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LETTER |
Jon S. Vernick and Stephen P. Teret are with the Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management.
Correspondence: Requests for reprints should be sent to Jon S. Vernick, JD, MPH, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 21205 (e-mail: jvernick{at}jhsph.edu).
In his editorial "A New Traffic Safety Vision for the United States,"1 Evans argues that litigation has harmed the US motor vehicle safety effort and that interventions focused on changing the behavior of drivers, rather than the safe design of vehicles, are "overwhelmingly" more important. Although one might not realize it from Evans’s editorial, the reduction in the risk of fatal motor vehicle crash is one of the major success stories of public health and injury prevention. From 1966 to 2001, the fatality rate per million vehicle miles traveled has declined by more than 70%.2
This reduction has been achieved not by a single-minded focus on driver behavior but through a combination of improving vehicle, roadway, and driver safety. But it is perhaps not surprising that Evans, having previously been a research scientist at General Motors for more than 30 years, seeks to deflect attention away from vehicle-related factors and toward the role of the driver. This focus is contrary to well-accepted public health principles of injury prevention, established by Haddon and others, that reducing the likelihood of injury in the event of a crash is a crucial strategy.3,4
In the pages of the Journal, Evans has previously expressed his feelings toward lawyers and litigation in even more pejorative terms: "Only the most gullible can imagine that any net good emerges from the resulting system, which lavishly supports a pestilence of avaricious lawyers."5(p785) Actually, it is well documented that litigation against motor vehicle and other product manufacturers has made important contributions to public health, providing necessary incentives to make products safer.6–8
Evans also argues it is simply a "trivial truism" when litigation demonstrates that, had a car manufacturer made its product safer, "the outcome of a crash would have been different."1(p1385) We doubt that the families of people killed in vehicles without safety devices such as air bags—especially during the period when General Motors and other car manufacturers fought the imposition of the federal standard requiring them— would agree. And from a population perspective, air bags are estimated to have saved well over 2000 lives in the United States since 19879—an accomplishment that is hardly trivial.
Evans is correct to note that there remain too many deaths on US roadways each year. We see no reason why vehicle safety cannot continue to be improved while seat belt use and other driver-oriented interventions are also encouraged.
References
1. Evans L. A new traffic safety vision for the United States. Am J Public Health. 2003;93:1384–1386.
2. National Highway Traffic Safety Administration. Traffic Safety Facts 2001. Washington, DC: US Department of Transportation; 2002.
3. Haddon W. Advances in the epidemiology of injuries as a basis for public policy. Public Health Rep. 1980;95:411–421.[ISI][Medline]
4. Runyan CW. Introduction: back to the future—revisiting Haddon’s conceptualization of injury epidemiology and prevention. Epidemiol Rev. 2003;25:60–64.
5. Evans L. The dominant role of driver behavior in traffic safety. Am J Public Health. 1996;86:784–785.
6. Vernick JS, Mair JS, Teret SP, Sapsin JW. Role of litigation in preventing product-related injuries. Epidemiol Rev. 2003;25:90–98.
7. Teret SP. Litigating for the public’s health. Am J Public Health 1986;76:1027–1029.
8. Bogus CT. Why Lawsuits Are Good for America. New York, NY: New York University Press; 2001.
9. Effectiveness of Occupant Protection Systems and Their Use, Fourth Report to Congress. Washington, DC: National Highway Traffic Safety Administration; 1999.
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