Table 3 Source, place, aim of project, main results of included HIAs

Agarwal et al. 2021 [33]

Patna, India

The study quantifies the health benefits (reduction in mortalities) of a bicycle superhighway (BSH) in Patna, India

1. A bicycle superhighway increases the share of bicycles from 32.3% to 48.7%

2. A significant rise in the number of cyclists which is a result of better bicycle infrastructure

3. An increase in longer bicycle trips for higher-income groups

4. For the whole population, the average cycling duration has increased by 48% as a result of bicycle superhighway

5. 755 lives per year can be saved or 1640 deaths prevented/ million person as the result of increase duration of cycling

6. The monetized benefits turn out to 12.25 billion Indian rupee of saving by preventing 755 deaths annually

Andersen et al. 2017 [34]

Haraldsgade district, Copenhagen, Denmark

A multicomponent urban renewal project of approximately 35 million Euros including renovation of public housing and courtyards; adding streetlights; renovation or establishment of new urban green spaces, play grounds, and sport facilities; and opening of two civic centers offering social gatherings and sport activities

Adolescents spent more time in the district and in PA in the district in 2012, after the urban renewal project

Badland et al. 2017 [35]

Metropolitan Melbourne, Australia

1) Identifying spatial walking-related urban planning policies used in selected Australian states and territories;

2) creating spatial measures based on these policies; and

3) examining which, if any, are associated with transport walking in an urban context

Dwelling density and daily destinations predict walking trips

Association becomes stronger for larger neighbourhood areas: walking is influenced by attributes outside the immediate neighbourhood

Bias and Abildso 2017 [36]

Fairmont, West Virginia, USA

Aim of project:

Creating a comprehensive bicycle and pedestrian “connectivity plan”

Aim of HIA:

The original HIA intended to capture broad feedback from the public around barriers to connectivity and physical activity including physical environment, safety, crime, etc

Aim of study:

This study evaluates policy outcomes and other effects related to HIA after 21 months of the adoption of the HIA and Connectivity Plan

1. Seven of the eleven specific recommendations can be tracked to specific outcomes in just over a year and a half after adoption of the HIA report in Fairmont

2. The city is considering the creation of a Pedestrian Safety Board to further investigate recommendations around safe active commuting

3. There are tentative plans to use the connectivity plan and HIA as the basis of an application for TIGER (Transportation Investment Generating Economic Recovery) funding

Branas et al. 2011 [37]

Philadelphia, Pennsylvania, USA

A program to clean, green, and maintain abandoned vacant lots in Philadelphia, Pennsylvania. This program involved removing trash and debris, grading the land, planting grass and trees to create a park-like setting, and installing low wooden post-and-rail fences

1. Vacant lot greening was associated with consistent reductions in gun assaults and consistent reductions in vandalism

2. Vacant lot greening was associated with residents’ reporting less stress and more exercise in select sections of the city

Buekers et al. 2015 [38]

Flanders, Belgium

New bicycle highways Antwerp–Mechelen and Leuven–Brussels, which were built near important traffic axes to provide the densely populated region with an alternative to car use

1. Increased PA outweighed air polution and traffic incidents

2. The benefit:cost ratio was mainly positive

Buregeya et al. 2020 [39]

Quebec, Canada

Analyzing a HIA tool’s impact on the revitalization of road infrastructure, parks and green spaces, and residential housing

HIA acted in synergy with other policies or plans at the local level to foster actions favourable to health. For instance, the city’s active travel plan supported the HIA recommendations for additional cycling infrastructure. Furthermore, technical employees and elected local officials who advanced the inclusion of these recommendations in general gained a certain understanding of how transformed built environments contribute to liveable cities and a sustainable future

Chapman et al. 2018 [40]

New Plymouth and Hastings, New Zealand

New Zealand’s Model Communities Programme funded cycle paths, other walking and cycling facilities, cycle parking, ‘shared spaces’, media campaigns and events, such as ‘Share the Road’, and cycle-skills training

1. Annual benefits for health in the intervention cities were estimated at 34.4 disability-adjusted life years (DALYs) and two lives saved

