53653 Road Safety at a glance Why is Road Safety an important Disease burden (DALYs lost) for 10 leading causes worldwide public health issue? 1998 2020 Disease or injury Disease or injury In 1999, between 750 000 and 880 000 persons died in road crashes worldwide, and another 23 to 34 1. Lower respiratory infection 1. Ischaemic heart disease 2. HIV/AIDS 2. Unipolar major depression million people were injured (Jacobs et al. 2000. WHO 3. Perinatal conditions 3. Road traffic injuries 2001 gives much higher estimates). 4. Diarrhoeal diseases 4. Cerebrovascular disease 5. Unipolar major 5. Chronic obstructive depression pulmonary disease The situation is particularly critical in low and middle 6. Ischaemic heart disease 6. Lower respiratory infections income countries (LMCs) where about 86% of deaths 7. Cerebrovascular disease 7. Tuberculosis from road traffic injuries occur even though these coun- 8. Malaria 8. War 9. Road traffic injuries 9. Diarrhoeal diseases tries account for only 40% of all motor vehicles. The 10. Chronic obstruction 10. HIV/AIDS graph shows that the situation has been worsening in pulmonary diseases LMCs since 1987. Source: WHO 2001 Road Fatality Trends (% changes 1987­1995) countries and 3rd in the industrialized world (Krug 1999). RTIs are an escalating health, social and eco- nomic 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. Source: Jacobs, Aeron-Thomas and Astrop 2000 How to Improve Road Safety 1) Understand the issues better. The absence of reliable There are strong social, health and economic reasons data on the magnitude and nature of the problem is a to reduce the burden of road traffic injuries (RTIs): serious handicap that needs to be overcome as a prior- Casualties affect mostly economically active persons ity. Under-reporting is believed to be significant. and have a ripple effect on their dependents, caus- Official police statistics--the most common data ing suffering and poverty. sources used--are known to underestimate road traffic Crash victims represent between 30 and 86% of all fatalities by 50% or more, and the situation is even trauma admissions. They tend to stay in hospital worse for injuries (Aeron-Thomas 2000). Good data longer than average patients (Odero et al. 1997). systems are crucial to help identify who is at risk for Road crashes absorb massive financial resources: injury, and to help identify successful and cost-effective about 1% of GNP in developing countries, 1.5% in interventions. transitional countries and 2% in Highly Motorized Countries (HMCs). This amounts to US$65 billion in Who is at risk? There is evidence that pedestrians are developing and transitional countries, more than the the road users most affected by RTIs (Odero et al. total annual amount of development assistance 1997). Between 41% and 75% of all road deaths are worldwide. pedestrians, mostly in urban areas. Passengers and two-wheeled vehicles are also frequently involved in traffic crashes. Data show that the risks are higher The situation is expected to get worse: by 2020, RTIs among males, particularly those who are economically are forecast to rise from 9th to 2nd leading cause of active: about 56% of male road traffic deaths in 1998 disability-adjusted life years (DALYs) lost in developing in LMCs were in the 15­44 age group (Krug 1999). September 2003 What are the risk factors? Factors accounting for RTIs rule). Provision of basic first aid training by NGOs or are: lack of investment in road safety factors such as schools to all road-users, police and fire-fighters should driver training and testing, road layout and design, be considered. At the national and/or regional level, vehicle conditions, police and judicial enforcement of effective interventions include facilitating and financing traffic laws, and safe human behavior. Once crashes treatment, support of emergency systems and develop- occur, the lack of adequate medical facilities including ing locally appropriate guidelines for training, equip- limited emergency services and a general lack of quali- ment, and procedures. fied medical personal impedes prompt medical atten- tion. Generally, car crashes reflect the conjunction of 3) Finance implementation of the strategy. Without sus- multiple causes that involve road infrastructure, vehicles tainable financing, even the best action plans will fail. and people. Analyses should be conducted to better Because of limited resources and competing needs identify and rank the factors that increase the risk of faced by government, additional sources of funding injuries or disabilities. are required. Road user fees, levies on gas and on vehicle licenses, insurance premiums, private business 2) Design a road safety strategy. Understanding the funds and community contributions in kind (volunteer issues is a prerequisite to implementing a National work) are common measures. Road Strategy. Haddon's Matrix offers a framework for analysis that integrates a temporal dimension, and 4) Establish partnerships. The public sector is often ranges from prevention of RTIs to