意外，与杰西-辛格合作

I think it is important to note that while we construe these often as random and unpreventable things it is not true on either front. Accidental death is not unpreventable. We know this for two reasons. For one, in the United States accidental deaths declined for decades while the United States expanded regulations and the social safety net to protect people. That changed in 1992, when we started to dismantle those systems, and accidental death has been rising since.

We are at this crisis-level point right now where accidental death has been skyrocketing, but there were decades of decline when we were actually solving the problem. That is one way that we know this is a preventable problem. The other is that the United States leads the wealthy world in accidental deaths. You are much more likely to die by accident in this country than anywhere else in our peer nations.

The way that we know that these deaths are not random is when you look at who dies by accident. In the United States race and class define the likelihood of accidental death, and that is especially true for accidents in the home, on the road, and in the workplace, which is to say accidents that are preventable by public policy. Pretty much everyone in the United States dies choking on food by accident at the same rate, and that is because there is not much you can do to force people to chew slower, but when it comes to the quality of our roads, the safety of our workplaces, and fire prevention in our homes, those things are a matter of public policy, and that is where we see big race and class differences.

Just to name a few examples, in the United States Black people are more than twice as likely to die in a home fire as white people; Indigenous people are more than twice as likely to be struck and killed by a driver as white people; and people in West Virginia, which is a relatively poor state, are more than twice as likely to die by accident than people just across the state line, a few miles away, in Virginia, which is a relatively wealthy state. What we are talking about here is neither random nor unpreventable. What it is, though, is a product of capitalism, regulatory failure, and what we would rather ignore in a world that sees a lot of harm.

Let me talk a little bit about why none of these are accidents. The numbers certainly point to the idea that it seems very unlikely that any of this is random or unpredictable, but how do we get there? That is a big question: Why do we think of them that way? At the core of that is that most of the time when we say, "It was an accident," what we mean is a person screwed up but did not intend to. We are not talking about the harm or the death of the event, we are talking about intention, and following this tendency what we try to do when we solve the accident problem is fix the person who screwed up but did not intend to. We hear about an accidental death and we think: A human made an error. How can we make a better human?

This is at the core of what we get wrong about accidental death and injury and why we misperceive this huge problem. We focus on error. Questions of error always follow an accident: What did the person—usually the person hurt—do wrong? We ask questions like, "Why was he driving so fast?" or "Was she drunk?" or "Who wasn't paying attention?"

Inherent in these questions is a presumption that accidents are caused by accident-prone people, people making bad decisions, or people we think did things the wrong way. While it is true that people make mistakes and that "To err is human," the difference between an error and an accident is whatever is around the person who screws up, the surrounding conditions. The thing that turns an error into an accident is the harm caused by what is around you.

These are the two core ideas that we need to understand to understand accidents, error and conditions. A human error is a mistake, and a dangerous condition is an environment. To slip is a human error; water left on the floor is a dangerous condition. To exceed the speed limit, that is a human error; a wide-open road that encourages you to drive fast is a dangerous condition. To leave a vent open at a chemical plant is a human error; locating that chemical plant near where people live is a dangerous condition.

If you stick with the wet-floor example, you can slip anywhere, whether there is water on the floor or not. You can always trip and fall, but in the dangerous environment of a wet floor you are going to fall harder and faster, you are less likely to be able to catch yourself, and you are more likely to get hurt. The same would be true of that wide-open road or the chemical plant in the residential neighborhood. It is harder to control the harm of our mistakes in the face of dangerous conditions, and what matters, if we are talking about the life and death of an accident, is harm.

An accident—and this is my definition—is "what happens when human error occurs under dangerous conditions." You can make mistakes anywhere, but mistakes become accidental tragedies and disasters when they occur under dangerous conditions, and this gets at why we do not solve the problem, because we are so focused on error and are ignoring the conditions. The truth is that we do not need to fix behavior or perfect people; we just need to protect them.

