Crashes, Fires, and Falls

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Accidental-injury rates are at an all-time low, but mishaps still kill one American every six minutes. New advances in the safety wars create new demand for products and services in dozens of industries, from automobiles to packaged goods and tools.

The world might seem like a dangerous place, with daily media bulletins warning about everything from rogue nations to cholesterol. But for most Americans, life just keeps getting safer. People in the United States are less likely now than at almost any time in this century to suffer a fatal accident. Ambitious efforts in public education, improvements in product design, and stricter federal regulations have dramatically improved our chances of avoiding injury.

Safety is as close as you can get to a consensus issue in politics, and it is one of the most popular selling points in business. The safety sell is a challenge, however, because the facts about injury and Americans' attitudes about risk are constantly changing.

Accidents claimed 93,400 lives in the U.S. in 1996, according to estimates by the National Safety Council (NSC) of Itasca, Illinois. That number has fallen steadily from a peak of 116,385 in 1969. The accidental death total for 1930 was 5,700 greater than it was in 1996, even though the U.S. had 142 million fewer residents in 1930.

Safety gains have been especially rapid in the last decade. The rate of accidental death to children under age 5 declined 30 percent between 1986 and 1996, and rates for persons aged 5 to 24 fell 25 percent. With great effort, the rate of motor-vehicle fatalities has also been reduced. Motor-vehicle injury death rates in 1996 were at their lowest level in nearly 75 years, despite the rapid proliferation of drivers, cars, and miles driven.

Safety engineers look past these gains, however, because everyday tragedies are still so common. An accidental death occurs every six minutes in the U.S., and a nonfatal injury occurs every two seconds. Nonfatal accidents were responsible for almost 40 million emergency-room visits in 1996. Accidental injuries are still the country's fifth-leading cause of death, and they are the leading cause of death for all Americans under age 40. As a result, a product or service that decreases the risk of a serious accident has a competitive advantage, if its marketers know who to target and what to say.

The Five Biggest Killers Motor vehicles are by far the leading cause of fatal accidents. In fact, over 46 percent of injury deaths were motor-vehicle-related in 1996, according to the NSC. The second-largest share of fatal accidents occur in the home (over 28 percent), where most of us spend the largest single share of our time. Almost 23 percent of injury deaths occur in public spaces (places other than home, work, or automobile), and just over 2 percent are workplace accidents that do not involve motor vehicles.

After motor vehicles, the leading causes of accidental deaths are falls, poisonings, fires, and drowning. These have been the five leading causes for more than 25 years, and they currently account for 80 percent of all injury deaths.

Although motor-vehicle accidents claimed 43,300 lives in 1996, the rate per 100,000 Americans has dropped significantly in the last two decades because of safer cars, safer roads, and efforts to curb drunk driving, says Alan Hoskin, manager of research and statistics at NSC. The 1996 rate of 16 deaths per 100,000 population was down 18 percent from 1986, and down 41 percent from 1966.

The decline has not been steady, however. A sharp increase in motor-vehicle fatality rates occurred in the late 1960s, as millions of baby boomers got their first driver's licenses. Another spike occurred in the late 1970s, when baby boomers contributed to a national epidemic of drunk driving. Auto fatalities also have a high correlation to business cycles, says Hoskin; they tend to drop in recessions and rise when the economy is good. The trend is not an easy one to explain, but it seems likely that people have more time for social and recreational travel in good times. Increased time on the road may increase one's chances of having an accident.

Falls are the second-leading cause of accidental death, at 15 percent of all accidental deaths. More than 14,000 deaths in 1996 were related to falls, an increase of 23 percent over 1986. This is largely a reflection of rapid growth in the number of elderly Americans. The rate of fall-related deaths per 100,000 population has also increased, but at a slower 10 percent.

Deaths due to falls are difficult to track because relatively few fatalities are a direct result of a fall, says Judy Stevens of the National Center for Injury Prevention and Control in Atlanta. For the elderly, who have the highest incidence of falls, a traumatic hip fracture often leads to fatal health complications such as pneumonia.

