Notas de borrador para la conversación sobre Bicicleta y Cerebro del 7 de abril 2022


Notas de borrador para la conversación sobre Bicicleta y Cerebro del 7 de abril 2022
(Conversación con Carlos Rodriguez en el marco de la iniciativa de 30 días en/con bici)

[Notas desordenadas y en construcción.
(las notas, sobre todo las referencias bibliográficas, algunas de ellas bastante actualizadas y muchas de ellas muy sólidas como las del What Works for Health de los County Health Rankings & Roadmaps, creo que son bastante buenas para realizar un buen informe técnico si alguien tiene que realizarlo para justificar el porqué ciertas intervenciones que incrementan la movilidad activa en una ciudad – peatonalización, carriles bici, disminución de coches privados…- de la población de forma global tienen un impacto enorme en términos de salud colectiva y más aún, como serían un mandato de obligado cumplimiento según las normativas vigentes relacionadas con sostenibilidad, medio ambiente y etc.. Ahí lo dejo 🙂 ]

Las mujeres y los hombres en el territorio donde vivimos. Los lugares donde nacemos, crecemos, nos educamos, jugamos, nos relacionamos, trabajamos, paseamos y envejecemos tienen que ver mucho con nuestro bienestar (voy a tratar de no utilizar la palabra salud). Cómo nos movemos y nos desplazamos. Nuestros itinerarios vitales y nuestros itinerarios físicos. Dónde naces, dónde creces, dónde trabajas.

La forma en que ponemos nuestro cuerpo en la ciudad y en el territorio donde vivimos, cómo nos relacionamos con nuestros cuerpos en los territorios determina nuestro bienestar individual y colectivo. El uso que hacemos de nuestra ciudad y para qué lo hacemos. Cómo ponemos nuestro cuerpo en la ciudad como movimiento Poético y Político. (Política, cito textualmente: Actividad del ciudadano y de la ciudadana cuando interviene en los asuntos públicos con su opinión, con su voto, o de cualquier otro modo)

Las formas de medir salud y bienestar no son las mismas. Habría como diferentes medidas de salud y bienestar de una comunidad.

Un primer conjunto de medidas muy sanitarias sería medir por ejemplo problemas de salud cardiovascular, número de ictus, infartos, personas con diabetes, con obesidad o con un indice de masa corporal elevado.
Un segundo conjunto de medidas sería utilizar indicadores que midan grado de cohesión, conectividad y vinculos y que hagan actividades saludables entre personas de una comunidad para medir bienestar pero eso puede tener un sesgo enorme. Pero ojo. Creo que era César Rendueles quien suele utilizar que cuidado con mitificar comunidades con vínculos sólidos y cohesionadas porque comunidades con esas características fueron nichos donde anidó y creció el nazismo en el siglo XX. Es decir, imaginaros sólo el problema de utilizar indicadores de resultados de patología: por ejemplo si baja o no baja la diabetes. Por todo ello nuestra evaluación debería incluir una mirada sobre cómo además se están generan un incremento en aspectos relacionados con la diversidad, la inclusión, mejorar la justicia social, disminuir las desigualdades, favorecer la integración de las más vulneradas…
Es una foto más amplia, pero es realmente la buena foto panorámica que deberíamos sacar desde la salud pública y las políticas enfocadas al bienestar y el buen gobierno. y en salud pública nos gustan las fotos panorámicas.

Listado no exhaustivo de referencias y algunos artículos (la lectora o el lector puede añadir más si quiere en los comentarios del post):

Evidencias (articulo del Circulation Research de hace unos días sobre salud cardiovascular):

-La construcción de una ciudad (indices de walkability, conectividad entre calles…) tienen relación con disminución de diabetes tipo 2. 

-Ciudades con mejores índices de vivienda, ingresos, educación, acceso al trabajo están relacionados con menor incidencia de eventos cardiovasculares y de mortalidad post IAM.

-Más cohesion social. menos desigualdades, mayor sensación de seguridad mejor incidencia en CV 

-Más violencia peor datos de SCV.

-Impacto psicológico, mala percepción de estatus social, soledad, discriminación, stress crónico producen peores datos de SCV.

Revisión de evidencia en los County Health Rankings ( a través de este enlace)

Ciclismo holandés: cuantificación de la salud y los beneficios económicos relacionados (publicado en 2015 en American Journal of Public Health)
https://ajph-aphapublications-org.translate.goog/doi/abs/10.2105/AJPH.2015.302724?_x_tr_sl=auto&_x_tr_tl=es&_x_tr_hl=es

El ciclismo evita alrededor de 6500 muertes cada año, y los holandeses tienen una esperanza de vida medio año más larga gracias al ciclismo. Estos beneficios para la salud corresponden a más del 3% del producto interior bruto holandés

Study on costs and benefits of the sustainable urban mobility transition – D3: Final Report
https://www.eiturbanmobility.eu/wp-content/uploads/2021/10/Final-report_Long-version.pdf

Urban Mobility, proyecto europeo, con una publicación de noviembre de 2021 sobre costes y beneficios donde se tratan de resolver las siguientes preguntas:

• How much will the transition to sustainable urban mobility cost? What are its costs and benefits, including the monetization of all externalities? • What range of costs can be identified according to city variables? • What are the most cost-efficient measures to accelerate sustainable urban mobility? • For different types of measures, what are the investments needed?

