title: A health impact assessment of proposed public transportation service cuts and fare increases in Boston, Massachusetts (U.S.A.).
abstract: Transportation decisions have health consequences that are often not incorporated into policy-making processes. Health Impact Assessment (HIA) is a process that can be used to evaluate health effects of transportation policy. We present a rapid HIA, conducted over eight weeks, evaluating health and economic effects of proposed fare increases and service cuts to Boston, Massachusetts' public transportation system. We used transportation modeling in concert with tools allowing for quantification and monetization of multiple pathways. We estimated health and economic costs of proposed public transportation system changes to be hundreds of millions of dollars per year, exceeding the budget gap the public transportation authority was required to close. Significant health pathways included crashes, air pollution, and physical activity. The HIA enabled stakeholders to advocate for more modest fare increases and service cuts, which were eventually adopted by decision makers. This HIA was among the first to quantify and monetize multiple pathways linking transportation decisions with health and economic outcomes, using approaches that could be applied in different settings. Including health costs in transportation decisions can lead to policy choices with both economic and public health benefits.
authors.affiliation: Departments of Epidemiology and Environmental Health, Harvard School of Public Health, 401 Park Drive, Boston, MA 02215, USA. pjames@hsph.harvard.edu.
authors.forename: Peter
authors.initials: P
authors.lastname: James
authors.affiliation: Metropolitan Area Planning Council, 60 Temple Place, Boston, MA 02111, USA. kito@mapc.org.
authors.forename: Kate
authors.initials: K
authors.lastname: Ito
authors.affiliation: Harvard Center for Health and the Global Environment, 401 Park Drive, Boston, MA 02215, USA. jjb194@mail.harvard.edu.
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Buonocore
authors.affiliation: Boston University School of Public Health, 715 Albany St. Talbot Building, Boston, MA 02118, USA. jonlevy@bu.edu.
authors.forename: Jonathan I
authors.initials: JI
authors.lastname: Levy
authors.affiliation: Metropolitan Area Planning Council, 60 Temple Place, Boston, MA 02111, USA. mca767@mail.harvard.edu.
authors.forename: Mariana C
authors.initials: MC
authors.lastname: Arcaya
mesh_terms: D001900:Boston; D003657:Decision Making; D004782:Environmental Health; D062489:Health Impact Assessment; D006304:Health Status; D011050:Policy Making; D011640:Public Policy; D014186:Transportation / Q000191:economics*
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