Of course, this is where it gets tricky because I am sure you know that we rarely do that. Instead we spend loads of money focused on error. We make systems, education, and police enforcement to try to correct behavior while disregarding the social environment and the built environment that leaves people exposed to different dangerous conditions.

HILARY SUTCLIFFE: That is fascinating. Since I have learned these distinctions from you of human error and dangerous conditions, I mean, look at everything that you view as an accident or even when something happens to you in your own personal life. My son, who is 22 and has lots of accidents in all sorts of different types of areas, self-inflicted or not, you suddenly see the dangerous conditions more clearly and you see how they are being discounted, covered up, and ignored. There they are in plain sight, but they are not actually taken into consideration. Why do you think that is?

JESSIE SINGER: I think there are a lot of reasons why that is. When it comes down to it, essentially what we are doling in that moment, finding fault with human error, is blaming. We are finding a person to blame, and there are a lot of reasons why we do this. The most important ones I think are psychological. We are all psychologically primed toward understanding accidents, especially other people's accidents, as behavioral problems, or as human-error problems. This is a specific psychological bias that is well-studied.

There is an extremely strong human tendency to blame other people's accidents on their personal failings, like their character, who they are, and our own accidents on the situation that we were in at the time, so we see everyone else as a guilty screw-up and ourselves as innocent products of the environment. Psychologists call this phenomenon the "fundamental attribution error," and it is called that because fundamentally we get it wrong every time, even in the face of all evidence to the contrary, but I think it is important to note that that psychological tendency is also deeply comforting and taken advantage of.

Calling something an accident and blaming it on human error sort of solves something that might scare us in an easy way. When we say it was an accident and it was because this person was a screw-up, we get to move on from seemingly scary random tragedy and feel better. It is an easy shorthand for saying: "Everything's okay. Nothing is fundamentally systemically wrong. We can all feel better and move on." So the fundamental systemic problems, which are these dangerous conditions in our environment, remain.

I think it is important to note that there are also quite a few nefarious actors who help this idea that accidents are the fault of human error endure, and they do this because it benefits them, whether it is large corporations or governments. An accident is cheaper than criminal negligence in terms of liability. It is cheaper to respond to an accident if you understand it as behavioral, because if you understand it as a systemically dangerous condition, you need to rethink the system of your business, the system of your government, and the system of your policy, but if you understand it as a people problem then you just have to create a cheap worker-education program rather than redesigning your business model. Police enforcement is cheaper than redesigning a road. Blaming people is cheaper than questioning the underlying system.

HILARY SUTCLIFFE: I think we see that time and time again, whether it is in my area, for every single new tech we are living at the moment all around artificial intelligence, it is just the same: blame the victim rather than blame the business model.

What I enjoyed was your case study on transportation, roads, and cars, and how that started. I loved that bit where when Henry Ford invented the car and we all had more cars anybody who ran over somebody was hauled out of their car as a murderer. The power and efficacy was with the person driving the car and that changed. Can you give us that story of how that switched and how we think about that now?

JESSIE SINGER: This is such an interesting point because it is proof of the magic of the accident that shifts our conception. With cars there are two major points here. There is the point at which cars start to overrun cities. Where city streets used to be playgrounds and open-air marketplaces full of people walking, lots of pedestrians started to get killed by drivers. They also started to mount protests in cities against cars, and people were saying, "Cars in cities is an inherently dangerous condition, and we have to get rid of these cars."

What the automakers did was essentially create a new term, the "jaywalker." A "jay" is old-timey slang for a hillbilly, so to be a jaywalker meant you were a country bumpkin who did not know how to walk in the city. It did not used to be a crime. It did not used to be a law. It was just an insult. Through paid advertisements and through controlling crash reporting they created this concept. They even bought signs for cities that said "jaywalking outlawed," even though it was not a law at all, and they created this concept that there was a "wrong" way to walk in cities, which did not exist before the car. There was no right or wrong way to walk in a city. People were saying cars are a dangerous condition, and they instead created a story and said: "No, no, no. This is a human error problem. It is this individual human who should not have been walking in the street."

