The crowded, congested, contested road: unsafe at nearly every speed

Seattle traffic

Seattle traffic is among the worst in the nation, and it can be downright deadly, according to those who track road-related fatalities.

Every day that I drive to work, I am literally putting my life on the line. I commute roughly 80 miles daily, round trip, from Seattle to Tacoma, navigating one of the most harrowing urban traffic corridors in the Untied States, on Interstate 5 and two state highways. (My story why I am commuting this way will be for another day, but there are good reasons.)

Routinely, erratic drivers dangerously pass me, putting our lives at risk, in order to gain a few extra minutes by speeding. I have seen many accidents, some fatal, on this route over the years, and I am glad that I have my will and living will in proper order in case a truck jack-knifes near me in the rain—and yes I’ve seen that happen twice before on the freeway system around Seattle.

Seattle Road Kill 2001-2009

How deadly are roads in the Puget Sound–take a look at the roadkill on this data map showing types of mortality by form of transportation for 2001-2009.

Judging by this map, we get a fair share of road kill in the metro area I call home.

The Centers for Disease Control and Prevention (CDC) put the number of road deaths annually in my home state at nearly 500 (2009). Nationally, in 2012, the United States reported that 34,080 people died in motor vehicle traffic crashes in 2012, a 5.3% jump over 2011. This ranks as 10th leading cause of death in the United States, if one pulls this form of death from all accidental deaths, in which it is grouped by the CDC epidemiologists.

So by all counts, getting in one’s car (or on one’s bike or in a bus or other form of transportation) and hitting the road can be deadly business in my country, especially given the proliferation of mobile-device users and drunk drivers.

In 2011, cell phone use in the good ole’ U.S.A. was a contributing factor in more than 3,300 deaths and for the previous year, in 387,000 motor vehicle injuries. These are very sobering numbers, and I actually expected there would be more given that I have seen far too many texters during peak travel times in vehicles moving 70 mph. Normally I move over a lane or lay on my horn to snap them out of it.

But this is nothing compared to the perils that passengers and drivers experience globally. According to the World Health Organization (WHO), road accidents claimed 1.2 million lives globally in 2011, ranking as the No. 10 cause of death, on a list that has some pretty nasty company, including respiratory infections (3.5 million), tuberculosis (1.3 million), and the big killer of children ages 0-5 years, diarrhea (2.5 million).

The Institute for Health Metrics produced this data table showing how road deaths globally compared to other causes of death (it's No. 10); go to: http://www.healthmetricsandevaluation.org/gbd/visualizations/gbd-heatmap

The Institute for Health Metrics produced this data table showing how road injury globally compares to other burdens of disease (it is No. 10); go to: http://www.healthmetricsandevaluation.org/gbd/visualizations/gbd-heatmap

A typical story that one sees with mind-numbing frequency overseas are bus collisions with motorcycles and motor scooters. This November 2012 story, 19-yr-olds crushed to death by bus, notes two aspiring young men were run over by an errant bus driver and dragged 40 feet in Chandigarh, India; the driver then fled the scene. Both of the men’s heads were crushed by the bus’s wheels.

I saw no less than three similar road maulings on the island of Java in 2009, when I visited Indonesia. That island, one of the most densely populated locations in the world, is overwhelmed with low-income and middle-income residents on  scooters competing for space with trucks and army of loosely and unregulated van taxis and buses.

Indonesians who use these highly efficient and inexpensive 100-125cc motor scooters are frequently killed on the island nation's infamously unsafe and crowded roads.

Indonesians who use these highly efficient and inexpensive 100-125cc motor scooters are frequently killed on the island nation’s infamously unsafe and crowded roads.

Road accidents alone in Indonesia account for more than 48,000 deaths annually, the 9th leading cause of death in the world’s largest Muslim nation.

The United States Department of State offers this stern warning to would-be American visitors to Indonesia–a country I really loved by the way: “Air, ferry, and road accidents resulting in fatalities, injuries, and significant damage are common. … While all forms of transportation are ostensibly regulated in Indonesia, oversight is spotty, equipment tends to be less well maintained than that operated in the United States, amenities do not typically meet Western standards, and rescue/emergency response is notably lacking.”

During my two-week visit in 2009 to the island nation, I rode about a dozen different buses and equally as many microbuses, not to mention the country’s crash-prone domestic air carriers once, their local train service (also unsafe at times), and the far less safe inter-island ferry services. I saw about a half dozen crashes from my bus window, most fatal and usually with motor cycle riders as victims, and from my hotel room I heard one multi-vehicle crash in the middle of the night that clearly claimed many lives. I learned the next day it was between a bus and truck. The bus was totaled.

