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Addressing the Epidemic of Traffic Violence: Why We Need a Public Health Approach to Safer Streets

Charlene Addy McGee, EMPA

Multnomah County Health Dept

Director, Prevention and Health Promotion

REACH Program, Principal Investigator

Abstract: Transportation Equity: A Public Health Approach Transportation decisions affect our lives and health. Everyone relies upon various modes of transportation to get to work or school, receive medical attention, access healthy foods at grocery stores and markets and participate in countless other activities. However, too many people are negatively impacted by inequitable transportation decisions that are detrimental to public health. The many connections between transportation and health have gained attention in recent years, particularly the health impacts of transportation to vulnerable populations. Health and transportation professionals have different scientific backgrounds and separate organizational structures, yet they aim to answer similar questions. What are the linkages between health and transportation datasets? What is the scientific literature telling us about these linkages, on topics like safety, physical activity, air quality and access? What are the implications for the nation’s most vulnerable communities, and what health disparities are impacting them? Fortunately, the emerging research and policy implications provide a common ground for health improvement.
Traffic violence is an urgent public health issue.
Public health approach can address root causes of traffic violence.
Upstream interventions are key to preventing traffic injuries and fatalities.
Collaboration across sectors is crucial for success.

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We want to acknowledge that the data presented in this report represent real people – members of our community. These individuals are sisters, brothers, mothers, fathers, and friends in our county.

The numbers we speak about represent individuals - they are our brothers, sisters, friends and beloved family members
Every death is significant, no matter how small the count
Multnomah County (Multco) REACH’s priority population is the Black/African American population, including African immigrants and refugees, of Multnomah County, Oregon. Black/African American residents comprise 7.3% of Multnomah County’s 800,000+ population (about 60,000 persons). Local Black/African American communities face life-course health inequities from infancy through death, especially related to chronic disease. They are more than twice as likely as white residents to be diagnosed with diabetes and obesity and are more likely to die from heart disease, stroke, and cancer. Blacks/ African Americans have been overrepresented among Multnomah County’s COVID-19 hospitalizations (8%) and die of COVID-19 at a higher rate than other racial and ethnic groups.
Humanizing the data and not putting the blame on the individuals but the system (built environment)
This presentation and work focuses on disparities; it is not an assessment of community strengths. We know there are a plethora of strengths, compelling stories and an enormous amount of resilience in the communities. The disparities we discuss today would undoubtedly be worse without those strengths.
The data I present represent real people – sisters, brothers, mothers, and fathers in our county. The results are sobering, and may cause you to feel uncomfortable and upset.
Yet, it is through this discomfort that we, perhaps, can recognize the importance of these data in raising awareness and serving as a call to action.
This information can seem overwhelming to look at where we want to be, but the community is in this together.

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Multnomah County

Multnomah County (Multco) REACH’s priority population is the Black/African American population, including African immigrants and refugees, of Multnomah County, Oregon.
Black/African American residents comprise 7.3% of Multnomah County’s 800,000+ population (about 60,000 persons).
Local Black/African American communities face life-course health inequities from infancy through death, especially related to chronic disease. They are more than twice as likely as white residents to be diagnosed with diabetes and obesity and are more likely to die from heart disease, stroke, and cancer. Blacks/ African Americans have been overrepresented among Multnomah County’s COVID-19 hospitalizations (8%) and die of COVID-19 at a higher rate than other racial and ethnic groups.
We know that despite the disparities - that being Black isn’t a risk factor. Rather the conditions in which we are forced to navigate bred these outcome
We lead with culture and the strength, brilliance and resiliency of our community! While we value and respect public health - we know the community wisdom including lived experiences are also critical to successful implementation and monitoring of public health promograming
Our multisectiorial panrtes and staff are members of the community and trusted leaders!
The relatively small proportion of Black/AA persons in Multnomah County is an indicator of a unique history of discrimination. While Black/AA persons were among the first U.S. settlers of the area, Oregon is the only state in the country whose original constitution explicitly banned Black/AA persons from legal residence. Despite this history, Multnomah County’s Black/AA community is vibrant and resilient, representing 47% of Black/AA persons living in the state. However, residual effects of redling including exclusion are exacerbated by continued racism and institutional inequities. A prime example is the gentrification of traditionally Black/AA neighborhoods in North/Northeast (N/NE) Portland. Over recent decades, many Black/AA families have been forced to uproot and move into more affordable housing in East Portland and Gresham, characterized by more suburban sprawl, unfinished infrastructure, and fewer resources. As gentrification has continued and the latest hotspots of investment change, families have not only continued to move eastward, but also move repeatedly within N/NE and East Portland/Gresham, as well as back and forth between the two.

