Assessing the Health Impacts of Walking Enabled by the Dowlat Abad Metro Station

Document Type : Original Article

Authors

1 Department of Regional Planning, Faculty of Urban Planning, College of Fine Arts, University of Tehran, Tehran, Iran.

2 Department of Regional Planning, School of Urban Planning, College of Fine Arts, University of Tehran, Tehran, Iran

Abstract
Introduction
Physical inactivity is a pressing global health concern, exacerbated in modern urban environments by sedentary lifestyles. In Iran, it is a major risk factor for prevalent non-communicable diseases like heart disease and diabetes. Concurrently, rapid urbanization and growing dependence on private vehicles have worsened environmental issues and diminished active transportation. Public transit systems, notably metros, offer a sustainable alternative that can alleviate congestion, improve air quality, and inherently promote physical activity by requiring walking for access and egress. Despite these potential benefits, the integration of health impact assessments into transport planning is often overlooked. This study addresses this gap by conducting a health economic evaluation of the Dowlat Abad Metro Station in Tehran, inaugurated in 2019. The primary aim is to quantify the health benefits, specifically in terms of prevented premature deaths and associated economic savings, arising from the increased physical activity facilitated by the station.

Theoretical Framework
This research is grounded in the methodology of Health Impact Assessment (HIA) and utilizes the World Health Organization's Health Economic Assessment Tool (HEAT) for walking and cycling (Kahlmeier et al., 2023). The theoretical basis is supported by robust epidemiological evidence establishing a continuous, dose-response relationship between physical activity and health; higher activity levels correlate with a reduced risk of all-cause mortality and diseases such as cardiovascular conditions. The study draws on international literature confirming that proximity to public transport, especially rail-based metros, is inversely associated with obesity rates, primarily due to the integration of walking into daily commutes. For economic valuation, the HEAT framework primarily employs the Value of a Statistical Life (VSL) approach, which estimates the societal economic value placed on reducing the risk of premature death.
Methodology
The study applied the WHO's HEAT methodology within the context of Tehran. The standard HIA process—comprising screening, scoping, appraisal, and reporting—was followed. Data were collected via a survey of 213 users of the Dowlat Abad Metro Station to capture travel patterns, including walking times to/from the station, trip frequency, and socio-demographic data. The core analysis calculated avoided premature deaths attributable to the metro-induced physical activity. Key parameters included:
1- Physical Activity Volume: Based on average walking times of 11-15 minutes (access) and 5-10 minutes (egress), converted into Metabolic Equivalent of Task (MET) expenditure;
2- Relative Risk (RR): A value of 0.81 for 660 MET-minutes/week was used to link activity to mortality risk reduction;
3- Population Attributable Fraction (PAF): Calculated as PAF = (RR-1)/RR to determine the fraction of preventable deaths;
4- Avoided Mortality (E): Estimated using E = PAF × B × P, where B is Tehran's baseline mortality rate and P is the exposed population;
5- Economic Valuation: Benefits were monetized using both the official Iranian "Diyah" (blood money) and Iran-specific VSL estimates.
Discussion and result
Survey findings indicated the station is mainly used by a young, educated population for work and study, with most users walking to and from it. The health appraisal revealed significant outcomes: the station's use prevents an estimated 68 premature deaths annually, equating to 1,020.6 Years of Life Lost (YLL) prevented (range: 719.4–1,321.8 YLL). Economically, using the "Diyah" value (1.2 billion tomans per life) yielded annual savings of 1,632,960 million tomans. A more precise analysis using Iran-specific VSL data estimated savings of 452 billion tomans per year. These results align with global studies using HEAT, affirming that the health gains from active travel outweigh risks like air pollution. They underscore that metro investments are not merely transport solutions but also crucial public health interventions. The discussion notes that the metro's impact is mediated by local factors, such as the quality of the pedestrian environment around stations. While the metro expands "activity spaces," maximizing its health potential requires supportive urban design, including safe pathways for the "last mile" of the journey.
Conclusion
This study demonstrates that the Dowlat Abad Metro Station has yielded substantial health and economic benefits for Tehran by promoting physical activity. The prevention of dozens of premature deaths and the generation of significant financial savings highlight the important co-benefits of investing in sustainable public transport infrastructure. The research underscores the necessity of integrating health considerations into urban and transport policy from the outset, advocating for a move beyond sectoral silos. It concludes that while metro development is a necessary step for improving population health, it is not sufficient on its own. To fully realize its potential, it must be coupled with complementary measures such as creating safe pedestrian and cycling infrastructure and promoting mixed land use. Future research should conduct prospective HIAs before project implementation and utilize longitudinal designs and localized data to enhance the accuracy of impact assessments.

