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Traffic reduction: An urgent public health priority

Traffic is the leading cause of death among children worldwide and the leading cause of death among 1-34 year olds in the United States. So, why isn't traffic considered the top threat to public health by the CDC, WHO and federal, state and local governments?


Photo by Diana Beideman on Flickr.

Why don't officials approach traffic reduction with the same urgency that they approach, say, tobacco or malnutrition? The answer can be found in the CDC's publications on injury prevention.

CDC's research and prevention efforts target this serious public health problem. We focus on improving car and booster seat and seat belt use and reducing impaired driving, and helping groups at risk: child passengers, teen drivers, and older adult drivers.
The CDC, NIH and other agencies focus on traffic safety as the preventable cause of death, not traffic itself. WHO's recommendations for addressing traffic fatalities are "speed, alcohol, seat-belts and child restraints, helmets, and visibility."

The flaw in this exclusive focus on traffic safety is that increased safety only matters when vehicle miles traveled (VMT) are kept static or reduced. Instead, safety improvements that reduce fatalities per VMT have been offset by rising VMT.

Investments in traffic safety finally began to matter in 2004. According to the Brookings Institution, "driving, as measured by national VMT, began to plateau as far back as 2004 and dropped in 2007 for the first time since 1980," obviously due to rising gas prices. As a result, the rate of traffic fatalities per 100,000 population finally began a much steeper decline in 2004 compared to earlier periods when safety improvements had been largely undermined by VMT increases.

But did this demonstrate the urgency of reducing traffic? Not according to NHTSA Administrator David Strickland, who said the following in a press release celebrating the decline:

This continuing decline in highway deaths is encouraging, but our work is far from over. We want to see those numbers drop further. We will not stop as long as there are still lives lost on our nation's highways. We must continue our efforts to ensure seat belts are always used and stay focused on reducing distracted and impaired driving.
Attributing the recent decline in traffic fatalities solely or primarily to safety improvements is not only sloppy statistics given that safety improvements have lead to steady declines in fatalities per VMT for decades. It also sends the wrong messagepeople can feel safe driving, as driving itself is not part of the problema message which will only increase VMT further and bring a halt to reductions in traffic fatalities.

Attributing the declining fatality rate to safety improvements also allows the myth to perpetuate that moving to the suburbs is safer than living in the city, a myth that, left unchallenged, increases VMT and undermines safety improvements. This myth was exposed by the New York City Department of Health, which recently revealed that their low VMT per child made NYC a much safer place for children than the rest of the country.

So why does the CDC, WHO, NIH, NHTSA and probably every other public health agency treat poor traffic safety as the preventable cause of the top killer of children worldwide, and not traffic as well? And how many children will have to die for this to change? Are we serious about public health? The sooner we start demanding honesty about the causes of the top killer of children here and abroad the better, because during the 2 minutes you spent reading this article, another child died in a traffic collision.

Ken Archer is CTO of a software firm in Tysons Corner. He commutes to Tysons by bus from his home in Georgetown, where he lives with his wife and son. Ken completed a Masters degree in Philosophy from The Catholic University of America. 

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I wonder if you can make an argument for regulation of traffic under police powers based on Constitutional law, in reference to health, safety, and welfare: http://legal-dictionary.thefreedictionary.com/Police+Power

by Paul C on Jul 27, 2010 11:02 am • linkreport

I saw a report about teens not having jobs and not owning cars at the same rate. Fairly dramatic decline, which makes sense during a recession. I have to think that is the cause of the death decline, since teens are the worst/most dangerous drivers.

by charlie on Jul 27, 2010 11:08 am • linkreport

Ken - brilliant! You revolutionary. Excellent articulation of an ingrained windshield perspective that has blinded these agencies to the most obvious intervention for reducing bad outcomes attributable to driving. Thanks!

by Bianchi on Jul 27, 2010 11:10 am • linkreport

@charlie -- New drivers are the worst/most dangerous drivers. Don't stereotype.

by andrew on Jul 27, 2010 11:15 am • linkreport

Perhaps you should revise terminology: The concern here is not vehicle miles traveled but passenger miles traveled. A few obvious suggestions: Do not count children for purposes of HOV restrictions. This just encourages suburban parents to drive very young children extra miles on interstate highways to day care in DC instead of leaving them in the suburbs (and possibly taking mass transit). And the HOV lanes were meant to encourage car pooling, not single-worker occupancy.

The daycare late fee also provides a perverse incentive to take your child into town. Of course, if you actually have lunch and see your toddler during breaks maybe it is worth the risk of the extra driving in some cases.

The child care tax deduction in general may be an additional financial incentive to take your child on the road. Maybe the deduction should only go to late fees, since a subsidy for late fees would make parents worry less about the late fee and more inclined to leave child near home.

by Jim Titus on Jul 27, 2010 11:17 am • linkreport

@Andrew, no, it is teen drivers.

Male teen drivers love to speed, have serious attention issues, and don't have the mental control to realize their action are dangerous.

New drivers of any age are risky, but it is the testosterone and immature brains that make teen drivers dangerous.

by charlie on Jul 27, 2010 11:20 am • linkreport

Paul C - if you're looking for federal regulation then the more appropriate jurisdictional hook is either the Commerce Clause or the Spending Clause.

The federal government does not have any general police power. The 10th Amendment reserves that power for the states.

by BMV on Jul 27, 2010 11:22 am • linkreport

WHO report link broken.

by Peter Smith on Jul 27, 2010 11:22 am • linkreport

The other problem with the focus on "safety" instead of "traffic" is that it rewards bigger cars and beefier structures. This is great for occupants but is not so good for
(a) pedestrians, cyclists, and those in smaller cars because the drivers feel comfortable taking more risks, and because the cars impart more energy upon collision.
(b) gas mileage
(c) innovation, as the weight of regulation makes it more difficult to get approval for smaller, lighter cars or use of different materials. See e.g. SMART cars, Aptera, etc.

by SJE on Jul 27, 2010 11:28 am • linkreport

Ban cars. Problem solved. Children were never killed during the horse and buggy era.

