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1 Introduction B y some measures, the safety of road travel has improved greatly over the history of the automobile. Traffic deaths per kilometer of vehicle travel were five times higher in the United States in 1950 than today (National Safety Council 2007, 110–111; NHTSA 2010, 2). Per capita annual deaths of pedestrians and cyclists in road crashes declined by about two-thirds over the same period, although walking and bicycle trips per household have increased at least since the 1970s (FHWA 1983, 1, 6; FHWA 2010). However, because of growth in traffic, the health costs of automobile travel remain high. U.S. traffic deaths fluctuated between 40,000 and 44,000 annually from 1993 to 2007, then fell by 9.3 percent to 37,423 in 2008 and by an additional 9.7 percent to 33,808 in 2009, the fewest since 1949 (NHTSA 2010, 1). The exceptional percentage decline in deaths from 2007 to 2009 probably is largely a consequence of the recession that began in 2007.1 About 262,000 persons suffered incapacitating injuries in traffic crashes in 2008 (NHTSA 2009, Table 54). Motor vehicle crashes caused 28 percent of all deaths among young people 1 to 24 years of age in the United States in 2006 (Heron et al. 2009, Table 10). The lack of progress in reducing the highway casualty toll might suggest that Americans have resigned themselves to this burden of deaths and injuries as the inevitable consequence of the mobility provided by the road system. In other countries, public officials responsible for the roads have declared that this human and economic cost is neither inevitable nor acceptable and have undertaken rigorous and innovative interventions to reduce crashes and casualties. In Europe, Australia, and Japan, annual numbers of deaths and death rates per kilometer of vehicle travel have declined dramatically. Nearly every high-income country is today reducing annual traffic fatalities and fatality rates faster than is the United States, and several countries where fatality rates per kilometer of travel were substantially higher than in the United States 15 years ago are now below the U.S. rate. Officials responsible for traffic safety in the countries with relatively good safety performance attribute this progress primarily to government traffic safety programs, including improvements in traffic control and road design, vehicle safety regulations, and willingness to enact and enforce stringent driver regulations regarding speed, alcohol and drug use, seat belt use, and restrictions according to driver age. The gap between traffic safety progress in the United States and the other high-income countries deserves the attention of U.S. transportation administrators and the public because it indicates that the United States may be missing important opportunities to reduce traffic deaths and injuries. The Transportation Research Board (TRB) formed the Committee for the Study of Traffic Safety Lessons from Benchmark Nations to review the evidence on the factors that account for other countries’ safety improvements and to recommend actions that would take 1 As Chapter 2 describes, relatively large declines in deaths and in the fatality rate occurred during past recessions; therefore, it seems likely that the recession that began in 2007 is the major factor behind the recent trend. Traffic deaths increased with economic recovery after past recessions, and it is too early to determine whether the recent sharp decline represents a break from the long-term trend. 9

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10 Special Report 300: Achieving Traffic Safety Goals in the United States: Lessons from Other Nations advantage of the foreign experience and would fit in the U.S. context. The study committee’s charge (defined in the task statement approved by the National Research Council) is as follows: This study will document the experience of nations such as Sweden, United Kingdom, Netherlands, and Australia in sharply reducing traffic deaths and injuries through safety programs designed to alter driving behavior. The study will focus on the strategies these nations used to build public and political support for such interventions. The purpose of the committee’s study was to identify traffic safety strategies that could succeed in the United States. However, comparative analyses of international traffic safety experience also have relevance outside the United States. With increased motor vehicle use worldwide, most dramatically in China, India, and other developing countries, traffic fatalities and injuries have become a major and rapidly growing global public health threat. The World Health Organization has estimated that 1.2 million deaths and 20 million serious injuries occur annually in road traffic crashes (TRB 2006, 1–9). Therefore, recognition of the successes that some countries have achieved should be of value internationally. The charge calls on the committee to document the experience of other countries in reducing road traffic casualties. In fact, the international experience has been documented extensively in the reports on safety programs and management practices of a series of delegations of U.S. administrators to agencies in other countries, sponsored by the Federal Highway Administration (FHWA) and the American Association of State Highway and Transportation Officials (AASHTO) (FHWA 2009) and in reports of the Organisation for Economic Co-operation and Development (OECD) Working Groups on Speed Management (OECD and ECMT 2006a) and on Achieving Ambitious Road Safety Targets (OECD and International Transport Forum n.d.; OECD and International Transport Forum 2008). The latter OECD panel undertook a systematic benchmarking effort, soliciting reports from member states on fatality trends and on laws and safety initiatives concerning speeding, drunk driving, seat belt use, young drivers, pedestrians, and road infrastructure hazards. In 2004, TRB’s Research and Technology Coordinating Committee commissioned a report that describes safety management methods used abroad and compares them with methods in U.S. states with successful safety programs (Diewald 2004). In 2006 the National Academies, with the sponsorship of the National Highway Traffic Safety Administration and the Centers for Disease Control and Prevention, convened a workshop on transferring the traffic safety technology of the high- income countries to developing nations (TRB 2006). The AAA Foundation for Traffic Safety, the Governors Highway Safety Association, and other organizations in the United States also are examining the international experience and developing programs to emulate international best practices. In 2009, FHWA and AASHTO began an initiative to develop a new national strategic highway safety plan through a series of workshops and other public events. The initiative, Toward Zero Deaths: A National Strategy on Highway Safety, reflects awareness of other countries’ progress and methods on the part of U.S. safety administrators. (FHWA n.d.). The past reviews (summarized in Chapter 3) concur that successful national programs function effectively at three levels: • Management and planning, • Technical implementation of specific countermeasures, and • Political support and leadership.

