title: Improving health through policies that promote active travel: a review of evidence to support integrated health impact assessment.
abstract: BACKGROUND
  Substantial policy changes to control obesity, limit chronic disease, and reduce air pollution emissions, including greenhouse gasses, have been recommended. Transportation and planning policies that promote active travel by walking and cycling can contribute to these goals, potentially yielding further co-benefits. Little is known, however, about the interconnections among effects of policies considered, including potential unintended consequences.
  
  
  OBJECTIVE
  We review available literature regarding health impacts from policies that encourage active travel in the context of developing health impact assessment (HIA) models to help decision-makers propose better solutions for healthy environments. We identify important components of HIA models of modal shifts in active travel in response to transport policies and interventions.
  
  
  CONCLUSIONS
  Policies that increase active travel are likely to generate large individual health benefits through increases in physical activity for active travelers. Smaller, but population-wide benefits could accrue through reductions in air and noise pollution. Depending on conditions of policy implementations, risk tradeoffs are possible for some individuals who shift to active travel and consequently increase inhalation of air pollutants and exposure to traffic injuries. Well-designed policies may enhance health benefits through indirect outcomes such as improved social capital and diet, but these synergies are not sufficiently well understood to allow quantification at this time.
  
  
  CONCLUSIONS
  Evaluating impacts of active travel policies is highly complex; however, many associations can be quantified. Identifying health-maximizing policies and conditions requires integrated HIAs.
authors.affiliation: Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain. anazelle@creal.cat
authors.forename: Audrey
authors.initials: A
authors.lastname: de Nazelle
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Nieuwenhuijsen
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authors.initials: JM
authors.lastname: Antó
authors.forename: Michael
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authors.lastname: Brauer
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authors.lastname: Briggs
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authors.lastname: Kingham
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authors.initials: JD
authors.lastname: Marshall
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authors.lastname: Matamala
authors.forename: Giorgos
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authors.lastname: Mellios
authors.forename: Michelle
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authors.lastname: Mendez
authors.forename: Hala
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authors.lastname: Nassif
authors.forename: David
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authors.lastname: Ogilvie
authors.forename: Rosana
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authors.lastname: Peiró
authors.forename: Katherine
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authors.lastname: Pérez
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authors.lastname: Rabl
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authors.lastname: Ragettli
authors.forename: Daniel
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authors.lastname: Rojas
authors.forename: Pablo
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authors.lastname: Ruiz
authors.forename: James F
authors.initials: JF
authors.lastname: Sallis
authors.forename: Jeroen
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authors.lastname: Terwoert
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Toussaint
authors.forename: Jouni
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authors.lastname: Tuomisto
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authors.lastname: Zuurbier
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mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000397:Air Pollution / Q000009:adverse effects / Q000706:statistics & numerical data; D001642:Bicycling / Q000706:statistics & numerical data; D004781:Environmental Exposure / Q000706:statistics & numerical data; D058735:Environmental Policy; D015444:Exercise; D015438:Health Behavior; D006291:Health Policy; D006304:Health Status; D006358:Hot Temperature / Q000009:adverse effects; D006801:Humans; D009624:Noise, Transportation / Q000009:adverse effects / Q000706:statistics & numerical data; D013472:Sunlight / Q000009:adverse effects; D014186:Transportation / Q000706:statistics & numerical data*; D014195:Travel; D016138:Walking / Q000706:statistics & numerical data