Captcha: Flame warts

by Fritz on Jul 27, 2010 11:29 am • linkreport

Ken +1+1+1+1...

Look at the insanity that happened after 3000 people died on 9/11. In our "defense" we sent 5000 more Americans to their deaths.

Now compare that with the efforts to reduce the 37,000 traffic deaths every day.

It does not hold up, but (aluminum head alert) the military-industrial complex is too powerful.

Please keep hammering on this point. The pain felt by someone who lost someone in traffic is not smaller than that of someone who lost someone in a terror attack.

by Jasper on Jul 27, 2010 11:30 am • linkreport

@ BMV:

good call. Do you think then that one state could take a stand with those powers?

by Paul C on Jul 27, 2010 11:35 am • linkreport

Has any economist estimated the impact of gas taxes on vehicular deaths or injuries?

If not, a crude way, suggested or implied by this article, is simply to estimate the impact of the tax on VMT and the impact of VMT on deaths.

The important questions to test are whether the gas tax reduces certain types of driving or vehicles in the short and long term and how those changes affect vehicular deaths.

On the other side of the ledger of course would be the deadweight loss associated with less gas consumption, but still...

by Ward 1 Guy on Jul 27, 2010 11:43 am • linkreport

Andrew.

No, teenagers are different.

"A National Institutes of Health study suggests that the region of the brain that inhibits risky behavior is not fully formed until age 25, a finding with implications for a host of policies, including the nation's driving laws. "

Brain Immaturity Could Explain Teen Crash Rate:

http://www.washingtonpost.com/wp-dyn/articles/A52687-2005Jan31.html

by RJ on Jul 27, 2010 11:44 am • linkreport

@Paul C. - As long as a state's regulatory framework does not unconstitutionally burden interstate commerce and assuming federal preemption is not an issue, there would be no apparent federal or constitutional impediment to taking a stand.

by BMV on Jul 27, 2010 12:09 pm • linkreport

@Jasper Look at the insanity that happened after 3000 people died on 9/11. In our "defense" we sent 5000 more Americans to their deaths.

And how many more Americans (and others) would have died if those brave 5000 hadn't sacrifice their lives in defense of the rest of us?

by Lance on Jul 27, 2010 12:41 pm • linkreport

@Ken ... Why not simply increase birth control? If we can reduce the number of people out there in general, we're sure to reduce deaths of all kinds ... Don't you agree?

I.e., Your logic is 'faulty' ... at best.

by Lance on Jul 27, 2010 12:43 pm • linkreport

And how many more Americans (and others) would have died if those brave 5000 hadn't sacrifice their lives in defense of the rest of us?

Good question. And it all depends on whether you believe a) invading Iraq/Afghanistan "pinned down the Bad Guys" so we could "fight 'em there" so we "don't have to fight 'em there", or b) believe it was a fool's errand, creating more resentment and instability than the status quo, and playing straight into the stated strategy of the instigators of the 9/11 attacks. IOW, depends on whether you're a child or an adult.

Either way, probably outside the scope of the transit discussion.

by oboe on Jul 27, 2010 12:56 pm • linkreport

@Lance - Kens taking the perspective that exposure to driving/being in a car on the roads is the risk factor. Intervening on the risk factor is the basic model for prevention. For instance death due to small pox is greatly reduced due to intervention both in rate and actual numbers compared to 100 years ago even though the population has increased substantially. A smaller population doesn't necessarily have a lower death rate of anything.

by Bianchi on Jul 27, 2010 12:57 pm • linkreport

@ Lance: Yeah, why worry about the potential terror attack while we had 400,000 (10*37,000 + a bit because the number used to be higher) actual people die in traffic?

by Jasper on Jul 27, 2010 12:59 pm • linkreport

@Lance

The goal is to reduce deaths per capita, and the leading cause of deaths per capita for Americans age 1-34 is traffic collisions. (Birth control doesn't reduce per capita deaths.) Are traffic-related deaths preventable deaths? Yes. So, what is the preventable cause? One's answer to that question reveals, in my mind, one's seriousness about public health.

by Ken Archer on Jul 27, 2010 1:07 pm • linkreport

@KenArcher: So what's your policy solution? Because it seems like you're implying that the only effective solution would be to deal with traffic by, essentially, reducing traffic. As I see it, the only way to really reduce traffic is to make car ownership and usage more limited, either by increasing its costs or reducing its allowed usage.

Is that what you're hinting at: Make car usage much more expensive or restrict who can use a car?

If so, why not come out and say so, rather than beat around the bush?

by Fritz on Jul 27, 2010 1:14 pm • linkreport

@Ken -OT Birth control doesn't reduce per capita deaths. Use of birth control has greatly reduced maternal death due to childbirth.

However, it is indeed Lance's "faulty logic" that reducing the population decreases mortality rate of anything.

by Bianchi on Jul 27, 2010 1:14 pm • linkreport

@Jasper
Look at the insanity that happened after 3000 people died on 9/11. In our "defense" we sent 5000 more Americans to their deaths.

Now compare that with the efforts to reduce the 37,000 traffic deaths every day.

