To promote biking and walking, new health commish Tom Farley could send DOH representatives to CB meetings about street safety improvements. Photo: Tulane University.

First, some words of encouragement for Farley, who biked to work every day at his previous job in New Orleans. Riding in Midtown is a lot less intimidating than it was just a short while ago, with a new bike route running from Columbus Circle down to Madison Square nearing completion. Once Farley's bike gets shipped and he takes a few practice runs on the Hudson River Greenway, a tour of Manhattan's burgeoning bike network is highly recommended.

Second, no one needs to remind Farley that safe streets pay enormous public health dividends. As co-author of "Prescription for a Healthy Nation," he helped coin the term "healthscaping" to express the idea that physical environments can be shaped to encourage healthier habits. In public talks, he's been known to sing the praises of walking and biking as transportation. When it comes to the transportation-health connection, the commish knows what's up.

Under Mayor Bloomberg, the Health Department has been an influential pulpit from which to launch high-profile policy initiatives. Witness the trans-fats and smoking bans that helped catapult our last commissioner, Tom Frieden, to the top job at the Centers for Disease Control. Street safety could be the next frontier for a major DOH campaign -- reducing injuries and fatalities while making streets more appealing for active transportation.

Traditionally, the Health Department has played a marginal role in enhancing street safety, so I asked Transportation Alternatives director Paul Steely White how Farley might go about this. He suggested that DOH start by analyzing traffic injuries and deaths with epidemiological rigor. Safety trends in New York City are positive -- annual traffic deaths have declined about 30 percent this decade -- but if we want to keep moving in the right direction, we'll need to understand a lot more about why this is happening. Currently, no one really knows.

"The DOT points to improvements they made on a handful of dangerous streets like Queens Boulevard; the NYPD points to TrafficStat and more targeted enforcement; hospitals and emergency responders point to advances they've made in urgent emergency care," White said. "But there's no science to bolster agency claims that they're responsible for the drop in deaths."

The fact that we're still guessing about causes is itself troubling. "You'd be hard-pressed to find another example of such a precipitous decline in preventable deaths where there wasn't an accompanying study figuring out how this happened," he said. "The city could achieve a much greater reduction through such a study and the more systematic application of best design and enforcement practices."

DOH could also marshal support for safer streets on the city's front lines: community board meetings. DOT often cites health rationales to make the case for bike and pedestrian improvements, but on that score an engineer or planner's word doesn't carry as much weight as that of a health expert. "If Commissioner Farley is really interested in making New York City safer for cycling and pedestrians, injecting a compelling health perspective into that debate would help enormously," said White. "Bike lanes and traffic calming aren't just window dressing; it's necessary for the health and safety of New Yorkers. To date, the DOH has been absent from that discussion on the community level."

"Non-Transport Accidents" includes burns from fire and scalding liquids, falls, and several other causes of injury. "Transportation Accidents" is mainly comprised of kids on foot killed by autos. Chart: NYC Department of Health.

Injuries took the lives of 388 New York City children from 2001 to 2007, and if you break down the specific causes of unintentional fatalities cited in the report, the single biggest risk to kids appears to be traffic.

I say "appears" since the report presents information on traffic deaths in a rather indirect fashion. 77 kids age 12 and under were killed by motor vehicle crashes that "involved child pedestrians." This data comes on page 21 of a 29-page document. No graph or chart shows traffic deaths side-by-side with other specific causes of death. It's not until page 23 that one learns "motor vehicle-related accidents (occurring on streets and roadways) remain the largest contributor to child injury deaths overall."

I mention this because the purpose of the report is "to inform policies, laws, regulations, and prevention activities in order to prevent future deaths." To make those policies and laws effective, you need to have a clear picture of relative risk. Preventing deaths from, say, poisoning is certainly important, but preventing deaths from traffic would save more lives by a huge margin. There are broad implications for police, legislators, and planners that follow.

Yet, in its recommendations, the report only touches on measures to improve safety inside the home. It's a stark change from the initial report released by the Health Department's Child Fatality Review Team in 2007 [PDF].

That document focused intently on traffic-related injuries and deaths. It included a long list of recommendations, touching on the need for speed cameras, safe routes to school, and trucks designed to improve drivers' vision of the street.

We sent a request in to the Health Department to determine why this year's report includes no such recommendations. A spokesperson emailed this reply:

The 2007 CFRT report focused on child deaths related to motor vehicle accidents, the leading cause of child injury deaths among children in New York City overall. The 2008 report focused on fire- and burn-related deaths, the City’s second leading cause of unintentional injury-related deaths among children ages 1-12. The 2009 report builds on findings from the previous reports and presents an in-depth case review of fatal unintentional child injuries in the home, as homes represent the most common setting for fatal childhood injuries.

Maybe officials don't see the need to repeat the conclusions of a previous report. But that hardly seems like a sufficient reason to downplay traffic as a threat to public health. If New Yorkers are still dying from Swine Flu two years from now, will we stop trying to highlight that danger too?

"Streets to Live By" marshals data from several cities to make the case for investing in livable streets in New York.

