Vol. 13 No. 2 (2021): Archives of Public Health
Public Health

Assessment of health and economic benefits of walking in the Republic of North Macedonia using Health Economic Assessment Tool (HEAT)

Jansun Bukovetz
Institute of Public Health of the Republic of North Macedonia; Ss Cyril and Methodius University in Skopje, Faculty of Medicine, Republic of North Macedonia
Kristina Shuntova
Ss Cyril and Methodius University in Skopje, Faculty of Medicine, Republic of North Macedonia
Igor Spiroski
Institute of Public Health of the Republic of North Macedonia; Ss Cyril and Methodius University in Skopje, Faculty of Medicine, Republic of North Macedonia
Shaban Memeti
Institute of Public Health of the Republic of North Macedonia; Ss Cyril and Methodius University in Skopje, Faculty of Medicine, Republic of North Macedonia

Published 2021-11-20


  • HEAT,
  • walking,
  • Republic of North Macedonia

How to Cite

Bukovetz J, Shuntova K, Spiroski I, Memeti S. Assessment of health and economic benefits of walking in the Republic of North Macedonia using Health Economic Assessment Tool (HEAT). Arch Pub Health [Internet]. 2021 Nov. 20 [cited 2024 Apr. 16];13(2):17-29. Available from: https://id-press.eu/aph/article/view/6010


Walking as a form of physical activity has immense health benefits, but it also has economic benefits. Walking is a very efficient activity that prevents certain diseases and enables better quality of life of people who already have some disease.A considerable contribution of walking is detected in cardiovascular diseases, type 2 diabetes, obesity and chronic pulmonary diseases.The aim of this study was to make a health and economic assessment of the benefits of walking in the Republic of North Macedonia by using the Health and Economic Assessment Tool (HEAT).Materials and methods:Health Economic Assessment Tool is a relatively new tool, developed by WHO experts whose expertise is in the field of Public health and is able to calculate the health effects of regular walking and/or cycling. This study was based on using this tool for walking mode for the first time in the Republic of North Macedonia in a population group of 191 participants between the age of 20 to 73 years, with the average age of 35 years.Results:Besides the aforementioned health benefits, HEAT calculates the economic benefits of walking. The tool applied to 191 participants resulted in a total economic value of 108 808.8€ for one yearas well as reduction in mortality rate. Conclusion: We found that less than one fifth of our assessed population spends time in walking according to the WHO, CDC and AHA recommendations. The rest of them, more than four fifths are not following these recommendations. Our assessed population was relatively young, the average age being 35 years old, and the population was healthy, but still the results from this survey were not satisfying.


