.

United Kingdom (UK)

  • The Cycling Towns programme in England provided funding to selected towns and cities to increase levels of cycling. In Brighton & Hove, local authority and National Health Service staff used HEAT to explore the potential health economic benefits from involvement in the programme.
    Results showed a 30% increase in the number of cyclists during 2007-2010. The current value of the mean annual benefit averaged across 10 years was £220 115.
  • The Glasgow Centre for Population Health in Scotland used HEAT to estimate the value of existing levels of cycling, supported by data from Glasgow City Council Land and Environmental Services. The study population comprised Glasgow residents commuting into the city centre (20% of all cycling commuter journeys).  
    The HEAT-estimated mean annual benefit was just over £3 million in 2009, increasing to over £4 million between 2009 and 2012. This is considered to be a conservative estimate as the tool only accounts for reduced mortality and not reduced morbidity and other health benefits associated with cycling.  
    The results attracted extensive media coverage and the attention of local decision-makers and others, who indicated that they will use the findings, where possible, in the development of local development plans and other action plans.
  • Sustrans, a UK charity enabling people to travel by foot, bike or public transport for more of their daily journeys, used HEAT to estimate the value of existing levels of walking and cycling across the UK’s National Cycle Network.
    Results showed that levels of cycling in 2011 prevented 264 deaths, valued at £286 million, and levels of walking prevented 144 deaths, valued at £156 million. HEAT values were used as part of the evidence to support continued investment in the National Cycle Network.

United States of America

The Boston Metropolitan Area Planning Council used HEAT along with a health impact assessment to evaluate  proposals to increase fares and cut services on public transport. 

HEAT helped estimate the economic costs of potential increases in mortality as a consequence of decreases in regular walking. Results showed that across the 2 proposals there would be 9 to 14 additional deaths per year due to decreased physical activity, which could be valued between $74.9 and $116.5 million. This significant cost associated with the proposed fare and service changes was second only to the cost of time lost to congestion.

Central Europe - BICY Project 

The University of Bologna, Italy, used HEAT as part of the BICY Project ("Cities and Regions for Cycling"), which aims to identify the most effective strategies to increase cycling in central Europe. The project involves 11 partners in 6 countries (Austria, Czech Republic, Hungary, Italy, Slovakia and Slovenia). HEAT was used to estimate the value of existing and projected future levels of cycling or walking in 12 of the cities studied.

The study produced a range of results according to different projections. For example, reaching the target of 15% mode share for cycling by 2015 in 6 eastern European cities would prevent between 1.7 and 33.3 deaths per year in each city (depending on the population size of the city). This would generate average annual benefits of between €1.3 million  and €24 million in each city per year.

Using projected costs of the network construction, this equates to a cost per life saved per year of between €463 738 and €1.56 million; and benefit-cost ratios of between 4.6:1 and 15.6:1, with larger cities showing higher cost-benefit returns than smaller towns.