The progress in the number of motorists who arrive alive is not uniquely American. Fatality rates have sunk in other wealthy countries such as France, Australia, and of course safety-conscious Sweden. (I ended up buying a Volvo.) But it can be attributed to living in a wealthy country. Emerging nations like India, China, Brazil, and Nigeria have per capita traffic death rates that are double that of the United States and seven times that of Sweden.44 Wealth buys life.
A decline in road deaths would be a dubious achievement if it left us more endangered than we were before the automobile was invented. But life before the car was not so safe either. The pictorial curator Otto Bettmann recounts contemporary accounts of city streets in the horse-drawn era:
“It takes more skill to cross Broadway . . . than to cross the Atlantic in a clamboat.” . . . The engine of city mayhem was the horse. Underfed and nervous, this vital brute was often flogged to exhaustion by pitiless drivers, who exulted in pushing ahead “with utmost fury, defying law and delighting in destruction.” Runaways were common. The havoc killed thousands of people. According to the National Safety Council, the horse-associated fatality rate was ten times the car-associated rate of modern times [in 1974, which is more than double the per capita rate today—SP].45
The Brooklyn Dodgers, before they moved to Los Angeles, had been named after the city’s pedestrians, famous for their skill at darting out of the way of hurtling streetcars. (Not everyone in that era succeeded: my grandfather’s sister was killed by a streetcar in Warsaw in the 1910s.) Like the lives of drivers and passengers, the lives of pedestrians have become more precious, thanks to lights, crosswalks, overpasses, traffic law enforcement, and the demise of hood ornaments, bumper bullets, and other chrome-plated weaponry. Figure 12-4 shows that walking the streets of America today is six times as safe as it was in 1927.
Figure 12-4: Pedestrian deaths, US, 1927–2015
Sources: National Highway Traffic Safety Administration. For 1927–1984: Federal Highway Administration 2003. For 1985–1995: National Center for Statistics and Analysis 1995. For 1995–2005: National Center for Statistics and Analysis 2006. For 2005–2014: National Center for Statistics and Analysis 2016. For 2015: National Center for Statistics and Analysis 2017.
The almost 5,000 pedestrians killed in 2014 is still a shocking toll (just compare it with the 44 killed by terrorists to much greater publicity), but it’s better than the 15,500 who were mowed down in 1937, when the country had two-fifths as many people and far fewer cars. And the biggest salvation is to come. Within a decade of this writing, most new cars will be driven by computers rather than by slow-witted and scatterbrained humans. When robotic cars are ubiquitous, they could save more than a million lives a year, becoming one of the greatest gifts to human life since the invention of antibiotics.
A cliché in discussions of risk perception is that many people have a fear of flying but almost no one a fear of driving, despite the vastly greater safety of plane travel. But the overseers of air traffic safety are never satisfied. They scrutinize the black box and wreckage after every crash, and have steadily made an already safe mode of transportation even safer. Figure 12-5 shows that in 1970 the chance that an airline passenger would die in a plane crash was less than five in a million; by 2015 that small risk had fallen a hundredfold.
Figure 12-5: Plane crash deaths, 1970–2015
Source: Aviation Safety Network 2017. Data on the number of passengers are from World Bank 2016b.
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Who by water and who by fire. Well before the invention of cars and planes, people were vulnerable to lethal dangers in their environments. The sociologist Robert Scott began his history of life in medieval Europe as follows: “On December 14, 1421, in the English city of Salisbury, a fourteen-year-old girl named Agnes suffered a grievous injury when a hot spit pierced her torso.” (She was reportedly cured by a prayer to Saint Osmund.)46 It was just one example of how the communities of medieval Europe were “very dangerous places.” Infants and toddlers, who were left unattended while their parents worked, were especially vulnerable, as the historian Carol Rawcliffe explains:
The juxtaposition in dark, cramped surroundings of open hearths, straw bedding, rush-covered floors and naked flames posed a constant threat to curious infants. [Even at play] children were in danger because of ponds, agricultural or industrial implements, stacks of timber, unattended boats and loaded wagons, all of which appear with depressing frequency in coroners’ reports as causes of death among the young.47
The Encyclopedia of Children and Childhood in History and Society notes that “to modern audiences, the image of a sow devouring a baby, which appears in Chaucer’s ‘The Knight’s Tale,’ borders on the bizarre, but it almost certainly reflected the common threat that animals posed to children.”48
Adults were no safer. A Web site called Everyday Life and Fatal Hazard in Sixteenth-Century England (sometimes known as the Tudor Darwin Awards) posts monthly updates on the historians’ analyses of coroners’ reports. The causes of death include eating tainted mackerel, getting stuck while climbing through a window, being crushed by a stack of peat slabs, being strangled by a strap that hung baskets from one’s shoulders, plunging off a cliff while hunting cormorants, and falling onto one’s knife while slaughtering a pig.49 In the absence of artificial lighting, anyone who ventured out after dark faced the risk of drowning in wells, rivers, ditches, moats, canals, and cesspools.
