Investments in infrastructure to promote bicycling and walking under the proposed Transportation and Climate Initiative (TCI) could mean major health benefits and savings for residents across the Northeast and Mid-Atlantic region, according to a new study conducted by Boston University School of Public Health (BUSPH) and Harvard T.H. Chan School of Public Health.

Published in the Journal of Urban Health, the analysis shows that the monetary benefit of lives saved from increased walking and cycling exceed the estimated annual investment for such infrastructure, without considering the added benefits of reducing air pollution and tackling climate change.

“Our study suggests that if all the states joined TCI and collectively invested at least $100 million in active mobility infrastructure and public transit, the program could save hundreds of lives per year from increased physical activity,” says study lead author Matthew Raifman, a doctoral student in environmental health at BUSPH. “These benefits are larger than the estimated air quality and climate benefits for the TCI scenarios, highlighting the importance of leveraging investments in sustainable active mobility to improve health.”

The TCI program, a partnership of 12 states and the District of Columbia currently under development, would implement a cap-and-invest program to reduce transportation sector emissions across the Northeast and Mid-Atlantic region, including investment in cycling and pedestrian infrastructure as well as other sustainable transportation strategies like electric vehicle charging and public transit.

Raifman and colleagues used an investment scenario model and the World Health Organization (WHO) Health Economic Assessment Tool methodology to estimate how many lives would be saved in each of the 378 counties in the Northeast and Mid-Atlantic regions due to increased physical activity (walking/running and cycling) and accounting for the potential for changes in traffic fatalities.

The team analyzed nine scenarios that differed in their greenhouse gas emission caps as well as how the proceeds from the program would be invested across a range of transportation options. The scenario with the largest health benefits assumed a 25% reduction in greenhouse gas emissions, and investment of $632 million of the proceeds in cycling and pedestrian infrastructure across the 12 states and D.C. The researchers estimated that this scenario could save 770 lives regionwide due to reduced cardiovascular mortality, accounting for changes in pedestrian accident fatality rates. Meanwhile, the monetary value of the reduced health risk would be $7.6 billion per year.

Health benefits across the other scenarios that were analyzed roughly scaled with the degree of investment in pedestrian and cycling infrastructure. The states with the largest estimated health benefits from active mobility under all policy scenarios are the populous states of New York, New Jersey, Pennsylvania, and Maryland.

The study is part of the Transportation, Equity, Climate and Health (TRECH) Project, a multi-university research initiative independently analyzing TCI and other policy scenarios. The TRECH Project is made possible in part by a grant from the Barr Foundation to the Center for Climate, Health, and the Global Environment at the Harvard T.H. Chan School of Public Health (Harvard Chan C-CHANGE).