As Sweden Slashes Motor Vehicle Deaths, the U.S. Toll Is Climbing

Preventable deaths — deaths that could be avoided through effective public health and primary prevention measures — can tell us a lot about a country’s social infrastructure. The United States has among the highest rates of preventable deaths among high-income nations, and, in 2022, about 4 percent were due to motor vehicle accidents.

Motor vehicle accidents are largely preventable, yet they were the leading cause of death in the U.S. between 2015 and 2019. Each year, they lead to an average of 3.8 million emergency department visits and more than 3 million injuries and disabilities. In 2019, these accidents cost Americans $340 billion, after factoring in costs stemming from medical and emergency services, lost productivity, legal and court fees, insurance claims, and workplace losses like lost wages due to injury, among other sources.

Road traffic injuries are also an equity issue. That’s because they tend to impact people, usually those with low income, who rely on “riskier” modes of transport like cycling, walking, and motorbikes. In fact, socioeconomic status is a well-known predictor of crash risk. People of color, people with lower incomes, and those with less education are more likely to be killed or injured in a crash. Moreover, health care costs after an accident can be exorbitant, and, depending on the injuries sustained, they can prevent a return to normal life.

In 1995, Sweden’s government recognized that while traffic accidents are part of life in the modern world, they don’t have to cost so many people their lives or health. Over the past three decades, Sweden’s Vision Zero program has led to a 50 percent reduction in transportation-related mortality. Here’s how they did it.

Sweden’s Vision for Zero Road Traffic Fatalities

The Swedish National Road Administration developed Vision Zero through a comprehensive analysis of highway safety data involving highway and traffic engineers, law enforcement, vehicle designers, medical and public health specialists, media, and others. Together they sought to understand how and why road traffic accidents were occurring, and what could be done.

Based on the findings, the government undertook a number of roadway and safety improvements, including:

• Erecting median barriers on roads with speeds above 50 m.p.h. to prevent head-on crashes
• Installing roadside barriers to minimize rollovers and off-road crashes
• Reducing speed limits and adding speed bumps on roadways in urban areas
• Introducing a traffic safety camera system — the largest per capita in the world — to increase compliance
• Installing roundabouts to minimize crashes and damage caused by side collisions
• Prioritizing pedestrians and cyclists over vehicle traffic on local streets by creating pedestrian-only areas, bike lanes, and more
• Becoming a founding member of the European New Car Assessment Programme, which pushes vehicle improvements and technology beyond regulation.

Because of Sweden’s combination of safer vehicles, better road infrastructure, and lower average speeds, 50 percent fewer people were admitted to the hospital from road accidents in 2022 compared to 2001.

In the U.S., Progress Has Come at the Cost of Equity

Over the past decade or so, several major U.S. cities have declared motor vehicle–related deaths a public health problem, and more than 50 have implemented their own versions of Vision Zero. But their varied success illustrates the fact that Vision Zero is not a one-size-fits-all solution.

In 2014, New York City implemented arguably the most comprehensive such strategy in the U.S. As well as lowering the speed limit to 25 m.p.h., the city launched the largest automated speed-enforcement program in the world. Red-light violations have since fallen over 75 percent and right-angle crashes by 80 percent. In the decade since New York introduced its Vision Zero initiative, pedestrian deaths have fallen 29 percent compared to a 67 percent increase nationally. Overall traffic fatalities also dropped 16 percent in the city.

U.S. programs tend to lean heavily on the police over other enforcement mechanisms. And because these models have been implemented almost exclusively in metropolitan areas, which tend to have larger communities of color, this has presented a unique equity issue, local police forces have disproportionately targeted low-income and minority communities. In New York, for example, police enforcement in communities of color has come at the expense of improvements like pedestrian plazas and bike lanes, which are more likely to be implemented in wealthier, whiter neighborhoods. This disjointed approach has resulted in a 20 percent decrease in traffic fatalities among white people between 2014 and 2020 but increases of 7 percent and 2 percent among Latino and Black New Yorkers, respectively.

U.S. implementations of Vision Zero also often miss a big point of the Swedish model: road safety responsibility is assigned to infrastructure designers, such as government bodies, road authorities, and vehicle manufacturers. This is underpinned by the belief that road safety issues stem from design flaws, and that the most effective solutions involve safer infrastructure and vehicle designs. In contrast, the U.S. focuses on individual responsibility.

U.S. cities also may struggle with implementing infrastructural safety interventions due to entrenched car dependence and a lack of public transportation, particularly in low-income neighborhoods. Additionally, opposition from businesses and minority groups, who fear socioeconomic impacts and gentrification, highlights the need for inclusive and consultative planning processes.

Health promotion is often viewed through a rather narrow lens. We think first of things like access to hospitals or doctor’s appointments, while the reality is that there are countless factors contributing to a healthy society. These include designing infrastructure in a way that prioritizes people’s safety and well-being, as well as helping the public understand that safer driving practices save lives.

The author would like to thank Matts-?ke Belin, Henok Girma Abebe, and Eva Bj?rk and her team at Vision Zero Academy for review of this Insight.