In addition to its potential contribution to reaching climate targets, cycling may generate substantial population-level health benefits through the physical activity it requires. Due to the lack of nationally representative mobility data, the health impact of current levels of cycling is still unknown for France. Relying on a health impact assessment framework and using recent nationally-representative data on mobility, we assessed the health and related economic benefits of cycling in 2018-2019 in France. We show that such benefits remain moderated and fall short when compared to those estimated in other countries with high cycling levels. We argue that cycling in France did not receive the attention and investments it deserves over the past decade and thus represents a missed opportunity for climate action and public health.

Objectives Promoting active modes of transportation such as cycling may generate important public health, economic, and climate mitigation benefits. We aim to assess mortality and morbidity impacts of cycling in a country with relatively low levels of cycling, France, along with associated monetary benefits; we further assess the potential additional benefits of shifting a portion of short trips from cars to bikes, including projected greenhouse gas emissions savings. Methods Using individual data from a nationally-representative mobility survey, we described the French 2019 cycling levels by age and sex. We conducted a burden of disease analysis to assess the incidence of five chronic diseases (breast cancer, colon cancer, cardio-vascular diseases, dementia, and type-2 diabetes) and numbers of deaths prevented by cycling. We assessed the corresponding tangible costs saved based on direct medical costs and intangible costs based on the value of a statistical life year. Lastly, based on individual simulations, we assessed the likely additional benefits of shifting 25% of short (<10km) car trips were shifted to cycling. Results The French adult (20-89 years) population was estimated to cycle on average of 1min 17sec pers-1.day-1 in 2019, with important heterogeneity across gender and age. This yielded benefits of 1,919 (uncertainty interval, UI: 1,101-2,736) premature deaths and 5,963 (95% UI: 3,178-8,749) chronic disease cases prevented, with males enjoying nearly 75% of these benefits. Direct medical costs prevented were estimated at Euros 191 million (UI: 98-285) annually, while the corresponding intangible costs were nearly 25 times higher (Euros 4.8 billion, UI: 3.0-6.5). Shifting 25% of short car trips to biking would yield approximatively a 3-fold increase in benefits, while also generating important CO2 emission reductions (0.688 MtCO2e, UI: 0.524-0.854). Conclusion In a country of low- to moderate cycling culture, cycling already generates important public health and health-related economic benefits. Further development of active transportation would increase these benefits while also contributing to climate change mitigation targets.