budgetary crisis, there are actually low-cost solutions that would save money and lives. one ofone of the directives thae out a year ago was to a 1915- mile per hour is known in all of our schools. one year later, all of our school zones had the speed limit. how much to bring the department to together to talk about the plenitude of research that has already been done, action plans that have already been written up. in some ways, it makes the issue easier for us because we are not asking more studies, but we are just gonna see what we can do. it is not a gotcha session, but you want to see what work has been done, but the bears have been to implementing the action plan already proposed and what we can do to further the process and work together to make that happen. the first presentation we have today will be with the department of public health.

supervisor mirkarimi: welcome. you are not on the microphone. madam clerk, should he go to the other microphone? >> hearing go. we appreciate you holding this hearing. what i will try to do in this presentation, which i shared with you, first of all, quickly state what our roles are in this process. it is definitely an issue that requires many agencies working

together with you, the legislature. second, i am going to provide some of the key data on causes of what we already know in san francisco. i think this will highlight some of the reasons we see high rates of collisions and fatalities in the central city areas. and also explain why we see higher rates in other areas, for example, district 1. then i will talk a little bit about the programmatic work we are doing, closing with a few comments on some of the obstacles, cultural and policy obstacle that we need to attend to to implement these largely known effective solutions in this country. meghan weir and anna will be joining me to talk about the programmatic peace. it is important to say that this is not just a san francisco issue. we have a fairly horrendous performance of our

transportation system in the country with regard to safety. 33,000 deaths last year, 2.2 million injuries, 200,000 hospitalizations, including 400 pedestrian deaths. $230 million a year in cost. our role in san francisco as the health department's is several. one is the promotion of knowledge, attitudes, behavior is for drivers and pedestrians and bicyclists. the collection and integration of pedestrian safety data. the analysis and cost and consequences of a fatality. environmental assessment of causes. leadership and participation in interagency planning. sharing data to make the data drive the solutions and where investments are made. finally, care of the injured and

disabled pedestrians. as we heard, we have about 800 police-reported injury collisions a year, about 100 people killed or seriously injured, 25 deaths per year. this is five times the rate of injury -- this is five times the established public health goals. it is important to note, these are police-reported estimates, and these are under estimates of the true number. we did a study a few years ago and found 22% of the serious injuries that came to san francisco general hospital were not included. probably the rate of under reporting of non serious injuries is higher than that. so this 800 per year is probably under the total number of injuries. that is important to keep in mind. i would say san francisco streets are more dangerous, yet,

walking is more dangerous than driving in san francisco. the way the streets have been designed in every other city is quite the same, with the same standards. what we have in san francisco is a lot of cars and a lot of people sharing the same space. that is one of the fundamental causes. what is notable is drivers are quite a bit safer in san francisco than the rest of the country, while walkers, it is equally dangerous or more dangerous than the rest of the country. the urban areas, speeds are slower, so everyone is safer. also important, the risk of dying from walking is four times that of driving in san francisco. that should be intolerable for a city that wants to promote walking. the causes of vehicle pedestrian collisions are very well established through international research. they are environmental, they relate to the ability of people,

and reaction to behavior's. where you have more traffic flow, more people flow and higher vehicle speeds, there are going to be more collisions. the vehicle type plays a role, safe design and crosswalk treatments, also play an important role. physical ability also plays a physique -- a role. the reason we see higher rates in the young and elderly is there are differences in physical ability and perception. young people cannot tell if cars are speeding, for example, while elderly walker's can walk only as fast as they are -- walkers can walk only as fast as they physically can. cell phone use carries a four times risk of accidents while driving. regardless of whether handsfree or with. what is also important is, given that we know all of these