Today Transportation Alternatives released "Streets to Live By" [PDF], the report previewed last week in the Observer. It seeks to define what makes a street livable and to synthesize a broad range of data, culled from numerous cities, on the effects of policies that put pedestrians first.

This doc is a big one, and we're still sifting through it. An early impression: The evidence gathered here related to economic development, health, and social wellbeing suggests that a number of city agencies should be shepherded into the livable streets fold. From the report's recommendations:

Improvements that support livable streets, whether through new construction, street rebuilding or zoning amendments, should be the standard. Coordination and creative problem solving between these agencies, including the Department of City Planning (DCP), Office of Management and Budget (OMB), Department of Design and Construction (DDC), Economic Development Corporation (EDC), Department of Environmental Protection (DEP), and Department of Sanitation (DOS) would be best led by the DOT and the Mayor’s Office of Planning and Sustainability.

The report also names the Department of Health and the Department of Small Business Services as agencies that can forge stronger ties to a livable streets agenda, and calls for a livable streets training program aimed at the city's community boards. "We recognize that the jurisdiction of each agency only goes so far," says T.A.'s Shin-pei Tsay, "and we hope there can be greater collaboration between them."

In contrast -- or, conceivably, as a complement -- to the L.A. Times portrait of city cycling, here's a Streetfilm from Elizabeth Press, shot yesterday at Transportation Alternatives' Bike Month NYC kick-off.

At a press conference held in the new 14th Street plaza, DOT Commissioner Janette Sadik-Khan talks about present and future street-level improvements, Parks Commissioner Adrian Benepe sums up progress on greenways, and Health & Mental Hygiene Assistant Commish Jane Beddell promotes biking as part of the solution to the city's obesity problem. TA's Paul Steely White then gives a quick run-down of some of the 200+ Bike Month events.

Transportation Commissioner Janette Sadik-Khan and Chinese Chamber of Commerce Chairman David J. Louie will distribute free NYC bicycle helmets to delivery workers on Tuesday, June 26th, 2007. The Department of Health and Mental Hygiene will also distribute reflective safety vests at the event. The helmet fitting and distribution will be held from 12:00 pm to 2:00 pm at the Chinese Consolidated Benevolent Association, 62 Mott Street.

The event is intended to inform businesses and bicycle operators about two new laws that take effect on July 26th, 2007 and were sponsored by Council members Gale Brewer and Alan Gerson, both of whom attended today's announcement.

The Department of Health and Mental Hygiene has begun a pilot program to provide delivery workers with reflective vests that increase cyclists' visibility and allow for easy display of identifying information. Under city law, commercial cyclists must display a sign indicating their employer's name and a personal, three-digit identification number.

New York City just released its first-ever study of bicycle injuries and fatalities. There's good news and bad news. The good news is that four City agencies (health, transportation, parks and police) admitted, finally, that bicycling is good for New York City, and pledged to expand the City's cycling infrastructure. The study also didn't indulge in the NYPD's habitual victim-blaming in cycling fatalities, a significant though unacknowledged shift.

Going forward, the involvement of the Dept. of Health may help move the discussion from harping on the dangers of cycling to highlighting its health benefits.

But here's the bad news: The study has many methodological flaws and misleading findings, leading it to over-emphasize helmets and bike lanes and neglect the need for universal street safety. And the study completely neglects the fact that most fatal crashes are caused by aggressive, self-entitled drivers, and laissez-faire policing that allows motorists to literally get away with murder.

The study attributes 42% of all fatal bike-vehicle crashes to "bicycle factors," 20% to "vehicle factors" (i.e., drivers), and 36% jointly to both cyclists and drivers (another 2-3% of cases couldn't be coded). That's an improvement from the NYPD's made-up "statistic" that 75-80% of biking fatalities are solely the cyclists' fault. But it's still deeply misleading. I know because I was given access to the NYPD's cause-coding for three of the years studied (1996-98).

I headed up the team at Right Of Way that analyzed 1995-98 fatal bike crashes and wrote RoW's Only Good Cyclist Report (PDF file) in 2000. My review of the NYPD's crash analysis found them rife with errors. In one case, a driver ran a red light and struck and killed a cyclist proceeding lawfully through an intersection; The NYPD gave the cause as "Bike Thru Red Traffic Signal Light And Struck By Vehicle" and actually assigned a Bike Factor of "Traffic Control Disregarded." Similarly: a cyclist was crushed when a Mack truck made a right turn directly into his path. NYPD said, "Unsafe Bike Operator Turned Into Vehicle And Was Struck By Turning Vehicle" and assigned a Bike Factor of "Unsafe Lane Changing," even though it was the truck that changed lanes unsafely and turned into the cyclist, who had been traveling straight with the right of way.

I found that only 20% of the fatal bike-vehicle crashes could be attributed to "bicycle factors" (vs. the City's 42%), while 44% were the exclusive result of "vehicle factors" (vs. the City's 20%). The remaining 36% were the fault of both cyclists and drivers (the same as the City's tally). In effect, my analysis turned the City's cause factors upside down.

Diagnosis dictates treatment. If driver aggression or inattention is killing cyclists, the answer is to change that behavior. To say the very least, the study missed a priceless opportunity to tell it like it is.