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7ORLD REPORT ON
ROAD TRAFlC INJURY PREVENTION
SUMMARY
%DITED BY
-ARGIE 0EDEN 2ICHARD 3CURlELD
$AVID 3LEET $INESH -OHAN
!DNAN ! (YDER %VA *ARAWAN
#OLIN -ATHERS
7ORLD (EALTH /RGANIZATION
'ENEVA
7(/ ,IBRARY #ATALOGUING
IN
0UBLICATION $ATA
7ORLD REPORT ON ROAD TRAFlC INJURY PREVENTION SUMMARY EDITED BY -ARGIE 0EDEN x ;ET AL=
!CCIDENTS 4RAFlC n PREVENTION AND CONTROL !CCIDENTS 4RAFlC
TRENDS
3AFETY 2ISK FACTORS 0UBLIC POLICY 7ORLD HEALTH )0EDEN -ARGIE
)3".
.,- CLASSIlCATION 7!
7ORLD (EALTH /RGANIZATION
!LL RIGHTS RESERVED 0UBLICATIONS OF THE 7ORLD (EALTH /RGANIZATION CAN BE OBTAINED FROM -ARKETING AND $ISSEMINATION 7ORLD (EALTH
/RGANIZATION !VENUE !PPIA 'ENEVA 3WITZERLAND TEL FAX E
MAIL BOOKORDERS WHO
INT 2EQUESTS FOR PERMISSION TO REPRODUCE OR TRANSLATE 7(/ PUBLICATIONS n WHETHER FOR SALE OR FOR NONCOMMERCIAL DISTRIBUTION
n SHOULD BE ADDRESSED TO 0UBLICATIONS AT THE ABOVE ADDRESS FAX E
MAIL PERMISSIONS WHOINT
4HE DESIGNATIONS EMPLOYED AND THE PRESENTATION OF THE MATERIAL IN THIS PUBLICATION DO NOT IMPLY THE EXPRESSION OF ANY OPINION
WHATSOEVER ON THE PART OF THE 7ORLD (EALTH /RGANIZATION CONCERNING THE LEGAL STATUS OF ANY COUNTRY TERRITORY CITY OR AREA OR OF ITS
AUTHORITIES OR CONCERNING THE DELIMITATION OF ITS FRONTIERS OR BOUNDARIES $OTTED LINES ON MAPS REPRESENT APPROXIMATE BORDER LINES
FOR WHICH THERE MAY NOT YET BE FULL AGREEMENT
4HE MENTION OF SPECIlC COMPANIES OR OF CERTAIN MANUFACTURERS PRODUCTS DOES NOT IMPLY THAT THEY ARE ENDORSED OR RECOMMENDED BY
THE 7ORLD (EALTH /RGANIZATION IN PREFERENCE TO OTHERS OF A SIMILAR NATURE THAT ARE NOT MENTIONED %RRORS AND OMISSIONS EXCEPTED
THE NAMES OF PROPRIETARY PRODUCTS ARE DISTINGUISHED BY INITIAL CAPITAL LETTERS
4HE 7ORLD (EALTH /RGANIZATION DOES NOT WARRANT THAT THE INFORMATION CONTAINED IN THIS PUBLICATION IS COMPLETE AND CORRECT AND
SHALL NOT BE LIABLE FOR ANY DAMAGES INCURRED AS A RESULT OF ITS USE
4HE NAMED EDITORS ALONE ARE RESPONSIBLE FOR THE VIEWS EXPRESSED IN THIS PUBLICATION
$ESIGNED BY MINIMUM GRAPHICS
#OVER BY 4USHITA 'RAPHIC 6ISION
4YPESET AND PRINTED IN &RANCE
#(!04%2 4(% &5.$!-%.4!,3 s III
#ONTENTS
&OREWORD
0REFACE
!CKNOWLEDGEMENTS
4HE FUNDAMENTALS
)NTRODUCTION
! PUBLIC HEALTH CONCERN
4HE SOCIAL AND ECONOMIC COSTS OF ROAD TRAFlC INJURIES
#HANGING FUNDAMENTAL PERCEPTIONS
4HE PREDICTABILITY AND PREVENTABILITY OF ROAD CRASH INJURY
4HE NEED FOR GOOD DATA AND A SCIENTIlC APPROACH
2OAD SAFETY AS A PUBLIC HEALTH ISSUE
2OAD SAFETY AS A SOCIAL EQUITY ISSUE
3YSTEMS THAT ACCOMMODATE HUMAN ERROR
3YSTEMS THAT ACCOUNT FOR THE VULNERABILITY OF THE HUMAN BODY
4ECHNOLOGY TRANSFER FROM HIGH
INCOME COUNTRIES
4HE NEW MODEL
! SYSTEMS APPROACH
$EVELOPING INSTITUTIONAL CAPACITY
!CHIEVING BETTER PERFORMANCE
3HARING RESPONSIBILITY
3ETTING TARGETS
"UILDING PARTNERSHIPS
4HE GLOBAL IMPACT
V
VII
XI
'LOBAL REGIONAL AND COUNTRY ESTIMATES
'LOBAL REGIONAL AND COUNTRY TRENDS
0ROlLE OF PEOPLE AFFECTED BY ROAD TRAFlC INJURIES
3OCIOECONOMIC STATUS AND LOCATION
/THER HEALTH SOCIAL AND ECONOMIC COSTS
(EALTH AND SOCIAL COSTS
%CONOMIC COSTS
.EED FOR RELIABLE INFORMATION
2ISK FACTORS AND INTERVENTIONS
)NTRODUCTION
-ANAGING EXPOSURE WITH LAND
USE AND TRANSPORT POLICY
%XPOSURE TO RISK OF ROAD TRAFlC INJURY
2EDUCING EXPOSURE THROUGH LAND
USE AND TRANSPORT PLANNING
%NCOURAGING THE USE OF SAFER MODES OF TRAVEL
IV s #/.4%.43
-INIMIZING EXPOSURE TO HIGH
RISK TRAFlC SCENARIOS
0LANNING AND DESIGNING ROADS FOR SAFETY
2ISK OF INJURY FROM POOR PLANNING AND DESIGN
3AFETY
CONSCIOUS DESIGN OF ROADS
3AFETY AUDITS
2EMEDIAL ACTION AT HIGH
RISK CRASH SITES
0ROVIDING VISIBLE CRASHWORTHY SMART VEHICLES
2ISK OF INJURY FROM POOR VEHICLE DESIGN AND MAINTENANCE
)MPROVING THE VISIBILITY OF VEHICLES AND VULNERABLE ROAD USERS
)MPROVING THE CRASHWORTHINESS OF MOTOR VEHICLES
$ESIGNING SMART VEHICLES
3ETTING ROAD SAFETY RULES AND SECURING COMPLIANCE
2ISK OF INJURY FROM LACK OF RULES AND ENFORCEMENT
3ETTING AND ENFORCING SPEED LIMITS
3ETTING AND ENFORCING ALCOHOL LIMITS
-EDICINAL AND RECREATIONAL DRUGS
!DDRESSING THE PROBLEM OF DRIVER FATIGUE
2EDUCING THE RISK OF JUNCTION CRASHES
2EQUIRING SEAT
BELTS AND CHILD RESTRAINTS
2EQUIRING HELMETS ON TWO
WHEELERS
"ANNING DRIVERS FROM USING HAND
HELD MOBILE PHONES
%DUCATING AND INFORMING THE PUBLIC
$ELIVERING CARE AFTER CRASHES
)MPROVING CARE BEFORE REACHING A HOSPITAL
)MPROVING HOSPITAL CARE
)MPROVING REHABILITATION
$OING RESEARCH
#ONCLUSIONS AND RECOMMENDATIONS
-AIN MESSAGES FROM THE REPORT
2ECOMMENDED ACTIONS
#ONCLUSION
2EFERENCES
#(!04%2 4(% &5.$!-%.4!,3 s V
&OREWORD
%VERY DAY THOUSANDS OF PEOPLE ARE KILLED AND
INJURED ON OUR ROADS -EN WOMEN OR CHILDREN
WALKING BIKING OR RIDING TO SCHOOL OR WORK
PLAYING IN THE STREETS OR SETTING OUT ON LONG TRIPS
WILL NEVER RETURN HOME LEAVING BEHIND SHATTERED
FAMILIES AND COMMUNITIES -ILLIONS OF PEOPLE
EACH YEAR WILL SPEND LONG WEEKS IN HOSPITAL AFTER
SEVERE CRASHES AND MANY WILL NEVER BE ABLE TO LIVE
WORK OR PLAY AS THEY USED TO DO #URRENT EFFORTS TO
ADDRESS ROAD SAFETY ARE MINIMAL IN COMPARISON TO
THIS GROWING HUMAN SUFFERING
4HE 7ORLD (EALTH /RGANIZATION AND THE 7ORLD "ANK HAVE JOINTLY PRODUCED THIS 7ORLD REPORT ON ROAD TRAFlC INJURY
PREVENTION )TS PURPOSE IS TO PRESENT A COMPREHENSIVE OVERVIEW OF WHAT IS KNOWN ABOUT THE MAGNITUDE RISK FAC
TORS AND IMPACT OF ROAD TRAFlC INJURIES AND ABOUT WAYS TO PREVENT AND LESSEN THE IMPACT OF ROAD CRASHES 4HE
DOCUMENT IS THE OUTCOME OF A COLLABORATIVE EFFORT BY INSTITUTIONS AND INDIVIDUALS #OORDINATED BY THE 7ORLD
(EALTH /RGANIZATION AND THE 7ORLD "ANK OVER EXPERTS FROM ALL CONTINENTS AND DIFFERENT SECTORS n INCLUD
ING TRANSPORT ENGINEERING HEALTH POLICE EDUCATION AND CIVIL SOCIETY n HAVE WORKED TO PRODUCE THE REPORT
2OAD TRAFlC INJURIES ARE A GROWING PUBLIC HEALTH ISSUE DISPROPORTIONATELY AFFECTING VULNERABLE GROUPS
OF ROAD USERS INCLUDING THE POOR -ORE THAN HALF THE PEOPLE KILLED IN TRAFlC CRASHES ARE YOUNG ADULTS AGED
BETWEEN AND YEARS n OFTEN THE BREADWINNERS IN A FAMILY &URTHERMORE ROAD TRAFlC INJURIES COST LOW
INCOME AND MIDDLE
INCOME COUNTRIES BETWEEN AND OF THEIR GROSS NATIONAL PRODUCT n MORE THAN THE
TOTAL DEVELOPMENT AID RECEIVED BY THESE COUNTRIES
"UT ROAD TRAFlC CRASHES AND INJURIES ARE PREVENTABLE )N HIGH
INCOME COUNTRIES AN ESTABLISHED SET OF INTER
VENTIONS HAVE CONTRIBUTED TO SIGNIlCANT REDUCTIONS IN THE INCIDENCE AND IMPACT OF ROAD TRAFlC INJURIES 4HESE
INCLUDE THE ENFORCEMENT OF LEGISLATION TO CONTROL SPEED AND ALCOHOL CONSUMPTION MANDATING THE USE OF SEAT
BELTS AND CRASH HELMETS AND THE SAFER DESIGN AND USE OF ROADS AND VEHICLES 2EDUCTION IN ROAD TRAFlC INJURIES
CAN CONTRIBUTE TO THE ATTAINMENT OF THE -ILLENNIUM $EVELOPMENT 'OALS THAT AIM TO HALVE EXTREME POVERTY AND
SIGNIlCANTLY REDUCE CHILD MORTALITY
2OAD TRAFlC INJURY PREVENTION MUST BE INCORPORATED INTO A BROAD RANGE OF ACTIVITIES SUCH AS THE DEVELOP
MENT AND MANAGEMENT OF ROAD INFRASTRUCTURE THE PROVISION OF SAFER VEHICLES LAW ENFORCEMENT MOBILITY
PLANNING THE PROVISION OF HEALTH AND HOSPITAL SERVICES CHILD WELFARE SERVICES AND URBAN AND ENVIRONMENTAL
PLANNING 4HE HEALTH SECTOR IS AN IMPORTANT PARTNER IN THIS PROCESS )TS ROLES ARE TO STRENGTHEN THE EVIDENCE
BASE PROVIDE APPROPRIATE PRE
HOSPITAL AND HOSPITAL CARE AND REHABILITATION CONDUCT ADVOCACY AND CONTRIBUTE
TO THE IMPLEMENTATION AND EVALUATION OF INTERVENTIONS
4HE TIME TO ACT IS NOW 2OAD SAFETY IS NO ACCIDENT )T REQUIRES STRONG POLITICAL WILL AND CONCERTED SUSTAINED
EFFORTS ACROSS A RANGE OF SECTORS !CTING NOW WILL SAVE LIVES 7E URGE GOVERNMENTS AS WELL AS OTHER SECTORS OF
SOCIETY TO EMBRACE AND IMPLEMENT THE KEY RECOMMENDATIONS OF THIS REPORT
0HOTO 7ORLD "ANK 0HOTO ,AB
0HOTO 7(/ 0 6)2/4
,%% *ONG
WOOK
$IRECTOR
'ENERAL
7ORLD (EALTH /RGANIZATION
*AMES $ 7OLFENSOHN
0RESIDENT
7ORLD "ANK 'ROUP
VI s 7/2,$ 2%0/24 /. 2/!$ 42!&&)# ).*529 02%6%.4)/.
0REFACE
/VER +ENYANS ARE KILLED ON OUR ROADS EVERY YEAR MOST OF THEM BETWEEN THE AGES OF AND YEARS
4HE COST TO OUR ECONOMY FROM THESE ACCIDENTS IS IN EXCESS OF 53 MILLION EXCLUSIVE OF THE ACTUAL LOSS
OF LIFE 4HE +ENYAN GOVERNMENT APPRECIATES THAT ROAD TRAFlC INJURIES ARE A MAJOR PUBLIC HEALTH PROBLEM
AMENABLE TO PREVENTION
)N THE NEWLY FORMED 'OVERNMENT OF THE .ATIONAL !LLIANCE 2AINBOW #OALITION TOOK UP THE ROAD
SAFETY CHALLENGE )T IS FOCUSING ON SPECIlC MEASURES TO CURTAIL THE PREVALENT DISREGARD OF TRAFlC REGULATIONS
AND MANDATING SPEED LIMITERS IN PUBLIC SERVICE VEHICLES
!LONG WITH THE ABOVE MEASURES THE 'OVERNMENT HAS ALSO LAUNCHED A SIX
MONTH 2OAD 3AFETY #AMPAIGN
AND DECLARED WAR ON CORRUPTION WHICH CONTRIBUTES DIRECTLY AND INDIRECTLY TO THE COUNTRYS UNACCEPTABLY
HIGH LEVELS OF ROAD TRAFlC ACCIDENTS
) URGE ALL NATIONS TO IMPLEMENT THE RECOMMENDATIONS OF THE 7ORLD REPORT ON ROAD TRAFlC INJURY PREVENTION AS A
GUIDE TO PROMOTING ROAD SAFETY IN THEIR COUNTRIES 7ITH THIS TOOL IN HAND ) LOOK FORWARD TO WORKING WITH
MY COLLEAGUES IN HEALTH TRANSPORT EDUCATION AND OTHER SECTORS TO MORE FULLY ADDRESS THIS MAJOR PUBLIC
HEALTH PROBLEM
-WAI +IBAKI 0RESIDENT 2EPUBLIC OF +ENYA
)N 7ORLD (EALTH $AY ORGANIZED BY THE 7ORLD (EALTH /RGANIZATION WILL FOR THE lRST TIME BE DEVOTED
TO 2OAD 3AFETY %VERY YEAR ACCORDING TO THE STATISTICS MILLION PEOPLE ARE KNOWN TO DIE IN ROAD ACCIDENTS
WORLDWIDE -ILLIONS OF OTHERS SUSTAIN INJURIES WITH SOME SUFFERING PERMANENT DISABILITIES .O COUNTRY IS
SPARED THIS TOLL IN LIVES AND SUFFERING WHICH STRIKES THE YOUNG PARTICULARLY %NORMOUS HUMAN POTENTIAL IS
BEING DESTROYED WITH ALSO GRAVE SOCIAL AND ECONOMIC CONSEQUENCES 2OAD SAFETY IS THUS A MAJOR PUBLIC
HEALTH ISSUE THROUGHOUT THE WORLD
7ORLD (EALTH $AY WILL BE OFlCIALLY LAUNCHED IN 0ARIS ON !PRIL &RANCE IS HONOURED )T SEES THIS AS
RECOGNITION OF THE MAJOR EFFORTS MADE BY THE &RENCH POPULATION AS A WHOLE WHICH MOBILIZED TO REDUCE THE
DEATH AND DESTRUCTION IT FACES ON THE ROADS 4HESE EFFORTS WILL ONLY ACHIEVE RESULTS IF THEY ARE SUPPORTED BY
A GENUINE REFUSAL TO ACCEPT ROAD ACCIDENTS FATALISTICALLY AND A DETERMINATION TO OVERCOME ALL TOO FREQUENT
INDIFFERENCE AND RESIGNATION 4HE MOBILIZATION OF THE &RENCH 'OVERNMENT AND THE RELEVANT INSTITUTIONS
PARTICULARLY CIVIC ORGANIZATIONS TOGETHER WITH A STRONG ACCIDENT PREVENTION AND MONITORING POLICY REDUCED
TRAFlC FATALITIES IN &RANCE BY FROM IN TO IN -UCH REMAINS TO BE DONE BUT ONE
THING IS ALREADY CLEAR IT IS BY CHANGING MENTALITIES THAT WE WILL TOGETHER MANAGE TO WIN THIS COLLECTIVE AND
INDIVIDUAL STRUGGLE FOR LIFE
*ACQUES #HIRAC 0RESIDENT &RANCE
VIII s 02%&!#%
'LOBALLY DEATHS AND INJURIES RESULTING FROM ROAD TRAFlC CRASHES ARE A MAJOR AND GROWING PUBLIC HEALTH
PROBLEM 6IET .AM HAS NOT BEEN SPARED )N THE YEAR THE GLOBAL MORTALITY RATE DUE TO TRAFlC ACCIDENTS
WAS PER POPULATION WHILE IN 6IET .AM THE lGURE WAS PER POPULATION 2OAD TRAFlC
COLLISIONS ON THE NATIONS ROADS CLAIM lVE TIMES MORE LIVES NOW THAN THEY DID TEN YEARS AGO )N A TOTAL
OF INCIDENTS WERE REPORTED LEADING TO DEATHS INJURIES AND THOUSANDS OF BILLIONS OF
6IET .AM $ONG IN COSTS
! MAIN CONTRIBUTOR TO ROAD CRASHES IN 6IET .AM IS THE RAPID INCREASE IN THE NUMBER OF VEHICLES PARTICULARLY
MOTORCYCLES WHICH INCREASE BY EVERY YEAR .EARLY HALF OF THE MOTORCYCLE RIDERS ARE NOT LICENSED
AND THREE QUARTERS DONT COMPLY WITH TRAFlC LAWS !LSO THE DEVELOPMENT OF ROADS AND OTHER TRANSPORT
INFRASTRUCTURE HAS NOT BEEN ABLE TO KEEP PACE WITH RAPID ECONOMIC GROWTH
4O REDUCE DEATHS AND INJURIES PROTECT PROPERTY AND CONTRIBUTE TO SUSTAINABLE DEVELOPMENT THE
'OVERNMENT OF 6IET .AM ESTABLISHED THE .ATIONAL #OMMITTEE ON 4RAFlC 3AFETY IN )N THE
'OVERNMENT PROMULGATED THE .ATIONAL 0OLICY ON !CCIDENTS AND )NJURY 0REVENTION WITH THE TARGET OF
REDUCING TRAFlC DEATHS TO PER VEHICLES 'OVERNMENT INITIATIVES TO REDUCE TRAFlC ACCIDENTS INCLUDE
ISSUING NEW TRAFlC REGULATIONS AND STRENGTHENING TRAFlC LAW ENFORCEMENT )N THE NUMBER OF TRAFlC
ACCIDENTS WAS REDUCED BY OVER THE PREVIOUS YEAR WHILE THE DEATHS AND INJURY RATES DECLINED BY
AND RESPECTIVELY
4HE 'OVERNMENT OF 6IET .AM WILL IMPLEMENT MORE STRINGENT MEASURES TO REDUCE ROAD TRAFlC INJURIES
THROUGH HEALTH PROMOTION CAMPAIGNS CONSOLIDATION OF THE INJURY SURVEILLANCE SYSTEM AND MOBILIZATION
OF VARIOUS SECTORS AT ALL LEVELS AND THE WHOLE SOCIETY 4HE 'OVERNMENT OF 6IET .AM WELCOMES THE 7ORLD
(EALTH /RGANIZATION7ORLD "ANK 7ORLD REPORT ON ROAD TRAFlC INJURY PREVENTION AND IS COMMITTED TO IMPLEMENTING
ITS RECOMMENDATIONS TO THE FULLEST EXTENT POSSIBLE
(% -R 0HAN 6AN +HAI 0RIME -INISTER 3OCIALIST 2EPUBLIC OF 6IET .AM
)N 4HAILAND ROAD ACCIDENTS ARE CONSIDERED ONE OF THE TOP THREE PUBLIC HEALTH PROBLEMS IN THE COUNTRY $ESPITE
THE 'OVERNMENTS BEST EFFORTS THERE ARE SADLY OVER DEATHS AND MORE THAN ONE MILLION INJURIES EACH
YEAR AS THE RESULT OF ROAD ACCIDENTS WITH SEVERAL HUNDRED THOUSAND PEOPLE DISABLED !N OVERWHELMING
MAJORITY OF THE DEATHS AND INJURIES INVOLVE MOTORCYCLISTS CYCLISTS AND PEDESTRIANS
4HE 2OYAL 4HAI 'OVERNMENT REGARDS THIS PROBLEM TO BE OF GREAT URGENCY AND HAS ACCORDED IT HIGH PRIORITY
IN THE NATIONAL AGENDA 7E ARE ALSO AWARE OF THE FACT THAT EFFECTIVE AND SUSTAINABLE PREVENTION OF SUCH INJURIES
CAN ONLY BE ACHIEVED THROUGH CONCERTED MULTISECTORAL COLLABORATION
4O DEAL WITH THIS CRUCIAL PROBLEM THE 'OVERNMENT HAS ESTABLISHED A 2OAD 3AFETY /PERATIONS #ENTRE
ENCOMPASSING THE DIFFERENT SECTORS OF THE COUNTRY AND COMPRISING THE GOVERNMENT AGENCIES CONCERNED
NONGOVERNMENTAL ORGANIZATIONS AND CIVIL SOCIETY 4HE #ENTRE HAS UNDERTAKEN MANY INJURY PREVENTION
INITIATIVES INCLUDING A h$ONT $RINK AND $RIVEv CAMPAIGN AS WELL AS A CAMPAIGN TO PROMOTE MOTORCYCLISTS
TO WEAR SAFETY HELMETS AND TO ENGAGE IN SAFE DRIVING PRACTICES )N THIS REGARD WE ARE WELL AWARE THAT SUCH
A CAMPAIGN MUST INVOLVE NOT ONLY PUBLIC RELATIONS AND EDUCATION BUT ALSO STRINGENT LAW ENFORCEMENT
MEASURES
4HE PROBLEM OF ROAD TRAFlC INJURIES IS INDEED A HIGHLY SERIOUS ONE BUT IT IS ALSO A PROBLEM THAT CAN BE
DEALT WITH AND PREVENTED THROUGH CONCERTED ACTION AMONG ALL THE PARTIES CONCERNED 4HROUGH THE LEADERSHIP
AND STRONG COMMITMENT OF THE 'OVERNMENT WE ARE CONlDENT THAT WE WILL BE SUCCESSFUL IN OUR EFFORTS AND
WE HOPE THAT OTHERS WILL BE AS WELL
4HAKSIN 3HINAWATRA 0RIME -INISTER 4HAILAND
02%&!#% s IX
7E ARE PLEASED THAT THE 3ULTANATE OF /MAN WITH OTHER COUNTRIES HAS BROUGHT UP THE ISSUE OF ROAD SAFETY TO
THE 5NITED .ATIONS 'ENERAL !SSEMBLY AND PLAYED A MAJOR ROLE IN RAISING GLOBAL AWARENESS TO THE GROWING
IMPACT OF DEADLY ROAD TRAFlC INJURIES ESPECIALLY IN THE DEVELOPING WORLD
4HE MAGNITUDE OF THE PROBLEM ENCOURAGED THE 5NITED .ATIONS 'ENERAL !SSEMBLY TO ADOPT A SPECIAL
RESOLUTION .O AND THE 7ORLD (EALTH /RGANIZATION TO DECLARE THE YEAR AS THE YEAR OF ROAD
SAFETY
)N TAKING THESE TWO IMPORTANT STEPS BOTH ORGANIZATIONS STARTED THE WORLD BATTLE AGAINST TRAUMA CAUSED BY
ROAD ACCIDENTS AND WE HOPE THAT ALL SECTORS OF OUR SOCIETIES WILL COOPERATE TO ACHIEVE THIS NOBLE HUMANITARIAN
OBJECTIVE
4HE WORLD REPORT ON ROAD TRAFlC INJURY PREVENTION IS NO DOUBT A COMPELLING READING DOCUMENT 7E CONGRATULATE THE
7ORLD (EALTH /RGANIZATION AND THE 7ORLD "ANK FOR PRODUCING SUCH A MAGNIlCENT PRESENTATION
1ABOOS BIN 3AID 3ULTAN OF /MAN
,AND TRANSPORTATION SYSTEMS HAVE BECOME A CRUCIAL COMPONENT OF MODERNITY "Y SPEEDING UP COMMUNICATIONS
AND THE TRANSPORT OF GOODS AND PEOPLE THEY HAVE GENERATED A REVOLUTION IN CONTEMPORARY ECONOMIC AND
SOCIAL RELATIONS
(OWEVER INCORPORATING NEW TECHNOLOGY HAS NOT COME ABOUT WITHOUT COST ENVIRONMENTAL CONTAMINATION
URBAN STRESS AND DETERIORATING AIR QUALITY ARE DIRECTLY LINKED TO MODERN LAND TRANSPORT SYSTEMS !BOVE ALL
TRANSPORTATION IS INCREASINGLY ASSOCIATED WITH THE RISE IN ROAD ACCIDENTS AND PREMATURE DEATHS AS WELL AS
PHYSICAL AND PSYCHOLOGICAL HANDICAPS ,OSSES ARE NOT LIMITED TO REDUCED WORKER PRODUCTIVITY AND TRAUMA
AFFECTING A VICTIMS PRIVATE LIFE %QUALLY SIGNIlCANT ARE THE RISING COSTS IN HEALTH SERVICES AND THE ADDED
BURDEN ON PUBLIC lNANCES
)N DEVELOPING COUNTRIES THE SITUATION IS MADE WORSE BY RAPID AND UNPLANNED URBANIZATION 4HE ABSENCE
OF ADEQUATE INFRASTRUCTURE IN OUR CITIES TOGETHER WITH THE LACK OF A LEGAL REGULATORY FRAMEWORK MAKE THE
EXPONENTIAL RISE IN THE NUMBER OF ROAD ACCIDENTS ALL THE MORE WORRYING 4HE STATISTICS SHOW THAT IN "RAZIL
PEOPLE DIE EVERY YEAR IN ROAD ACCIDENTS /F THESE ARE BETWEEN AND YEARS OF AGE AND
ARE MEN
!S IN OTHER ,ATIN !MERICAN COUNTRIES THERE IS A GROWING AWARENESS IN "RAZIL AS TO THE URGENCY OF REVERSING
THIS TREND 4HE "RAZILIAN 'OVERNMENT THROUGH THE -INISTRY OF #ITIES HAS PUT CONSIDERABLE EFFORT INTO
DEVELOPING AND IMPLEMENTING ROAD SECURITY EDUCATION CAMPAIGNS AND PROGRAMMES THAT EMPHASIZE CITIZEN
INVOLVEMENT !S PART OF THIS ENDEAVOUR "RAZIL RECENTLY ADOPTED A NEW ROAD TRAFlC CODE THAT HAS BROUGHT DOWN
THE ANNUAL NUMBER OF ROAD DEATHS BY ABOUT 4HIS IS A WELCOME DEVELOPMENT THAT SHOULD SPUR US TO EVEN
FURTHER PROGRESS 4HE CHALLENGES ARE ENORMOUS AND MUST NOT BE SIDE STEPPED 4HIS IS WHY ROAD SECURITY WILL
REMAIN A PRIORITY FOR MY 'OVERNMENT
4HE PUBLICATION OF THIS REPORT IS THEREFORE EXTREMELY TIMELY 4HE DATA AND ANALYSIS THAT IT BRINGS TO LIGHT
WILL PROVIDE VALUABLE MATERIAL FOR A SYSTEMATIC AND IN
DEPTH DEBATE ON AN ISSUE THAT AFFECTS THE HEALTH OF
ALL /F EVEN GREATER SIGNIlCANCE IS THE FACT THAT THE REPORT WILL HELP REINFORCE OUR CONVICTION THAT ADEQUATE
PREVENTIVE MEASURES CAN HAVE A DRAMATIC IMPACT 4HE DECISION TO DEDICATE THE 7ORLD (EALTH $AY TO
2OAD 3AFETY POINTS TO THE INTERNATIONAL COMMUNITYS DETERMINATION TO ENSURE THAT MODERN MEANS OF LAND
TRANSPORTATION ARE INCREASINGLY A FORCE FOR DEVELOPMENT AND THE WELL
BEING OF OUR PEOPLES
,UIS )NCIO ,ULA DA 3ILVA 0RESIDENT &EDERATIVE 2EPUBLIC OF "RAZIL
#(!04%2 4(% &5.$!-%.4!,3 s XI
!CKNOWLEDGEMENTS
4HE 7ORLD (EALTH /RGANIZATION AND THE 7ORLD "ANK WOULD LIKE TO ACKNOWLEDGE THE MEMBERS OF THE
COMMITTEES REGIONAL CONSULTATION PARTICIPANTS PEER REVIEWERS ADVISERS AND CONSULTANTS FROM OVER
COUNTRIES WHOSE DEDICATION SUPPORT AND EXPERTISE MADE THIS REPORT POSSIBLE
4HE 7ORLD (EALTH /RGANIZATION THE 7ORLD "ANK AND THE %DITORIAL #OMMITTEE WOULD LIKE TO PAY A SPECIAL
TRIBUTE TO 0ATRICIA 7ALLER WHO PASSED AWAY ON !UGUST 3HE WAS A MEMBER OF THE TECHNICAL COMMIT
TEE FOR CHAPTER BUT SADLY BECAME TOO ILL TO PARTICIPATE (ER MANY CONTRIBUTIONS TO THE PROMOTION OF ROAD
