California hospitalization statistics also concur with the results of dozens of health studies in the U.S., Canada, Great Britain and New Zealand that correlate the risk of pedestrian injury and death, particularly among children, to income and related socioeconomic factors. These 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. Children in families without a car are twice as likely to be injured as those in car-owning families.(19)

Studies in Quebec(20) and in Scotland(21) found that poor children were four times as likely to be injured as children of wealthy families. A study in Baltimore found that children whose parents own a car and home cross an average of 3.7 streets a day, whereas children whose parents do not own both a car and home cross an average of 5.4 streets a day, a difference that is, say the researchers, "highly significant."(22)

Ian Roberts, who has done extensive research on the socioeconomic and racial determinants of pedestrian injury and death, wrote in the British Medical Journal, "For injuries to child pedestrians the number of roads that children cross is a key determinant of the occurrence of injury. Children in families with the lowest quarter of income cross 50 percent more roads than those in families in the highest quarter." Roberts goes on to add, "The strong association between injury and poverty is the most consistent finding in published epidemiological studies of childhood injury . . . the association between injury and poverty is particularly strong for traffic accidents."(23)

While no exact statistics are collected on socioeconomic status for pedestrian victims in California, both independent research and existing data on health insurance strongly suggest that that the state’s pedestrian accident victims are likely to be low-income. Of all hospitalized pedestrian injuries under 65 years of age in 1998, nearly 35 percent were covered by Medi-Cal. Of that same age group in the population at large, only 11 percent were covered by Medi-Cal in the same year (see Table 5). Caps on earnings for Medi-Cal insurance requires that recipients be in the lowest income brackets.

It is speculated that the link between pedestrian collisions and ethnicity is due to the fact that Latinos and African Americans in California are less likely to own a car and more likely to walk, bike and take public transit – resulting in greater exposure to the dangers of the street. The link with socioeconomic status may also have to do with the fact that more affordable housing is located along high-speed, high-volume arterial streets – which are more dangerous for pedestrians.

While spending on pedestrian safety measures usually fails to be a priority in local, regional and state transportation funding programs, health providers, private companies and Californians themselves are spending billions as a result of pedestrian injuries and fatalities. As demonstrated in Table 5, hospital charges alone are in excess of $200 million – a cost partly covered by health insurance providers but that also included over $23 million in out of pocket expenses in 1998. Yet these initial costs do not factor in physician charges, physical rehabilitation, work loss or property damages. An independent analysis of pedestrian injury and fatality data performed by the Children's Safety Network Economics and Insurance Resource Center concludes that pedestrian collisions cost California at least $1.3 billion in lost economic productivity in 1999 alone. This cost estimate rises to nearly $4 billion once "quality of life" costs including pain and suffering are accounted for (see Table 6).

Unfortunately, the initial response to increasing traffic dangers is often to limit pedestrian activity, and children in particular are often the first to be discouraged from walking or bicycling. But the fact that so many children are kept inside or are chauffeured to destinations in order to guarantee their safety has increased their exposure to another kind of danger – the health risks associated with inactivity and obesity. Seventy-eight percent of U.S. children already do not get the recommended daily dose of 30 minutes of exercise, including 20 minutes of vigorous activity.(24) This can have a negative impact on a child’s cardiovascular health(25) and also contributes to obesity. Physical activity not only stimulates muscles and joints but also improves concentration, memory and learning, and enhances creativity and problem-solving abilities.(26) Studies have shown that physical activity also improves the mood of children.(27)

Advocates working in low-income communities note that fear of both traffic and crime often cause parents to keep their children home from after-school programs. This loss of mobility and

independence prevents them from becoming familiar with and exploring their neighborhoods, and prevents them from acquiring the traffic skills they need in order to stay safe. In addition, researchers also believe that the loss of independence and mobility has even more significant impacts on their cognitive skills. Children who are driven everywhere and who aren’t allowed to venture outside are often unable to draw basic maps of their communities and develop an understanding of spatial relationships.(28)

"Independent play and mobility by school-aged children in their neighborhoods have been found to contribute to their social and spatial development," write UC-Irvine health researchers in a recent article published in the Journal of the Institute of Traffic Engineers. "If children play only under strict adult supervision, they miss the opportunity to develop skills such as negotiation and leadership. Residential neighborhoods without a safe and healthy environment do not accommodate the developmental needs of children."(29)

Those who are critical of efforts to improve pedestrian safety are often heard to cite studies showing that many pedestrians who are hit by cars are drunk. According to a 1997 study for the National Highway Traffic Safety Administration, one third of all adult pedestrians who are injured or killed were intoxicated.(30) But two thirds of the adults were not drunk, and many pedestrian victims are children. Moreover other examinations of local data, including a recent story in the Los Angeles Times, suggest that these results may be exaggerated. The Times analysis of accident reports in Santa Ana found that alcohol or drug use was cited in just six percent of the crashes that were blamed on pedestrians.(31)