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Introduction 11 U.S. road and safety officials recognize the successes of other countries but face obstacles in transferring the strategies that other countries have used. Among the obstacles are the following: • Decentralization: in most of the benchmark countries, regulation and enforcement are highly centralized, often the responsibility of a single national authority, whereas in the United States, 50 states and thousands of local jurisdictions are responsible for traffic safety and the operation of the highway system; • Public attitudes that oppose measures common elsewhere: for example, in the United States, motorcycle helmet laws and speed enforcement using automated cameras often encounter active public opposition; • Weak support for or opposition to rigorous enforcement in legislatures and among the judiciary, a reflection of these same public attitudes; • The constitutional prohibition of unreasonable searches, which prevents U.S. police from conducting the frequent and routine driver sobriety testing without probable cause that is common practice in some other countries; and • Resource limitations that prevent enforcement of the intensity common in other countries. The obstacles are, to an extent, the product of differences in political systems and in the physical characteristics of transportation systems, and possibly of other social and cultural factors. However, a further important obstacle has been lack of technical capacities required to apply the systematic management practices that all previous reviews have identified as critical to the performance of the benchmark nations’ safety programs. The committee has concentrated its attention on the obstacles to transferring successful practices of other countries to the United States, and the recommendations in Chapter 5 include proposals for steps toward overcoming the obstacles. The term “benchmark nations” in this report refers to the group of high-income nations whose traffic safety practices have been commonly compared with practices in the United States. The past reviews concluded that governments in these countries have given high visibility and genuinely high priority to traffic safety initiatives and that these nations have achieved low absolute rates of traffic fatalities and steady progress in reducing rates. The countries most often cited in the literature reviewed by the committee include Australia, New Zealand, Canada, the Netherlands, Germany, Sweden, Finland, Norway, France, and the United Kingdom. These countries are not uniform in their practices or results, and information was more readily available for some than for others. In the descriptions of safety programs in Chapters 3 and 4, the countries chosen for comparison with the United States vary with the topic under discussion. In this introductory chapter, the first two sections below introduce the study topic by summarizing statistics on traffic fatality trends in the United States and other countries and observations from several sources, including the scanning tours of FHWA and AASHTO, on the programs of some of the benchmark countries. The third section explains how the committee understood and responded to its charge. The final section outlines the remainder of the report.

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12 Special Report 300: Achieving Traffic Safety Goals in the United States: Lessons from Other Nations TRAFFIC SAFETY PROGRESS IN THE UNITED STATES AND OTHER COUNTRIES Fatality rates per vehicle kilometer of travel have declined greatly in the high-income countries for at least the past 40 years (and in the United States, for as long as data have been available, since the 1920s). For six large high-income countries, Table 1-1 shows fatalities per vehicle kilometer in 1970 and 2008 and the percentage decline in the fatality rate during the period. In France, Germany, and Japan, an automobile trip in 1970 was 10 times more likely to result in a death than an average trip of the same length today. In the 1970s, the U.S. fatality rate was the lowest in the world, but because safety has improved more slowly in the United States than elsewhere, today most high-income countries have matched or gone below the U.S. rate. Among 17 high-income countries with annual data available for the period 1997–2008, the U.S. speed of improvement was the poorest: a 2.4 percent reduction in the fatality rate annually compared with 6.9 percent in France, 6.4 percent in Germany, 5.5 percent in Japan, 4.3 percent in Australia, and 3.9 percent the United Kingdom (Figure 1-1). Reducing the fatality rate has reduced total annual fatalities in most high-income countries in the past decade. For the six countries tabulated above, Table 1-2 shows the reduction in fatalities. While some other countries reduced deaths by nearly half in the period, in the United States the decline was only 11 percent as a result of slow progress in reducing crash rates. If the United States had been able to reduce fatalities per kilometer of travel by the same percentage each year as did the United Kingdom (which achieved one of the slower average annual reductions among the countries shown in Figure 1-1), 29,000 U.S. lives would have been saved in the 1997–2008 period. The United States is larger and more diverse than any of the nations with which it is compared above, so a more meaningful comparison might be between other countries and U.S. regions with similar geographic characteristics (e.g., U.S. regions with population density and urbanization similar to those of European countries). Indeed, the fatality rate in the New England states about equals the rates in the best-performing countries abroad. However, no U.S. state has matched the median speed of improvement (a 5 percent annual reduction in the fatality rate) among the foreign countries shown Figure 1-1. The causes of these disparities in highway safety experience among the high-income countries are not well understood. Government traffic safety policies are a significant influence. However, research has shown that differences in demographic, geographic, and economic factors and in characteristics of vehicle fleets and transportation systems also affect international differences in crash rate trends, and evaluations designed to test the causal linkage between interventions and crash rates rigorously have been conducted too infrequently. Because crash risk varies with driver age, time of day, road characteristics, and other factors, it is possible for Country A to have a lower aggregate fatal crash rate than Country B and yet that a driver in Country B would always have a lower risk of a fatal crash than a driver in similar circumstances in Country A. For example, fatality rates on urban roads are generally lower than on rural roads worldwide. If Country A were predominantly urban and Country B rural, B could have lower fatality rates than A on both urban and rural roads and yet still have a higher total rate than A. The convergence of national fatality rates to similar values in recent years (in the range of 0.6 to 1.0 fatality per 100 million vehicle kilometers) suggests 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. From this point of view, the slow improvement of

