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1 From Accident to Crash: The Auto Industry and the Politics of Injury Author(s): Carol A. MacLennan Source: Medical Anthropology Quarterly, New Series, Vol. 2, No. 3, Health and Industry (Sep., 1988), pp Published by: Blackwell Publishing on behalf of the American Anthropological Association Stable URL: Accessed: 12/11/ :00 Your use of the JSTOR archive indicates your acceptance of JSTOR's Terms and Conditions of Use, available at JSTOR's Terms and Conditions of Use provides, in part, that unless you have obtained prior permission, you may not download an entire issue of a journal or multiple copies of articles, and you may use content in the JSTOR archive only for your personal, non-commercial use. Please contact the publisher regarding any further use of this work. Publisher contact information may be obtained at Each copy of any part of a JSTOR transmission must contain the same copyright notice that appears on the screen or printed page of such transmission. JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. For more information about JSTOR, please contact Blackwell Publishing and American Anthropological Association are collaborating with JSTOR to digitize, preserve and extend access to Medical Anthropology Quarterly.

2 CAROL A. MACLENNAN Science, Technology and Society Program Michigan Technological University From Accident to Crash: The Auto Industry and the Politics of Injury In many instances, the politics of public health is directly related to the problem of state power. This is especially true for automobile injuries and the 64-year history of the effort to reduce their number in the United States. This article looks at the continual redefinition of the automotive injury problem through these phases: (1) , when the automobile manufacturers controlled prevention programs that defined the driver as the cause of accidents, (2) , when federal regulations targeted vehicle technology as the best source of prevention strategies, and (3) 1979 to the present, when, during the Reagan years, the framework shifted toward defining health and injury prevention as economic commodities. Throughout this history the dominance of a market ideology in U.S. political culture has largely defined both the character of public health programs to reduce injuries and the capacity of the state to curtail industrial power to design hazardous technologies. he fact that automobile crashes in the United States kill nearly 50,000 people a year and seriously injure 100,000 others is a significant statement about the nation's health.' The fact that this problem has existed at proportionally the same magnitude for several decades, despite serious efforts to ameliorate it, is an important commentary on industrial power in America. The fact that we tolerate this annual toll indicates our strong dependence on motor vehicle transportation and a fateful acceptance of trauma. This is a view radically different from our concern with diseases such as cancer and AIDS, which are characterized by a strong public demand for a cure. Since death and injury are integral to an automotive technology to which the United States is culturally and economically so committed, political solutions to the problem of automobile crashes are fraught with cultural conflict and industrial resistance. To understand the reasons why this problem continues, we must thus look more closely at the relationship between culture, industry, and public policy. In this article I examine the history of automobile accidents and injuries in terms of the conflict of power and political ideology concerning the management of this public health problem. Automobile crashes are numerically and historically the most important cause of injury in the nation (see Tables 1 and 2). They have also received the most attention of all injuries. An entire federal agency (the National Highway Traffic Safety Administration) has been devoted to prevention of automotive in- 233

3 234 MEDICAL ANTHROPOLOGY QUARTERLY TABLE 1 Major causes of injury deaths in the United States (1982)." Injury category Total deaths % of all injuries Motor vehicles 44, Firearms 32, Falls and jumps 13, Drowning 7, Poisoning 7, Fires and burns 5, Suffocation, hanging, and strangulation 6, Cutting 4, Poisoning by motor vehicle carbon monoxide 2, Other 22, Total 147, aadapted from figures in National Academy of Sciences 1985:23. TABLE 2 Motor vehicle deaths and rates, a Death rate Per 100,000 Per 100,000,000 Year population vehicle miles avg. 6.8b avg avg avg Change, % -25% asource: National Safety Council (1986:59). bmileage data inadequate prior to juries. Yet the 64-year effort to achieve effective reduction has met with repeated political controversy, and the more recent public health effort to control harmful technologies in the form of industrial regulation has been singularly unable to

4 FROM ACCIDENTO CRASH 235 achieve a reduction in the magnitude of automobile injuries. To understand this state of affairs, we must examine the broad cultural and economic forces that have influenced the regulatory process over the past six decades. In undertaking this study, we must inevitably confront questions of state power, particularly the regulatory functions of government.2 Yet anthropologists have not closely examined either the moder American state or its relationship to the private economy. We must therefore turn to the work of other social scientists for important insights into the workings of the state in capitalist societies. Two central ideas from this literature are of particular relevance to the problem considered here: (1) the capitalist state is constrained rather than determined by the organization of the economy, and (2) specific state policies and the organizations (i.e., state capacity) that carry them out are more a product of state development than of economic factors. The first of these ideas emerges from a growing theoretical literature that can best be characterized as a reevaluation of Marx's and Lenin's writings on the state, which argued that political institutions were merely tools of class rule (Carnoy 1984; Jessop 1984). Yet the capitalist state responds today to pressures from the working class as well as from the capitalists. Class conflict thus occurs within the state itself and is resolved politically. The overall direction of that resolution, however, is largely constrained by the economic organization of society. Creation of the Occupational Safety and Health Administration (OSHA) and the debate over its regulations provide examples of this political process taking place within government. The best empirical research on state capacity, the second concept relevant to our inquiry, has been historical-for example, Skocpol's study of New Deal programs (1982) and Skowronek's study of the rise of the administrative state (Skowronek 1982; see also Orren and Skowronek 1986). In these works we see how organizational structures and policies emerge out of specific historical and political circumstances. Case studies of contemporary policies and political systems analyzed within this framework are rare, however. Noble's book (1986) on the Occupational Safety and Health Administration constitutes an important exception. While an emphasis on state development has been helpful in explaining the general configuration of programs and policies that appear on the surface to be contradictory or irrational, the question of how specific policies are created, institutionalized, and then redefined remains elusive. What must be more fully appreciated is that public policies arise within a political culture of ideas or ideologies about the proper functioning of the political-economic order. When we want to understand why certain social problems, such as motor vehicle deaths, and ideas for remedying them are continually defined and redefined in new waysand why the remedies themselves do not work-we should look at the ideologies that affect this process, at the culture of the regulatory process itself. Regulatory policy in the United States evolved within a liberal political culture, characterized by a belief in a private economy and a limited government (Noble 1986). Regulation is in effect a system of rules by which government can act in the event of a "market failure" that disturbs the social order. Disputes over regulation concern whether the marketplace is or is not working properly, and by this means industrial power constrains the state. In short, beliefs about what is possible or acceptable in policy govern its formulation and implementation.

