The Mobility Deficit and Public Health Imperative in Puerto Rico's Municipal Transit Systems

I. Executive Summary: The Fragmented Reality of Collective Mobility and the Chronic Disease Crisis

1.1. Statement of Problem and Primary Findings

The analysis of Puerto Rico’s transportation infrastructure reveals a critical and pervasive deficit in collective mobility across the Commonwealth’s 78 municipalities. While centralized metropolitan areas are served by the Metropolitan Bus Authority (AMA) and the Tren Urbano, municipal-level collective transport (MCT) systems operate in isolation, failing to establish a cohesive island-wide network. This severe fragmentation leaves a vast majority of the population reliant on private vehicles or informal transport options, directly impeding access to essential healthcare and preventative resources.

The study confirms that the overwhelming majority of Puerto Rico’s municipalities lack structured, fixed-route collective transport services. Although the total population of Puerto Rico is estimated to be approximately 3.2 million residents in 2024 ¹, the combined population of the few municipalities documented to operate dedicated, localized MCT systems—specifically Caguas, Vega Baja, Manatí, Dorado, Vega Alta, Aguada, and Barceloneta—amounts to roughly 325,375 residents.² This calculation, which excludes the primary AMA coverage area, demonstrates a substantial coverage crisis: an estimated 80% or more of the population, spread across 70 unserviced municipalities, lacks access to reliable local collective transit.

This pronounced mobility deficit has direct implications for chronic disease management. Puerto Rico faces a high public health burden, particularly concerning Type 2 Diabetes Mellitus (T2DM), with an overall estimated prevalence of 17.4% among adults aged 18 and over.⁵ Effective management of T2DM and co-morbidities like Hypertension (HTN) requires consistent access to medical appointments, pharmacies, healthy food sources, and opportunities for physical activity. The collective transport systems, where they exist, facilitate the critical step of active transit—walking to and from designated stops—which improves metabolic control. The absence of such systems for the vast majority of the population thus serves as a systemic barrier to effective preventative care and management.

II. The Landscape of Transportation Infrastructure in Puerto Rico

2.1. Defining the Primary Transportation Models

The transportation ecosystem in Puerto Rico is defined by two primary, largely uncoordinated, structures: the AMA network and the autonomous Municipal Collective Transport (MCT) systems.

The Metropolitan Bus Authority (AMA) network provides crucial fixed-route bus and rail services, but its geographic scope is narrowly focused on the San Juan Metropolitan Area (MSA). While essential for residents in high-density regions like San Juan, Bayamón, Guaynabo, and Carolina, this focus geographically isolates the remaining island municipalities. For the Septerional visualization platform, AMA data must be integrated to complete the island-wide coverage map, especially given that the Metro/Fajardo healthcare region accounts for a high T2DM prevalence of 16.6%.⁵

In contrast, the MCT systems—known by diverse local branding such as Trolleys, Transcriollo (Caguas), MOVICI (Vega Baja), TRANS-METRO (Manatí), and Ruta Corazón (Vega Alta)—are hyper-localized, fixed-route services managed independently by individual municipal governments.⁶ These systems include the routes documented in Caguas ⁶, Vega Baja [Image 1], Manatí [Image 3, Image 4], Dorado (Campo y Pueblo) ⁶, Vega Alta [Image 5, Image 6], Aguada (Ruta del Trolley) [Image 2], and Barceloneta.⁶

A significant challenge arises even in established urban centers. For instance, the Old San Juan Trolley, a vital mobility resource for both residents and visitors, is currently suspended.⁷ While informal alternatives like Garitas (golf cart taxis) may exist, the operational failure of a scheduled public service in the capital demonstrates institutional fragility, even where previous service capacity was robust.

The independent operation of these MCTs, evidenced by their disparate branding and varying operating schedules ⁶, underscores a critical lack of centralized planning or regional transit authorities outside of the AMA's jurisdiction. This systemic flaw prevents residents of non-serviced, smaller municipalities—like Lares, Hatillo, Mayagüez, and San Sebastián, from which public information is difficult to obtain—from effectively utilizing a neighboring town’s system, thereby exponentially increasing the overall mobility gap. The fragmentation effectively establishes a barrier to inter-municipal movement, making the establishment of a centralized information hub, such as the Septerional platform, necessary to compensate for this island-wide planning deficiency.