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Introduction 13 TABLE 1-1 Traffic Fatality Rates in Six Countries, 1970 and 2008 Fatality Ratea 1970 2008 Percent Change France 9.0 0.78 –91 Germany 7.8 0.65 –91 Great Britain 3.7 0.52 –86 Australia 4.9 0.65 –87 Japan 9.6 0.81 –92 United States 3.0 0.78 –74 a Fatalities per 100 million vehicle kilometers. SOURCES: OECD n.d.; NHTSA 2010; OECD and International Transport Forum 2010. Average annual percent reduction in fatalities per VKmT, 17 countries, 1997-2008 9 8 annual percent reduction 7 6 5 4 3 2 1 0 ay ia itz an y s Sw m Sl lic el nd Re e Au en No k m Ki nd A Be ia ria an ar nd nc en US do ra l iu b rw Sw ap la ra ite inla ed st nm pu m la ec Fra lg Is ov er ng Au st J er er F De th G Ne h d Cz Un FIGURE 1-1 Average annual percentage reduction in fatalities per vehicle kilometer traveled, 17 countries, 1997–2008. Netherlands value is for 1997–2005. (Sources: OECD n.d.; OECD and International Transport Forum 2009; OECD and International Transport Forum 2010; NHTSA 2010.)

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14 Special Report 300: Achieving Traffic Safety Goals in the United States: Lessons from Other Nations TABLE 1-2 Traffic Deaths in Six Countries, 1997 and 2008 Traffic Deaths 1997 2008 Percent Change France 8,400 4,300 –49 Germany 8,500 4,500 –48 United Kingdom 3,700 2,600 –29 Australia 1,800 1,400 –18 Japan 11,300 6,000 –46 United States 42,000 37,400 –11 NOTE: The United Kingdom includes Great Britain and Northern Ireland. SOURCE: OECD n.d. the U.S. fatality rate might not seem to be cause for concern, since the U.S. rate was already relatively low 15 years ago, and the other countries have simply been catching up to a level of performance that the U.S. achieved earlier. However, this interpretation of the trends is contradicted by the experience of several countries (including the United Kingdom, the Scandinavian countries, the Netherlands, West Germany, and Australia) that already had rates close to or lower than the U.S. rate in 1997 but nonetheless reduced their rates faster than did the United States in the past decade. Chapter 2 presents a more detailed comparison of safety trends in the United States and other countries and among U.S. states. It also reviews research on the causes of differences in the trends. NATIONAL STRATEGIES Several of the countries that have achieved lower fatality rates and faster safety improvement than the United States also have undertaken rigorous, sustained, and carefully planned safety initiatives that are internationally recognized as innovative. Features of programs in four countries are given below as examples. • France progressively strengthened its laws and enforcement efforts concerning seat belt use, drunk driving, and speeding during the 1990s. Then in 2002, the national government initiated a program for reducing fatalities by intensified enforcement, relying especially on automated speed enforcement coordinated with a public communication and marketing campaign. The initiative is centrally planned and administered; a central facility monitors the nationwide network of 2,300 automatic speed cameras, issues citations, and collects fines. It is supported by central data collection and analysis to guide management and measure results. The initiative has had sustained, high-level political support. At the beginning of his 2002 term, the president of France announced that traffic safety was among the top priorities of his administration, and a cabinet-level multiagency committee has met periodically to oversee the safety program. The program produced important reductions in average speeds throughout the road system (a two-thirds reduction in the fraction of vehicles exceeding speed limits by more than 10 km/h between 2001 and 2008). As noted in the preceding section, France has achieved one of the fastest rates of improvement in traffic safety in the past decade. Government analysts attribute a large share of the reduction to the enforcement program.

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Introduction 15 • Australia has a federal system of government, so major responsibilities for highway safety rest with the states, and innovative programs have emerged at the state level. The safety programs of the state of Victoria have received international attention. A series of formal plans has guided the Victoria program since 1990. The plans identify quantitative safety improvement targets, intervention strategies for meeting the targets, and requirements for interagency coordination. New regulations and enforcement strategies and added enforcement resources have targeted drunk driving, speeding, and oversight of new drivers. Speed limits in urban areas have been reduced, and automated speed enforcement is widely used. Random alcohol and drug testing of drivers is frequent, and the average driver can expect to be tested once every few years. Performance measurement is integrated with administration of the program. The program receives active support from elected officials, who make up the Ministerial Road Safety Council and Parliamentary Road Safety Council that oversee the state’s safety program. Traffic safety has been, at least at times, a high-visibility political issue. Victoria achieved a greater percentage reduction in traffic fatalities than Australia as a whole over the period 1988–2004. • United Kingdom traffic safety programs share some basic similarities with the programs in France and Australia: consequential national planning that incorporates targets and performance measurement, political visibility and high-level political support, and application of progressively more rigorous interventions over the past 20 years. As elsewhere, drunk driving and speeding have been important targets. A national blood-alcohol content (BAC) limit was enacted in 1967, 11 years before all U.S. states had such a limit. As in the United States, random alcohol testing of drivers is illegal; however, drivers in crashes and drivers stopped for traffic offenses may be tested. Laws and enforcement practices are largely uniform nationwide, although local government authorities have certain management responsibilities. Widespread deployment of automatic speed enforcement devices was coordinated and funded by a program of the national government from 2001 to 2007. Nongovernmental organizations, including the automobile clubs, were instrumental in starting the New Car Assessment Program (NCAP) and the Road Assessment Program (RAP) in the United Kingdom and other countries in the 1990s. These programs rate vehicles and roadway segments for safety and publicize the ratings. The U.K. rate of fatalities per vehicle kilometer, among the lowest in the world, has been lower than the U.S. rate since 1990 and has continued to decline more rapidly than the U.S. rate. The speed of improvement over this period has been similar to those of the Scandinavian countries and Australia (Figure 1-1). • Sweden’s road safety program also is based on effective national planning and sustained political support and has emphasized control of drunk driving and speed. The driver BAC limit (0.02 percent) is among the lowest in the world, and random alcohol checks are conducted. The speed control program aims to reduce average speeds throughout much of the road network, and many speed limits have been reduced since the 1990s. In 1997, the Swedish Parliament established the Vision Zero policy to guide Swedish safety programs. It sets zero road fatalities and injuries as the appropriate goal of transportation programs and places responsibility on road authorities and vehicle regulators for designing a transportation system that is forgiving of the errors of drivers. In practice, Vision Zero has been interpreted to mean that road designs and traffic and vehicle regulations should favor injury prevention more strongly than conventional considerations would dictate—for example, lower speeds and more frequent property-damage crashes in return for fewer serious injuries. Safe design of the highway system has entailed various traffic calming measures (road design features like narrow lanes and traffic circles that cause drivers to reduce speed) and rules to minimize conflicts between motorized and