2. The estimated benefit/cost ratio was 11:1 and $151.2 million

Coulson et al. 2011 [41]

Dings neighbourhood, Bristol, south-west England, UK

A ‘retro-fit’ model was applied, where pre-existing, residential streets were converted, and new features added. Also, a disused railway bed in neighbourhood was turned to a site for a short extension of the National Cycle Network

Several aspects of the neighbourhood were perceived to have improved, including spatial aesthetics, lighting and streetscape planting. However, influence on physical activity was minimal due to safety related concerns, poor public transport provision, local residents’ parking behaviour

Frank et al. 2019 [42]

Vancouver, Canada

The Comox Greenway is a major active transportation corridor aiming to improve conditions for bicyclists of all ages and abilities

1. Participants near the greenway doubled their odds of achieving 20 min daily MVPA

2. The odds of being sedentary for more than 9 h halved for nearby residents

3. Physical activity benefits declined with increasing 100 to 500 m distance from the greenway

Frank et al. 2022 [43]

San Diego county, California, USA

Palomar Gateway District redevelopment plan calls for increased housing with an emphasis on multi-family housing; additional non-residential development with a more compact urban form (i.e. multi-story buildings with less surface parking) than current development; upgrading the ridership capacity and accessibility of the light rail service along with other local bus improvements; and expansion of current pedestrian and bicycle infrastructure

1. Project increases physical activity from walking for transportation, park visitation, and reductions in type 2 diabetes and high blood pressure

2. Potential for increased exposure to air pollution among children and teens

3. The implementation of project is associated with a 9.6 percent reduction in type 2 diabetes and a 15.4 percent reduction in high blood pressure, better BMI, and general health status

4. Transportation walking increased by 67.9% for adults and 17.5% for children and teens

5. Increases in leisure walking, other leisure physical activity, moderate/vigorous PA; decreases in private automobile use, although these improvements were moderate (less than 10%)

6. Higher park visitation for all ages

7. The only health outcomes that worsened were asthma (a 10.9% increase among children and a 17.8% increase among teens) and the pedestrian/bicycle risk index (2.0% increase in risk)

Goodman et al. 2014 [44]

Cardiff, Kenilworth, Southampton,UK

Connect2 initiative was established with the intention of building or improving walking and cycling routes at 79 sites across the United Kingdom

1. Living nearer the infrastructure did not predict changes in activity levels at 1-year follow-up but did predict increases in activity at 2 years relative to those living farther away (15.3 additional minutes/week walking and cycling per km nearer; 12.5 additional minutes/week of total physical activity)

2. The effects were larger among participants without car

3. Individuals living near the infrastructure did not compensate for their increased walking and cycling by reducing their participation in other types of physical activity

Gotschi 2011 [45]

Portland, Oregon, USA

To assess how costs of Portland’s past and planned investments in bicycling relate to health and other benefits (cost/benefit analysis)

Benefit–cost ratio for health care and fuel saving: 3.8—.13

Benefit–cost ratio for value of statistical lifes: 53.3—20.2

Benefit–cost ratio decreasesfor plans with higher investments

Gu et al. 2017 [46]

New York, USA

1. To evaluate the cost effectiveness of investments in bike lanes using New York City’s (NYC) fiscal year 2015 investment

2. To provide a generalizable model, so that localities can estimate their return on bike lane investments

1. 45.5 miles of bike lanes NYC constructed in 2015 at a cost of $8 109 511.47 may increase the probability of riding bikes by 9.32%

2. The incremental cost-effectiveness ratio (ICER) was $1297/QALY gained (is considered very cost-effective)

Guo and Gandavarapu 2010 [47]

Dane County, Wisconsin, USA

Helping public investment decision makers see the greatest return on their built environment investments by developing an analysis framework for identifying the most promising improvement strategies and assessing the attainable return on investment

1. An investment of $450 million to make sidewalks available to all Dane County residents was estimated to yield a cost–benefit ratio of 1.87 over a 10-year life cycle

