Environment: Massachusetts had several independent transportation agencies. In addition, advocacy groups were promoting the need for safe, convenient, and affordable transportation. The state was also seeing a rise in obesity.

Solution: In 2009, Governor Deval Patrick consolidated all transportation agencies into one organization, MassDOT. The Healthy Transportation Compact (HTC) was created to strengthen the state’s commitment to public health.

Key Features: HTC promotes interagency collaboration to implement policies and programs supporting healthy transportation and ensuring “complete streets,” design that accommodates pedestrians and bicyclists in transportation and development projects.

Partners: Co-chaired by the Secretaries of Health and Human Services and Transportation, the HTC includes the Commissioner of Public Health, MassDOT Highway and Transit Administrators, and the Secretaries of Energy and Environmental Affairs and Housing and Economic Development.

Highlighted Impact: Massachusetts reports a 106 percent increase in commuters traveling via bicycle between 2005 and 2014.

The Healthy Transportation Compact (HTC), a requirement under the Massachusetts Transportation Reform Law of 2009, was established to facilitate multiagency collaboration that advances transportation reforms to promote better health outcomes. Under Governor Deval Patrick’s leadership, the 2009 legislation streamlined a previously segregated group of state transportation agencies into one unified Department of Transportation (MassDOT), and underscored the need to increase efficiencies and improve quality of life for state residents. The reform law generated a renewed focus on safety, health, and accountability within MassDOT. It was spurred by: (1) a desire to more efficiently use existing resources; (2) the promotion of smart spending and the need for safe, convenient, and affordable transportation options by advocacy groups such as WalkBoston and the Somerville Transportation Equity Partnership; and (3) climbing obesity rates across the state.

Co-chaired by the Secretary of Transportation and the Secretary of Health and Human Services, and comprised of several state agencies, the HTC requires a coordinated effort to: (1) encourage and enable active transportation modes like walking and biking; and (2) ensure that agencies take public health into account through the coordination of transportation, land use, and public health policies and decision-making.[i] This legislative requirement has facilitated a strong working partnership between the Department of Health (DPH) and MassDOT representatives, as well as enabled Massachusetts to leverage the unique skillsets, data access, and policy levers and initiatives across state agencies and local community partners.

Better Health Beyond Health Care

The Center for Health Care Strategies, with support from the Robert Wood Johnson Foundation, led an exploratory effort to identify key enablers of successful cross-sector collaboration to improve population health, beyond health care coverage and access to services. This series of case studies details how diverse state-level, cross-sector collaborations can positively impact population health.


the HTC has prompted key policies, resources, and initiatives to improve access for individuals with mobility limitations, increase opportunities for physical activity, and increase bicycle and pedestrian travel, including implementation of: (1) the Healthy Transportation Policy Directive, requiring that all MassDOT projects serve all travel modes and promote healthy options such as walking or bicycling; (2) Green Department of Transportation (GreenDOT) policies and initiatives to increase the amount of travel by walking, bicycling, and public transit; (3) a Health Impact Assessment (HIA) or similar analyses examining the effects of transportation projects on public health; (4) a Complete Streets Funding Program and promotion of MassDOT’s Project Development and Design Guide to enable safe and accessible travel modes for pedestrians, bicyclists, and motorists; and (5) expanded service offerings for the Safe Routes to School (SRTS) program and other programs like Mass in Motion.

This profile outlines key factors behind the success of Massachusetts’ cross-sector collaboration to improve health outcomes through a focus on healthy transportation, outlines statewide activities to expand mobility and improve public health, and explores initial achievements.

Key Factors for Program Success

“Transportation engineers used to think about moving cars. Now, it’s about moving people.”

Michael Trepanier, Senior Environmental Planner, MassDOT

The HTC enabled Massachusetts’ multifaceted efforts to promote healthy transportation through creating strong partnerships between public health, transportation, energy and environmental regulators, and the public. Key takeaways contributing to the effectiveness of the HTC include:

