Cycling against disease: The case for funding active mobility

With 68% of the world's population projected to live in urban areas by 2050, cities are grappling with worsening health burdens. Poor air quality and sedentary lifestyles are serious risk factors for millions of urban dwellers, contributing to noncommunicable diseases such as cancer, and chronic respiratory and cardiovascular diseases. Climate change and rising temperatures are expected to further amplify these vulnerabilities. Yet within this tangle of challenges lies an opportunity: Urban mobility interventions can unlock new financing pathways for NCDs funding while delivering a host of co-benefits. This may be especially valuable in unlocking public financing, as the return on investment spans multiple budget lines — from reduced health care costs to improved air quality, educational outcomes, and climate resilience. Jordi Honey-Rosés, director of City Lab Barcelona — a research group at the Institute for Environmental Science and Technology at the Universitat Autònoma de Barcelona — believes that cycling infrastructure, in particular, can be a high-impact, cost-effective NCD intervention. Speaking with Devex, he elaborated on the potential of urban infrastructure and mobility investments and interventions in addressing NCDs. This conversation has been edited for length and clarity. Why should people working in health finance, particularly around NCDs, be looking at urban infrastructure as a worthy investment? What's great about transformations to the built environment is that you're able to systematically integrate active lifestyles into everyone's everyday activities. It's not about having to go to the gym or eat better — you create a system where healthy decisions are integrated into daily life. These are the types of transformations that can impact more people over a longer period of time, rather than behavior change programs which are very difficult to show evidence for. How are urban environments exacerbating health challenges? And how can cycling help address them? Air pollution causes asthma and cardiovascular diseases, and it's especially worrisome with children. Recent research shows how poor air quality impacts children's cognitive development and capacities in schools. So cities in Europe have already been rethinking streetscapes around schools to improve air quality. Epidemiologists studying cohorts of 20,000-50,000 individuals have consistently found that those who cycle more have lower risks of asthma, lung disease, and cardiovascular disease. How about mental health? What evidence exists for the mental health benefits of mobility-based interventions? There's been extensive research on the mental restorative capacity of being in green spaces. When you look at satisfaction levels across different commute modes, cyclists consistently report being the happiest — even more than train riders who can work during their commute. It brings joy and connects people more with their city and neighbors. Many cities have promoted cycling in the last few years. What makes Barcelona different from a public health perspective? What makes Barcelona special is that it has been particularly effective at using health arguments to build the case for cycling infrastructure and super-blocks — unlike cities like Montreal or Milan that focus more on efficiency or climate change arguments. Local activists strategically chose to focus on the health impacts of safer streets. The fact that Barcelona wasn't complying with European Union air quality standards — and facing fines — also created urgency. These health regulations have real financial teeth and are likely to become an ever-stronger motivator. How can cities fund these mobility initiatives, beyond going the route of direct public investment? An alternative option is working with property developers. When rezoning areas, cities can ask developers to fund street redesign and green space additions in exchange for zoning changes. This is working already in Barcelona. It’s easy to find success stories in Europe or North America. But what are the specific challenges of encouraging cycling and more ambitious rezoning projects in the global south? Some challenges will be similar to high-income nations — existing road users being hesitant to give up space. But there are unique challenges like dealing with weak traffic regulations or the stigma around cycling. In some countries like China, cycling is associated with not being able to afford a car. However, there are also many advantages to promote — bikes are low cost, accessible, don't require fuel purchases, and with proper infrastructure, they're very fast compared to sitting in traffic congestion. How can low-income cities fund these initiatives when they have other urgent, and often competing, priorities? One innovative approach is coordinating these mobility initiatives with other infrastructure projects. When you already have to dig up streets for stormwater or electrical systems, for example. That's a great opportunity to rethink the street design for a fraction of the cost. Are there cities in low- or middle-income countries that already show the benefits of such investments? Cities like Bogota are already pioneers — they were one of the first to create closed streets for recreational cycling on weekends, which was later replicated in North American cities with great success. Mexico City has also greatly improved its cycling infrastructure. It’s not always easy, of course. Bloomberg Philanthropies is now funding several African cities, including Addis Ababa and Mombasa. What we need is more successful examples of cycling infrastructure in Latin America and Africa that can inspire other cities to make similar investments. Visit Accelerating Action — a series highlighting pathways for funding NCD prevention and control, spotlighting innovative financing models and cross-sector collaborations. This content is produced in partnership as part of our Accelerating Action series. To learn more about this series, click here.