2. Workers were likely to drive less and walk/bike more with increasing retail accessibility

3. People who lived in neighborhoods with a higher percentage of high-income households drove more and walked less

4. Land use mix measured within 1 mile of one’s residence was associated with decreased distance walked/biked

5. Increased length of bike lane within 1/4 mile of an individual’s residence has a significantly positive impact on non-motorized travel

Hoehner et al. 2012 [48]

St.Louis, Missouri, USA

Page Avenue project was a redevelopment plan including:

1. Building a new grocery store,

2. Commercial and mixed-income residential redevelopment,

3. Infrastructure improvements

1. Interdisciplinary teams are valuable but they require flexibility and organization

2. Engaging community stakeholders and decision-makers prior to, during, and following the HIA is critical to a successful HIA

3. HIA teams should not be too closely affiliated with decision-makers

Kaczynski and Sharratt 2010 [49]

Williamsburg, Southwestern Ontario, Canada

Qualitative analysis of perception of residents in a newly developed neighbourhood that was designed to increase walkability

Land use diversity, safety, parks, aesthetics, sense of community are mentioned as facilitating factors for walking, lack of (old trees) is mentioned as a problem

King et al. 2010 [50]

City in Colorado, USA

Discussing the benefits and challenges of applying RE-AIM to evaluate built environment strategies and recommended modest adaptations to the model; afterwards applying the revised model to 2 prototypical built environment strategies aimed at promoting healthful eating and active living

The 5 RE-AIM dimensions, with some modification of definitions, seem to be applicable to built environment interventions and provide added value given their usefulness in anticipating impact, planning for sustainability, and addressing unexpected or adverse consequences

Knuiman et al. 2014 [51]

Perth, Australia

Studying the influence of built environment characteristics (walkability) and its changes over time on transport walking

1. Neighborhood walkability (especially land-use mix and street connectivity), local access to public transit stops, and variety in the types of local destinations are important determinants of walking for transportation

2. Land-use mix had a greater and more significant relationship than did either street connectivity or residential density with transport walking

MacDonald et al. 2010 [52]

Charlotte NC, US

To examine the cross-sectional associations between objective and perceived measures of the built environment; BMI; obesity pre- and post-LRT (light rail transit) construction

1. More-positive perceptions of one’s neighborhood at baseline were associated with lower BMI; 15% lower odds of obesity; 9% higher odds of meeting weekly RPA through walking; and 11% higher odds of meeting RPA levels of vigorous exercise

2. The use of LRT to commute to work was associated with an average 1.18 reduction in BMI and 81% reduced odds of becoming obese over time

MacDonald Gibson et al. 2015 [53]

Raleigh, North Carolina, USA

Developing a computer simulation model for forecasting the health effects of urban features that promote walking

The simulation model predicts that the plan would increase average daily time spent walking for transportation by 17 min. As a result, annual deaths from all causes are predicted to decrease by 5.5%. Annual new cases of diabetes, coronary heart disease, stroke, and hypertension are predicted to decline by 1.9%, 2.3%, 1.3%, and 1.6%, respectively. The present value of these health benefits is $21,000 per resident

Mansfield and Gibson 2016 [54]

City Neighbourhoods in metropolitan areas, USA

Developing statistical models to estimate health impacts of alternative city planning scenarios (with and without infrastructure) to support active transportation (walking and cycling), and reduction of premature death without any referral to a specific disease. Application of mathematical models in hypothetical HIAs

1. Increase in the number of walking and biking trips

.2. Increased population density and percentage of rental units increased bike trips

3. Overall increase in duration of walking and biking trips

4. Built environment variables have small but significant effects on daily walking time but no significant effects on daily biking time

5. Case study of Raleigh–Durham–Chapel Hill:

5.a. The statistical model was able to predict observed transportation physical activity in the Raleigh–Durham–Chapel Hill region to within 0.5 MET-hours per day (equivalent to about 9 min of daily walking time) for 83% of observations

5.b. Across the Raleigh–Durham–Chapel Hill region, estimated 38 (95% CI 15–59) premature deaths potentially could be avoided if the entire population walked 37.4 min per week for transportation