Roads can really kill you overseas, and so can planes, boats, and trains too

Buses like these are cheap in Indonesia, but your life can be as some locals would say, insha-Allah, or at the mercy of God.

Buses like these are cheap in Indonesia, but your life can be as some locals would say, insha-Allah, or at the mercy of God.

The writer Carl Hoffman, author of the book The Lunatic Express: Discovering the World… via Its Most Dangerous Buses, Boats, Trains, and Planes, documents the horrendous conditions of ferries, public transportation, trains, planes, and other forms of transport. The book’s online promotion notes that it offers a “harrowing and insightful look at the world as it is, a planet full of hundreds of millions of people, mostly poor, on the move and seeking their fortunes.”

Anyone who has travelled in developing or “middle-income” countries (like, say, Chile or Turkey) knows their life is literally in the hands of drivers who may have no proper training, in busses with no proper maintenance or even reliable brakes. Worse, the drivers of buses and microbuses in countries from Uganda to India to Mexico may trust their fate to Allah, Saint Christopher, the Virgin Mary, or Krishna. Those who have travelled in such places know this to be true, by the many religious deities dangling at the front of public transportation by the drivers’ seats.

Worse, the drivers will often play chicken with their competitors by speeding into oncoming traffic at high speeds while passing other vehicles or simply to “have fun.” I swear I thought I would die on many occasions in: Mexico, Guatemala, Nepal, Peru, Uganda, Indonesia, Egypt, Turkey, Chile, Argentina, India, and other places that I’d rather forget just now.

accident or more by Birn

When is an accident really an accident, or when it is linked to larger systems issues? This analysis is provided by Anne-Emmanuelle Birn in her description of the social determinants of health (SDOH).

Three separate times, after I lived through the near mishap, I swore I would never, ever take a bus again in a developing nation. Yet I threw caution to the wind, as I needed to get around, and I could not afford to get around any other way. Not seeing the country I was visiting was not an option.

Is it really  “just an accident” or something more?

Anne-Emmanuelle Birn, international health professor at the University of Toronto, and co-author of the widely used global health tome called Textbook of International Health, points out the deeper connections that road-related deaths have to poverty and social inequity in undeveloped and middle-income countries. Birn writes that road traffic accidents are the second-leading cause of death for children between 5 and 14 years of age globally, and that poor and working classes are disproportionately affected in most countries. In high- income countries, most of those killed are drivers and passengers, whereas in low- and middle-income countries pedestrians, cyclists, and public transport passengers make up nine out of every 10 road-related deaths.

In Haiti, for instance, the word for local transport is molue (“moving morgue”) and in southern Nigeria locals say danfo (“flying coffins”).

Duncan Green, an Oxfam policy adviser and development blogger, recently wrote an article asking when road traffic injuries would finally be recognized as a priority by the international development community.

In fact a major report released in June 2013 by the Overseas Development Institute, the United Kingdom’s leading development think tank, notes that transportation is not recognized as a human right like access to water, yet it still is a fundamental factor for many to achieve basic human rights. Well-run transportation systems, for people and for goods and services, promote benefits, while unsafe and weak transportation systems harm the most vulnerable citizens.

Given the debate emerging now for future sustainable development post-2015, the deadline set for the Millennium Development Goals, road safety may finally find a way into the broader public health, development, and environment agenda, as a way to tackle this clearly documented major global killer. Perhaps the threat may finally be treated as the international epidemic that is is, globally or closer to home in the United Sates. For me, this includes the roads in the Puget Sound where I spend more than two hours daily to and from my public health job.

Portland: hip, healthy, homogeneous, and house of the homeless

I just visited Portland, Ore., twice now in the last nine days. Though I moved away in 1987, I have returned countless times. I still love it, as I have since I first visited the Rose City back in April 1983. I went to college in Portland from 1983 to 1987, and I have always felt comfortable studying, living, and working there. I fondly remember my outdoor summer job painting homes during the day and being able to commute nearly everywhere by my bike to my work locations.

I was enamored by the quirky stores like Corno’s on MLK Boulevard, which closed sadly in 1995 (RIP Corno’s we loved you!), and by the many urban gardens I saw in southeast Portland around the campus of Reed College. I also liked that I could bike throughout the city and feel relatively safe that bike commuting was accepted and more secure than in other cities because of the budding efforts by city planners to make that city bike friendly. Portland’s famous mayor from 1985-92, Bud Clark, a former Reed College dropout and tavern owner, made biking cool to a national audience by biking to his job in downtown nearly every day (way to go, Bud!). Mayor Bud made a big impression on me when we overlapped in Portland.