  • Establishing a Formal Structure for Collaborative Implementation and Sustainability. The HTC established a formal structure through which MassDOT coordinates across sectors to advance shared goals and focus on the health outcomes of transportation decision-making. The structure includes: (1) HTC leadership, including agency secretaries or designees meeting regularly to design and continuously refine the overall priorities and work plan; (2) an HTC Advisory Council comprised of subject matter experts (e.g., from Massachusetts Public Health Association and the Harvard T.H. Chan School of Public Health) and advocacy group representatives (e.g., from WalkBoston) who help guide and promote the activities of the HTC; and (3) a cross-sector, bureau-level staff working group that carried out day-to-day HTC implementation. This formal structure provides a level of legitimacy to the collaboration, supports sustainability throughout leadership or administration changes, and creates an unprecedented framework for coordination at the policy and operational levels across multiple departments.
  • Leveraging Partnerships and Complementary Initiatives to Maximize Impact. Select initiatives that were underway prior to the transportation reform law have been informed by the HTC and its focus on improving health outcomes. In addition, due to a strengthened partnership under HTC, MassDOT and DPH are better able to leverage one another’s efforts to maximize reach and impact. For example, the HTC included a provision to expand MassDOT’s SRTS program—a federally funded safety education program for elementary and middle school students. The SRTS program collaborates with and complements Mass in Motion—an initiative of DPH that works with communities, schools, and others to promote opportunities for healthy eating and active living. MassDOT and DPH share community information and best practices to support and collaborate on both initiatives, particularly the focus on reducing health disparities. An example of this collaboration is the leveraging of strong relationships that SRTS regional coordinators have with local schools for Mass in Motion implementation. SRTS is one of the strategies that community participants often include in their Mass in Motion initiatives. Mass in Motion connects communities with state SRTS regional coordinators, who provide technical assistance to schools and municipalities. SRTS programs can also make use of technical assistance offered through Mass in Motion. In addition, Mass in Motion can advocate for policy change whereas SRTS cannot due to federal funding restrictions, so representatives of both programs communicate to share policy-related issues and priorities.
  • Building Local-level Capacity for Implementation. A critical component of MassDOT and DPH’s implementation of HTC goals is strengthening the capacity of local transportation and public health agencies. For example, activities such as Mass in Motion and Massachusetts’ Complete Streets Funding Program (whereby local municipalities that adopt Complete Street best practices are eligible for state funding to rebuild local streets) offer opportunities for state-local partnerships and provide state technical assistance and resources to local partners.
  • Making Use of Existing Resources and Expertise. The HTC uncovered the vast resources and expertise that already existed within Massachusetts’ state agencies and departments that were not being leveraged. For example, DPH’s robust data registries provided MassDOT with data to support the McGrath Highway HIA pilot project, and health equity data related to transportation access, as well as other metrics. In addition, MassDOT has a formal research program, in partnership with the University of Massachusetts system, focused on promoting transportation research and education that can support the priorities of MassDOT and DPH. The University of Massachusetts Transportation Center (UMTC) supports the MassDOT research program with a focus on improving transportation mobility, safety, and health. UMTC facilitates the use of university resources for transportation research through an Interdepartmental Service Agreement between MassDOT and the University of Massachusetts system—providing a mechanism to efficiently collaborate on research projects.

Select Activities

The HTC has enabled a multifaceted effort with cross-agency, statewide initiatives focused on: (1) assessing the effects of transportation projects on public health; (2) establishing healthy transportation-related policies; and (3) implementing programs that promote healthy transportation modes like walking and bicycling. Following are specific activities:

Health Impact Assessment

The transportation reform law requires the HTC to “establish methods to implement the use of HIAs.”[ii] To get a better sense of how HIAs could improve transportation planning, DPH, in partnership with MassDOT and with support from the Health Impact Project—a collaboration of the Robert Wood Johnson Foundation and the Pew Charitable Trusts—conducted a pilot HIA of a transportation planning study to assess alternatives for an outdated highway viaduct in Somerville, Massachusetts.[iii] In addition, two-day training sessions on HIAs were held in 2011 for MassDOT and DPH staff who subsequently collaborated on the McGrath and other HIAs. MassDOT and DPH view HIAs as one tool among many to consider health in transportation projects, and are currently exploring use of the Integrated Transport and Health Impact Modelling approach to assess the health effects of transportation-related policies through its research partnership with the University of Massachusetts system.

Healthy Transportation-Related Policies

The Healthy Transportation Policy Directive requires all MassDOT funded or designed transportation projects to increase bicycling, transit, and walking options.

MassDOT’s GreenDOT Policy Directive and Implementation Plan is a broad sustainability initiative that considers health in coordination with other priorities. Its goals for transportation planning and other activities include: (1) reducing greenhouse gas emissions; (2) promoting the healthy transportation options of walking, cycling, and transit; and (3) supporting “smart growth,” which refers to planned economic and community development that attempts to curb worsening environmental conditions.[iv] MassDOT’s inclusion of health within its sustainability goals reflects its view that these topics are important and intertwined.

