What We Might Learn From Automobile Safety

One of the major advancements in public health has been the decrease in mortality from automobile accidents, as seen in this graph.

This achievement took action on part of engineers, behavioral psychologists, law enforcement, and countless other individuals working together to create a desired effect. For instance, below is a video from the National Highway Transportation Safety Administration (NHTSA) showing the result of a 1959 Bel Air automobile crashing into a 2009 Chevy Malibu. Although the Chevy Malibu is a smaller car, the passenger in the Malibu is much more likely to survive a crash than the passenger in the larger Bel Air. This occurred largely secondary to the impact of improved seat belts, improved crunch zones, and air bags.

Let’s break down how some of this achievement in decreasing automobile fatalities occurred. Here is a graph showing how seat belts (particularly shoulder-restraint rather than lap belts) saved lives, as well as the potential impact from air bags.

 

Further, behavioral modification changes such as greater criminalization of drunken driving have also decreased mortality.

We still have significant challenges, such as the increase in distracted driving by people texting or using their phone to search the internet, the potential increase in death rates from higher speed limits, the potential increase in marijuana-related accidents, and the challenge to decrease mortality from more fuel efficient cars that are often made with less steel. But these are seen as process-oriented problems with a hope for process-oriented solutions.

In short, this improvement in automobile fatalities occurred because many bright people from different fields worked together to help create a desired outcome.

But what would have happened if we just left the outcome to the individual buyer or driver of the car? Would the outcome have been as positive?  What if the buyer were given the option not to purchase that annoying beep when you don’t buckle your seat belt? Or if he/she could have paid a little less money not to have seat belts or air bags?

Yet when it comes to public health, we often state, “Well, it’s up to the individual.” Is this the best way to effect behavioral change? As a country, it is estimated that our obesity rate will be 42% to 50% by 2030. How will we pay for the increased health care costs that wlll result? If we have an outcome we desire as a population, for the individual and society, such as decreased obesity, why don’t we have thought leaders from many disciplines -– healthcare providers, industrial engineers, city planners, nutrition specialists, exercise physiologists, restaurateurs, farmers, basic scientists working on human homeostasis -- all work together to help generate the desired outcome?

Perhaps we may have better opportunity to effect the behavioral change desired if we create cities where people want to walk around, create communities that foster social interaction in healthy behaviors, create more nutritious fast food meals that are satisfying yet low in calories, and work together to decrease the burden for individuals and for society.