SAFETY IN THE CONTEXT OF PUBLIC HEALTH ARE ACKNOWLEDGED 3HE WAS A FRIEND AND MENTOR TO MANY
4HE REPORT ALSO BENElTED FROM THE CONTRIBUTIONS OF A NUMBER OF OTHER PEOPLE )N PARTICULAR ACKNOWLEDGEMENT
IS MADE TO *EANNE "REEN AND !NGELA 3EAY FOR WRITING THE REPORT UNDER VERY TIGHT TIME CONSTRAINTS TO 4ONY
+AHANE FOR EDITING THE lNAL TEXT TO 3TUART !DAMS FOR WRITING THE SUMMARY AND $AVID "REUER FOR EDITING THE
SUMMARY 4HANKS ARE ALSO DUE TO THE FOLLOWING #AROLINE !LLSOPP AND -ARIE &ITZSIMMONS FOR THEIR INVALUABLE
EDITORIAL SUPPORT !NTHONY "LISS FOR TECHNICAL SUPPORT ON TRANSPORT
RELATED MATTERS -ELECKIDZEDECK +HAYESI
AND 4AMITZA 4OROYAN FOR ASSISTANCE WITH THE DAY
TO
DAY MANAGEMENT AND COORDINATION OF THE PROJECT +ARA
-C'EE AND .IELS 4OMIJIMA FOR STATISTICAL ASSISTANCE 3USAN +APLAN AND !NN -ORGAN FOR PROOFREADING 4USHITA
"OSONET AND 3UE (OBBS FOR GRAPHIC DESIGN AND LAYOUT ,IZA &URNIVAL FOR INDEXING +EITH 7YNN FOR PRODUCTION
$ESIREE +OGEVINAS ,AURA 3MINKEY AND 3ABINE VAN 4UYLL VAN 3EROOSKERKEN FOR COMMUNICATIONS 7OUTER
.ACHTERGAELE FOR ASSISTANCE WITH REFERENCES +EVIN .ANTULYA FOR RESEARCH ASSISTANCE AND 3IMONE #OLAIRO
0ASCALE ,ANVERS
#ASASOLA !NGELA 3WETLOFF
#OFF FOR ADMINISTRATIVE SUPPORT
4HE 7ORLD (EALTH /RGANIZATION ALSO WISHES TO THANK THE FOLLOWING FOR THEIR GENEROUS lNANCIAL SUPPORT
FOR THE DEVELOPMENT AND PUBLICATION OF THE REPORT THE !RAB 'ULF 0ROGRAMME FOR 5NITED .ATIONS $EVEL
OPMENT /RGANIZATIONS !'&5.$ THE &)! &OUNDATION THE &LEMISH 'OVERNMENT THE 'LOBAL &ORUM FOR
(EALTH 2ESEARCH THE 3WEDISH )NTERNATIONAL $EVELOPMENT !GENCY THE 5NITED +INGDOM $EPARTMENT FOR
4RANSPORT 2OAD 3AFETY $IVISION THE 5NITED 3TATES .ATIONAL (IGHWAY 4RAFlC 3AFETY !DMINISTRATION AND THE
5NITED 3TATES #ENTERS FOR $ISEASE #ONTROL AND 0REVENTION
4HE FUNDAMENTALS
)NTRODUCTION
2OAD TRAFlC INJURIES ARE A MAJOR BUT NEGLECTED PUB
LIC HEALTH CHALLENGE THAT REQUIRES CONCERTED EFFORTS
FOR EFFECTIVE AND SUSTAINABLE PREVENTION /F ALL THE
SYSTEMS WITH WHICH PEOPLE HAVE TO DEAL EVERY DAY
ROAD TRAFlC SYSTEMS ARE THE MOST COMPLEX AND THE
MOST DANGEROUS 7ORLDWIDE AN ESTIMATED MIL
LION PEOPLE ARE KILLED IN ROAD CRASHES EACH YEAR AND
AS MANY AS MILLION ARE INJURED 0ROJECTIONS INDI
CATE THAT THESE lGURES WILL INCREASE BY ABOUT
OVER THE NEXT YEARS UNLESS THERE IS NEW COMMIT
MENT TO PREVENTION .EVERTHELESS THE TRAGEDY BE
HIND THESE lGURES ATTRACTS LESS MASS MEDIA ATTENTION
THAN OTHER LESS FREQUENT TYPES OF TRAGEDY
4HE 7ORLD REPORT ON ROAD TRAFlC INJURY PREVENTION IS THE
lRST MAJOR REPORT BEING JOINTLY ISSUED BY THE 7ORLD
(EALTH /RGANIZATION 7(/ AND THE 7ORLD "ANK
ON THIS SUBJECT )T UNDERSCORES THEIR CONCERN THAT
UNSAFE ROAD TRAFlC SYSTEMS ARE SERIOUSLY HARMING
GLOBAL PUBLIC HEALTH AND DEVELOPMENT )T CONTENDS
THAT THE LEVEL OF ROAD TRAFlC INJURY IS UNACCEPTABLE
AND THAT IT IS LARGELY AVOIDABLE
4HE REPORT HAS THREE AIMS
s 4O CREATE GREATER LEVELS OF AWARENESS COMMIT
MENT AND INFORMED DECISION
MAKING AT ALL LEV
ELS n GOVERNMENT INDUSTRY INTERNATIONAL AGEN
CIES AND NONGOVERNMENTAL ORGANIZATIONS n SO
THAT STRATEGIES SCIENTIlCALLY PROVEN TO BE EFFEC
TIVE IN PREVENTING ROAD INJURIES CAN BE IMPLE
MENTED !NY EFFECTIVE RESPONSE TO THE GLOBAL
CHALLENGE OF REDUCING ROAD TRAFlC CASUALTIES
WILL REQUIRE ALL THESE LEVELS TO MOBILIZE GREAT
EFFORT
s 4O CONTRIBUTE TO A CHANGE IN THINKING ABOUT
THE NATURE OF THE PROBLEM OF ROAD TRAFlC IN
JURIES AND WHAT CONSTITUTES SUCCESSFUL PREVEN
TION 4HE PERCEPTION THAT ROAD TRAFlC INJURY IS
THE PRICE TO BE PAID FOR ACHIEVING MOBILITY AND
ECONOMIC DEVELOPMENT NEEDS TO BE REPLACED
BY A MORE HOLISTIC IDEA THAT EMPHASIZES PRE
VENTION THROUGH ACTION AT ALL LEVELS OF THE ROAD
TRAFlC SYSTEM
s 4O HELP STRENGTHEN INSTITUTIONS AND TO CREATE
EFFECTIVE PARTNERSHIPS TO DELIVER SAFER ROAD
TRAFlC SYSTEMS 3UCH PARTNERSHIPS SHOULD EX
IST HORIZONTALLY BETWEEN DIFFERENT SECTORS OF
GOVERNMENT AND VERTICALLY BETWEEN DIFFER
ENT LEVELS OF GOVERNMENT AS WELL AS BETWEEN
GOVERNMENTS AND NONGOVERNMENTAL ORGANIZA
TIONS !T THE GOVERNMENT LEVEL THIS MEANS ES
TABLISHING CLOSE COLLABORATION BETWEEN SECTORS
INCLUDING PUBLIC HEALTH TRANSPORT lNANCE LAW
ENFORCEMENT AND OTHER SECTORS CONCERNED
4HIS SUMMARY OF THE 7ORLD REPORT ON ROAD TRAFlC INJURY
PREVENTION IS PRIMARILY INTENDED FOR PEOPLE RESPON
SIBLE FOR ROAD SAFETY POLICIES AND PROGRAMMES AT THE
NATIONAL LEVEL AND THOSE MOST CLOSELY IN TOUCH WITH
ROAD SAFETY PROBLEMS AND NEEDS AT THE LOCAL LEVEL
4HE VIEWS EXPRESSED AND THE CONCLUSIONS DRAWN ARE
TAKEN FROM THE MAIN REPORT AND THE MANY STUDIES TO
WHICH THAT REPORT REFERS
! PUBLIC HEALTH CONCERN
%VERY DAY AROUND THE WORLD MORE THAN PEO
PLE DIE FROM ROAD TRAFlC INJURY ,OW
INCOME AND
MIDDLE
INCOME COUNTRIES ACCOUNT FOR ABOUT
OF THE DEATHS AND FOR OF THE ANNUAL DISABILITY
ADJUSTED LIFE YEARS $!,9S LOST BECAUSE OF ROAD
TRAFlC INJURY
0ROJECTIONS SHOW THAT BETWEEN AND
0EDEN - ET AL EDS 4HE WORLD REPORT ON ROAD TRAFlC INJURY PREVENTION 'ENEVA 7ORLD (EALTH /RGANIZATION
s 7/2,$ 2%0/24 /. 2/!$ 42!&&)# ).*529 02%6%.4)/. 35--!29
ROAD TRAFlC DEATHS WILL DECLINE BY
ABOUT IN HIGH
INCOME COUN
TRIES BUT INCREASE SUBSTANTIALLY IN
LOW
INCOME AND MIDDLE
INCOME
COUNTRIES 7ITHOUT APPROPRIATE
ACTION BY ROAD TRAFlC INJU
RIES ARE PREDICTED TO BE THE THIRD
LEADING CONTRIBUTOR TO THE GLOBAL
BURDEN OF DISEASE AND INJURY
4ABLE
4HE SOCIAL AND ECONOMIC
COSTS OF ROAD TRAFlC
INJURIES
4!",%
#HANGE IN RANK ORDER OF $!,9S FOR THE LEADING CAUSES OF THE GLOBAL
BURDEN OF DISEASE
2ANK
$ISEASE OR INJURY
2ANK
$ISEASE OR INJURY
,OWER RESPIRATORY INFECTIONS
)SCHAEMIC HEART DISEASE
$IARRHOEAL DISEASES
5NIPOLAR MAJOR DEPRESSION
0ERINATAL CONDITIONS
2OAD TRAFlC INJURIES
5NIPOLAR MAJOR DEPRESSION
#EREBROVASCULAR DISEASE
)SCHAEMIC HEART DISEASE
#HRONIC OBSTRUCTIVE PULMONARY DISEASE
#EREBROVASCULAR DISEASE
,OWER RESPIRATORY INFECTIONS
4UBERCULOSIS
4UBERCULOSIS
-EASLES
7AR
2OAD TRAFlC INJURIES
$IARRHOEAL DISEASES
#ONGENITAL ABNORMALITIES
()6
$!,9 $ISABILITY ADJUSTED LIFE YEAR ! HEALTH GAP MEASURE THAT COMBINES INFORMATION ON
THE NUMBER OF YEARS LOST FROM PREMATURE DEATH WITH THE LOSS OF HEALTH FROM DISABILITY
3OURCE REFERENCE
%VERYONE KILLED INJURED OR DIS
ABLED BY A ROAD TRAFlC CRASH HAS A
NETWORK OF OTHERS INCLUDING FAM
ILY AND FRIENDS WHO ARE DEEPLY AF
FECTED 'LOBALLY MILLIONS OF PEOPLE ARE COPING WITH
THE DEATH OR DISABILITY OF FAMILY MEMBERS FROM ROAD
TRAFlC INJURY )T WOULD BE IMPOSSIBLE TO ATTACH A VAL
UE TO EACH CASE OF HUMAN SACRIlCE AND SUFFERING
ADD UP THE VALUES AND PRODUCE A lGURE THAT CAPTURES
THE GLOBAL SOCIAL COST OF ROAD CRASHES AND INJURIES
4HE ECONOMIC COST OF ROAD CRASHES AND INJURIES IS
ESTIMATED TO BE OF GROSS NATIONAL PRODUCT '.0
IN LOW INCOME COUNTRIES IN MIDDLE INCOME
COUNTRIES AND IN HIGH INCOME COUNTRIES 4HE
GLOBAL COST IS ESTIMATED TO BE 53 BILLION PER
YEAR ,OW INCOME AND MIDDLE INCOME COUNTRIES AC
COUNT FOR 53 BILLION MORE THAN THEY RECEIVE IN
DEVELOPMENT ASSISTANCE
2OAD TRAFlC INJURIES PLACE A HEAVY BURDEN NOT
ONLY ON GLOBAL AND NATIONAL ECONOMIES BUT ALSO
HOUSEHOLD lNANCES -ANY FAMILIES ARE DRIVEN DEEP
LY INTO POVERTY BY THE LOSS OF BREADWINNERS AND THE
ADDED BURDEN OF CARING FOR MEMBERS DISABLED BY
ROAD TRAFlC INJURIES
"Y CONTRAST VERY LITTLE MONEY IS INVESTED IN PRE
VENTING ROAD CRASHES AND INJURIES 4ABLE COMPARES
THE FUNDS SPENT ON RESEARCH AND DEVELOPMENT FO
CUSED ON SEVERAL HEALTH CONCERNS INCLUDING ROAD
SAFETY #OMPARATIVELY LITTLE IS SPENT ON IMPLEMENTA
TION EVEN THOUGH MANY INTERVENTIONS THAT WOULD
PREVENT CRASHES AND INJURIES ARE WELL KNOWN WELL
TESTED COST EFFECTIVE AND PUBLICLY ACCEPTABLE
#HANGING FUNDAMENTAL
PERCEPTIONS
3INCE THE LAST MAJOR 7(/ WORLD REPORT ON ROAD
SAFETY ISSUED OVER YEARS AGO THERE HAS BEEN
A MAJOR CHANGE IN THE PERCEPTION UNDERSTANDING
AND PRACTICE OF ROAD INJURY PREVENTION AMONG TRAF
lC SAFETY PROFESSIONALS AROUND THE WORLD &IGURE
SETS OUT THE GUIDING PRINCIPLES OF THIS SHIFT OF PARA
DIGMS
4HE PREDICTABILITY AND PREVENTABILITY OF
ROAD CRASH INJURY
(ISTORICALLY MOTOR VEHICLE hACCIDENTSv HAVE BEEN
VIEWED AS RANDOM EVENTS THAT HAPPEN TO OTHERS
AND AS AN INEVITABLE OUTCOME OF ROAD TRANSPORT 4HE
TERM hACCIDENTv IN PARTICULAR CAN GIVE THE IMPRES
4!",%
%STIMATED GLOBAL RESEARCH AND DEVELOPMENT
FUNDING FOR SELECTED TOPICS
$ISEASE OR INJURY
53 MILLIONS
$!,9S $!,9S
RANKING
RANKING
()6!)$3
n
-ALARIA
$IARRHOEAL DISEASES
2OAD TRAFlC CRASHES
n
4UBERCULOSIS
n
3OURCE REFERENCE
4(% &5.$!-%.4!,3 s
&)'52%
4HE ROAD SAFETY PARADIGM SHIFT
!
!
!
SION OF INEVITABILITY AND UNPREDICTABILITY n AN EVENT
THAT CANNOT BE MANAGED 4HIS IS NOT THE CASE 2OAD
TRAFlC CRASHES ARE EVENTS THAT ARE AMENABLE TO RATIO
NAL ANALYSIS AND REMEDIAL ACTION
)N THE S AND EARLY S MANY HIGHLY
MO
TORIZED COUNTRIES BEGAN TO ACHIEVE LARGE REDUC
TIONS IN CASUALTIES THROUGH OUTCOME
ORIENTED AND
SCIENCE
BASED APPROACHES 4HIS RESPONSE WAS STIMU
LATED BY CAMPAIGNERS INCLUDING 2ALPH .ADER IN THE
5NITED 3TATES OF !MERICA AND GIVEN INTELLECTUAL
STRENGTH BY SCIENTISTS SUCH AS 7ILLIAM (ADDON *R
4HE NEED FOR GOOD DATA AND A SCIENTIlC
APPROACH
$ATA ON THE INCIDENCE AND TYPES OF CRASHES AS WELL AS
A DETAILED UNDERSTANDING OF THE CIRCUMSTANCES THAT
LEAD TO CRASHES IS REQUIRED TO GUIDE SAFETY POLICY
+NOWLEDGE OF HOW INJURIES ARE CAUSED AND OF WHAT
TYPE THEY ARE IS A VALUABLE INSTRUMENT FOR IDENTIFY
ING INTERVENTIONS AND MONITORING THE EFFECTIVENESS
OF INTERVENTIONS (OWEVER IN MANY LOW
INCOME
AND MIDDLE INCOME COUNTRIES SYSTEMATIC EFFORTS
TO COLLECT ROAD TRAFlC DATA ARE NOT WELL DEVELOPED
AND UNDERREPORTING OF DEATHS AND SERIOUS INJURIES IS
COMMON 4HE HEALTH SECTOR HAS AN IMPORTANT ROLE TO
PLAY IN ESTABLISHING DATA SYSTEMS ON INJURIES AND THE
EFFECTIVENESS OF INTERVENTIONS AND THE COMMUNICA
TION OF THESE DATA TO A WIDER AUDIENCE
2OAD SAFETY AS A PUBLIC HEALTH ISSUE
4RADITIONALLY ROAD SAFETY HAS BEEN ASSUMED TO BE
THE RESPONSIBILITY OF THE TRANSPORT SECTOR )N THE EARLY
S MANY DEVELOPED COUNTRIES SET UP TRAFlC SAFE
TY AGENCIES USUALLY LOCATED WITHIN A GOVERNMENTS
TRANSPORT DEPARTMENT )N GENERAL HOWEVER THE PUB
LIC HEALTH SECTOR WAS SLOW TO BECOME INVOLVED
"UT ROAD TRAFlC INJURIES ARE INDEED A MAJOR PUB
LIC HEALTH ISSUE AND NOT JUST AN OFFSHOOT OF VEHICU
LAR MOBILITY 4HE HEALTH SECTOR WOULD GREATLY BEN
ElT FROM BETTER ROAD INJURY PREVENTION IN TERMS OF
FEWER HOSPITAL ADMISSIONS AND A REDUCED SEVERITY OF
INJURIES )T WOULD ALSO BE TO THE HEALTH SECTORS GAIN
IF n WITH SAFER CONDITIONS ON THE ROADS GUARANTEED
FOR PEDESTRIANS AND CYCLISTS n MORE PEOPLE WERE TO
ADOPT THE HEALTHIER LIFESTYLE OF WALKING OR CYCLING
WITHOUT FEARING FOR THEIR SAFETY
4HE PUBLIC HEALTH APPROACH TO ROAD TRAFlC INJURY
PREVENTION IS BASED ON SCIENCE )T DRAWS ON KNOWL
EDGE FROM MEDICINE BIOMECHANICS EPIDEMIOLOGY
SOCIOLOGY BEHAVIOURAL SCIENCE CRIMINOLOGY EDUCA
TION ECONOMICS ENGINEERING AND OTHER DISCIPLINES
7HILE THE HEALTH SECTOR IS ONLY ONE OF MANY BOD
IES INVOLVED IN ROAD SAFETY IT HAS IMPORTANT ROLES TO
PLAY 4HESE INCLUDE
s DISCOVERING THROUGH INJURY SURVEILLANCE AND
SURVEYS AS MUCH AS POSSIBLE ABOUT ALL ASPECTS
OF ROAD CRASH INJURY n BY SYSTEMATICALLY COLLECT
ING DATA ON THE MAGNITUDE SCOPE CHARACTERIS
TICS AND CONSEQUENCES OF ROAD TRAFlC CRASHES
s RESEARCHING THE CAUSES OF TRAFlC CRASHES AND IN
JURIES AND IN DOING SO TRYING TO DETERMINE
CAUSES AND CORRELATES OF ROAD CRASH INJURY
FACTORS THAT INCREASE OR DECREASE RISK
FACTORS THAT MIGHT BE MODIlABLE THROUGH
INTERVENTIONS
s EXPLORING WAYS TO PREVENT AND REDUCE THE SE
VERITY OF INJURIES IN ROAD CRASHES BY DESIGNING
s 7/2,$ 2%0/24 /. 2/!$ 42!&&)# ).*529 02%6%.4)/. 35--!29
IMPLEMENTING MONITORING AND EVALUATING AP
PROPRIATE INTERVENTIONS
s HELPING TO IMPLEMENT ACROSS A RANGE OF SETTINGS
INTERVENTIONS THAT APPEAR PROMISING ESPECIALLY
IN THE AREA OF HUMAN BEHAVIOUR DISSEMINATING
INFORMATION ON THE OUTCOMES AND EVALUATING
THE COST
EFFECTIVENESS OF THESE PROGRAMMES
s WORKING TO PERSUADE POLICY
MAKERS AND DE
CISION
MAKERS OF THE NECESSITY TO ADDRESS IN
JURIES IN GENERAL AS A MAJOR ISSUE AND OF THE
IMPORTANCE OF ADOPTING IMPROVED APPROACHES
TO ROAD TRAFlC SAFETY
s TRANSLATING EFFECTIVE SCIENCE
BASED INFORMATION
INTO POLICIES AND PRACTICES THAT PROTECT PEDES
TRIANS CYCLISTS AND THE OCCUPANTS OF VEHICLES
s PROMOTING CAPACITY BUILDING IN ALL THESE AREAS
PARTICULARLY IN THE GATHERING OF INFORMATION
AND IN RESEARCH
#ROSS
SECTORAL COLLABORATION IS ESSENTIAL HERE AND
THIS IS SOMETHING THE PUBLIC HEALTH SECTOR IS IN A
GOOD POSITION TO PROMOTE
2OAD SAFETY AS A SOCIAL EQUITY ISSUE
3TUDIES SHOW THAT MOTOR VEHICLE CRASHES HAVE A DIS
PROPORTIONATE IMPACT ON THE POOR AND VULNERABLE
IN SOCIETY 0OORER PEOPLE COMPRISE THE
MAJORITY OF CASUALTIES AND LACK ONGOING SUPPORT IN
THE EVENT OF LONG
TERM INJURY 4HEY ALSO HAVE LIM
ITED ACCESS TO POST
CRASH EMERGENCY CARE )N
ADDITION IN MANY DEVELOPING COUNTRIES THE COSTS
OF PROLONGED MEDICAL CARE THE LOSS OF THE FAMILY
BREAD WINNER THE COST OF A FUNERAL AND THE LOSS
OF INCOME DUE TO DISABILITY CAN PUSH FAMILIES INTO
POVERTY
! LARGE PROPORTION OF THE ROAD CRASH VICTIMS IN
LOW
INCOME AND MIDDLE
INCOME COUNTRIES ARE VUL
NERABLE ROAD USERS SUCH AS PEDESTRIANS AND CYCLISTS
4HEY BENElT LEAST FROM POLICIES DESIGNED FOR MO
TORIZED TRAVEL BUT BEAR A DISPROPORTIONATE SHARE OF
THE DISADVANTAGES OF MOTORIZATION IN TERMS OF IN
JURY POLLUTION AND THE SEPARATION OF COMMUNITIES
%QUAL PROTECTION FOR ALL ROAD USERS SHOULD BE A GUID
ING PRINCIPLE TO AVOID AN UNFAIR BURDEN OF INJURY AND
DEATH FOR POORER PEOPLE AND VULNERABLE ROAD USERS
4HIS ISSUE OF EQUITY IS A CENTRAL ONE FOR REDUCING
THE GLOBAL BURDEN OF ROAD CRASH DEATH AND INJURY
3YSTEMS THAT ACCOMMODATE HUMAN ERROR
4HE TRADITIONAL VIEW IN ROAD SAFETY HAS BEEN THAT
ROAD CRASHES ARE USUALLY THE SOLE RESPONSIBILITY OF IN
DIVIDUAL ROAD USERS DESPITE THE FACT THAT MANY OTHER
FACTORS BEYOND THEIR CONTROL MAY HAVE COME INTO
PLAY SUCH AS THE POOR DESIGN OF ROADS OR VEHICLES "UT
HUMAN ERROR DOES NOT ALWAYS LEAD TO DISASTROUS CON
SEQUENCES (UMAN BEHAVIOUR IS GOVERNED NOT ONLY
BY THE INDIVIDUALS KNOWLEDGE AND SKILLS BUT ALSO BY
THE ENVIRONMENT IN WHICH THE BEHAVIOUR TAKES PLACE
)NDIRECT INmUENCES SUCH AS THE DESIGN AND LAY
OUT OF THE ROAD THE NATURE OF THE VEHICLE AND TRAFlC
LAWS AND THEIR ENFORCEMENT AFFECT BEHAVIOUR IN IM
PORTANT WAYS &OR THIS REASON THE USE OF INFORMATION
AND PUBLICITY ON THEIR OWN IS GENERALLY UNSUCCESSFUL
IN REDUCING ROAD TRAFlC COLLISIONS n
3YSTEMS THAT ACCOUNT FOR THE VULNERABILITY
OF THE HUMAN BODY
4HE UNCERTAINTY OF HUMAN BEHAVIOUR IN A COMPLEX
TRAFlC ENVIRONMENT MEANS THAT IT IS UNREALISTIC TO EX
PECT THAT ALL CRASHES CAN BE PREVENTED (OWEVER IF
GREATER ATTENTION IN DESIGNING THE TRANSPORT SYSTEM
WERE GIVEN TO THE TOLERANCE OF THE HUMAN BODY TO IN
JURY THERE COULD BE SUBSTANTIAL BENElTS %XAMPLES IN
CLUDE REDUCING SPEED IN URBAN AREAS SEPARATING CARS
AND PEDESTRIANS BY PROVIDING PAVEMENTS IMPROVING
THE DESIGN OF CAR AND BUS FRONTS TO PROTECT PEDESTRI
ANS AND A WELL
DESIGNED AND CRASH
PROTECTIVE INTER
FACE BETWEEN THE ROAD INFRASTRUCTURE AND VEHICLES
4ECHNOLOGY TRANSFER FROM HIGH
INCOME
COUNTRIES
4RANSPORT SYSTEMS DEVELOPED IN HIGH
INCOME COUN
TRIES MAY NOT lT WELL WITH THE SAFETY NEEDS OF LOW
INCOME AND MIDDLE
INCOME COUNTRIES FOR A VARIETY
OF REASONS INCLUDING THE DIFFERENCES IN TRAFlC MIX
n )N LOW
INCOME COUNTRIES WALKING CY
CLING MOTORCYCLING AND THE USE OF PUBLIC TRANSPORT
ARE THE PREDOMINANT TRANSPORT MODES )N DEVELOPED
COUNTRIES CAR OWNERSHIP IS HIGH AND MOST ROAD US
ERS ARE VEHICLE OCCUPANTS
4ECHNOLOGY TRANSFER THEREFORE NEEDS TO BE AP
PROPRIATE FOR THE MIX OF DIFFERENT VEHICLE TYPES AND
THE PATTERNS OF ROAD USE 4HE PRIORITY IN DEVEL
OPING COUNTRIES THEREFORE SHOULD BE THE IMPORT AND
4(% &5.$!-%.4!,3 s
ADAPTATION OF PROVEN AND PROMISING METHODS FROM
DEVELOPED NATIONS AND A POOLING OF INFORMATION
AS TO THEIR EFFECTIVENESS AMONG OTHER LOW
INCOME
COUNTRIES
4HE NEW MODEL
'LOBALLY THERE IS A NEED TO IMPROVE THE SAFETY OF
THE TRAFlC SYSTEM FOR USERS AND TO REDUCE CURRENT
INEQUALITIES IN THE RISK OF INCURRING ROAD CRASH IN
JURIES
! SYSTEMS APPROACH
)N THE 5NITED 3TATES SOME YEARS AGO 7ILLIAM
(ADDON *R DESCRIBED ROAD TRANSPORT AS AN ILL
DESIGNED hMAN
MACHINEv SYSTEM NEEDING COMPRE
HENSIVE SYSTEMIC TREATMENT (E PRODUCED WHAT
IS NOW KNOWN AS THE (ADDON -ATRIX ILLUSTRATING
THE INTERACTION OF THREE FACTORS n HUMAN VEHICLE
AND ENVIRONMENT n DURING THREE PHASES OF A CRASH
EVENT PRE
CRASH CRASH AND POST
CRASH 4HE RESULT
ING NINE
CELL (ADDON MATRIX MODELS THE DYNAMIC
SYSTEM WITH EACH CELL OF THE MATRIX ALLOWING OP
PORTUNITIES FOR INTERVENTION TO REDUCE ROAD CRASH
INJURY SEE &IGURE 4HIS WORK LED TO SUBSTANTIAL
ADVANCES IN THE UNDERSTANDING OF THE BEHAVIOURAL
ROAD
RELATED AND VEHICLE
RELATED FACTORS THAT AF
FECT THE NUMBER AND SEVERITY OF CASUALTIES IN ROAD
TRAFlC
"UILDING ON (ADDONS INSIGHTS THE hSYSTEMSv
APPROACH SEEKS TO IDENTIFY AND RECTIFY THE MAJOR
SOURCES OF ERROR OR DESIGN WEAKNESS THAT CONTRIB
UTE TO FATAL AND SEVERE INJURY CRASHES AS WELL AS TO
MITIGATE THE SEVERITY AND CONSEQUENCES OF INJURY
BY
REDUCING EXPOSURE TO RISK
PREVENTING ROAD TRAFlC CRASHES FROM OCCUR
RING
REDUCING THE SEVERITY OF INJURY IN THE EVENT OF
A CRASH
REDUCING THE CONSEQUENCES OF INJURY THROUGH
IMPROVED POST COLLISION CARE
%VIDENCE FROM SOME HIGHLY MOTORIZED COUNTRIES
SHOWS THAT THIS INTEGRATED APPROACH TO ROAD SAFETY
PRODUCES A MARKED DECLINE IN ROAD DEATHS AND SERI
OUS INJURIES BUT THAT THE PRACTICAL REAL
IZATION OF THE SYSTEMS APPROACH REMAINS THE MOST
IMPORTANT CHALLENGE FOR ROAD SAFETY POLICY MAKERS
AND PROFESSIONALS
$EVELOPING INSTITUTIONAL CAPACITY
4HE DEVELOPMENT OF TRAFlC SAFETY POLICY INVOLVES A
WIDE RANGE OF PARTICIPANTS REPRESENTING A DIVERSE
GROUP OF INTERESTS SEE &IGURE 4HE STRUCTURE AND
MANAGEMENT SYSTEMS MAY VARY )N %UROPEAN 5NION
COUNTRIES FOR EXAMPLE NATIONAL GOVERNMENTS MAN
AGE MANY ASPECTS OF ROAD SAFETY BUT THE %UROPEAN
5NION REGULATES MOTOR VEHICLE SAFETY )N THE 5NITED
3TATES BOTH THE FEDERAL AND STATE GOVERNMENTS ARE
RESPONSIBLE FOR ROAD SAFETY
"OGOT THE CAPITAL OF #OLOMBIA HAS A POPULATION
OF MILLION AND PROVIDES AN EXCELLENT EXAMPLE OF
ROAD SAFETY MANAGEMENT .ATIONAL AND LOCAL AUTHORI
TIES UNIVERSITIES AND CITIZENS WORK TOGETHER ON MAN
AGING ROAD SAFETY AND HAVE ACHIEVED DRAMATIC RESULTS
&)'52%
4HE (ADDON -ATRIX
!
!
$ "
"
"""#!
"
"
% " !!
"
"
! & #"
"!
!" "!
!
# & $ "
# " !
! !" "!
"
# " !" "!
" !"&$!
! ""$!
! ""$ ! "!
!" !
!#!"
!"!
!!" !
! !!
!
!#"!