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Walking the Talk

Evolution Into Active Transportation

Personal Evolution is Now A Professional Mission

Connection between Chronic disease and active transportation

Build up over the last 11+ years

Intersection of safety and Blackness

AAOA

An Active Child

Sense of Personal Safety

The purpose of the African American Outdoor Association is to: ��- conduct active outdoor excursions that encourage African Americans to explore the natural environment. ��- promote healthy living by encouraging families to shift to physically active lifestyles. ��- increase knowledge and appreciation of the beauty and natural resources of the Pacific Northwest, and��- build community around active living.

Before we start, a reminder: we’re all at different places in thinking about and working on health equity. As we view and talk about the videos, truly, there are no right or wrong answers. This is a safe space—you’ll find no judgment here, just open inquiry and exploration in the spirit of learning together.

Encourage you to be and stay curious, lean into your discomfort, challenge your assumptions and consider new ways to move the work forward

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The Road Ahead

Context Setting
Transportation as a Social Determinant of Health
Health Equity Tools
Action Item to bridge racial, health and transportation equity
Case Study + Examples
Recommendations
Q & A

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Community & Social Context

Community engagement

Social integration & support

Available resources

Historical treatment

Education

Vocational training

Literacy

Language

Early childhood education

Higher education

Economic Stability

Employment

Income

Housing stability

Food security

Medical bills

Health Care System

Access to health care

Provider availability

Provider linguistic & cultural responsive

The Social Determinants of Health

Neighborhood & Physical Environment

Transportation

Walkability

Safety

Housing

Parks

Access to healthy foods

Speaker Notes:

We’ve mentioned that REACH supports work to address the social determinants of health, but what are they?
The social determinants of health fall into five buckets, including neighborhood and physical environment, community and social context, education, economic stability, and the health care system.
Examples of neighborhood and physical environment issues include walkability and access to healthy foods
Examples of community and social context issues include social integration and support and available resources
Examples of education include vocational training and higher education opportunities
Examples of economic stability include employment opportunities and housing stability
Examples of health care system issues include access to health care and access to providers who are linguistically and culturally responsive

Adapted from:

Centers for Disease Control and Prevention website. Social determinants of health (SDOH): Conditions in the places where people live, learn, work, and play affect a wide range of health risks and outcomes. Available at https://www.cdc.gov/socialdeterminants/. Accessed August 5, 2018.
Henry J Kaiser Family Foundation website. Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity. Available at http://files.kff.org/attachment/issue-brief-beyond-health-care. Published May 10, 2018. Accessed August 5, 2018.
U.S. Department of Health and Human Services. Office of Disease Prevention and Health Promotion. Social Determinants of Health. Available at https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health. Updated August 6, 2018. Accessed August 7, 2018.

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America’s Chronic Disease Burden

Source: Center for Disease Control. (2021) Health United States, 2021. https://www.cdc.gov/nchs/data/hus/hus11.pdf

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Cancer
Heart disease
Unintentional injury
Stroke
COVID-19
Alzheimer Disease
Chronic lower respiratory disease
Diabetes
Suicide
Chronic liver disease

Leading causes of death in Multnomah County 2020-2022

Physical inactivity

Traffic injury

Air pollution

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Leading Causes of Death Categories

Air Pollution

Cancer
Heart Disease
Chronic Lower Respiratory Disease
Alzheimer’s
Chronic Liver Disease

Physical Activity

Cancer
Heart Disease
Stroke
Diabetes
Chronic Liver Disease
Hypertension

Injury

Unintentional Injury

Suicide

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Source: National Equity Atlas. (2023) Air pollution. https://nationalequityatlas.org/indicators/Air-pollution

Air Pollution Exposure Index by Race/Ethnicity in the United States (2020)

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Bike and Walk As An Alternative Mode Among African Americans

Count of Bikeshare Program Usage

Source: Walking the Talk? Empowering Black Communities Through Inclusive Active Transportation. (2023) https://issuu.com/congressionalblackcaucusfoundation/docs/2024_cbcf_cpar_walking_the_talk_md1.3-2

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Smart Growth America. (2022) Dangerous by Design 2022. https://smartgrowthamerica.org/dangerous-by-design/

Pedestrians Deaths Per 100,000 By Race and Ethnicity (2016-2020)

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Pedestrian Fatalities Per 100,000 People by Census Tract Income

Smart Growth America. (2022) Dangerous by Design 2022. https://smartgrowthamerica.org/dangerous-by-design/

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Compared to non-Hispanic white residents, for Black residents, the death rate is:

3.0 times higher for diabetes

2.3 times higher for stroke

1.8 times higher for traffic crash injury

1.1 times higher for cancer

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Group	Life expectancy in years (95% CI)
Total population	79.4 (79.3-79.6)
American Indian/Alaska Native	74.4 (72.7-76.2)
Black	74.9 (74.3-75.6)
Non-Hispanic White	79.5 (79.4-79.7)
Hispanic or Latinx	83.5 (82.7-84.3)
Asian/Pacific Islander	85.5 (84.9-86.0)

Life expectancy by race and ethnicity in Multnomah County, 2013-2017

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Why the County leads with race

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Multnomah County REACH

Works towards health equity by grounding culturally tailored strategies in community-based participatory and evidence-based approaches that mesh public health, multi-sectoral partners, and community voice and resiliency.