That was happening in the 1920s and 1930s, but an even more important story happens in the middle of the 20th century. There is an important figure here, a man named Hugh DeHaven, the "father of injury prevention," the inventor of crashworthiness in vehicles, and to understand him you have to understand the situation before he arrived on the scene.

Before Hugh DeHaven, in the first half of the 20th century, there was no notion that the machine of a car itself could have any effect on whether or not you survived a car crash. If you died in a car crash, the understanding was that you were the "nut behind the wheel," you just drove like a crazy person and that is why you died. Automakers pushed this story of nuts behind the wheel in tandem with the jaywalker. In both narratives, whether you were the driver or the pedestrian, the problem was not that cars are inherently dangerous, the problem was human error.

What Hugh DeHaven did was proved that the machine mattered, that the box, the vehicle you were in when you smashed into a tree mattered, and this changed the narrative because he proved that for people inside the car you could be safe even if you drove like a crazy person. What happened was that Hugh DeHaven, who was an inventor, witnessed a car crash and was shocked by what he saw as clear causality: the driver pierced their head on a sharp dashboard knob. He was like: "Well, this person would be alive if the dashboard knob wasn't so sharp. I understand cause and effect."

He teams up with the Indiana State Police Department and starts looking through every single photo of a year's worth of crash fatalities and essentially develops a list of the most dangerous parts of a car from the inside and presents this to automakers. This is interesting because it tells you about why we do not challenge actions and how change happens. Essentially Hugh DeHaven was like, "Look, even if people drive like nuts, they could survive car crashes if you fix these problems," and the automakers essentially were like, "Oh, that's very interesting, thank you so much, Mr. DeHaven," and then it is just crickets. Ten years pass. Hundreds of thousands die.

Essentially what happened is another man named Ralph Nader takes DeHaven's research, investigates it further, and publishes a book calledUnsafe at Any Speed: The Designed-In Dangers of the American Automobile, that leads to congressional hearings, becomes a weird bestseller because it was a book about cars, and brings the public protest into this problem. That is how we got in the United States the first regulatory agencies, and those regulatory agencies forced automakers to build safer cars on the inside for people.

This is the real lesson. When seatbelts were first proposed by those regulatory agencies, Henry Ford insisted they were technically unfeasible and so bad for his bottom line that he would need to shut down the Ford Motor Company. Obviously, Ford is still in business and every car in America has seatbelts. That is regulated.

Another thing that Nader uncovers is that, all the way back when Hugh DeHaven was unveiling what was dangerous about the cars, one of those dangerous things was that the steering column did not collapse on impact, so people would get impaled on steering columns. The car companies already had a patent for collapsible steering columns, but they were not installing them in the cars. Airbags is another one. Airbags were invented in the 1960s. They were not required in cars until 1998. The thing that drives these safety failures is the narrative that if you crash your car and you die, you are dead because you are a nut, because you drove that way, and not because the inside of the car is inherently dangerous.

I think there are two lessons there. One is that corporations are never going to protect you unless you demand it, and the other is that these innovations—a seatbelt, an airbag—do not change human error. They do not prevent you from driving like a nut. They do not fix the behavioral problem. They just fix the dangerous condition. They protect you when you screw up. They protect you from the consequences of your mistakes rather than trying to make a person, a driver, a jaywalker, anyone, into someone who does not make mistakes.

HILARY SUTCLIFFE: Fascinating. Of course the built environment, where the car exists, is another factor and a whole other area of incumbent biases that people do not want to change and do not want to admit that they might not have gotten it right. Tell us more about that.

JESSIE SINGER: The truth is that often when we talk about the "built environment" we are talking about public infrastructure, but the dangerous conditions we face are built into many layers of exposure.

