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2 World and U.S. Safety Trends C hapter 1 explained that the safety programs of other countries seized the attention of U.S. safety professionals and advocacy groups because of impressive declines in numbers and rates of traffic fatalities relative to U.S. experience. In this chapter, the first section compares traffic safety trends of the United States and other countries over the past 40 years. The second compares trends among U.S. states, since the performance of the best states might also be a useful benchmark for judging U.S. safety programs, along with the best performances among other countries. The third section reviews studies that used statistical methods to explain why some countries and states have performed better than others. The final section presents a more detailed characterization of the U.S. traffic safety problem, describing how risks differ among categories of roads, vehicles, regions, and drivers. WORLD FATALITY RATE TRENDS Nations differ greatly in traffic fatality rates (per capita and per vehicle kilometer) and in trends in rates over time. They differ also in practices with regard to driver and vehicle safety regulation and enforcement and road construction. The relative success of the different policies cannot be inferred by examining the aggregate fatality rate data alone because many factors other than government policies affect the trends. Nonetheless, the trends measure overall progress in reducing risk and naturally have led policy makers to ask whether lessons applicable to the less successful jurisdictions can be learned from the experiences of those that are more successful. Most of the comparisons in this chapter are in terms of fatality rates per kilometer of vehicle travel. Comparisons of rates of injuries and total crashes would also be valuable, but comparable international data on these measures do not exist. Box 2-1 explains why rates per vehicle kilometer are useful measures for comparisons. When fatality rates for high-income and low-income countries over many years are compared, a pattern emerges of rising per capita fatality rates in the earlier stages of motorization of transport, followed by falling rates in the later stages. Because motorization rises with income, fatalities per capita tend to increase with increasing income among countries with low to medium income per capita, and then to decline with increasing income among countries with medium to high average incomes (Figure 2-1). For example, from 1975 to 1998, reported road traffic deaths per capita declined by 43 percent in France and 27 percent in the United States but rose by 79 percent in India (1980–1998) and 243 percent in China (Kopits and Cropper 2005a, 170). In the poorest countries, only a small proportion of trips is by motor vehicle, and deaths are relatively rare. However, fatality rates per vehicle kilometer of travel are high for several reasons: the condition of infrastructure and vehicles may be poor; road users and authorities lack experience; and on roads where motor vehicles mix with many pedestrians and cyclists, deaths of pedestrians and cyclists are a large share of the total. 27

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28 Special Report 300: Achieving Traffic Safety Goals in the United States: Lessons from Other Nations Box 2-1 Measures for International Comparisons of Safety Performance Some analysts have argued that total fatalities or casualties or per capita rates are more suitable measures than rates per vehicle kilometer for benchmarking safety performance or for defining safety goals. For example, the Organisation for Economic Co-operation and Development’s Working Group on Achieving Ambitious Road Safety Targets avoids reporting crash rates per vehicle kilometer, explaining (OECD and International Transport Forum 2006, 8): The relative progress in road safety depends somewhat on what one uses as a measure of exposure to risk (i.e., population, registered vehicles, distance travelled). There has been a considerable debate in the past about which measure is most appropriate as an exposure measure. Those in the health sector prefer the use of population as the denominator since it permits comparisons with other causes of injury or with diseases. As the health and transport sector increase their level of co-operation, fatalities per 100 000 population are becoming more widely used. In the transport sector, it has been common, where data are available, to use fatalities per distance travelled (e.g. fatalities per million vehicle-kilometres) as a principal measure or fatalities per 10 000 vehicles. Fatalities per distance travelled has traditionally been favoured by road transport authorities as it implicitly discounts fatality rates if travel is increased. Objections to the use of rates per vehicle kilometer to measure safety have been strongly stated, for example as follows (Richter et al. 2001): The use of [deaths per vehicle mile] as the criterion implicitly endorses an ethically problematic paradigm that weighs the benefits of transportation—time saved—against the losses—deaths and injuries. If we use absolute numbers, we hold that individuals should not be sacrificed for collective benefits. . . . The use of time trends in [deaths per vehicle mile] within one mode of travel precludes examining alternative strategies based on shifts to public transport, a mode usually with much lower risks. In this report, international and interstate comparisons are expressed in terms of rates per vehicle kilometer and of total numbers of fatalities. One of the goals of public policy concerning road safety is to reduce the risk of road travel. The road-using public expects government authorities to provide safe roads. Crash and fatality rates per unit use of the road system (e.g., per vehicle kilometer) are measures of this risk. (In contrast, few people would argue that reducing tobacco-related fatalities per cigarette smoked should be a goal of health policy.) Observing rates, and not just numbers of crashes, is essential in determining the effectiveness of most of the safety measures that road authorities have at their disposal. The reductions in total annual fatalities in the benchmark nations are the consequence of declining rates of fatalities per vehicle kilometer, not of declining use of the roads in those countries. This rate decline is therefore the phenomenon that must be understood if the United States is to take advantage of other countries’ experiences. (continued)