5.c. If changes to the built environment induced 14.5% of drivers to commute by public transit, estimated 6.2 (95% CI 2.6–10.3) premature deaths could have been prevented in 2013

Mansfield and Gibson 2015 [55]

North Carolina, USA

To demonstrate the use of DYNAMO-HIA for supporting health impact assessments of transportation infrastructure projects

1. In the BRRC, DYNAMO-HIA estimates a significant reduction in premature all-cause mortality as well as significant preventive effects for hypertension, type 2 diabetes mellitus, and CHD

2. In Sparta, significant reductions in premature mortality, cases of hypertension, and cases of type 2 diabetes mellitus are estimated; however, estimated effects on avoided cases of CHD are minimal

3. In Winterville, DYNAMO-HIA estimates small, yet significant, reductions in premature mortality and cases of hypertension and minimal effects on type 2 diabetes and CHD

4. Across all sites, no significant reductions in cases of stroke are estimated

Mansfield et al. 2015 [56]

Raleigh-Durham-Chapel Hill, North Carolina, USA

Modelling impact of 3 scenarios (base case, compact growth and increased sprawl) of urban development on air quality and mortality

1. Compact development slightly decreases (-0.2%) point estimates of regional annual average PM2.5 concentrations, while sprawling development slightly increases (+ 1%) concentrations

2. Point estimates of health impacts are in opposite directions: compact development increases (+ 39%) and sprawling development decreases (-33%) PM2.5 -attributable mortality

3. Compactness increases local variation in PM2.5 concentrations and increases the severity of local air pollution hotspots

Mueller et al. 2018 [57]

Spain, UK, Belgium, Austria, Germany, Switzerland, Italy

Estimating the impact of cycling network expansions in seven European cities

1. A cycling network of 315 km/100,000 persons lead to cycling mode share of 24.7%

2. A cycling mode share of 24.7% could prevent 10,000 premature deaths

3. Benefits of increases in PA outweighed detriments of air pollution and traffic incidents

4. Air pollution exposure have higher risk than fatal traffic incident

5. Senario1 (10% expansion of cycling network) had the largest cost–benefit ratios

6. S4 (expansion of all streets) produced greatest benefits among other scenarios with high increase of cycling and lower annual premature deaths

Mueller et al. 2020 [58]

Barcelona, Spain

Implementation of the Superblock Model in Barcelona/Spain. Superblocks are blocks of streets with pacified interior streets that are devoted to active transport and residential traffic

1. Prevention of 667 annual premature deaths

2. Greatest number of preventable deaths could be attributed to reductions in NO2, followed by noise, heat, and green space development

3. Increased PA for an estimated 65,000 persons shifting car/motorcycle trips to public and active transport resulted in 36 preventable deaths

4. An average increase in life expectancy for the adult population of almost 200 days

5. Annual economic impact of 1.7 billion EUR

Nicholas et al. 2019 [59]

Los Angeles, California, USA

1. To determine the health impacts of three future scenarios of travel behavior by mode

2. To provide specific recommendations for how to conduct health impact assessments of local transportation plans

1. The largest impacts were on cardiovascular disease through increases in physical activity

2. Reductions in air pollution–related illnesses were more modest

3. Traffic injuries and deaths increased across all scenarios but were greatly reduced through targeted roadway safety enhancements

4. Both aspirational scenarios produce net savings ($79 million and $162 million, respectively), the conservative scenario produces net costs attributable to the high costs of traffic injuries

Panter et al. 2016 [60]

Cambridge, UK

The Cambridgeshire Guided Busway comprised a new bus network and an adjacent 22-km traffic-free walking and cycling route in and around Cambridge

1. Exposure to the busway was associated with a significantly greater likelihood of an increase in weekly cycle commuting time

2. An increase in overall time spent in active commuting among the least active commuters at baseline

Payton Foh et al. 2021 [61]

Newark, New Jersey, USA

Opening of park for recreational activities

1. Self-reported neighborhood walkability was associated with increased walking (P = .01)

2. Increased perception of neighborhood safety was associated with less walking (P = .01)

3. Positive changes associated with improvements to the built environment may be limited by social conditions such as neighborhood violence