treatment. It also deemed responsible for road safety, especially the helps to clarify the proper role of different partners. transport ministry and police. However, health, educa- tional and judiciary agencies have a large role to play Haddon's Matrix: basic road safety elements as well. Civil society, academic and non-government People Vehicle Environment agencies, and the private sector are being strongly Pre-crash Crash Education/ Road- Road urged to help form a wide partnership to initiate Prevention training worthiness design appropriate, feasible and cost-effective responses Impairment System Signs, to the problem. Attitudes/ (lights, markings behavior brakes, etc.) Maintenance Crash Injury Use of Restraints Protection People Vehicle Environment Prevention restraints Crash- (barrier) Pre-crash Crash Min. of Min. of Min. of Impairment worthiness Pedestrians Prevention education transport work Maintenance crossing Min of Manufacturers Local Post-crash Life First aid Ease of Rescue health Advertisers govt. sustaining skill access facilities Police Fleet owners Contractors Access to Fire risk Congestion Employers Police medics Civil society Crash Injury Min. of Min. of Min. of Preventing crashes and injuries: Prevention relies on dif- Prevention transport transport work Police Manufacturers Local ferent actors: government (law establishment), NGOs, Employers Owners govt. local communities, schools (sensitizing children to the Civil society issue), media, private businesses, and the transport Post-crash Life Min. of Min. of Police and health sectors. Raising the level of awareness of sustaining health transport Road Min. of Manufacturers authorities all the actors is a prerequisite to crash and injury pre- education Emergency Emergency vention. Measures should first focus on road-users' Civil society services services behavior (reduce speed, anti-drinking campaigns, Insurers mandatory use of seat-belts and helmets, safe pedes- trian behavior), since 64% to 95% of casualties in developing countries are due to improper human beha- Along with other donors, the World Bank has pro- vior (TRL 1990). Improved infrastructure (better geomet- moted the establishment of the Global Road Safety ric design, intersection control, provision of crash Partnership (GRSP), a tri-sector collaboration among barriers) and vehicle attributes (seat belts, brakes, etc.) governments, civil society and the private sector. is also required. The police play an important role in Coordination and building consensus among these dif- enforcing safe driving practices. ferent partners are not easy. To promote an effective partnership, all partners should work towards win-win Saving Lives: treatment and rehabilitation of injuries. situations. A strong leader ("a champion") is a pre- Timely and appropriate treatment of injuries prevents deaths and permanent disabilities (the golden hour requisite of any successful program. Objectives Core Interventions Target Groups Indicators 1) Establish a reliable management information system on road crashes Identify (or establish) data Develop hospital data on RTIs Policy makers Hospital data: reason for admission, type of injury sources Public sector: Health, (fatalities, light, severe injuries), type of road-user (driver, Reduce under-reporting Train police to code and report accidents Transport, Education passenger, pedestrian, two-wheeled driver) Police Police records: # of cars & motorcycles, # and type of RTIs Systematize the use of tools to collect and analyze crash data Private sector, NGOs Specific surveys: eg household surveys Academics Estimated % of under-reporting 2) Identify risk factors Define international standards Research on WHO Type of RTIs per person, per vehicle (by type), per km - RTI epidemiology and burden of disease Policy makers of roadway, per vehicle*km roadway, per vehicle km Determine the magnitude and - risk factors associated with fatalities, light and severe injuries Public sector (Health, traveled, per person km traveled. characteristics of the problem - high risk groups (poverty, gender, location and age issues) Transport, Education) Road deaths by causes - methodologies to evaluate the costs of RTIs Private sector Fatality rates, fatality risks, prevalence of disabilities Determine cost-effective measures - cost/benefit analyses of safety measures NGOs Trends by gender, urban/rural and age, examine Academics causal associations and relative risks Provide guidance to monitor Road accident costs as % of GNP, per person, as % of effective interventions transport & health sector expenditures, Cost-effective ratios of safety measures (wearing seat-belts, helmets, "drunk-driving" campaigns, etc.) 3) Improve Prevention of Injuries Education: Public information and training in better traffic behaviors of Population Knowledge/attitude/practice assessment of road increase knowledge and drivers (alcohol, fatigue, visibility, enough training, respect for Mass-media, NGOs safety issues awareness of road safety issues traffic rules) and pedestrians (walk on pavement, crossing) Education