Transportation-related deaths, represented on their own as the thick green line in this chart, remain the single largest killer of New York City children. Image: NYC Department of Health

Every year, the Department of Health releases a report on the injuries that kill NYC children [PDF]. And every year, the grim statistics show traffic to be the single largest cause of injury-related death among kids.

Between 2001 and 2009, 1,681 children under 13 years old died in New York City, 324 of them from unintentional injuries. Of those, 41 percent — 134 children — were killed in traffic crashes. Most of them were on foot when they were hit by a car or truck driver.

“Unintentional motor vehicle traffic accidents contributed the most to child injury deaths in NYC overall, with more than three quarters of deaths occurring among pedestrians,” the authors write.

The first report in this series focused specifically on traffic crashes, detailing specifically how motor vehicles kill New York City children. Last year’s report examined the massive racial inequalities in traffic fatalities; though 26.6 percent of New York City residents are black, black children make up 46 percent of all kids killed by cars.

This year, the Department of Health expanded the scope of its research to include serious injuries as well as fatalities. Between 2001 and 2008, 4,944 children were hospitalized with injuries from traffic crashes. Again, most were walking when hit. Traffic crashes are not the leading cause of hospitalizations among kids — about twice as many are caused by falls.

As preventable as these injuries are, and as much as these numbers need to come down, the rate of traffic injuries and fatalities suffered by NYC kids is lower than other American cities. Because New Yorkers extensively ride transit and walk rather than drive, child traffic deaths are three times lower per capita than the national average. New York’s far safer transportation system saves enough lives that it is the primary reason why the overall mortality rate for local kids is 30 percent below the national average.

In addition to urging parents to buckle in their children properly and teach them to cross the street safely, the Department of Health repeated its call for Albany to authorize camera enforcement of the speed limit on dangerous streets. Legislation to that effect went nowhere in the state legislature this spring.

Health Commissioner Tom Farley, a sometimes-bike commuter, offered strong support for slower traffic speeds last Friday. Photo: Daily News

Last Friday, Transportation Alternatives kicked off a new phase of its campaign for safer streets with the Stop Speeding Summit, bringing together doctors, elected officials, transportation advocates and engineers to outline the high costs of high vehicle speeds and plot a course toward slower traffic.

We’ll be bringing you a series of posts from Friday’s event and wanted to let Thomas Farley, the city’s health commissioner, start things off. Farley laid out the public health argument for 20 mph traffic at the summit and offered to send Health Department staff to community boards and other public meetings to lend some lab coat gravitas to livable streets arguments.

Farley made clear that building safer streets is a top priority for him as a health professional. “We are living in the era of chronic diseases and injuries as the top killers,” he explained. Nearly all the top killers in New York are chronic diseases, with heart disease topping the list. “Accidents,” a category which includes traffic crashes, come in at number four.

That means promoting physical activity is a public health necessity. “Even just taking transit as opposed to driving could make a substantial reduction in heart disease deaths,” Farley said, adding that walking or biking for longer distances would improve health even more.

Because obesity, diabetes, high blood pressure, and other conditions correlated to the lack of physical activity are so widespread, Farley said that New York needs to address them by redesigning the city, not through individual conversations with doctors. “The way that we have an impact on the entire population is change the environment in which they live,” he said.

To that end, Farley endorsed both traffic calming and bike lanes as changes that make it safer, easier and more pleasant to get physical activity. Street redesigns also help reduce injuries and deaths sustained in traffic crashes. While New York’s streets are extremely safe by national standards, said Farley, the number of traffic fatalities and injuries remains indefensibly high. The Department of Health released a short report on traffic safety this morning [PDF].

Farley also endorsed taking steps to reduce traffic speeds. “We definitely are in favor of having lower speeds to reduce injuries,” he said, though he couldn’t say what approach might be the most effective. He did imply that addressing the problem would entail more than cracking down on those driving above the city’s 30 mph speed limits. “There’s a huge difference between being struck at 30 mph and 20 mph,” said Farley.

And for the hard-working activists in the trenches, working to convince New York’s community boards to get behind street safety, Farley made a promise they’ll be sure to appreciate. He said he’d be happy to send Department of Health staff to community board meetings whenever it would help bolster the argument for safety.

Image: NYC Department of Health

DOH studied cyclists on four blocks with bike lanes. Two, DeKalb Avenue where it crosses Throop and Bedford Avenue where it crosses Fulton Street, had buffered lanes. The others, Tompkins at Putnam and Franklin at Myrtle, had unbuffered painted lanes. The researchers gathered most of their data on cyclist behavior using video cameras, and also conducted more than 300 surveys. 