Ver anexo con definiciones más ampliadas de cada una de las políticas:

Investing for Momentum in Active Mobility. Discussión paper. October 2021
(acceso)
https://www.eiturbanmobility.eu/

-Prioritizing active mobility in policies on national and local levels by aligning it to broader goals on climate, road safety, health, equity, and build back better strategies

-Integrating cycling and pedestrian infrastructure into: (i) long term transport plans as a key component of integrated transport systems, (ii) standards for design in local practices for urban infrastructure, and (iii) financing schemes at the national and regional or metropolitan levels

-Setting a minimum 20 percent of the transport or infrastructure budget for active mobility is the most straightforward way to fulfill active mobility goals in a sustained form. 

-Establishing a screening process for transport and road infrastructure projects to ensure adequate and appropriate inclusion of walking and cycling components. Screening for inclusion of safe active travel accommodations and infrastructure in major trans

Health impact assessment of active transportation: A systematic review
https://pubmed.ncbi.nlm.nih.gov/25900805/

Diseño de pop-up bike lanes durante la pandemia para facilitar la movilidad y la caminabilidad de la población
https://www.wri.org/research/safe-bicycle-lane-design-principles

Is cycle network expansion cost-effective? A health economic evaluation of cycling in Oslo

(BMC Public Health. Diciembre 2020).

Background: Expansion of designated cycling networks increases cycling for transport that, in turn, increases physical activity, contributing to improvement in public health. This paper aims to determine whether cycle-network construction in a large city is cost-effective when compared to the status-quo. We developed a cycle-network investment model (CIM) for Oslo and explored its impact on overall health and wellbeing resulting from the increased physical activity.

Methods: First, we applied a regression technique on cycling data from 123 major European cities to model the effect of additional cycle-networks on the share of cyclists. Second, we used a Markov model to capture health benefits from increased cycling for people starting to ride cycle at the age of 30 over the next 25 years. All health gains were measured in quality-adjusted life years (QALYs). Costs were estimated in US dollars. Other data to populate the model were derived from a comprehensive literature search of epidemiological and economic evaluation studies. Uncertainty was assessed using deterministic and probabilistic sensitivity analyses.

Results: Our regression analysis reveals that a 100 km new cycle network construction in Oslo city would increase cycling share by 3%. Under the base-case assumptions, where the benefits of the cycle-network investment relating to increased physical activity are sustained over 25 years, the predicted average increases in costs and QALYs per person are $416 and 0.019, respectively. Thus, the incremental costs are $22,350 per QALY gained. This is considered highly cost-effective in a Norwegian setting.

Conclusions: The results support the use of CIM as part of a public health program to improve physical activity and consequently avert morbidity and mortality. CIM is affordable and has a long-term effect on physical activity that in turn has a positive impact on health improvement.

The Health Cost of Transport in Cities. (publicado en 2021)
https://pubmed.ncbi.nlm.nih.gov/33686593/

Purpose of review: The study aims to provide an understanding of health cost assessments of different transport modes in urban contexts, and their relevance for transport planning and political decision-making.

Recent findings: There is strong evidence that motorized transportation imposes a high health cost on society, and specifically children. In contrast, active transport is a very significant health benefit. Economic analyses support urban change in favor of compact neighborhoods and public transit, as well as infrastructure exclusively devoted to active transport. Private cars need to be restricted because of the high cost they impose on society.

Planes de organización para bicicletas y peatones (referencia)

Los costos de las mejoras de infraestructura varían significativamente según el lugar y el tipo de mejora; por ejemplo, el costo medio de un portabicicletas es de $540 y el paso elevado de un puente de madera para peatones es de $122,610. El costo medio por milla es de $89 470 para un carril para bicicletas y de $261 000 para un sendero pavimentado de usos múltiples 14 . Un análisis de costo-beneficio basado en los Países Bajos sugiere que las inversiones en mejores infraestructuras e instalaciones para bicicletas producen beneficios netos positivos a largo plazo 15 .

Understanding the role of equity in active transportation planning in the United States.
https://www.tandfonline.com/doi/abs/10.1080/01441647.2016.1239660?journalCode=ttrv20&

These recommendations include considering other transportation-disadvantaged groups beyond low-income and minority populations in equity analysis, adopting new performance measures, increasing inter-agency coordination, the need for stronger guidance from the federal government, and more representation from transportation-disadvantaged groups in the public participation and decision-making process. If the costs and benefits of active transportation are to be fairly shared among all users, equity will need to be meaningfully addressed in the planning process.

