A Health Disparity Exposed on Our Roadways

Guest blogger Cindy Brown, executive director of the New York Coalition for Transportation Safety (NYCTS), examines the health disparities that exist on our roadways and the resulting cost to life and society.

More often than not, bicyclists and walkers hit by a car end up in the hospital emergency room.  Unfortunately, many never leave the hospital because they die from their injuries.  New York State’s Statewide Planning and Research Cooperative System (SPARCS) data show that throughout New York State, excluding New York City, 35,796.98 individuals per 100,000 — or roughly 4,006,610.16 people— were hospitalized from 2016-2018. Of those ~four million hospitalizations, 755.35 per 100,000, or roughly 84,543.25 of them were the result of a motor vehicle crash.  That’s just over two percent.  While this may not seem like a large percentage, consider that such hospitalizations were avoidable.

Even more striking is new research that shows glaring health disparities exist even in the realm of pedestrian and bicyclist crashes. A recent report from the Governor’s Highway Safety Association analyzed traffic fatalities by race and ethnicity, and identified a new-found health disparity— traffic crash fatalities disproportionately affect black, indigenous and people of color (BIPOC).

Why would this be?

It all harkens back to the social and behavioral determinants of health that we all have come to understand have an immense bearing on a person’s health.  Not even a walk in the neighborhood or leisure bike ride on our roadways shields us from the effects of outside forces.  In this case, transportation is the social determinants of health factor at play. Neighborhood and built environment are key determinants in pedestrian, cyclist, and motorist accident outcomes on our shared roadways.

Report Findings

American Indian/Alaskan Native persons have a substantially higher per-capita rate of total traffic fatalities compared with all other racial groups. Of all races/ethnicities, American Indian/Alaskan Native persons have the highest annualized, age-adjusted traffic-related pedestrian death rates. The analysis also found that a disproportionately large percentage of fatalities are accounted for by motor vehicle traffic crashes, especially among Native American and Hispanic persons.

Black persons have the second highest rate of total traffic deaths, including pedestrian and bicyclist traffic deaths. Black children ages 4-15 have the highest rates of fatalities of all motor vehicle accidents. Asian persons have the lowest per-capita rate of involvement for virtually all categories of traffic deaths, and white persons generally have lower traffic fatality rates than BIPOC (with the exception of motorcycle driver and passenger deaths).

There are measurably higher levels of vehicle traffic in census tracts where low-income and BIPOC populations are more concentrated. The report also references two studies, one of which found people who live in areas of high economic hardship have an increased risk of being in a severe crash and dying in traffic crashes more often and at a higher rate than residents of more affluent neighborhoods; the other found that injury risk for pedestrians and cyclists is 20-30 percent higher among children of manual workers than those of intermediate and high-level salaried employees, which illustrates an effect of socio-economic status on crash involvement.

Causal Factors

The report draws compelling conclusions about why this is happening, and how we can work to eliminate this disparity. This issue is deeply entrenched in other factors that affect crash risk and access to life-saving care after a crash. Existing health inequities, lack of infrastructure such as lighting in low-income areas, and the effect of socio-economic status all point to existing, underlying disparities as the main driver of the disproportionate number of BIPOC represented in fatal traffic crashes. In many instances, individuals with low income cannot afford a car, and therefore utilize walking, biking, and public transportation as their main forms of transportation. Public transportation hubs are typically located in high traffic areas. 

Historically, in an effort to move motor vehicles faster, existing communities were often divided to build new high speed roadways that would ease congestion and meet the needs of drivers.  It resulted in the creation of wide, multi-lane streets with high speed limits and traffic signals blocks apart.  Right turns on red were permitted and bicycle lanes were non-existent. Shopping and other types of services were frequently on one side of the road and housing was on the other, either because of zoning restrictions or political influence. When these roads were built, the needs of all users were not a consideration. Today “all users” are to be considered when new roadways are built, or old ones are rebuilt. However, many of these existing roads have yet to be rebuilt and are still traveled daily. Without assessment and investment in improving these roads, they remain dangerous for those who must travel them. 