!"
s 7/2,$ 2%0/24 /. 2/!$ 42!&&)# ).*529 02%6%.4)/. 35--!29
&)'52%
0ARLIAMENTARY #OMMITTEES
)NFORMED AND COMMITTED POLITI
CIANS ARE ESSENTIAL TO ACHIEVING
GOVERNMENT
COMMITMENT TO ROAD
SAFETY SINCE THEY AUTHORIZE POLICIES
PROGRAMMES AND BUDGETS 4HEY ALSO
PLAY CENTRAL ROLES IN DEVELOPING ROAD
SAFETY LEGISLATION
4WO EXAMPLES OF THIS COMMIT
MENT INCLUDE
THE 0ARLIAMENTARY 3TANDING #OM
MITTEE ON 2OAD 3AFETY IN THE !USTRA
LIAN STATE OF .EW 3OUTH 7ALES WHICH
IN THE EARLY S WAS RESPONSIBLE
FOR THE INTRODUCTION AND FULL IMPLE
MENTATION OF RANDOM BREATH TESTING
WHICH LED TO A REDUCTION IN
DEATHS
THE 0ARLIAMENTARY !DVISORY
#OUNCIL FOR 4RANSPORT 3AFETY IN THE
5NITED +INGDOM WAS RESPONSIBLE
FOR THE INTRODUCTION OF LEGISLATION FOR
FRONT SEAT
BELT USE IN THE S
FOLLOWED SOME YEARS LATER BY THE
4HE ROLE OF GOVERNMENT
INTRODUCTION
OF SPEED HUMPS AND THE USE OF
(ISTORICALLY GOVERNMENTAL RESPONSIBILITIES FOR TRAF
REAR SEAT
BELTS
lC SAFETY FALL WITHIN THE TRANSPORT MINISTRY WITH
OTHER GOVERNMENT DEPARTMENTS SUCH AS POLICE JUS
TICE HEALTH PLANNING AND EDUCATION HAVING SOME 2ESEARCH
RESPONSIBILITY FOR KEY AREAS %XPERIENCE OF SEVERAL )MPARTIAL RESEARCH AND DEVELOPMENT ON ROAD SAFETY
IS AN ESSENTIAL ELEMENT OF ANY EFFECTIVE ROAD SAFETY
COUNTRIES INDICATES THAT EFFECTIVE STRATEGIES FOR RE
PROGRAMME
DUCING TRAFlC INJURY HAVE A GREATER CHANCE OF BE
)NDEPENDENT INSTITUTES THAT CONTRIBUTE TO UNDER
ING APPLIED IF THERE IS A SEPARATE GOVERNMENT AGENCY
WITH THE POWER AND BUDGET TO PLAN AND IMPLEMENT STANDING ROAD SAFETY ISSUES INCLUDE THE $UTCH )N
STITUTE FOR 2OAD 3AFETY 2ESEARCH 42, ,TD FORMERLY
ITS PROGRAMME 4WO EXAMPLES OF SUCH AGEN
CIES ARE THE 3WEDISH .ATIONAL 2OAD !DMINISTRATION KNOWN AS THE 4RANSPORT 2ESEARCH ,ABORATORY IN THE
3.2! AND THE 5NITED 3TATES .ATIONAL (IGHWAY 5NITED +INGDOM AND THE ROAD SAFETY RESEARCH UNITS
4RAFlC 3AFETY !DMINISTRATION .(43! !LTHOUGH AT UNIVERSITIES IN (ANOVER 'ERMANY AND !DELAIDE
AND -ELBOURNE !USTRALIA 4HE 5NITED 3TATES HAS
STAND
ALONE AGENCIES ARE LIKELY TO INCREASE THE PRI
ORITY GIVEN TO ROAD SAFETY THEY ARE NOT A SUBSTITUTE MANY INCLUDING THE .ORTH #AROLINA (IGHWAY 3AFETY
FOR STRONG POLITICAL SUPPORT AND ACTIONS FROM OTHER 2ESEARCH #ENTER THE 5NIVERSITY OF -ICHIGAN 4RANS
PORTATION 2ESEARCH )NSTITUTE AND THE .ATIONAL #ENTER
AGENCIES
)F THE ESTABLISHMENT OF A STAND
ALONE AGENCY IS FOR )NJURY 0REVENTION AND #ONTROL AT THE #ENTERS FOR
NOT POSSIBLE THEN AN ALTERNATIVE IS TO STRENGTHEN THE $ISEASE #ONTROL AND 0REVENTION
4HE 4RANSPORTATION 2ESEARCH AND )NJURY 0REVEN
EXISTING ROAD SAFETY UNIT GIVING IT GREATER POWERS
TION
0ROGRAMME AT THE )NSTITUTE OF 4ECHNOLOGY IN
RESPONSIBILITY AND AUTHORITY WITHIN THE GOVERNMENT
.EW $ELHI )NDIA AND THE #ENTRE FOR )NDUSTRIAL AND
TRANSPORT MINISTRY
4HE KEY ORGANIZATIONS INmUENCING POLICY DEVELOPMENT
4(% &5.$!-%.4!,3 s
3CIENTIlC 2ESEARCH AND $EVELOPMENT IN 3OUTH !F
RICA HAVE BOTH CONTRIBUTED TO IDENTIFYING INTERVEN
TIONS THAT CAN PROTECT VULNERABLE ROAD USERS WITH
SPECIAL ATTENTION TO INTERVENTIONS THAT LOW INCOME
AND MIDDLE INCOME COUNTRIES CAN AFFORD
4HE MOST PRACTICAL COURSE OF ACTION FOR LOW IN
COME AND MIDDLE INCOME COUNTRIES IS TO IMPORT AND
ADAPT PROVEN AND PROMISING ROAD SAFETY TECHNOLOGY
FROM OTHER COUNTRIES $OING THIS REQUIRES HAVING THE
CAPACITY TO CONDUCT RESEARCH INTO THEIR OWN ROAD
TRAFlC SYSTEMS AND TO IDENTIFY WHICH OF THE KNOWN
TECHNOLOGIES MAY BE APPROPRIATE AND WHAT ADAPTA
TIONS MAY BE NECESSARY )N ADDITION UNIQUE NATIONAL
AND LOCAL ROAD TRAFlC SITUATIONS ARE LIKELY TO REQUIRE
THE DEVELOPMENT OF NEW TECHNOLOGIES
)NVOLVEMENT OF INDUSTRY
)NDUSTRY SHARES RESPONSIBILITY FOR ROAD SAFETY BY DE
SIGNING AND SELLING VEHICLES AND OTHER PRODUCTS BY
USING ROAD TRAFlC SYSTEMS TO DELIVER ITS PRODUCTS AND
BY EMPLOYING PEOPLE WHO USE ROADS 2ECOGNIZING
THIS RESPONSIBILITY INDUSTRY HAS CONTRIBUTED TO IM
PROVING ROAD SAFETY &OR EXAMPLE &INLANDS INSUR
ERS FUND INVESTIGATES EVERY FATAL ROAD TRAFlC INJURY
IN THE COUNTRY AND PROVIDES THE RESULTING DATA TO THE
'OVERNMENT OF &INLAND AND OTHERS WITH AN INTER
EST IN ROAD SAFETY 4HE )NSURANCE )NSTITUTE FOR (IGH
WAY 3AFETY IN THE 5NITED 3TATES PROVIDES DATA ON THE
CRASH PERFORMANCE OF NEW CARS AND OTHER ROAD SAFE
TY ISSUES TO GOVERNMENT AGENCIES AND INDEPENDENT
RESEARCH INSTITUTES
.ONGOVERNMENTAL ORGANIZATIONS
.ONGOVERNMENTAL ORGANIZATIONS PROMOTE ROAD
SAFETY BY PUBLICIZING THE PROBLEM OF ROAD TRAFlC
INJURY IDENTIFYING EFFECTIVE SOLUTIONS CHALLENGING
INEFFECTIVE POLICIES AND FORMING COALITIONS TO LOBBY
FOR IMPROVED ROAD SAFETY
4HE 4RAUMA #OMMITTEE OF THE 2OYAL !USTRALASIAN
#OLLEGE OF 3URGEONS ADVOCATES THE BEST POSSIBLE
POST CRASH CARE FOR INJURED PEOPLE PROPER TRAINING
IN HANDLING TRAUMA CASES FOR HEALTH PROFESSIONALS
AND GATHERING AND REPORTING CLINICAL DATA TO EN
HANCE THE UNDERSTANDING OF INJURIES -OTHERS
!GAINST $RUNK $RIVING IN THE 5NITED 3TATES HAS SUC
CESSFULLY LOBBIED FOR THE ENACTMENT OF HUNDREDS OF
LAWS TO COMBAT DRIVING WHILE UNDER THE INmUENCE
OF ALCOHOL 4HE %UROPEAN 4RANSPORT 3AFETY #OUNCIL
A COALITION OF NONGOVERNMENTAL ORGANIZATIONS HAS
HAD REMARKABLE INmUENCE ON THE 2OAD 3AFETY AND
4ECHNOLOGY 5NIT OF THE %UROPEAN #OMMISSIONS
$IRECTORATE
'ENERAL FOR %NERGY AND 4RANSPORT AND
ON THE %UROPEAN 0ARLIAMENT
3OME NONGOVERNMENTAL ORGANIZATIONS IN LOW
INCOME AND MIDDLE
INCOME COUNTRIES HAVE
DIFlCULTY IN RAISING FUNDS FOR THEIR EFFORTS TO CAM
PAIGN FOR ROAD SAFETY (OWEVER SEVERAL AC
TIVE NONGOVERNMENTAL ORGANIZATIONS PROMOTE ROAD
SAFETY IN THESE COUNTRIES FOR EXAMPLE !SOCIACIN
&AMILIARES Y 6CTIMAS DE !CCIDENTES DEL 4RNSITO
;!SSOCIATION OF &AMILIES AND 6ICTIMS OF 4RAFlC
!CCIDENTS= !RGENTINA &RIENDS FOR ,IFE )NDIA
!SSOCIATION FOR 3AFE )NTERNATIONAL 2OAD 4RAVEL
+ENYA AND 4URKEY 9OUTH !SSOCIATION FOR 3O
CIAL !WARENESS ,EBANON AND $RIVE !LIVE 3OUTH
!FRICA
!CHIEVING BETTER PERFORMANCE
3HARING RESPONSIBILITY
2OAD SAFETY IS BEST ACHIEVED WHEN ALL THE KEY GROUPS
IDENTIlED EARLIER &IGURE SHARE A CULTURE OF ROAD
SAFETY
7HEN THERE IS A CULTURE OF ROAD SAFETY THE PRO
VIDERS AND ENFORCERS OF ROAD TRAFlC SYSTEMS VEHICLE
MANUFACTURERS ROAD TRAFlC PLANNERS ROAD SAFETY
ENGINEERS POLICE EDUCATORS HEALTH PROFESSION
ALS AND INSURERS TAKE RESPONSIBILITY FOR ENSURING
THAT THEIR PRODUCTS AND SERVICES MEET THE HIGHEST
POSSIBLE STANDARDS FOR ROAD SAFETY 2OAD USERS TAKE
RESPONSIBILITY BY COMPLYING WITH LAWS INFORMING
THEMSELVES ENGAGING IN SAFE ROAD BEHAVIOUR AND
ENGAGING IN DISCUSSION AND DEBATE ABOUT ROAD SAFETY
ISSUES WHETHER INDIVIDUALLY OR THROUGH NONGOVERN
MENTAL ORGANIZATIONS
2ESPONSIBILITY REQUIRES ACCOUNTABILITY AND THIS
NECESSITATES WAYS OF MEASURING PERFORMANCE OBJEC
TIVELY
)N 3WEDENS PARLIAMENT APPROVED 6ISION
:ERO A NEW ROAD SAFETY PROGRAMME IN WHICH THE
PROVIDERS ENFORCERS AND USERS OF 3WEDENS ROAD TRAF
lC SYSTEM WORK IN PARTNERSHIP SETTING TARGETS AND
OTHER PERFORMANCE STANDARDS 4HE ULTIMATE GOAL OF
s 7/2,$ 2%0/24 /. 2/!$ 42!&&)# ).*529 02%6%.4)/. 35--!29
6ISION :ERO IS A ROAD TRAFlC SYSTEM WITH ZERO FATALI
TIONS TO RANK THEM ACCORDING TO THE IMPACT THEY
TIES OR SEVERE INJURIES THROUGH ROAD CRASHES )T HAS ARE PROVEN TO HAVE ON THE INCIDENCE OF INJURY AND
PUBLIC HEALTH AS ITS UNDERLYING PREMISE
TO IMPLEMENT THE ONES THAT ARE MOST EFFECTIVE %ACH
6ISION :ERO HAS A LONG
TERM STRATEGY IN WHICH PROVIDER AND ENFORCER OF ROAD SAFETY CAN SET ITS OWN
ROAD SAFETY IS IMPROVED GRADUALLY UNTIL OVER TIME THE INTERNAL TARGETS AND MONITOR AND ASSESS ITS OWN PER
VISION IS ACHIEVED )T ADVOCATES SHARED RESPONSIBILITY FORMANCE
AND mEXIBILITY SO THAT THE ALLOCATION OF RESPONSIBIL
4O ACHIEVE TARGETS ROAD SAFETY PLANNERS NEED TO
ITY CAN CHANGE AS SCIENCE AND EXPERIENCE REVEAL THE CONCERN THEMSELVES WITH A WIDE VARIETY OF FACTORS
OPTIMUM ROLE FOR THE MOTOR VEHICLE INDUSTRY ROAD THAT INmUENCE SAFETY /NE FACTOR THEY HAVE
TRAFlC PLANNERS ROAD SAFETY ENGINEERS LAW ENFORCERS TO CONSIDER IS THAT THE OBJECTIVE OF ROAD SAFETY OF
HEALTH PROFESSIONALS EDUCATORS AND ROAD USERS
TEN CONmICTS WITH OTHER OBJECTIVES INCLUDING MO
&OR EXAMPLE IF THE INHERENT SAFETY OF MOTOR VE
BILITY AND ENVIRONMENTAL CONSERVATION 4HEY NEED
HICLES AND ROADS CAN NO LONGER BE IMPROVED MUCH TO IDENTIFY POSSIBLE BARRIERS TO IMPLEMENTING ROAD
MORE EMPHASIS MAY HAVE TO BE PLACED ON REDUCING SAFETY MEASURES AND DETERMINE HOW THESE BARRIERS
SPEED #ONVERSELY IF REDUCING SPEED ANY FURTHER IS MIGHT BE OVERCOME
NO LONGER ACCEPTABLE MORE EMPHASIS MAY HAVE TO
)N .EW :EALAND THE ROAD SAFETY PROGRAMME HAS
BE PLACED ON IMPROVING THE SAFETY OF VEHICLES AND FOUR LEVELS OF TARGET
ROADS
s 4HE OVERALL TARGET IS TO REDUCE THE SOCIAL AND
4HE $UTCH hSUSTAINABLE SAFETYv IS ANOTHER EXAM
ECONOMIC COSTS OF ROAD CRASHES AND INJURIES
PLE OF SHARED RESPONSIBILITY
,AUNCHED IN THIS STRATEGY
AIMS TO REDUCE ROAD TRAFlC DEATHS 4!",%
A
BY AND INJURIES BY BY %XAMPLES OF CURRENT FATALITY REDUCTION TARGETS IN USE
#OUNTRY OR AREA
"ASE YEAR 9EAR IN WHICH TARGET
4ARGET REDUCTION
THE YEAR
3ETTING TARGETS
3EVERAL STUDIES HAVE
SHOWN THAT SETTING TARGETS FOR RE
DUCING THE INCIDENCE OF ROAD TRAF
lC INJURY CAN IMPROVE ROAD SAFETY
PROGRAMMES BY MOTIVATING EVERY
ONE INVOLVED TO MAKE OPTIMAL USE
OF THEIR RESOURCES &URTHER AMBI
TIOUS LONG
TERM TARGETS ARE MORE
EFFECTIVE THAN MODEST SHORT
TERM
ONES 4ABLE
! PREREQUISITE FOR SETTING TAR
GETS IS GOOD BASELINE DATA ON ROAD
TRAFlC INJURY WHICH MEANS THAT AN
INJURY SURVEILLANCE SYSTEM OR SOME
OTHER MEANS OF PROVIDING FAIRLY
COMPLETE AND ACCURATE INFORMA
TION ON THE INCIDENCE OF ROAD TRAF
lC INJURY MUST BE IN PLACE
4ARGETS ENCOURAGE PEOPLE TO
IDENTIFY ALL POSSIBLE INTERVEN
FOR TARGET
IS TO BE REALIZED
!USTRALIA
IN THE NUMBER
OF ROAD TRAFlC FATALITIES
n
!USTRIA
n
n
#ANADA
n
n
n
$ENMARK
n
%UROPEAN 5NION
n
&INLAND
n
n
n
&RANCE
'REECE
n
n
)RELAND
n
n
n
-ALAYSIA
DEATHS VEHICLES
.ETHERLANDS
n
.EW :EALAND
n
n
)TALY
0OLAND
n
3AUDI !RABIA
n
3WEDEN
n
n
n
n
5NITED +INGDOM
5NITED 3TATES
)T SHOULD BE NOTED THAT SOME OF THESE TARGETS ALSO INCLUDE REDUCTIONS IN SERIOUS INJURY
AND ARE SUPPLEMENTED BY OTHER TARGETS EG TO REDUCE THE NUMBERS OF CASUALTIES AMONG
CHILDREN
A
3OURCES REFERENCES
4(% &5.$!-%.4!,3 s
s 4HE SECOND LEVEL OF TARGET REQUIRES SPECIlC RE
DUCTIONS IN THE NUMBERS OF ROAD TRAFlC FATALI
TIES AND SEVERE INJURIES
s 4HE THIRD LEVEL CONSISTS OF PERFORMANCE INDI
CATORS RELATED TO REDUCING SPEED REDUCING THE
INCIDENCE OF DRIVING WHILE UNDER THE INmUENCE
OF ALCOHOL AND INCREASING THE USE OF SEAT
BELTS
s 4HE FOURTH LEVEL IS CONCERNED WITH INSTITU
TIONAL OUTPUT INCLUDING THE NUMBER OF POLICE
PATROL HOURS AND THE KILOMETRES OF HIGH
RISK
CRASH SITES TREATED TO REDUCE RISK
"UILDING PARTNERSHIPS
4HE STATE OF 6ICTORIA !USTRALIA HAS DEVELOPED A PART
NERSHIP BETWEEN THOSE RESPONSIBLE FOR ROAD SAFETY
AND THOSE INVOLVED IN COMPENSATION FOR INJURY 4HE
4RANSPORT !CCIDENTS #OMMISSION COMPENSATES ROAD
CRASH SURVIVORS THROUGH A NO
FAULT INSURANCE SYSTEM
FUNDED BY PREMIUMS LEVIED AS PART OF ANNUAL VEHICLE
REGISTRATION CHARGES 4HE #OMMISSION INVESTS HEAVILY
IN IMPROVING ROAD SAFETY KNOWING THAT ITS INVESTMENT
WILL BE MORE THAN OFFSET BY SAVINGS IN THE COMPENSA
TION IT PAYS OUT 4HREE GOVERNMENT MINISTERS n RE
SPONSIBLE FOR TRANSPORT JUSTICE AND INSURANCE n JOINT
LY SET THE POLICY AND COORDINATE THE PROGRAMME
4HE PROVINCE OF +WA:ULU
.ATAL IN 3OUTH
!FRICA HAS TRANSFERRED AND ADAPTED THE 6ICTORIA STATE
MODEL
4HE 5NITED +INGDOM $EPARTMENT FOR 4RANSPORT
ENCOURAGES LOCAL PARTNERSHIPS IN WHICH THE DE
PARTMENT AND LOCAL AUTHORITIES POLICE COURTS AND
SOMETIMES HEALTH AUTHORITIES WORK TOGETHER ON
ENFORCING SPEED LIMITS AND RECOVERING THE COSTS OF
THIS /VER THE lRST TWO YEARS PILOT STUDIES LAUNCHED
IN HAVE REDUCED THE INCIDENCE OF ROAD CRASH
BY AND THE INCIDENCE OF FATAL AND SERIOUS IN
JURY TO PEDESTRIANS BY 4HE SAVINGS ON ADMIN
ISTERING SERVICES TO ROAD CRASH SURVIVORS HAVE FREED
UP ABOUT a MILLION TO BE INVESTED IN OTHER WAYS
4HE ECONOMIC BENElT TO SOCIETY IS ESTIMATED TO BE
ABOUT a MILLION
4HE .EW #AR !SSESSMENT 0ROGRAMME .#!0
WAS ESTABLISHED IN THE 5NITED 3TATES IN 5N
DER THE PROGRAMME MANUFACTURERS BUYERS AND
GOVERNMENT COOPERATE SUBJECTING NEW CAR MODELS
TO A RANGE OF CRASH TESTS AND RATING THEIR PERFOR
MANCE WITH A hSTARv SYSTEM 4HERE IS NOW AN !US
TRALIAN .#!0 AND A %UROPEAN ONE CALLED %URO.#!0
4HE PARTNERS IN %URO.#!0 INCLUDE NATIONAL TRANS
PORT DEPARTMENTS AUTOMOBILE CLUBS THE %UROPEAN
#OMMISSION AND ON BEHALF OF CAR BUYERS )NTERNA
TIONAL #ONSUMER 2ESEARCH AND 4ESTING )N %UROPE
RESEARCH HAS SHOWN THAT IN CAR TO CAR COLLI
SIONS CARS RATED WITH THREE OR FOUR STARS ARE ABOUT
SAFER THAN ONES WITH TWO STARS OR FEWER
%UROPEAN AUTOMOBILE CLUBS ARE NOW WORKING
ON DEVELOPING STAR RATING SYSTEMS FOR ROADS SO THAT
ROAD BUILDERS LIKE CAR MANUFACTURERS ARE ENCOUR
AGED TO IMPROVE THE SAFETY OF THEIR PRODUCTS
4HE GLOBAL IMPACT
'LOBAL REGIONAL AND COUNTRY
ESTIMATES
,ONG BEFORE CARS WERE INVENTED ROAD TRAFlC INJURIES
OCCURRED INVOLVING CARRIAGES CARTS ANIMALS AND
PEOPLE 4HE NUMBERS GREW EXPONENTIALLY AS CARS
BUSES TRUCKS AND OTHER MOTOR VEHICLES WERE
INTRODUCED AND BECAME EVER MORE COMMON !
CYCLIST IN .EW 9ORK #ITY WAS THE lRST RECORDED
CASE OF INJURY INVOLVING A MOTOR VEHICLE ON
-AY AND A ,ONDON PEDESTRIAN WAS THE lRST
RECORDED MOTOR VEHICLE DEATH ON !UGUST OF THE
SAME YEAR 4HE CUMULATIVE TOTAL OF ROAD TRAFlC
DEATHS HAD REACHED AN ESTIMATED MILLION BY
)N AN ESTIMATED MILLION PEOPLE DIED
FROM ROAD TRAFlC CRASHES AN AVERAGE OF DEATHS
PER DAY 2OAD TRAFlC INJURIES ACCOUNTED FOR OF
ALL GLOBAL DEATHS MAKING THEM THE ELEVENTH LEADING
CAUSE OF GLOBAL DEATHS
)N ADDITION TO DEATHS AN ESTIMATED MILLION TO
MILLION PEOPLE ARE INJURED IN ROAD CRASHES EACH
YEAR )N AN ESTIMATED MILLION
$!,9S WERE LOST BECAUSE OF ROAD CRASHES OR
OF ALL $!,9S LOST 4HIS MADE ROAD TRAFlC INJURIES THE
&)'52%
2OAD TRAFlC INJURY MORTALITY RATES PER POPULATION IN 7(/ REGIONS
3OURCE 7(/ 'LOBAL "URDEN OF $ISEASE PROJECT 6ERSION
s 7/2,$ 2%0/24 /. 2/!$ 42!&&)# ).*529 02%6%.4)/. 35--!29
4!",%
0REDICTED ROAD TRAFlC FATALITIES BY REGION IN THOUSANDS ADJUSTED FOR UNDERREPORTING n
.UMBER OF
COUNTRIES
#HANGE
n
%AST !SIA AND 0ACIlC
%AST %UROPE AND #ENTRAL !SIA
,ATIN !MERICA AND #ARIBBEAN
-IDDLE %AST AND .ORTH !FRICA
3OUTH !SIA
3UB 3AHARAN !FRICA
3UB TOTAL
(IGH INCOME COUNTRIES
n
4OTAL
2EGIONA
&ATALITY RATE DEATHS
PERSONS
$ATA ARE DISPLAYED ACCORDING TO THE REGIONAL CLASSIlCATIONS OF THE 7ORLD "ANK
3OURCE REPRODUCED FROM REFERENCE WITH MINOR AMENDMENTS WITH THE PERMISSION OF THE AUTHORS
NINTH LEADING CONTRIBUTOR TO THE GLOBAL BURDEN OF
DISEASE AND INJURY
4HE RATES OF ROAD TRAFlC DEATH VARY CONSIDERABLY
BETWEEN REGIONS AND BETWEEN COUNTRIES WITHIN
REGIONS &IGURE )N GENERAL RATES ARE HIGHER IN
LOW INCOME AND MIDDLE INCOME COUNTRIES THAN IN
HIGH INCOME COUNTRIES !LTOGETHER LOW INCOME AND
MIDDLE INCOME COUNTRIES ACCOUNTED FOR OF ALL
ROAD TRAFlC DEATHS IN
'LOBAL REGIONAL AND COUNTRY
TRENDS
2OAD TRAFlC DEATH RATES HAVE DECREASED IN HIGH
INCOME COUNTRIES SINCE THE S AND S AL
THOUGH COUNTRIES RATES VARY GREATLY EVEN WITHIN
THE SAME REGION &OR EXAMPLE IN .ORTH !MERICA
FROM TO THE ROAD TRAFlC FATALITY RATE PER
POPULATION DECLINED BY IN THE 5NITED
3TATES BUT BY IN #ANADA
-EANWHILE RATES IN LOW
INCOME AND MIDDLE
INCOME COUNTRIES HAVE INCREASED SUBSTANTIALLY
!GAIN COUNTRIES VARY WIDELY )N !SIA FROM
TO ROAD TRAFlC FATALITY RATES ROSE BY
IN -ALAYSIA BUT BY IN #HINA
4WO MAJOR STUDIES PREDICT THAT THE TREND TOWARDS
INCREASE IN LOW
INCOME AND MIDDLE
INCOME COUN
TRIES WILL CONTINUE UNLESS DELIBERATE ACTION CHANGES
IT !S A RESULT THE ANNUAL NUMBERS OF ROAD TRAFlC
DEATHS GLOBALLY WILL RISE SHARPLY OVER THE NEXT TWO
DECADES
4HE lRST STUDY THE 7(/ 'LOBAL "URDEN OF $IS
EASE STUDY PREDICTS THE FOLLOWING CHANGES FROM
TO
s 2OAD TRAFlC INJURIES WILL RISE IN RANK TO SIXTH
PLACE AS A MAJOR CAUSE OF DEATH WORLDWIDE
s 2OAD TRAFlC INJURIES WILL RISE TO BECOME THE
THIRD LEADING CAUSE OF $!,9S LOST
s 2OAD TRAFlC INJURIES WILL BECOME THE SECOND
LEADING CAUSE OF $!,9S LOST FOR LOW
INCOME
AND MIDDLE
INCOME COUNTRIES
s 2OAD TRAFlC DEATHS WILL INCREASE WORLDWIDE
FROM MILLION TO MILLION REPRESENT
ING OF ALL DEATHS
s 2OAD TRAFlC DEATHS WILL INCREASE ON AVERAGE BY
OVER IN LOW
INCOME AND MIDDLE
INCOME
COUNTRIES AND DECLINE BY ALMOST IN HIGH
INCOME COUNTRIES
s $!,9S LOST WILL INCREASE WORLDWIDE FROM
MILLION TO MILLION REPRESENTING OF
THE GLOBAL BURDEN OF DISEASE
4ABLE SHOWS THE RESULTS OF THE SECOND STUDY A
7ORLD "ANK STUDY ON TRAFlC FATALITIES AND ECONOMIC
GROWTH )N HIGH
INCOME COUNTRIES THE AN
NUAL NUMBER OF ROAD TRAFlC DEATHS IS PROJECTED TO
DECREASE BY FROM TO )N THE SIX
REGIONS WHERE LOW
INCOME AND MIDDLE
INCOME
COUNTRIES ARE CONCENTRATED THE ANNUAL NUMBER OF
ROAD TRAFlC DEATHS IS PROJECTED TO INCREASE BY
4HE PROJECTED PERCENTAGE INCREASES FROM TO
ARE VERY SIMILAR IN THESE TWO STUDIES
4(% ',/"!, )-0!#4 s
0ROlLE OF THE PEOPLE
AFFECTED BY ROAD
TRAFlC INJURIES
&)'52%
2OAD USERS KILLED IN VARIOUS MODES OF TRANSPORT AS A PROPORTION OF ALL
ROAD TRAFlC DEATHS
&IGURE SHOWS THE DISTRIBUTION
.,-+ &$
OF ROAD TRAFlC DEATHS BY TYPE OF
ROAD USER IN SELECTED COUNTRIES
&#$( $
0EDESTRIANS CYCLISTS AND MOPED
AND MOTORCYCLE RIDERS ARE THE ( .("( )( ,$
MOST VULNERABLE ROAD USERS
* (
)N LOW INCOME AND MIDDLE IN
& 0,$
COME COUNTRIES THEY ACCOUNT FOR
LARGE PORTIONS OF ROAD TRAFlC AND
-# +& ( ,
MOST ROAD TRAFlC DEATHS
)N HIGH INCOME COUNTRIES CAR
)+/ 0
OWNERS AND DRIVERS ACCOUNT FOR A
LARGE MAJORITY OF ROAD USERS AND )&)' )+$ (%
THE MAJORITY OF ROAD TRAFlC DEATHS
# $& (
.EVERTHELESS EVEN THERE PEDES
TRIANS CYCLISTS AND MOPED AND
MOTORCYCLE RIDERS HAVE A MUCH
HIGHER RISK OF DEATH PER KILOMETRE
+ (- "
TRAVELLED
,-+$ (,
0 &$,-,
)-)+$1 -/)/# & +,
)-)+$1 !).+/# & +,
-# +
&IGURE SHOWS THE DISTRIBUTION
3OURCE REFERENCE
OF GLOBAL ROAD TRAFlC DEATHS BY SEX
)N PEOPLE AGED n YEARS ACCOUNTED
AND AGE )N ALL AGE GROUPS MALES
ACCOUNT FOR MORE DEATHS THAN FEMALES )N THE FOR MORE THAN HALF OF ALL ROAD TRAFlC DEATHS GLOBALLY
ROAD TRAFlC DEATH RATES WERE PER MALES 4HEY ALSO ACCOUNTED FOR ABOUT OF ALL $!,9S
AND PER FEMALES -ALES ACCOUNTED FOR LOST BECAUSE OF ROAD TRAFlC INJURY )N HIGH
OF DEATHS AND OF ALL $!,9S LOST BECAUSE OF INCOME COUNTRIES PEOPLE AGED n YEARS HAD THE
HIGHEST DEATH RATES PER POPULATION BUT IN
ROAD TRAFlC INJURY
LOW
INCOME AND MIDDLE
INCOME COUNTRIES PEOPLE
YEARS AND OLDER HAD THE HIGHEST RATES )N LOW
&)'52%
INCOME AND MIDDLE
INCOME COUNTRIES CHILDREN
2OAD TRAFlC DEATHS BY SEX AND AGE GROUP WORLD
HAVE MUCH HIGHER RATES OF ROAD TRAFlC DEATH THAN IN
HIGH
INCOME COUNTRIES
)N PEOPLE YEARS AND OLDER ACCOUNTED FOR
MORE THAN ROAD TRAFlC DEATHS 4HEIR DEATH
RATES PER POPULATION WERE THE HIGHEST OF ALL
AGE CATEGORIES IN LOW
INCOME AND MIDDLE
INCOME
COUNTRIES 7HEN INVOLVED IN A MOTOR VEHICLE CRASH
ELDERLY PEOPLE ARE MORE LIKELY TO BE KILLED OR SERI
OUSLY DISABLED THAN YOUNGER PEOPLE BECAUSE THEY
ARE GENERALLY LESS RESILIENT
5NITED .ATIONS POPULATION PROJECTIONS INDICATE
THAT PEOPLE YEARS AND OLDER WILL ACCOUNT FOR
EVER
GREATER PORTIONS OF ALL COUNTRIES POPULATIONS
3OURCE 7(/ 'LOBAL "URDEN OF $ISEASE PROJECT 6ERSION
s 7/2,$ 2%0/24 /. 2/!$ 42!&&)# ).*529 02%6%.4)/. 35--!29
OVER THE NEXT YEARS 4HE VULNERABILITY OF ELDERLY
PEOPLE TO ROAD TRAFlC DEATH AND SERIOUS INJURY WILL
BE OF INCREASING CONCERN GLOBALLY
3OCIOECONOMIC STATUS AND LOCATION
3EVERAL STUDIES n HAVE SHOWN THAT PEOPLE
FROM LESS
PRIVILEGED SOCIOECONOMIC GROUPS ARE AT
GREATER RISK OF INJURY FROM ALL CAUSES INCLUDING ROAD
CRASHES )N THE CASE OF ROAD CRASHES THE EXPLANATION
MAY LIE IN THEIR GREATER EXPOSURE TO RISK !