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World and U.S. Safety Trends 29 Box 2-1 (continued) The number of fatalities per vehicle kilometer is an imperfect measure of road travel risk. Data on rates for all crashes and for injury crashes by severity would be more useful in examining the effects of safety programs, but these data are not available on a consistent basis internationally. In addition, aggregate annual rates for entire national or state road systems hide important geographical and temporal differences. In wealthier countries, most trips are by motor vehicle, and thus deaths of persons who are not motor vehicle occupants are a smaller proportion of total traffic deaths than in low- income countries. Also, vehicle occupant fatalities per vehicle kilometer decline, presumably because infrastructure and vehicles become safer, drivers become more skilled, traffic regulation becomes more effective, and increasing vehicular congestion in cities slows speeds and thus reduces crash severities. Eventually fatalities per vehicle kilometer decline enough that fatalities per capita begin to fall. The negative correlation between degree of motorization and national traffic fatality rate is known as Smeed’s law and has long been a subject of study and controversy (Adams 1987). Fatality rates per vehicle kilometer have declined greatly in every high-income country in the past several decades (Figure 2-2a, Table 1-1), and the absolute disparity of rates among countries has lessened (Figure 2-3). A comparison of the U.S. experience with that of 15 other high-income countries for which 1975–2008 data are available shows that the U.S. fatality rate was less than half the aggregate rate in the other countries in 1975 but has been higher since 2005 (Figure 2-2c). Consequently, total annual traffic deaths in the 15 countries fell by 66 percent in the period, while U.S. deaths fell by only 16 percent. The U.S. fatality rate was among the best before 1990 but has been below the median rate of the group every year since 2001. 0 5,000 10,000 15,000 20,000 25,000 Per Capita GDP, 1985 dollars FIGURE 2-1 Traffic fatality rate per capita versus income, 88 countries, 1963–1999. (SOURCE: Kopits and Cropper 2005a.; copyright, Elsevier; used with permission.)

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30 Special Report 300: Achieving Traffic Safety Goals in the United States: Lessons from Other Nations 10 9 8 7 fatality rate (per 100 million vehicle-kilometers ) 6 5 4 3 2 1 0 1965 1970 1975 1980 1985 1990 1995 2000 2005 Australia Austria Belgium Czech Republic Denmark Finland France Germany Great Britain Japan Netherlands Norway Slovenia Sweden Switzerland United States 1.8 1.6 1.4 fatality rate (per 100 million vehicle-km) 1.2 1 0.8 0.6 0.4 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Australia Austria Belgium Denmark Finland France Germany Great Britain Japan Netherlands Norway Slovenia Sweden Switzerland US (a)

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World and U.S. Safety Trends 31 70,000 7000 60,000 6000 50,000 5000 annual vehicle-km (billions) annual fatalities 40,000 4000 30,000 3000 20,000 2000 10,000 1000 0 0 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 year fatalities, 15 countries (not including US) fatalities, US vehicle-km, 15 countries vehicle-km, US (b) 5 4.5 4 3.5 fatalities/100M vkmt 3 2.5 2 1.5 1 0.5 0 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 year fatalities/100M vkmt, 15 countries fatalities/100M vkmt, US (c) FIGURE 2-2 (a) Fatality rates per vehicle kilometer, selected high-income countries, 1965– 2005 and 1997–2008. (b) Annual traffic fatalities and vehicle kilometers, United States and 15 other high-income countries, 1975–2009. (c) Fatalities per 100 million vehicle kilometers, United States and 15 high-income countries, 1975–2008. Note: Countries included in Figures 2-2b and 2-2c are Australia, Austria, Belgium, Denmark, Finland, France, Germany, Great Britain, Israel, Japan, Netherlands, Norway, Slovenia, Sweden, and Switzerland. (SOURCES: OECD n.d.; OECD and International Transport Forum 2010.)