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16 Special Report 300: Achieving Traffic Safety Goals in the United States: Lessons from Other Nations nonmotorized traffic. Sweden’s fatality rate per kilometer of vehicle travel has been the lowest in the world for most of the past 20 years, and progress in reducing the rate has been faster than in the United States (Figure 1-1). Programs of these benchmark nations are described in more detail in Chapter 3, where the sources of information for the above descriptions are cited. STUDY ORIGIN AND CHARGE Some past analyses have found deficiencies in U.S. traffic safety efforts at each of the three functional levels identified above: for unfocused management practices, for reliance on ineffective countermeasures, and for failure to sustain political and public support. These criticisms are relevant to the committee’s charge because they are hypotheses about the sources of the differences in safety performance between the benchmark nations and the United States. The following three subsections cite examples of such criticisms. They describe the views of others and are not conclusions of the committee. The final section explains how the committee took into account these criticisms of U.S. practice in responding to its charge. Unfocused Management Most comparisons of U.S. and international safety efforts have noted differences among jurisdictions in safety program management practices. For example, the members of one of FHWA’s scanning teams that observed safety programs abroad were struck by the results of greater application of measurement and evaluation as management tools in other countries (MacDonald et al. 2004, xiii): The scan team found examples in which the processes of setting priorities and making planning, investment, and management decisions are based on, or use, performance measures to a much greater extent than is typical in the United States. In those cases where performance measures were used as input to priority setting, the process represented a new level of organizational behavior. . . . Perhaps the most impressive application of performance measurement, in terms of showing how the process can influence governmental policy and budget determinations, was in the area of road safety. Impressive results in reducing fatalities and injuries have occurred in some of the sites the scan team visited through a comprehensive program of engineering, enforcement, and education. Another comparison of safety management and planning in the United States and Australia, after noting “a sound and realistic plan” as one of the factors accounting for success of Australian programs, observes that “lack of progress reduces the FHWA [1998] strategic plan to little more than a publicity piece, since the results have so little relationship to the goals. During the eight years since the plan was announced, there has been little tracking of results, and almost no mid-course corrections to ensure that the goals are being met” (Tarnoff 2007, 22). The 2008 report of the OECD Working Group on Achieving Ambitious Road Safety Targets, which compared programs of OECD nations, also emphasizes “a robust management

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Introduction 17 system” as a critical factor distinguishing successful from unsuccessful programs (OECD and International Transport Forum 2008, 16–17; see also Box 3-4 in Chapter 3). The FHWA report Halving Roadway Fatalities, on lessons for U.S. safety programs from the Victoria, Australia, program (written by one of the designers of the Australian program), similarly ranks management practices higher than any specific countermeasure among the critical factors accounting for Victoria’s relative success in reducing fatalities (Johnston 2006, 16): Note that there is nothing [among the identified critical factors] about specific measures. The keys are knowing what the big problems are, selecting interventions known to be effective, and systematically implementing those for which political and community support can be garnered. Different packages of measures will have different aggregate impacts, require different levels of investment, and operate on different time frames, but many different packages will work. In other words, according to this view, systematic, results-oriented, data-driven management can produce safety progress with the tool kit of countermeasures that is available to the responsible agencies. Jurisdictions that fail to make progress are those that lack adequate overall long-term management of their safety programs. Any comparison of management methods in other countries with those of the United States must take into account the highly decentralized structure of U.S. government. The U.S. federal government regulates motor vehicle safety and the safety of commercial truck and bus operations, but otherwise its involvement is indirect, exercised through rules imposed on state and local government recipients of federal highway and traffic safety grants. State governments build and operate intercity roads; state police enforce traffic regulations mainly on major roads; state laws and courts govern driver licensing, vehicle inspection, speed limits, impaired driving, and other aspects of traffic safety. Local governments operate local streets and roads, enact local regulations, and provide local police and courts that enforce traffic laws within their jurisdictions. In contrast, most of the benchmark countries’ governments are relatively highly centralized; for example, a national police force may conduct most traffic enforcement. Australia’s federal system has similarities to the U.S. structure, but no country’s institutions match the thousands of U.S. entities with independent authority for public safety and for road maintenance and operation. Ineffective Countermeasures The committee’s charge (given earlier in this chapter) asserts that interventions aimed at modifying driver behavior explain the relatively rapid declines in traffic fatalities that the benchmark nations have experienced. The most prominent behavior modification initiatives in these countries have targeted speeding and drunk driving. The managers of these programs attribute their success to a great extent to these interventions. For example, France’s safety statistical agency estimated that three-fourths of the sharp reductions in fatalities and injuries on French roads between 2002 and 2005 resulted from a decline in speeds over the period induced by the speed control program begun in 2002 (CISR 2006, 6). With experiences like this in mind, the report of the OECD Working Group on Speed Management promised rapid reduction in fatalities through more effective regulation of driver behavior (OECD and ECMT 2006b, 3):

