A healthy t for a healthy region

Working under difficult fiscal and political constraints, the Massachusetts Bay Transportation Authority (MBTA) proposed two sets of fare increases and service cuts aimed at closing its projected deficit of $161 million last year. Under the proposed Scenarios, fares would have increased by 35%-43% and service reductions would have affected 34–64 million trips each year. In collaboration with colleagues from the Harvard School of Public Health and the Boston University School of Public Health, the Metropolitan Area Planning Council (MAPC) conducted a rapid Health Impact Assessment (HIA) of the Scenarios. To assess how the Scenarios might impact health, we examined the Boston Region Metropolitan Planning Organization's Central Transportation Planning Staff (CTPS) estimates of how the Scenarios would affect vehicle miles travelled, time spent driving, ridership loss, and air quality in the region. We then applied findings from peer reviewed scientific literature to the results of the CTPS transportation models, in consultation with local experts in the fields of air quality, environmental health, and physical activity. We considered both health and indirect economic impacts to the region. This analysis shows that the proposed changes to MBTA fares and services would carry significant health and financial costs, resulting in avoidable loss of life and hundreds of millions of dollars per year in lost time, wasted fuel, and preventable hospitalizations and crashes. Implementing either proposal would result in cost shifting—between $272.1 million and $386.9 million per year in additional health costs for the region—that far exceeds the budget shortfall the proposed changes seek to address. The HIA contributed to the dialogue around the Scenarios and earned over 50 media stories. After significant public input in response to the proposed Scenarios, the MBTA ultimately implemented fare increases and service cuts that were significantly scaled back from the proposed Scenarios.