Actionable Ways to Work toward Equity in Traffic Safety

Eliminating these underlying disparities may seem like an insurmountable task, but we have the collective power to work toward mitigating this particular issue by digging deeper and working to address the root of the problem. The report emphasizes this point, calling for a more equitable allocation of resources to address pedestrian safety needs in BIPOC communities. On state and community levels, leaders must prioritize planning and investing in infrastructure within the areas and neighborhoods that have suffered from years of discrimination and disinvestment. Addressing other underlying issues such as poverty and lack of access to mental health services could also be useful in addressing crash prevention.

While we wait for these better roads to be built, we can take action now to keep ourselves safe.  There are dozens of pedestrian safety laws in New York State.  Unfortunately, many people are unaware of these laws and enforcement is spotty.  One simple law is to walk facing traffic when a sidewalk is not available. Why? Because the driver can make a psychological connection with the pedestrian’s face.  Studies document that this reduces crash incidence. Unless we know this law exists, would anyone consciously think about what side of the road to walk on?   Dozens of laws similar to this one can be found on the state’s website and on NYCTS’ website dedicated to raising awareness about pedestrian safety.

Pedestrian safety is another pressing public health issue.  Our community and state leaders must adopt the same view and treat traffic crash involvement as the health disparity issue it truly is. This means more diverse representation within the leadership of our state and city transportation agencies and traffic safety committees. More diverse representation in leadership would also foster more effective safety education campaigns and outreach efforts to address the specific needs and cultures of BIPOC communities.

The report also calls for some additional research needs, such as better public health data, state level Fatality Analysis Reporting System (FARS) data analysis, and a deeper understanding of the role of race in crash outcomes by examining the National Emergency Medical Services Information System (NEMSIS) database that collects State and Territorial EMS injury and fatality data from 911 calls.

The Road Ahead

The term “social determinants of health” may be relatively new, but the reality of the concept is as old as time. BIPOC have endured bias and disparity in nearly every aspect of society for centuries. Unfortunately— but unsurprisingly—the issues of pedestrian safety and traffic fatality are no exception to this trend. The GHSA’s new report is eye-opening and confirms the need to take strides toward more equitable roadways.

About the New York Coalition for Transportation Safety )   

The New York Coalition for Transportation Safety is a non-profit, statewide organization originally established in 1982 as the New York Coalition for Safety Belt Use, Inc. The Coalition was founded jointly by the Medical Society of the State of New York and the American Association for Automotive Medicine.

Initially the Coalition was a single focus group that sought to reduce motor vehicle related trauma in the State of New York by increasing the use of safety belts by motorists. In time it became apparent that many factors contribute to the complex picture that is motor vehicle injuries. We expanded our scope to include safety programs for pedestrians and bicyclists, as well as motorists, and changed our name to the NY Coalition for Transportation Safety to better reflect our expanded our efforts.

Our mission is to reduce the number of injuries and fatalities occurring on our roadways through outreach and education programs aimed at pedestrians, bicyclists and motorists. During its thirty-eight years of operation, the NY Coalition has received grants from federal, state, local and private agencies. Grant funds are used to develop and conduct public information and education campaigns in a variety of locales.

About the Suburban Hospital Alliance of New York State

The Suburban Hospital Alliance of New York State advocates on behalf of hospitals in the Hudson Valley and Long Island regions. It engages key lawmakers and regulatory decision-makers in Albany and Washington to ensure reasonable and rational health care policy prevails.

About the Nassau-Suffolk Hospital Council (NSHC)   

The Nassau-Suffolk Hospital Council represents the not-for-profit and public hospitals on Long Island. It works in conjunction with the Suburban Hospital Alliance of New York State to advance legislative and regulatory priorities.  NSHC serves as the local and collective voice of hospitals on Long Island.

About the Northern Metropolitan Hospital Association (NorMet)  

The Northern Metropolitan Hospital Association represents the not-for-profit and public hospitals in the Hudson Valley region. It works in conjunction with the Suburban Hospital Alliance of New York State to advance legislative and regulatory priorities.  NorMet serves as the local and collective voice of hospitals in the Hudson Valley.

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