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32 Special Report 300: Achieving Traffic Safety Goals in the United States: Lessons from Other Nations 7 6 number of countries 5 4 3 2 1 0 0-0.2 0.2-0.4 0.4-0.6 0.6-0.8 0.8-1.0 1.0-1.2 1.2-1.4 1.4-1.6 1.6-1.8 1.8-2.0 2.0-2.2 2.2-2.4 >2.4 fatalities per 100M vehicle-km 1994 2007 FIGURE 2-3 Distribution of fatality rates of 16 high-income countries, 1994 and 2007. Note: Countries are as in Figure 2-2, including the United States. (SOURCE: OECD n.d.) The roughly exponential shapes of the fatality rate time trends and the bunching of national fatality rates in the 0.6 to 1.0 range in recent years (Figure 2-3) suggest the possibility that, as rates become lower, it becomes more difficult to obtain further reductions comparable in absolute terms with the reductions of earlier decades. According to this interpretation of the trends, U.S. improvement has been slow because the U.S. rate was already low 30 years ago, and other countries have been able to improve more rapidly because improvement is easier when the starting point is a relatively high fatality rate. These curves suggest at least that some underlying universal phenomena have driven fatality rate trends toward convergence. It may be speculated that the improvement reflects a learning process by all the agents—drivers, nonmotorized road users, road authorities, health services, and law enforcement and public safety agencies—within the road transportation system as that system develops and matures in a country. In the 1960s, U.S. highways, vehicles, and travel patterns differed greatly from those of most of the benchmark countries. Today, the differences persist but have narrowed. However, the experience of the past decade no longer appears to fit this description of convergence to similar, stable fatality rates. In a group of countries that includes the United Kingdom, Sweden, Norway, Finland, the Netherlands, Switzerland, West Germany, and Australia, the fatality rate per vehicle kilometer was close to or lower than the U.S. rate in 1997, yet each achieved a greater percentage improvement in its rate than did the United States in the 1997–2007 period (Figure 2-2a). In this period, every high-income country shown in Figure 2-2 has reduced its fatality rate by a greater percentage than has the United States. Improvement in fatality rate in the decade is only weakly correlated with the level of the 1997 rate among high- income countries (Figure 2-4).

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World and U.S. Safety Trends 33 Fatality rates of 16 countries: average annual percent change 1997- 2007 versus 1997 rate 1997 fatality rate (fatalities/100 million vehicle-km) 0 0.6 0.8 1 1.2 1.4 1.6 1.8 2 2.2 2.4 2.6 2.8 3 3.2 3.4 average annual % change in rate, 1997- -1 USA -2 -3 2007 -4 -5 2 R = 0.28 -6 -7 -8 FIGURE 2-4 Fatality rates of 16 countries: average annual percentage change for 1997– 2007 versus 1997 rate. The countries included are as in Figure 2-2. (SOURCE: OECD n.d.) U.S. STATE FATALITY RATE TRENDS If fatality rate trends can be used as indicators of jurisdictions with relatively successful government safety programs, then comparisons of trends among the U.S. states might have at least as much relevance as comparisons of the United States with other countries. The states independently manage their traffic safety programs [although with a degree of central control through federal-aid highway program rules and National Highway Traffic Safety Administration (NHTSA) regulations] and are diverse with respect to demographics, geography, and transportation system characteristics. The pattern of fatality rates among the states in some ways mirrors that of the high- income nations. The 2007–2008 average rate varied among the states from below 0.5 deaths per 100 million vehicle kilometers in Massachusetts and Rhode Island to 1.3 in Louisiana and 1.4 in Montana (Figure 2-5). Similar to the distribution of national rates, the distribution of state fatality rates (Figure 2-6) shows a shift toward lower rates and a bunching of rates in the 0.6 to 1.0 range over the past decade. The rates of four states (Massachusetts, Rhode Island, Minnesota, and New Jersey) were lower in 2008 than that of any of the countries of Figure 2-2. It is in the speed of improvement in highway safety that the experience of the states differs from performance abroad. Few states could match the 4 to 6 percent annual reductions in fatality rates that many high-income nations achieved in the period 1994–2008 (Figure 2-7). Figures 2-8 and 2-9 show fatality rate trends for selected states that improved more slowly (Figure 2-8) and more rapidly (Figure 2-9) than the U.S. average in the past decade. The five states included in Figure 2-8 are those with the smallest percentage declines in the period among all states with above-average 2008 fatality rates, excluding states with fewer than 300 traffic deaths in 2008. The five states included in Figure 2-9 are those with the greatest percentage declines in the period among all states with below-average 2008 fatality rates, excluding states with fewer than 300 traffic deaths in 2008.

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34 Special Report 300: Achieving Traffic Safety Goals in the United States: Lessons from Other Nations FIGURE 2-5 State fatality rates per 100 million vehicle kilometers, 1994–1995 and 2007–2008. (SOURCE: NHTSA n.d.) 18 16 14 number of states 12 10 8 6 4 2 0 0-0.2 0.2-0.4 0.4-0.6 0.6-0.8 0.8-1.0 1.0-1.2 1.2-1.4 1.4-1.6 1.6-1.8 1.8-2.0 2.0-2.2 2.2-2.4 >2.4 fatalities per 100M vehicle-kilometers 1994-1995 avg. 2007-2008 avg. FIGURE 2-6 Distribution of U.S. state fatality rates, 1994–1995 average and 2007–2008 average. (SOURCE: NHTSA n.d.)

