Global collaboration on road traffic injury prevention

Worldwide, nearly 1.2 million people are killed in road traffic crashes every year and 20 million to 50 million more are injured or disabled. These injuries account for 2.1% of global mortality and 2.6% of all disability-adjusted life years (DALYs) lost. Low- and middle-income countries account for about 85% of the deaths and 90% of the DALYs lost annually. Without appropriate action, by 2020, road traffic injuries are predicted to be the third leading contributor to the global burden of disease. The economic cost of road traffic crashes is enormous. Globally it is estimated that US$518 billion is spent on road traffic crashes with low- and middle-income countries accounting for US$65 billion--more than these countries receive in development assistance. But these costs are just the tip of the iceberg. For everyone killed, injured or disabled by a road traffic crash there are countless others deeply affected. Many families are driven into poverty by the expenses of prolonged medical care, loss of a family breadwinner or the added burden of caring for the disabled. There is an urgent need for global collaboration on road traffic injury prevention. Since 2000, WHO has stepped up its response to the road safety crisis by firstly developing a 5-year strategy for road traffic injury prevention and following this by dedicating World Health Day 2004 to road safety and launching the WHO/World Bank World Report on Road Traffic Injury Prevention at the global World Health Day event in Paris, France. This short article highlights the main messages from the World Report and the six recommendations for action on road safety at a national and international level. It goes on to briefly discuss other international achievements since World Health Day and calls for countries to take up the challenge of implementing the recommendations of the World Report.     

Productivity losses from road traffic deaths in Turkey

The importance of road traffic injuries in Turkey is not generally appreciated, in part due to lack of knowledge of its economic burden and in part due to major underestimation in official statistics. The total years of potential life lost and potentially productive years of life lost from mortality were calculated in order to estimate the cost of productivity losses from road traffic deaths in Turkey. More years of potentially productive life are lost due to road traffic deaths than to respiratory tract illnesses or diabetes mellitus, two other serious health problems in Turkey. Road traffic deaths cost Turkey an estimated USD 2.6 billion every year in productivity losses alone, more than the World Bank estimate of the indirect costs from the 1999 Marmara earthquake (USD 1.2-2 billion), Turkey's worst earthquake since 1939 (World Bank Turkey Country Office, 1999). This study highlights the importance of accurate information in ameliorating the burden of road traffic safety in Turkey. Turkey has great opportunities to implement cost-effective interventions to reduce the economic burden of fatal and non-fatal road traffic injuries.     

List of Reviewers 2013

Motor vehicle accidents are the leading cause of death in adolescents and young adults worldwide. Nearly three-quarters of road deaths occur in developing countries and men comprise a mean 80% of casualties. The rate of road traffic accidents caused by four-wheeled vehicles is the highest globally reported road traffic accidents statistic. In Saudi Arabia, the motor vehicle is the main means of transportation with one person killed and four injured every hour. Over 65% of accidents occur because of vehicles travelling at excess speed and/or drivers disobeying traffic signals. Road traffic injuries cause considerable economic losses to victims, their families, and to nations as a whole. Strategic prevention plans should be implemented soon by various sectors (health, police, transport, and education) to decrease the mortality and morbidity among adolescent and young age group. Strong and effective coordination between ministry of health and other ministries together with World Health Organization and other related organisations will be an important step towards implementing the international Decade of Action for Road Safety (2011–2020). The aim of this review article is to highlight some aspects of the health impacts of road traffic accidents.     