Portland is well-loved by its fans. Some call it one of the healthiest cities because of its many trails in the hills above the city, in Forest Park, an Olmstead Brothers designed gem from 1903 that today encompasses more than 5,100 acres and miles of multi-use trails and many critters.

Portland also defied a national trend by preventing a major highway construction project planned for Highway 26 from plowing through the downtown (the Mt. Hood Freeway). Instead, famed Gov. Tom McCall diverted highway funds ($23 million) in 1974 to build the now famous public transit system that laid the groundwork for the visionary light rail line known as MAX. Portland still has its freeways and gridlock, but it did go its one way. A highway was torn up in downtown and turned into a riverfront park. In essence, Portland has been making policy changes for many years that promoted an alternative vision to the sprawl development that has fueled this country’s destructive and costly obesity epidemic and proclivity to chronic diseases.

Portland is not perfect, however. By becoming trendy with progressives and attractive for lifestyle refugees, it is becoming more expensive and perhaps less diverse in some measurable ways.

First, on the plus side, many have praised the benefits to the “new urbanism” in Portland, for which the city is becoming increasingly famous. I’m not entirely convinced the high-end makeover of parts of Portland, such as the Pearl District, where the once famous Henry Weinhard’s brewery was converted to pricey condos and office/retail, is a good thing. Portland also has lots of farmers markets, parks, green spaces, and policy measures promoting healthy lifestyles and food choices. The Centers for Disease Control and Prevention touts this as “healthy community design.”

On top of design features, such as denser developments that are pedestrian friendly and built to promote interactivity, the city is now ranked No. 1 as the most bike-friendly, knocking rival and bike-loving powerhouse Minneapolis-St. Paul back down to the No. 2 slot, according to Bicycling Magazine. “After being named runner-up in our last round of best bike city rankings in 2010, Portland reclaims the top spot. The only large city to earn Platinum status from the League of American Bicyclists is a paragon of bike-friendliness, with 180 miles of bike lanes and 79 miles of off-street bike paths. Always quick to embrace cyclist-friendly innovations, Portland was the first city in the United States to implement bike boxes at intersections and elementary-school bike commuting trains. Among the city’s many bike shops is newcomer Go By Bike, which is located under the aerial tram and offers valet parking, rentals, and repairs.”

Of course there’s a downside. The Oregonian newspaper in 2011 analyzed 2010 census data and found the “whitest city” in the country– that would be, yes, Portland–became even less diverse in the last decade, while surrounding areas have grown more diverse. This is also a national trend in other major cities, where exurbs and suburbs are becoming more diverse ethnically.

The April 30, 2011, article in the Oregonian (In Portland’s heart, 2010 Census shows diversity dwindling), noted: “Of 354 census tracts in Multnomah, Washington and Clackamas counties, 40 became whiter from 2000 to 2010, according to The Oregonian’s analysis of the 2010 Census. … The city core didn’t become whiter simply because lots of white residents moved in, the data show. Nearly 10,000 people of color, mostly African Americans, also moved out.” Census data show that of the city’s 584,000 residents, 76% are white, compared to Oregon’s whopping 86% figure. Latinos are the next largest racial/ethnic group at 9.4%, followed by Asian Americans (7.1%), and African Americans (6/3%). And not everyone is living well, riding overpriced road bikes, and sipping microbrews. About one in six residents lives below the poverty line. The unemployment is slightly higher than the nation’s, though on average four in 10 residents has a college degree. One person who works in public health I talked to about job prospects in Portland told me, many PhDs were pouring beers and waiting tables while looking for professional work on the side; don’t come here without a job.

The most glaring example of the problems I saw during my two visits was the crush of humanity that was waiting at the entrance to the Multnomah County Library as it opened its door on a sunny July 3 morning. I counted about 60 persons, the majority of whom were clearly homeless or indigent. There are about 1,700 people living on Portland’s streets. Many persons I saw that morning were carrying all of their possessions in backpacks or large plastic bags. Many had not had a shower in some time. The library provided both a restroom to use and Internet access and simply a shelter. It basically resembled libraries in Seattle that serve as de facto homeless shelters during business hours.

I decided not to photograph the clear signs of economic distress I saw on the streets or at the library’s gates and focused on snapshots of the downtown features that make the city fun and livable – its downtown streetcar, the MAX light rail, beautiful open spaces, yummy food carts, a downtown farmer’s markets, bike infrastructure that made me salivate, and a vibe that keeps my teenager’s crush alive and throbbing.

