Road safety: It’s become one of Sweden’s most successful exports—right up there with flat-pack furniture and affordable fashion. Back in 1997, the Swedish parliament adopted a policy known as Vision Zero, premised on the idea that traffic deaths and serious car accidents are unacceptable and that the state should go to great lengths to help citizens avoid them. Today, the approach has been embraced everywhere from the European Union to New York City and San Jose. Just in recent weeks, Qatar hosted a vision-zero conference and Singapore unveiled a vision-zero campaign for the workplace.
There’s a logic behind this imitation. Sweden has engineered one of the world’s lowest traffic-related fatality rates thanks to educational campaigns, new vehicle technology, surveillance systems, and infrastructural innovations, including pedestrian bridges and bike-lane barriers. Fewer than three out of every 100,000 Swedes die in road accidents each year, compared with more than 11 in the United States. As The Economist noted about Sweden last year, “Although the number of cars in circulation and the number of miles driven have both doubled since 1970, the number of road deaths has fallen by four-fifths during the same period.”
But in Sweden, Vision Zero thinking—the idea of aiming for a society free from serious accidents and for systems “designed to protect us at every turn”—has also come to permeate spheres far beyond roads and traffic. This year alone, demands for similar initiatives have come from the Swedish Life Rescuers’ Association (whose members want a Vision Zero approach to drowning accidents), the National Association of Pensioners (a Vision Zero scheme to prevent falls among the elderly), and a coalition of construction workers’ associations and unions (a Vision Zero plan to eliminate construction-site accidents). Sweden’s minister for employment recently vowed to develop a Vision Zero program to eliminate fatal accidents at Swedish workplaces because “nobody should have to die on the job.” And in February, Ebba Busch Thor, the current leader of Sweden’s Christian Democrat Party, called for a Vision Zero approach to abortion.
The healthcare sector is not immune. In 2008, Sweden’s then center-right coalition government announced a Vision Zero approach to suicide prevention. “No one should have to end up in such a vulnerable situation where the only perceived way out is suicide,” the plan stated.
“The government’s vision is that no one should have to take their own life.” The government summarised the national campaign in a nine-point program with broad strategies like reducing “alcohol consumption in the general population and in high-risk groups” and harnessing “medical, psychological, and psychosocial measures.” These strategies have had some concrete effects. For instance, the goal of “reducing access to means and methods for committing suicide” has altered Swedish cityscapes, leading to initiatives like mounting fences along bridges to discourage people from jumping off of them.
But so far, there’s little evidence that the program has achieved measurable success in eliminating suicides or even driving down the suicide rate. Around 1,400 to 1,500 people kill themselves every year in Sweden, a country with a population of 9.6 million. The suicide rate was declining for several decades prior to the 2000s, when the rate plateaued at roughly 20 suicides per 100,000 citizens aged 15 and above. (Suicide is an especially touchy subject in Sweden; a government website debunks the perception that “Swedes are suicidal,” noting that the country “ranks outside the world’s top 40” for suicides per capita and tracing the myth to Dwight Eisenhower claiming that the Swedish welfare system had spawned “sin, nudity, drunkenness and suicide.”) Sweden witnessed its lowest suicide rate since 1980 in 2011, when 1,378 people killed themselves. But that number then rose to 1,600 in 2013. Today, suicide is the most common cause of death for Swedish men and women aged 15 to 24. In the 15-to-44 age group, suicide is the most common cause of death among men and the second-most common cause of death among women.
Some attribute this lack of success to the nine-point plan’s vague objectives. In a 2012 op-ed, Alfred Skogberg, president of the non-profit organisation Suicide Zero, called for practical, targeted measures like airbags on the front of trains in case someone jumps on the tracks, suicide-safe exhaust pipes for cars, tougher rules for selling painkillers to young people, and four mandatory therapy sessions for individuals who have attempted suicide. Skogberg pointed out that while five times more Swedes die from suicide than from traffic accidents, the state allocates three million Swedish krona per year (roughly US$360,000) to the National Center for Suicide Research and Prevention of Mental Ill-Health—the authority responsible for suicide research and prevention programs—while investing between 100 and 150 million krona per year in traffic-safety research. With such insufficient investment, Skogberg said, the vision of eliminating suicide will prove elusive. (Kerstin Evelius, the Swedish government’s coordinator for psychiatric health, told me that the three million krona given to the center is just a fraction of the government’s investments in suicide-prevention efforts, which are also dispensed at the regional and local levels.)
Skogberg isn’t alone in his critique of the government’s suicide-prevention efforts. The Swedish mental-health charity Mind supports the zero-suicide vision but maintains that not enough has been done to achieve it. The organisation’s director, Carl von Essen, suggested a series of reforms in a 2014 op-ed, including formulating indicators and annual targets like halving the number of suicides in the country by 2025. Von Essen, who recently participated in a government-commissioned inquiry to improve the zero-suicide plan, takes issue with critics who say that the goal of eliminating suicides is unrealistic. “There are countries with lower suicide rates than Sweden, so it is entirely feasible to reduce suicide mortality further here, too,” he told me.
But other mental-health professionals have questioned the very premise of the Vision Zero approach, which is animated by the idea that the state has a duty to prevent individuals from harming both others and themselves. One such critic is David Eberhard, the chief physician at a psychiatric clinic in Stockholm, the Swedish capital. He told me that the country’s Vision Zero schemes are the ultimate proof of Swedes’ “addiction to safety” and of the Swedish state’s tendency to intervene in the personal lives of its citizens. (theatlantic.com)
CONTINUES TOMORROW QUOTE
Sweden witnessed its lowest suicide rate since 1980 in 2011, when 1,378 people killed themselves. But that number then rose to 1,600 in 2013. Today, suicide is the most common cause of death for Swedish men and women aged 15 to 24. In the 15-to-44 age group, suicide is the most common cause of death among men and the second-most common cause of death among women.