4. Physical activity policies or interventions aimed at increasing access to open spaces must involve comprehensive, multi-pronged approaches that recognize the realities of the local social context to ensure their long-term success

Perdue et al. 2012 [62]

Oregon, USA

To inform the debate, within a state legislature, about the value of state policy and provide information for local planning agencies to better incorporate health considerations into planning activities

1. Increasing the cost of driving was not consistently found to reduce air pollution, increase physical activity, or reduce collisions

2. Strengthening public transit was associated with increased levels of physical activity

3. Altering the built environment was associated with increased physical activity and decreased air pollution

Ross et al. 2012 [63]

Atlanta, Georgia, USA

The BeltLine project will transform a 22-mile loop of an abandoned railroad and surrounding property to 2100 acres of parks; 33 miles trails; 22 miles of transit, 6500 acres of redevelopment, 30,000 new jobs, plus sidewalk, streetscape, road, and intersection improvements

1. Giving priority to the construction of trails and greenspace rather than residential and retail construction,

2. Making health an explicit goal in project,

3. Adding a public health professional to decision-making boards,

4. Increasing the connectivity between the BeltLine and civic spaces,

5. Ensuring affordable housing

Stevenson et al. 2016 [64]

Melbourne, Australia; London UK; Boston, USA; Copenhagen, Denmark; Sao Paulo, Brasil; Delhi, India;

Estimation of the population health effects arising from alternative land-use and transport policy initiatives (modelling compact city scenarios) in six cities using a health impact assessment framework

1. Modelled compact city scenario resulted in health gains for all cities (for diabetes, cardiovascular disease, and respiratory disease) with overall health gains of 420–826 disability-adjusted life-years (DALYs) per 100 000 population due to modal shift towards walking and cycling

2. For moderate to highly motorised cities, such as Melbourne, London, and Boston, the compact city scenario predicted a small increase in road trauma for cyclists and pedestrians (health loss of between 34 and 41 DALYs per 100 000 population)

Thornton et al. 2013 [65]

Baltimore, Maryland, USA

Health impact assessment (HIA) of a rezoning effort in Baltimore (TransForm Baltimore) by highlighting its' effects on multiple health outcomes, including physical activity, violent crime, and obesity

1. Health was not an active goal for TransForm Baltimore for many city offcials and expert consultants

2. Mixed-use developments are associated with increasing physical activity, decreasing obesity and obesity-related illness especially for socioeconomically advantaged populations

3. Increased mixed-use developments can be associated with increased crime

4. Higher density of alcohol sales outlets is associated with an increased risk of violent crime

5. TransForm Baltimore would increase the percentage of city residents living in neighborhoods with pedestrian-oriented design from 1 to 24%

6. The TransForm Baltimore HIA identified mixed-use development as an important mechanism for impacting health through zoning via potential impacts on physical activity, violent crime, and obesity

Tiwari et al. 2016 [66]

3 Cities in India

Assess impact of improving non-motorized traffic infrastructure and public transport infrastructure on CO2 emissions and traffic fatalities

1. Maximum reduction in CO2 emissions and highest improvement in safety and reduce traffic fatalities is achieved when both PT (Public transport) and NMT (non-motorized transport) infrastructure are improved

2. Improving only PT infrastructure may have marginal effect on overall reduction of CO2 emissions and adverse effects on traffic safety

3. NMT infrastructure is crucial for maintaining the travel mode shares in favor of PT and NMT in future

Tully et al. 2013 [67]

Belfast, Northern Ireland, UK

Connswater Community Greenway: major inner city urban regeneration project:

The project involves:

1. A major urban regeneration project called The Connswater Community Greenway in Belfast including

a. Development of a 9 km linear park, and new cycle paths and walkways

b. Improvement of the aesthetics of shared public spaces (i.e. planting trees/shrubs, erection of public art)

c. Remediation of water courses to improve the natural diversity and reduce the risk of flooding

d. Change perception of safety in the community through 24/7 lighting, CCTV and the presence of park wardens

2. A number of programmes to promote physical activity in the area (i.e. extension of neighbourhood walking groups, schools-based initiatives, community-based social marketing initiatives)