STUDY IN +ENYA FOR EXAMPLE FOUND THAT
OF COMMUTERS WITH NO FORMAL EDUCATION TRAVELLED
ON FOOT USED BUSES OR MINIBUSES AND ONLY
USED PRIVATE CARS "Y CONTRAST OF PEOPLE WITH
A SECONDARY
LEVEL EDUCATION TRAVELLED IN PRIVATE CARS
USED BUSES AND NONE WALKED
7HERE PEOPLE LIVE CAN ALSO INmUENCE THEIR EX
POSURE TO ROAD TRAFlC RISK )N GENERAL PEOPLE LIVING
IN URBAN AREAS ARE AT GREATER RISK OF BEING INVOLVED
IN ROAD CRASHES BUT PEOPLE LIVING IN RURAL AREAS ARE
MORE LIKELY TO BE KILLED OR SERIOUSLY INJURED IF THEY
ARE INVOLVED IN CRASHES /NE REASON IS THAT MOTOR
VEHICLES TEND TO TRAVEL FASTER IN RURAL AREAS )N MANY
LOW
INCOME AND MIDDLE
INCOME COUNTRIES MANY
PEOPLE ARE EXPOSED TO NEW RISKS WHEN NEW HIGH
WAYS ARE BUILT THROUGH THEIR COMMUNITIES
/THER HEALTH SOCIAL AND ECONOMIC
COSTS
%STIMATING THE COSTS OF ROAD CRASHES AND INJURIES CAN
HELP COUNTRIES TO UNDERSTAND THE SERIOUSNESS OF THE
PROBLEM OF ROAD CRASHES AND INJURIES AND TO UNDER
STAND THE BENElTS OF INVESTING IN MEASURES TO PRE
VENT ROAD CRASHES AND INJURIES !N ASSESSMENT SHOULD
TAKE INTO ACCOUNT BOTH THE DIRECT AND INDIRECT COSTS
!T MINIMUM THE DIRECT COSTS SHOULD INCLUDE THOSE
OF PROVIDING HEALTH CARE AND REHABILITATION AND
THE INDIRECT COSTS SHOULD INCLUDE THE VALUE OF LOST
HOUSEHOLD SERVICES AND LOST EARNINGS FOR SURVIVORS
CAREGIVERS AND FAMILIES
-ANY HIGH
INCOME COUNTRIES PRODUCE ANNUAL ES
TIMATES OF THE COSTS OF ROAD CRASHES AND INJURIES THAT
TAKE INTO ACCOUNT LOST EARNINGS HEALTH CARE COSTS AND
THE COSTS OF PROPERTY DAMAGE ADMINISTRATION SUCH
AS THE COSTS OF POLICE COURTS AND INSURANCE COMPA
NIES AND TRAVEL DELAYS (EALTH CARE AND REHABILITA
TION COSTS CAN BE PROHIBITIVELY EXPENSIVE IN CASES OF
SERIOUS INJURY &URTHER LITTLE EFFORT IS USUALLY MADE
TO ATTACH A COST TO PSYCHOLOGICAL STRESS AND SUFFERING
EXPERIENCED BY SURVIVORS AND THEIR FAMILIES
%STIMATING THE COSTS IN LOW
INCOME AND MIDDLE
INCOME COUNTRIES IS MORE DIFlCULT BECAUSE GOOD
DATA ON ROAD CRASHES AND INJURIES ARE LACKING .EVER
THELESS A SURVEY OF THE LITERATURE YIELDED A FEW STUD
IES THAT SHED LIGHT ON THE COSTS OF ROAD CRASHES AND
INJURIES FOR THESE COUNTRIES
(EALTH AND SOCIAL COSTS
$ATA FROM THE 7(/ 'LOBAL "URDEN OF $ISEASE STUDY
IN SHOW THAT OF THOSE INJURED SEVERELY ENOUGH
TO REQUIRE ATTENTION FROM A HEALTH FACILITY ALMOST
ONE QUARTER HAD TRAUMATIC BRAIN INJURY AND ONE
TENTH HAD OPEN WOUNDS &RACTURED BONES ACCOUNTED
FOR MOST OTHER INJURIES 3TUDIES SHOW THAT ROAD TRAF
lC CRASHES ARE THE LEADING CAUSE OF TRAUMATIC BRAIN
INJURY IN BOTH HIGH
INCOME AND LOW
INCOME AND
MIDDLE
INCOME COUNTRIES n
! COMPREHENSIVE SURVEY OF NUMEROUS STUDIES
FOUND THAT ROAD TRAFlC INJURIES ACCOUNTED FOR n
OF TRAUMA ADMISSIONS IN SOME LOW
INCOME AND MID
DLE
INCOME COUNTRIES 4HE MEAN LENGTH OF HOSPITAL
STAY REPORTED IN STUDIES FOR INPATIENTS WITH ROAD
TRAFlC INJURIES WAS DAYS 0EOPLE WITH ROAD TRAFlC
INJURIES ACCOUNTED FOR n OF ALL INJURY
RELATED
ATTENDEES AND OF BED OCCUPANCY IN SURGICAL
WARDS AND WERE THE MOST FREQUENT USERS OF OPERATING
THEATRES AND INTENSIVE CARE UNITS 4HE INCREASED WORK
LOAD IN RADIOLOGY DEPARTMENTS AND INCREASED DEMAND
FOR PHYSIOTHERAPY AND REHABILITATION SERVICES WERE
LARGELY ATTRIBUTED TO ROAD TRAFlC INJURIES
-ANY LOW
INCOME AND MIDDLE
INCOME COUN
TRIES CANNOT PROVIDE ALL THE HEALTH CARE SERVICES THAT
PEOPLE SUSTAINING ROAD TRAFlC INJURIES WOULD GET IN
HIGH
INCOME COUNTRIES ! RECENT STUDY IN +ENYA FOR
EXAMPLE FOUND THAT ONLY OF ALL HEALTH FACILITIES
COULD HANDLE MORE THAN INJURED PEOPLE AT A TIME
4HE LEAST
PREPARED FACILITIES WERE THE PUBLIC HEALTH
UNITS MOST FREQUENTLY USED BY POOR PEOPLE -ANY OF
THESE LACKED ESSENTIAL EQUIPMENT AND SUPPLIES FOR
HANDLING TRAUMA CASES INCLUDING OXYGEN PLASTER OF
0ARIS BLOOD DRESSINGS ANTISEPTICS LOCAL AND GENERAL
ANAESTHETICS AND BLOOD PRESSURE MACHINES -ISSION
4(% ',/"!, )-0!#4 s
AND PRIVATE HOSPITALS ON THE OTHER HAND USUALLY PLACE )N ADDITION A FOLLOW
UP STUDY FOUND
HAD ALL THESE
THAT ROAD TRAFlC SURVIVORS AND THEIR FAMILIES WERE
! RECENT STUDY FOUND THAT PEOPLE SUSTAINED DISSATISlED WITH CRIMINAL PROCEEDINGS INSURANCE
MILLION NONFATAL INJURIES IN IN THE 5NIT
AND CIVIL CLAIMS AND THE INFORMATION AND SUPPORT
ED 3TATES AS A RESULT OF ROAD CRASHES WITH OF THEY HAD RECEIVED TO HELP THEM COPE
THE INJURIES CONSIDERED MINOR 4HE COST OF TREATING
)N ALL COUNTRIES THE LOSS OF INCOME EARNERS AND
ALL THESE INJURIES WAS 53 BILLION PLACING A THE COSTS OF FUNERALS AND PROLONGED CARE FOR DISABLED
TREMENDOUS BURDEN ON PUBLIC HEALTH CARE SERVICES PEOPLE CAN PUSH FAMILIES INTO POVERTY #HILDREN ARE
AND THE lNANCES OF ROAD TRAFlC CASUALTIES AND THEIR OFTEN HARDEST HIT )N -EXICO THE LOSS OF PARENTS IN
FAMILIES 4HE SERIOUS INJURIES INCLUDING BRAIN AND ROAD TRAFlC CRASHES IS THE SECOND LEADING CAUSE OF
SPINAL CORD INJURIES COST AN AVERAGE OF 53 CHILDREN BECOMING ORPHANED
PER INJURY
2EGARDLESS OF THE COSTS OF HEALTH CARE AND REHA
%CONOMIC COSTS
BILITATION INJURED PEOPLE BEAR ADDITIONAL COSTS 0ER
#OST TO COUNTRIES
MANENT DISABILITY SUCH AS PARAPLEGIA QUADRIPLEGIA 4HE 4RANSPORT 2ESEARCH ,ABORATORY NOW 42, ,TD
LOSS OF EYESIGHT OR BRAIN DAMAGE CAN DEPRIVE AN IN
EXAMINED DATA ON ROAD TRAFlC INJURIES FROM LOW
DIVIDUAL OF THE ABILITY TO ACHIEVE EVEN MINOR GOALS MIDDLE AND HIGH
INCOME COUNTRIES AND PRODUCED
AND CAN RESULT IN DEPENDENCE ON OTHERS FOR lNANCIAL CRUDE ESTIMATES THAT ROAD TRAFlC INJURIES COST LOW
IN
SUPPORT AND ROUTINE PHYSICAL CARE ,ESS SERIOUS IN
COME COUNTRIES AN AVERAGE OF OF THEIR GROSS NA
JURIES CAN RESULT IN CHRONIC PHYSICAL PAIN AND LIMIT TIONAL PRODUCT '.0 VERSUS FOR MIDDLE
INCOME
THE INJURED PERSONS PHYSICAL ACTIVITY FOR LENGTHY PE
COUNTRIES AND FOR HIGH
INCOME COUNTRIES
RIODS 3ERIOUS BURNS CONTUSIONS OR LACERATIONS CAN
!PPLYING THESE AVERAGES TO '.0 IN 42,
LEAD TO EMOTIONAL TRAUMA ASSOCIATED WITH PERMA
,TD ESTIMATED THAT ROAD TRAFlC INJURIES COST 53
NENT DISlGUREMENT
BILLION GLOBALLY AND THAT HIGH
INCOME COUN
)N THE %UROPEAN 5NION EVERY YEAR MORE THAN TRIES ACCOUNTED FOR 53 BILLION OF THIS ,OW
IN
PEOPLE ARE KILLED AND MORE THAN COME AND MIDDLE
INCOME COUNTRIES ACCOUNTED FOR
ARE DISABLED FOR LIFE BY ROAD CRASHES .EARLY 53 BILLION OF THIS MORE THAN THEY RECEIVED IN
FAMILIES ARE NEWLY BEREAVED OR LEFT WITH DISABLED DEVELOPMENT ASSISTANCE 4ABLE 42, ,TD EMPHA
FAMILY MEMBERS #OPING WITH A DISABLED FAM
SIZED THAT THE ESTIMATES WERE CRUDE AND THAT COUN
ILY MEMBER OFTEN REQUIRES THAT AT LEAST ONE FAMILY TRIES VARIED WIDELY &OR EXAMPLE EVIDENCE SUGGESTED
MEMBER TAKE TIME AWAY FROM OTHER
ACTIVITIES INCLUDING EMPLOYMENT 4!",%
SO THAT FAMILIES LOSE INCOME 2OAD CRASH COSTS BY REGION
! STUDY FOUND THAT OF 2EGIONA
'.0
%STIMATED ANNUAL CRASH COSTS
53 BILLION
THE FAMILIES OF PEOPLE DYING FROM
!S PERCENTAGE
#OSTS
OF '.0
53 BILLION
ROAD TRAFlC CRASHES AND OF
THE FAMILIES OF DISABLED ROAD TRAF
!FRICA
!SIA
lC SURVIVORS REPORTED A SIGNIlCANT
,ATIN !MERICA AND #ARIBBEAN
DECLINE IN THEIR QUALITY OF LIFE -IDDLE %AST
-ANY SURVIVORS AND MEMBERS OF #ENTRAL AND EASTERN %UROPE
THEIR FAMILIES SUFFERED FROM HEAD
3UBTOTAL
ACHES SLEEPING PROBLEMS GENERAL (IGHLY MOTORIZED COUNTRIESB
HEALTH PROBLEMS AND NIGHTMARES 4OTAL
AND REPORTED NO SIGNIlCANT IM
A $ATA ARE DISPLAYED ACCORDING TO THE REGIONAL CLASSIlCATIONS OF THE 42, ,TD 5NITED +INGDOM
PROVEMENT IN THESE CONDITIONS B !USTRALIA *APAN .EW :EALAND .ORTH !MERICA AND THE WESTERN %UROPEAN COUNTRIES
THREE YEARS AFTER CRASHES HAD TAKEN 3OURCE REPRODUCED FROM REFERENCE WITH THE PERMISSION OF THE AUTHOR
s 7/2,$ 2%0/24 /. 2/!$ 42!&&)# ).*529 02%6%.4)/. 35--!29
THAT THE COSTS WERE OF '.0 IN 6IET .AM BUT
ALMOST OF '.0 IN -ALAWI
/THER STUDIES FOCUSING ON PARTICULAR REGIONS OR
COUNTRIES HAVE PRODUCED ESTIMATES AS FOLLOWS
s 2OAD TRAFlC INJURIES COST %UROPEAN 5NION
COUNTRIES _ BILLION ANNUALLY TWICE THE AN
NUAL BUDGET FOR ALL ACTIVITIES IN THESE COUNTRIES
s 4HE COST IN THE 5NITED 3TATES IS 53 BIL
LION ANNUALLY OR OF '.0
s 6ARIOUS STUDIES DONE IN THE S PRODUCED
ESTIMATES OF OF GROSS DOMESTIC PRODUCT
'$0 IN THE 5NITED +INGDOM IN 3WE
DEN IN )TALY AND AN AVERAGE OF OF
'$0 IN HIGH
INCOME COUNTRIES
s )N ROAD TRAFlC INJURIES COST "ANGLADESH
53 MILLION OF '.0
s )N THEY COST 3OUTH !FRICA 53 BILLION
s )N 5GANDA ROAD CRASHES INJURIES AND FATALITIES
COST 53 MILLION PER YEAR OR OF '.0
s )N EASTERN %UROPE IN ROAD TRAFlC IN
JURIES COST %STONIA 53 MILLION TO
53 MILLION ,ATVIA 53 MILLION TO
53 MILLION AND ,ITHUANIA 53
MILLION TO 53 MILLION
s )N #HINA IN ROAD TRAFlC INJURIES CAUSED
THE LOSS OF MILLION POTENTIALLY PRODUCTIVE
LIFE YEARS WITH AN ESTIMATED VALUE OF 53
BILLION ALMOST FOUR TIMES THE COUNTRYS ANNUAL
HEALTH BUDGET
#OST TO FAMILIES
!S DISCUSSED EARLIER PEOPLE n YEARS OLD AC
COUNT FOR MORE THAN HALF OF ALL ROAD TRAFlC DEATHS
AND OF THE PEOPLE KILLED ARE MALE 0EOPLE OF
THAT AGE ARE IN THEIR MOST PRODUCTIVE EARNING YEARS
SO THEIR FAMILIES SUFFER lNANCIALLY WHEN THEY ARE
KILLED OR DISABLED ! RECENT STUDY IN "ANGLADESH
FOUND THAT OF ROAD TRAFlC DEATHS OC
CURRED TO HOUSEHOLD HEADS AMONG NON POOR PEO
PLE VERSUS AMONG POOR PEOPLE 4HREE QUARTERS
OF ALL POOR FAMILIES WHO HAD LOST A MEMBER TO ROAD
TRAFlC DEATH REPORTED A DECREASE IN THEIR STANDARD
OF LIVING AND REPORTED THAT THEY HAD HAD TO
BORROW MONEY TO COVER EXPENSES FOLLOWING THEIR
LOSS
&AMILIES WHO LOSE THE EARNING CAPACITY OF MEM
BERS DISABLED BY ROAD TRAFlC INJURIES AND WHO ARE
BURDENED WITH THE ADDED COST OF CARING FOR THESE
MEMBERS MAY END UP SELLING MOST OF THEIR ASSETS
AND GETTING TRAPPED IN LONG
TERM INDEBTEDNESS
.EED FOR RELIABLE INFORMATION
/NLY COUNTRIES REPORT ANNUAL DATA ON ROAD TRAFlC
INJURIES 4HE OTHERS HAVE NO NATIONAL HEALTH INFOR
MATION SYSTEMS THAT CAN PRODUCE SUCH DATA
-ANY OF THE GLOBAL ESTIMATES GIVEN HERE ARE DE
RIVED FROM THE 7(/ -ORTALITY $ATABASE THE 7(/
'LOBAL "URDEN OF $ISEASE VERSION DATABASE FOR
THE 42, ,TD DATA AND A 7ORLD "ANK STUDY
ON TRAFlC FATALITIES AND ECONOMIC GROWTH 4HE
7(/ -ORTALITY $ATABASE lLLED IN GAPS BY PRODUC
ING COUNTRY ESTIMATES BASED ON SMALL SAMPLES 4HE
7(/ 'LOBAL "URDEN OF $ISEASE PROJECT PRODUCED
ESTIMATES FOR BY PROJECTING ESTIMATES
4HE 42, ,TD AND 7ORLD "ANK DATA RELIED ON POLICE
REPORTS AND ADJUSTED FOR LACK OF SUCH REPORTS FROM
SOME COUNTRIES AND FOR DIFFERENCES IN DElNITIONS
USED IN THE AVAILABLE REPORTS 4HIS MEANS THAT THE
ESTIMATES FROM THESE SOURCES SHOULD BE CONSIDERED
APPROXIMATE OR INDICATIVE EVEN THOUGH THEY MAY
BE THE BEST AVAILABLE /THER STUDIES MENTIONED IN
THE PREVIOUS DISCUSSION OFTEN USED SIMILAR MEANS
FOR PRODUCING THEIR ESTIMATES AND PROJECTIONS
!CCURATE DATA ARE ESSENTIAL FOR PRIORITIZING PUB
LIC HEALTH ISSUES MONITORING TRENDS AND ASSESSING
INTERVENTION PROGRAMMES -ANY COUNTRIES HAVE IN
ADEQUATE INFORMATION SYSTEMS ON ROAD TRAFlC INJURY
MAKING IT DIFlCULT TO REALIZE THE FULL NATURE OF THE
PROBLEM AND THUS GAIN THE ATTENTION THAT IS REQUIRED
FROM POLICY
MAKERS AND DECISION
MAKERS 4HERE ARE
A NUMBER OF AREAS WHERE ROAD TRAFlC INJURY DATA ARE
OFTEN PROBLEMATIC AND THESE INCLUDE
SOURCES OF DATA n FOR EXAMPLE WHETHER DATA
ARE FROM POLICE OR HEALTH SOURCES
THE TYPES OF DATA COLLECTED
INAPPROPRIATE USE OF INDICATORS
NON
STANDARDIZATION OF DATA
DElNITIONAL ISSUES RELATED TO TRAFlC DEATHS
AND INJURIES
4(% ',/"!, )-0!#4 s
UNDERREPORTING
POOR HARMONIZATION AND LINKAGES BETWEEN
DIFFERENT SOURCES OF DATA
4HE LACK OF RELIABLE DATA IS MOST CRITICAL AT THE
NATIONAL AND LOCAL LEVELS WHERE THE DATA ARE NEED
ED AS A SOUND BASIS FOR ROAD SAFETY PLANNING AND
DECISION MAKING 4HE 7ORLD REPORT ON ROAD TRAFlC INJURY
PREVENTION DISCUSSES THIS SUBJECT IN FULL AND PROVIDES
GUIDANCE /THER USEFUL RESOURCES AVAILABLE FROM
7(/ ARE )NJURY SURVEILLANCE GUIDELINES AND 'UIDE
LINES FOR CONDUCTING COMMUNITY SURVEYS ON INJURIES AND VIOLENCE
2ISK FACTORS AND INTERVENTIONS
)NTRODUCTION
)N ROAD TRAFlC RISK IS A FUNCTION OF FOUR ELEMENTS
4HE lRST IS THE EXPOSURE n THE AMOUNT OF MOVE
MENT OR TRAVEL WITHIN THE SYSTEM BY DIFFERENT US
ERS OR A GIVEN POPULATION DENSITY 4HE SECOND IS THE
UNDERLYING PROBABILITY OF A CRASH GIVEN A PARTICULAR
EXPOSURE 4HE THIRD IS THE PROBABILITY OF INJURY GIV
EN A CRASH 4HE FOURTH ELEMENT IS THE OUTCOME OF IN
JURY 2ISK CAN BE EXPLAINED BY HUMAN ERROR KINETIC
ENERGY TOLERANCE OF THE HUMAN BODY AND POST
CRASH
CARE
2OAD TRAFlC INJURY SHOULD BE CONSIDERED ALONG
SIDE HEART DISEASE CANCER AND STROKE AS A PUBLIC
HEALTH PROBLEM THAT RESPONDS WELL TO INTERVENTION
THAT CAN PREVENT MUCH OF IT FROM OCCURRING
4HE KNOWN INTERVENTIONS WERE DISCOVERED
THROUGH RESEARCH AND DEVELOPMENT CONDUCTED
MAINLY IN HIGH
INCOME COUNTRIES &URTHER RE
SEARCH AND DEVELOPMENT WILL RESULT IN NEW AND
BETTER INTERVENTIONS AND WAYS OF ADAPTING KNOWN
INTERVENTIONS TO NEW CIRCUMSTANCES !LL COUNTRIES
CAN BENElT BY TRANSFERRING AND ADAPTING ROAD
SAFETY TECHNOLOGY THAT HAS BEEN PROVEN IN A FEW
COUNTRIES
4HE INTERPLAY OF RISK FACTORS AND INTERVENTIONS IN
A ROAD TRAFlC SYSTEM IS SO COMPLEX THAT PRESENTING
THEM IN NEAT RISKnINTERVENTION PAIRINGS IS IMPOS
SIBLE WITHOUT BEING HIGHLY REPETITIVE AND SIMPLISTIC
4HE FOLLOWING SECTION ORGANIZES MATERIAL ACCORDING
TO CATEGORIES OF INTERVENTION ALTHOUGH THE INTER
VENTIONS WITHIN EACH CATEGORY OFTEN ADDRESS MORE
THAN ONE CATEGORY OF RISK 4HE WAY ROADS ARE LAID
OUT AND DESIGNED FOR EXAMPLE CAN REDUCE THE EX
POSURE TO TRAFlC OF VULNERABLE ROAD USERS REDUCE THE
PROBABILITY THAT CRASH AND INJURY OCCUR WHEN THESE
USERS ARE EXPOSED AND REDUCE THE SEVERITY OF INJURY
IF IT OCCURS
-ANAGING EXPOSURE WITH LAND
USE
AND TRANSPORT POLICY
%XPOSURE TO RISK OF ROAD TRAFlC INJURY
%XPOSURE TO RISK MEANS EXPOSURE TO ROAD TRAFlC RE
SULTING FROM THE NEED TO USE ROADS AND FROM THE
VOLUMES AND MIXES OF TRAFlC ON THE ROADS 7ITHOUT
NEW SAFETY MEASURES ALL ROAD USERS MAY BE EXPOSED
TO EVER GREATER RISK AS THE VOLUMES OF TRAFlC INCREASE
ESPECIALLY WHEN DIFFERENT TYPES OF MOTOR VEHICLE
SOME TRAVELLING AT HIGH SPEEDS SHARE ROADS WITH
EACH OTHER AND WITH PEDESTRIANS AND CYCLISTS
&IGURE SHOWS HOW THE NUMBER OF MOTOR VE
HICLES PER PEOPLE RISES IN RELATION TO '$0
PER CAPITA )N THE MEMBER COUNTRIES OF THE /R
GANISATION FOR %CONOMIC #O
OPERATION AND $EVEL
OPMENT THE NUMBER OF MOTOR VEHICLES IS PROJECTED
TO INCREASE BY UP TO BETWEEN AND
TO MILLION )N #HINA THE NUMBER OF MO
TOR VEHICLES QUADRUPLED BETWEEN AND
TO MORE THAN MILLION AND IN 4HAILAND BETWEEN
AND THERE WAS AN ALMOST FOUR
FOLD IN
CREASE IN THE NUMBER OF REGISTERED MOTOR VEHICLES
FROM MILLION TO MILLION
$ESPITE RAPID MOTORIZATION IN #HINA AND OTHER
LOW
INCOME AND MIDDLE
INCOME COUNTRIES MOST
FAMILIES IN THESE COUNTRIES ARE UNLIKELY TO OWN A CAR
OR OTHER MOTORIZED FOUR
WHEELER WITHIN THE NEXT
YEARS .EVERTHELESS AS PEDESTRIANS CYCLISTS
RIDERS OF MOTORIZED TWO
WHEELERS AND PUBLIC TRANS
PORT PASSENGERS THEY MAY BE EVER MORE EXPOSED TO
MOTORIZED FOUR
WHEELERS ON THEIR ROADS
0ROJECTIONS INDICATE THAT COMPARED WITH OTHER
COUNTRIES !SIAN COUNTRIES WILL EXPERIENCE THE GREAT
EST GROWTH IN THE NUMBERS OF MOTOR VEHICLES FOR
THE FORESEEABLE FUTURE BUT MOST OF THE GROWTH WILL
BE IN MOTORIZED TWO
WHEELERS AND THREE
WHEELERS
SUCH AS MOTORIZED RICKSHAWS AND JITNEYS )N
s 7/2,$ 2%0/24 /. 2/!$ 42!&&)# ).*529 02%6%.4)/. 35--!29
&)'52%
-OTORIZATION RATE VERSUS INCOMEA
MENT IS NOT COMMON THE
.ETHERLANDS HAS SOME EX
PERIENCE WITH THIS
0ROMOTING EFlCIENT PAT
TERNS OF LAND USE
! COMMUNITYS PATTERN OF
LAND USE AFFECTS THE NUM
BER AND LENGTHS OF TRIPS
PEOPLE MAKE AND THEIR
CHOICE OF ROUTE AND TRAVEL
MODE 3MART GROWTH
POLICIES FOR EXAMPLE FA
VOUR COMPACT HIGHER
DENSITY DEVELOPMENT WITH
MIXED USES SO THAT THE
PLACES WHERE PEOPLE LIVE
WORK GO TO SCHOOL SHOP
A
($) IS THE 5NITED .ATIONS (UMAN $EVELOPMENT )NDEX #OUNTRIES WITH AN ($) MORE THAN ARE
AND lND OPPORTUNITIES FOR
LABELLED AS ($ WHILE THOSE WITH A VALUE LESS THAN ARE DENOTED AS ($
RECREATION AND ENTERTAIN
3OURCE REPRODUCED FROM REFERENCE WITH MINOR EDITORIAL AMENDMENTS WITH THE PERMISSION
MENT ARE CLOSE TOGETHER
OF THE AUTHORS
4HEY MAY CHOOSE TO WALK
CYCLE OR USE PUBLIC TRANS
6IET .AM FOR EXAMPLE SUCH VEHICLES ALREADY AC
COUNT FOR OF ALL MOTOR VEHICLES 4HE NUMBER OF PORT RATHER THAN USE PRIVATE CARS
MOTORCYCLES IN 6IET .AM GREW BY IN AND
THIS GROWTH WAS ASSOCIATED WITH A INCREASE IN 0ROVIDING SHORTER SAFER ROUTES FOR VULNERABLE
ROAD USERS
THE NUMBER OF ROAD TRAFlC DEATHS
"USES AND TRUCKS ARE ALSO COMMON MODES OF -OST PEDESTRIANS AND CYCLISTS TAKE SHORTER AND EAS
IER PATHS EVEN IF THIS IS LESS SAFE 3TUDIES IN
TRANSPORT IN LOW INCOME AND MIDDLE INCOME COUN
TRIES 4HEY POSE RISKS BOTH TO THEIR OCCUPANTS AND "RAZIL -EXICO AND 5GANDA FOUND THAT PEDESTRIANS
TO OTHERS )N $ELHI THEY ARE INVOLVED IN ALMOST TWO WOULD RATHER CROSS A DANGEROUS ROAD THAN GO OUT
THIRDS OF CRASHES INVOLVING VULNERABLE ROAD USERS OF THEIR WAY TO TAKE PEDESTRIAN BRIDGES
! ROAD TRAFlC SYSTEM SHOULD ENSURE THAT THE SHORTER
WHO ACCOUNT FOR OF ALL ROAD TRAFlC DEATHS
ROUTES ARE ALSO THE SAFER ONES FOR VULNERABLE ROAD
USERS -OTOR VEHICLE TRAFlC SHOULD BE CHANNELLED AS
2EDUCING EXPOSURE THROUGH LAND USE AND
MUCH AS POSSIBLE ALONG OTHER ROUTES IN AREAS WHERE
TRANSPORT PLANNING
PEDESTRIANS AND CYCLISTS ARE COMMON &OR EX
%LIMINATING THE NEED OR DESIRE TO TRAVEL IS NOT POS
SIBLE BUT THE LENGTH AND INTENSITY OF EXPOSURE TO AMPLE THROUGH TRAFlC THAT NEITHER ORIGINATES IN NOR
TYPES OF ROAD TRAFlC THAT PUT PEOPLE AT RISK CAN BE IS DESTINED FOR RESIDENTIAL NEIGHBOURHOODS SHOULD
BE ROUTED AWAY FROM THESE NEIGHBOURHOODS
REDUCED
)N ADDITION LOCAL TRAFlC SHOULD BE CALMED TO SPEEDS
THAT ARE LESS RISKY FOR VULNERABLE ROAD USERS
2EQUIRING SAFETY IMPACT ASSESSMENT BEFORE
PLANNING DECISIONS ARE MADE
0ROPOSED POLICIES AND PROJECTS ARE OFTEN ASSESSED FOR
SAFETY BUT NOT OFTEN FOR THEIR EFFECTS ON THE SAFETY OF
AN ENTIRE ROAD TRAFlC SYSTEM !LTHOUGH SUCH ASSESS
$ISCOURAGING UNNECESSARY TRIPS
-EASURES TO REDUCE THE NUMBERS OF MOTOR VEHICLES
ESPECIALLY IN AREAS WHERE VULNERABLE ROAD USERS ARE
2)3+ &!#4/23 !.$ ).4%26%.4)/.3 s
COMMON CAN REDUCE THE RISK OF INJURY 0OLICIES TO
BAN OR DISCOURAGE PRIVATE CARS FROM ENTERING CITY
CENTRES OR UNIVERSITY CAMPUSES SUCH AS BY REQUIR
ING SPECIAL LICENCES CHARGING ENTRY FEES OR MAKING
PARKING SCARCE AND TO BAN FREIGHT TRUCKS AND TOURIST
COACHES IN CERTAIN ZONES DURING CERTAIN HOURS CAN
BE EFFECTIVE /THER POSSIBILITIES INCLUDE ENCOURAGING
TELECOMMUTING OR E
WORKING
%NCOURAGING THE USE OF SAFER MODES OF TRAVEL
/F THE FOUR MAIN MODES OF TRAVEL n ROAD RAIL AIR
AND MARINE n TRAVEL BY ROAD PUTS PEOPLE AT THE GREAT
EST RISK OF INJURY PER KILOMETRE TRAVELLED BY FAR
4ABLE SHOWS THE RESULTS OF A RECENT STUDY
COMPARING THE RISKS OF TRAVEL IN THE %UROPEAN 5NION
COUNTRIES BY THE FOUR MAIN MODES AND BY DIFFERENT
MEANS OF ROAD TRAVEL
4HE STUDY FOUND THAT COMPARED WITH A PERSON IN A
CAR A PERSON ON A MOTORIZED TWO
WHEELER IS TIMES
MORE LIKELY TO BE KILLED FOR EACH KILOMETRE TRAVELLED
A PERSON ON FOOT TIMES MORE LIKELY AND A PERSON
ON A BICYCLE TIMES MORE LIKELY ! PERSON IN A CAR
HOWEVER IS TIMES MORE LIKELY TO BE KILLED THAN A
PASSENGER IN A BUS OR COACH AND TIMES MORE LIKELY
TO BE KILLED THAN A PASSENGER IN A TRAIN
0ROVIDING CONVENIENT AND AFFORDABLE PUBLIC
TRANSPORT BY RAIL ANDOR BUS AND COACH CAN REDUCE
4!",%
$EATHS PER MILLION PASSENGER KILOMETRES VERSUS
PASSENGER TRAVEL HOURS IN %UROPEAN 5NION COUNTRIES
FOR THE PERIOD n
$EATHS PER
$EATHS PER
MILLION PASSENGER MILLION PASSENGER
KILOMETRESA
TRAVEL HOURSB
2OADS TOTAL
0OWERED TWO WHEELERS
#YCLE
#AR
"US AND COACH
&ERRY
!IR CIVIL AVIATION
2AIL
&OOT
0ASSENGER
KILOMETRES IS THE TOTAL DISTANCE COVERED BY ALL THE INDI
VIDUALS TRAVELLING ON THAT MODE
B
0ASSENGER
TRAVEL HOURS IS THE TOTAL TIME SPENT BY ALL THE INDIVIDU
ALS TRAVELLING ON THAT MODE
3OURCE REPRODUCED FROM REFERENCE WITH MINOR EDITORIAL AMEND
MENTS WITH THE PERMISSION OF THE PUBLISHER
A
THE DISTANCE TRAVELLED USING HIGHER RISK MODES !
