Systems approaches to integrated health and injury control: guiding principles and practical applications for community engagement
Since 2009, pedestrian fatalities, both in number and in rate, have been increasing after years of declining numbers. Across disciplines, many explanations that cite many causal factors have been named as the reason for this recent increase. We sought to explore these multiple explanations, recognizing the complexity of the system that has led to the rise in pedestrian fatalities while also using a systems approach to identify other factors that need further exploration to understand better this issue.

Through a series of systems mapping workshops, we gathered stakeholders across multiple disciplines to collaborate on identifying the variables and their relationships at the root of the rise in pedestrian fatalities. In each workshop, participants learned the basics of systems mapping and story-telling through an example. They then created individual and group maps or models explaining the interrelationships between health, physical activity, injury, roadway design, and other issues. Through these models we identified key variables to inform hypotheses for further research. These included theories related to the feedback loops (or virtuous or vicious cycles) in place in transportation systems that are accelerating or balancing the forces that influence pedestrian safety, comfort, equity, and other outcomes.

The participants in each workshop represented a range of disciplines and professional experience. As a result, the components of the system map represented influences from planning and engineering, public health, law enforcement, and emergency response. A key theme in the system maps and story-telling around them related to elements that encouraged or discouraged walking, and the impact of increasing or decreasing walking. The findings from this study supported evidence from prior systems work, including the work of McClure et al. that focuses on policy levers to improve population health, including a reduction in crashes and mode shift to more active travel (2015). They employed a systems model to explore outcomes related to policies that drew the relationship between modal shift and the overall health
of the population. Though the ultimate goal of the systems mapping performed for our project focused on the relation to pedestrian fatalities, many of the explanatory loops also related to overall physical health in a similar way by increasing walking. One feedback loop or system structure, the “fear of walking” loop, tells the story of pedestrian safety as it relates to the desire to walk, where a lack of pedestrians leads to less yielding behavior, which increases crashes and fatalities and the perception of risk. In reverse, as numbers increases, driver awareness and yielding increases, and pedestrians feel safer and are more likely to walk. Similarly the “walking culture” loop linked an increase of pedestrians on the road to a culture of walking that perpetuates an increase in pedestrian activity. Finally, the “infrastructure support” loop expands upon the “walking culture” loop to include an increase in support for pedestrian infrastructure which creates a safer environment that encourages more walking. These three loops reveal the interconnectedness between improving safety, by making pedestrian-friendly environments, and health through the increase in physical activity.

Presenter: Laura Sandt
Agency Affiliation: UNC Highway Safety Research Center

Presenter Biographical Statement: [biography]