sector Use of reflectorized material by pedestrians and motorcycles Health sector Trend analyses Regulation and Enforcement: Transport sector establish rules or laws for Speed control, mandatory use of seat belts and helmets better Police appropriate behavior, and the enforced by the police Government consequences for non- Increase alcohol testing (legislation and % of drivers stopped by police who are: unrestrained, compliance Mandatory vehicle inspection (tires, brakes, lights) enforcement) without a helmet, drunk, driving at high speed, per Private sector age, gender and location (reported by the police) Engineering and technology: Accident prevention: introduce road safety audits of all new Manufactures focus on creating a hazard-free schemes and existing roads with many crashes Insurance Sector % of two-wheeled vehicle drivers wearing a helmet physical environment Accident reduction: black spot analyses of hazardous road sections and intersections % of cars taking and passing inspection Improved road design: traffic lights, road signs and markings, wider shoulders, traffic calming measures (speed bumps, chicanes, narrow roads, etc.) 4) Improve life sustaining measures Provide rapid and efficient Assess the following needs and their provision: Population Assessment of first-aid knowledge via surveys, treatment and rehabilitation of - basic first aid delivered to the population Mass-media, NGOs academic tests, driving license tests the injured - standardized first aid training curriculum for pre-licensing Government (law) Response time from emergency staff drivers, the police and fire fighters Health sector Assessment of pre-hospitalized care and emergency - an emergency telephone number Education sector hospital care - rapid and low-cost emergency vehicles Transport sector % of pre-hospitalized deaths - better training and better equipment for primary health facilities Insurance % of hospitalized deaths - developing decent hospital trauma care Police, fire-fighters Where to start? Key Contacts at the World Bank The Road Safety Strategy must start with raising the Eva Jarawan (Lead Health Specialist in Africa awareness of the concerned government officials and Region) and Richard Scurfield (Transport Sector other stakeholders to gain their support. The health Leader) sector has an important role to play in promoting road safety and injury prevention, in particular regarding safe behavior. Data collection and analysis and dis- Useful Web sites semination of the results and recommendations are WHO RTIs Home Page also of utmost importance. www.who.int/violence_injury_prevention World Bank Road Traffic Home Page www.worldbank.org/html/fpd/transport/ Do and Don'ts roads/safety.htm DO improve the quality of RTI data. Use injury Road Safety Program Home Page Global information from hospital data to complement police www.GRSProadsafety.org records. DFID transport link website (Password: CONNECT) www.transport-links.org/transport_links/ DO more effective research on crash risks, and also on prev_login.asp crash costing, and cost-effective measures and do a better job of disseminating the results. Carry out effec- Key References tive public information campaigns. Aeron-Thomas A 2000, Under-Reporting of Road DO be sensitive to local conditions. Traffic Casualties in Low Income Countries, Unpublished Project Report, PR/INT/199/00. DO NOT forget that road safety is a cross-sector issue, GRSP, Moving Ahead: Emerging Lessons. involving transportation, health and educational Jacobs G, A Aeron-Thomas & A Astrop 2000, activities. Estimating Global Road Fatalities, Transport Research Laboratory, DFID. DO NOT forget that road safety is not only a public Krug E (Ed.) 1999, Injury: a leading cause of the sector matter: DO place more emphasis on the medical global burden of disease, World Health community, civil society and businesses. However, Organization, Geneva. DON'T involve too many partners in the project; DO Murray C, and A Lopez (Eds.) 1996, The Global focus on those who can make a difference ("the Burden of Disease, WHO, World Bank and Harvard champions") and clarify roles and funding sources. University. Odero W, P Garner, & A Zwi 1997, Road Traffic DO emphasize the need for political leadership and will. Injuries in Developing Countries: a Comprehensive Review of Epidemiological Studies, Tropical Medicine and International Health, vol. DO consider that local involvement in the project is a 2(5): 445-460. major ingredient of success. TRL(Transport Research Laboratory) 1990, Road Safety in Developing Countries, TRL Crowrthorne, UK. DO focus on a few targets and measures at a time, and assess their effectiveness periodically. WHO 2001, A 5-Year WHO strategy for road traf- fic injury prevention, World Health Organization, Geneva. WHO 1999, World Health Report ­ Making a Difference, World Health Organization, Geneva. Expanded versions of the "at a glance" series, with e-linkages to resources and more information, are available on the World Bank Health-Nutrition-Population web site: www.worldbank.org/hnp