Poisonings due to solids and liquids are the third-leading cause of accidental death, at 11 percent in 1996. An estimated 9,800 people died from such accidents that year, more than twice the number in 1986. Nearly two-thirds of these deaths are the result of drug overdoses involving adults aged 25 to 44, however, indicating a thin line in this case between death and suicide. While death rates for auto, drowning, and fire-related accidents declined dramatically between 1986 and 1996, poisonings from solids and liquids rose 85 percent.

Drowning deaths account for 4 percent of injury deaths. Fires and burns cause 3 percent. Both of these causes are on the wane. Between 1986 and 1996, the number of drowning deaths declined 32 percent, and the number of fire and burn injury deaths declined 34 percent. Hoskin credits the widespread availability of reliable and affordable smoke detectors with much of the decrease in fire deaths.

Not all injuries are fatal, of course, and the most common type of non-fatal injury that requires emergency-room treatment is a fall. More than one-fifth (21 percent) of emergency-room visits, or 8.4 million, were due to falls in 1994, according to the National Hospital Ambulatory Medical Care Survey. Motor vehicles may cause nearly half of fatal accidents, but they account for just 10 percent of non-fatal injuries. Striking against or accidentally being struck by a person or object accounted for 9 percent of emergency-room visits in 1994.

The Reckless Years In the first half of this century, childhood was the most dangerous season of life. Children were at high risk of death from communicable diseases like pneumonia and fevers, and their death rates from unintentional injury were as high or higher than national averages. Today, children under age 15 have the nation's lowest rates of injury death. The riskiest years are young adulthood (ages 15 to 24) and retirement (ages 65 and older).

In 1924, the rate of injury death for children under age 5 was 83 per 100,000, or 7 percent higher than it was for all Americans. In 1994, the rate for young children was just 17 per 100,000, or less than half the rate of the overall population (35). The rate was even lower for children aged 5 to 14 in 1994, at 9 accidental deaths per 100,000.

Public awareness of child safety hazards, stricter product regulations, and innovations such as safety seats and child-proof caps have done much to reduce fatalities at early ages. Children also benefit greatly from safety devices such as smoke detectors that give adults an early warning of danger. Between 1950 and 1996, the injury-death rate for children under age 14 declined 66 percent.

Next to children, the safest people in America may be their parents. The injury death rate among those aged 25 to 44 is just below the national average, and it is slightly lower (29 per 100,000 in 1994) for adults aged 50 to 54. One reason working-age adults are so careful is that they are responsible for so many dependents. In fact, they pay many of the bills for those most likely to be injured: teenagers, young adults, and the elderly.

Teenagers (aged 15 to 19) had an injury death rate of 37 per 100,000 in 1994, and the rate was even higher (40 per 100,000) for young adults aged 20 to 24. The most dangerous age of all may be 18, with a rate of 45 injury deaths per 100,000 in 1994. The reason is youth plus cars. More than three-fourths of 15-to-24-year-old injury deaths are the result of motor-vehicle accidents. Auto accidents account for an even higher share of injury deaths (80 percent) among drivers aged 16 to 18.

In an effort to bring these numbers down, some states have adopted graduated licensing laws that require new drivers to go through a probation period. Such laws may require the presence of an experienced driver or limit the number of other teenagers in the car. Measures like these will probably become more popular in the next decade, because the number of new drivers is increasing. In 1993, the first members of the baby-boomlet generation turned 16. This generation will continue producing high numbers of new drivers for another decade.

Accidental death rates are also above average at the upper end of the age spectrum. In 1994, the rate of injury death per 100,000 was 38 for Americans aged 65 to 69, 52 for those aged 70 to 74, 80 for those aged 75 to 79, and 139 per 100,000 for adults aged 75 and older. After age 75, the leading cause of accidental death changes from automobiles to falls. The shift partly reflects the lessened likelihood of the elderly to drive. It also reflects their decreased motor skills and increasing frailty.

Hip fractures are the most common life-threatening result of falls among the elderly, says Stevens. The trauma and resulting complications from hip fractures are so severe that 10 to 15 percent of people who suffer them die within a year of the accident. Half of those who suffer hip fractures never regain their previous mobility. Currently, Americans endure 250,000 hip fractures a year. That number may increase sharply over the next two decades, as the Census Bureau projects a 57 percent increase in the population aged 65 and older between 1996 and 2020.

