July 2, 2024

By Alina Schnake-Mahl, ScD, MPH, Josiah Kephart, PhD, MPH, and Alex Quistberg, PhD, MPH

Hot Topics in Urban Policy and Health: This UHC Policy Core blog series highlights important topics in urban policy that have implications for health and health equity. We hope the series helps our collaborators learn about various policy areas and sparks interest in future research and practice experience on these policies.

On June 30th, New York City was poised to become the first US city to implement congestion pricing, or a policy that requires fees for vehicles entering busy downtown or dense areas. The policy goal of congestion pricing was to use tolls to reduce motor vehicle traffic and congestion in high volume traffic areas (i.e., Lower Manhattan), and instead encourage public transit use, carpooling, walking, biking, or use of alternative routes.

Unfortunately, in a last-minute decision, NY Governor Kathy Hochul indefinitely paused the policy, potentially ending a decades-long process to limit car traffic in the most densely populated area in the country. The decision will cost the state billions of dollars of needed funding for the train and bus system, hundreds of millions already spent to set up the system, and thousands of lives that could have been saved and health improved had the policy been implemented.

NYC’s congestion pricing was the first attempt in the US to curb car usage in densely populated areas with good public transportation through vehicle fees, but several cities across the world have already successfully implemented these polices, including London, Stockholm, and Singapore. Research from these places suggests that congestion pricing has a twofold benefit. First, it raises money to invest in public transit and infrastructure, thereby contributing to better and cleaner transit options, and second, it discourages car travel into busy areas, reducing car use, traffic, air pollution, and reducing greenhouse gas emissions. Research from cities that have implemented congestion pricing found benefits to residents’ health, including lower asthma hospitalization rates, and decreases in air-pollution related health outcomes and road traffic injuries.

NYC congestion pricing appears to be defeated for now, but research on the impacts of cars and car traffic on air pollution and traffic injuries can help us understand what the health impacts of congestion pricing might have been for New Yorkers (and could be if Governor Hochul changes her stance or a future governor moves forward with the policy), and what the health impacts could be for other cities considering congestion pricing in the future.

Exhaust from gas and diesel-powered vehicles is one of the largest contributors to urban air pollution. These fossil fuel-powered vehicles produce large amounts of air pollutants, such as fine particulate matter (PM_2.5) and nitrogen dioxide (NO₂) that increase pollution levels in surrounding neighborhoods and harm the health of local residents. Breathing even low levels of PM_2.5 and NO₂ increases your risk of respiratory and cardiovascular disease and can contribute to premature mortality. Older adults and children are particularly sensitive to the health impacts of air pollution, and air pollution spikes are a common trigger for “episodes” or exacerbations among individuals with respiratory diseases such as asthma or COPD. Because of the health threats of air pollution from fossil-fuel powered vehicles, policies that prevent fossil-fuel powered vehicles from polluting dense residential areas are important for protecting public health. For example, UHC researchers have found that NYC’s clean bus program successfully reduced levels of harmful air pollution in the neighborhoods immediately surrounding bus routes.

Congestion pricing also has important implications for road safety. After implementation, cities with congestion pricing experienced large short-term and long-term decreases (over 50%) in road traffic crashes in congestion pricing areas as well as surrounding areas, including when compared to expected crash rates had congestion pricing not been implemented. While crashes decreased overall, the number of fatal and severe collisions among motorcyclists (~17%) and bicyclists (~13%) increased in the initial year, but then decreased in subsequent years, and the temporary increase in crashes may have been driven by increases in the motorcycle (+15%) and bicycle trips (+ 66%). These positive road safety effects may be amplified when paired with programs to reduce motorist speeds, such as Vision Zero and Complete Streets road designs, which are currently operating in NYC, which can reduce bicyclist and pedestrian injuries and deaths.

After Hochul’s decision to indefinitely postpone congestion pricing, NYC residents and visitors, including Philadelphians, will not experience these dramatic health benefits, and will not enjoy the climate benefits promised by the policy. Manhattan was a prime location to implement congestion pricing because of the high concentration of people living near and sharing air with roadways and vehicles and the wide availability of sustainable transportation alternatives. Philadelphia is the 4th most traffic congested city in the country, needs more money for SEPTA, had 9.2 per 100,000 motor vehicle deaths as of 2022 data, and has high concentrations of air pollutants, particularly during rush hour. Congestion pricing may not be viewed as Philadelphia’s ideal policy solution for these problems, but the NYC experiment would have provided valuable data on health impacts and lessons for Philadelphia.