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Economic Development/ Social Cohesion

ACHIEVE Coalition

Culture Preservation

Community Engagement

Farmer’s Market

Culturally Specific Contracted Partners

Physical Activity + Build Environment

Improve pedestrian, bicycle, or transit transportation systems

Safe Routes to Everyday Destination

Reduced traffic-related injuries and fatalities in the project area.

Community engagement

Breastfeeding

Black Farmers

Vocational Training

Farmer’s Market

Culturally Specific Contracted Partners

Vaccination

Access to health care + Safety Net Resources

Health Hubs

Health & Wellness Fairs

Tobacco Cessation

Leveraging CHWs & Healthcare Providers

Strategy Areas + Cross Cutting Themes

Nutrition

Equitable Food Oriented Development

Food Pantry

Culturally Specific CSA

Healthy Nutrition Standards

Healthy Food Procurement

•We’ve mentioned that REACH supports work to address the social determinants of health, but what are they?

•The social determinants of health fall into five buckets, including neighborhood and physical environment, community and social context, education, economic stability, and the health care system.

•Examples of neighborhood and physical environment issues include walkability and access to healthy foods

•Examples of community and social context issues include social integration and support and available resources

•Examples of education include vocational training and higher education opportunities

•Examples of economic stability include employment opportunities and housing stability

•Examples of health care system issues include access to health care and access to providers who are linguistically and culturally responsive

Adapted from:

•Centers for Disease Control and Prevention website. Social determinants of health (SDOH): Conditions in the places where people live, learn, work, and play affect a wide range of health risks and outcomes. Available at https://www.cdc.gov/socialdeterminants/. Accessed August 5, 2018.

•Henry J Kaiser Family Foundation website. Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity. Available at http://files.kff.org/attachment/issue-brief-beyond-health-care. Published May 10, 2018. Accessed August 5, 2018.

•U.S. Department of Health and Human Services. Office of Disease Prevention and Health Promotion. Social Determinants of Health. Available at https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health. Updated August 6, 2018. Accessed August 7, 2018.

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Implement local level policies and activities to connect pedestrian, bicycle, or transit transportation networks (e.g., activity-friendly routes) to everyday destinations.

Outcome:

Increase the number of policies, plans, or community design changes that improve access to physical activity.
Increase the number of places that improve community design by connecting safe and accessible places for increased access to physical activity.
Increase the number persons with access to safe and accessible places for physical activity.

REACH Physical Activity Tract

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Bridging Public Health & Transportation

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Transportation Intersects

Transportation is a key social determinant of health, impacting access to healthcare, jobs, education, healthy food, and physical activity.
Transportation decisions influence health outcomes, leading to illness, injury, and premature death.
Inequitable transportation systems disproportionately burden marginalized communities, perpetuating health disparities.
Public health strategies prioritizing safe, accessible, and equitable transportation can improve community well-being.
Safe and reliable transportation is fundamental to the health of people, communities, and economies, making it a social determinant of health.
The factors that influence health outcomes—including overall health status and individual and community quality of life—are known as social determinants of health.
The places where people live, learn, work, and play have a large effect on an individual’s health outcomes.
Transportation has the potential to negatively affect communities by limiting opportunities for safe physical activity, increasing exposure to pollution, and impacting community design.
Increasing transportation connections can improve access to health-supporting activities, medical services, recreational facilities, and healthy food, as well as other destinations including schools, jobs, and community centers.

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Public Health Approach to Traffic Fatalities

Traffic violence is a public health issue.

Public health approach can address root causes.

Upstream interventions are key to preventing traffic injuries and fatalities.

Collaboration across sectors is crucial for success.

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03

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Active People Healthy Nation℠

Active People, Healthy Nation℠ is CDC's national initiative to help 27 million Americans become more physically active by 2027.

Photo credit: Centers for Disease Control and Prevention

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Creating an Active Multnomah County, Together!

Active People, Healthy Multnomah County

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Equity Benefits Us ALL

Definition: Equity is fairness and justice achieved through systematically assessing disparities in opportunities, outcomes, and representation and redressing [those] disparities through targeted actions.