Every day can be bike to (fill in the blank) day

Here in the United States, promoters of biking and various groups attempt to rally public awareness around the health, environmental, cost, and multiple other benefits of biking by having “bike to work month” and “bike to work day.” This is important, because these activities can turn the attention of a chaotic media landscape for a brief moment on the incredible versatility and value of biking.

The down side is, once the day, week, or month passes, the next worthwhile cause takes the spotlight, and the public’s attention quickly turns away from biking, and without sustained interest, meaningful policy work and political momentum fizzles. Luckily, I live in a Seattle that at least has a critical mass of cyclists and some more “advanced” infrastructure to help keep cyclists somewhat safe from the perils of sharing roads with vehicles. To Seattle’s credit, it is getting ready to update its bicycle master plan. (For anyone who is from Seattle and who has not taken the survey, please do so.) And nationally, many advocates are working hard to sustain a national movement one community at a time.

As a highlight of “bike to work day” on May 18 in Seattle, a portion of the Ballard neighborhood was closed to vehicle traffic. Bikers were able to lock their bikes to makeshift bike locks. This is a scene we seldom see in this country because too few businesses and governments support and pay for basic infrastructure to make cycling more doable — such as having secure areas to lock bikes and accommodate them. (This is not the case in every community, and cycling advocates throughout the country are working to ensure new developments accommodate bikes with the right bike racks.)

Celebrating Bike to Work Day in Seattle’s Ballard neighborhood, May 18, 2012.

I remembered my travels to Germany. Even back in the 1980s, I found hundreds of bikes locked outside, in large bike parking areas, that were used during every month of the year, including winter months. I long for the day when bike racks are common in front of every building, and every rack is occupied by a locked bike.

A sea of bikes in in Heidelberg, Germany, December 1985 — winter did not scare these cyclists, and they had a place to park their bikes.

What Denmark can teach Snohomish County and other Puget Sound areas

For my current class on management in my public health program at the University of Washington, we are examining the Snohomish County Health District’s strategic plan. Snohomish, just north of Seattle, has nearly 720,000 people. The two top killers in the county are chronic diseases (cancer and heart disease).  The county’s health profile largely mirrors the rest of the nation’s—residents are suffering from obesity and being overweight, they rely heavily on personal vehicle use to travel, and their built environment has been created mostly to facilitate personal vehicle use. (There were 449 vehicular deaths in the county from 2002-08; deaths from unintentional injuries rank as 4th leading killer in the county.)

In short, the county is premised on sprawl development, which encouraged real-estate speculation, all collapsing with a bang when the housing bubble burst in 2008. Such sprawl, subsidized by taxpayer funded infrastructure (i.e., roads to serve the automobile) and extremely cheaply priced energy (gasoline), of course is one of the major factors leading to this nation’s ever-worsening health indicators, such as a rise in type 2 diabetes and bulging waist lines.

By comparison, Denmark, where I visited for more than a month in 2000, has a robust public health system and a healthier population than the United States’, and it spends about half per capita on health care than the extremely inefficient U.S. system. The country has strict land use and planning regulations, and nationally and locally they have a heavily subsidized public transportation system that enables residents to commute to work and their homes by bike, bus, and light rail.

I lived in Riis Skov, just north of Aarhus, the country’s second largest city. Aarhus, even back in 2000, had an incredibly well-designed multi-modal transportation system that encouraged “active transportation” (biking, walking). Today, one can find free bikes in the city.  The downtown area, site of the historic cathedral and main square, by the port, was pedestrian only. Bike paths in all directions from the city were designated in blue painted paths on the streets and with bike charettes or with clear white lines. People rode their low-tech, three-speed bikes everywhere, even in the rain (many did not use bike helmets, interestingly).

Multimodal planning in Aarhus, Denmark--making it safe for bikes in the city center

Here in Seattle, where I live, we have nowhere near as safe or robust a multi-modal transportation system. There are no blue-painted bike lanes. We have bike lanes painted onto dangerous busy streets, and we lack the sophistication in planning that Aarhus had achieved years before Seattle could build a light rail. We have a lot to learn from our Danish friends. Go Aarhus, go Denmark!

Rails and trails--how residents commute to and from Aarhus, Denmark

My $85 used bike — best investment I have made in years

Here she is, my  $85, Chinese-manufactured, used mountain bike. OK, I have replaced the rear wheel, chain, and rear derailleur, but that happens with all bikes. I bought it before I began my MPH program in 2010, so I would not have to worry about my wheels being stolen (who wants an $85 bike?) while I was in class or in my apartment, where I had to lock it outside. Since its purchase, I guess we have cycled more than 4,200 miles (mainly to and from the University of Washington campus, and around Seattle). She is my testimony to the marriage of health, policy, convenience, and common sense (all very American ideas in my book). In public health, I think it is critical practitioners practice what they preach, and this is testimony to that.