We were talking about a chemical plant. That might be the safety systems within a chemical plant but also where that chemical plant is located, how regulated that chemical plant is, and how much that dictates whether or not there are shoddy safety practices employed by that company, but it also matters where that chemical plant is located and who has to live nearby because that is the only place they can afford to live.

That is one example, but we see this on the roads. We know what types of roads people are more likely to crash and die on. Those roads are wide, they have lots of businesses and driveways along them, they are four lanes, and they have a high speed limit. These are not new ideas. This is basic physics. The heavier the vehicle and the faster it is going dictates the likelihood of death, but we often do not talk about those environments.

There are a lot of reasons. The automakers do not want us to talk about it. I don't think the government wants us to talk about it because it is expensive to redesign those roads, but it also involves admitting that maybe the priority of those road designers is not saving lives, is not protecting people, but rather is getting people to work as quickly as possible, and if some die, oh, well, it was an accident.

HILARY SUTCLIFFE: I was interested and intrigued by the case study on Sweden, where it dawned on their regulators that they could prioritize safety, and it transformed everything.

JESSIE SINGER: Sweden is the test case. What they did was called Vision Zero, and we see other things called Vision Zero in a lot of places now, and many of them are not Vision Zero. Pretty much across the board every city in the United States that has adopted Vision Zero is not actually doing it. It is just fancy marketing.

What happened in Sweden was that in the 1980s and early 1990s they said: "Right now when we build a road it has three priorities. It has to get people to work on time, it has to not let anyone get hurt, and it has to not cost too much." That is how pretty much every road in every wealthy country is designed, for those three priorities, all weighed equally.

In Sweden they said: "What if we just put at the top of the list that no one dies? What if that was the only priority in designing a road, and we said, 'It doesn't matter if it costs money, it doesn't matter if people have to go slow to work, we just want to prevent people from dying. What if we admitted that as a priority?'" They cut road fatalities by more than half, unprecedented lifesaving.

What can we say? They did the right thing. I think also a lot of what they did was they stopped whispering. We do not talk about the fact that we weigh equally a lack of congestion and thrift with whether people live or die. We do not talk about that. Part of what they did was start to talk about it. They looked at it and said, "Wow, this is horrifically unethical, and we can change it."

HILARY SUTCLIFFE: That is very interesting as well. I see that all the time, and I have thought that myself: You have to balance, this, that, and the other. But what if you don't? What if you don't balance that? What if you prioritize people? What if you prioritize the environment? What if you prioritize things ahead of money, getting to work on time, and those types of things? It is a very new way of looking at things, but as you say you have to follow through because it is another washing then, isn't it, "zero washing," "accident washing."

In your experience and research what is the tipping point that makes organizations, individuals, and cities take something very seriously and then do dramatic change?

JESSIE SINGER: This is a good question because I want to point out something that is a little hard to hear. I want to talk about something that does not make people take dramatic change, but it does make them pay attention, so it is tricky.

Most people who die by accident die in ones and twos. It is not the Grenfell Tower fire but a hundred other little fires where one person dies. That is how most people die. If you look at the big cumulative numbers, those hundreds of thousands of people, it is mostly deaths in ones and twos, but the big tragedies, the big, horrible accidents where lots of people die is a time when we pay a lot of attention, and it is what we think of. We focus on those, but often in their scope those are so big that we respond to a degree and maybe pass a few laws, but we are responding to this huge and unlikely event rather than addressing the daily dangerous conditions that we face and the daily basic small changes.

When we look at what has worked we see laws and policies that address those basic, daily, one-off, small accidents, and these are largely regulatory so that people are better protected from corporations, from greed, and from profit margins that would put them in harm's way, and a social safety net so that people can afford to better protect themselves. While regulation guarantees that every car is safe, a social safety net, enough money in one's pocket, means that you can buy a safer car, you can choose not to take the most dangerous job, or you can move out of an apartment that you know is a firetrap. Those are the only ways we have ever seen accidental deaths decline. In this country and in every other country that is the stuff.

