An economic evaluation of health-promotive built environment changes.

OBJECTIVES This study aimed to help 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. METHODS The 2001 National Household Travel Survey sample (N=4974) from Dane County, Wisconsin, was used to develop a Spatial Seemingly Unrelated Regression model of daily vehicle miles traveled and miles walked or biked. The empirical model was used to analyze the travel impacts of hypothetical built environment changes. These travel impacts were translated into health impacts and monetary values using cost-benefit analysis. RESULTS Two win-win built environment strategies were found: increased regional retail accessibility and increased prevalence of sidewalks. Based on the present analyses, 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. CONCLUSION Certain built environment measures could be predicted to be effective strategies for exerting a positive influence on people's travel behavior and the health of the community. Quantifiable public health benefits gained by better air quality and increased physical activity were shown to outweigh the cost of implementing the built environment measure of adding sidewalks to all roads.