Epidemic on the roads

PUBLIC

HEALTH

The Journal of the

Society of Medical Officers of Health I

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EPIDEMIC ON THE ROADS I~ 68 people had died of typhoid during the Easter week-end, there would have been a nation-wide howl of rage. As it was, those people were merely killed on the roads, so the country shrugged its shoulders, said "How terrible!", commented that the total was, after all, a little less than in 1963, and then set about preparing for a Whit week-end which was to produce a really substantial harvest of road deaths, 84. Typhoid is preventible and is in large part prevented. Road "accidents", though taken as inevitable, are also in theory largely preventible. There are, of course, occasional genuine accidents. A tree struck by lightning may fall on a passing vehicle, a river in sudden spate wash away a bridge which a car is crossing or premature metal fatigue cause a lorry's steering to fail on a steep hill. But apart from these and similar rarities, deaths on the road are associated with some element of human failure--inexperience, error of judgement, fatigue, too much alcohol consumed, selfishness, casualness over vehicle maintenance and the like. That all these could be totally eliminated is highly improbable but it is sheer defeatism to assume that they could not be greatly reduced. Before these words appear in print a good many people will have aired their pet theories and prejudices and, no doubt, Mr. Marples will once again have said that if only all drivers were perfect there would have been far fewer casualties. This is obviously true, but what are its practical implications ? Some drivers are quite unfit to be trusted on the road at all. Medical examinations before the issue or renewal of driving licences might exclude the physically unfit, but it would be quite impracticable to demand psychiatric examinations to exclude the temperamentally unfit. At present these latter stay on the roads until they have demonstrated their unfitness by damaging property or killing or maiming people. Heavier fines or prison sentences for bad drivers are only a very partial answer; they do not prevent the accident which has happened and they have limited deterrent value. They could well deter the driver who drinks before driving and there could be no harm and might be much good in their use in this context. But we doubt whether any driver is likely to refrain from dangerous overtaking merely because his friend or neighbour was, last week, fined fifty pounds for that offence. We doubt, indeed, 241

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whether he is deterred for long even after being fined himself. Nobody deliberately courts damage to himself or his car; he just discovers too late that he was wrong in his calculations. We certainly welcome the signs that this is being recognized and that more people are accepting the idea that the education of the bad driver should replace, or at least supplement, the imposition of a penalty. We should like to see the idea taken even further and some incentives introduced to persuade drivers to seek further and better tuition than the present driving test demands of the novice] Some experts feeI that the initial driving test should be made stiffer, others that the motorist will benefit more from "advanced" teaching after he has been on the road for a time and has acquired some experience; we have much sympathy with the latter view. But with all respect to the Minister of Transport, it seems reasonable to accept as a certainty that for a long time to come there will be a good many imperfect drivers on the road and that instead of weeping over their shortcomings it might be useful to try to minimise the consequences of their errors. Consider, first, the roads. "Accident black spot" notices proliferate and many notorious "hell comers" and "murder miles" have still not achieved the distinction of such notices. Why are these places "'black spots" ? Probably because there is something which deceives the unsuspecting stranger into believing that to maintain speed, to round a particular bend or to overtake is safe while, in fact, there is some potential hazard. Common sense would suggest that the cause of.repeated accidents should be investigated and that the hazard, once defined, should be eliminated. Pending elimination, a signpost indicating the precise hazard could be erected; it is not unknown for a motorist seeing a simple "black spot" notice to be so occupied in looking in several directions at once that he invites accident instead of avoiding it. Next, the vehicles. Preventive measures can be either prirnaryorsecondary. Secondary prevention--the reduction of the injury risk to drivers and passengers when an accident occurs--is a matter of vehicle design and the provision of safety accessories. (We would comment, in passing, that the latter are subject to purchase tax!) There is already evidence that the padded facia board, the collapsible steering column, safety belts and sundry other things are valuable. It would be reasonable to make them compulsory on all new cars; meanwhile there is need for research directed toward ensuring that people in cars are surrounded by protective armour rather than by something which becomes a sort of lethal mousetrap if it is involved in a collision. Primary prevention--the reduction of the chance of accidents occurring-can be furthered by attention to the fitness of vehicles. It is horrifying to know that heavycommercial vehicles, with so much greater lethal potential than private cars, are subjected to no regular fitness tests and that the "spot checks", which are at present the only means of control, find defects, often substantial, in as

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many as half of them. But in primary, no less than secondary, prevention, vehicle design has a part to play. It would appear, for instance, that some hez.vy lorries, even when new, have brakes inadequate to cope with their momentum at speed or brakes which the driver dare not use to the full when travelling at speed because their sudden application would throw the load forward and crush him; to us it seems criminal that such inherently dangerous things can be allowed on the road at all. A manufacturer may proudly increase the power and speed of one of his cars but leave the better brakes which this should demand as optional and expensive extras. It is said that insurance companies regard certain cars (we are not, here, referring to sports cars) as specially liable to be involved in accidents. Why is this so and what is being done about it ? The possible complexities are considerable--driving position, ventilation, driver's general comfort, visibility from the driving,seat and "'steering geometry" are only a few of the factors which might be involved. A particular car may be safe with one driver and potentially dangerous with one shorter, taller, fatter, or longer in the leg. Manifestly, more knowledge is needed. The inquiries at present made into the causes of accidents are far from satisfactory. The police are primarily concerned with firtdhag whether any survivor of the accident was sufficiently blameworthy to be prosecuted, the insurance companies with showing that their individual cliertt, dead or alive, was not culpable. The driver involved is mainly concerned with proving someone else's responsibility. There is every incentive to suppress or distort evidence in these circumstances. If the matter of road casualties is to be treated epidemiologically, which is surely the logical attitude to take toward a problem of this magnitude, then independent scientific investigation is clearly intdicated. Moreover, if it is true in this field--as it is in so many others--that man and machine may have a number of minor accidents before they sustain major ones, the investigation of minor accidents, now the subject of only perfunctory inquiries or, indeed, of none at all, might have a number of useful lessons to teach. Obviously, this kind of intensive study could not be at once undertaken on a nation-wide scale, but this is not necessary. A study of a carefully chosen sample area could be just as illuminating and is well within the bounds of practicability. Road accidents, no less than accidents in the home, are a proper concern of those who deal in preventive medicine; a campaign against unfit roads and vehicles is as much a matter of public health as a campaign against clothing which bursts into flame on the slightest provocation. At last organized medicine is showing an interest and the setting up of a joint medical commission to study the subject is something which we whole-heartedly welcome. In this field, no less than in others, the classical remark of King Edward VII on tuberculosis is fundamentally true, "If" preventible, why not prevented ?" Why not, indeed I