5 236 MEDICAL ANTHROPOLOGY QUARTERLY The recent cycle of state regulation and deregulation in this country provides an apt example for anthropological study. The rising demand for health and safety regulation during the 1960s and 1970s, which resulted in new laws and new agencies, is a story of expanding state power. The subsequent pressure for deregulation in the 1980s and withdrawal of the state from prevention-oriented health programs illustrate constraint on state capacity imposed by the private economy. These recent historical developments may be seen by the public as a succession of competing ideologies, each offering a new framework for understanding and solving the problem. (I use the term "ideology" here because the conflicting frameworks for the policy debate are really artifacts of power relations in the wider society.) The definition and redefinition of both the problem and the solution are organized discourses that mirror shifting relations of power among industry, the state, and society. It is essential to emphasize that the competing ideologies do not operate in a vacuum. They reflect material economic and social relations, but once constructed they can act as forces upon future events. The history of crash injury policy illustrates the role of ideology in public policy, and particularly in health and safety regulation. Traffic Safety and the "Accident" Problem (ca ) The first organized attempt in the United States to address traffic deaths started in the 1920s. Alarmed by the rising fatality rate, the U.S. Chamber of Commerce and the National Safety Council organized two conferences, one in 1924 and the other in Financed primarily by the automobile industry and other private businesses, these conferences also reflected growing concern in the business community with problems of automobile use and acceptance among the public. As motor vehicle fatalities continued to rise in the next decade (see Table 2),3 the automobile industry established the Automotive Safety Foundation in 1937 to fund and organize safety programs throughout the country. A decade later, with fatalities continuing to rise, the auto manufacturers and insurance companies were successful in focusing President Truman's attention on traffic safety in a 1946 President's Conference for Traffic Safety. In 1949 another President's Conference voiced the sentiment that highway deaths were a drain on national energy. Regular use of the word "carnage" in traffic safety vocabulary equated the human damage from accidents with that resulting from war. Despite the fact that the Nation is both more safety-conscious and more effectively mobilized to prevent accidents than ever before, still 32,000 Americans met death in traffic last year. More than a million others suffered disabling injuries. The bill we paid for the appalling carnage amounted to over 21/2 billion dollars. Few individuals can afford the luxury of a traffic accident. No more can the Nation as a whole support the prodigal waste of accidents in the aggregate. As President Truman has repeatedly emphasized, even a country as rich as ours cannot indefinitely endure such a drain on its human and material resources. [President's Highway Safety Conference 1949:1] The 1949 conference set up the President's Committee for Traffic Safety, a quasi-government agency responsible for coordinating and reporting on local traffic safety programs. Staffed by civil servants and managed by representatives from industry, this organization legitimized the industry's definition of the acci-

6 FROM ACCIDENT TO CRASH 237 dent problem. The Committee received 25% of its funding from private industry (mostly from the Automotive Safety Foundation, Insurance Institute for Highway Safety, American Automobile Association, and Outdoor Advertising Association) (U.S. Senate Government Operations Committee 1965). All these sponsors had an interest in promoting automobile use in the United States. Not surprisingly, therefore, the Committee adopted the industry's solution to the traffic safety problem: driver-oriented accident prevention programs.4 From 1920 through the 1950s the traffic safety establishment perpetuated the belief that drivers were responsible for accidents. A companion belief was that the technology (both vehicle and highway) was continually modernized by responsible, professional parties using the newest methods and materials. Because both vehicles and highways were considered to be as well designed as possible, the problem was therefore traceable to irresponsible and careless drivers. Drivers were suspect, while the actions of engineers and automakers were unquestioned. The problem was also viewed as one that required solutions at the state and local government levels. Throughouthis period the proposed remedies-such as a uniform vehicle code throughout the nation, driver education, traffic control, or enforcement of safety laws-dealt with eliminating driver fault. Federal policy reflected twin goals: punish the careless driver, and instill good driving habits in the general population. Federal research in traffic safety reflected this same focus on the driver, with questions targeted to driver attitudes, accident and violation repeaters, and the driver in relation to the vehicle and the road. Collection of statistics on accidents, too, was considered important, primarily to target regions where accident rates were high, so that an effort could be made to promote traffic safety. Even federal agencies, such as the U.S. Public Roads Administration, adopted the orthodox view and published reports such as "Driver Behavior: Key to Safe Highway Design" (President's Highway Safety Conference 1949). The notable lack of attention to the role of the automobile in accidents is typical for a period in which technology was generally considered a neutral force in society (Winner 1986). Human use alone determined its enhancing or destructive capabilities. It is not surprising that in an age when the notion of "what's good for General Motors is good for the country" was popular, public criticism of vehicle design was rare.5 Safety specialists devoted limited attention to the vehicle, and safety devices were thought of as items or additions that enabled safer driving by the individual driver (expanded windshields, better vehicle lighting, better brakes). Federal policy during this pre-regulatory period focused almost exclusively on fixing responsibility for automobile accidents on human carelessness. This perspective limited inquiry to the study of human behavior. The accident itself remained a black box, an obscure event.6 For the victim even today, an "accident" implies a chance occurrence over which one has no control. Yet there is a distinction to be made between responsibility for and causes of accidents. Concern with responsibility fixes blame and leads to punishment or reeducation. A focus on cause and effect is more scientifically oriented and directs attention to the physical event in order to design preventative measures. During this pre-regulatory period, which was dominated financially and organizationally by the automotive industry, public policy blurred this distinction between responsibility and cause.