Road traffic injuries in Mozambique

Road traffic injuries affect the economy, health and quality of life of the people of Mozambique. Current road safety programmes are inadequate and inefficient given the magnitude of the problem. Data reported on road traffic crashes in the period 1990 to 2000 from the National Institute for Road Safety, the traffic police and the Central Hospital of Maputo were reviewed. The burden of road traffic injuries in Mozambique is rising, with at least three people killed daily. The age group most affected is 25-38 (39.35%), followed by 16-24 (20.79%). The main causes of crashes include reckless driving, drunken driving, roads with potholes, inadequate signs, lack of protection for pedestrians, and inadequate traffic law enforcement. However, the data are not adequate to reveal the true magnitude of the problem. Data collected by different sources are incomplete and not coordinated with other sources and databases. In urban areas, however, better response to crashes, treatment of the injured, reporting and data collection is attributable to a greater concentration of police and medical facilities. Road traffic safety programmes in Mozambique are inadequate and inefficient, starting with the data collection system. Improvement of injury surveillance systems is needed to help make road traffic safety a national development agenda priority and for developing and implementing road safety policies. For road safety programmes to be effective, government must facilitate stakeholders’ involvement, and the clear definition of government activities, civil society activities and public-private partnerships need to be established.     

Estimating national road crash fatalities using aggregate data

Injuries and fatalities from road traffic crashes have emerged a major public health challenge in Pakistan. Reliable estimates of road crash fatalities (RCF) of a country, is a vital element needed for identification and control of key risk factors, road-safety improvement efforts and prioritizing national health. Reliability of current annual RCF estimates for Pakistan becomes highly questionable due to serious underreporting. This study aimed to predict annual RCF for Pakistan using data from World Health Organization and International Road Federation sources. An ordinary least square (OLS) regression model that relates fatality rate with different explanatory variables was developed. RCF were predicted for Pakistan for year 2012 and 2013, and results were compared with national police reported estimates. Study results indicated that there is serious underreporting of RCF in Pakistan and immediate measures are needed to improve the existing road crash recording and reporting system at the national and subnational levels.     

我国道路交通事故社会救助基金实施问题的思考

新交法规定我国实行机动车第三者责任强制保险制度,设立道路交通事故社会救助基金,目的在于加强对交通事故受害人的保护。随着《机动车交通事故责任强制保险条例》的生效实施,机动车交通事故强制责任保险制度开始运行并发挥作用,但是与之配套的道路交通事故社会救助基金制度的相关立法却尚未到位。本文拟在分析道路交通事故社会救助基金功能、立法现状的基础上,借鉴发达国家立法经验,对我国道路交通事故社会救助基金管理机构的设立及运行提出建议。     

Vision Zero – a road safety policy innovation

The aim of this paper is to examine Sweden's Vision Zero road safety policy. In particular, the paper focuses on how safety issues were framed, which decisions were made, and what are the distinctive features of Vision Zero. The analysis reveals that the decision by the Swedish Parliament to adopt Vision Zero as Sweden's road safety policy was a radical innovation. The policy is different in kind from traditional traffic safety policy with regard to problem formulation, its view on responsibility, its requirements for the safety of road users, and the ultimate objective of road safety work. The paper briefly examines the implications of these findings for national and global road safety efforts that aspire to achieving innovative road safety policies in line with the Decade of Action for Road Safety 2011–2020, declared by the United Nations General Assembly in March 2010.     

Designing the European Road Safety Observatory

The unavailability of consistent traffic accident data and road safety information limits the opportunities to provide target approaches to reduce road crashes. The European commission has decided to meet the demand for this data by establishing a new Road Safety Observatory. The structure and much of the initial content is being developed within the SafetyNet Integrated Project. This paper describes the structure of its key components.     

Vision Zero--a road safety policy innovation

The aim of this paper is to examine Sweden's Vision Zero road safety policy. In particular, the paper focuses on how safety issues were framed, which decisions were made, and what are the distinctive features of Vision Zero. The analysis reveals that the decision by the Swedish Parliament to adopt Vision Zero as Sweden's road safety policy was a radical innovation. The policy is different in kind from traditional traffic safety policy with regard to problem formulation, its view on responsibility, its requirements for the safety of road users, and the ultimate objective of road safety work. The paper briefly examines the implications of these findings for national and global road safety efforts that aspire to achieving innovative road safety policies in line with the Decade of Action for Road Safety 2011-2020, declared by the United Nations General Assembly in March 2010.     

What can we learn from the historic road safety performance of high-income countries?

