Pedestrian accidents are a significant public health problem in California and are one of the leading causes of fatal and hospitalized injuries for children statewide. Pedestrian fatalities alone accounted for nearly 20 percent of all traffic-related deaths in the state, even though only eight percent of all trips are made on foot. The number of pedestrians killed as a percentage of total traffic fatalities ranged as high as 26 percent in Sacramento County, 30 percent in Los Angeles County, and 54 percent in San Francisco County (Table 2).

According to an analysis of 1999 data, pedestrian accidents cost California nearly $4 billion in lost economic productivity, medical expenses and pain and suffering (Table 6). Yet California spends less than one percent of its federal transportation funds on pedestrian safety, less than any other state in the nation. Ironically, the most visible effort statewide related to pedestrians has been the highly controversial removal of crosswalks under the guise of improved safety.

An analysis of statewide data collected by the Department of California Highway Patrol shows that in 1999, at least 688 pedestrians died and another 14,346 were injured on California’s streets. Los Angeles County experienced by far the greatest number of pedestrian fatalities and injuries – 203 pedestrian deaths and 5,377 injuries represent more than a third of all pedestrian fatalities and injuries in the state. But Los Angeles is also California’s most populous county, and if the rankings are adjusted to reflect population, San Francisco ranks as having per person the highest incidence of pedestrian fatalities and deaths. However, more people walk in San Francisco than in any other California city because there is a mix of residential, retail and other land uses within walking distance, population and development patterns are dense, and public transit is convenient. Therefore, any real measure of the relative danger facing pedestrians must factor in the amount of walking, or "exposure," that occurs in each location.

These factors are all incorporated in a "pedestrian danger index," arrived at by dividing the number of fatalities and injuries in each county by population, and then dividing that number by the county’s "exposure index," or overall levels of pedestrian activity. This number is then adjusted to a relative scale from 1 to 100, with 100 being the most dangerous.

Using the pedestrian danger index, Sacramento County ranks as the most dangerous county for pedestrians in California in 1999, followed by Contra Costa, Los Angeles, Santa Clara and San Mateo (Table 1). This is the first time Sacramento County has ranked most dangerous since our survey began in 1996. Ventura County ranks in the top 10 for the first time since 1996, and San Francisco, San Joaquin and Tulare counties all climbed in the rankings. While Los Angeles County dropped from first to third, the number of fatalities actually increased from 200 to 203, and the drop in the rankings had more to do with the fact that the number of fatalities increased more sharply in other counties. The ranking shows that counties in Southern California, the Silicon Valley and the Central Valley are among the most dangerous in the state.

As alarming as these figures are they may not fully measure the danger to pedestrians because it’s been estimated that injuries are underreported by as much as 56 percent. Police often do not report collisions that result in emergency room treatment but not hospitalization, and don’t report collisions that occur on private property, or in alleys or driveways. These are the locations where many accidents involving the youngest children occur. It is important to note that pedestrian injuries account for two-thirds of all severe traffic-related injuries among children, and that the probability of a child dying or becoming severely disabled exceeds that of all other causes of childhood illness. The elderly are also two to four times more likely to die when struck.

As with automobile fatalities, the total number of pedestrian deaths has dropped slightly in the last few years. However, while the amount of driving is increasing, statistics show that the amount of walking is declining. This may mean that while driving is getting safer, walking is getting more dangerous. The sharp decline in walking has coincided with significant increases in obesity and inactivity among the general population. These trends have so alarmed health officials that they have joined with pedestrian advocates in calling for policies and investments that make communities safer and more walkable.

An analysis of the most recent statewide hospitalization data (a smaller but more detailed database that records race and ethnicity information) shows that Latinos and African Americans were more likely to be injured relative to their share of California’s overall population. While 30 percent of the population of California is Latino, 37 percent of all hospitalized pedestrian fatalities and injuries in 1998 were Latino. African Americans represented 7 percent of the state’s population but accounted for 10 percent of all hospitalized pedestrian fatalities and injuries (Table 3). Race and ethnicity data at the local level in California points to a similar trend, with Latinos and African Americans disproportionately represented as victims of pedestrian-vehicle crashes in nearly every one of the state’s most populous counties (Table 4).

Prior research, supported here with a new analysis by the Latino Issues Forum, also shows that low-income populations are more likely to be victims in pedestrian accidents. While 35 percent of all pedestrian victims under the age of 65 were covered by Medi-Cal, just 11 percent of the general population under 65 were covered by Medi-Cal. While the higher risk for low-income populations has been documented in dozens of studies conducted by health professionals here and abroad, this information has largely been absent from the public debate over pedestrian safety in California. Further analysis reveals hospital charges alone topped $200 million for pedestrian victims in 1998, $23 million of which was paid out of pocket. But when factoring in lost economic productivity and pain and suffering, pedestrian fatalities and injuries are estimated to cost California nearly $4 billion a year.

Other studies show that pedestrian injuries and deaths, particularly among children, are correlated to income and several other socioeconomic factors including access to a car. Factors include unemployment, single-parent and especially female-headed households, young mothers, low levels of education, the number of times a family has moved, and the number of children in a household. More than one study found that lack of access to a car was associated with a doubling of the risk of injury as a pedestrian.

Limiting exposure by simply staying inside, however, has grave implications for both health and well-being. The vast majority of children already fall short of the recommended daily dose of activity, which can have a negative effect on both a child’s physical and mental development. Concerns have also been raised about the extent to which transportation policy and investments focused on improving travel by automobile have circumscribed the independence and mobility of both children and the elderly.

For decades state and local governments have focused transportation policy and investments on accommodating more traffic by widening streets, increasing speed limits, removing crosswalks and enacting laws that give vehicles the advantage – such as allowing right turns on a red light. Meantime rapid suburbanization has dramatically increased traffic and spread development patterns ever further apart so that stores, homes, schools and other destinations are no longer easily accessible on foot. The result has been deadly for pedestrians. Studies show that traffic speed and traffic volume are two of the environmental factors with the highest correlation to pedestrian injury and death. One of the more disturbing trends in California is the removal of crosswalks at uncontrolled intersections (intersections without a stop sign or traffic signal), a policy that has left pedestrians to largely fend for themselves.

Moreover, in order to provide a safe environment for pedestrians, the basic infrastructure of sidewalks, paths and crosswalks must be provided. Yet an analysis of federal transportation funding shows that while California has the second highest share of pedestrian deaths compared to all traffic-related fatalities, it ranks last among the 50 states in spending on pedestrians. While an average of $40 per person in federal transportation funds was spent on highway projects statewide, an average of just 4 cents per person was spent on improving conditions for pedestrians. Even though statewide roughly 20 percent of all traffic fatalities are pedestrians, less than one percent of all federal traffic safety money was spent on making the streets safer for pedestrians.

Pedestrians, even if they are young children, are often found to be at fault in crashes, obscuring the fact that the real problem may be that laws favor motorists, that speed limits are set too high, or that there are a lack of crosswalks and safe places for children to play. The tendency to blame pedestrians creates the impression among policy makers and the public that nothing that can be done. As a result efforts to improve pedestrian safety are often limited to pedestrian education, even though numerous health studies conclude that education alone has limited effectiveness, especially with children, and that modifications in street design and the lowering and enforcement of speed limits are also needed.

The report also discusses how local and state policies across California that have focused on accommodating more traffic have been deadly for pedestrians, and why a tendency to blame pedestrians for collisions has served to further hamper programs and policies that could potentially prevent thousands of additional injuries. In conclusion, new policies and investments are suggested that can make California’s cities, towns and suburbs safe and walkable. The report’s recommendations include: