Note: Until the 1960s, highway safety efforts focused almost exclusively on preventing crashes by changing driver behavior. Such efforts rarely were evaluated. A pioneer in the successful effort to introduce a balanced approach, underpinned by scientific evaluations, was William Haddon, Jr., M.D., head of the first federal highway safety agency (1967-69) and president of the Insurance Institute for Highway Safety (1969-85). For the past 40 years or so, the field of highway safety has focused on loss reduction measures involving not only drivers but also vehicles and roads. Still, some people claim Haddon and others engineered an almost exclusive swing toward redesigning vehicles. They say driver measures began to be neglected, which hampered U.S. progress toward reducing crash deaths and injuries. This view was most recently propounded in a long magazine article by Malcolm Gladwell ("Wrong Turn," The New Yorker, June 11, 2001). The magazine publishes only short rebuttals, so Status Report offers the following response from Institute president Brian O'Neill.
According to Gladwell, highway safety policy in the United States took a "wrong turn" largely because it was influenced by William Haddon, Jr., who believed "that the best way to combat the epidemic on the highways was to shift attention from the driver to the vehicle." Gladwell claims highway safety orthodoxy for much of the last century "held that safety was about reducing accidents — educating drivers, training them, making them slow down. To Haddon this approach made no sense. His goal was to reduce the injuries that accidents caused. In particular, he did not believe in safety measures that depended on changing the behavior of the driver."
The first part of this claim is correct. Until the late 1960s, "orthodox" highway safety was only about preventing accidents. But the second part of the statement couldn't be further from the truth. Haddon believed there should be a systematic and balanced approach including measures to prevent crashes, reduce injuries during crashes, and reduce the consequences after crashes.
Today all students of injury control are familiar with the Haddon matrix, a tool to help systematically identify all options available to reduce injuries. Some of these options involve changing human behavior.
Gladwell is correct that "Haddon believed the best safety measures were passive." But Haddon didn't believe these were the only measures that could be effective. He strongly advocated those that scientific research demonstrated were effective — and science (then and now) showed most of the orthodox approaches of the day didn't work.
The "wrong turn" the United States supposedly took was to pass legislation in the late 1960s authorizing the federal government to set safety standards for new cars. Most, but not all, such standards resulted in "passive" safety features in vehicles. But the standards also included requirements for active safety features such as lap/shoulder belts. The passive features that required no action on the part of occupants included energy-absorbing steering columns, laminated windshields, side door beams, etc. Such features have saved thousands of lives, as have federally mandated lap/shoulder belts.
"No other country pursued the passive strategy as vigorously," Gladwell claims. Yet a few years after the introduction of the first new vehicle safety standards in the United States during the late 1960s and early 1970s, almost identical vehicle standards were adopted in Canada, Europe, and Australia.
What Gladwell fails to mention is that at the same time the U.S. Congress passed the legislation that authorized federal vehicle safety standards, it passed companion legislation to establish standards for state highway safety programs. As head of the first federal highway safety bureau, Haddon issued 13 such standards that addressed issues including alcohol-impaired driving, driver licensing, and motorcycle helmet use. This was part of the balanced approach — addressing road users and vehicles — that Haddon strongly believed in. (Road design standards weren't included only because they're administered by a different federal agency.)
The Haddon Matrix
One of the federal highway safety standards issued at Haddon's behest required all states to adopt motorcycle helmet use laws. By the early 1970s, all but three states had such laws covering all riders. But then politicians in California (one of the states without laws) challenged this requirement, and the challenge led to the demise of federal standards for state highway safety programs. Today only 21 states have motorcycle helmet use laws.
This one example illustrates why some other countries have been more successful than the United States in reducing some kinds of motor vehicle crash deaths and injuries. While U.S. states were repealing helmet use laws, other countries, which already had helmet laws, were adopting seat belt use laws. This was not because Haddon and his colleagues had no interest in such measures. In fact, Haddon endorsed seat belt use laws after research funded by the Institute in 1972 demonstrated the effectiveness of the world's first belt use law in Victoria, Australia. The erosion of effective highway safety programs aimed at road users occurred because state politicians refused to show leadership, not because of Haddon's ideology.
