Systems-Level Evaluation of Safe Routes to School Policies in El Paso, Texas: A Modeling Study on Health and Economic Outcomes.

Safe Routes to School (SRTS) policies are linked to physical health benefits for school-age children; however, few studies have assessed long-term impacts on cardiovascular disease (CVD). This study used systems science methods to predict long-term health and economic impact of SRTS among school-age children in El Paso County, Texas. We developed an agent-based model containing 2 modules: the pedestrian injury module and the CVD module. We simulated 10 000 school-age children under 2 scenarios-SRTS policies implemented and no SRTS policies implemented-and then calculated pedestrian injuries, pedestrian injury-related deaths, coronary heart disease (CHD) and stroke events, and health care costs. When SRTS policies were implemented, the model estimated 157 fewer CHD cases and 217 fewer stroke cases per 10 000 people and reduced CVD-related health care costs ($13 788 per person). The model also predicted 129 fewer pedestrian injuries and 1.3 injury-related deaths per 10 000 people and $2417 savings in injury-related health care costs. SRTS could save an estimated $16 205 per person in health care costs. This simulation shows SRTS in El Paso County could prevent pedestrian injuries among school-age children and protect cardiovascular health in the long term. Our findings provide evidence for practitioners and policy makers to advocate for SRTS policies at the local level.