In addition, building on GreenDOT and the HTC, in 2013 MassDOT established a Healthy Transportation Policy Directive. The directive requires all MassDOT funded or designed transportation projects to increase bicycling, transit, and walking options.[v] The policy supports Massachusetts’ goal of increasing the distance traveled by walking, bicycling, and transit by 2030. Examples of the policy requirements include sidewalks on both sides of roadways for pedestrians, and designated bicycle lanes (or paved outside shoulders) on freeways for bicyclists. The policy directive requires review of all projects in design, and any projects not meeting its defined standards require Secretary-level approval to proceed.

Programs that Promote Healthy Transportation Modes

The HTC includes a provision to “encourage the construction of complete streets, designed and operated to enable safe access for pedestrians, bicyclists, motorists, and bus riders of all ages to safely move along and across roadways in urban and suburban areas.”[vi] Since the HTC, MassDOT has developed its Complete Streets Funding program, which supports the implementation of its Project Development and Design Guide criteria for developing context-sensitive, community-friendly road and bridge projects. The objectives of the Complete Streets Funding program are to: (1) incentivize adoption of recommended municipal policies and best practices for healthy transportation; (2) encourage municipalities to adopt a strategic and comprehensive approach to support healthy transportation; (3) facilitate better pedestrian, bicycle, and transit travel for all users; and (4) achieve equity in program participation and award distribution. MassDOT has coordinated with DPH to conduct educational workshops for local policymakers, civil engineers, and MassDOT staff about the health and sustainability benefits of the Complete Streets design approach and how it can be implemented. Additionally, as mentioned above, MassDOT and DPH staffs coordinate on Mass in Motion and SRTS programs.


The transportation reform law and HTC have shifted MassDOT’s underlying vision to include a concerted focus on increasing healthy transportation access and improving health. The cross-sector collaboration formalized by the HTC has reinforced an emphasis on health and transportation into each department’s planning and decision-making, while also enabling information exchange between agencies, underscoring the importance of strong political leadership and forward thinking policy directives.

Although program evaluations are underway across MassDOT initiatives, transportation trends in Massachusetts include a 106 percent increase in commuters traveling via bicycle between 2005 and 2014.

Although program evaluations are underway across MassDOT initiatives, transportation trends in Massachusetts include a 106 percent increase in commuters traveling via bicycle between 2005 and 2014.[vii]

Another HTC achievement includes increased coordination and communication across agencies and departments, thereby facilitating an understanding of one another’s processes and priorities. For example, the MassDOT and DPH partnership has enabled transportation engineers to better understand health data, and public health professionals to better understand transportation planning processes.

In addition, MassDOT has received numerous awards on its Project Development and Design Guide, including a Transportation Achievement Award from the Institute for Transportation Engineers, and an Environmental Excellence Award from the Federal Highway Administration. The Design Guide allows for flexible transportation designs that better respond to community values, and provides guidance for applying strategies that accommodate pedestrians and bicyclists upfront rather than as an afterthought.

The healthy transportation-related policies and programs implemented are indicative of Massachusetts’ statewide efforts, and demonstrate the positive impact of cross-sector collaboration to maximize program reach and impact.

About the Robert Wood Johnson Foundation

For more than 40 years the Robert Wood Johnson Foundation has worked to improve health and health care. We are working with others to build a national Culture of Health enabling everyone in America to live longer, healthier lives. For more information, visit Follow the Foundation on Twitter at or on Facebook at

About the Center for Health Care Strategies

The Center for Health Care Strategies (CHCS) is a nonprofit policy center dedicated to improving the health of low-income Americans. It works with state and federal agencies, health plans, providers, and community-based organizations to develop innovative programs that better serve people with complex and high-cost health care needs. For more information, visit

[i] 2009 Transportation Reform Legislation. Chapter 25 of the Acts of 2009, Section 33.
[ii] Ibid.
[iii] 2013. Massachusetts Department of Public Health Bureau of Environmental Health. Health Impact Assessment of the Massachusetts Department of Transportation Grounding McGrath Study.
[iv] 2010 GreenDOT Policy Directive.
[v] 2013 Healthy Transportation Policy Directive.
[vi] 2009 Transportation Reform Legislation, op.cit.
[vii] 2014. League of American Bicyclists American Community Survey Data Report. Where we ride: Analysis of bicycle commuting in American cities.