2.2. Regulatory, Funding, and Resilience Challenges

The sustainability and expansion of collective transit are heavily influenced by external factors, including federal investment and infrastructure resilience.

Opportunities for expansion are substantial due to recent federal legislation. The Bipartisan Infrastructure Law is projected to allocate approximately $473 million to Puerto Rico over five years to improve public transportation options, representing a notable 33% increase over previous FAST Act formula transit funding levels.⁹ This potential infusion of capital presents a critical opportunity not only for expanding the geographic reach of existing MCTs but also for standardizing and professionalizing their operations.

Conversely, transit systems are highly vulnerable to environmental instability, which undermines operational reliability. The infrastructure disruptions caused by Hurricanes Irma, Maria (2017), and Fiona (2022) highlighted a widespread collapse of the electric grid and associated infrastructure, which indirectly affects transit operations and continuity of service.¹⁰ This fragility is particularly concerning for chronic disease patients who require guaranteed, reliable transit for critical medications and scheduled treatments.

The long-term viability of local MCT programs is often dependent on local political will and the continuity of grant funding. The difficulty in obtaining current public route and schedule information from several key municipalities, including Hatillo, Mayagüez, and San Sebastián, suggests that data availability and transparency are directly linked to system stability and the overall commitment to public access.

Mobility MetricImpact on T2DM/HTN OutcomesRequired Intervention FocusLack of fixed route serviceDelayed or missed medical appointments, reduced care adherence, increased risk of complications.Focus platform on underserved areas (70 municipalities) for telemedicine or paratransit support identification.Restrictive operating hours (e.g., 7 am – 3 pm)Limits access for working patients; forces reliance on expensive private alternatives.Advocate for extended evening and weekend service subsidized by Federal Transit Administration (FTA) funds.⁹

Requirement for Active Transit (Walking to Stop)Increased daily incidental physical activity, improved metabolic control and weight management.Geospatial analysis of "walkable sheds" around stops, critical for Septerional platform development.

III. Quantification of the Mobility Gap and Population Coverage

3.1. Delineation of Service Categories

Puerto Rico encompasses 78 municipalities. The current findings indicate that, outside of the AMA region, only a small minority (approximately 8) of these municipalities provide detailed, fixed-route MCTs. Consequently, the operational service availability rate for local, autonomous collective transport is approximately 10%.

The analysis of demographic data against transit service availability confirms a significant population coverage deficit.

• The total population of Puerto Rico is estimated to be between 3,203,295 and 3,235,289.¹
• Based on recent population estimates for the municipalities with documented local MCTs (Caguas, Vega Baja, Manatí, Barceloneta, Dorado, Aguada, Vega Alta), the total population served by these specific systems is estimated at roughly 325,375 residents.²

This disparity reveals a stark reality: over 80% of Puerto Rico’s residents reside in areas lacking a structured municipal collective transport system. This deficit disproportionately affects chronic disease management, where transit reliability is essential for maintaining health and wellness.

3.2. Detailed Population and Geographic Disparity

The documented MCTs often function as crucial lifelines between the central urban cores and the surrounding barrios or rural settlements, demonstrating a mission to serve peripheral populations who are often socioeconomically disadvantaged and face higher risks for chronic conditions.

For example, the MOVICI program in Vega Baja utilizes its four routes to explicitly connect the urban center with rural sectors such as Alturas, El Malecón, Pugnado, and Almirante [Image 1]. The Route 4 (Almirante) is designed to serve low-density, peripheral areas but operates with the lowest frequency—120 minutes.¹¹

Similarly, in Vega Alta, the Ruta Corazón routes are named after the surrounding sectors (e.g., Fortuna/Bajuras, Carmelite/Sabana Hoyos, Breñas/Cerro Gordo) [Image 5, Image 6], indicating a commitment to linking the dispersed population clusters to the commercial and medical center.

Although these systems intend to bridge the urban-rural divide, the low frequency observed in rural routes, such as the 120-minute frequency for Vega Baja Route 4, translates into a four-hour time commitment (waiting plus roundtrip time) for residents seeking a short medical appointment. This extreme time cost imposes a significant burden that disproportionately affects the rural poor, who may already lack alternative private transportation access. Therefore, when evaluating the utility of these transit systems for public health, the Septerional platform must weight the population density and frequency in its visualization, recognizing that a municipality with a 30-minute frequency provides a fundamentally superior service compared to one with a 120-minute frequency, even if both technically possess an "MCT."

