The global toll in auto fatalities.

In countries that are free of war, the largest cause of violent death is usually traffic fatalities. In the European Union, car accidents kill four times as many people as homicides do; in North America, they kill more than twice as many. In some Latin American countries, too, people are far more likely to die by motor vehicle accident than by murder.

A veteran soldier might scoff at the idea that driving a car is life-threatening. Yet car accidents took nearly as many American lives in 1993 alone as the Vietnam War did over the course of a decade. A survey of 100 countries that collect and report such data found that about 350,000 people die every year in motor vehicle accidents. Including the remaining 90 or so countries in such a survey might bring the total to nearly a half-million.

In Portugal, which has one of the highest traffic fatality rates, car accidents annually take twice as many lives as colon cancer, breast cancer, or prostate cancer. Nearly 3 percent of all deaths in Portugal are caused by car accidents. Even in Japan, which has a relatively low traffic fatality rate, accidents on the road take more than twice as many lives as breast cancer and four times as many as prostate cancer. In the early 1990s, they killed far more people than AIDS did in the United States.

Moreover, young people have more car accidents than almost any other age group, so traffic mishaps take an especially high toll when measured in lost years of life. Diseases, by contrast, take a heavier toll on older people and therefore have less impact on life expectancy. In most countries, it is young people--those under the age of 25--who are the most prone to traffic accidents. The 25-to 34-year-olds are usually next. At almost all ages, men are much more likely to die on the road than women are.

The magnitude of the menace posed by car accidents depends on several factors: the amount of driving done in a country; the safety of its cars and roads; the driving habits of its people; and the medical care received by the injured. In some wealthy countries with relatively safe roads and cars, the mortality rate is high because many people drive every day. On the other hand, in many poor countries that have hazardous, poorly maintained roads and cars--including Congo, Albania, and Thailand, for example--the number of lives lost remains small because few people drive.

The most effective way to prevent these accidental deaths is to drive less. Unfortunately, cars in what was then the European Community travelled more than twice as many kilometers in 1991 as they did in 1970; those in North America travelled almost twice as many; and vehicles in all industrial countries together covered 6.9 trillion kilometers in 1991 compared with 3.3 trillion in 1970.

During the last few decades, many industrial countries and some developing ones have experienced a move toward dispersed communities characterized by subdivisions, high-rise office buildings, and shopping malls connected by highways. In such places, many people cannot go to the grocery store, to their work places, or to a friend's home without driving. These land use trends will undermine attempts to cut traffic fatality rates.

Public transport systems such as trains and subways, whose safety records are far better than those of cars, can also help to reduce traffic deaths by providing alternatives to driving. But their development is being discouraged by the sprawl of subdivisions, where no single fixed point would serve as a central station. Funding and public support for public transit have been lacking in many regions where fatalities could be avoided.

The second way to reduce deaths on the road is to design cars and roads for safer use. With mandatory seat belt laws and slower speed limits in the United States, for example, traffic fatality rates have dropped by a quarter since 1970. Even though the number of miles driven rose sharply during that period, fewer than 40,000 Americans died from car accidents in 1992, compared with almost 55,000 in 1970. Scandinavian countries are famous for their strict and successful laws designed to prevent drunken driving, and their auto-related mortality rates are among the lowest in the world.

By preventing car accidents, safety precautions for driving may already save more years of life than many medical procedures, including some cancer and heart disease treatments. If these safety restrictions receive support from the public, automakers, and politicians, they will continue to be among the most successful public health initiatives ever taken. Many emergency room doctors have emphasized the fact that it is far more efficient to fight drunken driving than to try to put people back together once they arrive in the hospital.

HUMAN LIVES LOST IN MOTOR VEHICLE ACCIDENTS, SELECTED COUNTRIES, CIRCA 1990

Country                Deaths(*)

Latvia                      34
Estonia                     31
Portugal                    29
Saudi Arabia                23
Poland                      20
United States               17
Mexico                      17
France                      16
Canada                      14
Bulgaria                    13
Australia                   12
Japan                       12
Thailand                    11
Zambia                      10
Brazil                      10
Israel                       9
Morocco                      8
India                        7
Sweden                       7
Congo                        4

* per 100,000 people a year

Sources: International Road Federation, World Road Statistics 1987-91
(Washington, D.C.: 1992); WHO, World Health Statistics 1992 (Geneva: 1993);
data are for 1989, 1990, or 1991, depending on the country.

Many traffic fatalities are simply due to poor driving, rather than outside factors such as inclement conditions. Even when they stay within the speed limit or the law, many people drive unsafely. Accidents stem from one of two factors: either the layout of roads and the number and placement of cars is such that accidents are unavoidable, or one or more people drive in ways that allow an accident to happen. In growing urban areas, commuters spend hours every day behind the wheel, and these frequent drivers probably don't think of themselves as handling a deadly weapon.

Traffic fatalities affect the way we live. Protecting children from traffic, for example, means limiting where they are allowed to play. Especially in cities where streets run close by front doors, the danger posed by cars sometimes means some children must stay inside, or wait to be taken to a park to play.

Non-fatal injuries from traffic accidents also drive up health care costs and reduce productivity. In the United States, 3.6 million people are hurt in cars every year--some 1.5 percent of the population, or 1 in 70 people. In Belgium, more than 88,000 people were injured in 1990 by cars--almost 1 percent of the population--and in Germany, almost a half-million people are hurt each year. Most of those injuries are minor. But a number require months or years in a hospital and leave people unable to work.

Getting people to drive more carefully or to drive less will help combat one of the most deadly public health epidemics of our time. Traffic fatalities can be reduced, but success will require fighting drunk driving, increasing the use of seatbelts, accepting speed limits, enhancing road quality, raising the use of public transport, and introducing many other technological improvements. Most of all, it will involve designing communities that are less dependent on cars.