Today we don’t worry about babies getting eaten by sows, but other hazards are still with us. After car crashes, the likeliest cause of accidental death consists of falls, followed by drownings and fires, followed by poisonings. We know this because epidemiologists and safety engineers tabulate accidental deaths with almost plane-wreckage attention to detail, classifying and sub-classifying them to determine which kill the most people and how the risks may be reduced. (The International Classification of Diseases, tenth revision, has codes for 153 kinds of falls alone, together with 39 exclusions.) As their advisories are translated into laws, building codes, inspection regimes, and best practices, the world becomes safer. Since the 1930s, the chance that Americans will fall to their deaths has declined by 72 percent, because they have been protected by railings, signage, window guards, grab bars, worker harnesses, safer flooring and ladders, and inspections. (Most of the remaining deaths are of frail, elderly people.) Figure 12-6 shows the fall of falling,50 together with the trajectories of the other major risks of accidental death since 1903.
Figure 12-6: Deaths from falls, fire, drowning, and poison, US, 1903–2014
Source: National Safety Council 2016. Data for Fire, Drowning, and Poison (solid or liquid) are aggregated over 1903–1998 and 1999–2014 datasets. For 1999–2014, data for Poison (solid or liquid) include poisonings by gas or vapor. Data for Falls extend only to 1992 because of reporting artifacts in subsequent years (see note 50 for details).
The slopes for the liturgical categories of dying by fire and dying by water are almost identical, and the number of victims of each has declined by more than 90 percent. Fewer Americans drown today, thanks to lifejackets, lifeguards, fences around pools, instruction in swimming and lifesaving, and increased awareness of the vulnerability of small children, who can drown in bathtubs, toilets, even buckets.
Fewer are overcome by flames and smoke. In the 19th century, professional brigades were established to extinguish fires before they turned into conflagrations that could raze entire cities. In the middle of the 20th century, fire departments turned from just fighting fires to preventing them. The campaign was prompted by horrific blazes such as the 1942 Cocoanut Grove nightclub fire in Boston, which left 492 dead, and it was publicized with the help of heart-wrenching photos of firefighters carrying the lifeless bodies of small children out of smoldering houses. Fire was designated a nationwide moral emergency in reports from presidential commissions with titles like America Burning.51 The campaign led to the n
ow-ubiquitous sprinklers, smoke detectors, fire doors, fire escapes, fire drills, fire extinguishers, fire-retardant materials, and fire safety education mascots like Smokey the Bear and Sparky the Fire Dog. As a result, fire departments are putting themselves out of business. About 96 percent of their calls are for cardiac arrests and other medical emergencies, and most of the remainder are for small fires. (Contrary to a charming image, they don’t rescue kittens from trees.) A typical firefighter will see just one burning building every other year.52
Fewer Americans are accidentally gassing themselves to death. One advance was a transition starting in the 1940s from toxic coal gas to nontoxic natural gas in household cooking and heating. Another was better design and maintenance of gas stoves and heaters so they wouldn’t burn their fuel incompletely and spew carbon monoxide into the house. Starting in the 1970s, cars were equipped with catalytic converters, which had been designed to reduce air pollution but which also prevented them from becoming mobile gas chambers. And throughout the century people were increasingly reminded that it’s a bad idea to run cars, generators, charcoal grills, and combustion heaters indoors or beneath windows.
Figure 12-6 shows an apparent exception to the conquest of accidents: the category called “Poison (solid or liquid).” The steep rise starting in the 1990s is anomalous in a society that is increasingly latched, alarmed, padded, guard-railed, and warning-stickered, and at first I could not understand why more Americans were apparently eating roach powder or drinking bleach. Then I realized that the category of accidental poisonings includes drug overdoses. (I should have recalled that Leonard Cohen’s song based on the Yom Kippur prayer contains the lines “Who in her lonely slip / Who by barbiturate.”) In 2013, 98 percent of the “Poison” deaths were from drugs (92 percent) or alcohol (6 percent), and almost all the others were from gases and vapors (mostly carbon monoxide). Household and occupational hazards like solvents, detergents, insecticides, and lighter fluid were responsible for less than a half of one percent of the poisoning deaths, and would scrape the bottom of figure 12-6.53 Though small children still rummage under sinks, taste the offerings, and get rushed to poison control centers, few of them die.