The comparison of serviced and unserviced municipalities also highlights potential inequities in resource allocation. Manatí, for instance, has an estimated population of approximately 16,092 people and manages four fixed routes.² Municipalities such as Lares, Hatillo, and San Sebastián, which have not made their transit data publicly accessible (or lack service entirely), likely have comparable or greater populations and urban density, suggesting a significant underestimation of mobility demand or a failure in resource prioritization by local government. For the Septerional initiative, utilizing population and density metrics of comparable serviced towns (e.g., Manatí or Dorado, population 13,151 ³) allows for the projection of potential ridership and health impact that could be achieved by implementing similar MCT systems in unserviced, high-need areas.

Table 1: Municipal Collective Transportation (MCT) Service Coverage in Puerto Rico

MunicipalityMCT Program NamePopulation Estimate (2024)Service DensityPrimary Service FocusCaguasMAC / Transcriollo~86,804 ²

High (9+ Routes)Urban Core, Residential Barrios, Medical, EducationPonce (AMA focus)N/A (AMA only)~137,491 ²

Low/None (Local MCT)N/A (Relies on AMA for limited service)Vega BajaMOVICI~29,325 ²

Medium (4 Routes)Health Centers (CDT), Rural Sectors, CommercialManatíTRANS-METRO~16,092 ²

Medium (4 Routes)Medical Facilities, Commercial, ResidentialBarcelonetaCollective Transport~22,322 ²

High (7 Routes)Industrial, Health (Hospital Municipal)DoradoCampo y Pueblo~13,151 ³

Low (2 Fixed Routes)Health (CDT), Plaza PúblicaVega AltaRuta CorazónUndeterminedMedium (4 Routes)Health (CDT), Commercial, Residential/BarriosAguadaRuta del TrolleyUndeterminedLow (1 Fixed Route)Health (Medical Center), Schools, CommercialTotal Population Served by Local MCTs (Est.)

~325,375

Total PR Population (2024 Est.)

~3,203,295 ¹

80%+ Unserviced Population

IV. Detailed Analysis of Documented Municipal Collective Transit Systems (MCTs)

4.1. Case Studies in Integrated Transport Planning

4.1.1. Caguas (MAC/Transcriollo): The Paradox of High Service and High Disease Burden

Caguas represents a unique case study, featuring one of the most complex municipal systems—including fixed-route buses (Transcriollo C1-C6) and specialized trolley routes (R-E, RANS, C9) ⁶—that systematically links high-density residential areas (Villa Blanca, Idamaris Gardens) with critical civic and medical infrastructure (Plaza Centro, Judicial Center, Hospital Pavia).

Despite this robust transit infrastructure, the Caguas healthcare region exhibits the highest estimated prevalence of T2DM in Puerto Rico at 17.9%.⁵ This high disease burden, coexisting with accessible transit, suggests that the physical availability of a system does not automatically translate into improved health outcomes. The focus must shift to analyzing utilization patterns—understanding how frequently and effectively high-risk populations are able to use the transit system for crucial preventative care, maintenance appointments, and lifestyle activities.

4.1.2. Manatí (TRANS-METRO): Explicit Health Access Prioritization

Manatí’s system (Routes A, B, C, D) demonstrates a deliberate routing strategy focused on access to critical medical infrastructure. Routes A and C are specifically designed to serve the Manatí Medical Plaza, the Doctor's Center, and Farmacia Caridad (CVS) [Image 4]. The commitment to transport is further evidenced by the planned introduction of the new Route D, set to begin operation in May 2025 [Image 3]. This expansion targets peripheral and rural areas such as Tíerras Nuevas, Cantito, and Rábanos, signifying a local effort to map and mitigate the health disparity associated with rural isolation [Image 3].

4.2. Route Mapping and Service Reach: A Synthesis of Essential Destinations

Across all documented MCT systems, the route planning uniformly prioritizes the critical nexus of health, commerce, and education. This focus aligns perfectly with the goals of the Septerional platform.