TRIP USING PUBLIC TRANSPORT USUALLY HAS A WALKING OR
CYCLING COMPONENT !LTHOUGH THAT COMPONENT MAY
BEAR RELATIVELY HIGH RISK PEDESTRIANS AND CYCLISTS
POSE LESS RISK TO OTHER ROAD USERS THAN DO MOTOR
VEHICLES .ATIONAL TRANSPORT POLICY IN MANY
HIGH INCOME COUNTRIES NOW ENCOURAGES THE COMBI
NATION OF PUBLIC TRANSPORT WITH IMPROVED SAFETY OF
PEDESTRIAN AND CYCLING ROUTES
3TRATEGIES TO ENCOURAGE USE OF PUBLIC TRANSPORT
INCLUDE ROUTES STOPS SCHEDULES AND TICKETING SYS
TEMS THAT MAKE IT CONVENIENT AND EASY 0ROVIDING
AFFORDABLE FARES INCLUDING FREE TRAVEL OR PREFERRED
FARES FOR STUDENTS SAFE AND SECURE PARK AND RIDE
FACILITIES TAXI STANDS BICYCLE STORAGE AREAS PEDESTRI
AN APPROACHES WAITING AREAS AND ATTRACTIVE VEHICLE
INTERIORS ARE ALSO IMPORTANT )N ADDITION DISINCEN
TIVES MAY BE IMPLEMENTED TO USING OTHER MODES OF
TRAVEL INCLUDING HIGHER FUEL TAXES AND SOME OF THE
MEANS ALREADY MENTIONED FOR DISCOURAGING UNNEC
ESSARY TRIPS BY PRIVATE CAR
)N HIGH INCOME COUNTRIES INTEGRATING LAND USE
ROAD TRAFlC AND PUBLIC TRANSPORT POLICIES COULD RE
DUCE PER CAPITA CAR TRAVEL BY AN ESTIMATED n
-EANWHILE IN MANY LOW INCOME AND MID
DLE INCOME COUNTRIES PUBLIC TRANSPORT SERVICES ARE
UNREGULATED AND PROVIDE INADEQUATE SAFETY BOTH
FOR THEIR OCCUPANTS AND FOR ROAD USERS OUTSIDE THE
VEHICLES )MPROVING THE SAFETY AND OVERALL QUALITY
OF THESE SERVICES WILL BE IMPORTANT STRATEGIES FOR
THEM
-INIMIZING EXPOSURE TO HIGH RISK ROAD
TRAFlC SCENARIOS
2ESTRICTING ACCESS TO PARTS OF THE ROAD NETWORK
0REVENTING PEDESTRIANS AND CYCLISTS AND SOMETIMES
SLOW
MOVING FARM AND CONSTRUCTION VEHICLES FROM
ACCESSING HIGH
SPEED MOTORWAYS IS A WELL
ESTAB
LISHED ROAD SAFETY MEASURE 3O IS PREVENTING MOTOR
VEHICLES FROM ACCESSING PEDESTRIAN ZONES
'IVING PRIORITY TO HIGHER
OCCUPANCY VEHICLES
'IVING HIGH OCCUPANCY VEHICLES SUCH AS BUSES
OR CARS WITH TWO OR MORE OCCUPANTS PRIORITY
WITH THEIR OWN LANES CAN REDUCE THE USE OF MOTOR
VEHICLES
s 7/2,$ 2%0/24 /. 2/!$ 42!&&)# ).*529 02%6%.4)/. 35--!29
2ESTRICTING THE POWER
TO
WEIGHT RATIOS OF
MOTORIZED TWO
WHEELERS
)N THE 5NITED +INGDOM IN THE EARLY S THE
MAXIMUM ENGINE SIZE OF A MOTORCYCLE THAT LEARN
ERS COULD RIDE WAS REDUCED FROM CC TO CC
AND THE MAXIMUM POWER OUTPUT WAS LIMITED TO
K7 4HE RESULT WAS A REDUCTION IN THE NUM
BER OF ROAD TRAFlC INJURIES AMONG YOUNG RIDERS
!MONG MORE EXPERIENCED RIDERS THOSE ON LARG
ER MORE POWERFUL MOTORCYCLES HAD SIGNIlCANTLY
HIGHER RATES OF CRASH AND INJURY
2EGULATING MOTOR VEHICLE USE BY YOUNG RIDERS
AND DRIVERS
'LOBALLY ROAD TRAFlC INJURIES ARE A LEADING CAUSE
OF DEATH AMONG YOUNG PEOPLE WHO DRIVE CARS OR
RIDE MOTORIZED TWO WHEELERS 4HE DEATH RATES
ARE ESPECIALLY HIGH AMONG TEENAGERS AND MALES
! STUDY OF PATTERNS OF ROAD TRAFlC INJURY IN !US
TRALIA *APAN -ALAYSIA AND 3INGAPORE FOUND
THAT THE ROAD USERS AT HIGHEST RISK OF INJURY WERE
MOTORCYCLISTS WITH PROVISIONAL LICENCES FOLLOWED
BY THOSE IN THEIR lRST YEAR OF RIDING !NOTHER STUDY
FOUND THAT DRIVERS OF ALL TYPES OF VEHICLE WERE
AT GREATEST RISK DURING THEIR lRST YEAR OF DRIVING
#ONTRIBUTING FACTORS INCLUDE UNFAMILIARITY WITH
VEHICLES WHICH ARE OFTEN BORROWED THRILL SEEKING
AND OVERCONlDENCE LESS TOLERANCE OF ALCOHOL COM
PARED WITH OLDER PEOPLE AND EXCESS OR INAPPROPRI
ATE SPEED 4HE LATE NIGHT RISK IS THREE TIMES THE DAY
TIME RISK FOR YEAR OLD DRIVERS AND FOUR TIMES FOR
TO YEAR OLDS /NE CASEnCONTROL STUDY
FOUND THAT ONE THIRD OF ALL CRASHES INVOLVING
YOUNG DRIVERS MIGHT HAVE BEEN PREVENTED IF THEY
HAD BEEN RESTRICTED TO DRIVING WITH NO MORE THAN
ONE PASSENGER
-ALAYSIA HAS SIGNIlCANTLY REDUCED RATES OF MOTOR
CYCLE CRASH BY INCREASING THE LEGAL RIDING AGE FROM
YEARS TO YEARS )N .EW :EALAND
PIONEERED THE GRADUATED DRIVER LICENCE SYSTEM FOR
ALL MOTOR VEHICLES !USTRALIA #ANADA AND THE 5NITED
3TATES HAVE FOLLOWED SINCE
! GRADUATED DRIVER LICENCE SYSTEM PROVIDES STEP
WISE ACCESS TO A FULL DRIVING LICENCE 4HE ORIGI
NAL .EW :EALAND SYSTEM APPLIED TO ALL NEW DRIVERS
AGED n YEARS 3TEP ONE WAS A
MONTH SUPER
VISED DRIVER PERMIT OBTAINED BY PASSING WRITTEN AND
ORAL TESTS 3TEP TWO WAS AN
MONTH RESTRICTED PER
MIT THAT ALLOWED NO DRIVING FROM TO
NO PASSENGERS UNDER YEARS AND A BLOOD ALCOHOL
CONCENTRATION "!# LIMIT OF GRAMS PER DECI
LITRE GDL 3TEP A FULL LICENCE REQUIRED A PRACTICAL
DRIVING TEST AT THE END OF STEP %VALUATION SHOWED
THAT THE GRADUATED DRIVER LICENCE HAD CONTRIBUTED
TO AN REDUCTION IN CRASHES INVOLVING SERIOUS
INJURY AMONG YOUNG NOVICE DRIVERS !USTRALIA
ACHIEVED A REDUCTION OF OVER ONE THIRD LARGELY BY
REDUCING THE PERMITTED "!# TO GDL
0LANNING AND DESIGNING ROADS FOR
SAFETY
2ISK OF INJURY FROM POOR PLANNING AND DESIGN
)N MANY !SIAN CITIES AT LEAST SEVEN CATEGORIES OF MO
TORIZED AND NON
MOTORIZED VEHICLE PLUS PEDESTRIANS
AND CYCLISTS SHARE THE ROADS $IFFERENCES IN
KINETIC ENERGY n BETWEEN HEAVY VEHICLES TRAVELLING
AT HIGH SPEEDS AND LIGHT VEHICLES TRAVELLING AT LOW
SPEEDS n PUT THE OCCUPANTS OF MANY MOTOR VEHICLES
AT HIGH RISK OF INJURY
)N ALL COUNTRIES ROAD NETWORKS ARE LAID OUT AND
MOST ROADS ARE DESIGNED LARGELY FROM THE PERSPEC
TIVE OF MOTOR VEHICLE USERS &ROM THE PERSPEC
TIVE OF PEDESTRIANS AND CYCLISTS MIXING THEM WITH
MOTOR VEHICLES CAPABLE OF TRAVELLING AT HIGH SPEEDS
IS THE MOST IMPORTANT ROAD SAFETY PROBLEM
0EDESTRIANS AND CYCLISTS ARE RELATIVELY SAFE ONLY
ON ROADS WHERE MOTOR VEHICLES ARE TRAVELLING AT LESS
THAN KMH AND EVEN THERE ONLY IF THEY
ARE SEPARATED FROM MOTOR VEHICLES WITH THEIR OWN
SIDEWALKS PATHS OR LANES &ROM THE PERSPECTIVE OF
PEDESTRIANS AND CYCLISTS CROSSING AT JUNCTIONS IS THE
SECOND MOST IMPORTANT ROAD SAFETY PROBLEM )N UR
BAN AREAS MOST FATAL OR SERIOUS CRASHES INVOLVING
BICYCLES OCCUR AT JUNCTIONS
3AFETY
CONSCIOUS DESIGN OF ROADS
! ROAD NETWORK PLANNED FOR SAFETY HAS A HIERARCHY OF
ROADS WITH SEVERAL LEVELS OR CLASSIlCATIONS OF ROAD
EACH INTENDED TO SERVE A CERTAIN FUNCTION
)N THE .ETHERLANDS LAUNCHED A PROGRAMME
OF RECLASSIFYING ITS ROADS AND THEN MODIFYING THEM
2)3+ &!#4/23 !.$ ).4%26%.4)/.3 s
SO THAT EVERY ROAD WOULD HAVE A CLEAR UNAMBIGU
OUS FUNCTION !N EARLIER STUDY PREDICTED THAT
THIS CLARIlCATION OF FUNCTION FOR ALL ROADS COULD
REDUCE BY MORE THAN ONE THIRD THE AVERAGE NUM
BER OF ROAD TRAFlC INJURIES PER VEHICLEnKILOMETRE
TRAVELLED
$ESIGN TO SUIT ROAD FUNCTION
%ACH ROAD SHOULD BE DESIGNED ACCORDING TO ITS PAR
TICULAR FUNCTION IN THE ROAD NETWORK ! KEY CHAR
ACTERISTIC OF A WELL
DESIGNED ROAD IS THAT IT MAKES
COMPLIANCE WITH THE INTENDED SPEED LIMIT A NATURAL
CHOICE FOR DRIVERS
s (IGHER
SPEED ROADS MOTORWAYS EXPRESSWAYS
AND MULTI
LANE DIVIDED HIGHWAYS SHOULD HAVE
RESTRICTED ACCESS HORIZONTAL AND VERTICAL CURVES
OF LARGE RADIUS CRASHWORTHY SHOULDERS ME
DIAN BARRIERS AND GRADE
SEPARATED JUNCTIONS
WITH ENTRY AND EXIT RAMPS )F SUCH FEATURES ARE
PRESENT THESE ARE THE SAFEST OF ALL ROADS
-ANY LOW
INCOME AND MIDDLE
INCOME COUN
TRIES SHOULD ALSO HAVE SEPARATE LANES FOR MOTOR
IZED TWO
WHEELERS
s 2URAL ROADS SHOULD HAVE PERIODIC LANES FOR
OVERTAKING AND FOR TURNING ACROSS ONCOMING
TRAFlC MEDIAN BARRIERS TO PREVENT OVERTAKING
IN HAZARDOUS STRETCHES LIGHTING AT JUNCTIONS
ROUNDABOUTS ADVISORY SPEED LIMIT SIGNS
BEFORE SHARP BENDS REGULAR SIGNS TO REMIND
OF SPEED LIMITS RUMBLE STRIPS AND ROADSIDE
HAZARDS SUCH AS TREES AND UTILITY POLES
REMOVED
s 4RANSITIONAL ROADS CONNECTING HIGHER
SPEED
ROADS WITH LOWER
SPEED ROADS OR MOVING
FROM HIGHER
TO LOWER
SPEED STRETCHES SUCH
AS RURAL ROADS ENTERING VILLAGES SHOULD HAVE
SIGNS AND OTHER DESIGN FEATURES TO ENCOURAGE
DRIVERS TO SLOW DOWN IN GOOD TIME 2UMBLE
STRIPS SPEED BUMPS VISUAL WARNINGS IN THE
PAVEMENT AND ROUNDABOUTS ARE POSSIBILITIES
)N 'HANA THE USE OF RUMBLE STRIPS REDUCED
CRASHES BY AND DEATHS BY IN CERTAIN
LOCATIONS
s 2ESIDENTIAL ACCESS ROADS SHOULD HAVE SPEED
LIMITS OF NO MORE THAN KMH AND DESIGN
FEATURES THAT CALM TRAFlC
$ESIGN FOR PEDESTRIANS AND CYCLISTS
4HE SAFETY OF PEDESTRIANS AND CYCLISTS CAN BE ACHIEVED
THROUGH AREA
WIDE ROAD SAFETY MANAGEMENT THAT IN
CLUDES THE FOLLOWING
s .ETWORKS OF SEGREGATED OR SEPARATE PEDESTRIAN
AND BICYCLE ROUTES CONNECTING TO A PUBLIC TRANS
PORT SYSTEM ARE THE IDEAL 3UCH A NETWORK
MIGHT CONSIST OF SECTIONS OF FOOTPATH OR CYCLE
PATH SEPARATE FROM ROADS PLUS SECTIONS RUNNING
ALONGSIDE ROADS WITH PARTICULAR ATTENTION PAID
TO SAFE CROSSINGS AT JUNCTIONS 0EDESTRIANS HAVE
TWICE THE RISK OF INJURY WHERE PEDESTRIANS ARE
NOT SEPARATED OR SEGREGATED FROM MOTOR VE
HICLE TRAFlC 3TUDIES IN $ENMARK
HAVE SHOWN THAT PROVIDING SEGREGATED BICYCLE
TRACKS OR LANES ALONGSIDE URBAN ROADS REDUCED
DEATHS AMONG CYCLISTS BY
s 4RAFlC
CALMING MEASURES DISCOURAGE MOTOR
IZED TRAFlC FROM TRAVELLING AT SPEEDS THAT PUT
PEDESTRIANS AND CYCLISTS AT HIGH RISK 4HEY IN
CLUDE ROAD NARROWING ROUNDABOUTS RUMBLE
STRIPS AND SPEED BUMPS
7IDESPREAD EXPERIENCE WITH AREA
WIDE ROAD
SAFETY MANAGEMENT IN %UROPE SHOWS THAT IT CAN RE
DUCE CRASHES AND INJURIES BY n
4HE TOWN OF "ADEN !USTRIA LAUNCHED A MANAGEMENT
PLAN IN THAT HAS RESULTED IN ABOUT OF ITS
ROAD NETWORK BEING RESTRICTED TO SPEEDS OF KMH
OR LESS AND AN INTEGRATED SYSTEM OF PUBLIC TRANSPORT
WITH PEDESTRIAN AND BICYCLE ROUTES 4HE RATE OF ROAD
CASUALTIES HAS DECLINED BY
,OW
INCOME AND MIDDLE
INCOME COUNTRIES HAVE
EXPERIMENTED LITTLE WITH AREA
WIDE ROAD SAFETY
MANAGEMENT BUT SOME ROAD SAFETY EXPERTS BELIEVE
THAT THIS SHOULD BE A PRIORITY FOR URBAN AREAS IN ALL
COUNTRIES
$ESIGN FOR MOTOR VEHICLE DRIVERS RIDERS AND
PASSENGERS
!CCORDING TO RESEARCH IN !USTRALIA AND SEVERAL %URO
PEAN 5NION COUNTRIES COLLISIONS BETWEEN VEHICLES
AND SOLID ROADSIDE OBJECTS CONTRIBUTE TO n OF
ALL FATAL CRASHES 3UCH COLLISIONS FREQUENT
LY INVOLVE YOUNG DRIVERS EXCESS OR INAPPROPRIATE
SPEED THE USE OF ALCOHOL DRIVER FATIGUE OR RESTRICTED
VISIBILITY 2OADS AND ROADSIDES SHOULD BE DESIGNED
s 7/2,$ 2%0/24 /. 2/!$ 42!&&)# ).*529 02%6%.4)/. 35--!29
AND MAINTAINED TO MINIMIZE THE OPPORTUNITIES FOR
SERIOUS EFFECTS WHEN VEHICLES VEER OFF COURSE
s +EEPING ROADSIDES CLEAR OF TREES BOULDERS
STEEL AND CONCRETE PILLARS AND POSTS AND SIMILAR
RIGID ROADSIDE OBJECTS IS ESPECIALLY IMPORTANT
ON ROADS WHERE VEHICLES TRAVEL AT HIGH SPEEDS
s #OLLAPSIBLE LIGHTING COLUMNS AND SIGNS
MOUNTED ON SHEAR BOLTS OR MADE OF YIELDING
MATERIAL AND DESIGNED FOR ELECTRICAL SAFETY ARE
RECOMMENDED
s 3AFETY BARRIERS CAN BE USED TO CONTAIN MO
TOR VEHICLES WITHIN LANES PREVENTING HEAD
ON
OR SIDE COLLISIONS AND TO PREVENT THEM FROM
LEAVING ROADS 4HESE BARRIERS SHOULD BE DE
SIGNED TO DEmECT OR CONTAIN VEHICLES WHILE
DOING NO SERIOUS HARM TO OCCUPANTS
$ENMARK 3WEDEN 3WITZERLAND AND THE
5NITED +INGDOM FAVOUR mEXIBLE CABLE BARRI
ERS RATHER THAN RIGID CONCRETE OR SEMI
RIGID
STEEL SOMETIMES TO PREVENT DANGEROUS OVER
TAKING ON SINGLE
CARRIAGEWAY ROADS 5SED ON
DUAL
CARRIAGEWAY ROADS WITH NO PEDESTRIANS
OR BICYCLES TO PREVENT MOTOR VEHICLES FROM
CROSSING OVER AND CRASHING INTO TRAFlC GO
ING IN THE OPPOSITE DIRECTION THEY HAVE BEEN
FOUND TO REDUCE FATAL AND SERIOUS INJURIES BY
n
s #RASH CUSHIONS SLOW AND CUSHION MOTOR VE
HICLES BEFORE THEY STRIKE RIGID ROADSIDE OBJECTS
SUCH AS BRIDGE PILLARS SAFETY BARRIER ENDS AND
UTILITY POLES 4HEY HAVE REDUCED FATAL AND SE
RIOUS INJURIES RESULTING FROM IMPACT BY UP TO
IN THE 5NITED 3TATES AND BY OR
MORE IN THE 5NITED +INGDOM
3AFETY AUDITS
2OAD SAFETY AUDITS ARE GENERALLY CARRIED OUT AT UP TO
lVE STAGES OF A NEW ROAD PROJECT FEASIBILITY STUDY
DRAFT DESIGN DETAILED DESIGN PRE
OPENING AND A
FEW MONTHS AFTER OPENING 4HEY SHOULD BE DONE BY
EXPERIENCED TEAMS THAT ARE INDEPENDENT FROM THE
PROJECT TEAMS n
-OST COUNTRIES DO NOT CARRY OUT SUCH AUDITS BUT
THOSE THAT DO SUCH AS -ALAYSIA CAN PROVIDE GUIDE
LINES #OSTnBENElT ANALYSES OF SAFETY AUDITS HAVE
FOUND THEM TO BE HIGHLY EFFECTIVE WITH THE MONEY
INVESTED EARLY RETURNING SUBSTANTIAL SAVINGS LATER !
STUDY IN $ENMARK FOUND lRST
YEAR RETURNS OF
WELL OVER ON PROJECTS 4RANSIT .EW :EALAND
HAS ESTIMATED A POTENTIAL COSTnBENElT RATIO
OF TO 4OGETHER WITH AREA
WIDE SAFETY IMPACT
ASSESSMENTS BEFORE PROPOSALS FOR PROJECTS ARE IM
PROVED SAFETY AUDITS CAN HELP TO OPTIMIZE THE SAFETY
OF THE WHOLE ROAD NETWORK
2EMEDIAL ACTION AT HIGH
RISK CRASH SITES
2OAD CRASHES ARE NOT EVENLY DISTRIBUTED THROUGHOUT
A ROAD NETWORK 4HEY OCCUR IN CLUSTERS AT SINGLE SITES
ALONG PARTICULAR SECTIONS OF ROAD OR SCATTERED ACROSS
WHOLE RESIDENTIAL NEIGHBOURHOODS %VEN WHERE
AREA
WIDE IMPACT ASSESSMENT AND ROAD SAFETY AUDITS
ARE CARRIED OUT EXPERIENCE MAY SHOW THAT CERTAIN
SITES SECTIONS OR AREAS ARE HAZARDOUS AND NEED IM
PROVEMENT 0OSSIBILITIES INCLUDE ADDING SKID
RESIS
TANT SURFACES IMPROVING LIGHTING PROVIDING CENTRAL
REFUGES OR ISLANDS FOR PEDESTRIANS ADDING SIGNS
OR MARKINGS IMPROVING JUNCTIONS WITH SIGNALS OR
ROUNDABOUTS AND ADDING PEDESTRIAN BRIDGES
3AFETY DEFECTS MAY ALSO ARISE THROUGH POOR MAIN
TENANCE FOR EXAMPLE ROAD SURFACES AND SIGNS ARE
DETERIORATED AND ROADSIDE LIGHTS DO NOT FUNCTION
4HE IMPROVEMENTS NEEDED TO MAKE AN ENTIRE ROAD
NETWORK OR A HAZARDOUS SITE SAFER OFTEN COST LITTLE
BUT CAN RESULT IN HUGE BENElTS IN TERMS OF REDUCED
INCIDENCE OF ROAD CRASH AND INJURY .EVERTHELESS A
SURVEY OF %UROPEAN 5NION COUNTRIES
FOUND THAT ONLY SEVEN REPORTED HAVING FORMAL POLI
CIES ON REMEDIAL ACTION AT HIGH
RISK SITES ONLY THREE
DID EVALUATIONS AS A MATTER OF COURSE AND ONLY THREE
HAD SEPARATE BUDGETS FOR REMEDIAL ACTION ! STUDY IN
+ENYA FOUND ABOUT HAZARDOUS LOCATIONS ON THE
COUNTRYS MAIN ROAD NETWORK
-ONITORING THE ENTIRE ROAD TRAFlC SYSTEM IDENTI
FYING PROBLEMS AS THEY EMERGE AND CORRECTING THEM
ARE ALL IMPORTANT MEASURES FOR ENSURING ROAD SAFETY
0ROVIDING VISIBLE CRASHWORTHY
SMART VEHICLES
2ISK OF INJURY FROM POOR VEHICLE DESIGN
AND MAINTENANCE
6EHICLE DESIGN CAN HAVE CONSIDERABLE INmUENCE ON
CRASH INJURIES )TS CONTRIBUTION TO CRASHES THROUGH
2)3+ &!#4/23 !.$ ).4%26%.4)/.3 s
VEHICLE DEFECTS IS GENERALLY BETWEEN AND !
RECENT %UROPEAN #OMMISSION REPORT STATED
THAT IF ALL CARS IN THE %UROPEAN 5NION WERE DE
SIGNED TO BE EQUAL IN STANDARD TO THE BEST CAR AVAIL
ABLE IN EACH CLASS AN ESTIMATED OF ALL FATAL AND
DISABLING INJURIES COULD BE PREVENTED -EANWHILE
MANY LOW
INCOME AND MIDDLE
INCOME COUNTRIES DO
NOT SET AND ENFORCE STANDARDS AS HIGH AS THE ONES IN
THE %UROPEAN 5NION
&ROM A CAR OCCUPANTS PERSPECTIVE A MAJOR PROB
LEM IS THE MISMATCH IN SIZE AND WEIGHT BETWEEN
THE VEHICLES INVOLVED IN A CRASH 4HE RATES OF DEATH
AND SERIOUS INJURY ARE MANY TIMES HIGHER IN CAR
TO
TRUCK COLLISIONS THAN IN CAR
TO
CAR COLLISIONS
/THER PROBLEMS ARE FAILURE OF THE PASSENGER
COMPARTMENT TO PROVIDE A PROTECTIVE SHELL LACK OF
FEATURES TO STOP OCCUPANTS FROM BEING EJECTED FROM
THE CAR AND LACK OF OTHER SAFETY FEATURES SUCH AS
HIGH
MOUNTED STOP LAMPS IN THE REAR
0EDESTRIANS INVOLVED IN CRASHES MORE OFTEN SUS
TAIN MULTIPLE INJURIES RESULTING IN DEATH OR DISABILITY
THAN DO CAR OCCUPANTS )N %UROPE OF FA
TALLY INJURED PEDESTRIANS ARE STRUCK BY THE FRONTS OF
CARS BY OTHER PARTS OF CARS AND BY OTHER
TYPES OF MOTOR VEHICLE )N LOW
INCOME AND
MIDDLE
INCOME COUNTRIES OTHER TYPES OF MOTOR VE
HICLE ARE MORE OFTEN INVOLVED )N 'HANA OF
PEDESTRIAN TRAFlC DEATHS INVOLVE CARS BUT THE CARS
ARE OFTEN TAXIS BUSES OR MINIBUSES
HEAVY TRUCKS LIGHT TRUCKS MOTORCYCLES
BICYCLES AND OTHER
)N 4HAILAND HOSPITAL RECORDS SHOW THAT n
OF ROAD TRAFlC INJURIES AND n OF ROAD TRAFlC
DEATHS ARE AMONG USERS OF MOTORIZED TWO
WHEELED
VEHICLES )N ALL COUNTRIES SUCH ROAD USERS TEND
TO SUSTAIN MULTIPLE INJURIES TO THE HEAD CHEST AND
LEGS (EAD INJURIES CONTRIBUTE TO MOST DEATHS AND LEG
INJURIES TO MOST CASES OF LONG
TERM DISABILITY
)N LOW
INCOME AND MIDDLE
INCOME COUNTRIES
BUSES MINIBUSES AND TRUCKS n INCLUDING OPEN
BACKED TRUCKS FOR TRANSPORTING PASSENGERS n ARE FRE
QUENTLY INVOLVED IN CRASHES AND OFTEN DO NOT MEET
THE STANDARDS OF CRASHWORTHINESS DEMANDED IN
HIGH
INCOME COUNTRIES 4YPICALLY THEIR PASSENGERS
ARE NOT PROVIDED WITH SEAT
BELTS AND IN THE CASE OF
OPEN
BACKED TRUCKS THEY ARE THROWN FROM VEHICLES
/THER PROBLEMS INCLUDE LACK OF EMERGENCY
EXITS GLASS BREAKERS AND lRE EXTINGUISHERS ON PUB
LIC TRANSPORT VEHICLES
4HOUGH PERIODIC VEHICLE INSPECTIONS HAVE NOT
BEEN FOUND USEFUL IN REDUCING INJURY CRASHES IN
SPECTIONS AND CHECKS FOR OVERLOADING AND SAFETY
RELATED MAINTENANCE FOR LARGER COMMERCIAL VEHICLES
AND BUSES COULD BE IMPORTANT FOR VEHICLES MORE
THAN YEARS OLD
)MPROVING THE VISIBILITY OF VEHICLES AND
VULNERABLE ROAD USERS
3EEING AND BEING SEEN ARE FUNDAMENTAL PREREQUI
SITES FOR THE SAFETY OF ALL ROAD USERS )NADEQUATE VIS
IBILITY PLAYS A KEY ROLE IN THREE KINDS OF CRASH
AT NIGHT MOTOR VEHICLES RUNNING INTO THE REARS OR
SIDES OF SLOWLY MOVING OR STATIONARY MOTOR VEHICLES
BICYCLES OR PEDESTRIANS LOCATED AHEAD ON THE ROAD
WAY DURING THE DAY ANGLED OR HEAD ON COLLISIONS
AND AT ALL TIMES REAR END COLLISIONS IN FOG
4HERE ARE WAYS OF IMPROVING VISIBILITY
s $AYTIME RUNNING LIGHTS FOR CARS THOUGH NOT RE
QUIRED IN MANY COUNTRIES REDUCE THE INCIDENCE
OF DAYTIME CRASHES BY n
/NE STUDY FOUND A REDUCTION OF IN
CRASHES IN INJURIES AND IN DEATHS
s $AYTIME RUNNING LIGHTS FOR MOTORIZED TWO
WHEELERS ARE EQUALLY EFFECTIVE )N THE STATE OF
6ICTORIA !USTRALIA NOT BEING SUFlCIENTLY VIS
IBLE WAS A FACTOR IN OF CRASHES BETWEEN
CARS AND MOTORIZED TWO WHEELERS AND THE
SOLE CAUSE IN OF THEM 3TUDIES HAVE
FOUND THAT DAYTIME RUNNING LIGHTS REDUCED
THE CRASH RATE OF MOTORCYCLES BY n IN
-ALAYSIA BY IN THE 5NITED
3TATES BY IN 3INGAPORE AND
BY IN %UROPE
s (IGH MOUNTED STOP LAMPS IN CARS REDUCE REAR
END COLLISIONS BY n
s ,IGHTING ON TRUCKS AND THEIR TRAILERS IS OFTEN
INADEQUATE 2ESEARCH IN 'ERMANY FOUND
THAT NEARLY OF SEVERE CAR TO TRUCK COLLISIONS
ARE CAUSED BY THE POOR VISIBILITY OF TRUCKS OR
THEIR TRAILERS AT NIGHT SO CAR DRIVERS FAIL TO SEE
TRUCKS TURNING OFF ROADS TURNING AROUND OR
DRIVING AHEAD OF THEM
s 7/2,$ 2%0/24 /. 2/!$ 42!&&)# ).*529 02%6%.4)/. 35--!29
s &RONT REAR AND WHEEL REmECTORS AND LIGHTS ON
BICYCLES ARE REQUIRED IN MANY HIGH
INCOME
COUNTRIES ! STUDY IN THE .ETHERLANDS
FOUND THAT OF BICYCLE CRASHES OCCUR AT
NIGHT OR IN TWILIGHT AND COULD BE AVOIDED IF
BICYCLE LIGHTS WERE USED
s #OLOURFUL CLOTHING ACCESSORIES AND VEHICLE
PARTS CAN MAKE PEDESTRIANS RIDERS AND NON
MOTORIZED VEHICLES MORE VISIBLE 2EmECTIVE
VESTS ARE OFTEN USED IN HIGH
INCOME COUNTRIES
BUT THEIR COST AND UNSUITABILITY FOR HOT WEATHER
MAY MAKE THEM IMPRACTICAL FOR MANY LOW
IN
COME AND MIDDLE
INCOME COUNTRIES !LTERNA
TIVES INCLUDE BRIGHT YELLOW OR ORANGE CLOTHING
OR ACCESSORIES 3IMILAR COLOURS ON NON
MOTOR
IZED VEHICLES SUCH AS ON BICYCLE FRAMES OR THE
WHEELS AND REAR ENDS OF RICKSHAWS CAN MAKE
THEM MORE VISIBLE
)MPROVING THE CRASHWORTHINESS OF MOTOR
VEHICLES
! RECENT STUDY IN THE 5NITED +INGDOM CON
CLUDED THAT A COMBINATION OF IMPROVING VEHICLES
ROADS LAWS AND LAW ENFORCEMENT COULD REDUCE THE
NUMBER OF FATAL OR SERIOUS ROAD TRAFlC CRASHES BY
)MPROVING VEHICLES ALONE WOULD YIELD THE BEST
RESULTS A REDUCTION ! RECENT .EW :EALAND
STUDY CAME TO A SIMILAR CONCLUSION
(IGH
INCOME COUNTRIES TEND TO SHARE THE RESULTS
OF SUCH STUDIES THROUGH SUCH FORUMS AS THE )NTER
NATIONAL 4ECHNICAL #ONFERENCES ON THE %NHANCED
3AFETY OF 6EHICLES !LTHOUGH THEIR NATIONAL
AND REGIONAL AUTHORITIES SUCH AS THE %UROPEAN
5NION SET AND ENFORCE STANDARDS THEY ARE MOVING
TOWARDS COMMON STANDARDS BOTH TO ENSURE SAFETY
AND TO FACILITATE FREE TRADE -ANY LOW
INCOME AND
MIDDLE
INCOME COUNTRIES DO NOT ADOPT THE SAME
HIGH STANDARDS HOWEVER WITH THE RESULT THAT THEIR
NEW VEHICLES DO NOT INCORPORATE THE LATEST ADVANCES
IN ENGINEERING
)N ADDITION HIGH PROPORTIONS OF THE MOTOR VE
HICLES IN LOW
INCOME AND MIDDLE
INCOME COUNTRIES
ARE OBSOLETE OR DETERIORATED TO THE POINT AT WHICH
THEY WOULD NOT BE TOLERATED IN HIGH
INCOME COUN
TRIES ! RECENT STUDY FOUND THAT OCCUPANTS IN
CARS MANUFACTURED BEFORE HAVE ABOUT THREE
TIMES THE RISK OF CRASH INJURY OF OCCUPANTS OF RE
CENTLY MANUFACTURED CARS
0ROTECTING PEDESTRIANS AND CYCLISTS WITH
IMPROVED VEHICLE FRONTS
)N COLLISIONS WITH CARS THE MOST FREQUENT CAUSES OF
PEDESTRIAN INJURY ARE IMPACT BETWEEN THE PEDESTRI
ANS HEAD AND THE CAR BONNET OR WINDSCREEN FRAME
A PEDESTRIANS PELVIS OR ABDOMEN AND THE BONNET
EDGE A CHILD PEDESTRIANS ABDOMEN OR CHEST AND THE
BONNET EDGE AND THE LEGS AND THE CAR BUMPER
,OWER
LIMB TRAUMA IS THE MOST COMMON TYPE
OF PEDESTRIAN INJURY AND HEAD TRAUMA IS THE MOST
COMMON CAUSE OF DEATH 4ESTS SHOW THAT IN GENERAL
NEW CARS DO NOT PROTECT PEDESTRIANS AND
NO COUNTRY REQUIRES THE FRONTS OF MOTOR VEHICLES
TO HAVE CRASHWORTHY DESIGN TO MINIMIZE INJURY TO
PEDESTRIANS
3INCE THE S THERE HAVE BEEN STUDIES ON THE
SHAPE AND STIFFNESS OF MOTOR VEHICLE FRONTS AND HOW
THEY IMPACT PEDESTRIANS AND CYCLISTS ENGINEERS HAVE
KNOWN FOR SOME TIME HOW TO MODIFY THE FRONTS SO
THEY DO LESS HARM n 4HE %UROPEAN %N
HANCED 6EHICLE
SAFETY #OMMITTEE HAS DEVISED PER
FORMANCE TESTS FOR VEHICLE FRONTS )F MOTOR VEHICLES
WERE REQUIRED TO PASS THESE TESTS THE ANNUAL NUMBERS
OF DEATHS AND SERIOUS INJURIES TO PEDESTRIANS AND CY
CLISTS IN %UROPE COULD DECLINE BY AN ESTIMATED
-EANWHILE %URO.#!0 AND THE
!USTRALIAN .#!0 HAVE BEEN APPLYING THESE TESTS TO
NEW CARS FOR SEVERAL YEARS AND HAVE FOUND ONLY ONE
MODEL OF CAR THAT MEETS OF THE PROTECTION DE
MANDED AT AN ESTIMATED ADDITIONAL MANUFACTURING
COST OF E 3OME %UROPEAN COUNTRIES ARE
EXPECTED TO APPROVE LAWS REQUIRING SAFER CAR FRONTS
SOON 4HE %# ESTIMATES THAT DESIGNS
THAT MEET THE %%6# TESTS COULD SAVE UP TO
LIVES ANNUALLY IN THE %UROPEAN 5NION
)N LOW
INCOME AND MIDDLE
INCOME COUNTRIES
SIMILAR LAWS ARE URGENTLY NEEDED TO IMPROVE THE
FRONTS OF BUSES TRUCKS PICK
UPS VANS AND THE
UNIQUE VEHICLES FOUND IN SOME CITIES
)N .EW $ELHI )NDIA ABOUT TWO THIRDS OF
CRASHES INVOLVE BUSES OR TRUCKS BUT MANY OF
THE PEOPLE KILLED OR SERIOUSLY INJURED ARE NEITHER
PASSENGERS NOR DRIVERS BUT VULNERABLE ROAD USERS
2)3+ &!#4/23 !.$ ).4%26%.4)/.3 s
OUTSIDE THE VEHICLES 3EVERAL STUDIES
n HAVE IDENTIlED SAFER BUS AND TRUCK FRONTS
AS AN URGENT NEED
0ROTECTING MOTOR VEHICLE OCCUPANTS
4O PROTECT OCCUPANTS A MOTOR VEHICLE SHOULD BE DE
SIGNED SO THE PASSENGER COMPARTMENT MAINTAINS ITS
INTEGRITY DOES NOT COLLAPSE IN A CRASH AND HAS NO
ELEMENTS THAT COULD CAUSE INJURY 4HERE SHOULD BE
RESTRAINTS SO THAT OCCUPANTS DO NOT EJECT FROM THE VE