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World and U.S. Safety Trends 35 25 20 number of states 15 10 5 0 7 annual percent reduction 5 number of countries 4 3 2 1 0 7 annual percent reduction FIGURE 2-7 Distribution of average annual percent reductions in fatality rates of U.S. states (top) and of 16 high-income countries (bottom), 1994–2008. Note: In bottom graph, countries are as in Figure 2-2, including the United States. Values for Great Britain and Netherlands are for 1994–2007. (SOURCES: NHTSA n.d.; OECD n.d.) SOURCES OF DIFFERENCES IN THE TRENDS Safety researchers have attempted to understand the sources of differences in safety performance among countries and among the U.S. states by looking for correlations between crash frequencies or rates and the characteristics of the jurisdictions (including road conditions, safety policies, and demographic and economic factors) that are suspected to influence crash risk. A second research approach to this question is to measure the impacts of particular safety interventions directly and then to judge whether the measured program effects are large enough to explain the overall trends. Studies taking the latter approach to evaluate safety programs in France, Australia, and the United Kingdom are described in Chapter 3.

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36 Special Report 300: Achieving Traffic Safety Goals in the United States: Lessons from Other Nations 1.6 1.5 1.4 1.3 fatalities per 100M vehicle-km 1.2 LA 1.1 WV KY 1.0 SC PA 0.9 USA 0.8 0.7 0.6 0.5 0.4 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 year FIGURE 2-8 Fatality rates, selected states with 2008 rate higher than the U.S. average and with smaller than average rate declines since 1994. (SOURCE: NHTSA n.d.) 1.6 1.5 1.4 1.3 fatalities per 100M vehicle-km 1.2 MI MN 1.1 IL CO 1.0 NY USA 0.9 0.8 0.7 0.6 0.5 0.4 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 year FIGURE 2-9 Fatality rates, selected states with 2008 rate lower than the U.S. average and with greater than average rate declines since 1994. (SOURCE: NHTSA n.d.)

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World and U.S. Safety Trends 37 In general, the statistical studies take the following factors into consideration in their crash risk models: • Traffic characteristics, including the mix of pedestrians and vehicle types sharing the roads, the degree of congestion, and speeds; • Demographics: higher crash rates are expected among younger populations; • Land use: urban and rural areas may have differences in risks; • Road design standards and maintenance standards; • Motor vehicle characteristics and condition, including the average age of the fleet and the presence of passenger restraints; • Prevalence of alcohol abuse in the population of the jurisdiction; • Driver behaviors: the prevalence of drunk driving, the rate of seat belt use, speed, and respect for speed and other traffic laws; • Quality of medical services; and • Government safety policies, including vehicle and road design standards, traffic regulations, enforcement practices, and education and communication activities, which may influence all of the factors listed above. The high-income countries are diverse with respect to geography, population density, and transportation habits. These differences affect the risks that road users confront. As one example, in Japan and the Netherlands, pedestrians and cyclists make up a greater share of all persons killed in crashes than in the United States (Table 2-1 and Figure 2-10). Although exposure data are not available, it is likely that the differences shown in the table and figure primarily reflect differences in exposure: a much larger share of all road travel occurs on roads where motor vehicles are mixed with high volumes of bicycle travel in the Netherlands than in the United States. Such differences are likely to affect trends in fatality rates, but in complex ways. Trends will be affected by changes in transport habits (e.g., trends in the relative use of bicycles and motor vehicles), and the differences will affect the relative magnitudes of the impact of various interventions. For example, the emphasis in the Netherlands on pedestrian and bicycle safety reflects the high share of deaths in those user categories. TABLE 2-1 Fatalities by Category of Road User (Percentage of Total Traffic Fatalities) Japan 2005 Netherlands 2007 United States 2007 Motor vehicle occupants 40 46 74 Bicycle riders 12 24 2 Motorcycle and moped riders and passengers 17 8 13 Pedestrians and other nonoccupants 31 12 12 SOURCES: Cabinet Office 2006, 9; SWOV n.d.; NHTSA 2008.