7 238 MEDICAL ANTHROPOLOGY QUARTERLY Reform: Focus on Technology ( ) The industry-dominated view of the traffic safety problem as "the nut behind the wheel" did not go unchallenged. The pressure for change came from a few engineers and medical doctors who observed the causes and effects of vehicle crashes. Later, joined by lawyers and Congressional representatives, they came to argue that the prevailing wisdom on accidents retarded any serious attempt to curb the harm caused by motor vehicles. Out of their criticisms and their organized efforts came a political movement that resulted in the passage by Congress of the Motor Vehicle Safety Act of The reinterpretation of the problem, the location of the solution in the regulatory authority of the state, and the rallying of public opinion can be attributed in large part to the rising consumer movement of the time. For 40 years automotive manufacturers had successfully promoted the view that they were responsible agents, while drivers were irresponsible and unskilled. The 1966 Act challenged this assumption. The vehicle, not the driver, was the target for change. Strategies for reducing automobile deaths focused on the cause and prevention of injury rather than accidents. Engineers and medical researchers were to be key actors in designing injury-reduction programs. From an engineering standpoint, it was argued that a better understanding of the mechanisms that cause injury and the levels of human ability to withstand it were needed. From a biomedical standpoint, injury came to be seen as a "disease" for which a specific etiology needed to be identified. From both professional vantage points, automotive technology was identified as the target for change. Without realizing it, engineers and scientists who challenged the industry's orthodoxy about accidents were questioning what manufacturers perceived as their basic economic right to control vehicle design. The debate over traffic safety in the Congressional hearings of 1959 and 1965 was the direct result of research into injury and crash dynamics initiated by engineers, such as Hugh DeHaven and Colonel Stapp, and physicians, such as Claire Straithe and William Haddon. Their work, based on empirical observations and scientific procedures, built the foundation for the Congressional challenge to the automotive industry during the mid-1960s. DeHaven organized research on crash dynamics at the Cornell Aeronautical Laboratory in Buffalo during the 1950s. Funded by Liberty Mutual Insurance, the Cornell lab became the only center to carry out research on automobile crashes and to collect accident data continuously over several years. By 1956, the lab had built a safety car prototype with a design that would allow occupants to survive a fifty-mile-per-hour collision unhurt. This safety car created significant media attention, but automakers dismissed it as impractical. A second research operation at UCLA was started by Colonel Stapp with funding from the Air Force. Stapp's work survived only a few years before succumbing to budget pressures. It has been suggested that auto manufacturers were responsible for threatening Congressional committees to cut off all funds for aeromedical research unless Stapp's testing program ceased. This research was phased out in 1958 (Eastman 1981:418). Beginning in the 1930s, a number of physicians became active in promoting safer vehicle design as a preventive measure for face, head, and chest injuries.

8 FROM ACCIDENT TO CRASH 239 Detroit plastic surgeon Claire Straith directly lobbied automotive executives for specific safety features in vehicles such as seatbelts, padded dashboards, and removal of sharp, protruding objects in the vehicle interior. He experienced limited success in the late 1940s and early 1950s with small companies such as the Tucker Corporation and Kaiser-Frazer, both of which went out of business within just a few years of production. Both companies sold vehicles that advertised safety features. The original Tucker Torpedo was changed to the Tucker '48-a name change designed to emphasize safety rather than speed. However, even in a safety-conscious company like Tucker, seatbelts were omitted because the sales department argued that "the presence of safety belts would imply that the automobile was dangerous" (Tucker Corporation official, quoted in Eastman 1981:413). In the early 1950s the medical community by and large adopted a "vehicle" approach to injury reduction. In 1953 the American Medical Association passed a resolution recommending that the auto manufacturers "consider equipping all automobiles with safety belts" (quoted in Eastman 1981:421). Subcommittees on automobile safety were established by the American Medical Association and the American College of Surgeons. The physics of injury became a focus of attention, thus rendering the traditional wisdom of accident causation meaningless. If the occupant wore the car as he would a suit of armor [wrote one physician] the crushing of the car exterior in a collision would absorb tremendous amounts of impact energy and protect him from bodily injury. The occupant would be spared injury unless his passenger space became extensively crushed. But for some unexplained reason the teachings of physics have never been understood or accepted by the motorist-so, rather than 'strap on' the vehicle and take advantage of its protective armor in a crash, the motorist watches the vehicle crash relatively slowly to a stop and then dashes himself violently to pieces against the interior! This makes no sense at all, but it is still standard practice after 50 years of automobile accident history. [quoted in Eastman 1981: ] What physicians and engineers were describing in the professional journals in the 1950s became more popularly known ten years later as the "second collision": the crash of the occupant with the vehicle. This popular recognition led to discussions of better automotive design for occupant protection or "crashworthiness." If injury caused by the second collision was the problem, then vehicle design to reduce injury was the solution. Research at the Cornell Lab identified the sources of injury as the steering column, windshield, dashboard, and passenger compartments that would crush on impact, and obvious technical solutions to improve these sources of injury, such as collapsible steering columns, padded interiors, shatterproof windshields, and anchored seatbelts, were developed in the 1950s. After trying unsuccessfully to lobby auto executives for safer cars, a number of physicians began publicly to hold the manufacturers responsible for highway deaths. A 1954 article in Surgery argued: These deaths, for the most part, occur because the motorcar manufacturer makes no provision whatsoever for the control of the occupants when they must decelerate rapidly. What happens to the motorcar rider under conditions of rapid deceleration is left entirely to chance. [quoted in Eastman 1981:421] Ralph Nader publicized the concept of the "second collision" in his book Unsafe at Any Speed (1965) and during Congressional hearings in the mid- 1960s.