Keywords

Subjects

1.       Basakha, M., Soleimanvandiazar, N., Tavangar, F., & Daneshi, S. (2021). Economic value of life in iran: The human capital approach. Iranian Journal of Public Health, 50(2), 384.
https://doi.org/10.18502/ijph.v50i2.5357
2.       Cole, B. L., MacLeod, K. E., & Spriggs, R. (2019). Health impact assessment of transportation projects and policies: living up to aims of advancing population health and health equity? Annual review of public health, 40(1), 305–318. https://doi.org/10.1146/annurev-publhealth-040617-013836
3.       Diao, M., Lin, K., & Chang, Z. (2024). Impacts of new metro lines on the activity space of older people. Transportation Research Part D: Transport and Environment, 137, 104505. https://doi.org/10.1016/j.trd.2024.104505
4.       Ding, D., Mutrie, N., Bauman, A., Pratt, M., Hallal, P. R., & Powell, K. E. (2020). Physical activity guidelines 2020: comprehensive and inclusive recommendations to activate populations. The Lancet, 396(10265), 1780–1782.
5.       Gharibzadeh, F., Nazparvar, B., Azadehdel, Y., Aghaei, M., & Yunesian, M. (2024). Health and economic impact assessment of active travel modes in Tehran megacity. Transportation Research Part D: Transport and Environment, 126, 104016. https://doi.org/10.1016/j.trd.2023.104016
6.       Goel, R., Guttikunda, S., & Tiwari, G. (2022). Health modelling of transport in low-and-middle income countries: A case study of New Delhi, India. Active Travel Studies, 2(1). https://doi.org/10.16997/ats.1231
7.       Greer, S. L., Falkenbach, M., Siciliani, L., McKee, M., Wismar, M., & Figueras, J. (2022). From health in all policies to health for all policies. The Lancet Public Health, 7(8), e718–e720.
8.       Hall, D., Linogao, J., Zentz, L., Shaw, G., Lamb, T., & Simms, C. (2023). Detailed analysis of New York City subway pedestrian incidents from 2019. Transportation research record, 2677(11), 642–650. https://doi.org/10.1177/03611981231166692
9.       Hamer, M., & Chida, Y. (2008). Walking and primary prevention: a meta-analysis of prospective cohort studies. British journal of sports medicine, 42(4), 238–243. https://doi.org/10.1136/bjsm.2007.039974
10.   Harada, K., Lee, S., Lee, S., Bae, S., Anan, Y., Harada, K., & Shimada, H. (2018). Distance from public transportation and physical activity in Japanese older adults: The moderating role of driving status. Health psychology, 37(4), 355.
11.   Hay, S. I., Abajobir, A. A., Abate, K. H., Abbafati, C., Abbas, K. M., Abd-Allah, F., Abdulkader, R. S., Abdulle, A. M., Abebo, T. A., & Abera, S. F. (2017). Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet, 390(10100), 1260–1344.
12.   He, D., Sun, G., De Vos, J., & Webster, C. (2022). The effects of metro interventions on physical activity and walking among older adults: A natural experiment in Hong Kong. Health & place, 78, 102939. https://doi.org/10.1016/j.healthplace.2022.102939
13.   Health, W. C. o. S. D. o., & Organization, W. H. (2008). Closing the gap in a generation: health equity through action on the social determinants of health: Commission on Social Determinants of Health final report. World Health Organization.
14.   Iungman, T., Khomenko, S., Nieuwenhuijsen, M., Barboza, E. P., Ambròs, A., Padilla, C., & Mueller, N. (2021). The impact of urban and transport planning on health: Assessment of the attributable mortality burden in Madrid and Barcelona and its distribution by socioeconomic status. Environmental Research, 196, 110988. https://doi.org/10.1016/j.envres.2021.110988