The vast majority of adults aged 50 and older (83 percent) say they would prefer to remain at home as they age, according to the American Association of Retired Persons. Medical advances and the growth of home-based care have already increased the share of elderly living at home. Although the population aged 65 and older increased 18 percent between 1985 and 1995, the number of nursing-home residents increased just 4 percent. Older Americans are already employing thousands of contractors and others who work to reduce risk in the home.

Home improvements to reduce the risk of falls may be as simple as improved lighting fixtures and better handrails on the stairs. Grab bars in bathrooms, secured rugs and carpets, and even light carts that aid in moving items between rooms can help the elderly remain self-sufficient. Because isolation is another risk in the event of a fall or other emergency, some elderly people who live alone feel more secure with portable phones or emergency call devices that can be carried from room to room.

Improvements can also include considerable changes to house plans. Elderly adults who remain in larger homes often adapt them for single-floor living, adding a downstairs shower or changing entryways. Others may replace the short steps of interior stairs with ramps. For many, the ability to remain at home will depend on how well their home can be adapted to meet their changing needs.

Relatively simple measures such as these can greatly reduce the risk of falls. But the risk of injury from a fall has just as much to do with an individual's health and habits, says Stevens. These personal factors are among the most difficult for anyone else to improve.

Safety and Business Product safety is such a high priority for government and business that consumers may be taking it for granted. The share of Americans who say that business has a definite responsibility to make safe products has fallen from a peak of 88 percent in 1980 to 70 percent in 1996, according to Roper Starch Worldwide.

But public opinion still holds that safety is a business's greatest responsibility. Roper respondents are more likely to say that business should definitely make safe products and protect the safety of their workers than they are to say that business has a responsibility to advertise honestly (64 percent say this), charge reasonable prices (59 percent), or be a good community member (52 percent).

The decline in expectations may be one result of rising satisfaction with product safety. Approximately two-thirds of respondents in 1978 felt that business was doing a fairly or very good job of making safe products. The share rose to 76 percent in 1982 and remained stable through the 1980s, the period during which expectations began to decline. By 1996, 77 percent of respondents felt that business was doing well at making safe products.

Companies benefit most when they offer a product that enhances well-being while it meets product requirements, says Joe Sirgy, professor of marketing and consumer psychologist at Virginia Tech's Pamplin College of Business, and executive director of the International Society for Quality-of-Life Studies. When customers perceive that a product benefit actually increases their quality of life, they usually develop long-term loyalty to that company.

A car can simply meet a driver's need for transportation. But it enhances quality of life when it minimizes risks while providing value. The best car will reduce physical risk by being sturdy and equipped with safety features. It will reduce mental risk by being easy to maintain and dependable. And it will reduce social risk by being more stylish than a rusted lime-green Gremlin.

The benefits of a product with minimal risk may be most visible in the automobile industry. But it wasn't always that way. When Ford first offered optional front seatbelts in 1956, few buyers responded. Customers were motivated by tailfins and chrome bumpers during the automotive industry style wars of the 1950s. By the late 1960s, however, the federal government required all new U.S. cars to have front seatbelts and harnesses, front headrests, and rear seatbelts. The maximum speed limit was reduced to 55 mph in 1974, partly in an effort to reduce traffic deaths. Soon thereafter, the federal government purchased 240 Volvo sedans and drove them into a wall to establish safety standards for the U.S. auto industry.

Twenty-five years after those Volvos were destroyed, a steady stream of public-awareness campaigns and federal regulations have created consumer demand for a wide range of standard safety features. Consumers now say they are willing to pay extra for certainsafety options. Nearly six in ten car buyers in 1997 definitely want anti-lock brakes on their next car, according to J.D. Power and Associates of Agoura Hills, California. They are willing to pay a median price of $386 for safer brakes. Nearly one in three definitely want "smart" airbags that deactivate when a child is in the front seat. That bit of safety is worth a median of $176.

Today's drivers even desire safety more than style, according to Roper Starch Worldwide. Half of all respondents say they would most enjoy driving a "safe" car--twice the share that prefer a "sporty" car. Safety is also more preferable than economy (preferred by 36 percent) and power (30 percent).