Where is this stat from? 37,000 traffic deaths a day? That would mean we're losing 13.5 million people a year, which seems extreme. The roads are not that unsafe.

by Art on Jul 27, 2010 1:16 pm • linkreport

It's 37,000 a year. Except it's about 35,000 now.

by Jamie on Jul 27, 2010 1:19 pm • linkreport

I don't think these things matter as much because of the philosophy of informed consent. Most people know that driving is inherently dangerous, but they are willing to take that risk anyway. Government, then, should work to make the basic action (driving) safer (buckle up). In that case, the goal is to reduce the number of deaths per VMT, rather than simply the raw number of dead.

by OctaviusIII on Jul 27, 2010 1:22 pm • linkreport

@Fritz- the only way to really reduce traffic is to make car ownership and usage more limited, either by increasing its costs or reducing its allowed usage.

No. By making other mode choices more accessible! Increase transit; make biking a good alternative for more people. Invest in the purple line instead of the ICC, etc. So many places I need to go my only good choice is to drive because the alternatives are too dangerous (biking) or non-existent/so inaccesible as to be non-existent (transit).

by Bianchi on Jul 27, 2010 1:24 pm • linkreport

So what's your policy solution?

There are many possible solutions. Bringing attention to them, however, distracts from the central argument I'm making that public health officials aren't searching for solutions that reduce VMT levels at all. If they were, they would probably come up with better solutions that I have.

What is simply wrong is to approach transportation and planning decisions with the goal of balancing competing lifestyle choices. From a safety perspective, avoiding and reducing traffic is no more a lifestyle choice than is reducing tobacco, increasing vaccine availability and research, ensuring global access to clean water, or any other major public health priority. And we shouldn't be timid about saying so.

by Ken Archer on Jul 27, 2010 1:28 pm • linkreport

@Octavius3 - Most people know that driving is inherently dangerous, but they are willing to take that risk anyway.

That's not why. Its b/c driving is so often the only good alternative and often the only alternative. One piece of evidence for this is the high price of real estate in walkable communities. People pay a premium to live where they can walk/transit to many destinations and leave the car behind as much as possible.

by Bianchi on Jul 27, 2010 1:29 pm • linkreport

You know while I fully favor improving non-driving infrastructure options for a wide variety of reasons, I feel like the argument for treating driving like a disease is not going to end up giving you the result you want.

The DC metro area, with about 5.5 million residents, would be expected to have around 600 traffic-related fatalities each year as a pure ratio of national statistics. However, since we have good, well-used public transit already, it's probably lower.

DC itself had 34 in 2009, and as a proportion of the national stats, we should have had 68. So living in a city seems to about cut your risk in half.

So, how much improvement could we possibly expect in our (somewhere under 600 deaths per year) from better transit in the entire region?

How many trillions of dollars would it cost to create transit infrastructure in the entire metro region, that is as good as just DC's?

For that we could expect at most a couple hundred lives per year to be saved in the area. That puts a price tag of millions, if not billions of dollars on each life saved by improving transit.

I'm pretty sure you could save more lives by spending that money in other ways.

by Jamie on Jul 27, 2010 1:31 pm • linkreport

I don't think these things matter as much because of the philosophy of informed consent.

It's a small, small percentage of Americans who are able to not drive. The increasing VMT that has offset safety improvements is not just the free choice of individuals. It's the result of government policies (primarily zoning, tax subsidies that favor mortgages over rent and historical highway subsidies that for decades dwarfed gas tax revenues) that generally continue today.

by Ken Archer on Jul 27, 2010 1:37 pm • linkreport

@Jamie - ken is not saying driving/traffic is a disease. He's saying its a risk factor (a measurable RF) for a bad outcome, like small throw rugs are a RF for falls. He's questioning why the major public health institutions don't describe it that way. Its a great question. I guarantee if you go to the CDC website you can find information on reducing falls that includes "don't use small throw rugs". Rugs aren't a disease - they contribute to a bad outcome. Thus the advice to not use them/reduce their use. Driving/traffic can be viewed the same way.

by Bianchi on Jul 27, 2010 1:43 pm • linkreport

Driving is "inherently dangerous" just as living, biking,walking, skiing, etc. are inherently dangerous. It is one thing to seek to reduce the risks that are inexpensive to reduce, but not all of them are. It's simply not acceptable to the American public to require everyone to drive around gigantic pillows at 5mph, so why bother?

Identify some inexpensive safety hazards for driving that can be eliminated and that's an actual contribution to the conversation. Otherwise it's just harangue about cars=evil.

by ah on Jul 27, 2010 1:43 pm • linkreport

It is one thing to seek to reduce the risks that are inexpensive to reduce, but not all of them are.

This is the mindset that I don't understand. We're talking about the #1 killer of children here and everywhere. How much is too much to spend?

by Ken Archer on Jul 27, 2010 1:48 pm • linkreport

@Bianchi, I don't think that's true.

http://www.cdc.gov/nchs/fastats/lcod.htm

Causes of death
Accidents (unintentional injuries): 123,706

http://www.cdc.gov/NCHS/data/nvsr/nvsr58/nvsr58_19.pdf

"The mechanism involves the circumstances of the injury (e.g., fall, motor vehicle accident, poisoning)."

What exactly are we arguing for here? That auto accidents should be singled out? They wouldn't even make the top 10 if you did that.

by Jamie on Jul 27, 2010 1:50 pm • linkreport

@Jamie - what don't you think is true? That rugs are a trip/fall RF? Or that traffic/driving is a RF for morbidity and mortality? Or that driving/traffic can be viewed as a RF as Ken has put down? Or something else? Just Clarifying communication.

by Bianchi on Jul 27, 2010 1:54 pm • linkreport

@Bianchi, I'm arguing that treating traffic the same way we treat other risk causes is absolutely fine. And it would lead to the inevitable conclusion that it's a very poor place to invest money in if your goal is to reducing risk factors to save lives.

Almost ten times as many people die of HIV in DC every year than in auto accidents. 50 times more die of heart disease.

