Mask mandates have generated intense fights throughout the pandemic, sparking comparisons to early battles over seat-belt laws, which were similarly divisive when they were introduced in the United States in the 1980s. As they have with masks, opponents initially derided seat belts as uncomfortable and constricting, and they portrayed state laws requiring the restraints as government overreach. “Seat-belt laws steal our freedom,” proclaimed a 1989 editorial. “This has nothing to do with public safety,” another seat-belt law opponent argued in 1986. “It’s personal safety, and people should have the right to choose for themselves.”

Yet, there are key differences between seat-belt laws and mask mandates. While the mask requirements started with adults, the first passenger restraint laws in the United States targeted children. And although both seat-belt laws and mask mandates became highly politicized, the state that paved the way for seat-belt requirements in the United States was a relatively conservative state in the South — Tennessee — rather than a more liberal one in the Northeast or the West, where the first mask mandates were passed. Understanding and learning from this history could help make public health measures less polarizing.

By the 1970s, most developed countries had adult seat-belt laws, but, despite numerous attempts, no U.S. state had managed to pass similar measures, in large part because car manufacturers had lobbied against them.

Everything changed, however, when children became the focus of passenger restraint laws. The efforts of Robert Sanders, a pediatrician in Murfreesboro, Tenn., and his wife, Pat, precipitated this shift. The two were so persistent in meeting with state politicians, including a young Al Gore, about child safety seats that they became known as “Dr. and Mrs. Seat Belt.”

Robert Sanders didn’t set out to become involved with public health or politics, but in the 1970s, he was asked to join a state automobile accident prevention committee, and his traffic safety advocacy arose from that work. As a pediatrician, Sanders already knew that car accidents were a leading cause of death among young children in the United States, killing hundreds of toddlers and infants each year. But through the accident prevention committee, he learned about studies that showed child safety seats, which represented new technology at the time, could reduce childhood traffic deaths by up to 90 percent. He became convinced that every child passenger deserved the protection of a car seat, which meant requiring them by law rather than merely encouraging parents to use them.