Road Safety

Why is Road Safety an important public health issue?

In 1999, between 750 000 and 880,000 persons died in road crashes worldwide, and another 23 to 34 million people were injured (Jacob et al , 2000. WHO 2001 gives a much higher estimate of deaths.)

The situation is particularly critical in low and middle income countries (LMCs) where about 86% of deaths from road traffic injuries occur even though these countries account for only 40% of all motor vehicles. The graph shows that the situation has been worsening in LMCs since 1987.

There are strong social, health and economic reasons to reduce the burden of road traffic injuries (RTIs):

• Casualties affect mostly economically active persons and have a ripple effect on their dependents, causing suffering and poverty. 
• Crash victims represent between 30 and 86% of all trauma admissions. They tend to stay in hospital longer than average patients (Odero et al. , 1997).
• Road crashes absorb massive financial resources: about 1% of GNP in developing countries, 1.5% in transitional countries and 2% in Highly Motorized Countries (HMCs). This amounts to US$65 billion in developing and transitional countries, more than the total annual amount of development assistance worldwide.

The situation is expected to get worse: by 2020, road accidents are forecast to rise from 9^th to 2^nd leading cause of disability-adjusted life years (DALYs) lost in developing countries and 3^rd in the industrialized world (Krug 1999). RTIs are an escalating health, social and economic hazard in countries with the least resources.

Developed countries have been relatively successful in reducing the burden of RTIs. This shows that more, better targeted and sustainable investment can prevent RTIs and reduce the damage that results from crashes. Poorer countries clearly need a new and broader approach to road safety.

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How to Improve Road Safety

1) Understand the issues better . The absence of reliable data on the magnitude and nature of the problem is a serious handicap that needs to be overcome as a priority. Under-reporting is believed to be significant. Official police statistics - the most common data sources used - are known to underestimate road accident fatalities by 50% or more, and the situation is even worse for injuries (Aeron-Thomas 2000). Good data systems are crucial to help identify who is at risk for injury, and to help identify successful and cost-effective interventions.

Who is at risk? There is evidence that pedestrians are the road users most affected by RTIs (Odero et al, 1997) . Between 41% and 75% of all road deaths are pedestrians, mostly in urban areas. Passengers and two-wheeled vehicles are also frequently involved in traffic accidents. Data show that the risks are higher among males, particularly those who are economically active: about 56% of male road traffic deaths in 1998 in LMCs were in the 15-44 age group ( Krug 1999).

What are the risk factors ? Factors accounting for RTIs are: lack of investment in road safety factors such as driver training and testing, road layout and design, vehicle conditions, police and judicial enforcement of traffic laws, and safe human behavior. Once crashes occur, the lack of adequate medical facilities including limited emergency services and a general lack of qualified medical personal impedes prompt medical attention. Generally, car accidents reflect the conjunction of multiple causes that involve road infrastructure, vehicles and people. A lack of reliable data has prevented assessments of the relative weight of each factor. Analyses should be conducted to better identify and rank the factors that increase the risk of injuries or disabilities.

2) Design a road safety strategy. Understanding the issues is a prerequisite to implementing a National Road Strategy. Haddon’s Matrix offers a framework for analysis that integrates a temporal dimension, and ranges from prevention of RTIs to treatment. It also helps to clarify the proper role of different partners.

Preventing crashes and injuries: Prevention relies on different actors: government (law establishment), NGOs, local communities, schools (sensitizing children to the issue), media, private businesses, and the transport and health sectors. Raising the level of awareness of all the actors is a prerequisite to crash and injury prevention. Measures should first focus on road-users’ behavior (reduce speed, anti-drinking campaigns, mandatory use of seat-belts and helmets, safe pedestrian behavior), since 64% to 95% of casualties in developing countries are due to improper human behavior (TRL 1990). Improved infrastructure (traffic lights, bumpers, etc.) and vehicle attributes (seat belts, brakes, etc.) should also be considered. The police play an important role in enforcing safe driving practices.

Saving Lives: treatment and rehabilitation of injuries. Timely and appropriate treatment of injuries prevents deaths and permanent disabilities (the golden hour rule). Provision of basic first aid training by NGOs or schools to all road-users, police and fire-fighters has proved effective. At the national and/or regional level, effective interventions include facilitating and financing treatment, support of emergency systems and developing locally appropriate guidelines for training, equipment, and procedures.