This article is a protocol, therefore there are no outcomes

Veerman et al. 2016 [68]

Perth, Australia

Analysing the cost-effectiveness of extending the length of sidewalks in a neighbourhood to increase levels of walking and improve health

1. Investing in the length of sidewalks is unlikely to be a cost-effective method of improving health at the existing levels of residential density in Perth

2. 10 km of sidewalk in an average neighbourhood with 19,000 adult residents was estimated to cost A$4.2 million over 30 years and gain 24 HALYs over the lifetime of an average neighbourhood adult resident population

3. The incremental cost-effectiveness ratio was A$176 000/HALY

4. Increasing population densities improves cost-effectiveness by spreading the fixed costs of neighbourhood improvements over more people, and leading to greater overall benefit, which improves cost effectiveness

Woodcock et al.2013 [69]

England and Wales (London was excluded), UK

Evaluation of health and environmental impacts of high walking and cycling transport scenarios

1. Considerable reductions in disease burden

2. The largest health gains were from changes in ischemic heart disease, stroke, and dementia, followed by reductions in injuries

3. Largest benefits resulted from,in order, physical activity, road traffic injuries, and air pollution

Zapata-Diomedi et al. 2016 [70]

Brisbane, Perth and Adelaide, Australia

Deriving scenarios from the literature for the association between built environment attributes and physical activity, then using a mathematical model to translate improvements in physical activity to health-adjusted life years (HALYs) and healthcare costs

1. Density had no statistically significant estimation with gained HALYs

2. No significant result on the impact of diversity on physical activity/HALYs

3. Design has increasing impact on HALYs via connectivity (intersec-tions within area), availability of side-walks within neigh-bourhood, street lights

4. Providing additional recreational destination increases HALYs

5. Availability of bus stops increases walking for transport, gains HALYs

6. Improvements in walking for transport (measured in standardised walkability index) have positive impact on HALYs

7. Health care cost savings due to prevented physical activity-related diseases ranged between A$1300 to A$105,355 per 100,000 adults per year

8. Additional health care costs of prolonged life years attributable to improvements in physical activity were nearly 50% higher than the estimated health care costs savings

Zapata-Diomedi et al. 2019 [71]

Melbourn, Australia

Plan Melbourne aims to influence housing supply within the existing urban area by industrial land redevelopment and new suburbs on the city’s fringe

Plan Melbourne addresses:

1. transport congestion

2. employment

3. public transport

4. services accessibility

5. housing affordability

6. environmental sustainability

1. Altona North Developed vs Truganina:

a. greater housing density (9 vs 3.5 dwellings per hectare),

b. greater diversity of land uses (0.74 vs 0.53),

c. destination accessibility train station, bus stop and supermarket, and 11 local living destination score, while, Truganina only had access to bus stops, and 8 local living destinations score

d. higher Design number of intersections (54 vs 33 /sq.km),

e. higher probability of transport walking (48% vs 26%),

f. an Altona North Developed resident was estimated to walk 131 min per week for transport purposes, while a Truganina resident was estimated to walk 71 min per week

2. The new development in Altona North is not changing the destination mix and density significantly

3. There will be modest improvements in the probability of walking i.e.only 2% as the result of new develpment in Altona North

4. If the population (21,000) of greenfield neighbourhood (similar to Truganina) were exposed to the urban development form in a brownfield neighbourhood (similar to Altona North Developed) the decrease in incidence and mortality of physical inactivity-related chronic diseases would lead to 1600 HALYs and economic benefits of A$94 million

5. Well-located higher density brownfield developments in established areas with existing amenities are likely to produce better health outcomes and economic benefits compared with continuing to house people in low density developments on the urban fringe

Zapata-Diomedi et al. 2018 [72]

Australia

Calculating monetised PA-related health benefits of walking and cycling

Results indicate that the value of PA-related health benefits associated with walking is A$0.98 (95% Uncertainty Interval (UI) 0.73 to 1.24) per kilometre. For cycling the benefits are worth A$0.62 (95% UI 0.46 to 0.79) per kilometre