How many lives will a $1.5 billion dollar streetcar save? How many lives could be saved if that money was spent on HIV medication, better food for schools, instead?

I'm not arguing against the streetcar on this basis, I'm just trying to make a point. You can't look at it like a preventable risk, because traffic is not a disease. Unlike HIV, poor nutrition, heart disease, and poor rug placement, driving has benefits that are substantial and the goal is not to eliminate it.

by Jamie on Jul 27, 2010 2:00 pm • linkreport

Jamie,

There's no debate that traffic accidents are the top killer of children here and everywhere. You're first link is to total deaths, the leading ones obviously afflicting the elderly.

"The mechanism involves the circumstances of the injury (e.g., fall, motor vehicle accident, poisoning)."

And what is our response to poisoning? Don't confuse a classification scheme with the root cause analysis that public health officials conduct to identify the preventable causes. It's that causal analysis that I'm critiquing as sidestepping an obvious contributing preventable cause because it's inconvenient or assumed to be non-preventable. The drop in VMT since the rise in gas prices in 2004 shows that increasing VMT is obviously preventable.

by Ken Archer on Jul 27, 2010 2:00 pm • linkreport

@Ken Archer: I'm confused. You don't want to offer any policy solutions? Just offer up the argument that driving can result in accidents and deaths?

Or is the argument you're not making that we have to spend whatever it costs to whatever it is that we're supposed to do because "it's for the children"?

I'm befuddled as to what the point is that you're trying to make. Driving can be dangerous. So can flying. Or taking Metro. Or walking. Or going to work.

So what do you suggest we do about it, other than all nodding our heads in agreement that driving can be dangerous?

by Fritz on Jul 27, 2010 2:03 pm • linkreport

@ Jamie - exactly what you say is one reason why I like Kens assertion so much. Aside from the infectious diseases on that link to leading causes of death, they are all reduced with more (or even adequate) physical activity. (on the population level). Increased physical activity is found where people can choose other modes of travel besides driving. Thus if the CDC advocated for reduced traffic/driving through increased transit and opportunities for "active transport" -which is already one of their campaigns to intervene on the diabesity epidemic, the public health message would be more powerful.

I agree the goal is not to eliminate driving. The goal is to make other choices more available with a shift in planning and policies.

by Bianchi on Jul 27, 2010 2:10 pm • linkreport

infections and unintentional injury.^

by Bianchi on Jul 27, 2010 2:15 pm • linkreport

I'm confused. You don't want to offer any policy solutions?

I don't have a cure for HIV, but I think we should continue to invest in HIV research the way we have. In the same way, my prescription is for the CDC, WHO, NHTSA and other public health agencies to spend as much money on traffic reduction campaigns as they do on traffic safety campaigns.

by Ken Archer on Jul 27, 2010 2:26 pm • linkreport

I'm still confused about what you expect CDC to do. What is a "traffic reduction campaign?" For the people in this country who have any public transit option at all, e.g. the ones in metropolitan areas, what do you think would convince them to use alternative transit if they don't already, because it is cost effective and/or reasonable given their circumstances?

The only thing that gets people to use transit is to make it a better option then driving.

Back full circle now...

by Jamie on Jul 27, 2010 2:29 pm • linkreport

I'm still confused about what you expect CDC to do. What is a "traffic reduction campaign?"

Why doesn't the CDC campaign for businesses to locate next to transit? Why don't I see video campaigns for "5 Minute Living - What You Can Do" encouraging shopping and playing locally as much as I see campaigns against distracted driving? Why doesn't the CDC circulate booklets on the link between sprawl and the #1 killer of kids to zoning boards across the country?

by Ken Archer on Jul 27, 2010 2:37 pm • linkreport

Ken's point is that they are assuming that VMT is a totally independent variable that must simply be accepted as unchangeable as genetics. Treating childhood vehicle deaths as simply a safe use question would be like treating childhood obesity as simply a diet problem without considering exercise. There are clear things we can do to reduce VMT that don't involve building a train to every house. The simplest is to raise the cost of gas via a higher gas tax. Ken is arguing that these agencies have a blind spot on issues like the gas tax because they have faulty assumptions about the nature of VMT.

by Reid on Jul 27, 2010 2:38 pm • linkreport

I have no problem with those things in principle. I just don't see any substantial outcome. The benefit would primarily seem to be in making some transit advocates feel better.

All of the examples you mention are driven by existing infrastructure. Businesses already fully understand the benefits of being near a metro. That is why real estate near metros is more expensive.

People who can shop and play locally do so. What point would there be in handing out leaflets to Columbia Heights residents encouraging them to shop at Target or eat at Red Rocks? We already do. That's why we moved there. And likewise, what point is there in doing the same to people living somewhere that has no amenities nearby?

OK, so maybe your goal is to try to educate people who don't live near these things, on how great their life would be if they did. To support developing such communities so 10 or 20 years from now they might be near one.

Don't you think most people have a pretty good sense for the costs and benefits of different kinds of living? Again, you might have noticed: real estate in Columbia Heights is a lot more expensive that real estate in Bowie.

There is a big difference between "helping people understand the benefits of city living" and "helping people avoid risk factors."

Telling someone to wash their hands or avoid dangerous rug placement is information that can have immediate consequences. You are asking CDC to do public transit policy lobbying.

by Jamie on Jul 27, 2010 2:47 pm • linkreport

The CDC currently gives out grants to communities for programs like 'safe walk to school' to increase physical activity(PA)in kids; and money for bike trails and even ped safety and things like that. They make a concerted effort to get the message about increasing PA to intervene on diabesity at local policy levels. The message for changes in planning that increase PA can be coupled with the message that these changes also reduce exposure to the RF for injury inherent in spending more time in traffic.

