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Remarks at Consortium of Universities for Global Health (CUGH)
T. Bella Dinh-Zarr, PhD, MPH
Washington, DC

Good afternoon.  Thank you very much to Dr. Hargarten and the organizers for inviting me to speak today.  I feel privileged to be here with my fellow panelists and with all of you, global health experts, who are here today.   The theme of this CUGH conference is “Healthy People, Healthy Ecosystems” and, since you are here today, perhaps you already have seen how transportation and the road environment affects all aspects of public health.  I started my public health training at the University of Texas and with a fellowship through the United States (U.S.) Guide to Community Preventive Services at the Centers for Disease Control and Prevention (CDC).   Dr. Ann Dellinger at the CDC, who is on the panel today, was and is a great role model for me.  In those days, I certainly never imagined my public health work would lead to my role at the National Transportation Safety Board (NTSB).  So, I feel privileged to speak to all of you today in my current position as one of the 5 independent Board Members of the NTSB. 
With the political changes among the federal agencies, and because our agency has term appointments, just in the past few weeks I have served in the roles of Vice Chairman, Acting Chairman, and now I continue my term as a Board Member.  My fellow panelists are on the ground around the world while my work now is primarily U.S.-based, so today I would like to tell you about the NTSB and our crash investigations in hopes that it may assist other countries that you work with and perhaps even enlist you, if you are not already involved, in our collective effort to make the road environment safer – as part of our overall effort to advance public health globally.
The NTSB is a unique federal agency in the U.S. because we are independent of all other government agencies and we are charged with investigating disasters in aviation, marine, highway, rail, pipeline, and hazardous materials. The public, including some people in other countries because we lend technical assistance in international aviation disasters, know us because we rush to the scene of transportation disasters with our trademark dark blue jackets with the large yellow NTSB emblazoned on the backs.  In fact, this fast-paced action following an accident is called a “Go Team Launch.”  As Dr. Steve Hargarten says, we are like infectious disease outbreak investigation teams, except what we are investigating is an outbreak of kinetic energy instead of a disease. 
Those on-scene accident investigations are an important part of our work – that is why we are on call 24 hours a day, 365 days a year.  Once we have finished the on-scene work, our investigations continue and the final reports are essentially very thorough case studies covering every aspect of an accident and resulting in a probable cause and safety recommendations to prevent the accident from happening again. 
Before I get more disapproving looks, yes, I did use the word accident.  Although the term “accident” has fallen out of favor, especially for motor vehicles crashes, we still use the term “accident” at the NTSB because, in our federal statute (the law that created the NTSB), we are charged by the U.S. Congress with investigating every civil aviation accident – as well as significant accidents in highway, marine, rail, pipeline, and hazardous materials.  It also is a term of art in aviation and other modes.  Finally, it underscores the fact that we investigate unintentional accidents – we leave the criminal investigations to the FBI. 
It may seem unexpected to have a person trained in public health at the NTSB, but NTSB investigation work mirrors public health work in many ways.  There is a focus on prevention and our core values are independence, credibility, and transparency. 
We are an independent agency but we also have five independent board members, who are nominated by the President and confirmed by the Senate, so our board member terms are not tied to Presidential Administrations or elections.  We do not report to anyone – not the U.S. Department of Transportation (DOT) or the U.S. Department of Health and Human Services (HHS) or any other federal agency – so we can make recommendations to anyone. 
Unlike many government agencies, the NTSB does not have regulatory authority so it is our reputation that allows us to advance recommendations. We maintain our credibility by conducting very thorough investigations that touch on every single aspect of an accident from engineering to human performance to weather.  We value scientific and investigative rigor because our credibility lies in our well-regarded reports and recommendations. 
As for transparency, all our meetings and deliberations are done in the public eye under the Government in the Sunshine Act.  As you can see if you ever watch our accident investigation and other board meetings, we often do not agree – but that is part of the beauty and strength of the NTSB, we debate publicly not for any political gain, but in order to come to the best resolution for the sake of safety.
Although we do not have any regulatory authority, our reputation – thanks in large part to our extremely transparent process - and our persistence in advocating for them -  helps get our recommendations adopted.  Since our establishment, approximately 80% of our more than 14,000 safety recommendations, issued to 2,300 recipients, have been adopted successfully.
Board Members like myself are not political in the traditional sense, but by law.  NTSB is bipartisan since no more than 3 of the 5 board members can be nominated by the same party – but we never let politics get in the way of safety.  This philosophy of collegiality for the sake of a good cause is strong among the current NTSB Board Members. 