HICLE OR TUMBLE ABOUT INSIDE IT INJURING THEMSELVES
AND OTHER OCCUPANTS )N ADDITION VEHICLES SHOULD
BE DESIGNED TO MINIMIZE THE IMPACT IN CRASHES WITH
OTHER VEHICLES OF DIFFERENT MASS AS IN COLLISIONS BE
TWEEN SPORTS UTILITY VEHICLES AND SMALLER CARS BE
TWEEN CARS AND MOTORCYCLES AND SO ON
4HE VAST MAJORITY OF CAR CRASHES IN HIGH
INCOME
COUNTRIES ARE OFFSET FRONTAL CRASHES FRONTAL IMPACT
WITH PARTIAL FRONT
END OVERLAP (IGH
INCOME
COUNTRIES THEREFORE GENERALLY REQUIRE THAT NEW MOD
ELS BE TESTED TO ENSURE THAT PASSENGER COMPARTMENTS
MAINTAIN THEIR INTEGRITY AND THAT OCCUPANT RESTRAINTS
ARE EFFECTIVE IN SUCH CRASHES !LTHOUGH
SIDE
IMPACT CRASHES ARE LESS COMMON THEY RESULT
IN MORE DEATH AND SERIOUS INJURY PER CRASH %NGI
NEERS ARE WORKING ON WAYS TO ENSURE THE INTEGRITY OF
PASSENGER COMPARTMENTS AND TO RESTRAIN OCCUPANTS
APPROPRIATELY IN SUCH CRASHES 0ROVIDING BETTER PAD
DING AND SIDE AIRBAGS ARE POSSIBLE IMPROVEMENTS
!S DISCUSSED LATER USING SEAT
BELTS REDUCES THE
RISK OF SERIOUS AND FATAL INJURY BY n -OST
HIGH
INCOME COUNTRIES REQUIRE CARS AND LIGHT TRUCKS
TO HAVE SEAT
BELTS THAT MEET CERTAIN TECHNICAL STAN
DARDS AND INCREASINGLY TO HAVE AUDIBLE ALARMS TO RE
MIND DRIVERS AND PASSENGERS TO USE THEM !NECDOTAL
EVIDENCE SUGGESTS THAT HALF OR MORE OF THE MOTOR
VEHICLES IN LOW
INCOME AND MIDDLE
INCOME COUN
TRIES MAY LACK FUNCTIONING SEAT
BELTS
!IR BAGS HAVE BEEN ESTIMATED TO REDUCE DRIVER
AND FRONT PASSENGER DEATHS BY n IN ALL TYPES OF
CRASHES n AND BY n IN FRONTAL CRASH
ES n 4HE COMBINATION OF SEAT
BELTS PLUS AIR
BAGS HAS REDUCED DRIVER AND FRONT PASSENGER DEATHS
BY AN ESTIMATED )N THE 5NITED 3TATES
MANY CHILDREN HAVE BEEN FATALLY OR SEVERELY INJURED
WHILE SEATED IN REAR
FACING CHILD SAFETY SEATS WHEN
THERE WERE ALSO AIR BAGS n #ONCERN ABOUT
THIS HAZARD HAS CAUSED SOME %UROPEAN COUNTRIES TO
REQUIRE WARNING LABELS IN CARS AND AUTOMATIC SEN
SORS TO DETECT THE PRESENCE OF CHILD RESTRAINTS AND
AUTOMATICALLY DISABLE THE AIRBAG
)MPROVING VEHICLE
TO
VEHICLE COMPATIBILITY
"ECAUSE OF CONCERN ABOUT DEATHS AND SERIOUS IN
JURIES AMONG CAR OCCUPANTS WHEN CARS CRASH WITH
SPORTS UTILITY VEHICLES AND OTHER LIGHT TRUCKS THE
5NITED 3TATES .ATIONAL (IGHWAY 4RAFlC 3AFETY !D
MINISTRATION HAS MADE VEHICLE COMPATIBILITY
ONE OF ITS HIGHEST PRIORITIES
)N %UROPE EFFORTS ARE BEING MADE TO IMPROVE
CAR TO CAR COMPATIBILITY IN FRONT TO FRONT AND SIDE
TO FRONT CRASHES 4HE FRONTS OF MANY NEW CARS
ARE CAPABLE OF ABSORBING THEIR OWN KINETIC ENERGY
IN CRASHES BUT NO COUNTRY HAS LEGISLATION REQUIR
ING THAT CARS BE CAPABLE OF ABSORBING THE KINETIC
ENERGY OF DIFFERENT MODELS OF CAR 4HUS STRONGER
MORE MASSIVE CARS CRUSH WEAKER LESS MASSIVE ONES
IN CRASHES
/F GREATER CONCERN IN MOST LOW INCOME AND
MIDDLE INCOME COUNTRIES ARE CAR TO TRUCK AND CAR
TO BUS COLLISIONS (IGH INCOME COUNTRIES
HAVE ADDRESSED SOME OF THIS CONCERN BY REQUIRING
REAR AND SIDE UNDER RUN GUARDS ON TRUCKS PREVENT
ING UNDER RUNNING BY CARS AND AT THE SIDES BY BI
CYCLES 0ROVIDING ENERGY ABSORBING FRONT REAR AND
SIDE UNDER RUN PROTECTION CAN REDUCE DEATHS BY
AN ESTIMATED IN CRASHES INVOLVING TRUCKS AND
LIGHTER VEHICLES
)MPROVING BICYCLE DESIGN
"ICYCLES SHOW LARGE DIFFERENCES IN COMPONENT
STRENGTH AND THE RELIABILITY OF BRAKES AND LIGHTING
!BOUT THREE QUARTERS OF CRASHES INVOLVING CYCLISTS IN
THE .ETHERLANDS INVOLVE FEET BEING TRAPPED IN THE
WHEEL SPOKES AND OF CYCLES HAVE NO PROTECTION
SYSTEM TO PREVENT THIS
$ESIGNING SMART VEHICLES
.EW TECHNOLOGIES ARE OPENING NEW OPPORTUNITIES
FOR ROAD SAFETY 3OME OF THE MORE PROMISING RECENT
DEVELOPMENTS ARE
s 7/2,$ 2%0/24 /. 2/!$ 42!&&)# ).*529 02%6%.4)/. 35--!29
s 3MART AUDIBLE SEAT BELT REMINDERS THAT DETECT
WHETHER OR NOT BELTS ARE IN USE IN EACH OC
CUPIED SEAT AND EMIT INCREASINGLY AGGRESSIVE
WARNING SIGNALS UNTIL BELTS ARE FASTENED
)N 3WEDEN FOR EXAMPLE OF ALL NEW CARS
SOLD ARE EQUIPPED WITH THESE !LTHOUGH
3WEDEN ALREADY HAS HIGH RATES OF SEAT BELT USE
THESE REMINDERS COULD BOOST THE RATE TO AN ESTI
MATED AND CONTRIBUTE TO A REDUCTION
IN DEATHS AMONG CAR OCCUPANTS
s )NTELLIGENT SPEED ADAPTATION IS A SYSTEM BY
WHICH THE VEHICLE DETERMINES THE SPEED LIMIT
FOR A ROAD #URRENT VERSIONS USE A DIGITAL ROAD
MAP ONTO WHICH SPEED LIMITS HAVE BEEN CODED
)NTERVENTION LEVELS CAN BE SET TO ADVISORY IN
FORMING THE DRIVER OF LIMITS AND VIOLATIONS
VOLUNTARY THE SYSTEM IS LINKED TO THE CONTROLS
BUT THE DRIVER CAN ENABLE OR DISABLE THE LINK
OR MANDATORY THE DRIVER CANNOT OVERRIDE THE
SYSTEMS CONTROL 4HE SYSTEM COULD REDUCE
FATAL CRASHES BY AN ESTIMATED n AT THE
ADVISORY LEVEL n AT THE VOLUNTARY LEVEL
AND n AT THE MANDATORY LEVEL %X
PERIMENTAL TRIALS IN 3WEDEN INDICATE HIGH DRIV
ER ACCEPTANCE OF SUCH A SYSTEM IN URBAN AREAS
s !LCOHOL IGNITION INTERLOCK SYSTEMS DETECT AL
COHOL ON THE BREATH OF DRIVERS PREVENTING
THEM FROM STARTING THEIR MOTOR VEHICLES -ANY
STATES IN THE 5NITED 3TATES AND SOME PROVINCES
IN #ANADA NOW HAVE LAWS REQUIRING THAT SUCH
SYSTEMS BE INSTALLED IN CARS OWNED BY REPEAT
VIOLATORS OF LAWS PERTAINING TO DRIVING WHILE
UNDER THE INmUENCE OF ALCOHOL )N 3WEDEN TWO
MAJOR MANUFACTURERS ARE OFFERING THE SYSTEMS
AS STANDARD EQUIPMENT IN TRUCKS AND MORE
THAN TRUCKS NOW HAVE THEM INSTALLED
s %LECTRONIC STABILITY PROGRAMMES CAN HELP MAIN
TAIN THE STABILITY OF A CAR IN ADVERSE WEATHER
CONDITIONS PREVENTING SKIDDING AND LOSS OF
CONTROL ON WET ROADS AND ICE %LECTRONIC STA
BILITY PROGRAMMES ARE BEING OFFERED ONLY IN
LUXURY VEHICLES BUT RECENT TESTS IN 3WEDEN IN
DICATE THAT THEY COULD REDUCE CRASHES RELATED TO
ICE AND SNOW BY n
3ETTING ROAD SAFETY RULES AND
SECURING COMPLIANCE
2ISK OF INJURY FROM LACK OF RULES AND
ENFORCEMENT
$RIVING AT EXCESS OR INAPPROPRIATE SPEEDS WHILE
UNDER THE INmUENCE OF ALCOHOL WHILE SLEEPY OR FA
TIGUED AND WITHOUT PROTECTIVE GEAR SUCH AS SEAT
BELTS CHILD RESTRAINTS AND HELMETS FOR ALL VEHICLE
OCCUPANTS ARE MAJOR CONTRIBUTORS TO ROAD CRASHES
DEATHS AND SERIOUS INJURIES ,AWS ALONE ARE NOT
ENOUGH TO DISCOURAGE THESE ERRORS %NFORCED COM
PLIANCE IS THE KEY )N THE %UROPEAN 5NION IMPROV
ING ENFORCEMENT OF CURRENT LAWS COULD REDUCE THE
NUMBER OF ROAD TRAFlC DEATHS AND SERIOUS INJURIES
BY AN ESTIMATED
!N EXTENSIVE REVIEW OF INTERNATIONAL EXPERIENCE
WITH ENFORCEMENT CONCLUDED AS FOLLOWS
s #REATING A MEANINGFUL DETERRENT IS CRITICAL
s %NFORCEMENT LEVELS NEED TO BE HIGH AND MAIN
TAINED SO THE PERCEIVED RISK OF APPREHENSION IS
HIGH
s !PPREHENSION MUST BE FOLLOWED BY SWIFT AD
MINISTRATION OF PENALTIES
s !UTOMATED ENFORCEMENT n SUCH AS CAMERAS TO
CATCH SPEEDERS n IS MOST EFFECTIVE
s 0UBLIC EDUCATION WITHOUT ENFORCEMENT HAS
NEGLIGIBLE EFFECT BUT COMBINED WITH ENFORCE
MENT INCREASES COMPLIANCE WITH LAWS
3ETTING AND ENFORCING SPEED LIMITS
2ISK POSED BY SPEED
4HE HIGHER THE SPEED THE SHORTER THE TIME A DRIVER
HAS TO STOP AND AVOID A CRASH 4HE HIGHER THE SPEED
THE MORE SEVERE THE IMPACT IS WHEN A CRASH OCCURS
4HE PROBABILITY THAT A CRASH WILL RESULT IN INJURY IS
PROPORTIONAL TO THE SQUARE OF THE SPEED FOR SERIOUS
INJURY PROPORTIONAL TO THE CUBE OF THE SPEED AND
FOR FATAL INJURY PROPORTIONAL TO THE FOURTH POWER OF
THE SPEED
6ULNERABLE ROAD USERS OUTSIDE MOTOR VEHICLES
ARE AT ESPECIALLY HIGH RISK OF INJURY FROM SPEEDING
MOTOR VEHICLES 4HE PROBABILITY OF A PEDESTRIAN DY
ING AS A RESULT OF A CAR CRASH INCREASES EXPONENTIALLY
AS THE SPEED OF THE CAR INCREASES &IGURE
/LDER PEDESTRIANS ARE MORE VULNERABLE THAN
YOUNGER ONES 4HE PROBABILITY THAT A PEDESTRIAN
2)3+ &!#4/23 !.$ ).4%26%.4)/.3 s
GOVERNORS IN BUSES MINIBUSES AND TRUCKS TRAVELLING
ON THE RURAL ROADS OF LOW
INCOME AND MIDDLE
IN
COME COUNTRIES COULD CONTRIBUTE EVEN MORE
&)'52%
0EDESTRIAN FATALITY RISK AS A FUNCTION OF THE IMPACT
SPEED OF A CAR
3ETTING AND ENFORCING ALCOHOL LIMITS
2ISK POSED BY ALCOHOL
3OURCE REPRODUCED FROM REFERENCE WITH THE PERMISSION OF THE
PUBLISHER
AGED YEARS OR MORE WILL BE KILLED BY A CAR GOING
KMH IS MORE THAN VERSUS FOR A PEDES
TRIAN YOUNGER THAN AGE YEARS
3PEED LIMITS
3PEED LIMITS THAT ROAD USERS PERCEIVE AS REALISTIC
AND THOSE THAT ARE SELF ENFORCING HAVE THE GREATEST
CHANCE FOR ACHIEVING COMPLIANCE 4HE LAYOUT OF ROAD
NETWORKS AND THE DESIGN OF ROADS AS DISCUSSED EAR
LIER CAN MAKE DRIVERS UNCOMFORTABLE WITH EXCEED
ING SPEED LIMITS
3PEED CAMERAS OR RADAR CAN CATCH DRIVERS WHO ARE
EXCEEDING SPEED LIMITS ! RECENT ANALYSIS OF EXPERI
ENCE IN SEVERAL COUNTRIES FOUND THAT INSTRU
MENTS THAT AUTOMATICALLY CATCH DRIVERS REDUCED ROAD
TRAFlC DEATHS AND SERIOUS INJURIES BY WHEREAS
ENFORCEMENT BY POLICE OFlCERS ACHIEVED A REDUC
TION 0UBLICIZING THE PRESENCE OF SPEED CAMERAS OR
RADAR HAS BEEN FOUND TO INCREASE COMPLIANCE WITH
SPEED LAWS AND TO REDUCE THE INCIDENCE OF CRASH AND
INJURY SUBSTANTIALLY n
.EVERTHELESS AN EARLIER STUDY IN 4ASMANIA !US
TRALIA FOUND THAT THE LONG TERM PLACEMENT OF
STATIONARY POLICE VEHICLES ON EACH OF THREE HIGH
RISK STRETCHES OF A RURAL ROAD ACHIEVED AN AVERAGE
KMH REDUCTION IN SPEED AND A REDUCTION IN
CRASHES RESULTING IN DEATH OR SERIOUS INJURY
3PEED LIMITING DEVICES BUILT INTO VEHICLES ARE ALSO
EFFECTIVE 3PEED LIMITING GOVERNORS IN HEAVY GOODS
VEHICLES COULD REDUCE THE INCIDENCE OF ROAD TRAFlC
INJURY BY AN ESTIMATED 2EQUIRING SPEED
,IKE SPEED ALCOHOL CONSUMPTION INCREASES THE PROB
ABILITY BOTH THAT A CRASH WILL OCCUR AND THAT DEATH OR
SERIOUS INJURY WILL RESULT
-AKING COMPARISONS IS DIFlCULT BECAUSE LEGAL
"!# LIMITS AND ENFORCEMENT VARY SO MUCH FROM
COUNTRY TO COUNTRY .EVERTHELESS SEVERAL STUD
IES INDICATE THE EXTENT OF DRIVING WHILE UNDER THE
INmUENCE OF ALCOHOL ! REVIEW OF SURVEYS DONE IN
%UROPEAN 5NION COUNTRIES FOUND THAT n
OF DRIVERS WERE UNDER THE INmUENCE DEPENDING ON
THE COUNTRY 3URVEYS IN #ROATIA FOUND THAT OVER
OF DRIVERS WERE INTOXICATED ! STUDY IN 'HANA
FOUND THAT THE "!# OF MORE THAN OF DRIV
ERS EXCEEDED GDL
! SURVEY OF STUDIES IN LOW
INCOME AND MIDDLE
INCOME COUNTRIES FOUND THAT BLOOD ALCOHOL WAS
PRESENT IN n OF FATALLY INJURED DRIVERS AND IN
n OF DRIVERS INVOLVED IN CRASHES BUT NOT FATALLY
INJURED 3TUDIES IN 3OUTH !FRICA FOUND
THAT ALCOHOL WAS A FACTOR IN OF DRIVER DEATHS AND
OF CRASHES IN WHICH DRIVERS WERE NOT KILLED
EXCESS ALCOHOL WAS PRESENT IN OF THE PEOPLE
WITH TRAUMA INVOLVED IN ROAD CRASHES )N .EW
$ELHI )NDIA A STUDY FOUND THAT ONE THIRD OF
MOTORIZED TWO
WHEELER RIDERS TAKEN TO HOSPITAL AD
MITTED TO RIDING UNDER THE INmUENCE OF ALCOHOL
0EDESTRIANS TOO PUT THEMSELVES AT GREATER RISK OF
ROAD TRAFlC INJURY WHEN THEY CONSUME TOO MUCH
ALCOHOL ! SURVEY OF STUDIES IN !USTRALIA
FOUND THAT THE "!# OF n OF PEDESTRIANS DY
ING IN ROAD CRASHES EXCEEDED GDL ! STUDY IN
3OUTH !FRICA FOUND THAT ALCOHOL WAS INVOLVED
IN MORE THAN OF PEDESTRIAN FATALITIES ! RECENT
STUDY IN THE 5NITED +INGDOM CONCLUDED THAT
OF PEDESTRIANS KILLED IN ROAD TRAFlC COLLISIONS
HAD BEEN DRINKING
"LOOD ALCOHOL CONCENTRATION LIMITS
)N THE 'RAND 2APIDS STUDY SHOWED HOW
THE CRASH RISK INCREASED WITH THE AMOUNT OF ALCOHOL
s 7/2,$ 2%0/24 /. 2/!$ 42!&&)# ).*529 02%6%.4)/. 35--!29
#$# $ # % &%!(#!
CONSUMED BY DRIVERS AND PROVIDED &)'52%
THE BASIS FOR THE GDL "!# STILL 2ELATIVE RISK OF DRIVER INVOLVEMENT IN POLICE REPORTED CRASHES
ACCEPTED AS THE LIMIT IN MANY COUN
TRIES 3UBSEQUENT STUDIES n
HAVE FOUND THAT EVEN LOWER LEVELS IN
CREASE THE RISK OF CRASH &IGURE
5PPER "!# LIMITS OF GDL FOR
MATURE DRIVERS OF FOUR WHEELED VEHI
! "%! % !$ !' %(%
CLES ARE NOW COMMON IN %UROPE )N
THE 5NITED 3TATES THE STATES SET THEIR
OWN LIMITS THEY VARY FROM TO
GDL ! REVIEW OF THE EXPERI
!# $% % $!"
ENCE IN STATES FOUND THAT THE
STATES WITH THE LOWER LIMIT HAD
FEWER ALCOHOL RELATED VEHICLE CRASHES
!! !! ! %#% !
5GANDAS LIMIT IS GDL
3OURCE REFERENCES n
-ANY %UROPEAN COUNTRIES AND
MANY STATES IN THE 5NITED 3TATES SET A
"!# LIMIT OF GDL FOR YOUNG DRIV
JURISDICTIONS 3OME ALLOW THE POLICE TO STOP ONLY
ERS GENERALLY UNDER YEARS IN THE 5NITED 3TATES OBVIOUSLY IMPAIRED DRIVERS 3OME ALLOW ROADBLOCKS
AND FOR ALL RIDERS OF MOTORIZED TWO WHEELERS 3OME OR SOBRIETY CHECKPOINTS AND TESTING ONLY OF THOSE
SET THE LOWER LIMIT FOR ALL NEWLY LICENSED DRIVERS ! SUSPECTED OF IMPAIRMENT /THERS ALLOW STOPPING
REVIEW OF PUBLISHED STUDIES FOUND THAT LIMITS DRIVERS AT RANDOM AND TESTING EVERYONE STOPPED
OF BETWEEN AND GDL CAN REDUCE THE RATE OF
7IDESPREAD RANDOM BREATH TESTING n APPLIED TO
CRASHES FOR YOUNG OR NOVICE DRIVERS BY n
AT LEAST IN DRIVERS EVERY YEAR n ACHIEVES THE
HIGHEST COMPLIANCE WITH LAWS SETTING "!# LIMITS
%NFORCING BLOOD ALCOHOL CONCENTRATION LIMITS
%NFORCEMENT SHOULD BE UNPREDICTABLE AS TO TIME
AND PUBLICIZING ENFORCEMENT
AND PLACE SO DRIVERS CANNOT AVOID BEING TESTED
2ESEARCH n HAS SHOWN THAT THE PERCEIVED 4HREE STATES IN !USTRALIA HAVE REDUCED THEIR RATES OF
RISK OF BEING CAUGHT IS CONSIDERABLY MORE EFFECTIVE ALCOHOL RELATED ROAD TRAFlC DEATHS BY n WITH
THAN THE SEVERITY OF THE PENALTY IN DISCOURAGING DRIV
INTENSIVE RANDOM BREATH TESTING COVERING ANYWHERE
ING WHILE UNDER THE INmUENCE OF ALCOHOL .EVERTHE
FROM ONE THIRD TO THREE QUARTERS OF DRIVERS
LESS BOTH THE PERCEPTION OF THE RISK OF BEING CAUGHT
%NFORCEMENT IS MOST EFFECTIVE AT REDUCING THE
AND THE ACTUAL LIKELIHOOD ARE LOW IN MOST COUNTRIES FREQUENCY OF DRIVING WITH "!# EXCEEDING LEGAL LIM
! RECENT SURVEY IN 4HAILAND FOUND THAT MORE ITS IF IT IS ACCOMPANIED BY MASS MEDIA CAMPAIGNS
THAN OF RESPONDENTS CONSIDERED THEIR CHANCES THAT INCREASE PUBLIC PERCEPTION OF THE RISK OF BEING
OF BEING STOPPED BY THE POLICE FOR "!# TESTING VERY CAUGHT REDUCE PUBLIC ACCEPTANCE OF DRINKING AND
LOW BUT MORE THAN AGREED THAT ENFORCING "!# DRIVING AND INCREASE PUBLIC ACCEPTANCE OF ENFORCE
LIMITS WAS BENElCIAL
MENT
"REATH TESTING DEVICES THAT PROVIDE OBJECTIVE EVI
)N GENERAL HARSH PENALTIES SUCH AS IMPRISON
DENCE OF "!# ARE THE MOST EFFECTIVE ENFORCEMENT MENT DESPITE BEING TRIED IN SEVERAL HIGH INCOME
TOOL !LTHOUGH THEY ARE USED IN MOST HIGH INCOME COUNTRIES HAVE NOT BEEN FOUND TO DETER PEOPLE
COUNTRIES THEY ARE NOT USED IN MOST LOW INCOME AND FROM DRIVING AFTER DRINKING -ORE EFFECTIVE IS
MIDDLE INCOME COUNTRIES )N ANY CASE THE DETERRENT SWIFT AND CERTAIN PUNISHMENT SUCH AS DISQUALIlCA
EFFECT OF BREATH TESTING DEPENDS ON THE LAWS GOV
TION FROM DRIVING AFTER FAILING A BREATH TEST OR REFUS
ERNING THEIR USE 0OLICE POWERS VARY AMONG ING TO SUBMIT TO A TEST 4HERE IS ALSO EVIDENCE
2)3+ &!#4/23 !.$ ).4%26%.4)/.3 s
THAT REQUIRING HIGH
RISK OFFENDERS THOSE WITH "!#
EXCEEDING GDL TO TAKE DRIVER REHABILITATION
COURSES CAN REDUCE THE RATE OF REPEAT OFFENCES
-EDICINAL AND RECREATIONAL DRUGS
4HE EFFECTS OF DRUGS ON DRIVING PERFORMANCE AND
CRASH INVOLVEMENT ARE MUCH LESS WELL UNDERSTOOD
THAN THOSE OF ALCOHOL LARGELY BECAUSE SO MANY DIF
FERENT DRUGS ARE USED IN VARYING DOSES AND COMBI
NATIONS ALL WITH DIFFERING EFFECTS ON DIFFERENT IN
DIVIDUALS $RIVERS WITH MEDICAL CONDITIONS FOR EX
AMPLE MAY DRIVE MORE SAFELY WHEN TAKING CERTAIN
MEDICINAL DRUGS THAN WHEN NOT TAKING THEM
4HERE IS NO STRONG EVIDENCE THAT THE USE OF MEDICI
NAL DRUGS AND DRIVING CONSTITUTES A SIGNIlCANT ROAD
CRASH RISK
(OWEVER THERE IS EVIDENCE FOR THE INCREASING USE
AMONG DRIVERS OF MANY PSYCHOACTIVE DRUGS BOTH
MEDICINAL AND RECREATIONAL OFTEN IN CONJUNCTION
WITH ALCOHOL 2ESEARCH ON THIS SUBJECT
IS URGENTLY NEEDED -EANWHILE RECENT STUDIES IN
&RANCE AND THE 5NITED +INGDOM HAVE
FOUND REDUCED DRIVER CAPABILITY WHEN CANNABIS
AND ALCOHOL ARE USED IN COMBINATION AND A HIGHER
PREVALENCE OF THE COMBINATION IN DRIVERS INVOLVED
IN ROAD CRASHES THAN IN OTHER DRIVERS
!DDRESSING THE PROBLEM OF DRIVER FATIGUE
! RECENT STUDY IN .EW :EALAND FOUND THAT THE
INCIDENCE OF ROAD CRASHES COULD BE REDUCED BY UP TO
IF PEOPLE DID NOT DRIVE WHILE FEELING SLEEPY
AFTER SLEEPING FOR LESS THAN lVE HOURS IN THE PRE
VIOUS HOURS OR BETWEEN AND
!N EARLIER STUDY IN THE 5NITED 3TATES IDEN
TIlED THREE GROUPS OF DRIVERS AT HIGH RISK OF BEING
INVOLVED IN CRASHES WHILE FATIGUED YOUNG PEOPLE
ESPECIALLY MEN AGED n YEARS SHIFT WORKERS
WHO WORK AT NIGHT OR HAVE LONG IRREGULAR WORKING
HOURS AND PEOPLE WITH UNTREATED SLEEP APNOEA OR
NARCOLEPSY
!NOTHER STUDY IDENTIlED ALL OF THESE AND
OTHER FACTORS CONTRIBUTING TO FATIGUE AND CRASH IN
VOLVEMENT INCLUDING DRIVING LONG DISTANCES UN
DER PRESSURE ON MONOTONOUS ROADS ON UNFAMILIAR
ROADS AFTER CONSUMING ALCOHOL IN EXTREME WEATHER
DURING HOURS WHEN NORMALLY ASLEEP AFTER POOR
QUALITY SLEEP AND DURING PERIODS OF THE DAY SUCH
AS IN THE AFTERNOON WHEN THE DRIVER NORMALLY FEELS
DROWSY
3EVERAL STUDIES HAVE FOUND FATIGUE TO BE ESPE
CIALLY FREQUENT AMONG COMMERCIAL DRIVERS 3URVEYS
IN LOW INCOME AND MIDDLE INCOME COUNTRIES
HAVE REVEALED THAT TRANSPORT COMPANY
OWNERS FREQUENTLY FORCE THEIR DRIVERS TO WORK LONG
HOURS TO WORK WHEN EXHAUSTED AND TO DRIVE AT EX
CESSIVE SPEEDS 3TUDIES IN THE 5NITED 3TATES
HAVE FOUND THAT FATIGUE WAS A FACTOR IN OF FATAL
CRASHES INVOLVING HEAVY COMMERCIAL VEHICLES AND IN
OF ALL SINGLE VEHICLE CRASHES INVOLVING TRUCKS
)N THE LATTER CASE OF THE DRIVERS ADMITTED HAV
ING FALLEN ASLEEP
-ANY HIGH INCOME COUNTRIES HAVE LAWS RESTRICT
ING THE NUMBER OF HOURS COMMERCIAL DRIVERS CAN
DRIVE AT A STRETCH BUT THE EFFECTIVENESS OF SUCH RE
STRICTIONS BY THEMSELVES IS QUESTIONABLE %VIDENCE
SUGGESTS THAT THE TIME OF DAY WHEN COMMERCIAL
DRIVING TAKES PLACE IS MORE PERTINENT AND ALSO
THAT CHANGING SHIFTS OF WORK CAN RESULT IN INCREASED
SLEEP DEBT AND DIFlCULTIES IN ADAPTING TO CIRCADIAN
RHYTHMS 2ESEARCH SUGGESTS THAT LAWS
SHOULD BE GUIDED BY THE FOLLOWING CONSIDERATIONS
THE RISK OF BEING INVOLVED IN CRASHES DOUBLES AFTER
HOURS OF DRIVING THE RISK OF FATIGUE RELATED CRASHES
IS TIMES GREATER AT NIGHT THAN DURING THE DAY AND
ADEQUATE TIME AND FACILITIES SHOULD BE PROVIDED TO
ALLOW BREAKS FOR REST MEALS AND NAPS
2EDUCING THE RISK OF JUNCTION CRASHES
*UNCTION CRASHES ARE A LEADING SOURCE OF ROAD TRAF
lC INJURY )MPROVING JUNCTION LAYOUT AND DESIGN
n FOR EXAMPLE REPLACING SIGNAL CONTROLLED JUNCTIONS
WITH ROUNDABOUTS n CAN REDUCE THE RISK OF JUNCTION
CRASHES ! HIGHLY COST EFFECTIVE MEASURE IS TO INSTALL
CAMERAS THAT TAKE PHOTOGRAPHS OF VEHICLES GOING
THROUGH TRAFlC LIGHTS WHEN SIGNALS ARE RED
)N !USTRALIA INSTALLING RED LIGHT CAMERAS REDUCED
THE TOTAL NUMBER OF ROAD CRASHES BY AND
AT TREATED SITES )N /XNARD #ALIFORNIA INSTALL
ING RED LIGHT CAMERAS YIELDED A REDUCTION IN
CRASHES WITH INJURY AND A REDUCTION IN FRONT
INTO SIDE CRASHES WITH INJURY AT TREATED SITES
s 7/2,$ 2%0/24 /. 2/!$ 42!&&)# ).*529 02%6%.4)/. 35--!29
2EQUIRING SEAT
BELTS AND CHILD RESTRAINTS
3EAT
BELTS
-ANDATORY SEAT
BELT USE HAS BEEN ONE OF THE GREAT
EST SUCCESS STORIES OF ROAD INJURY PREVENTION AND HAS
SAVED MANY LIVES 3EAT
BELTS WERE INTRODUCED AS OP
TIONAL FEATURES IN NEW CARS IN THE S 4HEY SOON
PROVED SO SUCCESSFUL AT REDUCING THE INCIDENCE OF
FATAL AND SERIOUS INJURY THAT IN THE STATE OF
6ICTORIA !USTRALIA LED THE WAY IN PASSING LAWS TO
REQUIRE THEIR PRESENCE AND USE IN ALL CARS "Y THE
END OF THAT YEAR THE RATE OF OCCUPANT DEATHS IN CAR
CRASHES HAD DECLINED BY /THER COUNTRIES
FOLLOWED SUIT AND HAVE SINCE FOUND THAT IMPROVED
ENFORCEMENT AND COMPLIANCE CAN ACHIEVE EVEN BET
TER RESULTS
3EVERAL STUDIES ON THE BENElTS OF
SEAT
BELTS FOR DRIVERS AND FRONT
SEAT PASSENGERS HAVE
FOUND THAT SEAT
BELTS CAN REDUCE THE RISK OF ALL IN
JURIES BY n OF SERIOUS INJURIES BY n
AND OF FATAL INJURIES BY n 4ABLE SHOWS THEIR
EFFECTIVENESS IN VARIOUS TYPES OF CRASH 4HEY ARE FOR
EXAMPLE HIGHLY EFFECTIVE IN FRONTAL CRASHES WHICH
ARE THE MOST COMMON KIND OF CRASH AND OFTEN RESULT
IN SERIOUS HEAD INJURIES 4HEIR EFFECTIVENESS
FOR PEOPLE IN FRONT SEATS IS REDUCED IF PASSENGERS IN
REAR SEATS ARE NOT ALSO WEARING SEAT
BELTS OR IF THERE
ARE UNRESTRAINED OBJECTS SUCH AS LUGGAGE IN REAR
SEATS
BELTS ! RECENT STUDY IN !RGENTINA FOUND THAT
OF DRIVERS AND FRONT
SEAT PASSENGERS USED SEAT
BELTS IN "UENOS !IRES AND ON NATIONAL HIGH
WAYS ! STUDY OF %UROPEAN 5NION COUNTRIES IN THE
MID
S FOUND FRONT
SEAT USE OF SEAT
BELTS
OF n AND REAR
SEAT USE OF n 5SE OF SEAT
BELTS IN FRONT SEATS IN THE 5NITED 3TATES ROSE FROM
IN TO IN &OLLOWING A
NATIONAL CAMPAIGN OF POLICE ENFORCEMENT AND IN
CREASED lNES IN THE 2EPUBLIC OF +OREA RATES OF SEAT
BELT USE AMONG DRIVERS ROSE TO IN
%XPERIENCE HAS SHOWN THAT SELECTIVE TRAFlC EN
FORCEMENT PROGRAMMES WORK BEST TO INCREASE COM
PLIANCE WITH SEAT
BELT LAWS 4HESE INVOLVE WELL
PUB
LICIZED HIGHLY VISIBLE AND INTENSIVE ENFORCEMENT
OVER PARTICULAR PERIODS SEVERAL TIMES PER YEAR
)N PROVINCES IN &RANCE AND THE .ETHERLANDS
COMPLIANCE WITH SEAT
BELT LAWS INCREASED BY ABOUT
n WITHIN ONE YEAR OF IMPLEMENTING SUCH A
PROGRAMME )N 3ASKATCHEWAN #ANADA
OF DRIVERS AND OF PASSENGERS COMPLIED WITH
SEAT
BELT LAWS IN &IGURE )MPLEMENTA
TION OF A SELECTIVE TRAFlC ENFORCEMENT PROGRAMME
HAD PRODUCED COMPLIANCE BY
!NOTHER EFFECTIVE APPROACH INVOLVES INCENTIVES IN
WHICH PEOPLE FOUND WEARING SEAT
BELTS ARE ELIGIBLE
FOR PRIZES IN MUCH THE SAME WAY THEY MIGHT BE IN A
LOTTERY
4!",%
#HILD RESTRAINTS
)NJURY REDUCTION EFFECTS OF SEAT
BELTS FOR VARIOUS TYPES
OF CAR CRASH
#HILD RESTRAINTS WORK IN THE SAME WAY AS SEAT
BELTS
! STUDY IN THE 5NITED 3TATES FOUND THAT CHILD
RESTRAINTS REDUCE THE DEATH RATES IN CAR CRASHES BY
AMONG INFANTS AND BY AMONG YOUNG
CHILDREN
6ARIOUS MODELS ARE APPROPRIATE FOR CHILDREN OF
DIFFERENT AGES &OR INFANTS AGED n MONTHS WEIGH
ING UP TO KG FORWARD
FACING CHILD RESTRAINTS RE
DUCE ALL INJURIES BY AND SEVERE INJURIES BY
BUT REAR
FACING CHILD RESTRAINTS REDUCE ALL INJURIES BY
AND SEVERE INJURIES BY 2EAR
FACING
RESTRAINTS OPTIMALLY DISTRIBUTE ANY FORCE OF IMPACT
OVER INFANTS BACKS AND HEADS !S DISCUSSED PREVI
OUSLY PLACING SUCH SEATS IN FRONT OF AIR BAGS IS DAN
GEROUS UNLESS THE AIR BAG MECHANISM CAN AUTOMATI
CALLY DETECT SUCH A SEAT AND SWITCH IT OFF
#RASH TYPE
0ROPORTION OF ALL
CRASHES
$RIVER SEAT
BELT EFFEC
TIVENESS IN DIFFERENT
CRASH TYPES
&RONTAL
3TRUCK SIDE
.ON STRUCK SIDE
2EAR
2OLL OVER
3OURCE REPRODUCED FROM REFERENCE WITH THE PERMISSION OF THE
PUBLISHER
2ATES OF SEAT
BELT USE VARY FROM COUNTRY TO COUN
TRY DEPENDING ON THE EXISTENCE AND ENFORCEMENT OF
LAWS ! SURVEY IN +ENYA FOUND THAT ONLY OF
CAR OCCUPANTS INJURED IN CRASHES WERE WEARING SEAT
2)3+ &!#4/23 !.$ ).4%26%.4)/.3 s
&)'52%
5SE OF SEAT BELTS BY CAR DRIVERSFRONT SEAT PASSENGERS
IN 3ASKATCHEWAN #ANADA n
!