Places a

focus on

Social

justice

Engages systems change

Shifts power

to

Communities

And the

most

marginalized

Reduces the risk of reinforcing, existing inequalities

EQUITY

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Five Strategies for Centering Equity for the Common Good

Create Accountability

05

Build equity leadership and accountability for results

Work with Community

04

Listen to and act with community

Shift & Share Power

03

Shift and share power within the collaborative and with community

Focus on Systems Change

02

Focus on systems change, in addition to programs and services.

Ground the Work in Shared Language; Data & Context; Targeted Solutions

01

Create a shared language; ground the work in data and context; and target solutions to groups with disparities

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Curb Effect

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Exclusion laws

Redlining

Urban renewal

Unfair lending

Restrictive zoning

Displacement

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Policies and Decision making

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Share Knowledge

Spark Conversation

Implement Resources

The purpose of this report is to establish baseline data on transportation safety for the Black/African American and African Immigrant/Refugee population that transportation planners and advocates can use to gauge progress toward racial equity goals
Traffic crashes are a contributor to unintentional injury, the third leading cause of death in Multnomah County during the ten-year period of 2007-2016. The mortality rate from unintentional injury for Black/African American residents is 1.17 times the rate for white residents in Multnomah County, as displayed in Table 1. This difference is statistically significant (p<0.05).
The REACH program developed this report to build awareness of safety concerns and the Black communities’ experience. In addition, this report describes practical solutions to address the communities’ concerns through policy changes that correct historic injustices, system changes that reinforce accountability, and environmental changes that alter the physical spaces (i.e., built environment) through which people travel. Since many local entities have new policies to model equity in a systematic manner, this report can be a resource for private and public agencies to reduce the health burden of travel-related decisions.
Key findings: Black Multnomah County residents appear to be over-represented among patients visiting emergency departments for traffic.
For example, the 2017 MAX stabbings were identified in Walking While Black as having a lasting impact.

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Six Domains of Transportation Safety

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(3.5 min)

https://app.frame.io/reviews/81d9a6b1-8ea5-47c8-a6e5-8245a11

a9aa6/3f0a8ccf-2056-4f79-8cb8-20371aa29640?version=50438dd1-a203-449c-836d-577cdf874189

Traffic violence contributes to health inequities for Black/African American residents in Multnomah County, as they are disproportionately affected by traffic crashes compared to non-Hispanic white residents. The death rate from traffic crash injuries is 1.8 times higher for Black residents, demonstrating the unequal burden of traffic violence on this community. This disparity can be attributed to several factors, including historical transportation policies that have led to segregation and limited access, as well as a lack of investment in safe infrastructure in Black communities. These inequities result in increased exposure to traffic violence and contribute to the overall health disparities experienced by Black/African American residents in Multnomah County.

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Public Health Civic Leadership Academy

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The Public Health Framework

Define the Problem: Clearly describe traffic violence as a public health crisis.

Identify Risk and Protective Factors: Analyze contributing factors like speeding, impairment.

Develop and Implement Interventions: Prioritize upstream interventions, policy changes, enforcement.

Conduct Evaluation: Monitor and assess intervention effectiveness, make data-driven adjustments.

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02

03

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Way Forward: Equitable Public Engagement

Inclusive: What communities and interests need to be represented and in what capacity? Who benefits? Who pays? Who decides?

Accessible: Will people and organizations from diversity of backgrounds feel comfortable and engaged?

Transparent: How does public engagement interact and influence decision-making?

Intentional Recruitment: Recruit community members from marginalized groups.

Compensation: Provide stipends, childcare, and/or transportation for participants.

Outreach: Meet people where they are, use multiple languages, mtg time, go where people are

Plain Language: Use accessible language and concepts.

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Recommendations

Goal: Zero traffic deaths and serious injuries
Intersectional Solutions To Advance Equity
REACH Across Sectors: To Find Solutions to Health Disparities
Acknowledge past + current transportation, land use policies' racist impacts.
Redress disparities in traffic enforcement, infrastructure, investment.
Centering equity in transportation planning and decision-making
Prioritize needs of communities harmed by transportation policies.
Prioritize equitable access, improve safety, affordable transportation and active mobility for all.
SAFETY!

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Vehicle Speed and Pedestrian Fatalities

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The Fierce Urgency of Now

“We are now faced with the fact that tomorrow is today. We are confronted with the fierce urgency of now. In this unfolding conundrum of life and history, there 'is' such a thing as being too late. This is no time for apathy or complacency. This is a time for vigorous and positive action.”

- Rev. Dr. Martin Luther King

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Montgomery Bus Boycott

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Be A Bridge - REACH Out:

Let’s Connect!

Charlene McGee

Multnomah County Health Department

Cell: 971.334.4381 (Ok to text)

Email: charlene.a.mcgee@ multco.us