9 240 MEDICAL ANTHROPOLOGY QUARTERLY He summarized the research findings of the Cornell and UCLA labs, pointed to the reluctance of the manufacturers and the traffic safety establishment to accept scientific evidence concerning the cause of crashes, and generally promoted the idea of a "crashworthy vehicle." Nader went further than physicians and engineers in laying the blame for crash injuries at the doorstep of the manufacturers. A great problem of contemporary life is how to control the power of economic interests which ignore the harmful effects of their applied science and technology. The automobile tragedy is one of the most serious of these man-made assaults on the human body. The history of that tragedy reveals many obstacles which must be overcome in the taming of any mechanical or biological hazard which is a by-product of industry or commerce. [R. Nader 1965:ix] To resolve the problem, Nader argued for a public initiative to regulate the industry. The result was the Motor Vehicle Safety Act of 1966, which gave administrators complete discretion over the scope of new safety requirements: "They could demand only a single change in windshield wipers, or they could ban convertibles and small cars" (Drew 1966:102). The 1966 Act was a radical departure from the government's respectful hands-off approach to the automobile industry. Engineering and safety design, rather than education and enforcement, were to be the new tools for attacking the problem. This change set the stage for limited political control over industrial technology. However, that control never materialized. Inevitably, battles between industry and the new government agency concerned standards for safety. The new program was based on application of scientific (physical and biomedical) principles to both the study of crash dynamics and the development of safety devices.7 William Haddon, the first administrator of the new National Highway Traffic Safety Administration (NHTSA), was a physician and public health specialist who persuasively promoted a scientific approach to hazard control. This approach, he argued, demanded that we understand the etiology of crash injuries. He pointed out that the "ability to describe human morbidity and mortality etiologically requires an understanding of causation. Hence it opens the door to the possibility of manipulation and control" (1968: ). The science of crash injuries requires analyzing causes into manageable variables in order to develop countermeasures. As opposed to the descriptive concept of "accident," the etiologic perspective led to consideration of a range of new phenomena. During his tenure as administrator of the new auto safety agency, Haddon developed a program of action that reflected the sequence of events leading to automotive injuries. In the precrash phase, the research issues include those of alcoholism, blowouts, coefficients of friction of road surfaces. In the crash phase, there are the injury thresholds of drivers and others, the dynamic integrity of vehicle packages, and highway crash design. In the post-crash phase, the issues for research and programs include emergency signal generation and other communications, emergency transportation, emergency medical care, debris removal, and police work. [Haddon 1968:1435] With the work of Haddon and others in the public health profession, the phrase "injury control" gradually began to replace "accident prevention." Im-

10 FROM ACCIDENT TO CRASH 241 plicit in their view was the recognition that while accidents could never be eliminated, injuries produced from crashes could be controlled and, in many instances, prevented altogether. The entire language and conceptual framework had changed. More important, it altered the political relationship between the auto industry and the federal government. How did the automotive industry lose its power over the policy process? Why did such a shift in political culture occur? The answer is related to the larger question of what brought in an era of regulation in the 1960s by a government that had for decades been dominated by a pro-business orientation. Recently, several analysts have concluded that the regulatory wave was a temporary one and can be attributed to a combination of factors. With respect to automobile safety, political entrepreneursuch as Ralph Nader led the effort to force the state to establish consumer protection laws through successful use of Congressional hearings and media exposure (Pertschuk 1982). At the same time, the industry was enjoying a period of rapid overseas expansion and experiencing healthy profits (Ferguson and Rogers 1986). Although the manufacturers objected to the regulatory solution to the accident problem, auto executives were generally ill-experienced in political affairs and ill-prepared at Congressional hearings. As a result, they were unable to mount a convincing compaign against Nader and the evidence consumer advocates presented (Noble 1986). As a result, a new view of public policy-one that was technology-oriented and regulation-based-prevailed. The Politics of Crash Injuries: The Airbag Controversy8 With the emergence of NHTSA and its open mandate to design safety standards that preserved lives, the stage was set for battles with industry. But it took awhile for the conflict to emerge, as industry slowly organized itself in response to the new regulatory environment. Similar to the experience of other health and safety agencies, it was not until the mid-1970s that the full force of industrial resistance to auto regulation appeared. The power to set standards for reducing environmental hazards was novel in American government. In its early years the Agency decided to focus on performance rather than design standards. Many of the industry's voluntary regulations, such as those developed by the Society of Automotive Engineers (SAE), specified a particular design for a component or part. On the other hand, the new standards set goals for the performance of a component by requiring that a certain level of effectiveness or protection be achieved and leaving it up to the manufacturer to figure out specific designs. During the first years at NHTSA the "science" of crash injury blossomed, and both industry and government made notable strides in research on safety technology. NHTSA Administrator Haddon and other safety specialists, intent on developing crash research as a science, worked to establish a new profession of specialists. They deliberately encouraged engineers to replace the word "accident" with "crash" to help shift public thinking away from a fatalistic acceptance of highway death and toward the idea that harm from injury could be limited (see Haddon, Klein, and Suchman 1964). Most of the new professionals were biomechanical engineers, and a few were from public health fields. A by-product of

