Driverless cars, or "autonomous vehicles," are the next big thing in transportation. They have a lot going for them, not least in the critical public health arena of saving lives. Yet they also raise a series of ethical and population health issues, from life-or-death decision-making algorithms that have not been fully explained (why hit that person?), to whom they will help (the poor?), and which priorities they fulfill (public transit?).

The public health discussion is a long time coming. Vehicles equipped with partially automated driving systems, such as assisted parking or braking, are already on our roads. The international association of automotive engineers, SAE International, describes what's coming – fully autonomous vehicles that drive themselves independently, at least some of the time, without human intervention or continuous monitoring.  Tech companies and vehicle manufacturers including Tesla, Volvo, Nissan, Volkswagen, Audi and Ford are aggressively exploring the technology, believing that, eventually, fully autonomous vehicles will eventually do everything a human driver can do, only better.

Autonomous vehicle technology is already big business. Bain and Company estimate the sector including autonomous vehicles and assistive safety and comfort features will be worth $22 to $26 billion annually by 2025. The business is competitive, aggressive, and quick-moving, as typified by when Intel Bought Mobileye for $15.3 billion in an attempt to capture an important lead in the lucrative market. Manufacturers and tech companies have much at stake in the race to develop a safe fully autonomous vehicle, and they recognize that both consumer and community enthusiasm will be essential for widespread success.

From a public health perspective, nothing on the horizon offers the potential for more significant reduction in morbidity and mortality rates from motor vehicle accidents. By eliminating those accidents caused by human error, autonomous vehicles could reduce traffic fatalities up to 90%, potentially saving more than 29,000 lives in the United States and 10 million lives per decade around the world. Autonomous vehicles could create one of the most important public health advances of the 21st century, just as seatbelts and airbags put motor vehicle safety on the Centers for Disease Control and Prevention's list of the 10  greatest public health achievements of the 20th century.

At their best, autonomous vehicles could provide broader access to safe transportation, especially for people with disabilities or those who are impaired by substances, fatigue, or the irresistible urge to incessantly text message. However, as I point out in "Public Health, Ethics and Autonomous Vehicles"  in the April 2017 issue of the American Journal of Public Health, we should reflect on several of the ethical and public health issues:

  1. Let's start with the decision-making algorithms currently being created for autonomous vehicles that find themselves in situations that offer two bad possible choices. Hit the parked car or hit a pedestrian? Easy choice. Swerve into oncoming traffic to avoid hitting a person changing the tire by the side of the road? That choice is much more difficult and ethically complex. The weighing and balancing of choices in life-or-death situations entails complex value decisions about prioritizing autonomous vehicle passengers, occupants of other vehicles, and bystanders. Forced choice algorithms are being programmed into the vehicles now, yet they rest on fundamental ethical assumptions that have not been well-articulated.

  2. The classic Code of Ethics for Public Health focuses on advocating for the rights of individuals and communities through processes that engage communities and ensure community support.  Yet many communities are ill-prepared to examine the effect of autonomous-vehicle-testing in their midst, much less the effect of autonomous vehicles as permanent features of their built environment. Will autonomous vehicles really meet the needs of our most vulnerable? Have we engaged the communities in which they will be tested and rolled out? Or will they simply be a status symbol of the wealthy or a profit-making tool in privately-owned commercial fleets?

  3. While touted as a disruptive innovation, autonomous vehicles operate squarely within the current transportation paradigm of individual, personal transportation ridden to a single destination. Health professionals and public health experts have long advocated more walking and biking to help combat obesity, heart disease, and other diseases of inactivity. Instead of adapting our built environment to improve mass transit for the less able-bodied, or developing more and safer biking lanes, or creating dedicated pedestrian streets and improved footpaths, our streets will continue to be clogged with small vehicles suitable for transporting just a few passengers at a time. While driverless cars might make travel safer and more convenient for those who can afford to ride in them, they currently promise little for the health of our communities and population at large. Public health experts and communities should be engaging in this conversation to ensure that the full range of transportation innovations are considered – not just a reinvention of the wheel we already have.

While the improved safety and potential convenience of autonomous vehicles could be an incredible boon to the transportation system, the broader public health implications warrant further analysis and serious public discussion. The financial stakes for automakers and tech companies are huge. But the introduction of autonomous vehicles will affect our cities for decades to come. Public health experts have important skills and expertise to contribute to this conversation, and community engagement is critically important as we shape our urban environment. Let's join together to shape the process and not just settle for being willing passengers, taken for a ride.

Janet Fleetwood, PhD, MPH, a professor of Community Health & Prevention at Drexel University's Dornsife School of Public Health, focuses on urban issues in public health, bioethics, and social justice.

Read more about The Public's Health.