One evening in 1899, New York City real estate dealer Henry H. Bliss stepped off a streetcar and into history books as the country’s first recorded motor vehicle fatality.   

The Manhattan intersection at Central Park West and 74th Street where a taxicab ran over Bliss was called the “Dangerous Stretch,” a section of street shared by horses and buggies, trollies, cyclists, and pedestrians. Early automobiles were a new and unwelcome intruder.  

“Motorists were expected to yield to pedestrians,” says Peter Norton, PhD, MA, an associate professor of history at the University of Virginia. “People agreed that the street is for everyone.”  

As more and more autos clogged the early 20th-century streets, traffic fatalities climbed for people inside and out of cars. Today, roughly 120 people die each day, or 44,500 individuals in 2023, from vehicle collisions in the U.S., according to the nonprofit National Safety Council.  

“It’s as if a regional jet were crashing every day, but somehow we accept it,” says Lorraine Martin, MS, the council’s president and CEO. “We don’t see traffic fatalities the same way as other public health crises. But getting on our roadways is the most dangerous thing we do every day, across the board.” 

Complex factors have influenced the country’s traffic fatality rates, from the safety of the vehicles to drivers’ behaviors. An emphasis on swiftly transporting goods and people has driven roadway design, says Health Policy and Management Distinguished Scholar Jeffrey Michael, EdD, a national expert on road safety.  

“It’s good for the economy, but it’s very bad for people in crashes, particularly vulnerable road users like pedestrians and cyclists,” he says.  

Back when Bliss alighted from the trolley that evening, automobiles were considered a novelty reserved for the rich. That changed with the mass-produced Ford Model T, which brought car ownership within reach of middle-class Americans in the 1920s.  

With more drivers, increasingly powerful engines, and scarce laws, the 1930s were a risky decade to be on the roads. A popular Reader’s Digest article “And Sudden Death” described the frightening uptick in fatalities. Political support grew for more protective laws and regulations. But auto lobbying groups deflected the idea that speed was to blame, turning the conversation to safer design features like three-way traffic lights and shatterproof windshields. 

The war years led to a drop in fatalities as fewer people drove. Afterward, home ownership grew, fueled by low-interest loans for veterans and a baby boom. This was a time of suburbs and commutes, a growing love for the automobile, and a surge in traffic-related deaths.   

“What happens next is paradoxical: Engineers would look at these highway deaths and say we need more highways,” Norton says. “The more deaths we have, the more that proves we need bigger, wider highways with better visibility, and that will solve the traffic death problem.” 

In the 1950s, the national highway system carved a vast network of interstate routes across the country. With more people traveling at faster speeds, the next decade emphasized crash safety efforts. Car manufacturers debuted crash test dummies and installed energy-absorbing steering columns that would cushion impact.  

Once again, global events shaped traffic death tolls in the U.S. The 1973 oil embargo—and the sky-high gas prices that followed—reduced driving and fatalities. Meanwhile, radar guns helped enforce a new 55-mph national speed limit. Even though 1972 marked a record 55,000 traffic deaths, the fatality rate per miles traveled was steadily dropping. By the end of the ’70s, 3.3 people died per 100 million vehicle miles traveled, after hovering around five for most of the previous decade.  

In the 1980s, the focus turned to driver behavior to reduce roadway deaths. While laws against drinking and driving had existed for decades, the practice was normalized. That shifted, thanks to the forceful advocacy of Mothers Against Drunk Driving and the unbearable losses so many suffered. “Designated driver” and “friends don’t let friends drive drunk” entered the cultural lexicon. The ’80s also become the seatbelt era, with a flurry of state-by-state laws requiring their use.  

A 2015 government report credits seatbelts with saving more lives—about 330,000 total from 1960 to 2012—than any other car safety technology. That period overall represented “a revolution in safety” for people in vehicles with features like air bags, braking improvements, side impact protection, and electronic stability control, a technology that prevents skidding by automatically adjusting braking. 

In subsequent years, though, fatality rates plateaued, and then rose during the COVID-19 pandemic. In 2019, the traffic fatality count was about 39,000, according to the National Safety Council. In 2022, it rose by 18% to roughly 46,000. Even though 2023 figures declined, they’re still nearly 14% above pre-pandemic levels. While it’s hard to single out one cause, experts point to a mix of distracted driving, increased alcohol and substance use, shifting weather, increased speeding, and longer commutes. 

Despite the disconcerting recent figures, many observers see a better road ahead. Attention is turning to a “Safe System” approach that prioritizes safety for pedestrians and bike riders as well as car occupants. This might mean slimming lanes on busy arterial roads to slow vehicles and creating separate spaces for bike lanes. Roundabouts replace risky intersections and speed cameras enforce lower speed limits. 

There’s money fueling the shift thanks to the Bipartisan Infrastructure Law’s Safe Streets and Roads for All program. Over five years, $5–6 billion is dedicated to improvements designed to prevent roadway fatalities with the goal of zero deaths. Accomplishing that will require an important shift from speed to safety, says Shannon Frattaroli, PhD ’99, MPH ’94, director of the Bloomberg School’s Center for Injury Research and Policy and professor in Health Policy and Management.

“Public health, the government, and law enforcement need to roll up their sleeves and understand that 45,500 people should not be dying on the roads each year,” Frattaroli says. “There is a solution and the solution is smarter design.”