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Status Report, Vol. 37, No. 10 | SPECIAL ISSUE: HIGHWAY SAFETY GETS SHORT SHRIFT | December 7, 2002 Subscribe

Low priority assigned to highway safety among public health needs

The facts should demand attention. Motor vehicle crash deaths on U.S. roads exceed 40,000 annually, totaling more than 3 million since the automobile was introduced. This is the leading killer of Americans 1 to 35 years old. Yet society responds with something akin to a collective shrug. Opportunities are being missed to reduce the losses, even as the toll mounts at the rate of 115 crash deaths per day, on average.

On an individual level, we tend to think of crashes and their consequences as events that befall other people. This is a common trait, not one peculiar to Americans, but in this country there's an added problem. Traffic safety laws that are known to be effective — and that are implemented in other countries with little or no controversy — often are resisted by U.S. politicians.

The upshot is that the United States now lags behind a number of other countries. It's not that American society has become generally unconcerned about threats to life and limb. It's that we've been emphasizing other threats while ignoring many proven ways to significantly reduce the deaths and injuries from crashes.

"It's a low priority," says Institute chief scientist Allan Williams. "The issues aren't very often debated in the national policy arena. When was the last time you heard candidates for public office trading ideas for improving traffic or road safety?"

Follow the money

An indication of the low priority assigned to crash deaths and injuries is the way our U.S. tax dollars are doled out. In 2001 NHTSA got $58 million for motor vehicle safety research, and the National Center for Injury Prevention and Control added another $3.5 million. These are small sums compared with what's reserved for research to address other public health problems. The National Institute of Dental and Craniofacial Research, for example, netted $289 million for research in 2001.

Federal funding indicates the low priority

In 1985 the National Academy of Sciences identified the shortfall in federal financial support for research on ways to reduce injuries from all causes. But the report didn't have much effect on funding to reduce motor vehicle crash injuries, which were (and are) by far the major contributors to the overall injury problem. Financial support wasn't boosted.

A modest injury control program was established as part of the Centers for Disease Control, but its initial funding came from the existing budget of the federal agency with principal responsibility for motor vehicle safety, the National Highway Traffic Safety Administration (NHTSA). Thus, the establishment of the National Center for Injury Prevention and Control failed to boost overall highway safety funding.

The situation hasn't changed appreciably. Federal dollars flowing to the National Institutes of Health have nearly tripled since 1991, from $10 billion to $27 billion, while funding hasn't kept pace for NHTSA. This agency's overall budget has increased about 75 percent since 1991, from $249 million to $430 million.

Funds earmarked for research are especially lopsided. The National Cancer Institute's research budget is 54 times as big as NHTSA's, for example.

"We should spend more to find ways to fight cancer. After all, it's an even bigger killer than motor vehicle crashes. But the funding gap is way too big. It doesn't reflect the fact that crashes are a major cause of lost years of productive life," Williams says. For each cancer death, the National Cancer Institute's 2001 research expenditure was about $5,800 compared with NHTSA's $1,400 per crash death.

The NHTSA research budget doesn't even approach what goes to less heralded branches of the National Institutes of Health. For example, the National Institute of Dental and Craniofacial Research got $289 million for research in fiscal 2001 compared with NHTSA's $58 million — a huge imbalance considering that motor vehicle crashes are the nation's fourth leading cause of death, while dental disease isn't much of a killer.

Even the National Center for Complementary and Alternative Medicine, which studies unconventional and sometimes controversial approaches to healing, got $71 million for research in 2001.

The problem isn't just failure to devote enough public funds to highway safety research. Once the studies are complete and we know what's effective (and what's not) to reduce crash deaths and injuries, there's what the National Academy of Sciences calls "a yawning gap" between what we know and what actually gets done.

Williams points out that "no such gap exists when it comes to other threats to public health and safety, even ones that involve far less loss of life or none at all. At the same time we put a low priority on crash deaths and injuries, other threats do grab our collective attention and prompt us to root out the sources and fix them. The response can be frenzied, even when the threat is merely perceived and not real."

In the late 1980s when concern about the use of alar on apples started surfacing in television and newspaper reports, the Food and Drug Administration calmly assured people that "the federal government believes it is safe to eat apples." No ill effects on humans were found, even though alar had been widely used since the 1960s.

Still, a scare took hold. Apples disappeared from grocery store shelves, and officials in some jurisdictions banned the fruit from school lunchrooms. The media blanketed the issue, right down to interviews with children who had been deprived of their juice. So intense was the attention that researchers later studied it, concluding that it amounted to "a major landmark in the media coverage of risk." This occurred even though the risk associated with alar didn't, in fact, exist.

The response to highway crashes, even ones in which people die, is muted by comparison. Reporters don't necessarily cover fatal crashes at all, and when they do it's usually a terse account on an inside page of a local newspaper. Only if a crash rises to spectacular proportions — if it involves multiple deaths, the death of a celebrity, or if it ties up traffic for hours — will television cameras roll and the story play at the top of the news.

It may be that this sporadic-at-best media coverage helps to keep the problem of crash deaths and injuries off the national priority list. Or it may be that the media tend to cover issues that already are on the priority list. Either way, highway safety problems get short shrift in relation to the toll they take.

Frank Robinson

Media coverage shows priorities

Shortly after Frank Robinson took off from a Maryland airport in a Cessna 182 on Christmas Eve 2000, the plane crashed. Neither Mr. Robinson nor his passenger sustained anything more than minor injuries. Yet this crash attracted prominent media attention. In contrast is how motor vehicle crashes, even those involving fatalities, are covered. Among the hundreds of fatal car crashes that occurred in Maryland in the months surrounding the Cessna crash, fewer than half made the newspaper. Only a handful got prominent coverage.

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