"The only thing that gets people to use transit is to make it a better option then driving."

Exactly. Its not an impossible task.

by Bianchi on Jul 27, 2010 2:53 pm • linkreport

I have no problem with those things in principle. I just don't see any substantial outcome. The benefit would primarily seem to be in making some transit advocates feel better.

Again, it's this fatalistic attitude about the #1 killer of kids that I simply don't understand. What are your solutions? Many have been proposed in this thread and there are many, many others. Did you ever say that HIV research will only make advocates feel better? No. So why the fatalism about the #1 killer of kids?

by Ken Archer on Jul 27, 2010 3:00 pm • linkreport

The point of informing the populace is so they (we) can tell our policy makers "change the zoning so my kid can walk to school; so I can walk to the store; spend less on more roads and more on transit so I can ride a bus instead of driving" etc. Traditional sprawl is based on zoning and other policies that prohibit these activities while guaranteering more time spent in traffic/driving. Individuals can't make these changes by themselves. These are policy based changes, like the examples Ken gave above.

by Bianchi on Jul 27, 2010 3:03 pm • linkreport

"So why the fatalism about the #1 killer of kids?"

Why the fatalistic attitude towards everyone else?

So, if 34 people a year are killed in DC in traffic accidents, four or five of them being kids, how much money would you divert from flu vaccines, healthy lunches, HIV treatment, or anywhere else where we spend money to make people healthier, in the name of better transit to save lives?

How many kids would that save, and what would be the cost in other areas?

Your jedi mind tricks don't work on me. I value everyone's life equally no matter how many times you say "it's for the kids."

by Jamie on Jul 27, 2010 3:07 pm • linkreport

@jamie - the changes don't have to come from the piss poor public health budget. The public health goal of increasing mode share can be achieved can be achieved through shifting transportation spending and changing land use policies. See the post yesterday about MoCo DOT as an example.

by Bianchi on Jul 27, 2010 3:15 pm • linkreport

So, let me see if I got this correct: The Center for Diseases Control, the National Institutes of Health, the World Health Organization, the state departments of health are all supposed to, basically, become propaganda outlets for the benefits of Smart Growth?

Um...ok.

And how quickly do you think the Congressional oversight committees would be convened to look into why these federally-funded health institutions are spending taxpayer money to essentially bash the tens of millions of residents of rural and suburban areas for not caring enough about their childrens' lives and health to move into a high-density urban area with top-notch multi-transportation modes?

I just don't get this argument, its logic, or its practicality.

by Fritz on Jul 27, 2010 3:15 pm • linkreport

So, let me see if I got this correct: The Center for Diseases Control, the National Institutes of Health, the World Health Organization, the state departments of health are all supposed to, basically, become propaganda outlets for the benefits of Smart Growth?

When the benefits of smart growth include reducing a cause of the #1 killer of Americans age 1-34, why shouldn't federally-funded public health organizations advocate for it? With which facts of the argument I've presented do you disagree?

by Ken Archer on Jul 27, 2010 3:24 pm • linkreport

Let's see... 2009 federal highway spending was 41 billion. That's 136 bucks a person.

I can assure you that anyone who takes metro to work every day is subsidized for far more than $136 a year.

Public transit is expensive, even in a densely populated area. Outside urban centers, it gets more and more expensive per rider. Look at Amtrak.

It's not that I don't believe in the value, I do. I think it has many externalities that are positive in urban areas. It is worth the investment in cities where there are lots or riders and high population densities.

It is not a magic bullet for the "traffic problem" though.

But you just can't look a

by Jamie on Jul 27, 2010 3:25 pm • linkreport

@Ken Archer - Because federally funded health institutions aren't propaganda machines.

Do you really disagree with my contention that any such propaganda efforts would quickly be snuffed out by Congress who's suburban and rural members would take a bit of an offense at both the message and the mission creep?

by Fritz on Jul 27, 2010 3:35 pm • linkreport

@Bianchi @Lance - Kens taking the perspective that exposure to driving/being in a car on the roads is the risk factor. Intervening on the risk factor is the basic model for prevention. For instance death due to small pox is greatly reduced due to intervention both in rate and actual numbers compared to 100 years ago even though the population has increased substantially. A smaller population doesn't necessarily have a lower death rate of anything.

The difference between reducing the incidence of small pox and the incidence of 'driving' is that no good comes out of getting small pox, BUT a LOT of good comes out of driving.

In and of itself driving provides benefits that are incomparable to any other form of transport. It gets you a lot farther than you could go on foot or by bike, and it gets you whenever and (practically) wherever you want to go to places that trains/metros can't ... And for those 99% of destination and times that there would NOT be a boat load of other people needing and wanting to go to the same place at the same time as you, it does so much more efficiently.

I.e., "Driving" unlike smallpox is a good thing. It makes absolutely no sense to want to reduce that good thing ... like you would something like small pox which has no benefits that I know of. You just want to make driving safer, and not 'eradicate' it. Hence why Ken's logic is very faulty.

by Lance on Jul 27, 2010 3:44 pm • linkreport

What I disagree with, Fritz, is fatalism with regard to an obvious cause of the #1 killer of children here and everywhere. If you don't think public health agencies should address VMT, then what about the gas tax? What about local officials deciding to not build ICCs because, among other reasons, they kill kids?

What, in other words, are your solutions to the leading killer of children, given that data shows irrefutably that keeping VMT static or declining is an essential part of any solution?

by Ken Archer on Jul 27, 2010 3:46 pm • linkreport

@ Jamie: Let's see... 2009 federal highway spending was 41 billion. That's 136 bucks a person. I can assure you that anyone who takes metro to work every day is subsidized for far more than $136 a year.

