Autonomous cars and the coming public health campaign against “traditional” driving

Pam Laffin, left, in an anti-smoking ad from the 1990s. Right, a member of the California Highway Patrol inspects an accident scene.

Americans who were teens in the 1990s will likely remember Pam Laffin’s story, even if they don’t remember her name. During that decade, commercials documenting her story were shown widely on tv, along with an hour-long special on MTV. She started smoking at the age of 10, and in short order became stricken with a variety of smoking-related illnesses, from bronchitis, to emphysema. The advertising campaign, produced by the Massachusetts Department of Public Health, featured powerful imagery, including Pam undergoing invasive treatments, and the dissection of her diseased lung, tarred and impaired, on an exam table. Sadly, she died in 2000, waiting for a second lung transplant.

One day, not far at all from now, high school health classes across the country may be screening a similar campaign, fixated not on smoking but driving. Although we are still shy of self-driving cars on production lines and roads (save some prototypes), the risk that human (or what I’ll call “traditional”) driving presents will be increasingly conspicuous compared to its autonomous heir.

The rise and fall of smoking in America is instructive in predicting the public health response that will target traditional driving. In the late 1940s, evidence emerged in epidemiological studies that smoking was related to a range of maladies, from shortness of breath, to lethal forms of cancer. Challenged head on by a well-heeled lobbying apparatus (the dubious Tobacco Institute was one such example), those facts took decades to become consensus in the U.S., and even longer for public policy to match that consensus. Anecdotes from that ill-informed era are startling today; singer Nat King Cole smoked cigarettes daily, believing they kept his signature voice “toasted.” He died at age 45 of lung cancer. Boston Red Sox legend Ted Williams, who spent decades raising money for a cancer hospital for children, endorsed Chesterfield cigarettes. The posters proclaiming “More Doctors Smoke CAMELS Than Any Other Cigarette!” seem fictional at best.

Above, a comparison of Pam Laffin’s diseased lung, next to a non-smoker’s lung from the 1990s advertising campaign.

Aided by campaigns like Pam’s, public smoking prohibitions, and tobacco taxes, the incidence of smoking declined significantly in the latter decades of the 20th Century. In 1965, 42% of U.S. adults smoked, compared to just 17% in 2014. Although still too high, this decrease is something of a public health miracle compared to many other countries, such as China, where two thirds of adult men still smoke.

So it will go with driving; if self-driving cars are even 50% safer than traditional driving (initial tests indicate this estimate is conservative), then it will become patent that choosing to forego that technology will be imposing a tremendous risk to one’s safety. Here is where the analogy to smoking is the most interesting: the risk to others. We know impaired driving puts others in danger as much as the individual (the “second-hand smoking” of driving, if you will), which means that abstaining from available self-driving cars will be seen as reckless for not just the driver, but the population at large. For anyone that has had to take away the keys of an aging relative, the safety of others is likely fresh in their mind. Here, plainly, are all of the ingredients to prompt a public health response (behavior, risk, safer alternative) to what we long assumed was unavoidable.

32,675 — Total U.S. Motor Vehicle Fatalities in 2014.
Source: National Highway Traffic Safety Administration.

If that calculus takes hold, then the social pressure against traditional driving will grow from neighborhoods to state houses, to the halls of congress. Mothers Against Drunk Driving (MADD) could easily become “Mothers Against Traditional Driving.” The teens sneaking cigarettes in the locker room may find a greater sense of deviance by applying for their learner’s permit. The catalyst may be just one forward-thinking state taking the plunge to, yes, ban traditional driving on its roads. Without even considering the protests that would follow (clairvoyance for another essay), if that state could show a significant drop in motor vehicle fatalities, manifold forms of political support will follow. The bold anti-smoking measures of Massachusetts, New York, and California have consistently put the pressure on other states to follow suit.

The harder question embedded in all of these predictions is timing. Industry estimates range between 10 and 20 years for self-driving cars to become common on American roadways. Once they are, it should take less than a decade for them to gain a large market share, and even less for the social pressure to build against traditional driving. Given that driving is an already incredibly regulated behavior, the bureaucratic apparatus is in place for states to curb it in favor of a safer option. For the driving traditionalists, don’t fret, your hobby may still yet be allowed in non-autonomous lanes, or in certain states. But the norm as we know it is unquestionably ticking toward its demise, and public health officials have a winning playbook to copy.

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