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18 Special Report 300: Achieving Traffic Safety Goals in the United States: Lessons from Other Nations Speeding . . . is the number one road safety problem in many countries, often contributing to as much as one third of fatal accidents and speed is an aggravating factor in the severity of all accidents. . . . Research indicates that coordinated actions taken by the responsible authorities can bring about an immediate and durable response to the problem of speeding. Indeed, reducing speeding can reduce rapidly the number of fatalities and injuries and is a guaranteed way to make real progress towards the ambitious road safety targets set by OECD/ECMT countries. Similarly, a review of the history of road safety policy in France, written by a participant in the development of the policies, emphasized the power of behavior modification. The author attributes the large and rapid improvements in France and the other cases cited to government- organized campaigns of “psychological and media shocks” that combined stricter driver behavior rules (in particular with regard to speeding and drunk driving), stronger enforcement, and harsher penalties with well-funded and forceful public communication programs. The author concludes that this experience demonstrates that “all other things being equal, i.e., for a given population, road network, and vehicle fleet, the level of road crashes is in no way an incompressible figure and may vary considerably depending on the policies pursued by the authorities. An examination of crash trends shows that these may sometimes be rapidly cut by a quarter or a third, and even, in rare circumstances, by half” (Gerondeau 2006, 3). In comparison, U.S. safety programs have been faulted for concentrating on vehicle and infrastructure improvements while underemphasizing measures to control unsafe behavior more effectively. In the assessment of one safety researcher (Evans 2004, 389–408), the lag between percentage reductions in fatality rates in the United States and reductions achieved in other countries in recent decades reflects a “dramatic failure of U.S. safety policy” (Evans 2004, 390). Under the failed policy, “U.S. safety priorities have been ordered almost perfectly opposite to where technical knowledge shows benefits are greatest” (Evans 2004, 389). In particular, the author argues, policy has concentrated on regulation of vehicle design and safety features, which are of lesser value, and has neglected countermeasures aimed at altering the driver behavior factors that are the major determinants of risk. A similar criticism by public health professionals labeled U.S. safety policy “a public health failure” for neglecting to take advantage of the potential for “immediate, large and sustained reductions of deaths and injuries” through more rigorous speed control (Richter et al. 2001, 176, 177). Improving road safety by upgrading infrastructure and imposing safety design standards on new road construction (e.g., with regard to alignment, lane width, sight distance, and roadside clear zones) are central elements of the safety programs of the U.S. and state departments of transportation and of other nations’ road authorities. However, statistical analyses of the factors related to differences in traffic safety among countries or states have failed to find a strong correlation between the level of infrastructure investment and crash rates or frequencies (Noland 2003; Kopits and Cropper 2005). One such study concluded that this finding shows that traffic safety policy has been misdirected: “Changes in [U.S.] highway infrastructure that have occurred between 1984 and 1997 have not reduced traffic fatalities and injuries and have even had the effect of increasing total fatalities and injuries. This conclusion conflicts with conventional engineering wisdom on the safety benefits of ‘improving’ highway facilities and achieving higher standards of design. . . . Other factors, primarily changes in the demographic

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Introduction 19 age mix of the population, increased seat-belt usage, reduced per capita alcohol consumption, and improvements in medical technology are responsible for the downward trend in total fatal accidents” (Noland 2003, 610). The arguments of the researchers cited above regarding the relative effectiveness of categories of interventions highlight the difficulty of the problem of deciding on the best allocation of resources in the design of a long-term safety strategy. However, they cannot be regarded as definitive. Specific limitations of studies of the effect of infrastructure investment on safety are described in Chapter 2. Indeed, as Chapters 2 and 3 will describe, all strong statements about the causes of differences in safety trends among the high-income countries must be examined skeptically because data limitations seriously hamper historical research and because, even in the countries with the most advanced management systems, safety program evaluations often are lacking or are inconclusive. These arguments also are not fully consistent with the philosophies of the safety programs in the benchmark nations with the best safety records, all of which incorporate safe vehicle design and safe infrastructure design in their comprehensive strategies. Examples mentioned in the preceding section are the principle that roadway design should be error-tolerant that is part of Sweden’s Vision Zero framework and NCAP and RAP in the United Kingdom. The “sustainable safety” principles that are the guiding philosophy of the national road safety program in the Netherlands call for a systems perspective that seeks to optimize the performance of all components of the road transportation system, including infrastructure, vehicles, and drivers (OECD and ECMT 2006a, 228). The Halving Roadway Fatalities report on Australia’s safety programs explains the mix of measures used in that country as follows (Johnston 2006, 15): While evaluation research has shown high levels of effectiveness for most of these measures, it would be wrong to assume that Australia’s success turned entirely on the implementation of behavior-control measures. It is more that, of all the measures in the traffic safety toolbox, legislation and intense enforcement, supported by public education to secure community support, are the types of interventions most likely to produce systemwide results in a short timeframe. Australia has also benefited greatly from improvements in vehicle and road infrastructure safety. Indeed, the strategic plans now emerging focus on the need for greater investment in creating and maintaining a safe system. Australia’s current safety plans (described in Chapter 3) have adopted a comprehensive framework known as the safe system approach, which is directed at attaining safer speeds, designing roads and roadsides more forgiving of human error, promoting use of vehicles with features that reduce the likelihood of a crash and injury severity in a crash, and providing aid and incentives to road users for responsible driving. The various safety interventions operate over differing timescales. As Chapter 3 will describe, this difference has influenced the safety strategies of the benchmark countries. Intense enforcement has been demonstrated to produce immediate benefits in a number of countries. Investments in safe infrastructure accrue over time as the investment program is carried out over many years. Similarly, vehicle design changes take greater effect as the vehicle fleet modernizes over time. Some of the benchmark countries, searching for the means to continue improvement after the immediate gains of intense enforcement have been achieved, have renewed emphasis on the longer-term strategies.