15.   Jephcote, C., Clark, S. N., Hansell, A. L., Jones, N., Chen, Y., Blackmore, C., Eminson, K., Evans, M., Gong, X., & Adams, K. (2023). Spatial assessment of the attributable burden of disease due to transportation noise in England. Environment international, 178, 107966. https://doi.org/10.1016/j.envint.2023.107966
16.   Kahlmeier, S., Götschi, T., Cavill, N., Castro Fernandez, A., Brand, C., Rojas Rueda, D., Woodcock, J., Kelly, P., Lieb, C., & Oja, P. (2017). Health economic assessment tool (HEAT) for walking and for cycling: Methods and user guide on physical activity, air pollution, injuries and carbon impact assessments.
17.   Kelly, P., Kahlmeier, S., Götschi, T., Orsini, N., Richards, J., Roberts, N., Scarborough, P., & Foster, C. (2014). Systematic review and meta-analysis of reduction in all-cause mortality from walking and cycling and shape of dose response relationship. International journal of behavioral nutrition and physical activity, 11(1), 1–15. 10.1186/s12966-014-0132-x
18.   Khatami, S. M., Shahmiri, M. S., & Boujari, P. (2025). Comparing Three Transportation Development Scenarios with Sadr Highway in Tehran: A Health Economic Assessment. International Journal of Environmental Research, 19(3), 75 (2025). 10.1007/s41742-025-00739-1
19.   Khomenko, S., Cirach, M., Barrera-Gómez, J., Pereira-Barboza, E., Iungman, T., Mueller, N., Foraster, M., Tonne, C., Thondoo, M., & Jephcote, C. (2022). Impact of road traffic noise on annoyance and preventable mortality in European cities: A health impact assessment. Environment international, 162, 107160. https://doi.org/10.1016/j.envint.2022.107160
20.   Kim, J., Lee, J., Chung, S., & Jang, K. (2022). Effects of built environment in subway stations on pedestrian injuries. Journal of Transport & Health, 26, 101389. https://doi.org/10.1016/j.jth.2022.101389
21.   Knell, G., Durand, C. P., Shuval, K., Kohl Iii, H. W., Salvo, D., Sener, I. N., & Gabriel, K. P. (2018). Transit use and physical activity: Findings from the Houston travel-related activity in neighborhoods (TRAIN) study. Preventive medicine reports, 9, 55–61. https://doi.org/10.1016/j.pmedr.2017.12.012
 
22.   Kwan, S. C., & Hashim, J. H. (2020). Public transport and health. In Advances in Transportation and Health (pp. 149–173). Elsevier https://doi.org/10.1016/B978-0-12-819136-1.00006-1
23.   Kyu, H. H., Bachman, V. F., Alexander, L. T., Mumford, J. E., Afshin, A., Estep, K., Veerman, J. L., Delwiche, K., Iannarone, M. L., & Moyer, M. L. (2016). Physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events: systematic review and dose-response meta-analysis for the Global Burden of Disease Study 2013. bmj, 354. https://doi.org/10.1136/bmj.i3857
24.   Lachapelle, U., Frank, L., Saelens, B. E., Sallis, J. F., & Conway, T. L. (2011). Commuting by public transit and physical activity: where you live, where you work, and how you get there. Journal of Physical Activity and Health, S72–S82. https://doi.org/10.1123/jpah.8.s1.s72
25.   Lilly, K., Kean, B., Hallett, J., Robinson, S., & Selvey, L. A. (2023). Factors of the policy process influencing Health in All Policies in local government: a scoping review. Frontiers in Public Health, 11, 1010335. https://doi.org/10.3389/fpubh.2023.1010335
26.   Lovasi, G. S., Jacobson, J. S., Quinn, J. W., Neckerman, K. M., Ashby-Thompson, M. N., & Rundle, A. (2011). Is the environment near home and school associated with physical activity and adiposity of urban preschool children? Journal of urban health, 88, 1143–1157. https://doi.org/10.1007/s11524-011-9604-3
 