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40 Special Report 300: Achieving Traffic Safety Goals in the United States: Lessons from Other Nations measures of these factors would be difficult but might allow this kind of analysis to shed more light on the importance of policy interventions. The World Bank study findings are consistent with those of an earlier statistical comparison of traffic fatalities among OECD countries using annual data for 21 countries from 1980 to 1994, which related deaths in each year in a country to demographic characteristics, vehicles per capita, and alcohol consumption per capita (Page 2001). Fatalities were found to increase with the percentage of young people in the population, alcohol consumption, and percentage of the population employed, and to decrease with the percentage of the population that is urban. The author proposes that the difference between a country’s actual trend in fatalities over the period and the trend predicted by the statistical model is an indicator of the effectiveness of the country’s safety interventions. Because the analysis does not include data on safety effort, conclusions from its results concerning the effectiveness of country safety programs are speculative. Interpretation of the statistical results is problematic because data on vehicle kilometers of travel were not included in the analysis. Sources of Differences Among Fatality Rates of States and Local Areas The Insurance Institute for Highway Safety study used statistical methods to search for causes of the disparity in highway fatality rates among U.S. states (O’Neill and Kyrychenko 2006). As described above (and shown in Figure 2-5), the states with the highest rates have more than twice as many fatalities per kilometer of travel as the states with the lowest rates. The data examined were total fatalities and passenger vehicle occupant fatalities per billion vehicle miles of travel for 3 years combined (2001 to 2003) in each of the 50 states. The study tested whether the differences in fatality rates (annual state total traffic fatalities per vehicle mile) among the states could be accounted for by differences in characteristics of the populations and transportation systems: population density, the percentage of the population that is urban, percentage age 16 to 20, median income, percentage with college degree, school spending per pupil, highway traffic density, and average vehicle age. For example, since rural road fatality rates are higher than urban rates nationwide, a state with a high percentage of urban travel would have a lower total fatality rate than a more rural state, even if the two states had identical rates on urban roads and on rural roads. The analysis showed that most of the variation in fatality rates among the states could be explained by differences in these characteristics and that statistical models using the characteristics could fairly accurately predict the fatality rate ranking of each of the states. States with a higher percentage of urban population, higher population density, higher traffic density, higher incomes, and fewer young people had lower fatality rates. The authors conclude that “crash death rates are strongly influenced by factors unrelated to highway safety countermeasures. Death rates should not be used . . . to assess overall highway safety policies, especially across jurisdictions. There can be no substitute for the use of . . . scientific evaluations of highway safety interventions that use outcome measures directly related to the interventions” (O’Neill and Kyrychenko 2006, 307). The study shows how demographic factors influence state-level accident rates, but its results are not conclusive on the question of whether differences among the states in safety policies have affected their relative success in improving highway safety, and the study certainly is not intended to imply that safety policies do not matter. The inclusion of policy-related factors (e.g., the quality of the state’s roads or the intensity of enforcement) in the statistical analysis

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World and U.S. Safety Trends 41 might reveal that such factors account for a measurable share of the fatality rate differences among the states. The second study of differences among the states (Noland 2003) focused on how improvements in road infrastructure have affected traffic fatalities and injuries and considered the effects of demographics, seat belt use, alcohol consumption, and quality of medical services. Road improvements have always been an important element of U.S. safety programs. Roads built to high design standards (for example, the Interstates) have lower average fatality rates than roads of lower classes, so the expectation has been that upgrading the road system would improve safety. The study used data on annual injuries and fatalities and on various explanatory factors for each of the 50 states for 1985–1997. Road infrastructure was measured by data on lane miles by lane width and road class, excluding local roads. The statistical analysis also considered measures of seat belt use (belt use rates reported by NHTSA and whether a primary seat belt use law was in effect), demographics (state population by age cohort), quality of medical services (infant mortality rate and hospitals per square mile), and per capita alcohol consumption. The study concluded that there are no consistent safety benefits from improving road infrastructure, as measured by extent, functional class, and lane width. Adding lane miles increased fatalities. Upgrading the functional class distribution had little effect on fatalities or injuries. A higher percentage of arterial and collector lanes with widths of 12 feet or greater was associated with an increase in fatalities and injuries. The author notes that all of these conclusions conflict with engineering conventional wisdom about the safety effects of geometric improvements but are consistent with other statistical studies. For example, an earlier statistical study (Fridstrøm and Ingebrigsten 1991, 370) using county-level data in Norway found that when traffic expands and road capacity remains constant, casualty crashes increase by only half the increase in traffic and so the crash rate declines, but when traffic volume and road capacity both expand at the same rate, crash rates are unchanged. This study, as did the World Bank study, used very approximate measures of some of the explanatory factors because no direct measure was available. The analysis did not use vehicle kilometers of travel as an explanatory variable because, the author explains, vehicle kilometers are highly correlated with population, which was included. The omission of vehicle kilometers from the model means that a plausible alternative explanation for the findings cannot be excluded—that is, that a larger stock of infrastructure is observed to be related to higher fatalities because more infrastructure indicates more travel rather than because more infrastructure increases the risk of travel. The age distribution of the population was found to have a large effect. When the percentage of the population between ages 15 and 24 years increases, fatalities and injuries increase. When the percentage of the population over age 75 increases, fatalities and injuries decrease, perhaps because this age cohort travels less by road. An increase in seat belt use and the existence of a primary seat belt law both are found to reduce fatalities, but seat belt usage does not affect injuries. Lower alcohol consumption reduces fatalities but not injuries. Improvement in the quality of medical services, as approximated by the infant mortality rate in the state, reduces fatalities but does not have a significant effect on injuries. This result reinforces the conclusions of other research (Zwerling et al. 2005), which found by a different analysis method that, when crash severity is controlled for, persons injured in rural crashes have a lower chance of survival than persons injured in urban crashes, and that this difference accounts for an important share of the difference between urban and rural fatality rates. The