3OURCE REFERENCE
&OR CHILDREN AGED n MONTHS WEIGHING n KG
FORWARD
FACING CHILD RESTRAINTS ARE APPROPRIATE &OR
OLDER CHILDREN UP TO AGE YEARS BOOSTER CUSHIONS
OF APPROPRIATE THICKNESS CAN BE USED IN CONJUNCTION
WITH REGULAR SEAT
BELTS
!LTHOUGH CURRENT MODELS OF CHILD RESTRAINTS ARE
EFFECTIVE THERE IS ROOM FOR IMPROVEMENT ! STUDY
IN 3WEDEN FOUND THAT OF FATAL CAR CRASH INJURIES
AMONG CHILDREN UNDER YEARS RESULTED FROM SIDE
IMPACT IN WHICH CURRENT MODELS OF CHILD RESTRAINTS
ARE LESS EFFECTIVE %URO.#!0 HAS FOUND THAT
CURRENT RESTRAINTS DO NOT FULLY CONSTRAIN THE MOVE
MENT OF CHILDRENS HEADS
#HILD RESTRAINTS ARE COMMON IN HIGH
INCOME
COUNTRIES n USAGE RATES ARE IN !USTRALIA AND
IN THE 5NITED 3TATES n BUT RARE IN LOW
INCOME
AND MIDDLE
INCOME COUNTRIES #OST IS AN ISSUE EVEN
IN HIGH
INCOME COUNTRIES WHERE CHILD RESTRAINT
LOAN PROGRAMMES ARE COMMON 5NDER THESE PRO
GRAMMES FOR A SMALL FEE OR NO CHARGE PARENTS CAN
BORROW INFANT SEATS FROM MATERNITY HOSPITALS ! FUR
THER BENElT OF SUCH SCHEMES IS THEIR EDUCATIONAL
VALUE WITH THE OPPORTUNITY TO ADVISE PARENTS ON THE
VALUE OF THE INFANT SEATS AND HOW TO USE THEM
)N THE ABSENCE OF CHILD RESTRAINTS PARENTS SHOULD
BE ADVISED NOT TO CARRY CHILDREN ON THEIR LAPS WHERE
CHILDREN ARE LIKELY TO BE CRUSHED IN CRASHES
2EQUIRING HELMETS ON TWO
WHEELERS
(EAD INJURIES ARE THE MAIN CAUSE OF DEATH AMONG
THE RIDERS OF ALL TWO
WHEELERS (ELMETS PROTECT VERY
EFFECTIVELY AGAINST SUCH INJURIES
-OTORIZED TWO
WHEELERS
!MONG MOPED AND MOTORCYCLE RIDERS HEAD INJURIES
ACCOUNT FOR ABOUT OF DEATHS IN %UROPE
AND n IN -ALAYSIA /NE STUDY
FOUND THAT RIDERS WITHOUT HELMETS WERE THREE TIMES
MORE LIKELY TO SUSTAIN HEAD INJURIES THAN THOSE WITH
HELMETS !NOTHER FOUND THAT HELMETS REDUCED
FATAL AND SERIOUS HEAD INJURIES BY n
! STUDY IN )NDIA FOUND THAT MOTORCYCLISTS
BENElTED FROM ANY TYPE OF HELMET WITH PADDING
WHEREAS A STUDY IN THE 5NITED 3TATES FOUND
THAT THE NON
STANDARD HELMETS USED BY HALF OF ALL
MOTORCYCLISTS PRODUCED MORE FREQUENT HEAD INJURIES
THAN NOT WEARING A HELMET AT ALL -OST HIGH
INCOME
COUNTRIES SET STANDARDS AND A RECENT STUDY RE
VIEWED THESE FOR THEIR EFFECTIVENESS )N LOW
INCOME
AND MIDDLE
INCOME COUNTRIES DEVELOPING STANDARDS
THAT ARE SENSITIVE TO LOCAL MANUFACTURING CAPABILITIES
COST AND COMFORT FOR LOCAL CLIMATES IS MOST PRACTICAL
&OR EXAMPLE THE !SIA )NJURY 0REVENTION &OUNDATION
HAS DEVELOPED A LIGHTWEIGHT TROPICAL HELMET SUITABLE
FOR 6IET .AM AND HELMETS SUITABLE FOR CHILDREN ARE
NOW BEING DEVELOPED IN -ALAYSIA
,ESS THAN OF MOTORCYCLISTS WEAR HELMETS IN
MOST COUNTRIES THAT DO NOT REQUIRE THE USE OF HEL
METS BY LAW !LTHOUGH HELMETS HAVE GENERALLY
BEEN WIDELY WORN IN MOST HIGH
INCOME COUNTRIES
THERE IS SOME EVIDENCE OF A DECLINE )N THE 5NITED
3TATES HELMET USE FELL FROM IN TO IN
"ICYCLES
7EARING HELMETS AMONG CHILD CYCLISTS INVOLVED IN
CRASHES REDUCED THEIR INCIDENCE OF HEAD INJURY BY
AND OF LOSS OF CONSCIOUSNESS BY
!LTHOUGH !USTRALIA .EW :EALAND 3WEDEN THE
5NITED 3TATES AND SEVERAL OTHER COUNTRIES HAVE LAWS
REQUIRING THAT CYCLISTS WEAR HELMETS THE WORLDWIDE
PROPORTION OF BICYCLE HELMET USE IS LOW ! CONCERN IS
THAT REQUIRING HELMETS COULD DISCOURAGE PEOPLE FROM
PARTICIPATING IN HEALTHY CYCLING EVEN THOUGH THERE
s 7/2,$ 2%0/24 /. 2/!$ 42!&&)# ).*529 02%6%.4)/. 35--!29
IS ABUNDANT EVIDENCE THAT BICYCLE HELMETS PREVENT
THOUSANDS OF DEATHS AND SERIOUS INJURIES EVERY YEAR
)N THE STATE OF 6ICTORIA !USTRALIA A NEW LAW REQUIRING
HELMETS IN INCREASED THE USE OF HELMETS FROM
TO WITHIN ONE YEAR AND WAS ASSOCIATED WITH
A REDUCTION IN HEAD INJURIES TO CYCLISTS
"ANNING DRIVERS FROM USING HAND HELD
MOBILE PHONES
/VER THE PAST YEARS HAND HELD MOBILE TELE
PHONES HAVE EMERGED AS A ROAD SAFETY PROBLEM )N
THE 5NITED 3TATES FOR EXAMPLE THE NUMBER OF SUCH
PHONES INCREASED FROM IN TO MORE
THAN MILLION IN 2ESEARCH HAS
SHOWN THAT THE REACTION TIME OF DRIVERS INCREASES BY
TO SECONDS WHEN THEY ARE TALKING ON HAND
HELD PHONES AND DRIVERS HAVE DIFlCULTY MAINTAIN
ING THE CORRECT POSITIONS IN THEIR LANES MAINTAINING
APPROPRIATE SPEEDS AND JUDGING AND ACCEPTING SAFE
GAPS IN TRAFlC 3OME EVIDENCE INDICATES THAT DRIVERS
WHO USE HAND HELD PHONES FACE A RISK OF CRASH FOUR
TIMES HIGHER THAN RISK FACED BY OTHER DRIVERS IM
PERILING THEMSELVES AND OTHER ROAD USERS
(ANDS FREE PHONES CAN ALSO DISTRACT DRIVERS
BUT THE CURRENT EVIDENCE SUGGESTS THAT HAND HELD
PHONES POSE A GREATER PROBLEM !LMOST HALF
OF DRIVERS NOW USE MOBILE TELEPHONES TO CALL FOR
HELP IN EMERGENCIES SO BANNING THEIR PRESENCE IN
CARS MIGHT NOT BE DESIRABLE BUT ABOUT COUNTRIES
REPRESENTING ALL OF THE WORLDS REGIONS NOW BAN THE
USE OF HAND HELD MOBILE PHONES BY THE OPERATOR OF
THE VEHICLE WHILE DRIVING
%DUCATING AND INFORMING THE PUBLIC
)N ISOLATION PUBLIC EDUCATION AND INFORMATION
CAMPAIGNS DO NOT DELIVER TANGIBLE SUSTAINED
REDUCTIONS IN ROAD TRAFlC DEATHS AND SERIOUS INJURIES
n &OR THIS REASON EARLY EFFORTS AT
PUBLIC EDUCATION AND INFORMATION HAVE LEFT MANY
PEOPLE FEELING SCEPTICAL AS TO THEIR VALUE !S MENTIONED
PREVIOUSLY HOWEVER PUBLIC EDUCATION AND INFORMATION
CAMPAIGNS HAVE PROVEN TO BE HIGHLY EFFECTIVE WHEN
THEY ACCOMPANY LAWS AND LAW ENFORCEMENT
0UBLIC EDUCATION AND INFORMATION CAN CLEARLY IM
PROVE KNOWLEDGE ABOUT THE RULES OF THE ROAD AND
INCREASE COMPLIANCE 4HEY CAN TELL PEOPLE WHICH
VEHICLES ARE SAFER AND THEREBY INmUENCE THEIR PUR
CHASES 4HEY CAN ALSO CREATE A CLIMATE OF CONCERN
ABOUT ROAD SAFETY AND INCREASE PUBLIC ACCEPTANCE OF
EFFECTIVE INTERVENTIONS
$ELIVERING CARE AFTER CRASHES
4HE AIMS OF CARE AFTER CRASHES ARE TO AVOID PREVENTABLE
DEATH AND DISABILITY TO LIMIT THE SEVERITY AND SUFFER
ING CAUSED BY THE INJURY AND TO ENSURE OPTIMAL FUNC
TIONING OF THE CRASH SURVIVORS AND REINTEGRATION INTO
THE COMMUNITY ! CHAIN OF OPPORTUNITIES TO ACCOM
PLISH THESE AIMS INVOLVES BYSTANDERS AT THE SCENE OF
THE CRASH EMERGENCY RESCUE ACCESS TO THE EMERGENCY
CARE SYSTEM AND TRAUMA CARE AND REHABILITATION
)MPROVING CARE BEFORE REACHING A HOSPITAL
! REVIEW OF STUDIES IN %UROPE CONCLUDED THAT
ABOUT OF ROAD TRAFlC DEATHS OCCUR WITHIN A FEW
MINUTES AT THE SCENE OF THE CRASH OR ON THE WAY TO
A HOSPITAL AT THE HOSPITAL WITHIN HOURS OF
THE CRASH AND AFTER HOURS ! STUDY COMPAR
ING ROAD TRAFlC DEATHS ACROSS A RANGE OF COUNTRIES
FOUND THAT THE VAST MAJORITY OF DEATHS IN LOW
INCOME AND MIDDLE
INCOME COUNTRIES OCCUR BEFORE
REACHING THE HOSPITAL 4ABLE 4HE SAME STUDY ALSO
FOUND THAT THE PROBABILITY OF DYING BEFORE REACHING
THE HOSPITAL INCREASES AS THE SOCIOECONOMIC STATUS OF
THE VICTIM DECREASES
3TUDIES WORLDWIDE HAVE SHOWN THAT
DEATH COULD BE PREVENTED IN MANY CASES IN WHICH
PEOPLE DIED BEFORE REACHING A HOSPITAL -ANY COM
PLICATIONS RESULTING IN DISABILITY COULD ALSO BE PRE
VENTED PRE
HOSPITAL
4!",%
0ROPORTION OF ROAD DEATHS BY SETTING IN THREE CITIES
3ETTING
+UMASI 'HANA
-ONTERREY
-EXICO
3EATTLE 53!
0RE HOSPITAL
%MERGENCY ROOM
(OSPITAL WARD
3OURCE REFERENCE
2ESPONSE BY BYSTANDERS
4HE PEOPLE ARRIVING lRST AT THE SCENE OF A CRASH CAN
PLAY IMPORTANT ROLES IN PREVENTING MORE SERIOUS CON
2)3+ &!#4/23 !.$ ).4%26%.4)/.3 s
SEQUENCES BY CALLING EMERGENCY SERVICES PUTTING
OUT lRES SECURING THE SCENE TO PREVENT FURTHER COLLI
SIONS OR HARM TO OTHER BYSTANDERS AND RESCUERS AND
APPLYING lRST AID "YSTANDERS TRAINED IN lRST AID COULD
PREVENT FOR EXAMPLE MANY DEATHS THAT RESULT FROM
AIRWAY OBSTRUCTION OR EXTERNAL HAEMORRHAGE
)N LOW INCOME COUNTRIES AND SOME MIDDLE IN
COME COUNTRIES RESCUE BY AMBULANCE IS RARE AND
BYSTANDERS ARE THE MAIN MEANS OF ACCESS TO HEALTH
CARE )N 'HANA MOST INJURED PEOPLE WHO REACH A
HOSPITAL DO SO BY COMMERCIAL VEHICLE ! RECENT PROJ
ECT GAVE BASIC lRST AID TRAINING TO COMMERCIAL VE
HICLE DRIVERS IN THE HOPE THAT IT MIGHT HELP DECREASE
PRE HOSPITAL MORTALITY !LTHOUGH THE IM
PACT OF THAT PROJECT IS NOT YET KNOWN ANOTHER POS
SIBLE MODEL IS A PROJECT THAT GAVE BASIC lRST AID
TRAINING A TWO DAY COURSE TO PEOPLE LIKELY TO
BE lRST ON THE SCENE IN LANDMINE INFESTED AREAS OF
#AMBODIA AND NORTHERN )RAQ AND HOURS OF
PARAMEDIC TRAINING TO A SELECT FEW 7ITH BASIC SUP
PLIES BUT NO AMBULANCES THE PROJECT REDUCED MOR
TALITY FROM TO
!CCESS TO EMERGENCY SERVICES
)N MOST HIGH INCOME COUNTRIES THE LARGE VOLUME OF
ROAD TRAFlC AND THE LARGE NUMBER OF MOBILE PHONES
USUALLY PERMIT THE EARLY ALERTING OF EMERGENCY SER
VICES ABOUT A CRASH 4HERE IS USUALLY A WELL PUBLI
CIZED EMERGENCY NUMBER TO CALL BUT THE NUMBER
VARIES FROM COUNTRY TO COUNTRY !N INTERNATIONALLY
AGREED NUMBER WOULD BE AN IMPROVEMENT
-ANY LOW INCOME COUNTRIES HAVE FEW EMERGENCY
SERVICES DELIVERED AT THE SCENE OF ROAD CRASHES "Y
STANDERS RELATIVES OR COMMERCIAL VEHICLES EVACUATE
INJURED PEOPLE FROM THE SCENE AND TRANSPORT THEM
TO A HOSPITAL ! STUDY IN +ENYA FOUND THAT THE
POLICE EVACUATE ONLY OF CRASH SURVIVORS AND
HOSPITAL AMBULANCES
3OME !FRICAN COUNTRIES ARE STARTING TO PROVIDE
BASIC AMBULANCE SERVICES IN URBAN AREAS
6ARIOUS STUDIES HOWEVER PROVIDE A BASIS TO QUES
TION WHETHER EMERGENCY SERVICES SIMILAR TO THOSE
PROVIDED IN HIGH INCOME COUNTRIES ARE A PRIORITY
WHEN MONEY IS SCARCE AND THE NEED IS SO GREAT FOR
EXPENDITURE ON OTHER ELEMENTS OF HEALTH CARE "ASIC
lRST AID TRAINING TO GROUPS SUCH AS COMMERCIAL VE
HICLE DRIVERS WHO ARE MOST LIKELY TO BE AMONG THE
lRST AT CRASH SCENES MAY BE A MORE APPROPRIATE USE
OF SCARCE RESOURCES
#ARE BY EMERGENCY SERVICES
0OLICE AND lRElGHTERS OFTEN ARRIVE AT THE CRASH SCENE
BEFORE EMERGENCY MEDICAL PERSONNEL 0OLICE OFlCERS
AND lRElGHTERS SHOULD BE EQUIPPED AND TRAINED TO
RESCUE PEOPLE FROM A VARIETY OF EMERGENCY SITUA
TIONS SUCH AS lRE IMMERSION IN WATER AND ENTRAP
MENT IN A TWISTED VEHICLE AND TO PROVIDE BASIC lRST
AID
!NOTHER CONCERN IS THAT EMERGENCY VEHICLES ARE
HIGHLY PRONE TO BECOMING INVOLVED IN CRASHES SINCE
THEY TEND TO TRAVEL AT HIGH SPEEDS AND WEAVE IN AND
OUT OF TRAFlC 2OAD SAFETY LAWS INCLUDING ONES RE
QUIRING APPROPRIATE RESTRAINTS FOR VEHICLE OCCUPANTS
SHOULD ALSO APPLY TO THEM
)MPROVING HOSPITAL CARE
)N HIGH
INCOME COUNTRIES A CHAIN OF WELL
TRAINED
PRACTITIONERS TYPICALLY PROVIDE TRAUMA TREATMENT IN
HOSPITALS 4HERE IS ROOM FOR IMPROVEMENT BUT IN
GENERAL TRAUMA TREATMENT HAS BECOME SIGNIlCANTLY
BETTER OVER THE PAST YEARS 4HE !DVANCED 4RAUMA
,IFE 3UPPORT COURSE OF THE !MERICAN #OLLEGE OF
3URGEONS IS WIDELY ACKNOWLEDGED TO BE THE OPTI
MAL STANDARD FOR TRAINING IN HIGH
INCOME COUNTRIES
4HE #OLLEGE AND SIMILAR NATIONAL AND
INTERNATIONAL ORGANIZATIONS ALSO PROVIDE GUIDELINES
AND RECOMMENDATIONS ON STAFlNG EQUIPMENT SUP
PLIES AND ORGANIZATION
)N LOW
INCOME AND MIDDLE
INCOME COUNTRIES
MANY PEOPLE HAVE NO ACCESS TO HOSPITALS THROUGH
PUBLIC HEALTH SCHEMES OR PRIVATE INSURANCE
! STUDY IN 'HANA FOUND THAT ONLY
OF THE PEOPLE SERIOUSLY INJURED IN CRASHES RECEIVED
HOSPITAL CARE IN RURAL AREAS AND ONLY IN URBAN
AREAS )F TREATMENT IS AVAILABLE AT ALL IT IS OFTEN PRO
VIDED BY STAFF LACKING SPECIALIZED TRAINING IN HAN
DLING TRAUMA CASES ! STUDY OF RU
RAL HOSPITALS IN 'HANA FOUND THAT THEY WERE
STAFFED BY GENERAL PRACTITIONERS WITH NO TRAUMA
TRAINING
,OW
INCOME AND MIDDLE
INCOME COUNTRIES
ALSO LACK QUALIlED SURGEONS )N THE LATE S THE
s 7/2,$ 2%0/24 /. 2/!$ 42!&&)# ).*529 02%6%.4)/. 35--!29
5NITED 3TATES HAD SURGEONS PER POPULA
TION VERSUS ONLY PER IN ,ATIN !MERICA AND
PER IN !FRICA
,ACK OF QUALIlED MEDICAL SPECIALISTS OFTEN LEADS
TO LONG DELAYS BETWEEN ARRIVAL AT A HOSPITAL AND THE
START OF EMERGENCY SURGERY AND TREATMENT !
