Pedestrian and bicyclist deaths are up in North Carolina, and public health advocates are calling for change
By Vibhav Nandagiri
Steven Hardy-Braz rode more than 11,000 miles in the first 11 months of 2021. An avid road cyclist from Farmville, he took every precaution — reflective clothing, bright lights, mirrors. He also had a camera mounted on the back of his bike.
On Nov. 21 of that year, as Hardy-Braz biked down the two-lane U.S. 264 Alternate just outside of Greenville, his camera captured the moment a gray Toyota Corolla, going about 60 miles per hour, ran into his bicycle. He flipped over the car, landing in the grass embankment off the side of the road.
“Everything in my life has changed,” Hardy-Braz told NC Health News.
***DISTURBING VIDEO*** The rear view camera on Steven Hardy-Braz’s bicycle captured the moment he was hit from behind.
Hardy-Braz now uses a wheelchair. Although he can walk, putting weight on his right leg makes him want to scream. “Some days … I can function somewhat [like] half a person, and other days I can’t leave home.”
After multiple surgeries, physical therapy and talking to “about two dozen doctors,” per Hardy-Braz’s recollection, he’s shifted his goals from recovery to managing his injuries.
“I may not ever regain full function,” he said.
A staunch advocate for pedestrian and bike safety, Hardy-Braz knows things could have turned out differently. North Carolina’s roads are becoming an increasingly dangerous place for people who aren’t in motor vehicles. In 2022, 269 pedestrians and 20 bicyclists died on North Carolina roads. From 2018 to 2022, the state experienced a nearly 20 percent increase in the number of pedestrians killed. Of 1,784 deaths on roadways in North Carolina in 2022, 289 — or 16.2 percent — were pedestrian or bicyclist fatalities.
There are similar trends at the national level. From 2010 to 2021, the U.S. experienced a 77 percent increase in pedestrian deaths, according to a report by the Governors Highway Safety Association. This same report cited 2022 as the deadliest year for pedestrians on U.S. roadways since 1981. While preliminary national data from 2023 points toward a dip in pedestrian fatalities, these numbers far exceed those from just a decade ago.
In response to these trends, many across the state are looking for innovative approaches to pedestrian and bike safety. Public health advocates, in particular, have been at the forefront of a broad coalition of university researchers, government agencies and nonprofit advocacy groups working to improve safety for the most vulnerable on roads.
“We’ve seen a resurgence … for the need to draw upon public health approaches to attack the public health crisis that is happening on our roads,” said Nancy Pullen-Seufert, senior research associate at the Highway Safety Research Center at UNC Chapel Hill.
Pullen-Seufert believes changes to the transportation system can be made more robust by incorporating public health methodologies.
“I think the bringing together of public health and transportation is vital,” she added.
The path to zero
There are many reasons for the increase in crash fatalities: Wider roads (especially in suburbs), more distractions and larger cars have contributed to the high rates, but they are certainly not the only reasons.
A report by Smart Growth America found metro areas in the South and Sun Belt to be driving a large portion of the increase in pedestrian fatalities. Meanwhile, a New York Times article published last year found dangers for pedestrians to be especially pronounced in poorer suburban areas, many of them in the South. Communities of color are disproportionately represented in pedestrian crashes and deaths.
Designing a more equitable transportation system is a key goal of public health researchers.
“The deaths that we see on our roads are preventable,” Pullen-Seufert said.
The highway safety center at UNC works on a variety of projects in and out of the state. A large portion of their work relates to bike and pedestrian safety, which they tackle from a number of perspectives.
“Public health actually has a lot of different frameworks and approaches that have been applied to, for example, occupational safety, that could be applied to transportation,” said Elyse Keefe, road safety project coordinator at the UNC Injury Prevention Research Center.
Keefe’s primary role at the center is to coordinate the NC Vision Zero network. Vision Zero, an approach to road safety with a goal of achieving zero deaths within the transportation system, was started in Sweden during the 1990s; it has since been adopted by states across the United States.
At the annual NC Vision Zero Leadership Institute (June 3-4, 2024), traffic experts and safety advocates from across the state present on successful quick build projects from the previous year. Credit: Vibhav Nandagiri
As of 2023, 21 North Carolina communities were taking part in Vision Zero initiatives. These initiatives have already brought about several small-scale infrastructure changes, avoiding costly and lengthy approval processes for larger transportation projects. These “quick build” projects — such as setting up high-visibility pedestrian crosswalks, painting bike lanes, giving pedestrians a head start at crowded intersections and building neighborhood traffic circles — serve as low-cost traffic interventions that improve safety for all road users.
Vision Zero’s methodologies were recently found to have led to significant public health improvements in New York City. Research published in the American Journal of Public Health in May 2024 found that, from 2014 to 2019, the city’s Vision Zero policies resulted in a 30 percent reduction in pedestrian injuries and a 26 percent decrease in fatalities.