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42 Special Report 300: Achieving Traffic Safety Goals in the United States: Lessons from Other Nations largest positive effects (as indicated by the numbers of 1985 fatalities that would have been avoided if the 1997 values of the variables had prevailed) in the Noland study were for seat belt use, age distribution, and alcohol consumption. The two U.S. studies summarized above are representative of numerous studies that have used data on fatality or casualty frequency in multiple U.S. states over a period of years to assess statistically the effects of particular interventions (e.g., seat belt laws) or to explore the possible causes of interstate differences in casualty frequency and rate. Another recent study in this group (Babcock and Gayle 2009) includes a literature review. In general, the studies find that external factors (e.g., demographic and travel characteristics) account for a large share of variation in casualties over time and among states and that a large share of interstate and temporal variation is unexplained by the factors considered. Some studies conclude that specific interventions are effective, but the effects usually appear to be small in comparison with the overall variation among states and over time. Concluding Observations None of the studies offers a satisfactory comprehensive explanation for the general pattern of declining and converging fatality rates among countries and among the U.S. states shown in Figures 2-2 and 2-6. However, a small number of factors appear to be important in driving the trends: • The aging of the populations of the high-income countries has reduced fatality rates. • Increasing congestion appears to reduce rates, presumably through its effect on speed. • Higher alcohol consumption and alcohol abuse in the general population lead to higher traffic fatality rates. • Higher seat belt use decreases fatalities. • Improved quality of medical services reduces fatality rates. The most important effect may be the speed and quality of emergency medical services, but the statistical studies were not refined enough to isolate this aspect of medical systems. A lesson that all the studies support is that differences in national- or state-level rates are imperfect indicators of successful safety policies, because differences in these rates reflect to a great extent differences in fundamental demographic, economic, and geographical circumstances. Therefore, to find the best international models for the United States to emulate and to draw the right conclusions from these models, detailed examinations of specific policies and programs—how they were implemented and the results they produced—will be needed. FACTORS AFFECTING U.S. FATALITY RATE TRENDS The previous sections identified characteristics of populations (especially the age distribution) and highway systems (including the distribution of traffic between urban and rural areas, which is an indicator of congestion, speed, and timeliness of emergency response, and the mix of kinds of motorized and nonmotorized vehicles and pedestrians on the roads) that influence fatality rates and trends. As an aid to interpreting U.S. trends, this section describes coincident trends in population age distribution, the urban and rural distribution of travel, and the mix of size and