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20 Special Report 300: Achieving Traffic Safety Goals in the United States: Lessons from Other Nations Lack of Political and Public Support The study charge acknowledges that rigorous safety interventions depend on public and political support and directs the committee to examine how this support was built in the benchmark countries. Lack of support for road safety action has been cited as the underlying source of poor performance of U.S. programs. For example, the Insurance Institute for Highway Safety (IIHS) has commented as follows: “Motor vehicle crash deaths on U.S. roads exceed 40,000 annually. . . . Yet society responds with something akin to a collective shrug. . . . Traffic safety laws that are known to be effective—and that are implemented in other countries with little or no controversy—often are resisted by U.S. politicians” (IIHS 2002, 1–2). IIHS cites federal research funding as an indicator of the low priority that the public assigns to highway safety, noting that the National Institutes of Health’s 2001 budget for dental research was five times the research budget of the National Highway Traffic Safety Administration. IIHS cites as well weak media coverage of traffic safety issues and the success of organized public opposition to such measures as motorcycle helmet laws and red light cameras as indications of low priority. U.S. observers consistently have noted that the successful national programs rely on measures that are regarded in the United States as politically controversial or legally impermissible. State officials encounter public objection and interest group opposition to such measures as radar detectors, speed limit reductions, automatic speed and red light enforcement, helmet laws, seat belt laws, sobriety checkpoints, and reduced BAC limits. A summary of FHWA’s international safety scanning tours compared U.S. attitudes and institutions with those in other countries as follows (Baxter et al. 2005): Partly because of cultural differences . . . [other] countries may be more successful than the United States in implementing certain behavioral practices, such as seatbelt usage or prevention of impaired driving. Expectations about implementation may need to be adjusted because some countries can adopt practices at a national level that can be implemented only at a State or local level in the United States. Similarly, the political context in the United States may inhibit adoption of certain technologies that are more readily accepted in other countries, such as speed enforcement cameras. A compendium of 22 invited papers on Improving Traffic Safety Culture in the United States: The Journey Forward (AAA Foundation for Traffic Safety 2007) addressed the question of cultural factors influencing traffic safety outcomes. The articles, by authors from diverse disciplinary backgrounds, do not present empirical analysis of the relation of cultural factors to safety performance or of the effectiveness of interventions intended to change cultural attitudes, although there are references to such research in another area (for antismoking campaigns). The summary document (Hedlund 2007) contains a list of 20 actions derived from the papers, which, the author proposes, could contribute to producing cultural change. These recommendations include better communication with the public, communication across professional disciplines, planning and management based on performance goals, design of intervention programs based on scientific evidence, and research on the determinants of risk and on the elements of effective programs. Nearly all these amount to more effective performance of management functions that are already part of every state traffic safety program. More recently, the AAA Foundation for Traffic Safety and another transportation organization have proposed that the administration hold a White House conference on traffic

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Introduction 21 safety as a means of lending high-level political support to transportation safety initiatives (AAA Foundation for Traffic Safety 2009). That differences among societies in values and attitudes account for differences in traffic safety performance is a credible hypothesis, and a few studies have examined it empirically. A Belgian study examining why that country had one of the highest traffic fatality rates in Europe in 2000 found that the European countries have similar laws but nonetheless divergent results and noted a correlation between country fatality rates and an index of perceptions of the degree of corruption in public life. It concluded that “countries . . . where people are not convinced of the necessity of compliance with imposed measures, do not perform well in traffic safety improvement” and that public attitudes toward law-abiding behavior partly explain differences in the impact of traffic safety legislation (Vereeck and Deben 2003, 17, 21). An update of the Belgian study that used the same measure of attitudes toward authority concluded (on the basis of a statistical analysis of fatalities for 15 European countries for 1995–2002) that a major share of Belgium’s relatively high rate of traffic fatalities per vehicle kilometer of travel could be explained by the country’s higher alcohol consumption (which itself might be regarded as an indicator of social norms), but that Belgium’s higher score on the index of perception of the degree of corruption in public life also appeared to account for an important part of the difference (Vrolix and Vereeck 2006). The authors explain that “[the Corruption Perceptions Index] was used as a proxy for the general attitudes and social norms of citizens towards traffic legislation and policy. . . . In countries where corruption figures are low . . . it is assumed that law-infringing behavior is less tolerated” (Vrolix and Vereeck 2006, 43). A second empirical study examined correlations of traffic fatality rates per capita in 46 countries in 2007 with measures of quality of governance developed by the World Bank and with empirical measures of national cultural values taken from the sociology literature (Gaygisiz 2010). The study found that fatality rate correlates negatively with quality of governance, positively with cultural measures characteristic of traditionally hierarchical societies, and negatively with measures indicative of personal autonomy and egalitarianism. However, the simple correlations do not control for international differences in income, which is strongly correlated with fatality rate and with most of the cultural measures. The author concludes that “since cultural values . . . are almost impossible to change or would change very slowly . . . and the quality of governance seems to have both direct and indirect impact on traffic safety, the development programs aimed at the improvement of the governance quality of institutions may play an important role in changing the traffic safety conditions” (Gaygisiz 2010, 7). The comparison of Australian and U.S. planning cited above concludes that “perhaps most important [in the United States] there has been little legislative support for the use of techniques that will ensure these goals [of the 1998 FHWA strategic safety plan] are met. There is little point in strategic planning without assurance of the needed underlying support” (Tarnoff 2007, 22). The case studies of implementation of specific countermeasures that are presented in Chapter 4 cite instances where measures of proven effectiveness that are applied in some U.S. jurisdictions are rejected in others because of controversy or active opposition. In other instances, inaction may be the result of lack of public demand or inattention on the part of responsible officials rather than active opposition.

