San Francisco Bay Area's Regional Transportation Plan

Published Date
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Health Impact Project

This HIA, conducted by the Alameda County Public Health Department (ACPHD), informed the development of the San Francisco Bay Area’s Regional Transportation Plan (RTP), which will serve as a guide to transportation-related investments over the next 25 years. The assessment examined the equity impacts--or how the new Plan might affect different populations in different ways--of the RTP within Alameda County, specifically focused on transit-dependant populations and the expected health outcomes that may result from changes to bus access as determined by RTP. Since transit-reliant communities are primarily low-income people of color, the HIA also determined the potential for differential impacts on these vulnerable groups. The HIA focused on the impacts that changes in public transportation could have on access to health and social services, basic amenities such as grocery and retail stores, and employment, and how these changes could impact health in bus-dependent communities.

HIA Summary Findings

The HIA utilitized surveys and focus groups with 477 transit-dependent bus riders to investigate how recent bus service cuts and fare increases affected riders' quality of trip experience, affordability, and access to destinations essential for good health. The majority of surveyed riders were affected by service cuts in recent years. Two-thirds reported experiencing longer bus wait times, which increased stress and fear of crime at bus stops. More than one-third of riders surveyed reported more crowding, which can lead to reduced bus access, especially for riders in wheelchairs. Many focus group participants said they have to cut back on food, social activities, and trips to the doctor in order to cope with the rising cost of bus fare.


The HIA recommended increasing the funding for transit service, particularly bus service, in the RTP to support the health and wellbeing of transit-dependent riders and their communities and increase public transit ridership. Based on the study, the HIA recommended the Equity, Environment, and Jobs (EEJ) alternative RTP, as this alternative would likely provie the best mobility-related health benefits for transit-dependent riders across the region. The HIA also recommended that the Metropolitan Transportation Commission (MTC) conduct an evaluation of implementing a means-based fare program to assist low-income riders. A discounted transit pass has the potential to increase trips to essential destinations, including healthcase appointments. The HIA also recommended that the MTC analyze quality of trip experience and actual service conditions on the ground and treat these issues as critical to mobility-related health.

Supported by funding from The California Endowment.


This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

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Transit System

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Healthcare Access

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People Living in Poverty