Abstract

Road traffic deaths in high-income countries (HICs) have been steadily declining for five decades, but are rising or stable in low- and middle-income countries (LMICs). We use time-series cross-sectional methods to assess how age- and sex- specific death rates evolved in 20 HICs during 1955–2015, controlling for income, population density and urbanization. Past work has attributed improvements in safety in HICs to income growth, suggesting that countries intervene when they become richer (Kuznets hypothesis). In contrast, we show that HICs had statistically significant declines in road traffic injuries starting in the late 1960s that persist after controlling for income effects, and inclusion of a lagged dependent variable. These findings are consistent for all age-sex groups but the effects are strongest for the elderly and young children. We argue that the reversal in the traffic injury trend did not occur because HICs reached an income threshold. Instead, the 1960s were a period of paradigmatic change in thinking about road safety. Subsequent, safety improvements occurred because countries at different income levels established regulatory institutions that had a legislative mandate and financial resources to conduct large-scale safety interventions.     

Road traffic injuries in Colombia

Road traffic injuries are a leading public health problem in Colombia. Pedestrians are the most vulnerable road users, especially in the main urban centers of Bogotá, Medellin and Cali. Data analyzed in this report include official statistics from the National Police and the National Institute of Legal Medicine and Forensic Sciences for 1996-2000, and results of a study conducted at the National University of Colombia in 2000. Methods from the Highway Capacity Manual were used for determining physical and technical variables, and a Geographical Information System tool was used for the location and spatial analysis of the road traffic crashes. Pedestrians accounted for close to 32% of injuries and 40% of the deaths from road traffic crashes. The problem of road traffic crashes existed predominately in urban areas. In the main urban centers, pedestrians constituted nearly 68% of road traffic crash victims. The high level of risky road use behaviors demonstrated by pedestrians and drivers, and inadequate infrastructure for safe mobility of pedestrians in some sections of the road network were the main contributing factors. Major improvements were achieved in Bogotá following enhancements to the municipal transport system and other policies introduced since 1995. In conclusion, policies and programs for improving road safety, in particular pedestrian safety, and strengthening urban planning are top priority.     

Road traffic accidents and policy interventions in Korea

The high rate of road traffic crashes, in conjunction with the absence of order on the road, has long been considered a critical social problem in Korea. The Korean public seems to agree that high priority ought to be placed on policies for improving road safety. Using data from government sources, this study describes what has happened in the area of road traffic crashes since 1970, the causes of traffic crashes, and the relative importance of traffic injuries as a cause of death in Korea. Road traffic crashes in Korea increased nearly eightfold, from 37,000 in 1970 to 290,481 in 2000. The fatalities increased three-fold and injuries ten-fold over the same period. Road traffic injuries were the leading cause of death for people under 29. However, through multiple policy interventions, partly in response to the 2002 FIFA World Cup, about two thousand road traffic deaths and nine thousand traffic-related disabilities were averted in 2001 alone. The policy interventions included enforcement of penalties for seven risky driving behaviours, including drunk driving and speeding, installation of traffic-monitoring cameras, financial rewards for citizens who reported traffic violations, introduction of a road safety evaluation system, correction of accident black spots in existing roads, and road safety education programs. Through multiple policy interventions, road traffic crashes in Korea were reduced in a relatively short time period, along with their associated injuries and fatalities. However, road traffic crashes still pose a major public health problem, threatening the quality of life of the Korean people.     

Road trauma perceptions and the potential influence of the media

The United Nations Decade of Action for Road Safety (2011–2020) recognises the urgency of addressing global road trauma. Road crashes and attempts to reduce risky driving, including public education campaigns, receive media attention in many countries. In Australia, road fatalities have declined significantly. However, the extent of awareness about this success and of fatalities overall is unclear. A survey of 833 Australian drivers revealed the majority of participants under-estimated fatalities. Unexpectedly, some under-estimates appear based on recollections of media reports. The findings suggest lack of awareness of the extent of road deaths and that, paradoxically, media reports might contribute to under-estimations. This represents a major public health challenge. Engaging community support for road safety, relative to other health/safety messages, may prove difficult if the extent of road trauma is misunderstood. Misperceptions about fatality levels may be a barrier to road users adopting safety precautions or supporting further road safety countermeasures.     

