Prepared by Kim Perrotta, CHASE, May 2024

When working to influence policies and investments in local communities, it is useful to recognize the intersection between population health, health equity, and sustainability.  Communication surveys indicate that people are more likely to support climate-related policies when they understand that those policies can produce immediate health benefits.  In addition, when investments are being made in local communities to transition away from fossil fuels that are driving climate change, it is essential that consideration be given to how those investments can improve population health and reduce social inequities.  Investments in active transportation infrastructure have the potential to improve health and health equity while also reducing greenhouse gas emissions.  These investments can increase levels of physical activity, reduce air pollution, and improve safety and affordable access to essential services, jobs, and recreational opportunities, while fighting climate change.

Active Transportation Reduces Greenhouse Gases

The transportation sector is responsible for 24% of the greenhouse gases (GHGs) emitted in Canada.  While average vehicle-kilometres travelled (VKT) have decreased over the last 20 years, the total number of vehicles on the road has increased by 42%, leading to an increase in the total kilometres driven.[i] Active modes of transportation emit no GHGs so they have the potential to substantially reduce the GHGs associated with the transportation sector. Several modelling studies have found that, in large urban centres where significant population growth is expected, an ambitious active transportation strategy can substantially reduce VKT and GHG emissions.^[ii]

Physical Activity Reduces Chronic Diseases and Premature Deaths

The health benefits of physical activity are well known.  Regular physical activity is known to reduce the risk of developing several chronic conditions including diabetes, cardiovascular disease (CVD), several cancers, and premature deaths from all causes.[iv]  Researchers have estimated that 150 and 300 minutes of moderate to vigorous physical activity per week can reduce the risk of premature death from all causes by 14% and 26% respectively.^[v]

Physical activity is also good for mental health.  It can improve self-esteem, sleep, and cognitive functioning in older adults, and delay the onset of dementia. It can also relieve depression, anxiety and stress, and support drug and alcohol rehabilitation.^[vi] Many people in Canada do not engage in the levels of physical activity needed to maintain good health.

Less than half of the adults in Canada get the minimum of 150 minutes/week of physical activity that are recommended to maintain good health.[vii]  A little over one half of the youth in Canada are getting the 60 minutes/day of physical activity recommended for good health.[viii]  It has been estimated that physical inactivity results in approximately $6.8 billion/year in health-related costs based on its contribution to seven chronic diseases alone.^[ix]

Active Transportation Increases Physical Activity

Active modes of transportation, such as walking and cycling, allow people to incorporate physical activity into their daily schedules.^[x]  Over the last two decades, several cross-sectional studies and several long-term studies have identified linkages between active transportation, levels of physical activity, and positive health outcomes. [xi]  For example, a 2017 that followed more than 250,000 people from 22 communities across the United Kingdom over five years, identified strong relationships between active travel, physical activity, chronic diseases, and premature deaths.  After adjusting for a wide range of confounders, this study found that:

• Approximately 90% of cycling commuters and approximately 80% of mixed mode cycling commuters reached physical activity levels recommended by health guidelines;
• Approximately 54% of walking commuters and approximately 50% of mixed mode walking commuters met physical activity guidelines with their commutes;
• Commuting by cycling was associated with a lower risk of CVD and cancer, and a statistically significant lower risk of premature death from all causes; and
• Commuting by walking was associated with a lower risk of CVD, but only among those who walked more than six miles or two hours per week.^[xii]

Active Transportation Improves Air Quality

A modal shift to active modes of transportation can have a substantial impact on air quality and human health as well.  For example, a modelling study focused on the Midwestern United States estimated that $7.35 billion/year in health-related benefits could be gained for the 31.3 million people living in the region, if all vehicle trips that were 8 kilometres or less were eliminated, and one half of those were replaced with cycling.  Nearly one half of the health benefits were attributed to reductions in air pollution while the other half were attributed to increases in physical activity.^[xiii]

Physical Activity Benefits Outweigh Air Pollution Exposures

Concerns have been expressed about the air pollution exposure that cyclists can experience when travelling along roadways.  Studies have shown that while cyclists can be exposed to higher levels of air pollution when travelling beside roads, the health benefits gained from their increased levels of physical activity, far outweigh the health risks posed by their increased exposure to air pollution.  This held true for all but a few countries that have exceptionally high levels of air pollution.^[xiv],[xv]