Both of those things do the same thing. They look at protecting people. There is no world where correcting human behavior is saving lives. It is only protection.

People used to die in the workplace in untold numbers. The only thing that made them stop dying, even after there were reams of manuals and lectures on how to be a safe employee, how not to be accident-prone, and psychological tests to weed out the accident-prone employees, none of that did anything. The things that did something were limits on what was a safe and unsafe workplace and regulation that put the onus of that, the conditions of safety, on the employer so that it cost them money when they killed people.

HILARY SUTCLIFFE: We had the shoe bomber, and literally overnight we all had our 100-ml plastic bottles of shampoo in bags. That happened overnight, didn't it, but that was quite a big thing I would imagine for airlines, for airports, and for ourselves that happened because of this big thing, and yet you could save so many more lives with smaller things if you started to prioritize that.

JESSIE SINGER: Yes. You are getting at an important point, especially with the shoe bomber, because, even further, that was not a big accident. It was a big intentional act, or it did not end up being a big act. I think that is the key. We ignore these accidents, we pretend they are random, and part of that is because we are so focused on intention. We see the accident and say, "Oh, they screwed up but they didn't mean it, so let's just try to make people who behave better."

My personal story, how I came to write this book, actually follows the same route as the response to the shoe bomber. If you do not mind, I would be happy to share it.

HILARY SUTCLIFFE: Please do. It is very important to the thread through the whole book, fascinating and tragic.

JESSIE SINGER: It is a terrible story. There Are No Accidents, this book, is dedicated to a young man named Eric Ng. He was a New York City high school math teacher and my best friend. He was killed in 2006 riding his bike on a separated biking and walking path that runs along the west side of Manhattan. He was killed by a driver who mistakenly turned and entered the biking and walking path instead of the highway. That driver was drunk and speeding, and he went to prison. For a long time that was the end of the story.

The impetus for the book occurred 11 years later. A different man rented a truck and followed the exact same route as my best friend's killer, except this man intentionally turned onto the path. He killed eight people and injured 11 in an act of vehicular terrorism. I remember in the moment being so shocked that the exact same thing had happened, but there was one critical difference: intention.

I looked into it, and I looked at the place where my best friend had been killed, and other people had been killed on this same path before Eric was killed and after. Every time the drivers were different. They had all unintentionally done something wrong to end up there—distracted, lost, or drunk. The circumstances changed every time, but it was just an accident every time, so no problems were solved. It was just understood that someone unintentionally did something wrong.

We do not respond to intentional acts the way we do with unintentional ones because after the vehicular terror attack, that intentional act, the city and state got together and made this recurring harm impossible. They barricaded every entrance to the biking and walking path so you could walk through and bike through, but you could not fit a car through.

For me it was this lesson that "accident" is this magic word of willful ignorance that we use to gloss over preventable harm because the truth is the solution to the mass shooting is the same as the solution to the accidental shooting. The solution to the vehicular terrorist attack is the same as the solution to the traffic accident: protecting people from harm, putting barriers in place, whether they are social and policy or physical bollards, to protect people from these predictable, recurring harms, even if no one is acting with intention.

HILARY SUTCLIFFE: What I like as well with the book is that you are not flinching from the psychological aspects that we all have. We just do not want to hear. We want to try to rationalize it, swallow it, and smooth it out so that we can carry on with our day. It is interesting the psychology not just of ourselves but of governments and of companies, how we are all trying to deny the harms and the actual deaths of so many people for our own psychological safety in a way.

JESSIE SINGER: The human brain will go to great lengths to find comfort. Anyone who has been to therapy knows this. We will resist. Accidents are par for the course. I get it. I said that to people again and again as I was writing this book: "I get why you want this to be an accident." Accident feels good. Accident lets you move on, but this is just a tendency, an urge, a desire. Accident is just wish fulfilment in a word. It is a way to say: "Can I please feel better about this? I would really like to feel better about this," and to answer yourself, "Yes, it was just an accident."