11 242 MEDICAL ANTHROPOLOGY QUARTERLY the creation of this new professional elite was a complex technical language that mixed medical and engineering terminology. This language legitimated the expertise and exclusivity of these experts in regulatory decision making over the next decade. The evolution of a regulatory culture in the 1970s is reflected in the politics of crash injury research and particularly in the debate over the airbag, an inflatable bag designed to protect front-seat occupants in the event of a crash. During this period the science of crash research itself became politicized, though the lively technical debates between industry and government engineers obscured the much deeper conflict between the Agency and the manufacturers. In effect, the new law forced manufacturers to share their control over technical decisions with a public agency. Using evidence collected by the Cornell lab, NHTSA made the decision to focus its first major rulemaking activity on frontal crashes, which at that time accounted for 60% of all crashes and more than half the fatalities. In 1969 NHTSA published its first notice of a proposed rule for the airbag in the Federal Register. The airbag standard represented the "technology-forcing" role of the Agency by requiring manufacturers to utilize new technology that it believed feasible and effective. The intent was to make passive restraints, both bags and automatic seatbelts, standard safety features of vehicles. Twenty years later this has not yet happened. At first the industry seemed to favor installation of airbag technology in motor vehicles. They had, in fact, been actively pursuing airbag research. Beginning in 1971, however, automakers began to press for delays in the deadline for implementing the standard, and by 1974 they united in their opposition to the airbag standard. During that time General Motors, at the prodding of its president Edward Cole, actually marketed 10,000 airbag-equipped cars. This innovation had been planned in the late 1960s, and plants had actually been retooled before the airbag deadline was extended. Yet when Cole retired in 1974, the airbag experiment ended at GM. The manufacturers, through the courts and Congress, successfully engineered several delays in imposing the standard through the mid-1970s. The dispute focused on the technical design of the airbag (Reppy 1984). Activation of the airbag in the event of a crash relied solely on automatic sensors in the vehicle, requiring no effort on the part of the driver. The industry argued in its lawsuit during the early 1970s that the government's standard was not objective because of problems with testing procedures, that the regulations were not practical because the technology did not yet exist, and that the device was unsafe because it was more hazardous than the seatbelt alternative. Immediately the debate centered on new technical issues: whether seatbelt usage in the United States would ever achieve effective levels (they were currently being used by 10-14% of vehicle occupants), whether large-scale field tests should be completed before mandating a new technology, and whether the airbag was in fact reliable in the event of a crash. As in other regulatory conflicts, the controversy centered on the issue of scientific precision. Were anthropomorphic dummies sophisticated enough to measure the relationship between crash forces and human injuries? Could one fieldtest airbag-equipped cars utilizing a small sample (the 10,000 GM airbag cars had

12 FROM ACCIDENT TO CRASH 243 experienced fewer than 200 crashes by 1978) and at reasonable expense? These were questions that could only be answered by technical analysts, engineers, and scientists, and they were questions on which there was virtually no scientific agreement. Public and media efforts to sort out the scientific pros and cons were superficial at best, although rulemaking procedures mandated public involvement in finalizing regulations. The NHTSA docket, however, was monopolized by specialists in the scientific debate (particularly the automakers), and representations were highly technical in nature. One last attempt to push through the airbag standard (called Standard 208) came during the Carter Administration. When President Carter entered the White House in 1977, Secretary of Transportation Brock Adams and NHTSA Administrator Joan Claybrook revived Standard 208, requiring vehicles to be equipped with either airbags or automatic seatbelts by a date in Immediately the industry protested through the courts, Congress, and the media. In the courts the manufacturers charged that the standards were invalid because the Agency's estimates of effectiveness were based on experimental studies rather than field data. "Like the proverbial Catch-22, it seemed that there would never be any field data without a standard, yet the standard was forever being clocked on the grounds of insufficient data" (Tolchin 1984:76). Various Congressional initiatives, particularly from the Michigan delegation, attempted to block the standard. In 1978 the company that developed the airbag, Eaton, went out of the airbag business after a $20 million effort and 13 years of research. Frustrated with the regulatory process, Eaton's board chairman stated, "You've got to wonder what happens when Brock Adams goes out" (Tolchin 1984:77). During the Carter years industry's hostility to regulation intensified. Again, the regulatory process was characterized by feuds over the technological feasibility of safety design. Finally NHTSA built the Research Safety Vehicle (RSV) to show what type of car Detroit could produce if it made safety a priority. The vehicle could protect occupants in a 50 mph head-on crash and a mph side crash. Equipped with an advanced airbag system, it delivered 32 miles per gallon. Projected mass production cost was $7,000 in 1980 dollars (Claybrook et al. 1984). Auto executives charged the Agency with misleading the public about technologies that were not yet proven, and the automotive press labeled NHTSA Administrator Claybrook "the dragon lady." The RSV embarrassed the industry when NHTSA took it on the road to county fairs and advertised it on television. To complicate matters, Congress added the new Fuel Economy Program (1978 Energy Conservation Act) to NHTSA's responsibilities. New fuel economy regulations required several major changes in vehicle design over the years, including downsizing, smaller engines, and lighter materials to achieve higher fuel efficiency. This all occurred in a period of economic stress for American auto manufacturers: the Japanese share of the U.S. auto market increased to 26%, nearly 300,000 blue collar autoworkers were laid off indefinitely, and profits plummeted (MacLennan 1985b). As the economic and regulatory pressures on the industry intensified in , the discourse of regulation changed to reflect the economic concerns of the time. During the last two years of the Carter Administration, the costs of regulation became the major theme in decision making. Engineering debates over