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22 Special Report 300: Achieving Traffic Safety Goals in the United States: Lessons from Other Nations Committee’s Approach to Its Charge The various hypotheses about the causes of international differences in traffic safety progress are not mutually exclusive. Opportunities undoubtedly exist in the United States to reduce the costs of road crashes through improvements at all three levels of safety programs: through management reforms, wider application of the highest-payoff interventions, and more consistent political support. Most probably, sustained progress will require competent application of the full range of available interventions in a balance that is appropriate to the individual characteristics of jurisdictions. The task statement asserts that the benchmark countries’ fatality rate trends are explained by their behavioral (i.e., anti–drunk driving and speeding) interventions. However, the committee’s perspective has been that claims of the effectiveness of particular intervention programs or overall national strategies must be subjected to critical scrutiny. The claims that merit the greatest weight are those supported by rigorous and objective quantitative evaluation. In many instances such evaluations were not available. Therefore, as Chapter 2 explains, the committee concluded that the causes of trends in national rates are incompletely understood. As described above, the benchmark countries typically attribute their successes to comprehensive and balanced strategies that seek to reduce risk through interventions involving vehicle and road design, pedestrians, and emergency medical services as well as driver behavior regulations. The committee did not interpret the study charge reference to altering driver behavior as ruling out investigation of the role of other categories of intervention in explaining international differences. The committee’s examination of specific interventions in Chapters 3 and 4 covers occupant restraints, motorcycle helmets, and infrastructure improvements as well as antispeeding and anti–drunk driving campaigns (as case studies of methods rather than a comprehensive survey of interventions). The actions recommended in Chapter 5 include measures to improve the effectiveness of enforcement of antispeeding and anti–drunk driving laws as well as measures to strengthen infrastructure hazard elimination programs and occupant protection regulations. The recommendations regarding management practices are intended to increase the effectiveness of all categories of interventions. The committee considered the charge to imply three questions that U.S. policy makers and transportation program administrators must answer to profit from the experience of other countries: • What are the sources of the declines in highway injury rates in Europe, Australia, and the United States, and especially, what has been the contribution of government safety programs? • What are the necessary elements of successful national risk reduction programs? These elements may include safety management systems, the specific interventions employed, structures of administrative oversight and accountability, political support and leadership, and strategies for building public and political support. • What institutional or social differences between the United States and other countries might affect the success of efforts to transfer safety practices, and can any of these factors be altered to create a U.S. environment more conducive to safety improvement? This study has not definitively resolved the question of the sources of differences in national rates of improvement in traffic safety, and the committee has not attempted to outline a

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Introduction 23 comprehensive program to replicate the successes of other countries in the United States. The results of the study are more modest: in comparing the safety programs of the United States and other countries, the committee found certain gaps in the United States in program elements that appear to be prerequisites for progress. The most critical of these gaps may be in the management and planning capacities that safety agencies require to direct safety programs toward attaining defined goals. The recommendations propose measures to begin to close these gaps as first steps toward a more successful U.S. safety program. OUTLINE OF THE REPORT The remainder of this report is organized as follows. Chapter 2 describes trends in traffic fatalities and crashes in other countries, the United States, and U.S. states and reviews studies of the forces driving these trends. Chapter 3 contains a summary of conclusions of past studies about key elements of the most successful traffic injury reduction programs in other countries, descriptions of programs in five countries (Australia, Canada, France, Sweden, and the United Kingdom), and descriptions of aspects of the organization of U.S. state and federal safety programs for comparison with the other countries’ programs. Chapter 4 compares practices in the United States and other countries and among U.S. states in five categories of safety intervention: speed control, control of drunk driving, road hazard analysis and elimination, motorcycle helmet regulations, and seat belt regulations. These five areas were selected as case studies. The committee did not comprehensively survey all areas of safety practice. The selection of the interventions described in Chapter 4 was dictated mainly by the emphasis that the prominent benchmark countries place on these interventions in their accounts of their safety successes. The committee did not have independent means of verifying that these program areas are indeed the primary sources of other countries’ progress. Among the areas the chapter does not examine are countermeasures aimed at distracted driving and aggressive driving (i.e., the complex of hazardous behaviors that includes speeding, illegal passing, tailgating, weaving, and ignoring signals), truck safety, driver training, vehicle safety rating, emergency medical services, and graduated drivers’ licensing, some of which (e.g., graduated licensing) are areas of U.S. success and leadership. Chapter 5 presents the committee’s conclusions and recommendations. The conclusions identify the accomplishments of the benchmark nations, sources of success, and differences between U.S. and international practices. The recommendations, addressed to elected officials and to government safety professionals and administrators, identify actions needed in the United States to emulate the successes that other countries have achieved. REFERENCES Abbreviations CISR Comité Interministériel de la Sécurité Routière ECMT European Conference of Ministers of Transport FHWA Federal Highway Administration IIHS Insurance Institute for Highway Safety NHTSA National Highway Traffic Safety Administration