Highway Safety
In highway safety, with the recent release of the (FARS – Fatality Analysis Reporting System) national data on road deaths by the National Highway Traffic Safety Administration (NHTSA), we know that more than 30,000 people die in motor vehicle crashes in the U.S. alone – and all of you know better than anyone that it is 1.2 million worldwide.   30,000 is far too high a number but, with the implementation of our NTSB safety recommendations by NHTSA, FMCSA (Federal Motor Carrier Safety Administration), and other DOT agencies, the NTSB helped States & Territories in the U.S. make progress in many areas of highway safety over the years, such as requiring airbags in vehicles, passing impaired driving laws, passing seat belt laws, improving school bus design, passing motorcycle helmet laws, improving safety barriers in road design, and setting standards for road signage, to name a few.  All our recommendations are based on our detailed investigations so, rather than compiling information from all crashes, we focus on what can be learned from each individual crash. 
Although we have a good track record of having our recommendations adopted, we do not give up on targets that are not achieved immediately.  Some take years or even decades to become adopted, especially if they must pass individually in all 50 states in the United States.  We are sometimes criticized, even vilified, at first, for our efforts.  Yet, that does not stop us.
We use the results of those investigations to make safety recommendations with criteria for completion.  These recommendations, or targets, have helped States & Territories in the United States make progress such as requiring airbags in vehicles, passing impaired driving laws, passing seat belt laws, improving school bus design, passing motorcycle helmet laws, improving safety barriers in road design, and setting standards for signage, to name a few.
In order to have the information we need to make safety recommendations and set targets from a single investigation, our investigations are extremely thorough in all modes.  For major highway crashes, we have experts who investigate many areas including:
    human performance
    survival factors
    highway factors
    motor carrier
    medical issues
    vehicle factors
    data recorders, and
    weather and fire
Although we have no regulatory authority, our good reputation has enabled us to successfully set and track targets for the benefit of safety.  As I mentioned earlier, we have issued over 14,000 safety recommendations and about 80% have been adopted. 
As you know, gathering high quality data on the circumstances of crashes and the associated risk factors is critical to effective programs and policies to prevent crashes before they happen.  I would add that high-quality data can take different forms from crash investigations to population-based data.  In addition to collecting high-quality data on deaths, injuries, and risk factors, the data also should be widely accessible to governments, non-governmental organizations (NGOs), civil society, and the general public.  This can help stakeholders remain committed to the issue and hold us accountable for our work.
NTSB may provide a useful model, especially for those countries that are still in the early stages of building their data collection programs.  We all know that good population data is important but it takes time to build the infrastructure to collect even basic death and injury data accurately.  At the NTSB, we conduct very thorough transportation accident investigations and we are agile enough to make – and change – targets as new safety issues emerge, often based on a single representative accident.
At the NTSB, we make recommendations that are feasible, practical, and doable.  They are feasible because they must be measurable, and they must be based on sound science, but that does not mean they cannot also be inspiring and bold.  Taken as a whole, our safety recommendations ultimately must allow us to imagine what the world would be like if our work is as effective as it can be.  They allow us to imagine a world where no one dies because they were not properly restrained, a world where we know that our cars and our roads will protect us if we make a mistake, a world where no one thinks about getting behind the wheel when impaired by alcohol or drugs, a world where we can send our loved ones to school or work and know that they will come home safely.  Just as those of you who have worked so many years in infectious diseases were bold when you first imagined a world where smallpox and TB were eliminated, those of us in global road safety imagine a world where there are zero deaths on the roads.
Most Wanted List
For over 25 years, the NTSB has chosen ten issues – covering all modes of transportation - that represent safety challenges; challenges which have a strong chance of being advanced if given some good hard pushes by the NTSB.  Each Board Member is assigned 2 to 3 issue areas.  This year, 6 of the 10 issue areas we selected are related to motor vehicle safety.  They include:  Impaired Driving, Occupant Protection, Data Recorders in Vehicles, Crash Avoidance Systems, Distracted Driving, and Medical Fitness for Duty.  Also, although they are not on our Most Wanted List specifically, we recognize and are addressing the importance of protecting our vulnerable road users such as pedestrians and bicyclists, which are concerns in developing countries.
In conclusion, I would like to borrow a phrase from Dr. Frieden and our colleagues at the CDC who say that road safety is a “winnable battle”.  It is a battle because the number of deaths on our roads is large and it will not be easy to eliminate them.  I also sometimes feel it is a battle when I am on-scene and see the violent aftermath of a crash.
Nevertheless, despite these tragic and terrible examples, we cannot forget that this is a winnable battle – we cannot forget that if we apply effective interventions widely, we can save millions of lives. 
Thank you.