Federal Highway Spending are the key limiting words here. Considerably more money is spent on roads each years. Just as the Feds aren't the only spenders on metro. You have to include state and county contributions to start with. I-95 isn't very helpful without the road from my front door.

Furthermore, there is more spending than just spending on roads. And I'll won't even go to this thingie where we still own 60% of GM.

Oh, and BTW, if you think $41B is a lot, US spending in Iraq and Afghanistan was $864B last year. That's 20 times as much.

by Jasper on Jul 27, 2010 3:52 pm • linkreport

The more you say "cars kill kids" the less credibility you have. It just makes you sound crazy.

You continue to ignore the big picture. How many kids are killed by cars every year? You haven't mentioned that yet. It's about 2,000 in the U.S.

How many would be saved by NOT building the ICC? I don't know, but I bet some could die, if it makes it take longer for an ambulance to get to the hospital as a result of not building it. How much would it cost to build a viable public transit alternative to the ICC? I don't know, but it would be enormous, and it certainly would not be useful to anywhere near as many people as a road would out there.

It's a zero sum game. The money has to come from somewhere. Money spent on public transit is not always well spent - for example, subsidizing trains to go 3,000 miles across the country that hardly anyone rides. Money spent on roads is not always badly spent, because in many places there is not sufficient population density to make it practical for many people to use.

by Jamie on Jul 27, 2010 3:56 pm • linkreport

@Ken - My solutions (off the top of my head): improved car safety design and features, improved roadway design, better driver education - especially among teenagers, and increased enforcement against idiots on the roads. These are all areas where the federal DOT and state departments of transportation have played, are playing, and forever shall play the lead role.

If the top cause of preventable death of children is traffic fatalities, my solution would be to focus on reducing those numbers of fatalities, rather than spending taxpayer money to browbeat people who live in the suburbs, exurbs or rural areas.

Mission focus would be my solution, as opposed to your solution of unfunded mission creep.

by Fritz on Jul 27, 2010 3:58 pm • linkreport

I don't think 41 billion is a lot, I think it's not all that much. That is my point. You want to take money from other transit spending to build more trains with, remember? Our little streetcar project in DC is going to be $1.5 billion, probably double that by the time it's done, if it goes the way every other such project does. That's just for a couple streetcar lines in a place that has a high population density, meaning it might cover half of it's operating costs.

by Jamie on Jul 27, 2010 4:00 pm • linkreport

By the way, where do you get your numbers, generally? First we had this "37,000 people killed per day" thing that was off by a factor of 365. Now you're trying to tell me we spent $864 billion in the middle east, just last year??

You do realize the entire revenue of the U.S. last year was only about twice that, $2.1 trillion?

Go check again. That number is what is projected for the entire decade.

by Jamie on Jul 27, 2010 4:06 pm • linkreport

@Lance "a LOT of good comes out of driving." True. Its also is the cause of a lot of death and injury. That's why there is a concerted "safe driving" campaign (clickit or ticket etc.) However we have data proving that reduction in driving results directly in reduced death. (Note the population increased between 2007 and 2010, but driving was reduced). From the plain objective of reducing preventable death, reducing drving/traffic would accomplish that. Please don't infer I or Ken or anyone else is screaming "get rid of cars -outlaw driving!!!!!". No one said that or implied it. The message is that a reduction in driving translates directly in reduced deaths, followed by the question "why don't public health professionals point that out?" Thats all.

by Bianchi on Jul 27, 2010 4:13 pm • linkreport

"...increased enforcement against idiots". Oh yes. I concur. Whats the roadside test for this?

by Bianchi on Jul 27, 2010 4:15 pm • linkreport

Why don't they also point out that bike riding is risky, then?

The death rate per vehicle mile is a lot higher than in cars.

What about hang gliding? Being a firefighter?

It's just not their job. It's that simple.

by Jamie on Jul 27, 2010 4:16 pm • linkreport

"Why don't they also point out that bike riding is risky, then?" They do! Its no accident that helmet use has increased substantially from 1980 to 2010 for instance.

by Bianchi on Jul 27, 2010 4:19 pm • linkreport

http://www.maine.gov/dhhs/bohdcfh/inj/fs_bicycle.html

by Bianchi on Jul 27, 2010 4:21 pm • linkreport

... and they also tell you to wear a seatbelt and put your kid in a child restraint.

Apples and apples. If you want them to lobby against driving, generally, because it is an activity that you believe is inherently risky, then you should absolutely want them to advise people not to bike at all, since it's somewhere between 3 and 12 times as dangerous per vehicle mile.

by Jamie on Jul 27, 2010 4:21 pm • linkreport

"...it's somewhere between 3 and 12 times as dangerous per vehicle mile." Well heres the rub: its car traffic that makes biking dangerous.

by Bianchi on Jul 27, 2010 4:25 pm • linkreport

"Well heres the rub: its car traffic that makes biking dangerous."

And it's the muggers that make living in the city dangerous. It's the trees that make skiing dangerous. So what? Should we tell people to be alert and not walk around late at night by themselves, or not live in cities?

by Jamie on Jul 27, 2010 4:29 pm • linkreport

@Bianchi: Roadside test for idiots - If you're driving and on a cell phone, you get a big ticket. If you're driving and shaving, cooking, cleaning, or otherwise doing another task at the same time, you get a big ticket. There's plenty that can be done on that end, if cops really wanted to crack down on it.

And re: Helmet use -- Why doesn't every state require mandatory use of bike helmets for all cyclists?

by Fritz on Jul 27, 2010 4:32 pm • linkreport


When Ronald Reagan was elected in 1980 (and METRO was just four years old) Americans drove their cars about 6000 miles per capita. Today annual vehicle miles traveled are about 10,000. That is a 60% increase over four decades.

