for Prevention

Vision Zero: Preventing Traffic Deaths -The Critical Role of Clinicians

July 2019

Chandini Singh, MA

Kimberly Porter, PhD, MPH

Jean Armbruster, MA

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Traffic collisions are a leading cause of death for both adults and children in Los Angeles County. Pedestrians and older adults are at greater risk of death and severe injury in the event of a high-speed traffic collision. In addition to the human costs, there are significant financial impacts, with medical costs of traffic collisions involving pedestrians and/or bicyclists in LA County estimated at approximately $63.4 million in 2014 alone.1

Clinicians have an opportunity to support Vision Zero, a multidisciplinary effort to end traffic fatalities in LA County. This article describes concrete actions clinicians can take including: engaging patients in conversations about practicing safe transportation behaviors, sharing their first-hand experiences about victims of traffic collisions to promote culture change, advocating for local policy changes, and encouraging their patients to get involved with local advocacy efforts.

The Impact of Traffic Collisions in Los Angeles County

Between 2011 and 2017, an estimated 4,699 people died in traffic collisions in LA County.2 Countywide, motor vehicle collisions are the leading cause of death for children aged 5 through 14 years and the third leading cause of premature death overall.3

Traffic deaths are on the rise.

Locally and nationally, traffic deaths have increased significantly. From 2011 to 2017, traffic-related fatalities increased by an estimated 38% in LA County.2 During this time period, the number of fatalities on U.S. roadways increased by 14%.4

Figure 1: Los Angeles County Traffic-Related Fatalities (2011 - 2017)2

LA County Traffic-Related Fatalities

* 2016 and 2017 data are provisional and will not be finalized until the California Highway Patrol announces the Statewide Integrated Traffic Records System (SWITRS) annual report for those years.

Source: Transportation Injury Mapping System (TIMS), Safe Transportation Research and Education Center, University of California, Berkeley. 2019.


Pedestrians are greatly impacted.

Pedestrians are some of the most vulnerable users of the roadway. Research shows that in a pedestrian-motor vehicle traffic crash, death, and severe injury are more likely at higher vehicle speeds.


Figure 2: Why Speed Matters, When Hit at Higher Speeds Pedestrians
are Much Less Likely to Survive a Collision5

Figure: Why Speed Matters - When Hit at Higher Speeds Pedestrians are Much Less Likely to Survive a Collision

Source: AAA Foundation for Traffic Safety, Impact Speed and a Pedestrian’s Risk of Severe Injury or Death. 2011.
Graphic Credit: Nelson\Nygaard.


In 2016, LA County had more pedestrian fatalities than any other county in the U.S.6 The Los Angeles County Department of Public Health (LAC DPH) analyzed data for victims of pedestrian-motor vehicle traffic collisions treated at LA County trauma centers from 2013 to 2014. Findings revealed that:7

  • Vehicle speed matters greatly in injury outcomes. 9% of pedestrians hit at less than 20 miles per hour (mph) suffered severe or critical injuries, compared to 26% of pedestrians hit at 20 mph or greater.
  • People die even when hit at low vehicle speeds. 2% of pedestrian victims hit at less than 20 mph died, compared to 8% of pedestrian victims hit at 20 mph or greater.
  • Older adults are more likely to die of their injuries. 14% of pedestrian victims aged 65 years or older died of their injuries, compared to 2% of pedestrian victims under 18 years of age who died of their injuries.

The economic impacts, including medical costs, of traffic collisions are significant.

Motor vehicle traffic crashes result in devastating health outcomes and significant economic costs. In 2010, the economic costs of motor vehicle traffic crashes totaled $242 billion for the U.S., with $23.4 billion related to medical costs.8 In LA County in 2014, the direct costs of medical care alone for pedestrian victims was $51.5 million and for bicyclist victims was $11.9 million.1


Eliminating Traffic Deaths through a “Vision Zero” Approach

Vision Zero, first adopted in Sweden, is an international traffic safety movement committed to the systematic elimination of traffic deaths and severe injuries for all roadway users.9 Cities around the world are seeing dramatic improvements in street safety through Vision Zero initiatives. For example, since Vision Zero launched in 2014 in New York City, traffic fatalities declined 29% overall and pedestrian fatalities declined 45%.10

The Vision Zero Los Angeles County initiative aims to eliminate traffic fatalities in unincorporated LA County by 2035 and Vision Zero Los Angeles aims to do so in the city of Los Angeles by 2025. Achieving these goals will require an extensive prevention effort that includes strategies that address the root causes of fatal and severe injury crashes, reallocation of resources, multi-disciplinary collaboration, and data driven decision-making. Local community, medical, and public health stakeholders are working to identify local traffic safety concerns; raise awareness; and identify street safety enhancements, such as high visibility crosswalks, bike lanes, and traffic calming interventions such as curb extensions and traffic circles.

