In Reply: Dr O'Brien raises questions about
the contribution of public health in reducing motor-vehicle injuries. He claims
that we have done no better than previous generations in preventing motor
vehicle–related deaths. In truth, we have done much better.
In our article, we showed motor vehicle death rates from 1966 to the
present to illustrate the impressive declines that resulted from aggressive
traffic safety and public health measures. What we did not show was that prior
to 1966, despite continuous decreases in the traffic safety indicator (deaths
per 100 million vehicle miles traveled), the actual number of motor-vehicle
deaths increased 242% between 1925 to 1966 (from 21,900 to 53,041, respectively)
and the death rate per 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 per 100,000 population—increased
both before and after World War II. From 1960 to 1966, deaths per 100,000
population increased 28%, prompting federal legislation to curb the problem.1