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World and U.S. Safety Trends 43 types of vehicles on the roads. Chapter 4 will describe the U.S. incidence of high-risk behaviors (drunk driving, speeding, and failure to use occupant protection) that also influence trends and differences among countries. Demographics Research summarized in the previous section showed that countries with aging populations experience declines in highway fatality rates. U.S. drivers aged 16 to 20 years are involved in fatal crashes more than twice as frequently, per licensed driver in the age group, than drivers over age 35 (Figure 2-11). In the period 1997 to 2001, the fatal crash involvement rate per kilometer driven for drivers aged 16 to 20 years was 5 times the rate for drivers aged 45 to 54 years, and the rate per kilometer driven for drivers older than 75 years was nearly 4 times greater than the rate for drivers aged 45 to 54 years (GAO 2003, 18). Similar patterns probably hold in other countries. The median age of the U.S. population is lower than in most other high-income nations. This characteristic probably tends to elevate the U.S. fatality rate in comparison with other countries. However, the rate of aging of the U.S. population is in the middle of the range for high-income countries (Figure 2-12); therefore, differences in the rate of aging probably do not explain much of the difference between the United States and other countries in the rate of decline of crash rates in recent decades. Urban and Rural Travel One factor that can explain part of the variation in fatality rates across U.S. states is differences in the distribution of travel by road type and by urban versus rural setting. Fatality rates per vehicle kilometer are 2 to 3 times higher on roads in rural areas than on urban roads of similar design and function (Figure 2-13). Fatality rates on secondary roads (the collector and local classes in Figure 2-13) are 1.5 to 3 times higher than on roads built to Interstate highway standards (limited-access divided highways) (FHWA n.d.). Since the states differ in the fraction of travel that is urban and in the distribution of travel by road class, the differences in fatality rates shown in Figure 2-13 account for part of the variation in fatality rates across states. In particular, rural states tend to have high fatality rates. Some states in which both rural and urban rates are lower than the national averages have total rates above the national average because a high proportion of their travel is rural. Similar differences in the mix of travel by road type and land use, and trends over time in this distribution, probably account for some part of observed international differences in fatality rates and trends. The important policy problems are to determine why these differences by road type exist and what can be done to reduce fatality rates in the higher-risk road segments. Part of the difference in risk presumably relates to speeds (e.g., urban Interstates are more subject to congested, slower-speed operations) and to slower emergency response on rural roads. There may be other systematic differences among road classes in the frequency of alcohol-impaired driving, seat belt and helmet use, mix of vehicle types, and driver age distribution.

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44 Special Report 300: Achieving Traffic Safety Goals in the United States: Lessons from Other Nations 50 45 involvements per 100,000 drivers 40 35 30 25 20 15 10 5 0 16-20 21-24 25-34 35-44 45-54 55-64 65-74 >74 age FIGURE 2-11 Driver involvements in fatal crashes, per 100,000 licensed drivers, by age, United States, 2008. (SOURCE: NHTSA 2009, 100.) FIGURE 2-12 Median age in 2000 (top) and percentage change in median age between 1975 and 2000 (bottom) for various countries. (SOURCE: United Nations 2002, Annex III.)

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World and U.S. Safety Trends 45 2.5 fatalities per 100M vehicle-k m 2 1.5 1 0.5 0 Interstate Arterial Collector Local Rural Urban FIGURE 2-13 U.S. fatality rates by road class, 2007. Note: Arterials are roads designed to carry relatively high traffic volumes, usually at high speed. Local roads provide direct access to developed property and serve local trips; most are designed for relatively low volumes and low speeds. Collector roads are intermediate in function and design between local roads and arterials. (SOURCE: FHWA n.d.) Vehicle Mix The mix of vehicles in the United States has been changing over time and differs from that in many other countries. For example, in the United States, travel by light trucks (a category that includes light vans and sport-utility vehicles) has been growing more rapidly than that for passenger cars. The number of passenger cars involved in fatal crashes each year has been falling, while the number of light trucks involved increased from at least the 1970s until 2005 before beginning to decline. The number of motorcycles involved in fatal crashes increased sharply through 2008 (Figure 2-14). Motorcycle occupant fatalities declined from 2008 to 2009. Whereas fatal involvement rates for cars and light trucks have been falling, motorcycle fatal involvement rates have risen sharply since the late 1990s. NHTSA reports that the fatal crash involvement rate of motorcycles nearly doubled between 1998 and 2005 (from 14.1 to 27.8 involvements per 100 million motorcycle vehicle kilometers), then declined moderately by 2008 (to 23.0 involvements per 100 million vehicle kilometers). In the 1998 to 2008 period, the fatal involvement rate declined for cars by 30 percent (from 1.2 to 0.8 involvements per 100 million vehicle kilometers), for

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46 Special Report 300: Achieving Traffic Safety Goals in the United States: Lessons from Other Nations 35,000 30,000 25,000 vehicle involvement s 20,000 15,000 10,000 5,000 0 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 year passenger cars light trucks large trucks motorcycles FIGURE 2-14 Number of vehicles involved in fatal crashes, by vehicle type, United States, 1994–2008. (SOURCE: NHTSA 2009, 17.) light trucks by 26 percent (from 1.4 to 1.0 involvements per 100 million vehicle kilometers), and for large trucks by 29 percent (from 1.6 to 1.1 involvements per 100 million vehicle kilometers). Thus in 2008, NHTSA reports that the motorcycle fatal involvement rate was 29 times the rate for cars. Estimates of vehicle kilometers of travel of motorcycles are much more uncertain than for other vehicle classes because motorcycles make up only a small fraction (less than 1 percent) of all vehicles on the roads. Consequently, the reliability of the estimated trend of motorcycle fatal involvement rate per vehicle kilometer is unknown. The 1998–2008 increase in motorcycle fatal involvements per registered motorcycle was only 15 percent (NHTSA 2009, 17). The Business Cycle A 1984 study by a NHTSA analyst showed that U.S. traffic fatalities over the period 1960–1982 correlated closely with trends in population, employment, and unemployment, once adjustments were made for the 1973–1974 oil embargo and for the imposition of the 55-mph speed limit. The correlation raised the question of whether any of the slowdown in the growth of fatalities since the late 1960s could be attributed to the new federal highway safety programs introduced in the 1960s and 1970s. An update of the analysis (Partyka 1991) found that the model fit to the 1960–1982 data predicted future fatalities poorly: the number of fatalities in 1983–1989 steadily declined compared with the level that extrapolation of the historical relationship with population and employment would predict. (The gap was 19,000 fewer fatalities in 1989.) When the