How much would low- and middle-income countries benefit from addressing the key risk factors of road traffic injuries?

Abstract

Despite strong advocacy, the UN Decade of Action for Road Safety (2011–2020) is ending with most low- and middle-income countries (LMICs) no closer to the Sustainable Development Goals target of reducing traffic mortality by half. In contrast, most high-income countries (HICs) have seen large benefits in recent decades from large-scale safety interventions. We aimed to assess how much LMICs would benefit from interventions that address six key risk factors related to helmet use, seatbelt use, speed control, drink driving, and vehicle design for safety of occupants and pedestrians. We use a comparative risk assessment framework to estimate mortality and health loss (disability adjusted life years lost, DALYs) that would be averted if these risks were reduced through intervention. We estimate effects for six countries that span all developing regions: China, Colombia, Ethiopia, India, Iran, and Russia. We find relatively large benefits (27% reductions in road traffic deaths and DALYs) from speed control in all countries, and about 5%-20% reductions due to other interventions depending on who is at risk in each country. To achieve larger gains, LMICs would need to move beyond simply learning from HICs and undertake new research to address risk factors particularly relevant to their context.     

An evaluation of the effectiveness of televised road safety messages in Ghana

The goal was to evaluate the effectiveness of recent televised advertisements conducted by the National Road Safety Commission in Ghana. These concerned speeding and alcohol-impaired driving and were targeted towards commercial drivers. Focus group discussions were conducted with 50 commercial drivers in four cities. Discussions addressed coverage, clarity and appropriateness of messages, including suggestions for improvements. Most discussants indicated that the messages were clear and appropriate. Television reached all participants in this urban group. However, they felt that other modes of communication, such as flyers and radio, should also be used to reach drivers who did not own televisions. A particular problem was language. The advertisements had been in English and Akan (the most common vernacular language). Participants wanted the messages diversified into more of the major Ghanaian languages. Some participants were unclear on the behaviour that the advertisements were telling viewers to take. Participants advocated greater involvement by police in road safety and called for laws banning the sale of alcohol at bus stations. The advertisements reached and were understood by most of the target audience. Opportunities for strengthening the messages included using other media; increasing the number of languages; and stressing the change in behaviour being recommended. Overall road safety activities would be strengthened by increasing accompanying law enforcement activities related to speed and alcohol-impaired driving. To the authors' knowledge this is the first formal evaluation of a road safety social marketing programme in a low-income sub-Saharan African country. This evaluation will hopefully assist Ghana and other similar countries in strengthening road safety work.     

An analysis of risk factors associated with road crash severities in Namibia

Abstract

Road crash is a leading cause of death and disabilities in Namibia and other developing countries. Based on recent trends, the World Health Organization indicated that progress to realize Sustainable Development Goal (SDG) target 3.6 – which calls for a 50% reduction in the number of road traffic deaths by 2020 – remains far from sufficient. To contribute to efforts in reducing road fatalities in Namibia, this study examined risk factors associated with the severity of crashes recorded in the country. Mixed logit modelling methodology was adopted to address the problem of unobserved heterogeneity in injury severity analysis. Model estimation results reveal that collision with pedestrians, head-on collisions, ran-off road collisions and crashes involving high occupancy passenger vehicles were more likely to result in fatalities and severe injuries. The findings and recommendations of this study are expected to enhance countermeasure implementation to reduce road crashes in Namibia.     