13 244 MEDICAL ANTHROPOLOGY QUARTERLY technical feasibility diminished, as arguments escalated between economists and regulators over whether the costs of a standard outweighed its benefits. This shift in the regulatory process is reflected in the ongoing airbag controversy. In 1981, President Reagan subjected most existing and proposed health and safety regulations to a critical review in a government-wide move to gain regulatory relief for beleaguered industries. Auto regulations were prime candidates, especially since Reagan had already gone on record against airbags during the campaign. In addition, David Stockman, Reagan's director of the Office of Management and Budget (OMB), had opposed passive restraints when he was a Congressman, arguing that the auto industry would save $ million over three years if the standard were rescinded (Tolchin 1984:79). In 1981, three weeks after Secretary of Transportation Drew Lewis assumed office, he proposed delaying Standard 208 and eight months later revoked it. NHTSA Administrator Raymond Peck announced, It is time to stop the uncertainty abouthis standard. It is only by rescinding the standard and proceeding with what I have called this morning... 'a full court press' on technology, that we will be able to make material, substantial impact on reducing death on the highway. [quoted in Claybrook et al. 1984:169] The basis for this decision, the Administration claimed, was scientific: a cost-benefit evaluation of Standard 208 showed that the costs to industry outweighed the benefits to society. However, in 1982 the U.S. Court of Appeals issued a decision against the Agency on a suit filed by State Farm Insurance. It said the recision represented a paradigm of arbitrary and capricious agency action because NHTSA drew conclusions that are unsupported by evidence in the record and then artificially narrowed the range of alternatives available to it under its legislative mandate. [quoted in Tolchin 1984:79] In 1983 this decision was upheld unanimously by the Supreme Court. Secretary of Transportation Elizabeth Dole responded to the Court's decision by requiring automakers to equip all new passenger vehicles with either airbags or automatic belts by 1989, unless states representing two-thirds of the United States population passed legislation requiring the use of seatbelts by that time. That same day the automakers announced that they would equip vehicles with automatic belts instead of airbags; they also vigorously lobbied in state legislatures for mandatory seatbelt laws. Although the airbag controversy has led to the popular belief that seatbelts and airbags are interchangeable forms of occupant protection, they in fact are not. Seatbelts afford protection only up to about 35 mph in frontal crashes. Airbags are protective when seatbelts are not used and they augment belt protection over 35 mph. Essentially, both technologies are needed to prevent injury in most crashes. To date, the seatbelt laws that have been enacted do not yet account for twothirds of the U.S. population. As a result, some manufacturers have begun to phase in automatic belts and a few airbags in some of their luxury and large-size vehicles. Meanwhile, the cost-benefit framework has been effective in limiting new regulatory initiatives in auto safety, stalling pending regulations (e.g., the

14 FROM ACCIDENT TO CRASH 245 side-impact rule) and discouraging research and planning in areas of concern that might prove fruitful (e.g., protection of rear-seat passengers). The Cost-Benefit Framework in the 1980s When Congressional representatives adopted the regulatory method in 1966, they were persuaded by a microeconomic justification to support consumer protection. Hazards such as those produced by automotive transportation were believed to be marketplace failures. The costs of fatalities and injuries were not reflected in the market price of vehicles, since the market did not respond to a public health problem. Manufacturers, the reasoning went, had no incentive to develop and install safety devices in vehicles, and the federal government should compensate for this market failure and provide the incentive. It was argued that the "external costs" of these devices would, through government regulation, be reincorporated into the price of goods and services. By the mid-1970s the business community, arguing for deregulation, succeeded in shifting this microeconomic logic to a macroeconomic level and successfully undercu the market-failure argument (Noble 1986). Saving jobs, maintaining profits, and protecting the overall performance of the industrial sector became more importanthan the hazards of workplaces, products, and environment. The United States was in the midst of the first serious recession since World War II, and by 1980 this argument was further strengthened by a second recession beginning in In line with this gradual shift in orientation between 1975 and 1981, safety regulations became increasingly subject to economic review. Under the Ford Administration regulatory agencies had to prepare an "inflation impact statement" for each proposed rule. Later under Carter there existed the requirement that each new rule must meet a "cost-effective" test. Yet the full force of the cost-benefit approach was not felt until the Reagan years. Executive Order 12291, administered by the Office of Management and Budget (OMB), required that regulations meet a test to show that benefits outweigh costs. Previously, regulatory decisions were the product of many considerations, of which cost to industry was only one. Although regulations were backed by scientific research, the final decision to proceed with a controversial rule was an overt political decision. Reagan's mandate to consider promulgating rules based exclusively on costbenefit calculations gave the appearance of a rational, scientific decision-making process, not a political one. This, however, was not the case. EO left final review of new rules in the hands of OMB, a highly politicized agency in the White House, which is free from any public scrutiny or access. OMB meetings with agency officials or with industry are not open to the public, and internal OMB documents, unlike those of executive agencies, are not available under the Freedom of Information Act. Furthermore, Congress has little oversight over OMB. Originally merely an organization to coordinate and manage budget practices in executive agencies, under the Carter and Reagan administrations OMB became a powerful decision-making body. Yet, OMB has an extremely narrow viewpoint from which to make judgments on major regulatory issues, since the OMB criterion for regulatory effectiveness is purely cost. What has happened under EO 12291, in conjunction with the Reagan program for deregulation, is that tech-

15 246 MEDICAL ANTHROPOLOGY QUARTERLY nologies designed to save lives or reduce technological hazards have been redefined as economic burdens to society. A cost-benefit analysis (CBA) is a two-step activity in which the first procedure is to measure costs and benefits (a research function), and the second is to weigh the costs and benefits against each other (a policy function). Theoretically, CBA assumes that all costs and benefits are measurable in the same units. Yet researchers have failed to develop sensitive tools for the very difficult task of translating health-and-life benefits into monetary values (Center for Policy Alternatives 1980, 1982). In addition, costs are rather easily calculated and referred to businesses (e.g., the cost of installing airbags), while benefits are generally experienced by less well-defined populations (i.e., people in auto crashes), frequently years after the expenses of altering a particular product have been incurred. During the Reagan Administration CBA has been a central feature of regulatory culture, and indirectly imposition of the CBA requirement has effected deor nonregulation of industry (MacLennan 1985a). If one views government regulation as a formal mechanism of social control, then cost-benefit analysis can be considered an informal system of industrial control over government (Nader and Nader 1985). Since the early 1980s, CBA has functioned in three ways to enhance the power of the automotive industry in making auto safety policy.'? First, the EO requirementhat regulations be enacted only if the benefits exceed the costs sets the stage for extensive delay in implementation and/or for revisions in standards that weaken their ability to achieve the results desired by the general public (Eads 1981). Because proposed standards may also force technological improvements by pushing the private sector toward more effective production schemes, there are often few or no basic data on costs and benefits that will meet the qualifications of a supporting analysis required by OMB. It is only after introduction of a product or a procedure that an adequate picture of costs can be achieved. Both the passive restraint rule (Standard 208) and the side-impact protection program (Standard 214) were victims of the cost-benefit requirement. Calculations showed that well-documented cost to industry of Standard 208 overshadowed the benefits, which were indeterminate. The rule was revoked in October 1981, purportedly because it would save few, if any, lives. The Agency assumed that given the choice of installing either automatic seatbelts or airbags, manufacturers would install the former, less expensive alternative. NHTSA then argued that occupants would remove the detachable belts, and the effect of the regulation would therefore be negligible. The side-impact rule was in a preliminary stage of research and had not yet been published for comment at the start of the Reagan Administration. Because side impacts cause nearly one-third of all automotive injuries, it received second priority (after passive restraints) among NHTSA's proposed rules for passenger vehicles. In December 1979 NHTSA announced that a new, upgraded side-impact rule would be issued for public comment in In July 1982 NHTSA withdrew the rule, saying that it would be reopened "after research and analysis has progressed to the point that appropriate test methods and performance parameters can be developed," a process that would take about a year (Claybrook, Gillian,