More than 4,000 miles for less than the price of an iPhone

We are passed all the time on the Burke Gilman bike trail, but that is OK. I am still getting the benefits of a ride, 10 miles every weekday, when class is in session. There are simply few things in life that produce so many positive effects for such little money and with practically no environmental impacts. Here is why biking makes great sense, particularly in cities in the USA, and a few reasons why we have to do better, particularly with infrastructure and investments to make it safer.

Safety: We know that there are fewer accidents to pedestrians and bicyclists when there are safe areas for them to travel. Studies have shown that changes to our cities that make it safer to bike and walk help improve our health.

But in Seattle and elsewhere in the U.S., walking and cycling are much more dangerous, on a per-trip and per-mile basis. Compared to other countries such as Germany and Netherlands, where biking and walking are encouraged by changes in transportation designs, travel by biking and walking were six and eight times greater than the U.S., mainly because of real dangers. What’s more, in the U.S. a pedestrian is 23 times more likely to be killed than car occupants, and bikers 12 times more likely. On a per-kilometer/per-trip basis, U.S. walkers were three times more likely to get killed than German walkers, and six times more likely than Dutch pedestrians. Biking is healthy, but without infrastructure and numbers, we are greatly exposed. One reason German and Dutch cities are safer for walkers and bikers is because they provide safe and attractive corridors and crossings for them. We fail to do that in this country, even in “bike friendly” United States. We must do better, at the local and national policy levels.

Health: Biking literally makes you skinnier and it is great for your health. The U.S. Surgeon General recommends that adults engage in 30 or more minutes of physical activity a day – and barely half of all Americans engage in more than 30 minutes of exercise 5 days a week. Currently, more than a two-thirds of all Americans, according to the Centers for Disease Control and Prevention, are obese or overweight. Medical expenses associated with health issues related to obesity , according to the CDC, accounted for nearly 10 percent of total U.S. medical expenditures, totaling over $80 billion dollars annually. By contrast, in European countries, those with the highest rates of walking and cycling have much lower rates of obesity, diabetes, and hypertension. Type 2 diabetes alone is estimated to cost the U.S. $180 billion annually. In short, making it easier to bike makes health sense and fiscal sense. Including here in Seattle.

Car Trips Can Be Reduced: In the United States, more than 40 percent of all car trips were less than 2 miles, and 28 percent were less than 1 mile – and we know that biking can easily cover such distances. Americans need to get on their bikes for short trips, even in winter cities. It’s doable. Winter cities in Europe are filled with bikers. Addressing the safety barrier is a hurdle we have to overcome with designated bike corridors, to help encourage exercise levels needed to help reduce prevalence of some chronic diseases.

Two Great Reasons: New bicycle commuters can expect to lose 13 pounds their first year of bicycle commuting. [Bicycling Magazine]. If that wasn’t enough, we know that biking is cheaper than driving, a fact that make sense as we are seeing a spike in oil prices because of instability in the Mideast and North Africa.

Good Ideas: The Centers for Disease Control and Prevention has developed transportation policy proposals that could improve health. The CDC’s recommendations call for “healthy community design elements”—transportation networks, street designs, land use policies—that can mitigate adverse impacts from air and noise pollution and reduce injuries.  The proposals also call for policies that protect pedestrians and bicyclists, which in turn can have a profound positive impact on health. These include designing streets to reduce vehicle speeds and pedestrian and bike injuries and correcting hazards in infrastructure to make it safer for walkers and bicyclists.

I do not know if I will reach 5,000 miles with my cheapo bike, but think of the low-cost impact this kind of tool could have if just 1 percent of all Americans who did not own a bike found one on Craigslist, purchased it, and started to transform themselves and their neighborhoods. It is practically revolutionary as an idea, and good for the economy too.

Suggested Sources:

Pucher J, Dijkstra L. Promoting safe walking and cycling to improve public health: lessons from the Netherlands and Germany. American Journal of Public Health. 2003; 93:1509 –1516.

Making Healthy Places: Designing and Building for Health, Well-Being, and Sustainability. Eds.  Dannenberg, A., Frumkin, H., Jackson, R. Washington, DC: Island Press, 2011.

Centers for Disease Prevention and Control. CDC recommendations for improving health through transportation policy. 2010; http://www.cdc.gov/transportation/.