factors, we are not investigating these factors when we do routine accident investigations. women do routine accident investigations, we are only looking at behavioral factors, whether the pedestrian or motorists violated a rule. the factors such as the number of cars, number of people, speed of cars, ability of the victim is simply not recorded, and therefore not taken into account or an ally in our process. if we are not analyzing one of the causes of the problem, we are not likely to identify it as part of the problem and not likely to focus resources on the solution. as many of the, enters notice, the injuries are highly concentrated in certain neighborhoods, and this is one way to look at it. 50% of the injuries occur in 20% of the census tracts. that is a high degree of

overconcentration, these dark blue census tracks, showing where the highest number are. soma, downtown civic center, along the geary corridor, mission corridor, 19th. supervisor mirkarimi: some of the point you are making are stimulating some questions and queries. supervisor campos: just a quick question. in terms of why the environmental factors are not reported -- are not recorded, actually, in the report? >> there is a point about the cultural responsibility about pedestrian safety. historically, we have seen that we have not identified the environment as a cause of traffic fatality. we said, here is the system. we have designed it for moving cars faster which creates a risk

for pedestrians, but what we have not identified is speed and that traffic flow is a cause of a hazard. it is either the pedestrian making a mistake or bad behavior, or the driver making a mistake or bad behavior. so culturally, we have not seen this as an environmental problem, as we should. so with all of these factors, it is very important we not look at one factor in isolation. is it just crosswalks, speed, flow, bad behavior? unfortunately, a lot of the ways research looks at this is one factor at a time. the federal highway has a best practice of analyzing collisions, looking a multiple factors using a regression model to see what the independent effect of each factor was. that is the approach we have tried to take at the department of public health, so we can simultaneously look at the population factors, street

design, and countermeasures. we have done preliminary research and that has helped us prioritize what the risk factors are in san francisco, and also help us evaluate differently the effect of different solutions. for example, this was work we did in 2007, published in 2009. we looked at several factors and said what explains the difference of collision rates -- frequencies in different neighborhoods? we looked at many different variables. we found their ranges of collision frequency is quite wide, from 20 per 100,000 in some neighborhoods, to 500 per 100,000 in others. 20% of the variation between census tract collisions can be explained by differences in traffic volume. 13% in differences of the employee population. 10% by never commercial zoning.

10% are cheerless streets. 9% by residential population differences. 7% by residential neighborhood commercial zoning. 7% by land area. 5% by poverty. 5% by age. so traffic volume and population factors are the dominant root causes. we are not proposing to reduce the population. i think the modifiable thing here is we can reduce flow, do things that reduce the flow of traffic where people are. for soma, the implications of this, they are obvious. this is the city's -- these are the major thoroughfares through the city. soma is basically deliver the cars to and from the city from the freeway. i think to a lesser extent, many of the streets in the central downtown area are doing the

same. these are the highest volume streets. it is no surprise we see the most collisions between pedestrians and cars on these streets. these are densely populated areas, areas where some of the most of all rural populations live. so this is not a surprise. i am going to switch from the causes of fatalities and serious injuries are different from the causes themselves. while the number of people and cars explain why a collision happened, the causes of why and injury is severe, why people die and are disabled it is much simpler. the causes of disability and severe injury or the mass of the vehicle, speed, and the physical capacity of the individual to the door of the injury. there is nothing else. -- absorb the injury.

we can see in concentrated downtown areas, a clear pattern of arterial streets where there is high volume and high speed traffic. serious injury will not happen at low speeds. speeds affect both collisions and and, as well, a fax how soon you can see a pedestrian, a patrol of the vehicle. a one filed by our change in speed can result in a 5 mile per hour change in the number of collisions. this has been shown through international research. in san francisco, and this is important. 25 mile for our streets, 60% of people were speeding. culturally, many people would say that 26 miles per hour is not speeding.