Medical Facilities and Health Access: Direct connectivity to healthcare is a common mandate. Both Vega Baja (Route 1) [Image 1] and Dorado ⁶ explicitly link their residential areas to their respective CDTs (Centros de Diagnóstico y Tratamiento). Vega Alta also services a local CDT [Image 5]. Furthermore, Manatí routes focus on high-traffic medical facilities [Image 4], Barceloneta includes the Hospital Municipal ⁶, and Aguada services its Medical Center [Image 2].

Essential Services and Commerce: Universal connectivity is provided to the Plaza Pública (Town Square), key supermarkets (e.g., Los Rábanos Super Market in Manatí [Image 3]), and major commercial hubs (e.g., Plaza Dorada in Dorado ⁶, Centro Gran Caribe Mall in Vega Alta [Image 5]). This access is essential for ensuring nutritional security and medication adherence for chronic disease patients.

Active Lifestyle Destinations: Transit routes actively integrate stops near recreational areas, parks, and sports complexes, which is directly supportive of the Septerional mission by maximizing opportunities for active transit. Examples include the Complejo Deportivo in Vega Baja [Image 1] and the various park and recreational facilities noted in Barceloneta.⁶

4.3. Operational Constraints and System Limitations

The utility of these systems is critically compromised by severe operational constraints, which undermine their effectiveness as a reliable health management tool.

Time Limitations: Operational hours are heavily restricted, typically running only on weekdays (M-F), with early final departures. For example, Vega Baja service ends at 3:00 pm, and Manatí service concludes at 2:45 pm.¹¹ While Dorado offers an extended start time (6:00 am) ⁶, the mid-afternoon closure time imposes significant scheduling challenges for working patients or those requiring late-day medical appointments. This creates a time poverty trap, forcing many patients to choose expensive private alternatives or miss appointments entirely.

Frequency Issues: Route frequency is often low, ranging between 60 minutes and 120 minutes.¹¹ This low frequency, combined with a lack of documented real-time tracking, introduces high variability into travel planning. For patients managing chronic diseases, reliability is paramount. Unpredictable or infrequent service increases the time cost of transit, making it a less attractive and often impossible option for those requiring frequent or quick access to care.

Specialized Paratransit Services: Crucially, some systems offer specialized services. Dorado’s Servicio Complementario de Paratránsito Llame y Viaje and Vega Baja’s MOVICI Paratransit program ⁶ are vital for non-ambulatory or disabled users. Given that diabetes complications frequently lead to severe mobility issues and even amputations, these paratransit services are recognized not merely as accessibility features, but as a dedicated and necessary lifeline for the highest-risk diabetic patient populations. It is imperative that the Septerional platform explicitly detail the reservation procedures and eligibility criteria for these systems, as they represent the highest-priority mobility solution for severely compromised patients.

The challenge researchers face in obtaining current route information from key municipalities like Hatillo, Mayagüez, and San Sebastián highlights a critical issue of information asymmetry. If even administrative experts struggle to confirm current maps and schedules, the general population—particularly the elderly or those with low digital literacy—will be effectively cut off from using the service, even if it theoretically exists. Consequently, the core task of documenting and visualizing these routes through the Septerional platform is, in itself, a fundamental public health intervention that increases system transparency and public access.

V. The Public Health Burden: Mobility, Physical Activity, and Chronic Disease

5.1. Epidemiology of Chronic Disease in Puerto Rico

The prevalence of chronic diseases in Puerto Rico presents a severe public health challenge. The prevalence of T2DM in Puerto Rican adults ($\geq$ 18 years) is estimated at 17.4% island-wide.⁵ This figure indicates an epidemic far exceeding mainland United States averages and necessitates urgent, large-scale intervention. The geographic distribution of T2DM is not uniform; regional hotspots include the Caguas Region (17.9% prevalence) and the Metro/Fajardo region (16.6% prevalence).⁵ These regions offer unique opportunities to study the impact of existing collective transit infrastructure on chronic disease management and outcomes.

Hypertension (HTN) is a major co-morbidity. While self-reported HTN rates in Puerto Rico appear low (10.6% self-reported) ¹², the prevalence of HTN in the overall US adult population approaches 50% ¹³, indicating that the true diagnostic prevalence in Puerto Rico is likely high and requires integrated management alongside T2DM.

5.2. The Active Transit Hypothesis and Metabolic Outcomes

The founding principle of the Septerional Research Initiative posits that the use of collective transport inherently promotes active transit—the necessary walking component required to reach and depart from designated stops. This incidental physical activity is a scalable public health tool critical for managing T2DM and HTN through weight control and improved insulin sensitivity.