16 FROM ACCIDENT TO CRASH 247 and Strainchamps 1982). In 1988, the docket on Standard 214 was reopened. In the interim, all research on side impact in the Agency virtually ceased. A second deregulatory effect of CBA that enhances the political advantage of the auto industry arises from imposing the burden of proof for cost-benefit analyses on the government. The time and effort involved in such a process encourage the Agency to seek nonregulatory alternatives, and consumer education and public information campaigns have become a substitute for standards in the auto safety agency. NHTSA's seatbelt campaign, announced shortly after recision of Standard 208, provides an example of this shift, as does its drinking/driving campaign to reduce alcohol-related crashes. Relying on public education strategies popular during the days of the Action Program in the 1950s, NHTSA has shifted its research and policy staff from rulemaking to public relations and passed regulatory efforts on to the states, which were encouraged by Secretary Dole's revised Standard 208 to enact mandatory seatbelt laws. After several years of seatbelt promotion and mandatory laws in 29 states, there are indications that this strategy may not in fact improve occupant safety significantly. For while belt use increased in states that implemented mandatory laws, there is increasing evidence of a precipitous decline in use rates after a year or more. In addition, the Agency has not addressed the "comfort and convenience" problem of belts, which it identified as a major inhibiting factor in belt use during the late 1970s. In fact, in 1981 NHTSA eliminated most of its performance standards for seatbelts. Yet even if all belts were made more comfortable and effective, it is commonly acknowledged among technical analysts that they provide adequate protection only in crashes under 35 mph. The problem of higherspeed crashes, which was the original impetus that led to an airbag standard, still remains. The third and probably most important way in which the cost-benefit mandate has enhanced industry's power over safety policy is in restricting the regulatory debate to an economic framework away from the principles of health protection that underlay the regulatory initiatives of the 1960s and 1970s. Historically NHTSA has promoted programs that have had the highest probability of success in saving lives by attacking technological problems, rather than trying to reeducate the entire populace. The Role of Market Ideology in Regulatory Policy Today in the late 1980s the nation is at a stalemate in the attempt to reduce deaths and injuries resulting from auto crashes. Though industrial resistance to regulation has proven a major obstacle to solution of the problem, blaming industry is not a completely satisfactory explanation. The broad patterns of this story are also present throughout the health and safety initiatives of the Occupational Safety and Health Administration, the Consumer Product Safety Administration, and the Environmental Protection Agency. The root of the problem is larger, encompassing not only industry but the capacity of our political institutions to address social problems adequately. Our study of injury politics shows that the state has the capability to act in the interests of public health and against the interests of industry. Yet, the capacity of the state to regulate technological hazards and achieve satisfying levels of con-

17 248 MEDICAL ANTHROPOLOGY QUARTERLY sumer protection is affected by the culture of the regulatory process. For defining regulation as a means of improving the market system itself assumes a market ideology and incorporates beliefs of limited government and private rights to investment decisions, such as vehicle design or pricing of products. Though lifesaving and injury-control policies emerged from the non-economic belief that the human toll from auto accidents and other hazards was unacceptable, safety policies have been increasingly cast in economic terms. As a result, health and safety regulation is now bound to the ups and downs of the economic environment. During economic downturns, regulations become too costly. In periods of prosperity they are more affordable. As long as public health policies are tied to swings in economic fortune, auto safety programs, among others, will rise and fall with the fate of industry-a fate over which the state has little control. Under these circumstances, health and injury prevention remain little more than economic artifacts. NOTES Correspondence may be addressed to the author at the Science, Technology and Society Program, Michigan Technological University, Houghton, MI 'Annually, all types of non-fatal motor vehicle injuries total about 500,000, according to the Department of Transportation. Of these, 400,000 are considered minor to moderate injuries; 100,000 are estimated to be serious injuries. 2Use of the word "state" here refers to the generic concept of government as the national legislative, executive, judicial, and administrative apparatus. 3There are two standard means of reporting death rates for motor vehicle accidents, each yielding different results. Vehicle miles traveled (VMT) is a measure of real exposure. But some safety experts prefer to measure the death rate per capita (per 100,000 population), arguing that it is more realistic. This is because while individuals have higher rates of VMT in urban areas, driving conditions are worse and accident rates higher in rural areas. Exposure seems to be a less significant factor than originally believed. 4A good history of the traffic safety establishment and its rise is found in R. Nader (1965: ). 5The more recent wave of technological criticism began with Mumford (1964) and Ellul (1964), and continues today (Winner 1977, 1986). In this literature technology has been viewed more commonly as a force operating separately from other social processes and therefore as an object to be understood, controlled, and regulated. These ideas were popularized in the writings of Ralph Nader (1965) and Rachel Carson (1962), among others, resulting in regulatory programs to control harmful technologies. 6When pointing out the lack of a scientific basis for "accident prevention," William Haddon, a pioneer researcher in the epidemiology of injury, often compared traffic safety programs to Malinowski's description of Trobriand Island rituals for hazardous fishing in the high seas (1968; Haddon, Klein, and Suchman 1964). 7Until the mid-1960s, protection of the public from technological hazards was considered a private affair. Food safety laws were the only exception. The Motor Vehicle Safety Act was the first in a series of laws that gave the federal government regulatory authority over industries for purposes of protecting public health. Soon to follow were laws for air and water pollution, occupational health and safety, consumer product safety, and drug safety, among many others. 8For two good discussions of the history of the airbag controversy see Tolchin (1984) and Reppy (1984). 9Unlike Nixon and Ford, President Carter appointed regulatory administrators who were consumer and labor activists with experience in Washington politics. For instance,