56% of the people are going over the speed limit. every speed limit, a substantial portion are going over. that every speed limit, a substantial number are going 5 miles per hour above the limit. this is one of the causes of what people are dying in san francisco. i think this is a well-known fact, that the risk of pedestrian fatality is six times that at 30 miles per hour than at 20 miles per hour. many people do not think that 30 miles per hour is a dangerous speed, certainly not for the driver, but it is for a pedestrian. from a policy standpoint, it is important to note there are statewide and countrywide legislative obstacles to reducing speed. we are told on certain streets speed must be set at the high end of the speed range. this is state law.

there is no exemption for infill development or dense urban areas. this is something that might be considered. automated speed enforcement is a highly effective practice that is free, basically, to enforce the speed. this is a practice that is prohibited under california state law. we have known practices where within state law says we can do right now of. the current san francisco department of health focuses areas in pedestrian safety. i think this is where our strength is, coordinating and improving injury data collection and analysis. we want a full accounting of the injury. we are working on getting the data sources, hospitals, ambulances, police records, and merging them together. we believe environmental factors should be assessed for every injury. we will be working with task force to figure out how to do that. we think the data should target

investment, and we will be working with the task force to do that as well. we will the best practices and safety countermeasures' integrated in development plans. if we are tearing up the street or building and development, let's build it right in the first place. we want to continue to support safe routes to school and more funding. there is a lot of money going to transportation at every level. i think we have to think that what the balance our resources are going to be, directed within that i, too transportation safety. i'm going to turn over quickly, and then i will come back to talk about some final obstacles. >> good morning, supervisors. i will tell you about some of the programs we are leading a

health department. the first one is walker first. this is because of a grin that we got from the office of traffic safety. right now, the city does not have a systematic way of figuring out what are some of the key straits for walking and how to prioritize limited funding for capital improvements. so this is an interagency grant. dph is the lead but we are working with mta and the planning department, county transportation authority, and we have several objectives. we want to develop a city-wide map of where the ski zones are for pedestrians, establish a methodology for prioritizing capital improvements for pedestrians, developing some case studies and getting a very preliminary capital project, which i will admit, when we wrote this, or ambitious and

were a little naive and thought we could do all of this work in one year. mta just submitted two grant of occasions -- applications to do technical work and comprehensive coverage to pick up the project in the next coming here. so that is one of our efforts. the next one is safe routes to school. i believe you have probably heard about this. this is an international movement program to increase both safe and active walking and biking to and from school. 20 years ago we had almost half of our children walking and biking to school, now less than 15%. we are interested in making sure to bring those numbers back up because there are a lot of public health benefits to walking and biking, not only by increasing traffic safety, but physical activity, air quality

related to congestion, and this is a multi-partner effort. we have the police department, and mta, environment, the bike coalition, others very involved. we are currently working in 15 schools. they are only elementary schools at the unified school district. we made the application process open to every elementary school in the city. the district 6 school -- the only one that received an application was from marshall. we hope to work with them in the future. i will turn it over to meghan. >> hello, i have worked with the department of public health as an epidemiologist. in addition to supporting the data that are shared earlier, i wanted to share some of the work we had done.

as an appointed member of the western soma citizen task force, we have been participating since 2007 and providing health- based data and evidence in support of the planning efforts which included pedestrian safety recommendations for the plan. some of those recommendations to our traffic calming in the area, particularly, near residences, including crossings. we heard a lot of public need for that in earlier testimony. reductions in lanes. considering the new residences that are going in that area, thinking more thoughtfully about which streets are the designated truck routes. improving alleyways, a real opportunity for safe pedestrian networks and just better pedestrian-oriented design in the market district.