Women and elderly car buyers are the most likely to be shopping for safety, says Roper. That is significant in a market where more and more buying power is in the hands of those two consumer groups. Parents of children and teens are only slightly more likely than the average driver to favor safety. And men aged 18 to 49 are much less likely than the average American to say they would most enjoy driving a safe car.

Your Own Safety First When the U.S. government wanted to set the standards for crash safety, destroying Volvo sedans was the natural way of finding the benchmark. The Swedish automaker staked its claim on safety the day it arrived in the U.S. in 1956. Volvo has never had a large share of the U.S. market, but it found a niche in affluent metro areas like Boston, Washington, D.C., Los Angeles, and San Francisco, and it cultivated a small but loyal following. Volvo's message has been unique because the company has always asserted that safety comes from the product itself and not from certain product features, says company spokesman Bob Austin.

During the 1980s, Volvo took another step in its advertising about safety. Previous ads had stressed the car's physical sturdiness. But there were only so many people who found it relevant to watch a car run into a wall, says Austin. The new Volvo ads made explicit the much larger consumer benefit: survival. The ads featured people walking on the beach and playing ball. Their names and the dates of serious automobile accidents scrolled across the screen. The people were survivors who "share the belief that a car saved their lives."

In the early 1990s, as car buyers were shopping for safety like never before, Volvo's ads changed again. Suddenly the maker's new sedan was shown racing past a BMW. The ads did not mean that safety had gone out of style, says Austin. Volvo's change partly reflected the fact that safety has become a mainstream marketing message.

By the late 1980s, most cars on the U.S. market had a reasonable complement of safety features. The average car buyer perceived that she or he had a choice of cars that were safe enough without being a Volvo, says Austin. Meanwhile, Volvo had spent years making extraordinarily safe cars at the expense of looks, comfort, and handling. An early ad for Volvo pictured a couple leaning over the hood with the caption, "It's a Safe Car. It's a Sports Car." But car shoppers in the late 1980s didn't agree about the sports part.

When you said "Volvo" to many people, says Austin, they replied, "boxy, with two kids in the back." Volvo was strong in perceived physical benefits but weak in perceived social benefits, according to Sirgy's model of minimal risk. And while many non-parents were passing up Volvo as a parent's car, parents themselves were being offered new types of safe family vehicles such as minivans and sport-utility vehicles.

Volvo's new model, released with the new ads in 1992, was designed to appeal to a broader audience. The car is smaller than older Volvos but equipped with all of Volvo's latest safety features. Further, advertisements for the car emphasize its greater performance and streamlined style, not its exemplary safety features. Volvo sales have increased every year since the new model's introduction.

"Volvo will remain the safest car you can buy," says Austin. But that won't stop the company from offering a convertible in thespring of 1998. How safe can a convertible be? It will be "the safest convertible you can buy," says Austin.

Many parents who drove by the Volvo dealer in the 1990s headed straight for the bulk. Light trucks, minivans, and sport-utility vehicles (SUVs) are the fastest-growing segment of the auto industry, representing nearly 40 percent of vehicles sold in 1996. Larger, heavier, and higher off the road than passenger cars, SUVs sell largely based on their safety. In fact, some analysts see the popularity of SUVs as a kind of motorists' arms race. "Pretty soon, we'll all be driving around in tanks," says R. David Pittle, vice president of Consumers Union, publisher of Consumer Reports.

The perceived safety of SUVs has been challenged by studies that show their high center of gravity makes them more likely to roll over during sharp turns. In fact, the federal government is requiring that new SUVs be equipped with large, illustrated labels to warn of this danger. But a greater controversy over the safety of SUVs has to do with their impact on other motorists.

More than half of 1996 traffic fatalities involved "mismatch" collisions between light trucks (including SUVs) and passenger cars, according to the National Highway Traffic Safety Administration. Eighty percent of the fatalities in those accidents occurred in the passenger cars.

Some safety advocates are urging that SUVs, which were originally designed for off-road use, be modified for greater road safety. Some expect the rapid growth in SUVs will halt as awareness of mismatch collisions rises. "Sport-utility vehicles are more socially acceptable now than they will be in the future," said Clarence Ditlow of the Center for Auto Safety, in an interview on ABC's "World News Tonight." But Barry Felrice of the American Automobile Manufacturers Association has a different view: "Altruism doesn't go so far as trading off the safety of your family for others' safety."