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  1. Bulut S. Social determinants of health, physical activity. Turk Hij Den Biyol Derg 2013;70(4): 205-14.DOI:10.5505/TurkHijyen.2013.67442 DOI: https://doi.org/10.5505/TurkHijyen.2013.67442
  2. WHO. Executive summary. In: WHO guidelines on physical activity and sedentary behaviour. Geneva. World Health Organization. 2020;VIII
  3. HaskellLW, Lee M, Pate R. R, et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc 2007; 39(8):1423-1434.DOI: 10.1249/mss.0b013e3180616b27 DOI: https://doi.org/10.1249/mss.0b013e3180616b27
  4. World Health Organization. Physical activity. [cited 2020 Nov 26]. Available from: https://www.who.int/news-room/fact-sheets/detail/physical-activity
  5. KahlmeierS,Gotschi T, Cavill N, et al.HEAT, Health Economic and Assessment Tool for walking and cycling, Methods and user guide on physical activity, air pollution, injuries and carbon impact assessments. WHO Regional Office for Europe.2017; p21-46.
  6. Center for disease control and prevention. How much physical activity do adults need? 2020. Available from: https://www.cdc.gov/physicalactivity/basics/adults/
  7. http://www.heart.org/HEARTORG/GettingHealthy/PhysicalActivity/StartWalking/American-Heart-AssociationGuidelines_UCM_307976_Article.jsp
  8. WHO. Pedometer and physical activity. In: Pacific physical activity guidelines for adults. Switzerland. WHO. 2008; p9.
  9. Kyle’s converter. Available from: http://www.kylesconverter.com/
  10. Brown V, Zapata Diomedi B, Moodie M, et al. A systematic review of economic analyses of active transport interventions that include physical activity benefits.Transp Policy Elsevier. 2016; 45:190-208. DOI: 10.1016/j.tranpol.2015.10.003 DOI: https://doi.org/10.1016/j.tranpol.2015.10.003
  11. Cavill N, Kahlmeier S, Crone D, Goudas M. Measuring the value of an Urban Active Environment (UActivE) including case study examples from the EU SPACE (Supporting Policy and Action for Active Environments) project. 2017; p27-29
  12. Tas A, Karagulle D, Özcan S et al.Evaluation of walking level health and economic benefits by Europe health economic assessment tool for walking (heat - for walking). Journal of Environmental Protection and Ecology2019;20(1):461-467.
  13. Olabarria M, Pérez C, Santamariña-Rubio E.et al. Health impact of motorised trips that could be replaced by walking. European journal of public health2012; 23(2). DOI:10.1093/eurpub/cks015 DOI: https://doi.org/10.1093/eurpub/cks015
  14. SælensmindeK.Cost–benefit analyses of walking and cycling track networks taking into account insecurity, health effects and external costs of motorized traffic. Transportation Research Part A: Policy and Practice. Elsevier. 2004; 38(8):593-606.DOI:10.1016/j.tra.2004.04.003 DOI: https://doi.org/10.1016/j.tra.2004.04.003
  15. Gössling S, Choi A, Dekker K, et al. The social cost of automobility. Cycling and Walking in the European Union. Ecological Economics. Elsevier. 2019; 158(C):65-74. DOI: 10.1016/j.ecolecon.2018.12.016 DOI: https://doi.org/10.1016/j.ecolecon.2018.12.016
  16. Pérez K, Olabarria M, Rojas-Rueda D, et al. The health and economic benefits of active transport policies in Barcelona.JTranspHealth2017;4:316-324. DOI:10.1016/j.jth.2017.01.001 DOI: https://doi.org/10.1016/j.jth.2017.01.001
  17. Ангеловски Н.Втора национална стратегија на Република Македонија за унапредување на безбедноста на сообраќајот на патиштата. Скопје. РСБСП. 2014; с8-23.
  18. Републички совет за безбедност на сообраќајот на патиштата. Пешаците и понатаму се една од најзагрозените групи учесници во сообраќајот.Овозможено на: https://www.rsbsp.org.mk/
  19. Републички совет за безбедност на сообраќајот на патиштата.РСБСП со апел: Пешацитечестострадаат во сообраќајнинезгоди, бидетевнимателни! Овозможено на:https://www.rsbsp.org.mk/
  20. Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT; Lancet Physical Activity Series Working Group. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet. 2012 Jul 21;380(9838):219-29. doi: 10.1016/S0140-6736(12)61031-9. PMID: 22818936; PMCID: PMC3645500. DOI: https://doi.org/10.1016/S0140-6736(12)61031-9
  21. World Health Organization. Body mass index – BMI. Available from: https://www.euro.who.int/en/health-topics/disease-prevention/nutrition/a-healthy-lifestyle/body-mass-index-bmi
  22. Ekelund U, Ward A. H, Norat T, et al. Physical activity and all-cause mortality across levels of overall and abdominal adiposity in European men and women: the European Prospective Investigation into Cancer and Nutrition Study (EPIC)1–6. Am J ClinNutr 2015; 101(3):613–621.DOI: 10.3945/ajcn.114.100065 DOI: https://doi.org/10.3945/ajcn.114.100065
  23. Swartz MA, Strath JS, Bassett RB, et al. Increasing daily walking improves glucose tolerance in overweight women. Preventive Medicine 2003; 37(4):356-362.DOI: 10.1016/s0091-7435(03)00144-0 DOI: https://doi.org/10.1016/S0091-7435(03)00144-0
  24. Omura DJ, Ussery N E, Loustalot F, et al. Walking as an opportunity for cardiovascular disease prevention. Prev Chronic Dis 2019;16:E66. DOI:10.5888/pcd16.180690 DOI: https://doi.org/10.5888/pcd16.180690
  25. Dontje LM, Van der Wal HLM, Stolk PR, et al.Daily physical activity in stable heart failure patients. J CardiovascNurs 2014;29(3):218-226. DOI:10.1097/JCN.0b013e318283ba14 DOI: https://doi.org/10.1097/JCN.0b013e318283ba14
  26. Pritchett AM, Deswal A, Aguilar D, et al. Lifestyle modification with diet and exercise in obese patients with heart failure - A pilot study. J Obes Weight Loss Ther 2012;2(2):1-8. DOI: 10.4172/2165-7904.1000118 DOI: https://doi.org/10.4172/2165-7904.1000118
  27. Sharman EJ, Stowasser M. Australian Association for Exercise and Sports Science. Position statement on exercise and hypertension. J Sci Med Sport 2009; 12(2):252-257. DOI: 10.1016/j.jsams.2008.10.009 DOI: https://doi.org/10.1016/j.jsams.2008.10.009
  28. Wattanapisit A.Thanamee S. Evidence behind 10,000 steps walking. J Health Res 2017; 31(3): 241-248.
  29. Iwane M, MikioArita M, ShigehiroTomimoto S, et al. Walking 10, 000 steps/day or more reduces blood pressure and sympathetic nerve activity in mild essential hypertension. Hypertens Res 2000; 23(6):573-580. DOI: 10.1291/hypres.23.573 DOI: https://doi.org/10.1291/hypres.23.573
  30. McNiece L. K, Poffenbarger S. T, Jennifer L. et al. Prevalence of hypertension and pre-hypertension among adolescents. J Pediatr 2007; 150(6):640-644. DOI: https://doi.org/10.1016/j.jpeds.2007.01.052
  31. Wootton SL, Ng LW, McKeough ZJ, Jenkins S, Hill K, Eastwood PR, et al. Ground-based walking training improves quality of life and exercise capacity in COPD. Eur Respir J 2014;44(4):885-94. DOI: 10.1183/09031936.00078014 DOI: https://doi.org/10.1183/09031936.00078014
  32. Wouters FME, Posthuma R, Koopman M, et al. An update on pulmonary rehabilitation techniques for patients with chronic obstructive pulmonary disease. Expert Rev Respir Med 2020;14(2):149-161.DOI:10.1080/17476348.2020.1700796 DOI: https://doi.org/10.1080/17476348.2020.1700796