Image: NYC Department of Health

During the 10 recorded hours at each intersection, spread across the week, over 2,400 cyclists rode through the study areas: more than one per minute at each crossing. Most cyclists -- 89 percent -- rode in the bike lane, and those riders were obstructed by an illegally parked or idling car fully 10 percent of the time captured on camera. 

Demographically, 80 percent of the cyclists were men, with 40 percent identifying as black, 39 percent as white, 15 percent as Hispanic, and two percent as Asian. They tended to be regular commuters, with 65 percent reporting biking for half an hour or more at least five days in the previous week, and most lived in the area.

The survey also underscored the need for further bike safety improvements across the city. Of the cyclists surveyed, 27 percent had been involved in a crash in the last three years alone and a full 74 percent had felt unsafe on their bike. 

One reason that DOH survey is particularly important is the lack of decent data about biking behavior outside Manhattan. DOT's screenline count tracks only the crossings into the Manhattan CBD while a Department of City Planning study from last year looked at Manhattan bike lanes between 2001 and 2008. Census data covers the entire city, but is believed to undercount cycling by ignoring non-commute trips. These Bed-Stuy numbers may only be a one-year snapshot of a single neighborhood, but it's all part of painting a fuller picture of New York City cyclists. 

Transportation-related injuries, overwhelmingly caused by motorists hitting pedestrians, remain a top killer of New York City children. Graphic: NYC Department of Health

Last week the health department released their fourth yearly report on children's injury deaths [PDF]. As in past years, motor vehicles are the leading cause of death due to injury among children. Between 2001 and 2008, 1,535 children died in New York City, 445 from injuries. Of those, 106 were killed by motor vehicles. The overwhelming majority of these victims were walking at the time they were fatally struck, while a few were in cars themselves or on bikes or scooters. The first report in this series focused more closely on traffic crashes and offered a more detailed look at how cars kill children.

In this year's report, the Department of Health focused on disparities in fatalities, and the unequal burden of traffic couldn't be clearer. For instance, 26.6 percent of city residents are black, but black children account for 46 percent of the transportation injuries that claim the lives of New Yorkers age 12 and under.

"The public health imperative for safer streets has never been clearer," responded Transportation Alternatives' Wiley Norvell. "Our city's children are falling victim to dangerous roadways and reckless driving."

The ray of light that emerges from the grim statistics is that because so many New Yorkers rely on public transportation to get around, children are much safer than they would otherwise be. New York City has only a third as many transportation-related child fatalities as the national average. Our safer transportation system is the prime reason that overall, New York City kids die from injuries at half the national rate. 

The report also offers a few recommendations for how to keep New York's children safe. With regards to transportation, they recommend stronger enforcement of traffic violations and allowing cameras to enforce speeding laws on dangerous speeds (a measure that has seemingly stalled in Albany this session), as well as installing convex mirrors on trucks and better installation of child car seats. Said Norvell, "It's time to marshal every lever in government to bring these numbers down."

Health Commissioner Thomas Farley: ready to saddle up and ride to work. Image: NY Daily News.

With half a year in New York and (most of) a nasty flu season under his belt, new Health Commissioner Tom Farley recently sat down with Transportation Alternatives to discuss the importance of walking and biking for NYC's health.

Since Farley took the helm at the Health Department, the agency has shown increasing interest in the health benefits of using muscle power to get around. The department worked with several other agencies on the city's new Active Design Guidelines, recommending planning policies to promote walking and biking. The agency also recently released a study linking walking and biking with better health.

In the winter issue of TA's Reclaim magazine, Farley couldn't be clearer about the potential for active transportation in New York, telling TA that "there is more that we can do to make it more walkable and bikeable."

As for the Health Department's role in those improvements, one idea Farley puts forward in the interview is to help to temporarily free city blocks from traffic. "Making that process simple and encouraging people to do that and pointing out its value is something, I think, that is a role for the Health Department," he said. So, block parties and Summer Streets -- doctor's orders. Farley also discussed the Health Department's innovative Bedford-Stuyvesant Bike Lane Study, which is currently underway and seeks to assess cyclist behavior and needs.

Farley has recommitted himself to bike commuting too. Although he pedaled to work at his previous post in New Orleans, since arriving in New York, he's kept his bike reserved for weekend use only. Farley told TA, though, that "when things get a little warmer and flu is behind us," he'll start taking two wheels to work.  

