Roads for all, safety for some: addressing inequities in traffic fatalities through law and policy (Network for Public Health Law)

Motor vehicle crashes are preventable and yet remain the leading cause of death in the first four decades of people’s lives, resulting in an average of 101 deaths per day between 2015 and 2019 in the U.S. By 2021, nearly 43,000 people died on U.S. roads, the highest figure since 2005, and pedestrian deaths reached a 40-year high. A 2022 CDC study found that among high-income countries, the U.S. had the highest population-based road fatality rate in 2019 (11.1 per 100,000 population) — 2.3 times higher than the average rate for 28 other high-income countries (4.8 per 100,000 population). The number of road crash deaths in the U.S. has continued to increase, with the National Highway Traffic Safety Administration (NHTSA) reporting a 10% increase in traffic fatalities in 2021 over the previous year. The burden of traffic-related death and injury is worsening and is not borne equitably across all populations.

Knowledge about disparities in adverse crash outcomes along racial and ethnic lines is not new, but new research that controls for differences in travel distances has shown that racial disparities in traffic deaths are much wider than previously understood. Black Americans experience the highest traffic fatality rates per mile traveled across all modes of travel, with a passenger vehicle fatality rate 73% higher, a pedestrian death rate 118% higher, and a cycling fatality rate 348% higher than non-Hispanic White Americans. While White Americans ride their bikes four times the distance per capita as Black Americans, Black Americans still died at more than four times the rate per mile of cycling. Hispanic pedestrians experience a road fatality rate 84% higher than non-Hispanic Whites.

These sobering inequities are likely the result of structural racism in transportation infrastructure and processes. Areas that experience high rates of pedestrian fatalities tend to be characterized by roadway designs that encourage speeding and make walking difficult, often situated in lower-income, Black, or Hispanic communities. In recent years, public health research has shifted focus from identifying risk and protective factors to understanding the historical and current policies and systems that have created the health inequities we experience today. This trend is important and must continue.

Policies like redlining and discriminatory zoning laws created or exacerbated the structural racism that still leads to inequities in traffic-related death and injury. “Redlining” refers to a federal policy during the 1930s that legalized discrimination in housing and systematized structural racism on a national scale. Created as part of President Franklin D. Roosevelt’s New Deal, the Home Owners’ Loan Corporation (HOLC) made loans to new homeowners by refinancing mortgages at low-interest rates. HOLC used color-coded maps and assigned letter grades to group neighborhoods into financial risk and lending categories. Neighborhoods that were given the worst scores were populated by Black people and immigrants, who were denied homeownership loans, and led to decades of decreased generational wealth and limited community-level investment.

Unintended consequences of well-meaning laws have also impacted traffic-related morbidity and mortality among lower income, Black, and Hispanic communities. Research has shown that strong graduated driver licensing (GDL) laws are effective in reducing crash fatalities among 15- to 17-year-old drivers by limiting their exposure to driving risks while learning how to drive more safely. Some studies began to show an increase in fatal crashes among 18-year-old drivers in states with strong GDL laws, leading to concern that enhanced GDL requirements (supervised driving hours, driver education, behind-the-wheel instruction, and nighttime/passenger restrictions) cause some young people to wait until they reach the age at which the state no longer requires GDL restrictions (age 18 in most states). Several studies have shown that young Black and Hispanic drivers are more likely to delay licensure than their White peers and that low income is associated with delayed driver licensure. This means that the benefits of GDL laws may not be benefitting all novice drivers equitably. The same is true for the benefits that result from access to safe mobility. For example, among young adults, a lack of delay in driving licensure was associated with better self-reported health, higher education, and more working hours four years after leaving high school.

While law and policy have caused inequities in traffic-related injury and death, law is also the most powerful tool by which these inequities can be rectified. For example, technology offers promising new approaches for novice driver training, but laws are needed to guide implementation and ensure that its benefits accrue to all new drivers, regardless of wealth, race, or geographic location. Acknowledging the need for policy action to address transportation inequities, many U.S. cities have adopted Vision Zero Action Plans with a goal of reaching zero road fatalities through community engagement to build trust and understand community transportation needs; equitable data collection and analysis; and equitable implementation of safety improvements.

In response to Executive Order 13985: Advancing Racial Equity and Support for Underserved Communities Through the Federal Government, the U.S. Department of Transportation’s Equity Action Plan highlights key actions to address transportation inequities in all communities by focusing on wealth creation, power of community, interventions, and expanding access. Infrastructure improvements in high-risk areas can mitigate common causes of pedestrian-involved motor vehicle accidents, such as the installation of speed and red-light cameras, redesigning to enhance walkability, and use of traffic calming measures.

Lastly, research is needed to clearly demonstrate the causal relationships between transportation laws, including policies steeped in systemic and structural racism, with transportation-related morbidity and mortality. Availability of high-quality policy and geocoded motor vehicle crash data is critical for identifying and evaluating legal approaches to addressing transportation and mobility inequities. Accurate crash data coupled with law and policy evaluation can indicate which aspects of mobility/transportation policy and new driver training are most effective and can shed light on how such policies impact specific communities and can be adjusted to promote equity.

Access the Network for Public Health Law article about Roads for All to learn more.