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Reducing the Burden of Injury: Advancing Prevention and Treatment
Access and Licensing Issues
Screening and licensing are tools for regulating access to driving. In the United States, the courts have made a clear distinction between driving for financial gain (commercial driving) and driving for one's own personal purposes. In the latter case, the courts have ruled that the license is more than a privilege and cannot be denied or revoked without due process (Reese, 1965). Because mobility is recognized as so important in our society, states must be reasonably justified in restricting licensure (e.g., using licensing restrictions, suspensions, and revocations as methods to limit driving by individuals convicted of drunk driving) (Jacobs, 1989).
Current controversies relate to restrictive licensing of teenagers and to age-based requirements for elderly drivers. Night-time driving restrictions for young beginning drivers reduce injuries (Williams and Preusser, 1997) but are debated in terms of fairness, and the needs and desires for mobility during adolescence on the part of teens and their families. Although cognitive, perceptual, and motor abilities are known to decrease with increasing age, these changes are highly individual, and screening for licensing restrictions is difficult.
Opportunities for Further Progress
Although significant progress has been made in reducing motor vehicle injuries, not all developments have been positive, and there are important opportunities for further gains. Numbers of motor vehicle deaths have risen slightly in recent years, although the decline in the mileage-based death rate has continued (NSC, 1997). Even though 49 states now have laws regarding safety belt use, national belt use is at a relatively low 61 percent (NHTSA, 1997). States have been reluctant to allow primary enforcement of safety belt laws or to institute strong enforcement programs of the type that has enabled Canadian provinces to achieve belt-use rates in excess of 90 percent (Transport Canada, 1998). Many states have raised speed limits in recent years, after Congress allowed states to do so without sanctions in 1995, and as a result, fatalities have increased (Farmer et al., 1997; NHTSA, 1998).
Research is needed to continue to improve both the design and the use of safety features. Additionally, although airbags are effective in reducing injuries overall, further research is needed to prevent airbag-related deaths of children and others. The lack of injury reduction associated with antilock brakes—a highly touted safety feature—has been disappointing. A newly emerging issue concerns vehicle design mismatch between sport-utility vehicles and passenger cars.
Opportunities for further progress include continued improvement of public transport systems and wider application of safety-related highway and traffic countermeasures that are known—on the basis of competent research—to be effective. For this to happen, increased public and political support is needed.