So the single rising curve in figure 12-6 is not a counterexample to humanity’s progress in reducing environmental hazards, though it certainly is a step backward with respect to a different kind of hazard, drug abuse. The curve begins to rise in the psychedelic 1960s, jerks up again during the crack cocaine epidemic of the 1980s, and blasts off during the far graver epidemic of opioid addiction in the 21st century. Starting in the 1990s, doctors overprescribed synthetic opioid painkillers like oxycodone, hydrocodone, and fentanyl, which are not just addictive but gateway drugs to heroin. Overdoses of both the legal and illegal opioids have become a major menace, killing more than 40,000 a year and lifting “poison” into the largest category of accidental death, exceeding even traffic accidents.54
Drug overdoses clearly are a different kind of phenomenon from car crashes, falls, fires, drownings, and gassings. People don’t get addicted to carbon monoxide, or crave taller and taller ladders, so the kinds of mechanical safeguards that worked so well for environmental hazards will not be enough to end the opioid epidemic. Politicians and public health officials are coming to grips with the enormity of the problem, and countermeasures are being implemented: monitoring prescriptions, encouraging the use of safer analgesics, shaming or punishing pharma companies that recklessly promote the drugs, making the antidote naloxone more available, and treating addicts with opiate antagonists and cognitive behavior therapy.55 A sign that the measures might be effective is that the number of overdoses of prescription opioids (though not of illicit heroin and fentanyl) peaked in 2010 and may be starting to come down.56
Also noteworthy is that opioid overdoses are largely an epidemic of the druggy Baby Boomer cohort reaching middle age. The peak age of poisoning deaths in 2011 was around fifty, up from the low forties in 2003, the late thirties in 1993, the early thirties in 1983, and the early twenties in 1973.57 Do the subtractions and you find that in every decade it’s the members of the generation born between 1953 and 1963 who are drugging themselves to death. Despite perennial panic about teenagers, today’s kids are, relatively speaking, all right, or at least better. According to a major longitudinal study of teenagers called Monitoring the Future, high schoolers’ use of alcohol, cigarettes, and drugs (other than marijuana and vaping) have dropped to the lowest levels since the survey began in 1976.58
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With the shift from a manufacturing to a service economy, many social critics have expressed nostalgia for the era of factories, mines, and mills, probably because they never worked in one. On top of all the lethal hazards we’ve examined, industrial workplaces add countless others, because whatever a machine can do to its raw materials—sawing, crushing, baking, rendering, stamping, threshing, or butchering them—it can also do to the workers tending it. In 1892 President Benjamin Harrison noted that “American workmen are subjected to peril of life and limb as great as a soldier in time of war.” Bettmann comments on some of the gruesome pictures and captions he collected from the era:
The miner, it was said, “went down to work as to an open grave, not knowing when it might close on him.” . . . Unprotected powershafts maimed and killed hoopskirted workers. . . . The circus stuntman and test pilot today enjoy greater life assurance than did the [railroad] brakeman of yesterday, whose work called for precarious leaps between bucking freight cars at the command of the locomotive’s whistle. . . . Also subject to sudden death . . . were the train couplers, whose omnipresent hazard was loss of hands and fingers in the primitive link-and-pin devices. . . . Whether a worker was mutilated by a buzz saw, crushed by a beam, interred in a mine, or fell down a shaft, it was always “his own bad luck.”59
“Bad luck” was a convenient explanation for employers, and until recently it was a part of a widespread fatalism about lethal accidents, which were commonly attributed to destiny or acts of God. (Today, safety engineers and public health researchers don’t even use the word accident, since it implies a fickle finger of fate; the term of art is unintentional injury.) The first safety measures and insurance policies in the 18th and 19th centuries protected property, not people. As injuries and deaths started to increase unignorably during the Industrial Revolution, they were written off as “the price of progress,” according to a nonhumanistic definition of “progress” that was not reckoned in human welfare. A railroad superintendent, justifying his refusal to put a roof over a loading platform, explained that “men are cheaper than shingles. . . . There’s a dozen waiting when one drops out.”60 The inhuman pace of industrial production has been immortalized in cultural icons such as Charlie Chaplin on the assembly line in Modern Times and Lucille Ball in the chocolate factory in I Love Lucy.
Workplaces began to change in the late 19th century as the first labor unions organized, journalists took up the cause, and government agencies started to collect data quantifying the human toll.61 Bettmann’s comment on the lethality of work on trains was based on more than just pictures: in the 1890s, the annual death rate for trainmen was an astonishing 852 per 100,000, almost one percent a year. The carnage was reduced when an 1893 law mandated the use of air brakes and automatic couplers in all freight trains, the first federal law intended to improve workplace safety.
The safeguards spread to other occupations in the early decades of the 20th century, the Progressive Era. They were the result of agitation by reformers, labor unions, and muckraking journalists and novelists like Upton Sinclair.62 The most effective reform was a simple change in the law brought over from Europe: employers’ liability and workmen’s compensation. Previously, injured workers or their survivors had to sue for compensation, usually unsuccessfully. Now, employers were required to compensate them at a fixed rate. The change appealed to management as much as to workers, since it made their costs more predictable and the workers more coop
erative. Most important, it yoked the interests of management and labor: both had a stake in making workplaces safer, as did the insurers and government agencies that underwrote the compensation. Companies set up safety committees and safety departments, hired safety engineers, and implemented many protections, sometimes out of economic or humanitarian motives, sometimes as a response to public shaming after a well-publicized disaster, often under the duress of lawsuits and government regulations. The results are plain to see in figure 12-7.63