Gladwell correctly points out that in the 1970s many countries followed the lead of Victoria and adopted belt use laws. He then claims that "a similar movement in the United States in the early seventies stalled." What movement is he referring to? In the 1970s many states were repealing motorcycle helmet use laws, which were proven to reduce motorcyclist deaths, but there was no movement to pass seat belt use laws as early as the 1970s. Safety advocates including Haddon went on record in support of such laws. The federal government had some incentive grants available to any states that passed such laws. But there was no real movement and no progress toward seat belt use laws until the mid-1980s.
It is absurd to claim that "if [Ralph] Nader had advocated mandatory belt laws they might have carried the day." Does anyone believe politicians who voted to repeal helmet laws would have changed their minds and voted for seat belt laws because Nader asked them to?
Even today, most states have weak belt laws with significant gaps in coverage, minimum penalties, and enforcement only if another traffic violation has been observed. Only a few jurisdictions have good laws and politicians who encourage efforts to get more motorists to buckle up.
The contrast with other countries is obvious. In Canada, for example, belt use exceeds 90 percent in all provinces, a rate achieved by good seat belt use laws together with well-publicized enforcement. In the United States belt use rates range from below 50 percent in North Dakota to about 90 percent in California. Our generally dismal record with respect to belt use — compared with Canada, northern Europe, Australia, and a number of other countries — has nothing to do with a "wrong turn" in U.S. policy. It has to do with the failure of political leadership in many states.
Most highway safety measures that can successfully change road user behavior are implemented at the state level. Since the mid-1970s the federal safety program has been able to do little more than encourage appropriate state action. The balanced program Haddon and others supported in the late 1960s envisaged a much more direct federal role. Setting aside issues of federal versus state responsibilities, the undeniable fact is that the original federal role would have resulted in more progress in highway safety than has been accomplished.
As to Gladwell's section on seat belts and airbags, he needs a lesson in restraint system performance and design. He claims "that even today it is seat belts, not airbags, that are providing the most important new safety advances." He apparently is unaware that belt pretensioners are only possible because they use the same technology as airbags. He doesn't seem to be aware that belt force limiters, which allow belts to "pay out" extra webbing to reduce chest loads also are possible only with airbags. Without airbags, belt force limiters would allow drivers' faces to strike the steering wheels in many crashes. Today all auto manufacturers are designing their seat belts and airbags to work together as a single system to optimize occupant protection in crashes.
Finally, Gladwell describes a crash involving Robert Day and others, claiming Day's "best chance" of surviving "would have been to wear his seat belt." Day was in a side impact, during which Gladwell says "the door was driven into him like a sledgehammer." This is a crash circumstance when a belt almost certainly would have provided no benefit. Day would have been much more likely to benefit from a side impact torso airbag and/or improved side vehicle structure — the kinds of technologies Gladwell dismisses.
I had the privilege of working closely with Bill Haddon longer than perhaps anyone, from 1969 until his premature death in 1985. Gladwell's portrait is a distortion of the man and his views. The article fails to communicate the true scope of the original federal motor vehicle safety standards shepherded by Haddon. In addition, it hopelessly misrepresents the successful history of highway and motor vehicle safety efforts during the last three and half decades of the 20th century.
"In 1959, Haddon and I organized a conference, perhaps the first ever on automobile trauma as a public health issue ... . By the mid-nineteen-sixties, we had an agency with Haddon as its head. The issue had been correctly defined. This is what mattered, not the ups and downs that followed. Fifty years ago, cars didn't have 'crashes.' Drivers had 'accidents.' Haddon did this." — Former U.S. Senator Daniel Patrick Moynihan, letter to The New Yorker, July 9, 2001