18 FROM ACCIDENT TO CRASH 249 Claybrook had worked with Ralph Nader in his organization Public Citizen and had been a former NHTSA assistant to William Haddon. This policy for political appointments conflicted with Carter's subsequent policy to limit the independence of regulatory agencies (particularly in health and safety) by imposing a White House cost-benefit review of all pending regulations. During the last year or two of the Carter Administration, regulators found themselves in conflict with White House staff as much as with industry. '"The analysis presented in this section is based on the author's field research and involvement in auto safety regulation as an employee of the National Highway Traffic Safety Administration between 1979 and This period covered the end of the Carter Administration and the first term of the Reagan Administration. REFERENCES CITED Carnoy, Martin 1984 The State and Political Theory. Princeton, NJ: Princeton University Press. Carson, Rachel 1962 Silent Spring. New York: Fawcett Crest Books. Center for Policy Alternatives 1980 Benefits of Health, Environmental, and Safety Regulation. Prepared for the Senate Committee on Government Affairs. March 25, Washington: U.S. Government Printing Office Analyzing the Benefits of Health, Safety, and Environmental Regulations. Center for Policy Alternatives Report #CPA Cambridge: MA: Center for Policy Alternatives. Claybrook, Joan, Jacqueline Gillian, and Anne Strainchamps 1982 Reagan on the Road: The Crash of the U.S. Auto Safety Program. September, Washington: Public Citizen, Inc. Claybrook, Joan, et al Retreat from Safety: Reagan's Attack on America's Health. New York: Pantheon. Drew, Elizabeth B The Politics of Auto Safety. Atlantic Monthly (October): Eads, George 1981 Harnessing Regulation: The Evolving Role of White House Oversight. Regulation 5: Eastman, Joel W "Doctors Orders": The American Medical Profession and the Origins of Automobile Design for Crash Protection, Bulletin of the History of Medicine 55: Ellul, Jacques 1964 The Technological Society. New York: Vintage. Ferguson, Thomas, and Joel Rogers 1986 Right Turn: The Decline of the Democrats and the Future of American Politics. New York: Hill and Wang. Haddon, William, Jr The Changing Approach to the Epidemiology, Prevention, and Amelioration of Trauma: The Transition to Approaches Etiologically Rather than Descriptively Based. American Journal of Public Health 58(8): Haddon, William, Jr., David Klein, and Edward Suchman 1964 Toward a Science of Accident Research. In Accident Research: Methods and Approaches. W. Haddon, E. Suchman, and D. Klein, eds. Pp New York: Harper and Row.

19 250 MEDICAL ANTHROPOLOGY QUARTERLY Jessop, Bob 1984 Theories of the Capitalist State. New York: St. Martin's Press. MacLennan, Carol 1985a Comment: A Wide Angle on Regulation. In Regulatory Policy and the Social Sciences. Roger G. Noll, ed. Pp Berkeley: University of California Press. 1985b Political Response to Economic Loss: The Automotive Crisis of Urban Anthropology 14(1-3): Mumford, Lewis 1964 Authoritarian and Democratic Technics. Technology and Culture 5:1-8. Nader, Laura, and Claire Nader 1985 A Wide Angle on Regulation: An Anthropological Perspective. In Regulatory Policy and the Social Sciences. Roger G. Noll, ed. Pp Berkeley: University of California Press. Nader, Ralph 1965 Unsafe at Any Speed: The Designed-in Dangers of the American Automobile. New York: Grossman. National Academy of Sciences 1985 Injury in America: A Continuing Public Health Problem. Washington: National Academy Press. National Safety Council 1986 Accident Facts: 1986 Edition. Chicago: National Safety Council. Noble, Charles 1986 Liberalism at Work: The Rise and Fall of OSHA. Philadelphia: Temple University Press. Orren, Karen, and Stephen Skowronek 1986 Studies in American Political Development, Vol. 1. New Haven: Yale University Press. Pertschuk, Michael 1982 The Revolt Against Regulation: The Rise and Pause of the Consumer Movement. Berkeley: University of California Press. President's Highway Safety Conference Inventory and Guide for Action. Washington: Government Printing Office. Reppy, Judith 1984 The Automobile Airbag. In Controversy: Politics of Technical Decisions. D. Nelkin, ed. Pp Beverly Hills: Sage. Skocpol, Theda 1982 State Capacity and Economic Intervention in the Early New Deal. Political Science Quarterly 97(2): Skowronek, Stephen 1982 Building a New American State: The Expansion of National Administrative Capacities New York: Cambridge University Press. Tolchin, Susan J Airbags and Regulatory Delay. Issues in Science and Technology (Fall): U.S. Senate Government Operations Committee 1965 Federal Role in Traffic Safety. Hearings. March 22, 25, and 26. Part 1. Washington: Government Printing Office. Winner, Langdon 1977 Autonomous Technology: Technics-Out-of-Control as a Theme in Political Thought. Cambridge, MA: MIT Press The Whale and the Reactor: A Search for Limits in an Age of High Technology. Chicago: University of Chicago Press.

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