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World and U.S. Safety Trends 47 original model was refit to data for 1960 to 1989, some correlation remained, but it was much weaker (R2 = .64 versus .98). In the 1991 update study, the author speculates that over half of the 1980s decline in fatalities relative to the prior trend might be attributable to the effects of the increase in the use of seat belts and the decrease in the incidence of drunk driving between 1983 and 1989. The author estimates that 9,700 fewer traffic deaths occurred in 1989 than if belt use and drunk driving had remained at 1983 levels. The study results suggest that external economic factors are important in explaining safety trends, and in particular trends over shorter time periods, but do not by themselves fully account for long-term safety trends. U.S. traffic deaths declined by 9.3 percent from 2007 to 2008 and by 8.9 percent from 2008 to 2009 (NHTSA 2009; NHTSA 2010). These annual declines were two of the largest on record. The U.S. economy entered a recession in 2007, and the declines are consistent with experience in past recessions. The largest annual declines in U.S. traffic fatalities in the period 1971–2007 all occurred in the recession years of the period: 7.0 percent in 1991, 9.9 percent in 1982, and 16.4 percent in 1974 (the latter from the combined effects of recession and the oil embargo). U.S. traffic fatalities increased when economic growth resumed after these past recessions. In the 15 high-income countries shown in Figure 2-2b (not including the United States), total fatalities declined by 9.0 percent from 2007 to 2008 and by 5.6 percent from 2008 to 2009, somewhat less than the U.S. annual declines. The employment impact of the recession that began in 2007 was more severe in the United States than in most other high-income countries: the number of unemployed increased by 102 percent between 2007 and 2009 in the United States, compared with 29 percent in the other European Organisation for Economic Co- operation and Development member countries (OECD 2010). The significance of these short- period traffic safety trends is difficult to interpret, especially since data on traffic volumes in the period are not available for most countries. As Figure 2-2b shows, U.S. annual vehicle kilometers traveled declined from 2007 to 2008; this was the first annual decline since 1980. U.S. vehicle kilometers traveled rose by 0.2 percent from 2008 to 2009 (NHTSA 2010). Concluding Observations Differences in demographics, in the urban-versus-rural distribution of road travel (and the associated distribution of travel by congested and uncongested conditions), in the distribution of travel by road class, and in the mix of vehicle types using roads can account for a portion of the differences in fatality rates between the United States and other countries and among the U.S. states. However, these factors may not explain a large share of differences in trends in fatality rates over the past decade or two. Economic cycles and isolated shocks, such as the 1970s energy crisis, can affect the crash rate trend in the short run. The age distribution of the population is an external factor that is not directly affected by transportation policies, and road designs and the urban-versus-rural distribution of travel change only slowly. However, interventions can be targeted to the segments of road use that are associated with high risk. For example, licensing and testing requirements can target younger and older drivers, and highway network screening to identify and treat high hazard locations can reduce crashes on roads with high crash rates, provided the treatments selected are guided by sound research and evaluation.

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World and U.S. Safety Trends 49 Richter, E. D., P. Barach, E. Ben-Michael, and T. Berman. 2001. Death and Injury from Motor Vehicle Crashes: A Public Health Failure, Not an Achievement. Injury Prevention, Vol. 7, pp. 176–178. SWOV. n.d. Casualties by Mode of Transport. http://www.swov.nl/uk/research/kennisbank/inhoud/00_trend/01_monitor/casualties_by_mode_of_tra nsport.htm. United Nations. 2002. World Population Aging: 1950–2050. Department of Economic and Social Affairs, Population Division. Zwerling, C., C. Peek-Asa, P. Whitten, S. Choi, N. Sprince, and M. Jones. 2005. Fatal Motor Vehicle Crashes in Rural and Urban Areas: Decomposing Rates into Contributing Factors. Injury Prevention, Vol. 11, pp. 24–28.

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