Achieving public health is multi-faceted. It is so broad, that you would be hard-pressed to find a sector that does not have an effect on health in some way, shape, or form.
Pedestrian safety is a public health issue in and of itself, especially on Long Island. According to data from AAA Northeast, 684 pedestrians were killed or injured by a motorist from 2010 to 2019 across Long Island—400 in Suffolk and 284 in Nassau counties. Roadways in the island’s two counties notoriously rank as some of the most dangerous in New York year after year.
The Long Island Health Collaborative is a partnership of Long Island hospitals, county health departments, health providers, community-based social and human service organizations, academic institutions, health plans, local government, and the business sector, all engaged in improving the health of Long Islanders. We also study behavioral and social determinants of health (SDOH), analysis of which lends insight to why health disparities exist, and how we can work to eliminate them and promote health equity. Research shows that health disparities such as a higher incidence of chronic disease are most common among minority communities—this became especially evident in the wake of COVID-19. Health equity is still not a reality, as evidenced by the fact that COVID-19 has unequally affected many racial and ethnic minority groups.
Within the context of transportation, neighborhood and built environment are key determinants in pedestrian, cyclist, and motorist accident outcomes on our shared roadways. 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).
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% 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.
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 the LIHC naturally views pedestrian safety as a 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.
Some may point to enforcement as an effective measure, but as we all know, the relationship between BIPOC communities and law enforcement is historically and presently frayed. Should traffic enforcement programs be implemented as a measure to address the issue at hand, there needs to be extensive engagement with the local BIPOC community to consider the program’s equity. Assessing current enforcement tactics could also be a beneficial way to address and eliminate approaches that have the potential to exacerbate racial/socioeconomic issues.
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.
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.
To learn more about the aforementioned issues or to read the entire GHSA Analysis of Traffic Fatalities by Race and Ethnicity, visit https://www.ghsa.org/.