The strategic routing of MCTs, which connect residential urbanizations and barrios with recreational areas (parks, sports facilities), directly optimizes the spatial relationship between home, transit, and opportunities for essential physical activity. The Manatí and Vega Alta systems, which prioritize these mixed-use destinations, demonstrate this potential [Image 4, Image 5].

To effectively leverage this mechanism, the platform must use geospatial analysis to define the "walkable sheds" (typically a 0.5-mile radius) around every documented transit stop.⁶ Intersecting this data with known concentrations of diabetic patients, particularly in high-prevalence areas like the Caguas region ⁵, allows Septerional to prioritize health outreach and intervention efforts in zones where transportation is optimized for active lifestyles.

The demographic vulnerabilities further complicate access. The median age in Puerto Rico is approximately 45.8 years, significantly higher than the mainland US.² Older adults are statistically the most vulnerable group, with high rates of T2DM (the 75 years or more group accounted for 20.1% of patients in 2013) ⁵ and high HTN prevalence (71.6% for ages 60 and older).¹³ These demographics are also the most reliant on collective transit or specialized programs like the Conecta program for those 60 years and older in Vega Baja.¹¹ Therefore, the time-restricted MCT schedules and low frequencies severely and disproportionately compromise the ability of the most vulnerable demographic to maintain consistent chronic care access.

Furthermore, a strategic differentiation must be made between diabetes management and prevention. While high-service areas like Caguas are well-equipped for disease management (access to hospitals, pharmacies), the massive, unserviced population (over 80%) remains at higher risk due to poor access to foundational elements of health, including reliable transport to healthy food and preventative care. The Septerional platform should, therefore, serve a dual strategy: Optimization (improving utilization and efficacy in currently serviced areas) and Advocacy (demonstrating the economic and public health return on investment for implementing MCT systems in the unserviced, high-risk municipalities).

Table 3: Estimated Prevalence of Type 2 Diabetes Mellitus (T2DM) by Healthcare Region in Puerto Rico

Healthcare RegionEstimated Prevalence (%) (Adults ≥ 18)Key Municipalities in RegionMCT Availability StatusCaguas17.9% (Highest) ⁵

CaguasRobust (MAC/Transcriollo) ⁶

Metro/Fajardo16.6% ⁵

San Juan, Carolina, Trujillo Alto, FajardoHigh (AMA) but localized operational gaps (e.g., Old SJ Trolley suspension) ⁷

Ponce11.4% ⁵

PonceLow/None (Relies on AMA for limited service)Aguadilla/Mayaguez11.2% ⁵

Mayaguez, AguadaVery Low (Localized Aguada Trolley) [Image 2]Arecibo9.6% ⁵

Arecibo, Manatí, BarcelonetaLow (Manatí TRANS-METRO, Barceloneta) ⁶

Bayamón12.9% ⁵

Bayamón, Vega Baja, DoradoLow (Localized Vega Baja, Dorado) ⁶

VI. Integrating Transit Data for Septerional’s Platform: A Technical Road Map

6.1. Data Standardization and Visualization Requirements

The disparate nature of the source materials—ranging from detailed route lists to basic maps and text schedules ⁶—demands immediate data standardization into a Geographic Information System (GIS) compatible format.

The data translation process must involve three critical steps:

1. Stop Geocoding: Every documented stop, such as the 47 stops listed on Vega Alta's Breñas/Cerro Gordo Route [Image 6], must be converted into precise latitude and longitude coordinates.
2. Route Modeling: Fixed lines must be traced based on explicit road references provided in the materials (e.g., PR-684, PR-140 in Barceloneta ⁶).
3. Metadata Integration: Operational parameters, including schedules (Hours, Frequency, lunch breaks) ⁶ and specific rules (Paratransit eligibility), must be linked to each route segment.

The Septerional platform must employ visual tools, specifically heatmaps, to overlay T2DM prevalence data ⁵ with the identified transit access zones (walkable sheds). This visualization will immediately expose areas of high chronic disease burden coupled with poor mobility, allowing for targeted resource allocation.

