By Natalie Draisin
Often, I get some confused looks when I tell people I’m doing an internship at the National Transportation Safety Board (NTSB) as part of my joint public health and business degrees at Johns Hopkins University. “What does transportation have to do with public health?” they ask.
Actually, transportation has a whole lot to do with public health. How did you get to work or school today? If you walked, drove, cycled, or took a bus, you were in danger of a life-changing incident. You could’ve been struck by another vehicle. Imagine the hospital bills, the lost productivity, and the debilitating consequences. Flown on a plane recently? Did your palms sweat a little when the turbulence started? You probably arrived at your destination safely, nonetheless. That’s because your pilot was well trained, following safety protocols and mitigating the inclement weather that in another situation, could have brought the plane down.
If you believe that you have the right to cross the street without worrying about being hit, injured, or killed by a drunk driver, or you believe that you have the right to board a plane, take off, and land safely – then you believe in transportation safety, and you believe in public health.
The two are integrally linked – think about the effects of a transportation incident on our public’s health. When a bus carrying an entire high school band crashes, it has a ripple effect, impacting the rest of the transportation system, the health system, and of course, the victims’ families. Miles of bumper-to-bumper traffic will follow, which could lead to further crashes, along with lost productivity when you, and everyone else caught in traffic, are late to work. Hospitals nearby will receive an influx of patients. In major incidents, it’s often more than one hospital can handle. Victims may not be able to function at the same level thereafter, and their families might be permanently scarred, in desperate need of mental health services.
When a pipeline bursts (pipelines are a mode of transportation, as they bring something from one place to another), it has economic, environmental and health repercussions. Remember the 2010 pipeline rupture and fire in San Bruno, California? More than 4 years later, that community is still rebuilding homes and infrastructure; families are still trying to pick up the pieces. Transportation incidents don’t occur in a bubble, they affect society at large, which inherently includes, of course, the public’s health.
What is it about public health that uniquely positions the field to address transportation, and particularly traffic, safety? Public health is about protecting and improving the health and safety of the population. Public health figures out what’s hurting and killing people, and then uses evidence-based initiatives to fix it. We call that preventing morbidity and mortality. And, according to the Centers for Disease Control and Prevention (CDC) and the National Highway Traffic Safety Administration, motor vehicle crashes are a leading cause of injury in our country – 2,362,000 injured and 33,561 killed in 2012. The CDC estimates that Americans spend over one million days in the hospital each year from crash related injuries. In 2012, that translated into $18 billion in lifetime medical costs, and $33 billion lost in lifetime work, such as lost wages or benefits. That’s a lot of lives changed, expenses incurred, and productivity lost.
Though it may not seem like it, transportation incidents have a lot of characteristics similar to a disease, which public health analyzes through the lens of a host, agent, and the environment. In a car crash, the host could be the young driver; the agent, the impact of the car hitting another car; and the environment, the slippery roads at night. Like a disease, public health can intervene in a number of ways to reduce the occurrence of crashes – for example, implementing graduated driver’s licenses so youth can gain more experience before having full driving privileges, incorporating airbags and seat belts into cars to reduce the impact of a crash, or equipping roads with reflectors and guard rails to make it easier to see at night and in the rain, and harder to veer into oncoming traffic. Also like a disease, the incidence of these crashes can be tracked, so we can see if our interventions are working and revise them when they’re not.
The government recognizes that it has a responsibility to keep the public safe from incidents while using our transportation system, and that’s why they’ve created organizations like the NTSB. It’s not a public health agency, but that doesn’t mean it doesn’t address public health issues. And the good news is that through the help of agencies like the NTSB, we can work towards decreasing crash rates. The NTSB investigates accidents, determines probable cause, assists families, and then issues recommendations to federal agencies to prevent future accidents. This leads to life-saving changes.
At the NTSB, though, I didn’t sit at a desk and analyze crash data. I helped the NTSB address all elements of the public health triad – the host, the agent, and the environment. In the Safety Advocacy Division of the Office of Communications, I helped craft messages to internal and external stakeholders, to obtain support for our recommendations. Working with staff from the Office of Aviation Safety, I’ve drafted some of the web content for the NTSB’s Most Wanted List. I also wrote advocacy blogs about traffic safety, and tweets for forums. Building on my prior drunk driving prevention work, I’ve researched state laws addressing ignition interlocks (breathalyzers on cars to prevent drunk driving), and Automatic License Revocation. Some of these projects I’ve dreamed of working on for years, since I first became involved in traffic safety after the tragic death of a friend in college who was hit and killed by a drunk driver.
Throughout my internship, I’ve picked up invaluable skills. I’m fortunate to work for an outstanding group who were equally committed to developing my skills, providing constructive feedback, while at the same time, finding the synergy between their important safety work and mine. They are equally as talented and dedicated, and they’ve given me the opportunity to work with them on a variety of topics and projects. This team is representative of many of NTSB’s employees, some of the smartest, most driven people I’ve encountered. So, what does traffic safety have to do with public health? Everything.
Natalie Draisin was a graduate student intern in the Safety Advocacy Division.