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24 Special Report 300: Achieving Traffic Safety Goals in the United States: Lessons from Other Nations OECD Organisation for Economic Co-operation and Development TRB Transportation Research Board AAA Foundation for Traffic Safety. 2007. Improving Traffic Safety Culture in the United States: The Journey Forward. April. AAA Foundation for Traffic Safety. 2009. Traffic Safety Culture Summit. AAA Foundation for Traffic Safety E-Newsletter, Sept. 25, 2009. http://www.aaafoundation.org/e-news/issue21/TSCS.cfm. Baxter, J., M. L. Halladay, and E. Alicandri. 2005. Safety Scans—A Successful Two-Way Street. Public Roads, Vol. 69, No. 1, July–Aug., pp. 31–37. CISR. 2006. Dossier de Presse. July 6. Diewald, W. 2004. Recent Highway Safety Experience in Australia and Several European Countries. Staff working paper for TRB Research and Technology Coordinating Committee, Nov. 22. Evans, L. 2004. Traffic Safety. Science Serving Society, Bloomfield Hills, Mich. FHWA. 1983. Person Trip Characteristics: 1977 Nationwide Personal Transportation Study. Dec. FHWA. 2009. International Technology Scanning Program. Updated June 26. http://international.fhwa.dot.gov/scan/. FHWA. 2010. Introduction to the 2009 NHTS. http://nhts.ornl.gov/introduction.shtml. FHWA. n.d. Toward Zero Deaths: A National Strategy on Highway Safety. http://safety.fhwa.dot.gov/tzd/. Gaygisiz, E. 2010. Cultural Values and Governance Quality as Correlates of Road Traffic Fatalities: A Nation Level Analysis. Accident Analysis and Prevention, online prepublication, June. Gerondeau, C. 2006. Road Safety in France: Reflections on Three Decades of Road Safety Policy. FIA Foundation for the Automobile and Society, May. Hedlund, J. 2007. Improving Traffic Safety Culture in the United States: The Journey Forward: Summary and Synthesis. AAA Foundation for Traffic Safety, Dec. Heron, M., D. L. Hoyert, S. L. Murphy, J. Xu, K. D. Kochanek, and B. Tejada-Vera. 2009. Deaths: Final Data for 2006. National Vital Statistics Reports, Vol. 57, No. 14, April 17. IIHS. 2002. Status Report. Vol. 37, No. 10, Dec. 7. Johnston, I. 2006. Halving Roadway Fatalities: A Case Study from Victoria, Australia, 1989–2004. Federal Highway Administration, April. Kopits, E., and M. Cropper. 2005. Why Have Traffic Fatalities Declined in Industrialized Countries? Implications for Pedestrians and Vehicle Occupants. Policy Research Working Paper 738, World Bank, Aug. MacDonald, D., C. P. Yew, R. Arnold, J. R. Baxter, R. K. Halvorson, H. Kassoff, K. Philmus, T. J. Price, D. R. Rose, and C. M. Walton. 2004. Transportation Performance Measures in Australia, Canada, Japan, and New Zealand. Federal Highway Administration, Dec. National Safety Council. 2007. Injury Facts 2007. NHTSA. 2009. Traffic Safety Facts 2008. NHTSA. 2010. Highlights of 2009 Motor Vehicle Crashes. Aug. Noland, R. B. 2003. Traffic Fatalities and Injuries: The Effect of Changes in Infrastructure and Other Trends. Accident Analysis and Prevention, Vol. 35, No. 4, July, pp. 599–611. OECD. n.d. International Road Traffic Accident Database. http://www.swov.nl/cognos/cgi- bin/ppdscgi.exe?toc=%2FEnglish%2FIRTAD. OECD and ECMT. 2006a. Speed Management. Joint Transport Research Centre. OECD and ECMT. 2006b. Speed Management: Summary Document. Joint Transport Research Centre. OECD and International Transport Forum. 2008. Towards Zero: Ambitious Road Safety Targets and the Safe System Approach: Summary Document. Joint Transport Research Centre. OECD and International Transport Forum. 2009. Trends in the Transport Sector 1970–2007. OECD and International Transport Forum. 2010. Press Release: A Record Decade for Road Safety: International Transport Forum at the OECD Publishes Road Death Figures for 33 Countries. Sept. 15.

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Introduction 25 OECD and International Transport Forum. n.d. Country Reports on Road Safety Performance. http://www.internationaltransportforum.org/jtrc/safety/targets/Performance/performance.html. 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. Tarnoff, P. J. 2007. Can We Stop Now? Thinking Highways, Vol. 2, No. 1, pp. 18–22. TRB. 2006. Special Report 287: Improving Road Safety in Developing Countries: Opportunities for U.S. Cooperation and Engagement: Workshop Summary. National Academies, Washington, D.C. Vereeck, L., and L. Deben. 2003. An International Comparison of the Effectiveness of Traffic Safety Enforcement Policies. Proceedings, Hawaii International Conference on Social Sciences. http://www.hicsocial.org:16080/Social2003Proceedings/. Vrolix, K., and L. Vereeck. 2006. Social Norms and Traffic Safety: A Cross Country Analysis in the EU-15. Policy Research Center for Traffic Safety, Hasselt University, Belgium, March.

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