A route to active mobility: Evaluating the public health impact of e-bike subsidies on mode share and physical activity levels.

Abstract

Regular physical activity is essential for good health. However, in Norway, one in four adults falls short of meeting minimum activity recommendations, and only 30 per cent reach the levels necessary to offset the risks associated with prolonged sitting. To promote healthier, climate-friendly transport, Norway aims for bicycles to account for 8% of all trips nationwide and 20% in major urban areas. Currently, with cycling making up just 5% of all trips, there is a clear need for initiatives to increase cycling rates. Therefore, the overarching aim of this dissertation has been to assess the potential of subsidising e-bikes as an effective environmental and public health strategy. Through real-world experiments, it explores how financial initiatives for e-bikes affect the environment through changes in mode share and public health through shifts in physical activity. The thesis comprises three independent studies. Study 1: A prospective intervention study using a non-equivalent group design. Participants included applicants for an e-bike subvention and an external control group. Both groups completed pre- and post-intervention surveys to measure changes in mode share and cycling distance. Additionally, travel data during the post-intervention period were collected using a mobile app. Study 2: A prospective intervention study with a randomised group allocation. Both the participants who received subsidies and the control group, who did not receive subsidies, took part in surveys before and after the intervention. Changes in mode share and physical activity were measured using self-reported data. Study 3: A longitudinal observational study, consisting of 18 N-of-1 studies (i.e., where a single individual is studied over time), was conducted among employees participating in an e-bike leasing program. Physical activity data were continuously collected over 8–12 weeks using an activity sensor (Fibion SENS®). These studies, presented through four papers, address the thesis objectives. The first objective was to assess the impact of e-bike subsidies on bicycle mode share. Results showed an increase of 13 to 22 percentage points in bicycle mode share, accompanied by reductions in car and public transport usage (Paper I and II). The second objective examined the effect of e-bike subsidies on physical activity gained from active travel. Findings revealed a total increase in weekly cycling distance for transport (Paper I), a rise in e-cycling duration, and a decrease in the duration of conventional cycling. Overall, active travel increased after the purchase of a subsidised e-bike (Paper II). The third objective explored the impact of e-bike subsidies on total physical activity levels. The results showed a rise in cycling and no changes in overall physical activity (Paper II). The fourth objective was to further explore the associations between e-cycling and other moderate to vigorous physical activity, aiming to deepen the understanding of the theoretical underpinnings of the effects of these kinds of interventions. The results suggested that for the majority, e-cycling did not displace additional moderate to vigorous physical activity (Paper III). The fifth objective evaluated the economic efficiency of e-bike subsidies using cost-benefit analysis (CBA). The results indicated that the benefits of the subvention program outweighed its costs, thereby demonstrating the subsidies' economic sustainability (Paper IV). In conclusion, the findings in this thesis contribute to knowledge that is important for guiding policy development and underscores the transport sector’s potential – and perhaps the responsibility – to serve as a venue for public health initiatives. Overall, the findings suggest that a straightforward, non-targeted e-bike subvention could increase cycling levels and contribute to both environmental and public health goals. Additionally, despite the challenges associated with real-world experiments, this thesis shows that such research is both feasible and valuable. It emphasises the importance of conducting more studies reflecting the real-world environments to further our understanding and guide effective policy development that balances environmental and public health objectives.