Active Transportation Infrastructure Increases Safety and Modal Shifts

Research has demonstrated that people are more likely to walk if their route is safe and attractive. Vehicle-related collisions with pedestrians are more likely to occur near schools and in commercial areas where there is heavier traffic, more pedestrians, and a greater density of intersections.  Studies have demonstrated that pedestrian safety can be improved with infrastructure such as overpasses, barriers, fences, streetlights, traffic lights, and sidewalks.[xvi]

Studies from several countries have found that the number of cyclists killed or seriously injured decreases as the number of cyclists increases.  This pattern is attributed to both, the increased visibility of cyclists, and the increased awareness among drivers when the number of cyclists is high.^[xvii]  Cycling facilities also play a pivotal role in cycling safety.  In the US, where there has been relatively little investment in cycling facilities, cyclists have much higher serious injury and fatality rates than in European countries that have made significant investments in cycling infrastructure. [xviii]

A  study in Toronto and Vancouver found that cycle tracks (i.e., on-street bicycle lanes that are physically separated from motor vehicles by raised curbs, bollards, or concrete barriers) were the safest type of cycling facility. When compared to major streets with parked cars and no cycling facilities:

• Cycle tracks were 89% safer;
• Unprotected cycling lanes on major roads without parked cars were 53% safer; and
• Residential streets with light traffic and no cycling facilities were 56% safer.[xix]

A study based on 13 years of data from 12 large US cities, found that cities with a high-cycling modal share have roads that are safer for all road users, including cyclists.  After examining 17,000 fatalities and 77,000 severe injuries related to vehicle crashes, the research team concluded that the roads in these cities were safer because they have a greater prevalence of protected and separated bike facilities.  These cities also have higher intersection density that tends to be associated with more compact built environments that have lower traffic speeds. The research team noted that road safety is associated with gentrification, which suggests that there may not be equitable access to the safer roads.[xx]

Designated cycling infrastructure is essential to encourage reluctant cyclists, particularly new cyclists, to engage in cycling as a mode of transportation.  Studies have also found that cycling modal share is associated with the length of a cycling network.^[xxi],[xxii] A study of 167 European cities found that a cycling modal share of up to 24.7% could be achieved with a cycling network composed of 315 km of cycle track/100,000 people.[xxiii]

Active Transportation and Health Equity

Few studies have looked at the equity aspects of active transportation interventions. A 2022 scoping review identified 10 studies that examined the impact of health promotion programs, improvements to pedestrian and cycling infrastructure, and increased transit infrastructure or access.  Eight studies found a positive impact on health outcomes for all populations.  Nine found no significant difference or a favourable impact on the health of the disadvantaged  groups relative to the overall population. The review noted a significant gap in the literature between active travel and health inequities  including if active travel infrastructure is inequitably distributed.[xxiv]

In the City of Toronto, it has been acknowledged that the historic practice of investing in on-street cycling infrastructure in the downtown core has resulted in the inequitable distribution of active transportation infrastructure; that a number of lower income neighbourhoods in the city’s suburbs have not been well served by cycling investments.  The city is now working to address this problem by developing a Cycling Network Plan that applies an equity lens to its decisions.[xxv]

The needs of older adults are not always considered when communities are designed.  A 2020 study directed at older populations living in different types of neighbourhoods across Canada found that their use of active modes of transportation was influenced by the presence of cycling infrastructure, well maintained sidewalks, and traffic safety.[xxvi] People with mobility challenges are another group whose needs are not always reflected in neighbourhood design, and yet 14% of people in Canada who are 15 or older live with a disability that limits their daily activities. Evidence suggests that neighbourhoods with less traffic, uncrowded spaces, good accessibility, and high quality and safe streets, can increase the activity, social interaction, and productivity of people with disabilities.[xxvii]

The perception of traffic safety can be an important deterrent to cycling, particularly among women.  In countries where cycling can be perceived as unsafe, men cycle at much higher rates than women. In the Greater Toronto and Hamilton Area (GTHA) for example, fewer than 30% of cyclists are women.  In countries that have higher cycling modal shares and separated cycling infrastructure, women cycle at rates similar to those for men.  In the Netherlands and Denmark for example, women make 55% and 45% respectively of all bike trips.[xxviii]

Policies to Promote:

• Investing in safe and connected active transportation infrastructure
• Ensuring that all new roads or re-surfaced roads integrate active travel infrastructure
• Prioritizing low-income neighbourhoods for active transportation infrastructure

Download 3-Page Factsheet

To learn more, see the report and blogs prepared by CHASE in collaboration with the CPHA and OPHA:  

• Report: CLIMATE CHANGE, POPULATION HEALTH AND HEALTH EQUITY: Public health strategies and five climate solutions that produce health and health equity benefits. 
• Blog:  Applying Health Equity-informed Planning to Operations in Niagara Region
• Blog:  Promoting Active Transportation and Health Equity in Rural Haliburton
• Blog: Best Practices for Active Travel and Health Equity in Small Towns in British Columbia

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[i] Government of Canada. 2022. Greenhouse Gas Emissions, Sources and Sinks, Executive Summary. Web-page.

