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Death and injury from motor vehicle crashes: a public health failure, not an achievement
  1. E D Richter1,
  2. P Barach2,
  3. E Ben-Michael1,
  4. T Berman1
  1. 1Hebrew University-Hadassah School of Community Medicine and Public Health, Unit of Occupational and Environmental Medicine, Betts Injury Prevention Center, Jerusalem, Israel
  2. 2Department of Anesthesiology and Critical Care, Pritzker University of Chicago School of Medicine, Chicago, USA
  1. Correspondence to:
 Dr Elihu Richter, Unit of Occupational and Environmental Medicine, Hebrew University-Hadassah Medical School, Jerusalem 91120, Israel

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In 1999, the Centers for Disease Control (CDC), the United States government's leading agency in public health, published a document entitled Motor Vehicle Safety: A 20th Public Health Achievement.1 We suggest, however, that the record shows a failure, not an achievement

The document claims that systematic motor vehicle safety efforts, which began in the United States in the 1960s, were responsible for the enormous reduction in the risks for deaths from road injury. This claim is accompanied by a graph that shows the steady drop in death per vehicle miles traveled (D/VMT) from 18/100 million in 1925 to 1.7/100 million in 1997, a 90% decrease (fig 1). The document emphasizes that this drop occurred despite a 10-fold increase in miles traveled, a sixfold increase in the number of drivers, and an 11-fold increase in the number of motor vehicles. What, then, is wrong with the CDC's conclusions?

Figure 1

Motor vehicle related deaths/million miles traveled (VMT) and annual VMT, by year, United States 1925–97. Most of the drop in risk for deaths from road injury preceded 1966, when the United States initiated motor vehicle safety efforts. (Source: USCDC. Motor Vehicle Safety: a 20th Century Public Health Achievement 1999;48(18):369–74.)

In 1998, the absolute number of road deaths in the United States was 41 471 but since 1991 there have been no drops in the absolute number of road deaths/year, and between 1992–98 the D/VMT fell only slightly, from 1.7 to 1.6.2 Large drops in D/VMT in earlier decades should not divert attention from the subsequent failure to reduce deaths in absolute numbers.

Box 1: Countermeasures

  1. Increased mass/volume

  2. Better seat belt designs/child restraints

  3. Improved fireproofing of fuel tanks

  4. Seat belt laws

  5. Burstproof latches

  6. Collapsible steering wheels

  7. Shatterproof window panes

  8. Padded dashboards

  9. Non-protrusive accessories

  10. Reinforced passenger cabins

  11. Rear underride absorbers …

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