6.2. Detailed Route Data Extraction for Platform Prioritization

The following raw route data confirms the link between transit access and health destinations:

• Vega Baja (MOVICI) [Image 1]: Routes prioritize the Terminal HJS/Plaza, Escuela Bellas Artes, Terminal del Tren, Vega Baja Plaza, Hospital Vilma Vázquez, and essential sectors like Alturas, El Malecón, Pugnado, and Almirante. The focus on the Hospital and the CDT (Centro de Diagnóstico y Tratamiento) validates its public health utility.
• Aguada (Ruta del Trolley) [Image 2]: Key stops include the Centro Comercial, Estación de Policía, Supermercado, and the Aguada Medical Center, demonstrating a clear focus on commercial and medical needs.
• Manatí (TRANS-METRO) [Image 3, Image 4]: Route A and C access the Manatí Medical Plaza, Doctor’s Center, and Farmacia Caridad (CVS). The anticipated Route D expansion targets historically underserved areas like Tíerras Nuevas and provides access to the CDT Meléndez and Los Rábanos Super Market.
• Vega Alta (Ruta Corazón) [Image 5, Image 6]: The routes connect the Terminal to Caribe Medical, the local CDT, and extend deep into peripheral neighborhoods like Sabana Hoyos and Cerro Gordo, often stopping near essential services like the US Post Office.
• Barceloneta (Routes) ⁶: Transit links directly to the Hospital Municipal and major commercial centers (Sam's & Walmart), essential for daily living and medical care.

Table 5: Operational and Access Metrics of Key Municipal Transit Systems

SystemPrimary TerminalFixed Hours (Weekday)Frequency Range (Mins)Health Destinations TargetedActive Transit FeaturesVega Baja (MOVICI)HJS Terminal7:00 am – 3:00 pm [Image 1]60 – 120 ¹¹

CDT, Hospital Vilma Vázquez [Image 1]Paratransit, Conecta (60+) ¹¹

Manatí (TRANS-METRO)Central Transfer Point7:00 am – 2:45 pm (with lunch break) [Image 4]Undetermined (Implied hourly)Manatí Medical Plaza, Doctor's Center, Farmacia Caridad [Image 4]New Route D targeting rural barrios [Image 3]Dorado (Campo y Pueblo)CDT Dorado6:00 am – 5:00 pm ⁶

Undetermined (Fixed schedule)CDT Dorado ⁶

Early start time (6:00 am), Paratransito Llame y Viaje ⁶

Vega Alta (Ruta Corazón)Terminal7:00 am – 5:00 pm [Image 6]Undetermined (Fixed schedule)CDT (Implicit), Caribe Medical [Image 5]Extensive barrio coverage (Sabana Hoyos, Cerro Gordo) [Image 5, Image 6]

6.3. Technical Road Map for Future Data Collection

To ensure the Septerional platform provides a complete picture, a focused effort is required to address current data deficiencies. Municipalities like Hatillo, Mayagüez, and San Sebastián must be actively contacted through administrative inquiries to determine definitively if internal, unpublicized MCT systems exist or if the absence of data confirms a lack of collective transport.

Furthermore, maintaining data accuracy requires continuous verification of operational status. Given the documented suspension of the Old San Juan Trolley ⁸, all documented MCT schedules and operations must be periodically re-verified to ensure the Septerional platform data remains current and reliable for users, especially those managing chronic diseases who depend on accurate transit information for their health maintenance.

Conclusion: Mobilizing Health Equity

The investigation into Puerto Rico's collective mobility infrastructure confirms a profound health equity crisis rooted in transportation access. The Commonwealth operates a system defined by isolated successes in a few municipalities—where MCTs are effectively linking residents to medical and commercial hubs—surrounded by a vast area of service denial, covering over 80% of the island's population.

This absence of reliable collective transport directly exacerbates the crisis of Type 2 Diabetes Mellitus (17.4% prevalence) by reducing opportunities for incidental physical activity and creating logistical barriers to chronic care adherence. The limited operational schedules and low route frequencies in the few existing MCTs further place a disproportionate burden on the elderly and working populations.

The Septerional Research Initiative must leverage its platform to transform this fragmented data into a cohesive, actionable Geographic Information System (GIS). By spatially mapping route access against disease prevalence, the platform will not only compensate for the systemic failure of inter-municipal planning but will also provide the essential tools needed for patients with diabetes and hypertension to operationalize transportation as a direct determinant of improved health outcomes through intentional, active transit. This effort represents a necessary step toward mobilizing health equity across the entire Commonwealth.