Measuring the road safety performance of Iranian provinces: a double-frontier DEA model and evidential reasoning approach

Abstract

Road traffic accidents are critical public issue in developing countries, and they annually waste a significant amount of Gross Domestic Product (GDP). In order to urgently consider how this problem is related to the current policies, a proper safety evaluation of regional programmes in crash reduction is fundamental to the governments. The current research aims to employ a double-frontier Data Envelopment Analysis (DEA) model to assess the productivity of Iranian regional safety programmes in reducing the number of road fatalities. The safety efficiencies of Iranian provinces are simultaneously estimated using the double frontier DEA to reflect both the optimistic and pessimistic points of view. Then, the Evidential Reasoning (ER) approach is applied to aggregate the obtained efficiency values. These provinces are ranked based on the data panel for 2014–2016. Finally, a double-frontier Malmquist productivity index (MPI) is used to comprehensively measure the safety performance of Iranian roads over a period of time.     

Identifying the factors behind fatal and non-fatal road crashes: a case study of Lahore,Pakistan

ABSTRACT

The study identifies the factors behind fatal and non-fatal road crashes in Lahore, Pakistan, by investigating 461 reported cases to Traffic Police Lahore that occurred during January–November 2014. Road crashes are categorized into fatal and non-fatal crashes and, because of the binary nature of the dependent variable, logistic regression is used to identify the factors behind these crashes. As a follow-up, discriminant analysis is employed to classify the factors related to fatal and non-fatal crashes. The logistic regression results reveal that females are at higher risk of fatalities than male drivers. Among vehicle types, rickshaws and cars are more involved in fatal accidents because both are growing at large on roads. Long trucks and trailers are also involved in fatal accidents, mainly because of their huge size and drivers’ risky driving behaviours. It is also noted that risk of fatalities is higher in case where two vehicles bumped each other. Speeding and overloading are the common behaviours resulting in fatal crashes. Better urban transport systems and strict compliance with traffic rules and regulations may improve road safety in Pakistan.     

Gender and geographic differences in intentional and unintentional injury mortality among children in Illinois, 1988–1998

Road traffic crashes and injuries constitute a major health, economic and developmental challenge for many African countries. With only 4% of the world's motor vehicles, African roads witness more than 10% of the world total collision fatalities. With further motorisation, the number of road traffic crashes, injuries and fatalities are expected to grow. This study updates on the status, trends, causes, countermeasures and issues in traffic safety in African countries by reviewing studies published in the past 12 years. The study found that traffic fatalities continued its upward trend in recent years. Similar to those in motorised countries, the study identified that human behaviour and incapacitation account for more than 85% of the contributing factors reported by police in Africa. Unlike in developed countries, the victims of traffic casualties are primarily vulnerable road users. Pedestrians alone account for more than 40% of the total fatalities on African roads. Limited countermeasures were reported in the literature. The outcomes of these programmes are mixed and the research methods have inconsistent validity. Investigation in the feasibility of transferring proven programmes from motorised countries is suggested as an efficient measure for traffic safety improvement.     

Equity dimensions of road traffic injuries in low- and middle-income countries

Globally, poorer population groups bear a disproportionate burden of avoidable morbidity and mortality from road traffic injuries. The distribution of road traffic injuries is generally influenced by socioeconomic factors. Poor countries bear a disproportionate burden of injuries and fatalities, and within countries, poor people account for a disproportionate portion of the ill health due to road traffic injuries. The main source of data for this paper was the road traffic injury database of the WHO World Health Report for 1999 supplemented by the WHO Global Burden of Disease Study 2000 report, and published and unpublished works. Fatality rates for 0-4 and 5-14 year olds in low- and middle-income regions, measured as deaths per 100,000 population, were six times the rates for high-income regions, while within low- and middle-income regions the rates varied widely. Within poor countries, poor people – represented by pedestrians, passengers in buses and trucks, and cyclists – suffer a higher burden of morbidity and mortality from traffic injuries. In rich countries, children from poor socioeconomic classes suffer more injuries and deaths from road crashes than their counterparts from highincome groups. The disproportionate burden of morbidity and mortality in low- and middle-income countries, and among low socioeconomic groups in those countries, illustrates problems of global inequities in health. The problems can be addressed through policies that focus on the road safety of vulnerable groups.