The researchers then examined Medicaid claims data up to a year after someone had a crash and found Medicaid savings of more than $90 million, or $4.34 per enrollee per year, across the five-year period. These savings, according to the researchers, may have come from the reductions in severe injuries and hospitalizations after the city implemented Vision Zero reforms.
Government buy-in
Proponents of Vision Zero acknowledge and accept that accidents will happen on roadways even when people have the best intentions. What they are working toward is designing safer systems that limit the severity of injuries and deaths.
Mark Ezzell, director of the North Carolina Governor’s Highway Safety Program, described this approach as a “paradigm shift.”
The highway safety program runs through the state Department of Transportation and provides funding and technical assistance for North Carolina’s Vision Zero network.
For Ezzell, the work is personal. In 1991, his father, then a state senator, died in a single-vehicle car crash. That year, the younger Ezzell became involved with the highway safety program in a temporary role for three years. More than two decades later, in 2017, he returned to the program, this time as the director appointed by Gov. Roy Cooper. In between these stints, he worked on other public health initiatives, including substance use prevention and tobacco cessation efforts.
It‘s this “public health approach” that Ezzell says motivates him to make the state’s roadways safer.
“If you think about traffic safety, it’s a lot more than just transportation,” he said.
According to Ezzell, in the past, the Governor’s Highway Safety Program has focused many of its funding efforts on changing driving behavior through partnerships with law enforcement, such as the Click It or Ticket and Booze It & Lose It campaigns.
“For a long time, the field of transportation and road safety was going down this path of thinking about individual-level behavior change,” UNC’s Pullen-Seufert said.
Ezzell sees value in this type of behavioral change, but he recognizes the need for other approaches. “We’ve continued to fund a great deal of law enforcement efforts, but we’ve also expanded,” he said.
A look at the program’s grant funding reflects this wider project scope. In 2024, the Governor’s Highway Safety Program funded 108 grants totaling almost $20 million — $6.7 million of which was directed to police departments or sheriff’s offices. Meanwhile, $13.1 million went to other organizations, including university research centers — mostly at UNC’s Highway Safety Research Center and N.C. State’s Institute for Transportation Research & Education — and government offices.
Some of the grants given out by the Governor’s Highway Safety Program in 2024
$88,500 to Carolinas Medical Center in Charlotte for a social worker to direct drivers with road-based injuries to safe driving interventions and/or substance use disorder treatment centers.
$211,825 to the UNC Highway Safety Research Center to understand how using EMS and emergency room data can inform traffic safety decisions.
$130,112 to the Robeson County DA’s office to fund their DWI treatment court, which offers more wraparound services for people with substance use disorders and has been found to reduce repeat offenses.
Research needs
Integrating public health and transportation safety methods is still relatively new. In 2019, the National Cooperative Highway Research Program, led by UNC researchers, published a road map highlighting “highly relevant research needs at the intersection of transportation and public health.”
One of these needs, the researchers said, is to get more accurate crash data.
Keefe of the UNC Injury Prevention Research Center said the current reporting system “misses so many crashes” and “especially misses bike and pedestrian crashes.” A 2018 study by University of California-Berkeley researchers cited how crash reports filed by law enforcement officers do not capture the true number of crashes involving pedestrians and bicyclists and also underreport injury severity.
Health systems, many researchers say, ought to play a role in data collection. Obtaining more detailed injury information from EMS and hospital emergency rooms would allow people to “understand the full scope and burden” of traffic incidents, Keefe said. Research conducted by UNC and the state Department of Health and Human Services, using data from 2018, concluded that “Linking crash data and emergency department data provides a more realistic estimate of the burden of motor vehicle crash injury on our community.”
Ultimately, what’s driving researchers, planners and advocates is the hope that streets can be safer for people to work, live and play. Access to safe walking and biking paths improves people’s health, not only by increasing physical activity and reducing pollution from vehicles, but also by fostering a sense of community.
“How do we help community members — whether we’re talking about children or adults — feel more connected to other people and to their community?” Pullen-Seufert said.
Such safe interconnectivity can go a long way toward combating the mental health crisis and loneliness epidemic, she added.
“It goes back to centering people.”
Since his crash, Hardy-Braz has immersed himself in trying to improve conditions for vulnerable road users, from his work at state advocacy organizations to attending Vision Zero training sessions. “Now, I’m also advocating for myself,” he said.
He also recognizes the historical legacy of this work in this state.
For much of the past century, North Carolina had a reputation as the “Good Roads State” due to a successful campaign to pave the muddied and disconnected dirt roads between towns and cities. In 1977, North Carolina also was the first state to establish a state-level citizens’ committee for bicyclists. Now Hardy-Braz is campaigning for the state to regain its reputation for being a leader in road safety, especially for pedestrians and bicyclists.
“We led the country for a long time,” Hardy-Braz said. “And now, I think we’re among the worst.”
The post Pedestrian and bicyclist deaths are up in North Carolina, and public health advocates are calling for change appeared first on North Carolina Health News.
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