What was our country like back then? Did we live in some car-averse, public transportation 'utopia'?

Of course not. The country was much as it is now:
- 86% of commuters drove to work (88% now)
- 73% of the population was urban (78% now)
- 13% of households had no car (10% now)
- 2.7% of trips were made using public transit (2.27 % now)
- there were about 8 million lane miles of public road (8.5 now)

We just drove less. We hadn't yet turned the interstates into our main streets, and sprawling suburbs into our standard form of built environment.

If we drove now as we did back in 1980 (but in today's safer cars) our annual traffic fatality level would be about 22,000 rather than today's 37,000 (for a traffic fatality rate of about 7.3 per 100,000, comparable to other western industrialized countries).

To reiterate the point of the post: Because policymakers have not focused on curbing VMT as a matter of public health policy, tens of thousands of people have died in traffic accidents who wouldn't have.

by egk on Jul 27, 2010 4:40 pm • linkreport

You forgot to mention that it started dropping again in 2007.

"Because policymakers have not focused on curbing VMT as a matter of public health policy..."

You say that like if some bureaucrat had just made some pamphlets, we could have altered 30 years of post-industrial development in the richest nation in the world. Because everything that happened since 1980 has been part of some grand, well-thought-out plan that was completely in the control of a small number of individuals.

The reasons behind the number of miles driven for the last 30 years might, just maybe, be a little more complicated than that.

Anyway, along those lines, I'm sure glad that they invented the internet, because if they had not done that, then probably we'd still be on the rise for VMT. Good job, Al Gore! Or something.

by Jamie on Jul 27, 2010 4:51 pm • linkreport

@Jamie: Of course our current transportation system is the result of a complex process, with economic, political and social factors interacting in a multitude of ways.

The point of the post is that NO PART of that complex process has involved the recognition that driving is inherently dangerous (even with all the safety mitigation we have done) and that therefore it is good public-health policy to limit exposure to this risk.

The point of my comment is that we don't need to imagine a wildly different America to think about what a lower-VMT USA would look like.

(BTW VMT is back up this year...)

by egk on Jul 27, 2010 5:59 pm • linkreport

@egk - nicely presented stats and simplicity of point.
The point of my comment is that we don't need to imagine a wildly different America to think about what a lower-VMT USA would look like.
ahh. morning in America again...

by Bianchi on Jul 27, 2010 6:05 pm • linkreport

@Ken Archer: NIH is not a public health agency. It funds clinical and basic research. CDC is a public health agency, but it's primary partners are state and local health departments, for whom road systems are largely outside their jurisdiction. Do a campaign? At best, it may temporarily raise awareness, but behavior change is unlikely, esp. lasting behavior change.

The likely partners for this? Depts of transportation, law enforcement and non-profits like insurance-sponsored bodies and the safety council. health depts might be interested in states and large cities/counties, but otherwise, probably not so much--their basic functions like vaccination are constantly under budgetary attack. The question would be who comes up with the money? The policy solutions will vary depending on density, infrastructure, etc. There are probably natural experiments and other on the shelf data that could jump start the process.

Stay away from bromides or slogans. Saying NIH should do something about this just shows a naivety about how the world works. Campaigns--a naivety about how behavior gets changed.

by Rich on Jul 27, 2010 8:45 pm • linkreport

I only mentioned NIH in reference to their MedlinePlus public health project to which I linked in the post.

And, campaigns have changed behavior related to seat belts and child restraints. Given the rampant misinformation amongst parents that dense areas are less safe for children, why wouldn't an information campaign to the contrary be justified? Besides the reductions in VMT, however small, it brings about by parents it would also provide a very credible public health basis for appealing to the DOTs and zoning commissions to change their land use patterns.

by Ken Archer on Jul 27, 2010 8:55 pm • linkreport

"This is the mindset that I don't understand. We're talking about the #1 killer of children here and everywhere. How much is too much to spend?"

$2m/child killed, say. So come up with any solution that when imposed costs society less than $2m and saves one child's life. So, let's look at an example. How about guard rails along all sidewalks within a mile of elementary schools. Bet that costs $100m+, more likely in the billions. If that saves 50 lives, then lets do it. If not, too expensive.

You can go on, but you can't say do everything possible, money is no object. Because money is an object, and whether it's the government spending on it (instead of bike lanes, HIV vaccines, world hunger) or people spending it in the form of increased actual costs for vehicles (soft foam padding on all body panels) or increased implicit costs (time waiting in traffic; increased commute times generally) you have to consider the costs and whether it's worth the benefits.

by ah on Jul 27, 2010 9:17 pm • linkreport

There seem to be two issues on this thread, which became conflated. First we have the ever-present issue of reducing driving, for which child deaths are the factoid-of-the-day in support on an argument that several people would make without that fact. Solving that problem is a political question, not one that the bureaucracies--especially health and safety bureaucracies--are authorized to solve.

Second, we have the issue of reducing child injuries in traffic. Although that was the issue on the post, few if any commentators seem interested in efforts focused on children. Rather they use children as an indicator species for the broader issue. But that issue might actually be within the power of the bureaucracies to address. Public health agencies could provide advice on simple matters to reduce risk to children from driving (though the post seems to donwplay their importance) and the transportation/planning agencies could tweak their budgets and policies (e.g. the example of counting children for purposes of HOV, complete streets in areas where children walk, more traffic calming, and many others that people could enumerate were they interested).


Can anyone explain, for example, why pre-schools and schools can tranport todders with just seatbelts and kindergardeners without even a seatbelt while a parent who did so would be committing a crime? Is a child on a bus without a restraint really safer than in a car with a restraint?


by Jim Titus on Jul 28, 2010 8:38 am • linkreport

A week ago the CDC released a study that "reveals a powerful link between poverty and HIV risk" according to Kevin Fenton, the director of the CDCÂ’s AIDS center.