When we call something an accident we feel better at once, but also at once we fail to prevent it from happening again. If we care about the problem—and this was my hope with the book, that I could make people see the problem from enough angles and with enough humanity that they would want to overcome the tendency. It is only by overcoming the tendency to call something an accident that we can start to prevent it. It will take some work, but we can do it. We have the evidence from Sweden and from these differential rates of accidental deaths from around the country from simple efforts. In the United States states that provide access to naloxone have lower rates of overdose deaths. They do not necessarily have lower rates of people using drugs, but they do have fewer people dying from an accidental overdose.

We have seen in the United States too that accidental deaths declined for decades prior to 1992. If we are willing to invest in the problem, and that starts with taking a hard look at ourselves and saying, "Okay, the system is the problem, we need to rework it, it is going to be hard, but we actually can move forward on this."

HILARY SUTCLIFFE: My son read your book and has been very inspired. He is doing his dissertation on vaping, which is a new accidental death problem in the United Kingdom and I think certainly in the States as well. He is taking it apart and looking at it from a systems point of view and understanding the psychology of all of us—those manufacturers making these vapes in pretty pink and colored patterns to attract children and the regulators' difficulty dealing with it and our own just hoping it is all not going to happen. It is a very inspiring and positive book, although obviously quite a harrowing book to read.

We quite like to try to finish on something that we can all do and something that actually helps us take on what we have heard from you into our own lives and take some actions. Have you got any suggestions for us?

JESSIE SINGER: Absolutely. The thing I like to repeat to people is that accidents are simple. The mechanism of harm and accidental death is really rather predictable. It is basic physics. It is controlling energy that we know is dangerous, whether that is the energy of a drug or a car. This is not disease. This is not cancer. We know how to prevent accidental death and keep people safe. We have known for a long time. We just need the political will to spend the money to keep people safe.

People can do this. The best way to do this—we talked about the social safety net and federal regulatory agencies. Put that aside unless you are listening in from Washington, DC, and then get to work, please. The best way to get this done is within your community because there are a million ways to prevent accidental death. If you in your city or town advocate for traffic calming and public transit expansions, you will reduce traffic accidents because you are much less likely to die by accident on the train or bus than you are in an individual car. If you fight for safe injection sites and free naloxone in your city or town, you will reduce accidental overdose deaths. In your building where you work or live, demanding that your landlord install Americans with Disabilities Act accessibility like ramps and grab bars will reduce accident fall deaths. Fire safety requirements like sprinklers and self-closing doors will reduce the likelihood that an accidental fire becomes a fire death. These are all little things you can do in your community that will change the outlook.

One other thing that I do like to tell people is a little less specific. It is not policy, but I do think it makes a big difference. I have said "accident" a lot in this conversation because I want you to hear, as you start to think about these ideas, when it starts to sound weird and wrong, when it sounds like I am bullshitting you, but outside of these interviews I do not say "accident" in my day-to-day life, and I would encourage you not to say it too. More importantly than that, when you hear someone else call something an accident, ask questions. Ask: "Has this happened before? Could it happen again?" Ask: "How can we protect people from harm even if they make a mistake?" I think if we can ask those questions whenever we hear the word "accident," we will start to take a big step forward.

HILARY SUTCLIFFE: Jessie Singer, thank you very much. What a fantastic way to end. We are grateful that you came to talk to us. Your book is out in paperback as well as hardback, am I right?

JESSIE SINGER: That is correct. The paperback just came out in February.

HILARY SUTCLIFFE: Fantastic. Very good luck to you, Jessie, with this important work. Even when I read it I am very much more aware of not saying "accident" and looking at accidents for what they are. Good luck with all the work that you are doing.

JESSIE SINGER: Thank you so much for having me. It was a pleasure to be here.