Public health and traffic safety: a collaborative success.

In our original article, we showed graphically that deaths/100 million vehicle miles traveled (VMT) in the United States have been steadily decreasing since 1925. We also showed motor vehicle related death rates/100 000 population decreased from 1966 to 1999. This decrease in deaths/100 000 population illustrated the impressive declines that resulted from aggressive traYc safety and public health measures. Richter et al have taken issue with our assertion that motor vehicle safety represents a public health success launched in the 1960s. What we did not show in our original article was that before 1966, despite continuous decreases in the traYc safety indicator (deaths (D)/100 million VMT), the actual number of motor vehicle deaths increased 242% during the period 1925 through 1966 (from 21 900 to 53 041, respectively), and the death rate/100 000 population increased 42% (from 19.1 in 1925 to 27.1 in 1966). The measure used to set public health priorities and to compare health problems— deaths/100 000 population—increased both before and after World War II. From 1960 to 1966, deaths/100 000 population increased 28%, prompting federal legislation to curb the problem. Later, in response to a letter to the editor, we supported the observation that the Highway Safety Act of 1966 and related initiatives marked a milestone in motor vehicle safety, by showing deaths and death rates/100 000 population before and after enactment. 4 We include a similar figure here to show the increase in both deaths and death rates from 1925 to 1969, followed by dramatic declines after the creation of the National Highway TraYc Safety Administration in the United States Department of Transportation in 1970 (see fig 1). This began a 30 year downward trend in mortality, the longest in United States history, which occurred despite increased numbers of vehicles, miles traveled, and a growing population. This decline did not occur by happenstance; motor vehicle injury prevention became a major transportation and public health priority. As the end of the century approached, the Centers for Disease Control assessed key public health achievements for the 20th century— those significantly aVecting the nation’s health. The declines in motor vehicle related mortality rates, especially over the last third of the century, clearly had a marked impact on public health. In our original article, we recognized the contributions of multiple government and community based agencies and organizations. Motor vehicle safety programs succeed