Lappin imagines the office creating a citywide response to unsafe streets, combining design improvements with better enforcement, education and research. The Office of Road Safety would host monthly meetings with all the relevant government agencies: DOT, NYPD, the Health Department, and the vehicular crimes unit of all five district attorneys' offices. Family members of victims would be present at every session to meet with officials.

"By working together and making road safety a priority," Lappin said, "our city agencies can save lives."

The idea comes from Transportation Alternatives' report "Executive Order," and TA has endorsed the bill. "Every time these agencies have sat around the same table, it has yielded huge gains for street safety," said TA Executive Director Paul Steely White. "We need to institute and formalize this coordination."  

Other council members have also signaled their support. Although they haven't yet signed on as co-sponsors, council members Jimmy Van Bramer, Daniel Dromm, Gale Brewer and Robert Jackson have issued strong statements in favor of the Office of Road Safety. As for hearings and moving the bill forward in committee, Council Member Lappin is expected to meet with transportation committee chair Jimmy Vacca soon.

What resources the Office of Road Safety would have at its disposal is an open question. According to a Lappin spokesperson, details like funding and staffing will be hashed out once the bill gets a committee hearing. Dedicated staff could spell the difference between a valuable monthly gathering with limited authority and an office with some bureaucratic heft.

Heralded as a first-of-its-kind collaboration between four city departments -- Health, Transportation, Design and Construction, and City Planning -- the effort underscores that New Yorkers, as much as we like to think of  ourselves as a city of walkers, need to live healthier lifestyles.

The statistics touched on last night (included in the manual’s opening chapter), reveal that the majority of adults in New York City are either overweight or obese. More alarming, perhaps, is that 43 percent of elementary school children are overweight, and the rate is rising.

As sobering as those numbers are, Health Commissioner Thomas Farley stressed that the city’s effort "is not just about lowering obesity rates, but also about addressing diabetes, cancer, osteoporosis, depression, and cognitive decline.” Such chronic diseases, he stated, are exacerbated by how we currently design the built environment and may be quelled with even the most moderate amounts of exercise, whether it be from walking, bicycling, or even climbing the stairs.

To this end, livable streets activists will find much to applaud in the pages of the Active Design Guidelines. Inside, many elements of the city's new Street Design Manual are further substantiated with research indicating that safer streets will translate to a markedly healthier city. From mixing land uses to -- yes -- addressing the supply and location of parking, the guidelines focus on the role urban design should play in making New York City a healthier place to live.

While this is a far-reaching and impressive document that other cities should seek to emulate, it is, in the end, only guidelines. The hard part, as always, is executing the wisest policies and enacting the right recommendations.

Graphic: NYC Department of Health

There's a lot of interesting numbers to comb through, including some geographic data with big implications for New York City neighborhoods. First off, here are some of the major takeaways:

• Sixteen percent of New Yorkers incorporate walking, biking, running, or skating into their daily commute.*
  
• Eighty-three percent of adult New Yorkers who regularly walk or bike for transportation report excellent, very good or good health, compared to 70 percent of those who do not.
• The correlation between better health and frequent walking and biking is significant, regardless of income level.
• Only 10 percent of New Yorkers who regularly walk or bike report frequent mental distress, compared to 14 percent of those who do not regularly walk or bike.
• Men are significantly more likely to bike to work in New York City than women.

So in nerve-fraying NYC, getting around using your own muscle power can help alleviate mental stress. And walking and biking improves your chances of living in good health, no matter how much money you make. Chalk up more data to support Elana Schor's coinage from earlier this year: "Transportation reform is health reform."

But the cycling gender divide is real, and it's not the only significant discrepancy revealed by this report. Geographically, there are major variations in the percentage of New Yorkers who walk and bike regularly. Follow the jump to see the DOH map.

Lots of those light yellow areas really leap out. Sunset Park, north-central Brooklyn, East Harlem, the South Bronx -- they are, by and large, compact neighborhoods that are less affluent than areas of the city with higher rates of walking and biking. They are also the areas of the city, by and large, that experience the highest rates of obesity and diabetes, especially among young people.

The DOH report recommends a number of steps to help New Yorkers reap the health benefits of active transportation, including the construction of better infrastructure for walking and biking. This map makes a compelling argument for where to target that investment.

*You may be wondering why this figure is so low, since most New Yorkers commute via transit and must be walking a lot in the process. The methodology, according to DOH, involved asking survey participants how they get to work. Respondents could choose multiple options. Someone could say, for instance, "I walk and I take the train." Everyone who included walking, biking, running, or skating in their response counted toward the 16 percent "active commute" figure.

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.