27.   McAndrews, C., & Deakin, E. (2020). Public health sector influence in transportation decision-making: The case of health impact assessment. Case studies on transport policy, 8(3), 1116–1125. https://doi.org/10.1016/j.cstp.2018.02.002
28.   Mueller, N., Daher, C., Rojas-Rueda, D., Delgado, L., Vicioso, H., Gascon, M., Marquet, O., Vert, C., Martin, I., & Nieuwenhuijsen, M. (2021). Integrating health indicators into urban and transport planning: a narrative literature review and participatory process. International journal of hygiene and environmental health, 235, 113772.
29.   Mueller, N., Rojas-Rueda, D., Basagaña, X., Cirach, M., Cole-Hunter, T., Dadvand, P., Donaire-Gonzalez, D., Foraster, M., Gascon, M., & Martinez, D. (2017). Urban and transport planning related exposures and mortality: a health impact assessment for cities. Environmental health perspectives, 125(1), 89–96.
30.   Murray, C. J., Aravkin, A. Y., Zheng, P., Abbafati, C., Abbas, K. M., Abbasi-Kangevari, M., Abd-Allah, F., Abdelalim, A., Abdollahi, M., & Abdollahpour, I. (2020). Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet, 396(10258), 1223–1249.
31.   Nieuwenhuijsen, M. J. (2020). Urban and transport planning pathways to carbon neutral, liveable and healthy cities; A review of the current evidence. Environment international, 140, 105661.
32.   Ostro, B., & Organization, W. H. (2004). Outdoor air pollution: assessing the environmental burden of disease at national and local levels. World Health Organization.
33.   Ostro, B., & WHO. (2004). Outdoor air pollution: assessing the environmental burden of disease at national and local levels. World Health Organization.
34.   OECD (2012), Mortality Risk Valuation in Environment, Health and Transport Policies, OECD Publishing, Paris, https://doi.org/10.1787/9789264130807-en.
35.   Ross, C. L., Orenstein, M., & Botchwey, N. (2014). Health impact assessment in the United States. Springer Science & Business Media.
36.   Rundle, A., Roux, A. V. D., Freeman, L. M., Miller, D., Neckerman, K. M., & Weiss, C. C. (2007). The urban built environment and obesity in New York City: a multilevel analysis. American Journal of Health Promotion, 21(4_suppl), 326-334. doi:10.4278/0890-1171-21.4s.326
37.   Sallis, J. F., Cerin, E., Conway, T. L., Adams, M. A., Frank, L. D., Pratt, M., Salvo, D., Schipperijn, J., Smith, G., & Cain, K. L. (2016). Physical activity in relation to urban environments in 14 cities worldwide: a cross-sectional study. The lancet, 387(10034), 2207–2217.
38.   Shahabi Shahmiri, M., Boujari, P., Gharaei, A., Abolghasemi Soleh, M., & Sadeghnejad, S. (2025). Effect of a New Metro Station on Travel Behavior and Physical Activity in Tehran. Transportation Research Record, 2679(12). https://doi.org/10.1177/03611981251380578
39.   Stevenson, M., Thompson, J., de Sá, T. H., Ewing, R., Mohan, D., McClure, R., Roberts, I., Tiwari, G., Giles-Corti, B., & Sun, X. (2016). Land use, transport, and population health: estimating the health benefits of compact cities. The lancet, 388(10062), 2925–2935.
40.   Statistical Center of Iran. (1400). Statistical Yearbook 1400. Tehran. [in persian]
41.   Sun, G., Zhao, J., Webster, C., & Lin, H. (2020). New metro system and active travel: a natural experiment. Environment international, 138, 105605. https://doi.org/10.1016/j.envint.2020.105605
42.   Tainio, M. (2015). Burden of disease caused by local transport in Warsaw, Poland. Journal of Transport & Health, 2(3), 423–433. https://doi.org/10.1016/j.jth.2015.06.005
43.   Tan, Y., Zhao, P., & Li, L. (2025). Subway expansion, residential relocation, and travel behavior: Causal evidence from China. Journal of transport geography, 124, 104166. https://doi.org/10.1016/j.jtrangeo.2025.104166
44.   Tehran Municipality. (2016). Statistical Yearbook.[in persian]
 