Taking Chances Automobile safety products have a high profile because of the high risk of driving relative to other daily activities. But other products, such as smoke detectors, have become standard equipment in the same way. A new piece of safety equipment becomes a mainstream consumer product through a mixture of consumer advocacy, local ordinances, and growing public consciousness.

A helmet on the head of a cyclist was rare until recently. Now at least 15 states have bicycle helmet laws, adult cyclists in other states are sporting helmets voluntarily, and parents all over the country are strapping them onto children. There is good reason for this change. Bicycle injuries resulted in more than 566,000 visits to emergency rooms in 1996, according to the Consumer Product Safety Commission. In-line skaters added 103,000 visits, and skateboarders contributed another 36,000.

States with helmet laws make it easy for bicycle retailers to boost sales. But retailers also get the best results by staying on top of helmet and accessory fashions. The same applies to parents who buy protective gear for kids. "If the kneepads don't match the helmet, forget it," skateboarder Matt Lindenmuth said in the Wall Street Journal.

The safety sell can be applied to a wide variety of products, sometimes with dramatic results in increased sales. Automobile tires are a good example. Until a decade ago, tires were rarely seen as anything more than an automotive part. They were most often sold on price and performance features. Then in 1985, Michelin sat a baby down in the middle of one of its tires, and everything changed.

Michelin wanted to distinguish its premium tires from competitors, says Carter Covington of DDB Needham, the advertising agency for Michelin North America. The company also wanted to focus attention on the importance of good tires to a car's overall performance. With the baby campaign, Michelin tires suddenly became more than just tires. They became an important link to a child's safety.

Tires have always had all the ingredients for a successful safety campaign. Nearly all of a tire's attributes, such as traction and wet-weather handling, are safety-related, says Covington. The message resonated with a wide range of buyers. And safety is an especially effective strategy for selling a premium product. It is a benefit that many find worth an additional investment.

In the past five years, the rate of accidental deaths has leveled off because motor vehicle fatality rates have remained relatively flat. A new push is required to send them downward again, says Hoskin of the National Safety Council. In the coming decade, the best chance to save more lives may come from new efforts to reduce drunk driving, including lowering the legal blood-alcohol content and assessing stiffer penalties. The death rate could also drop if police began tighter enforcement of mandatory seatbelt laws, if more sophisticated safety features were placed in new cars, and if more states adopted "probation" laws for first-time drivers.

Each advance in the safety wars creates new demand for products and services. But even if products and laws strive for a state of perfect safety, the ultimate cause of most accidents will always remain beyond the control of institutions. In 1995, 41 percent of traffic fatalities involved an intoxicated or impaired driver, passenger, or pedestrian. Accidental poisonings due to drug overdoses are on the rise, even as the overall rate of accidental death inches down.

In the next decade, the campaign against accidents is likely to turn toward finding more sophisticated ways of persuading people and controlling their behavior. But until public-health campaigns can persuade Americans not to take reckless chances, emergency-room physicians will always have something to do.

Taking It Further For more information on injury statistics, see the annual publication Accident Facts and others from the National Safety Council in Itasca, Illinois; telephone (630) 285-1121; fax (630) 285-1315; e-mail; and Internet address Publications and conferences are also sponsored by the National Center for Injury Prevention and Control, at the Centers for Disease Control and Prevention in Atlanta, Georgia; telephone (770) 488-1506, or go to Internet address Statistics on non-fatal injuries are maintained by the National Hospital Ambulatory Medical Care Survey; for information, contact the National Center for Health Statistics in Bethesda, Maryland; telephone (301) 436-8500, or go to Internet address American attitudes toward safety are measured by Roper Starch Worldwide in Mamaroneck, New York; telephone (914) 698-0800, or go to Internet address For information on the International Society for Quality-Of-Life Studies, contact Joe Sirgy at Pamplin College of Business, Virginia Tech; telephone (540) 231-5110; Internet

About the author Kevin Heubusch is a freelance writer in Chicago, Illinois, and a contributing writer of American Demographics.

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