3) Finance implementation of the strategy. Without sustainable financing, even the best action plans will fail. Because of limited resources and competing needs faced by government, additional sources of funding are required. Road user fees, levies on gas and on vehicle licenses, insurance premiums, private business funds and community contributions in kind (volunteer work) are common measures.

4) Establish partnerships . The public sector is often deemed responsible for road safety, especially the transport ministry and police. However, health, educational and judiciary agencies have a large role to play as well. Civil society, academic and non-government agencies, and the private sector are being strongly urged to help form a wide partnership to initiate appropriate, feasible and cost-effective responses to the problem.

Along with other donors, the World Bank has promoted the establishment of the Global Road Safety Partnership (GRSP), a tri-sector collaboration among governments, civil society and the private sector. Coordination and building consensus among these different partners are not easy. To promote an effective partnership, all partners should work towards win-win situations. A strong leader (a “champion”) is a prerequisite of any successful program.

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Where to start?

The Road Safety Strategy must start with raising the awareness of the concerned government officials and other stakeholders to gain their support. The health sector has an important role to play in promoting road safety and injury prevention, in particular regarding safe behavior. Data collection and analysis and dissemination of the results and recommendations are also of utmost importance.

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Do and Don'ts

DO improve the quality of RTI data. Use injury information from hospital data to complement police records.

DO more effective research on crash risks, and also on accident costing, and cost-effective measures and do a better job of disseminating the results. Carry out effective public information campaigns.

DO be sensitive to local conditions.

DO NOT forget that road safety is a cross-sector issue, involving transportation, health and educational activities.

DO NOT forget that road safety is not only a public sector matter: DO place more emphasis on the medical community, civil society and businesses. However, DON’T involve too many partners in the project; DO focus on those who can make a difference (“the champions”) and clarify roles and funding sources.

DO emphasis the need for political leadership and will.

DO consider that local involvement in the project is a major ingredient of success.

DO focus on a few targets and measures at a time, and assess their effectiveness periodically.

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Key Contacts

Eva Jarawan (Lead Health Specialist in Africa Region) and Richard Scurfield (Transport Sector Leader)

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Useful Websites

WHO RTIs Home Page www.who.int/violence_injury_prevention

World Bank Road Traffic Home Page fety.htm

Global Road Safety Program Home Page www.GRSProadsafety.org

DFID transport link website ( Password: CONNECT) www.transport-links.org/transport_links/prev_login.asp

Road Traffic Injuries & Health Equity Conference (April 10-12, 2002) http://www.hsph.harvard.edu/traffic/

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Key References

Aeron-Thomas A 2000, Under-Reporting of Road Traffic Casualties in Low Income Countries, Unpublished Transport Research Library (TRL) Report PR/INT/199/00. TRL Ltd, Crowthorne. (www.trl.co.uk)

GRSP, Moving Ahead: Emerging Lessons. (go to http://www.grsproadsafety.org/ >Activities and Publications>Reports and Publications>Emerging lessons>GRSP report on emerging lessons)

Jacobs G, A Aeron-Thomas & A Astrop 2000, Estimating Global Road Fatalities, Transport Research Laboratory, DFID. (Copies of TRL Report445 are available from: TRL Limited, International Development Unit, Old Wokingham Road, Crowthorne, Berkshire RG45 6AU, United Kingdom)

Krug E (Ed.) 1999, Injury: a leading cause of the global burden of disease, World Health Organization, Geneva.

Murray C, and A. Lopez, (Eds), 1996, The Global Burden of Disease, WHO, The World Bank and Harvard University

Odero W, P Garner, & A Zwi 1997, Road Traffic Injuries in Developing Countries: a Comprehensive Review of Epidemiological Studies, Tropical Medicine and International Health, vol. 2(5): 445-460.

TRL 1990, Road Safety in Developing Countries, TRL Crowrthorne, UK.

WHO 2001, A 5-Year WHO strategy for road traffic injury prevention, World Health Organization, Geneva.

WHO 1999, World Health Report – Making a Difference, World Health Organization, Geneva.

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