45.   Tehran Municipality. (2018). Municipality of District 18 of Tehran. [in persian]
46.   Thangavel, P., Kim, K. Y., Park, D., & Lee, Y.-C. (2023). Evaluation of health economic loss due to particulate matter pollution in the Seoul subway, South Korea. Toxics, 11(2), 113.
47.   Thondoo, M., Mueller, N., Rojas-Rueda, D., de Vries, D., Gupta, J., & Nieuwenhuijsen, M. J. (2020). Participatory quantitative health impact assessment of urban transport planning: A case study from Eastern Africa. Environment international, 144, 106027. https://doi.org/10.1016/j.envint.2020.106027
48.   Van Soest, D., Tight, M. R., & Rogers, C. D. (2020). Exploring the distances people walk to access public transport. Transport reviews, 40(2), 160–182. https://doi.org/10.1080/01441647.2019.1575491
49.   Waheed, F., Ferguson, G. M., Ollson, C. A., MacLellan, J. I., McCallum, L. C., & Cole, D. C. (2018). Health Impact Assessment of transportation projects, plans and policies: A scoping review. Environmental Impact Assessment Review, 71, 17–25. https://doi.org/10.1016/j.eiar.2017.12.002
50.   Wasfi, R. A., Ross, N. A., & El-Geneidy, A. M. (2013). Achieving recommended daily physical activity levels through commuting by public transportation: Unpacking individual and contextual influences. Health & place, 23, 18–25. https://doi.org/10.1016/j.healthplace.2013.04.006
51.   Woodcock, J., Franco, O. H., Orsini, N., & Roberts, I. (2011). Non-vigorous physical activity and all-cause mortality: systematic review and meta-analysis of cohort studies. International journal of epidemiology, 40(1), 121–138. https://doi.org/10.1093/ije/dyq104
52.   Yin, C., Chen, Y., & Sun, B. (2024). Nonlinear relationships of commuting and built environments surrounding residences and workplaces with obesity. Humanities and Social Sciences Communications, 11(1), 1–14. https://doi.org/10.1057/s41599-024-03964-9
53.   Zheng, M., Guo, X., Liu, F., & Shen, J. (2021). Contribution of subway expansions to air quality improvement and the corresponding health implications in Nanjing, China. International journal of environmental research and public health, 18(3), 969. https://doi.org/10.3390/ijerph18030969
54.   Zukowska, J., Gobis, A., Krajewski, P., Morawiak, A., Okraszewska, R., Woods, C. B., Volf, K., Kelly, L., Gelius, P., & Messing, S. (2022). Which transport policies increase physical activity of the whole of society? A systematic review. Journal of Transport & Health, 27, 101488.
 

  • Receive Date 08 October 2025
  • Revise Date 28 January 2026
  • Accept Date 19 April 2026