The Role of Clinicians in Ending Traffic Fatalities

Achieving zero traffic fatalities through the Vision Zero approach requires broad culture, behavior, policy, and environmental change. Clinicians have an opportunity to be leaders in traffic fatality prevention by engaging patients in conversation about safe behaviors and acting as advocates for Vision Zero. Consider the following actions in your practice, institution, and local community.

  • Build patient awareness of traffic safety by sharing information on safe transportation behaviors, especially with parents and children. Resources that clinicians can use to encourage safer driving, bicycling, and walking are available in the ‘Counseling Points and Patient Education Materials’ section. They include tips for patients to: consider their abilities before driving or riding, avoid distractions, slow down, be sober, and give bicyclists at least 3 feet of clearance while driving.
  • Connect victims of traffic crashes and/or their family members with support services, if interested. For instance, local organizations such as the Southern California chapter of Families for Safe Streets or Streets Are For Everyone (SAFE) can provide a community of support and opportunity for your patients to channel their experiences into advocacy for safer streets.
  • Share your stories with neighbors, friends, and the community. Your stories about the victims of traffic collisions can elevate the priority of traffic safety and help create the culture change necessary to implement traffic safety improvements and policy changes. These experiences can be especially influential because achieving zero traffic-related fatalities may require tradeoffs. For example, slowing vehicle speeds on certain streets may be at odds with goals for faster commute times, but is an important intervention to prevent traffic fatalities and severe injuries.
  • Advocate for institutional and policy changes. Work with facility administrators to ensure safe walking and biking conditions at your own worksite. You can also use your influence as a clinician to support local initiatives, such as Vision Zero, that reduce the potential for fatal and severe injury collisions, and to promote policies that prioritize safety (e.g., bike and pedestrian plans and complete streets policies). Encourage decision-makers by signing a letter of support, authoring an op-ed piece, sharing concerns about traffic safety at community meetings, and testifying at planning commission or city council meetings. Contact the LAC DPH Vision Zero Project to learn about local advocacy opportunities for clinicians and others.



Opportunities to Support Vision Zero in Los Angeles County

Counseling Points and Patient Education Materials

Available on the Los Angeles County Department of Public Health PLACE Program Website:

Data and Reports

Further Reading

County of Los Angeles Vision Zero Initiative:

City of Los Angeles Vision Zero Initiative:

Vision Zero Network:

Families for Safe Streets:

Streets Are For Everyone (SAFE):



  1. Porter K, Singh C, Sternfeld I, Basurto-Davila R, Armbruster J. Los Angeles County Department of Public Health, Division of Chronic Disease and Injury Prevention, PLACE Program. Direct Costs of Medical Care for Pedestrians and Bicyclists Hit by a Vehicle in Los Angeles County Issue Brief. October 2018. Accessed May 2019.
  2. Transportation Injury Mapping System (TIMS): Los Angeles County, 2011 – 2017. Berkeley, CA: Safe Transportation Research and Education Center, University of California, Berkeley. Accessed March 8, 2019.
  3. Los Angeles County Department of Public Health. Mortality in Los Angeles County 2013: Leading Causes of Death and Premature Death with Trends for 2004-2013. Published October 2016. Accessed December 13, 2018.
  4. Roadway Safety Data Dashboard. Washington, DC: U.S. Department of Transportation, Federal Highway Administration. Accessed March 8, 2019.
  5. Los Angeles County. Vision Zero Los Angeles County: A Plan for Safer Streets 2019 – 2024 DRAFT, February 2019. Accessed June 17, 2019.
  6. Retting R. Pedestrian Traffic Fatalities by State: 2017 Preliminary Data. Governors Highway Safety Association. Published February 28, 2018. Accessed December 13, 2018.
  7. Porter K, Singh C, Armbruster J. Pedestrians in Motor Vehicle Crashes: How Do They Fare in Los Angeles County? Los Angeles County Department of Public Health, Division of Chronic Disease and Injury Prevention, PLACE Program Issue Brief. October 2018.
  8. Blincoe LJ, Miller TR, Zaloshnja E, Lawrence BA. National Highway Traffic Safety Administration. The economic and societal impact of motor vehicle crashes, 2010 (Revised). Published May 2014. Updated May 2015. Accessed December 13, 2018.
  9. What is Vision Zero? Vision Zero Network Web Site. Accessed October 19, 2018.
  10. City of New York. Vision Zero Year Four Report. Published March 2018. Accessed October 10, 2018.

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Author Information:

Chandini Singh, MA
Urban Planning, Senior Policy Strategist

Kimberly Porter, PhD, MPH*
Senior Research Analyst

Jean Armbruster, MA

PLACE Program
County of Los Angeles
Department of Public Health

*Dr. Porter is now with the American Academy of Orthopaedic Surgeons, Rosemont, IL.

Rx for Prevention, 2019

Published: July 11, 2019
(Revised July 16, 2019)