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Mortality, greenhouse gas emissions and consumer cost impacts of combined diet and physical activity scenarios: a health impact assessment study
  1. Marko Tainio1,2,
  2. Pablo Monsivais1,
  3. Nicholas RV Jones1,
  4. Christian Brand3,
  5. James Woodcock1
  1. 1MRC Epidemiology Unit, Centre for Diet and Activity Research, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, UK
  2. 2Systems Research Institute, Polish Academy of Sciences, Warsaw, Poland
  3. 3Transport Studies Unit, School of Geography and the Environment, University of Oxford, Oxford, UK
  1. Correspondence to Dr Marko Tainio; mkt27{at}


Objective To quantify changes in mortality, greenhouse gas (GHG) emissions and consumer costs for physical activity and diet scenarios.

Design For the physical activity scenarios, all car trips from <1 to <8 miles long were progressively replaced with cycling. For the diet scenarios, the study population was assumed to increase fruit and vegetable (F&V) consumption by 1–5 portions of F&V per day, or to eat at least 5 portions per day. Health effects were modelled with the comparative risk assessment method. Consumer costs were based on fuel cost savings and average costs of F&V, and GHG emissions to fuel usage and F&V production.

Setting Working age population for England.

Participants Data from the Health Survey for England, National Travel Survey and National Diet and Nutrition Survey.

Primary outcomes measured Changes in premature deaths, consumer costs and GHG emissions stratified by age, gender and socioeconomic status (SES).

Results Premature deaths were reduced by between 75 and 7648 cases per year for the physical activity scenarios, and 3255 and 6187 cases per year for the diet scenarios. Mortality reductions were greater among people of medium and high SES in the physical activity scenarios, whereas people with lower SES benefited more in the diet scenarios. Similarly, transport fuel costs fell more for people of high SES, whereas diet costs increased most for the lowest SES group. Net GHG emissions decreased by between 0.2 and 10.6 million tons of carbon dioxide equivalent (MtCO2e) per year for the physical activity scenarios and increased by between 1.3 and 6.3 MtCO2e/year for the diet scenarios.

Conclusions Increasing F&V consumption offers the potential for large health benefits and reduces health inequalities. Replacing short car trips with cycling offers the potential for net benefits for health, GHG emissions and consumer costs.

  • Physical activity
  • Cycling
  • health inequality
  • greenhouse gas emissions
  • consumer costs

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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  • Contributors All authors made substantial contributions to the conception and design of the study. JW and PM had the original idea of the study. NJ prepared the diet data. MT prepared the physical activity data, did the modelling and drafted the first version of the manuscript. CB provided data to calculate greenhouse gas emissions and costs of driving. All authors drafted and critically revised the manuscript.

  • Funding MT, PM, NJ and JW were supported by the Centre for Diet and Activity Research (CEDAR), a UKCRC Public Health Research Centre of Excellence. Funding from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the National Institute for Health Research, and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged. JW is also supported by an MRC Population Health Scientist fellowship (grant number: MR/K021796/1). CB is supported by the UK Research Councils (grant number: EPSRC EP/L024756/1) as part of the Decision Making Theme of the UK Energy Research Centre Phase 3.

  • Competing interests MT reports grant from the Coca Cola Foundation outside the submitted work.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Anonymised, non-identifiable participant-level cross-sectional survey data are freely available for academic researchers and public health staff to download from the UK Data Service ( The key data sources used in this study were: SN: 6533 National Diet and Nutrition Survey Years 1–4, 2008/09-2011/12:; SN: 7480 Health Survey for England, 2012:; SN: 5340 National Travel Survey, 2002–2012: