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Among New Yorkers with low incomes, the “Vision Zero” initiative to stem roadway crashes resulted in a marked, 30% reduction in traffic injuries of varying severity from early 2014—when the city government launched the program—until 2019, according to a new study conducted at New York University.

The study, published in the American Journal of Public Health, revealed this trend of improved safety by comparing Medicaid-covered injury treatments during Vision Zero’s first five years with those of Medicaid enrollees in neighboring jurisdictions on Long Island and in the Hudson Valley, where systematic traffic-calming was not then in place.

In addition to preserving people’s life and limbs, the program also realized financial benefits, with the federal and state governments saving $90.8 million on Medicaid reimbursement to health care providers, according to the study at NYU’s Robert F. Wagner Graduate School of Public Service by Kacie Dragan, now finishing her Ph.D. at Harvard, and Sherry Glied, Wagner school dean and professor of public service.

The largest reductions in injuries between 2014–2019 were seen among Black New Yorkers. Numerous other studies have seen persistent national disparities in traffic-related injuries by income and race, noting that Blacks and other people of color are most likely to live in high-crash area, and that long-standing roadway dangers tend to be more common and injuries more elevated in low-income urban neighborhoods.

The new study found that low-income New Yorkers suffered sharply reduced injuries across crashes involving cars, bicycles, motorcycles, and pedestrians but that the improvement evaporated during the COVID pandemic of 2020–21, possibly in part because traffic enforcement and ticket-writing fell during the health crisis.

Glied is a health economist, while Dragan is finishing a Ph.D. at Harvard. She was previously a staff researcher in the Robert Wood Johnson Foundation Policies For Action (P4A) research hub at Wagner and continues to collaborate on P4A projects.

The study measured traffic injury levels in “person-years,” meaning the total years for which individuals contributed data (someone whose Medicaid claims data were tracked for seven years of the study, for example, would represent a like number of person-years).

In all, there were 77.5 fewer injuries per 100,000 person-years annually in New York City from 2014–2019 under Vision Zero than would have been expected based on the rates of injury experienced in surrounding counties with no Vision Zero programs. The reduction comes out to about 30% overall, lasting until the pandemic struck.

Looking at individual-level patient data in Medicaid—the federal program established in 1965 that provides free health insurance for low income adults and children—the researchers compared road injuries in New York City’s five counties with Medicaid-covered treatment for injuries and care of residents in six surrounding counties. The counties were Nassau, Suffolk, Westchester, Putnam, Orange, and Rockland.

The Medicaid treatment measured was for both immediate (and requiring emergency treatment) and long-term care of Medicaid enrollees, as reflected in New York State Medicaid reimbursement claims and other data.

Since Vision Zero was rolled out in the New York City administration of then-Mayor Bill De Blasio—modeled after a program begun in Sweden—dozens of small and large U.S. cities have launched their Vision Zero plans, including Boston, Los Angeles, and Seattle. In New York, there are indications its gains in public safety may be picking up again.

Recently, Gov. Kathy Hochul signed laws making it easier for localities in New York State to lower speed limits and increase fines for hit-and-runs. And NYC recently committed to increasing traffic enforcement to pre-pandemic levels—”suggesting the potential for NYC to realize gains from Vision Zero once more,” the study authors wrote.

“Although NYC and other cities continue to face challenges in reaching the goal of zero fatalities, our finding that Vision Zero policy bent an otherwise upward trend in injuries supports the idea that comprehensive traffic reform can make a meaningful dent in injury incidence,” Dragan and Glied stated.

by New York University