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ABSTRACT Background 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, based on national incidence and mortality data and dose-response relationships from meta-analyses. We assessed the corresponding direct medical cost savings and the intangible costs prevented 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 (<5km) car trips were shifted to cycling. Findings 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 (UI: 3,178-8,749) chronic disease cases prevented, with males enjoying nearly 75% of these benefits. Direct medical costs prevented were estimated at €191 million (UI: 98-285) annually, while the corresponding intangible costs were nearly 25 times higher (€4.8 billion, UI: 3.0-6.5). We estimated that in average, €1.02 (UI: 0.59-1.62) of intangible costs were prevented for every km cycled. Shifting 25% of short car trips to biking would yield approximatively a 2-fold increase in death prevented, while also generating important CO 2 emission reductions (0.257 MtCO2e, UI: 0.231-0.288). Interpretation 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. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
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