[ii] David Suzuki Foundation, Sustainable Transportation Action Research Team (SFU) and Navius Research. 2019. Shifting Gears: Climate Solution for Transportation in Cities. Metro Vancouver Case Study. 75 pages.

[iii] Maizlish N et al. 2013. Health Co-benefits and Transportation-Related Reductions in Greenhouse Gas Emissions in the San Francisco Bay Area. American Journal of Public Health. April 2013.

[iv] Statistics Canada. 2020. Daily physical activity and sedentary behaviour across occupational classifications in Canadian adults. Prepared by Stephanie Prince et al. Sept 16

[v] Samitz G et al. 2011. Domains of physical activity and all-cause mortality: Systematic review and dose-response meta-analysis of cohort studies. Int J Epidemiol. 40(5):1382-1400

[vi] Bingham PB. 2009. Physical Activity and Mental Health Literature Review.

[vii] Statistics Canada. 2020. Canadian Health Measure Survey: Activity Monitor Data, 2018-2019

[viii] Statistics Canada. 2022. 60 minutes of play, every day.

[ix] Janssen I. 2012. Health care costs of physical inactivity in Canadian adults. Applied Physiology, Nutrition, and Metabolism. June 6.

[x] Canadian Fitness and Lifestyle Research Institute. 1996. Progress in Prevention: Barriers to physical activity.

[xi] Pucher J et al. 2011. Walking and Cycling to Health: A Comparative Analysis of City, State, and International Data. AJPH.

[xii] Celis-Morales CA et al. 2017. Association between active commuting and incident cardiovascular disease, cancer, and mortality: prospective cohort study. BMJ. 357:j1456

[xiii] Grabow M et al. 2011. Air Quality and Exercise-Related Health Benefits from Reduced Car Travel in the Midwestern United States, Environmental Health Perspectives. November

[xiv] Tanio M et al. 2016. Can air pollution negate the health benefits of cycling and walking? Preventive Medicine. Vol. 87. June

[xv] De Hartog JJ et al. 2010. Do the health benefits of cycling outweigh the risks?. Environmental health perspectives.

[xvi] Chief Public Health Officer. 2017. Designing Health Living. Public Health Agency of Canada.

[xvii] Woodcock J et al. 2009. Public health benefits of strategies to reduce greenhouse-gas emissions: urban land transport. Lancet, 374 (9705), pp. 1930–1943.

[xviii] Pedroso FE et al. 2016. Bicycle use and cyclist safety following Boston’s bicycle infrastructure expansion, 2009–2012. Am J Public Health.

[xix] Teschke K et al. 2012. Route infrastructure and the risk of injuries to bicyclists: a case-crossover study. Am J Public Health.

[xx] Marshal WE & Ferenchak NN. 2019. Why cities with high bicycling rates are safer for all road users. Journal of Transport and Health. Vol 13.

[xxi] Toronto Public Health. 2012. Road to Health: Improving Walking and Cycling in Toronto. April.

[xxii] Mueller N et al. 2019. Health impact assessment of cycling network expansions in European cities. Preventive Medicine. Vol. 109.

[xxiii] Mueller N et al. As cited above.

[xxiv] Hansmann K et al. 2023. Health Equity and Active Transportation: A Scoping Review of Active Transportation Interventions’ Impact on Health Equity. The Annals of Family Medicine January 2023, 21 (Supplement 1) 3657

[xxv] Perrotta K. 2022. Toronto introduces equity lens to cycling infrastructure. HealthyDesign.City Website. https://healthydesign.city/toronto-introduces-equity-lens-to-cycling-infrastructure/

[xxvi] O’Rourke N & Dogra S. 2020. Constraints to active transportation in older adults across four neighbourhoods: a descriptive study from Canada, Cities & Health, DOI: 10.1080/23748834.2020.1833282

[xxvii] Chief Public Health Officer. 2017. Designing Health Living. Public Health Agency of Canada.

[xxviii] Pucher et al. 2018 and Mitra et al. 2016 and WHO 2011 as cited by Daniel K & Perrotta K. 2017. Prescribing Active Travel for Healthy People and a Healthy Planet: A Toolkit for Health Professionals. Prepared for the Canadian Association of Physicians for the Environment.