Complete Streets & streetscape design initiatives   

A Northern Michigan Community Explores Its Assets and Resources

Fri, 12/27/2019 – 19:39

Members of Oscoda County’s CHOICES partnership were well aware of the challenges facing their rural Northern Michigan community. What they needed to understand was…

Houghton MI implements Complete Streets

Fri, 12/27/2019 – 19:39

To increase physical activity in a rural region with high rates of unemployment and poverty, and lots of snow, Michigan’s Western Upper Peninsula Health…
This partnership increased opportunities for active transportation through a Complete Streets policy, Safe Routes to School, and improved bicycle and walking trails throughout the region.

Complete Streets & streetscape design initiatives

Streetscape design improvements enable pedestrians, bicyclists, transit riders, and motorists to share and use the street, accommodating the needs of all users. Improvements to streetscape design can include increased street lighting, enhanced street landscaping and street furniture, increased sidewalk coverage and connectivity of pedestrian walkways, bicycling infrastructure, street crossing safety features, and traffic calming measures. Streetscape design improvement projects typically include elements from more than one of these categories; these projects can be implemented incrementally or comprehensively, and are often part of community-level Complete Streets policie

  • Expected Beneficial Outcomes (Rated)
  • Increased physical activity
  • Increased pedestrian and cyclist safety
  • Other Potential Beneficial Outcomes
  • Increased active transportation
  • Reduced obesity rates
  • Improved sense of community
  • Improved neighborhood safety
  • Reduced stress
  • Reduced vehicle miles traveled

Green space & parks   

Communities can increase green space and parks by creating new parks or open spaces, renovating or enhancing under-used recreation areas, or rehabilitating vacant lots, abandoned infrastructure, or brownfields. Rails to trails programs, brownfield redevelopment, community gardens, and park enhancements are examples of efforts to increase recreational green space, trails, and parks. Such efforts can be applied to spaces accessible by foot, bike, and other types of transportation.

https://www.countyhealthrankings.org/take-action-to-improve-health/what-works-for-health/strategies/green-space-parks

Multi-component workplace supports for active commuting   

https://www.countyhealthrankings.org/take-action-to-improve-health/what-works-for-health/strategies/multi-component-workplace-supports-for-active-commuting

Active commuting involves some form of physical exercise such as walking or bicycling as a way to travel to and from work. Multi-component workplace supports for active commuting can include physical infrastructure (e.g., bicycle parking or cyclist showers), educational or social support programs (e.g., workplace travel plans, transportation coordinators, walking groups, or walk/bike to work campaigns), or financial incentives (e.g., free bicycle parking, bicycle commuting reimbursements, or fees for car parking)1.

https://www.countyhealthrankings.org/take-action-to-improve-health/what-works-for-health/strategies/multi-component-workplace-supports-for-active-commuting

Open Streets

https://www.countyhealthrankings.org/take-action-to-improve-health/what-works-for-health/strategies/open-streets

Places for physical activity

https://www.countyhealthrankings.org/take-action-to-improve-health/what-works-for-health/strategies/places-for-physical-activity

Safe Routes to Schools

https://www.countyhealthrankings.org/take-action-to-improve-health/what-works-for-health/strategies/safe-routes-to-schools

Complete Streets & streetscape design initiatives   

https://www.countyhealthrankings.org/take-action-to-improve-health/what-works-for-health/strategies/complete-streets-streetscape-design-initiatives

Invest in Walking and Cycling For Sustainable, Safe Cities. Here’s How.

https://www.wri.org/insights/invest-walking-cycling-sustainable-safe-cities

Walk Score:

https://www.walkscore.com/professional/research.php


Cycle-network expansion plan in Oslo: Modeling cost-effectiveness analysis and health equity impact (diciembre 2021).
https://pubmed.ncbi.nlm.nih.gov/34611965/


Physical inactivity is the leading cause of non-communicable diseases, and further research on the cost-effectiveness of interventions that target inactivity is warranted. Socioeconomic status is vital in this process. We aim to evaluate the cost-effectiveness of a cycle-network expansion plan in Oslo compared to the status quo by income quintiles. We applied a Markov model using a public payer perspective. Health outcomes were measured by quality-adjusted life years (QALYs) gained from the prevention of coronary heart disease, stroke, type 2 diabetes, and cancer. We measured equity impact by the concentration index and social welfare using the achievement index. We conducted sensitivity analyses. The intervention was generally more costly and more effective than the status quo. Incremental cost per QALY falls with income quintile, ranging from $10,098 in the richest quintile to $23,053 per QALY gained in the poorest quintile. The base-case intervention increased health inequality. However, a scenario targeting low-income quintiles reduced inequality and increased social welfare. In conclusion, the cycle-network expansion is likely to be cost-effective, but with equity concerns. If decision makers care about health inequalities, the disadvantaged groups could be targeted to produce more equitable and socially desirable outcomes instead of a uniform intervention across income quintiles.

Anexo de Politicas del documento de Urban Mobility:

Demand responsive transport:
https://translink.com.au/travel-with-us/on-demand/logan/what-is-drt#:~:text=Demand%20Responsive%20Transport%20(DRT)%20is,and%20trains%20aren’t%20available.

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