Unequal paths to care: pedestrian crossing behavior and walkability in access to urban healthcare facilities located in high-injury streets

Walkability integrates built, natural, and social elements to support active living, access to services, and the social quality of urban environments. While prior models link pedestrian behavior to spatial context and trip goals, less attention has been given to how socioeconomic conditions shape these relationships, particularly in high-risk areas near healthcare facilities. In this study, we extend existing frameworks by incorporating a societal-level dimension, capturing both area-level socioeconomic characteristics and individual demographics. We examined pedestrian road-crossing behavior in two urban high-risk locations near healthcare facilities that differ in socioeconomic context and walkability (CWI) scores. A total of 343 pedestrians were observed at two times of day, and 40 passerby questionnaires were collected. Results indicate that higher walkability is associated with safer crossing behaviors, including increased traffic checking, greater use of designated crosswalks, and reduced abrupt road entry. Behavioral patterns also varied by time of day, gender, and age. Mobile phone use differed across contexts, peaking among younger pedestrians in the higher walkability area and remaining lowest among older adults. Group crossings were more frequent in the morning, particularly among males and individuals aged 20–40. Survey responses further indicated more positive perceptions of infrastructure and safety in the higher walkability area. These findings highlight the interaction between environmental quality, socioeconomic context, and pedestrian behavior, and underscore the importance of integrating equity considerations into urban design and policy, particularly in areas surrounding essential services such as healthcare facilities.