Is that lobbying? Where is the CDC study revealing the powerful link between VMT increases and the #1 killer of Americans age 1-34?

by Ken Archer on Jul 28, 2010 10:15 am • linkreport

@Ken Archer--you obviously don't know your history or the data behind the soundbites you quote, just as you are not aware of who has jurisdiction for what. And you've really gotten into deep weeds with the the HIV quote. Do some homework, then try to jawbone us. Note to David--find someone who does their homework before wasting space like this.

Campaigns had neglible long-term effects on seatbelt use. Making it illegal to drive w/o a belt lifted usage from 20-30% to nearly 100% in urban areas. Ditto child restraints.

The link between poverty and HIV is far from linear. Internationally, there are very poor places with neglible HIV prevalence. HIV often folows development. The same pattern repeats in the US--many very poor places with little HIV. HIV follows drug trafficking routes internationally and domestically. It is disproportionately more common in low uincome areas, but this is conflated with race and sexual and drug use networks.

by Rich on Jul 28, 2010 1:13 pm • linkreport

Rich,

Your comment is completely inappropriate and as a regular commenter, I know you know that. It's not appropriate on this forum to make a bunch of statements like "you don't know what you are talking about."

Ken is extremely thoughtful and knowledgeable about the topics he writes. However, even if he weren't, this blog would have about one post per month if every post had to be held to the standard of the writer having researched every particular detail of everything that any commenter might choose to pick on.

I'd much sooner get rid of you than him, and I'm seriously considering it. Knock it off, now.

by David Alpert on Jul 28, 2010 1:24 pm • linkreport

@Rich - care to share your public health credentials?

I found Ken's suggested perspective of exposure to the risk factor very refreshing and innovative, especially since this perspective could intersect with programs to increase mode share aimed at achieving other public health goals (namely increasing physical activity for the purpose of preventing a host of chronic diseases, among them epidemic diabetes).

Regarding "jurisdiction", NIH, CDC, US Surgeon General, FDA, etc. -are all headed by HHS -and all are public health institutions with the same generalized goal -improving/protecting the publics health.

If you don't think informational campaigns work then I suggest you need more information. Please take a look at the CDC's Guide to Community Preventive Services for physical activity as an example, and at the same time ask yourself why both the "Back to Sleep" informational campiagn has succeeded in increasing the proportion of babies regularly put to sleep on their backs (reducing risk for SIDS) and why regular condom use has increased since 1985. Niether of those behaviors are associated with law enforcement.

by Bianchi on Jul 28, 2010 5:26 pm • linkreport

Ken your article is really great. You are a good writer. A traffic reduction I needed. I wrote some of the comments and one statement attracted my attention - "New drivers are the worst/most dangerous drivers.". Do someone has an information what statistics show about the relevance between the age of the driver and the number of accidents he/she attends in. I consider that old people are sometimes more dangerous. This a statistics I found. i know it is very old and I'm sorry about this but I believe that the situation is not much different now.

by Chiswick cleaning on Jul 29, 2010 7:35 am • linkreport

Thank you. There comes a point where our willingness to acknowledge the causal connection between rising VMT and the leading cause of death in children is a matter of simple intellectual honesty. The Director of the Victoria Transport Policy Institute assumed this would be included in the WHO report I link to, and encountered the following opposition.
A few years ago, as a contributor to the World Health Organization’s 2004 “World Report on Road Traffic Injury Prevention” I was criticized by some team members (particularly those from the U.S.) for suggesting that mobility management should be included among the report’s safety strategy recommendations. These experts prefer to measure risk per unit of vehicle travel (per 100 million vehicle-miles or billion vehicle-kilometers) rather than per capita. When measured this way, traffic crashes have declined significantly over the last half-century, implying that current safety programs have been effective and should be continued. However, when measured per capita (per 10,000 residents), crash rates have hardly declined at all during the same period, despite huge increases in seatbelt use, reduced drunk driving, improved vehicle and roadway design, and better emergency response and medical treatments. As a result, although the U.S. has one of the lowest crash fatality rates per vehicle-mile, it has one of the highest rates per capita among OECD countries, indicating that current strategies have failed and new approaches are needed to truly increase traffic safety.
As for the age of the driver, drivers become much safer after age 24.

by Ken Archer on Jul 29, 2010 8:01 am • linkreport

Thanks for the fast response. These documents are interesting. The number of accidents of drivers under 16 is disturbing. as written: "Rates for drivers under age 16 are substantially overstated due to the high proportion of unlicensed drivers involved." There are not enough measures obviously.

by Chiswick cleaning on Aug 2, 2010 5:47 am • linkreport

A lot of the legislation and "improvements" to traffic and car safety fail to address the true problem-- bad drivers. Auto accidents are not caused from airbag failure or lack of safety restraint- they are caused by driver inattention and irresponsibility. Although increasing vehicle safety does help save lives- maybe we should focus our efforts on reducing the accidents that take these lives. The first step in saving lives in awareness and increased education starting from the teen years. Teenage drivers have an absurd chance of being involved in an accident simply because they are inexperienced- mandating increased driver training and more intense drivers ed courses will help dramatically.

Parents need to be aware and spend ample time talking to their teens about safe driving and teaching them proper driving habits-- practice may not make perfect, but it will make them better. You can view some great tools for teaching your teen how to drive, preparing them for the road and talking to them about drunk driving at my website: http://www.plg-pllc.com/resources/parent-resources/.

The first step in decreasing traffic fatalities is decreasing the accidents that cause them.

by Personal Injury Lawyer| Jason Epstein on Aug 26, 2010 2:22 pm • linkreport

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