>> as she mentioned, on december 20, mayor gavin newsom issued an executive directive on pedestrian safety. this was a fairly bold action and establishes, i think we have the first and only city-wide goal for the mayor production of serious and fatal injuries in this state. i think it is surprising and telling them we never had one of these goals before. we have had goals for homicide reduction, other issues, but never a pedestrian injury reduction. he asked us to come together to implement immediate short- term actions, as well as what is really needed, a long-term plan, one that is adequately resources, and addresses of the legislative and other cultural

barriers. we are honored to be cochairing that task force with the mta. i do feel there is a lot of good energy and faith in that task force, and we will come together to come up with a serious plan. we will need everyone's help in moving that forward. i think, as you will also hear from the mta, there are many known, proven strategies. in europe, they have been successful in reducing injuries by 50% by doing this. there is no reason we cannot do it either. there are some serious cultural barriers to these improvements, not only in san francisco, but it is an opportunity for us to lead in showing the way to what a sustainable city looks like. i want to highlight one best practice in dealing with these

barriers. safety is viewed as an individual responsibility. in my view, walking is an essential, natural human activity. and walking should be safe, know where art -- no matter where you are. unfortunately, we have to keep people safe. if we read a newspaper and the blog accounts, comments in the newspaper, it was, who was stupider? that is that the attitude that is going to get as to the solution. there is an accounting for the ability of walkers and children in this paradigms'. we allow mistakes to have fatal consequences. there is no other situation where a child not making -- making a simple mistake could die by not seeing the car. we have laws and policies like the 85% rule, a ban on

automated speed enforcement that creates barriers to speed enforcement. these are things that we really need to get around. in europe, starting in sweden, they implemented a best practices and cultural change, division movement. this was a cultural change practice, not a particular engineer strategy. they said ultimately the system designers and owners, and i think what is hard here is -- we as a city are the system designers. ultimately, we bear the responsibility for the transportation. but the system should be designed to prevent levels of violence intolerable to the human body. in my view, i do not think the goal should be preventing cars and bicycles and people from bumping into each other. we should make it so that when those bonds happen, that nobody loses a life or is disabled. system designers should account

for the expected behaviors and abilities of road users. these are some principles that could shake the system and enable the changes and strategies that are already available to us. we are very happy to work with you on this. we will make the materials available to you and this presentation on the website. happy to share our e-mail with anybody as well. thank you for your time. [applause] supervisor mirkarimi: thank you. supervisor kim, who would you like to bring up next? supervisor kim: next we have the ucf injury center.

>> good afternoon, everybody. i am a research fellow at san francisco general hospital. i wanted to begin by thanking the committee, chair, and supervisor kim for allowing us to discuss our work. as supervisor kim highlighted some of the important dimension to this problem, part of the problem is cost. there is clearly a human dimension to this problem but there is also cost and budget constraints that have to be dealt with. we feel we have a unique perspective to share on how we might find agreement on that matter. just to explain more of who we are, i work for the san

francisco injury center, one of 13 nationally-funded cdc's centers. we are housed at san francisco general hospital. we have a diverse professional staff and a full focus on research, prevention, policy, and education. san francisco general hospital, if you will permit some informality, at a deer second home to me. we are also a trauma center. we get about 90% of injured patients in this city regardless of their ability to pay. we see about 100,000 people a year. given that this is the only trauma center in this city, this is a unique opportunity to study pedestrian injuries. to echo the doctor and

department of public health, the scope of the problem is very wide. during 2008, in san francisco, 92 injuries for every 100,000 people. we had had previous work done through collaborations with other groups. we mentioned to the injury center. 650 to 750 pedestrian injuries are seen at the san francisco general hospital every year. so i would like to go through the day of an injured pedestrian. not to put a price tag, but to highlight the cost to mention to compound the human injury in this matter. they are involved in a collision with a vehicle. then in ambulance is sent to the scene. this carries a price tag of

$1,200 for transport. the third thing in the series is the patient is taken 2 san francisco general hospital, if the accident occurs within the city. visits to the emergency room cost about $6,400. the patient is then treated or well enough to go home the same day or is further admitted for more care. if they are admitted, the average for that is about $72,000. so a great deal of this cost is incurred during a mission in the hospital. we used our hospital diagnostic codes to identify patients who came in with pedestrian injuries related to automobiles. particularly, for residents of san francisco, excluding a small number of intentional injuries. this is just about 3600 cases in the years that we look at data. and there is a large cost difference between patientsha