STUDY IN 'HANA FOUND AN AVERAGE DELAY OF
HOURS AT THE MAIN HOSPITAL IN +UMASI AND THAT
LOW
COST BUT ESSENTIAL EQUIPMENT WAS MISSING FROM
HOSPITALS BECAUSE OF POOR ORGANIZATION NOT THE
COST ! SURVEY IN +ENYA FOUND THAT ONLY OF
HEALTH FACILITIES HAD KEY SUPPLIES AVAILABLE
6ERY LITTLE HAS BEEN DOCUMENTED ABOUT EFFEC
TIVE PROGRAMMES TO ADDRESS THESE ISSUES BUT THERE
IS SOME EVIDENCE OF SUCCESS )N 4RINIDAD FOR
EXAMPLE INSTITUTING THE !DVANCED 4RAUMA ,IFE 3UP
PORT COURSE FOR DOCTORS AND THE 0RE
(OSPITAL 4RAUMA
,IFE 3UPPORT COURSE FOR PARAMEDICS TOGETHER WITH
IMPROVED EMERGENCY EQUIPMENT REDUCED TRAUMA
MORTALITY SIGNIlCANTLY BOTH PRE
HOSPITAL AND IN HOS
PITAL -EANWHILE 7(/ AND THE )NTERNATIONAL
3OCIETY OF 3URGERY ARE COLLABORATING ON THE %SSENTIAL
4RAUMA #ARE 0ROJECT WHICH AIMS TO IMPROVE THE
PLANNING AND ORGANIZATION OF TRAUMA CARE WORLDWIDE
)MPROVING REHABILITATION
)N HIGH
INCOME COUNTRIES A VARIETY OF SPECIALISTS
PROVIDE REHABILITATION PHYSICAL THERAPISTS OCCUPA
TIONAL THERAPISTS PROSTHETISTS PROSTHETICS SPECIAL
ISTS NEUROPSYCHOLOGISTS PSYCHOLOGICAL COUNSELLORS
AND SPEECH THERAPISTS 3ERVICES AND EQUIPMENT ARE
OFTEN PROVIDED IN HOMES 4HESE SERVICES ARE KNOWN
TO MAKE IMPORTANT CONTRIBUTIONS TO REDUCING DIS
ABILITY ALTHOUGH THE BEST PRACTICES HAVE YET TO BE
DElNED .OT SURPRISINGLY SUCH SERVICES ARE
IN SHORT SUPPLY IN LOW
INCOME AND MIDDLE
INCOME
COUNTRIES 4HEY NEED TO EXPAND THE CAPACITY OF THEIR
HEALTH CARE SYSTEMS IN GENERAL AND DECIDE WHICH
REHABILITATION SERVICES ARE TO BE GIVEN HIGH PRIORITY
$OING RESEARCH
!LL THE KNOWN INTERVENTIONS THAT REDUCE THE RISK OF
ROAD TRAFlC CRASH AND INJURY HAVE RESULTED FROM SCI
ENTIlC RESEARCH AND DEVELOPMENT MOST OF IT CON
DUCTED IN HIGH
INCOME COUNTRIES 3OME PRIORITIES
FOR DISCOVERING NEW AND BETTER INTERVENTIONS OR
ADAPTING KNOWN ONES INCLUDE
s CONDUCTING TRIALS TO TEST KNOWN INTERVENTIONS
AND DETERMINE WHETHER THEY ARE APPROPRIATE
AND HOW THEY MIGHT BE ADAPTED TO LOW
IN
COME AND MIDDLE
INCOME COUNTRIES
s DEVELOPING ROAD NETWORKS WITH HIERARCHIES OF
ROADS AND ROAD DESIGNS APPROPRIATE FOR LOW
INCOME AND MIDDLE
INCOME COUNTRIES AND
SPECIlCALLY DEVELOPING DESIGN STANDARDS AND
GUIDELINES FOR INTERCITY ROADS CARRYING MIXED
TRAFlC
s DEVELOPING SAFER FRONTS FOR ALL FOUR
WHEELED
VEHICLES SO THAT THEY DO LESS HARM TO VULNER
ABLE ROAD USERS
s DEVELOPING STANDARDS FOR THE CRASHWORTHINESS
OF MOTORCYCLES AND FOR LIGHTER BETTER
VENTI
LATED HELMETS
s DEVELOPING BETTER METHODS FOR EVALUATING THE
EFFECTIVENESS OF PACKAGES OF INTERVENTIONS AND
DETERMINING WHICH MIXES OF INTERVENTION ARE
MOST EFFECTIVE
s DEVELOPING LOW
COST WAYS TO IMPROVE POST
CRASH
CARE IN LOW
INCOME AND MIDDLE
INCOME COUN
TRIES INCLUDING IMPROVING UNDERSTANDING AND
TREATMENT OF HEAD AND WHIPLASH INJURIES AND
s DEVELOPING BETTER STRATEGIES IN HIGH
INCOME
COUNTRIES FOR MANAGING EXPOSURE TO RISK AND
ADDRESSING THE INCOMPATIBILITY BETWEEN SMALL
ER LIGHTER VEHICLES AND LARGER HEAVIER ONES
#ONCLUSIONS AND RECOMMENDATIONS
2OAD TRAFlC CRASHES OCCUR ON ALL CONTINENTS IN EV
ERY COUNTRY OF THE WORLD %VERY YEAR THEY TAKE THE
LIVES OF MORE THAN A MILLION PEOPLE AND INCAPACI
TATE MANY MILLIONS MORE 0EDESTRIANS USERS OF NON
MOTORIZED VEHICLES n INCLUDING BICYCLES RICKSHAWS
AND CARTS n AND MOTORCYCLISTS IN LOW
INCOME AND
MIDDLE
INCOME COUNTRIES CARRY A LARGE PROPORTION
OF THE GLOBAL BURDEN OF ROAD TRAFlC DEATH AND SERI
OUS INJURY 4HE ELDERLY CHILDREN AND THE DISABLED ARE
PARTICULARLY VULNERABLE
$ESPITE THE GROWING BURDEN OF ROAD TRAFlC INJU
RIES ROAD SAFETY HAS RECEIVED INSUFlCIENT ATTENTION
AT BOTH THE INTERNATIONAL AND NATIONAL LEVELS 4HE
REASONS INCLUDE LACK OF GENERAL AWARENESS AND SPE
CIlC INFORMATION ON THE SCALE OF THE PROBLEM ON
THE HEALTH SOCIAL AND ECONOMIC COSTS OF ROAD TRAFlC
CRASHES AND ON THE INTERVENTIONS THAT CAN PREVENT
CRASHES OR REDUCE THE HARM THEY CAUSE
!NOTHER REASON IS THAT THE PROBLEM OF ROAD TRAFlC
CRASHES AND INJURIES DOES NOT hBELONGv TO ANY SPE
CIlC AGENCY EITHER AT NATIONAL OR INTERNATIONAL LEVELS
)NSTEAD RESPONSIBILITY FOR DEALING WITH THE VARIOUS
ASPECTS OF THE PROBLEM n INCLUDING THE DESIGN OF
VEHICLES THE DESIGN OF ROAD NETWORKS AND ROADS
URBAN AND RURAL PLANNING THE INTRODUCTION AND EN
FORCEMENT OF ROAD SAFETY LEGISLATION AND CARE AND
TREATMENT OF CRASH VICTIMS n IS DIVIDED AMONG MANY
DIFFERENT SECTORS AND GROUPS 4HERE HAS USUALLY BEEN
NO LEADER TO ENSURE THAT THEY COORDINATE THEIR EFFORTS
AND ADDRESS THE PROBLEM AS A WHOLE )N THIS ENVI
RONMENT IT IS NOT SURPRISING THAT POLITICAL WILL HAS
FREQUENTLY BEEN LACKING TO DEVELOP AND IMPLEMENT
EFFECTIVE ROAD SAFETY POLICIES AND PROGRAMMES
-AIN MESSAGES FROM THE REPORT
4HIS REPORT THE lRST JOINT REPORT BETWEEN 7(/ AND
THE 7ORLD "ANK ON THE TOPIC PRESENTS THE CURRENT
KNOWLEDGE ABOUT ROAD TRAFlC INJURIES AND THE AC
TIONS THAT NEED TO BE TAKEN IN ORDER TO TACKLE THE
PROBLEM 4HE FOLLOWING ARE SOME OF THE REPORTS KEY
MESSAGES
s !NY ROAD TRAFlC SYSTEM IS HIGHLY COMPLEX AND
HAZARDOUS TO HUMAN HEALTH %LEMENTS OF THE
SYSTEM INCLUDE MOTOR VEHICLES ROADS AND ROAD
USERS AND THEIR PHYSICAL SOCIAL AND ECONOMIC
ENVIRONMENTS -AKING A ROAD TRAFlC SYSTEM
LESS HAZARDOUS REQUIRES A hSYSTEMS APPROACHv
n UNDERSTANDING THE SYSTEM AS A WHOLE AND THE
INTERACTION BETWEEN ITS ELEMENTS AND IDENTIFY
ING WHERE THERE IS POTENTIAL FOR INTERVENTION )N
PARTICULAR IT REQUIRES RECOGNITION THAT THE HU
MAN BODY IS HIGHLY VULNERABLE TO INJURY AND
THAT HUMANS MAKE MISTAKES ! SAFE ROAD TRAFlC
SYSTEM IS ONE THAT ACCOMMODATES AND COMPEN
SATES FOR HUMAN VULNERABILITY AND FALLIBILITY
s 2OAD TRAFlC INJURIES ARE A HUGE PUBLIC HEALTH
AND DEVELOPMENT PROBLEM KILLING ALMOST
MILLION PEOPLE A YEAR AND INJURING OR DISABLING
BETWEEN MILLION AND MILLION MORE "OTH
7(/ AND 7ORLD "ANK DATA SHOW THAT WITH
OUT APPROPRIATE ACTION THESE INJURIES WILL RISE
DRAMATICALLY BY THE YEAR PARTICULARLY IN
RAPIDLY MOTORIZING COUNTRIES .OT ONLY IS
OF THE CURRENT BURDEN BORNE BY LOW INCOME
AND MIDDLE INCOME COUNTRIES BUT THE INCREASE
IN CASUALTY RATES WILL BE GREATEST IN THESE COUN
TRIES !LTHOUGH DATA ON THE COSTS OF ROAD TRAFlC
CRASHES ARE SPARSE PARTICULARLY FROM LOW IN
COME AND MIDDLE INCOME COUNTRIES IT IS CLEAR
THAT THE ECONOMIC IMPACT OF THESE INJURIES ON
INDIVIDUALS FAMILIES COMMUNITIES AND NA
TIONS IS ENORMOUS COSTING COUNTRIES BETWEEN
AND OF THEIR GROSS NATIONAL PRODUCT )N
ADDITION THERE IS THE HEAVY AND TRAGIC BURDEN
s 7/2,$ 2%0/24 /. 2/!$ 42!&&)# ).*529 02%6%.4)/. 35--!29
ON THOSE DIRECTLY AFFECTED BOTH PHYSICALLY AND
PSYCHOLOGICALLY n AS WELL AS ON THEIR FAMILIES
FRIENDS AND COMMUNITIES (EALTH FACILITIES AND
THEIR OFTEN MEAGRE BUDGETS ARE GREATLY OVER
STRETCHED IN DEALING WITH SURVIVORS OF ROAD
TRAFlC CRASHES
s -ANY COUNTRIES HAVE NO INJURY SURVEILLANCE
SYSTEMS THAT GENERATE RELIABLE DATA ON ROAD TRAF
lC CRASHES AND INJURIES )NDICATORS ESPECIALLY
FOR NON
FATAL OUTCOMES MAY NOT BE STANDARD
IZED MAKING COMPARISONS DIFlCULT 4HERE ARE
FREQUENTLY DISCREPANCIES BETWEEN DATA n FOR
EXAMPLE BETWEEN POLICE AND HEALTH
RELATED
SOURCES &URTHERMORE WIDESPREAD UNDERRE
PORTING OF ROAD TRAFlC FATALITIES AND INJURIES
n BOTH IN HEALTH AND POLICE DATA n LIMITS THE
USEFULNESS OF EXISTING DATA SOURCES 2ELIABLE
DATA ARE NEEDED TO PROVIDE A SOLID FOUNDATION
FOR ROAD SAFETY PLANNING AND DECISION
MAKING
%STABLISHING SIMPLE COST
EFFECTIVE INJURY SUR
VEILLANCE SYSTEMS IS AN IMPORTANT STEP TOWARDS
IMPROVING ROAD SAFETY (OWEVER THE LACK OF
RELIABLE DATA SHOULD NOT IMPEDE IMMEDIATE AC
TION -UCH CAN BE ACHIEVED BY ADAPTING AND
APPLYING PROVEN SAFETY PRACTICES
s ! NUMBER OF FACTORS AFFECTING THE PROBABILITY
OF A ROAD TRAFlC INJURY NEED TO BE CONSIDERED
WITHIN THE SYSTEMS APPROACH 4HE VARIOUS TYPES
OF RISK RELATED TO ROAD TRAFlC INJURY AND THE
FACTORS INmUENCING THESE RISKS ARE
&OR EXPOSURE TO RISK THE DETERMINANTS INCLUDE
ECONOMIC AND DEMOGRAPHIC FACTORS LEVEL OF
MOTORIZATION MODES OF TRAVEL THE VOLUME
OF UNNECESSARY TRIPS AND LAND USE PLANNING
PRACTICES
&OR CRASH OCCURRENCE THE RISK FACTORS INCLUDE
EXCESSIVE SPEED DRINKING AND DRIVING UN
SAFE VEHICLES UNSAFE ROAD DESIGN AND THE
RELATED LACK OF EFFECTIVE LAW ENFORCEMENT
AND SAFETY REGULATIONS
&OR INJURY SEVERITY THE RISK FACTORS INCLUDE THE
NON
USE OF SEAT
BELTS CHILD RESTRAINTS AND
CRASH HELMETS LACK OF hFORGIVINGv VEHICLE
FRONTS TO PROTECT PEDESTRIANS IN A COLLISION
ROADSIDE INFRASTRUCTURE THAT IS UNPROTECTIVE
IN A CRASH AND HUMAN TOLERANCE FACTORS
&OR POST CRASH INJURY OUTCOMES THE RISK FACTORS
INCLUDE DELAYS IN DETECTING A CRASH AND
PROVIDING LIFE SAVING MEASURES AND PSY
CHOLOGICAL ASSISTANCE LACK OF OR DELAYED
EMERGENCY CARE ON THE SPOT AND TRANSPORT
TO A HEALTH FACILITY AND THE AVAILABILITY AND
QUALITY OF TRAUMA CARE AND REHABILITATION
s 2OAD SAFETY IS A SHARED RESPONSIBILITY 2EDUC
ING THE RISK IN THE WORLDS ROAD TRAFlC SYSTEMS
REQUIRES COMMITMENT AND INFORMED DECISION
MAKING BY GOVERNMENT INDUSTRY NONGOVERN
MENTAL ORGANIZATIONS AND INTERNATIONAL AGENCIES
AND PARTICIPATION BY PEOPLE FROM MANY DIFFER
ENT DISCIPLINES SUCH AS ROAD ENGINEERS MOTOR
VEHICLE DESIGNERS LAW ENFORCEMENT OFlCERS AND
HEALTH PROFESSIONALS AND COMMUNITY GROUPS
s 6ISION :ERO IN 3WEDEN AND THE SUSTAINABLE
SAFETY PROGRAMME IN THE .ETHERLANDS ARE EX
AMPLES OF GOOD PRACTICE IN ROAD SAFETY 3UCH
GOOD PRACTICE CAN ALSO HAVE OTHER BENElTS )T
CAN ENCOURAGE HEALTHIER LIFESTYLES INVOLVING
MORE WALKING AND CYCLING AND CAN REDUCE THE
NOISE AND AIR POLLUTION THAT RESULT FROM MOTOR
VEHICLE TRAFlC #OLOMBIA IS AN EXAMPLE OF A DE
VELOPING COUNTRY THAT IS BEGINNING TO IMPLE
MENT A SIMILAR STRATEGY
s 4HE IMPORTANT ROLE THAT PUBLIC HEALTH CAN PLAY
IN THE PREVENTION OF ROAD TRAFlC INJURIES IN
CLUDES THE COLLECTION AND ANALYSIS OF DATA IN
ORDER TO DEMONSTRATE THE HEALTH AND ECONOMIC
IMPACT OF ROAD TRAFlC CRASHES RESEARCH ON RISK
FACTORS THE IMPLEMENTATION MONITORING AND
EVALUATION OF INTERVENTIONS THE DELIVERY OF AP
PROPRIATE PRIMARY PREVENTION CARE AND REHA
BILITATION FOR INJURED PEOPLE AND ADVOCACY FOR
GREATER ATTENTION TO THE PROBLEM
2OAD TRAFlC CRASHES ARE PREDICTABLE AND CAN BE
PREVENTED -ANY HIGH INCOME COUNTRIES HAVE SHOWN
SHARP REDUCTIONS IN CRASHES AND CASUALTY NUMBERS
OVER THE PAST COUPLE OF DECADES BY ADOPTING A SYS
TEMS APPROACH TO ROAD SAFETY THAT EMPHASIZES ENVI
RONMENT VEHICLE AND ROAD USER INTERVENTIONS RATHER
THAN SOLELY FOCUSING ON DIRECT APPROACHES AIMED AT
CHANGING THE BEHAVIOUR OF ROAD USERS !LTHOUGH SOLU
TIONS FOR LOW INCOME AND MIDDLE INCOME COUNTRIES
MAY DIFFER FROM THOSE COUNTRIES THAT HAVE A LONGER
#/.#,53)/.3 !.$ 2%#/--%.$!4)/.3 s
HISTORY OF MOTORIZATION SOME BASIC PRINCIPLES ARE THE
SAME 4HESE INCLUDE FOR EXAMPLE GOOD ROAD DESIGN
AND TRAFlC MANAGEMENT IMPROVED VEHICLE STANDARDS
SPEED CONTROL THE USE OF SEAT
BELTS AND THE ENFORCE
MENT OF ALCOHOL LIMITS 4HE CHALLENGE IS TO ADAPT AND
EVALUATE EXISTING SOLUTIONS OR ELSE CREATE NEW SOLU
TIONS IN LOW
INCOME AND MIDDLE
INCOME COUNTRIES
4RANSFERRING AND ADAPTING SOME OF THE MORE COM
PLEX MEASURES ARE MORE LONG TERM AND REQUIRE COUN
TRY
SPECIlC RESEARCH AND DEVELOPMENT )N ADDITION
MORE WORK IS CALLED FOR IN ALL COUNTRIES TO lND NEW
AND BETTER ROAD SAFETY MEASURES &OR EXAMPLE PROVI
SION OF SAFER FRONTS ON NEW DESIGNS OF MOTOR VEHICLES
IS URGENTLY NEEDED TO REDUCE THE HARM CAUSED IN VE
HICLE COLLISIONS WITH PEDESTRIANS AND CYCLISTS
4HERE ARE MANY PROVEN SCIENCE
BASED INTERVEN
TIONS AS WELL AS PROMISING STRATEGIES STILL UNDER STUDY
'OVERNMENTS CAN MAKE USE OF THESE TO DEVELOP EFFEC
TIVE AND COST
EFFECTIVE ROAD SAFETY PROGRAMMES 7ITH
PROPERLY TARGETED INVESTMENT COUNTRIES SHOULD DE
RIVE CONSIDERABLE SOCIAL AND ECONOMIC BENElTS FROM
REDUCED ROAD TRAFlC DEATHS INJURIES AND DISABILITIES
2ECOMMENDED ACTIONS
4HIS REPORT OFFERS GOVERNMENTS THE OPPORTUNITY TO AS
SESS THE CURRENT STATUS OF ROAD SAFETY IN THEIR COUNTRY
REVIEW POLICIES AND INSTITUTIONAL ARRANGEMENTS AND CA
PACITY AND TAKE APPROPRIATE ACTIONS !LL THE FOLLOWING
RECOMMENDATIONS SHOULD BE ADDRESSED ACROSS A WIDE
RANGE OF SECTORS AND DISCIPLINES IF THEY ARE TO ACHIEVE
SUCCESS (OWEVER THE RECOMMENDATIONS SHOULD BE
TREATED AS mEXIBLE GUIDELINES 4HEY LEAVE MUCH ROOM
FOR ADAPTATION TO LOCAL CONDITIONS AND CAPACITIES
)N CERTAIN LOW
INCOME AND MIDDLE
INCOME COUN
TRIES WITH LIMITED HUMAN AND lNANCIAL RESOURCES IT
MAY BE DIFlCULT FOR GOVERNMENTS TO APPLY SOME OF
THESE RECOMMENDATIONS ON THEIR OWN )N THESE CIR
CUMSTANCES IT IS SUGGESTED THAT COUNTRIES WORK WITH
INTERNATIONAL OR NONGOVERNMENTAL ORGANIZATIONS OR
OTHER PARTNERS TO IMPLEMENT THE RECOMMENDATIONS
2ECOMMENDATION )DENTIFY A LEAD
AGENCY IN GOVERNMENT TO GUIDE THE
NATIONAL ROAD TRAFlC SAFETY EFFORT
%ACH COUNTRY NEEDS A LEAD AGENCY ON ROAD SAFETY
WITH THE AUTHORITY AND RESPONSIBILITY TO MAKE DECI
SIONS CONTROL RESOURCES AND COORDINATE EFFORTS BY ALL
SECTORS OF GOVERNMENT n INCLUDING THOSE OF HEALTH
TRANSPORT EDUCATION AND THE POLICE 4HIS AGENCY
SHOULD HAVE ADEQUATE lNANCES TO USE FOR ROAD SAFETY
AND SHOULD BE PUBLICLY ACCOUNTABLE FOR ITS ACTIONS
%XPERIENCE ACROSS THE WORLD HAS SHOWN THAT DIF
FERENT MODELS CAN BE EFFECTIVE IN ROAD SAFETY AND THAT
EACH COUNTRY NEEDS TO CREATE A LEAD AGENCY APPRO
PRIATE TO ITS OWN CIRCUMSTANCES 4HE AGENCY MIGHT
TAKE THE FORM FOR EXAMPLE OF A DESIGNATED STAND
ALONE BUREAU OR A COMMITTEE OR CABINET REPRESENT
ING SEVERAL DIFFERENT GOVERNMENT AGENCIES )T MIGHT
ALSO BE PART OF A LARGER TRANSPORT ORGANIZATION 4HE
AGENCY MIGHT UNDERTAKE MUCH OF THE WORK ITSELF
OR ELSE IT MIGHT DELEGATE WORK TO OTHER ORGANIZA
TIONS INCLUDING PROVINCIAL AND LOCAL GOVERNMENTS
RESEARCH INSTITUTES OR PROFESSIONAL ASSOCIATIONS
3PECIlC EFFORTS SHOULD BE TAKEN BY THE AGENCY
TO ENGAGE ALL SIGNIlCANT GROUPS CONCERNED IN ROAD
SAFETY INCLUDING THE WIDER COMMUNITY !WARENESS
COMMUNICATION AND COLLABORATION ARE KEY TO ESTAB
LISHING AND SUSTAINING NATIONAL ROAD SAFETY EFFORTS
.ATIONAL EFFORTS WILL BE BOOSTED IF ONE OR MORE
WELL
KNOWN POLITICAL LEADERS CAN ACTIVELY CHAMPION
THE CAUSE OF ROAD SAFETY
2ECOMMENDATION !SSESS THE PROBLEM
POLICIES AND INSTITUTIONAL SETTINGS RELATING TO
ROAD TRAFlC INJURY AND THE CAPACITY FOR ROAD
TRAFlC INJURY PREVENTION IN EACH COUNTRY
!N IMPORTANT ELEMENT IN DEALING WITH ROAD SAFETY IS
ASCERTAINING THE MAGNITUDE AND CHARACTERISTICS OF THE
PROBLEM AS WELL AS THE POLICIES INSTITUTIONAL ARRANGE
MENTS AND CAPACITY WITHIN THE COUNTRY TO DEAL WITH
ROAD TRAFlC INJURIES 4HIS INCLUDES AN UNDERSTANDING
NOT ONLY OF THE VOLUME OF TRAFlC DEATHS INJURIES AND
CRASHES BUT ALSO OF WHICH ROAD USERS ARE MOST AFFECT
ED IN WHICH GEOGRAPHIC AREAS THE GREATEST PROBLEMS
ARE FOUND WHAT RISK FACTORS ARE CONTRIBUTING WHAT
ROAD SAFETY POLICIES PROGRAMMES AND SPECIlC INTER
VENTIONS ARE IN PLACE WHAT INSTITUTIONAL STRUCTURES
ARE ADDRESSING THE ROAD TRAFlC INJURY PROBLEM AND
WHAT THEIR CAPACITY IS )NTERMEDIATE OUTCOME MEA
SURES n SUCH AS MEAN SPEEDS RATES OF SEAT
BELT WEAR
ING AND RATES OF HELMET WEARING n CAN ALSO BE USEFUL
AND CAN BE OBTAINED THROUGH SIMPLE SURVEYS
s 7/2,$ 2%0/24 /. 2/!$ 42!&&)# ).*529 02%6%.4)/. 35--!29
0OSSIBLE SOURCES OF DATA INCLUDE POLICE HEALTH
MINISTRY AND HEALTH CARE SETTINGS TRANSPORT MINIS
TRIES INSURANCE lRMS MOTOR VEHICLE MANUFACTURING
COMPANIES AND GOVERNMENT AGENCIES COLLECTING DATA
FOR NATIONAL PLANNING AND DEVELOPMENT (OWEVER
THE ACCURACY CONSISTENCY AND THOROUGHNESS OF THESE
DATA SHOULD BE ASSESSED BEFORE MAKING USE OF THEM
)NFORMATION SYSTEMS ON ROAD TRAFlC DEATHS AND
INJURIES SHOULD BE SIMPLE AND COST EFFECTIVE TO IM
PLEMENT APPROPRIATE TO THE SKILL LEVELS OF THE STAFF
USING THEM AND CONSISTENT WITH NATIONAL AND INTER
NATIONAL STANDARDS
3TANDARDS THAT COULD BE EASILY AND PROlTABLY
ADOPTED INCLUDE THE USE OF THE DAY TRAFlC FATALITY
DElNITION THE )NTERNATIONAL 3TATISTICAL #LASSIlCATION OF
$ISEASES AND 2ELATED (EALTH 0ROBLEMS THE )NTERNATION
AL #LASSIlCATION OF %XTERNAL #AUSES OF )NJURY )#%#)
AND THE )NJURY 3URVEILLANCE AND 3URVEY GUIDELINES
DEVELOPED BY 7(/ AND ITS COLLABORATING CENTRES
$ATA SHOULD BE WIDELY SHARED AMONG THE RELEVANT
AUTHORITIES AND CONCERNED GROUPS PARTICULARLY THOSE
RESPONSIBLE FOR TRAFlC LAW ENFORCEMENT HEALTH AND
EDUCATION
4HE ECONOMIC IMPACT OF ROAD TRAFlC INJURIES IN
MOST COUNTRIES IS SUBSTANTIAL 7HERE THIS IS POSSIBLE
ASSESSING THE DIRECT AND INDIRECT ECONOMIC COSTS IN
PARTICULAR RELATIVE TO GROSS NATIONAL PRODUCT CAN HELP
INCREASE AWARENESS OF THE SCALE OF THE PROBLEM
! LACK OF DATA THOUGH SHOULD NOT DISSUADE GOV
ERNMENTS FROM BEGINNING TO IMPLEMENT MANY OF
THE OTHER RECOMMENDATIONS IN THIS REPORT
2ECOMMENDATION 0REPARE A NATIONAL
ROAD SAFETY STRATEGY AND PLAN OF ACTION
%ACH COUNTRY SHOULD PREPARE A ROAD SAFETY STRATEGY
THAT IS MULTISECTORAL n INVOLVING AGENCIES CONCERNED
WITH TRANSPORT HEALTH EDUCATION LAW ENFORCEMENT
AND OTHER RELEVANT SECTORS n AND MULTIDISCIPLINARY
n INVOLVING ROAD SAFETY SCIENTISTS ENGINEERS URBAN
AND REGIONAL PLANNERS HEALTH PROFESSIONALS AND OTH
ERS 4HE STRATEGY SHOULD TAKE THE NEEDS OF ALL ROAD
USERS INTO ACCOUNT PARTICULARLY VULNERABLE ROAD US
ERS AND SHOULD BE LINKED TO STRATEGIES IN OTHER SEC
TORS )T SHOULD INVOLVE GROUPS FROM GOVERNMENT THE
PRIVATE SECTOR NONGOVERNMENTAL ORGANIZATIONS THE
MASS MEDIA AND THE GENERAL PUBLIC
! NATIONAL ROAD SAFETY STRATEGY NEEDS TO SET AMBI
TIOUS BUT REALISTIC TARGETS FOR AT LEAST lVE OR TEN YEARS
)T SHOULD HAVE MEASURABLE OUTCOMES AND SUFlCIENT
FUNDING TO DEVELOP IMPLEMENT MANAGE MONITOR
AND EVALUATE ACTIONS /NCE THE ROAD SAFETY STRATEGY IS
PREPARED A NATIONAL ACTION PLAN SCHEDULING SPECIlC
ACTIONS AND ALLOCATING SPECIlC RESOURCES SHOULD BE
DEVELOPED
2ECOMMENDATION !LLOCATE lNANCIAL AND
HUMAN RESOURCES TO ADDRESS THE PROBLEM
7ELL
TARGETED INVESTMENT OF lNANCIAL AND HUMAN RE
SOURCES CAN REDUCE ROAD TRAFlC INJURIES AND DEATHS
CONSIDERABLY )NFORMATION FROM OTHER COUNTRIES ON
THEIR EXPERIENCE WITH VARIOUS INTERVENTIONS CAN HELP A
GOVERNMENT IN ASSESSING THE COSTS AGAINST THE BENElTS
OF SPECIlC INTERVENTIONS AND SET PRIORITIES BASED ON
WHICH INTERVENTIONS ARE LIKELY TO BE THE BEST INVEST
MENT OF SCARCE lNANCIAL AND HUMAN RESOURCES 3IMI
LAR COSTnBENElT ANALYSES OF POSSIBLE INTERVENTIONS IN
OTHER AREAS OF PUBLIC HEALTH CAN HELP SET OVERALL GOV
ERNMENT PRIORITIES FOR EXPENDITURE ON PUBLIC HEALTH
#OUNTRIES MAY HAVE TO IDENTIFY POTENTIAL NEW IN
COME SOURCES TO AFFORD THE INVESTMENT NEEDED TO
ACHIEVE ROAD SAFETY TARGETS %XAMPLES INCLUDE FUEL
TAXATION ROAD AND PARKING CHARGES VEHICLE REGISTRA
TION FEES AND lNES FOR TRAFlC VIOLATIONS !REA
WIDE
SAFETY ASSESSMENTS AT THE PROPOSAL STAGE OF PROJECTS
THAT MAY INmUENCE ROAD SAFETY AND SAFETY AUDITS
AS PROJECTS ARE CARRIED THROUGH TO COMPLETION CAN
HELP MAKE OPTIMAL USE OF LIMITED RESOURCES
-ANY COUNTRIES DO NOT HAVE THE HUMAN RESOURCES
WITH THE TRAINING AND EXPERIENCE REQUIRED TO DEVELOP
AND IMPLEMENT AN EFFECTIVE ROAD SAFETY PROGRAMME
AND THEREFORE NEED TO DEVELOP THESE RESOURCES !P
PROPRIATE TRAINING PROGRAMMES SHOULD BE A PRIORITY
3UCH TRAINING SHOULD COVER SPECIALIST lELDS n SUCH AS
STATISTICAL ANALYSIS ROAD DESIGN AND TRAUMA CARE n AS
WELL AS lELDS CUTTING ACROSS DISCIPLINES n SUCH AS UR
BAN AND REGIONAL PLANNING POLICY ANALYSIS AND DEVEL
OPMENT ROAD TRAFlC PLANNING AND HEALTH PLANNING
7(/ IS CURRENTLY DEVELOPING A CURRICULUM FOR
TEACHING THE PREVENTION OF ROAD TRAFlC INJURY IN
SCHOOLS OF PUBLIC HEALTH AND OTHER SETTINGS 3EVERAL
INTERNATIONAL NETWORKS INCLUDING THE )NJURY 0REVEN
TION )NITIATIVE FOR !FRICA AND THE 2OAD 4RAFlC )NJURY
#/.#,53)/.3 !.$ 2%#/--%.$!4)/.3 s
.ETWORK CURRENTLY PROVIDE TRAINING AS DO MANY
SCHOOLS OF PUBLIC HEALTH AND ENGINEERING
)NTERNATIONAL CONFERENCES n SUCH AS THE 7ORLD
#ONFERENCES ON )NJURY 0REVENTION AND 3AFETY 0RO
MOTION THE )NTERNATIONAL #ONFERENCES ON !LCOHOL
$RUGS AND 4RAFlC 3AFETY )#!$43 THE CONFERENCES
OF THE )NTERNATIONAL 4RAFlC -EDICINE !SSOCIATION
)4-! AND THE CONGRESSES OF THE 7ORLD 2OAD !S
SOCIATION 0)!2# n PROVIDE OPPORTUNITIES TO EX
CHANGE KNOWLEDGE ESTABLISH NETWORKS AND POTEN
TIAL PARTNERSHIPS AND STRENGTHEN COUNTRY CAPACITY
%FFORTS SHOULD BE MADE TO INCREASE ATTENDANCE
BY REPRESENTATIVES FROM LOW INCOME AND MIDDLE
INCOME COUNTRIES AT THESE CONFERENCES AND TO IN
VOLVE THEM IN SETTING GLOBAL AND REGIONAL AGENDAS
FOR ROAD SAFETY
2ECOMMENDATION )MPLEMENT SPECIlC
ACTIONS TO PREVENT ROAD TRAFlC CRASHES
MINIMIZE INJURIES AND THEIR CONSEQUENCES
AND EVALUATE THE IMPACT OF THESE ACTIONS
3PECIlC ACTIONS ARE NEEDED TO PREVENT ROAD TRAFlC
CRASHES AND TO MINIMIZE THEIR CONSEQUENCES 4HESE
ACTIONS SHOULD BE BASED ON SOUND EVIDENCE AND
ANALYSIS OF ROAD TRAFlC INJURIES BE CULTURALLY APPRO
PRIATE AND TESTED LOCALLY AND FORM PART OF THE NATION
AL STRATEGY TO ADDRESS THE PROBLEM OF ROAD CRASHES
#HAPTER OF THE MAIN REPORT DISCUSSED ROAD SAFETY
INTERVENTIONS IN DETAIL WITH THEIR EFFECTS ON REDUC
ING THE FREQUENCY AND SEVERITY OF CRASHES AS WELL AS
THEIR COST EFFECTIVENESS WHERE AVAILABLE .O STANDARD
PACKAGE OF INTERVENTIONS IS SUITABLE FOR ALL COUNTRIES
(OWEVER ALL COUNTRIES CAN FOLLOW SEVERAL GOOD PRAC
TICES INCLUDING
s INCORPORATING AS A LONG TERM GOAL SAFETY FEA
TURES INTO LAND USE AND TRANSPORT PLANNING
n SUCH AS THE PROVISION OF SHORTER AND SAFER
PEDESTRIAN AND BICYCLE ROUTES AND CONVENIENT
SAFE AND AFFORDABLE PUBLIC TRANSPORT n AND ROAD
DESIGN INCLUDING CONTROLLED CROSSINGS FOR PE
DESTRIANS RUMBLE STRIPS AND STREET LIGHTING
s SETTING AND ENFORCING SPEED LIMITS APPROPRIATE
TO THE FUNCTION OF SPECIlC ROADS
s SETTING AND ENFORCING LAWS REQUIRING SEAT BELTS
AND CHILD RESTRAINTS FOR ALL MOTOR VEHICLE OC
CUPANTS
s SETTING AND ENFORCING LAWS REQUIRING RIDERS OF
BICYCLES AND MOTORIZED TWO
WHEELERS TO WEAR
HELMETS
s SETTING AND ENFORCING BLOOD ALCOHOL CONCEN
TRATION LIMITS FOR DRIVERS WITH RANDOM BREATH
TESTING AT SOBRIETY CHECKPOINTS
s REQUIRING DAYTIME RUNNING LIGHTS FOR TWO
WHEELED VEHICLES THE USE OF DAYTIME RUNNING
LIGHTS ON FOUR
WHEELED VEHICLES SHOULD ALSO BE
CONSIDERED
s REQUIRING THAT MOTOR VEHICLES BE DESIGNED FOR
CRASHWORTHINESS TO PROTECT THE OCCUPANTS
WITH EFFORTS TO EXPAND THIS CONCEPT TO THE DE
SIGN OF THE FRONTS OF MOTOR VEHICLES SO AS TO
PROTECT PEDESTRIANS AND CYCLISTS
s REQUIRING NEW ROAD PROJECTS TO BE SUBJECT TO
A ROAD SAFETY AUDIT BY A ROAD SAFETY SPECIALIST
INDEPENDENT OF THE ROAD DESIGNER
s MANAGING EXISTING ROAD INFRASTRUCTURE TO
PROMOTE SAFETY THROUGH THE PROVISION OF SAFER
ROUTES FOR PEDESTRIANS AND CYCLISTS TRAFlC CALM
ING MEASURES LOW
COST REMEDIAL MEASURES AND
CRASH
PROTECTIVE ROADSIDES
s STRENGTHENING ALL LINKS IN THE CHAIN OF HELP FOR
ROAD CRASH VICTIMS FROM THE CRASH SCENE TO
THE HEALTH FACILITY FOR EXAMPLE SPECIlC GROUPS
SUCH AS COMMERCIAL VEHICLE DRIVERS MOST LIKELY
TO BE lRST ON THE SCENE OF CRASHES MIGHT BE
PROVIDED WITH BASIC TRAINING IN lRST AID AND
HEALTH PROFESSIONALS MIGHT BE PROVIDED WITH
SPECIALIZED TRAINING IN TRAUMA CARE
s ENHANCING PROGRAMMES OF LAW ENFORCEMENT
WITH PUBLIC INFORMATION AND EDUCATION CAM
PAIGNS n FOR EXAMPLE ON THE DANGERS OF SPEED
ING OR DRIVING WHILE UNDER THE INmUENCE OF AL
COHOL AND THE SOCIAL AND LEGAL CONSEQUENCES
OF DOING SO
2ECOMMENDATION 3UPPORT THE DEVELOP
MENT OF NATIONAL CAPACITY AND INTER
NATIONAL COOPERATION
4HE WORLD FACES A GLOBAL ROAD SAFETY CRISIS THAT HAS
NOT YET BEEN FULLY RECOGNIZED AND THAT WILL CON
TINUE TO GROW UNLESS APPROPRIATE ACTION IS TAKEN
)NTERNATIONAL ORGANIZATIONS n INCLUDING 5NITED
.ATIONS AGENCIES NONGOVERNMENTAL ORGANIZATIONS
s 7/2,$ 2%0/24 /. 2/!$ 42!&&)# ).*529 02%6%.4)/. 35--!29
AND MULTINATIONAL CORPORATIONS n AND DONOR COUN
TRIES AND AGENCIES HAVE IMPORTANT ROLES TO PLAY IN
ADDRESSING THIS CRISIS AND STRENGTHENING ROAD SAFETY
AROUND THE WORLD
$EDICATING 7ORLD (EALTH $AY TO ROAD SAFETY
IS ONE STEP 7(/ IS TAKING IN THIS DIRECTION "EYOND
THIS THE DONOR COMMUNITY URGENTLY NEEDS TO DEDI
CATE MORE OF ITS RESOURCES TO HELPING LOW
INCOME
AND MIDDLE
INCOME COUNTRIES IMPROVE ROAD SAFETY
#URRENTLY THE LEVEL OF SUPPORT GIVEN TO ROAD SAFETY
IS FAR BELOW THAT FOR OTHER HEALTH PROBLEMS OF COM
PARABLE MAGNITUDE &EW MULTILATERAL DONORS HAVE
INCLUDED ROAD SAFETY AMONG THEIR PRIORITY AREAS FOR
FUNDING 7ITH SOME EXCEPTIONS SUCH AS THE &)!
6OLVO AND 2OCKEFELLER &OUNDATIONS FEW FOUNDA
TIONS TO DATE HAVE PROVIDED SIGNIlCANT FUNDING FOR
INTERNATIONAL ROAD SAFETY PROGRAMMES
3EVERAL GLOBAL AND REGIONAL 5NITED .ATIONS OR IN
TERGOVERNMENTAL AGENCIES ARE ACTIVE IN ROAD SAFETY
!LTHOUGH THERE HAVE BEEN JOINT EFFORTS LITTLE COORDI
NATED PLANNING BETWEEN THESE AGENCIES TAKES PLACE ON
ANY LARGE SCALE )N ADDITION NO LEAD AGENCY TAKES RE
SPONSIBILITY FOR ENSURING THAT SUCH COORDINATED PLAN
NING TAKES PLACE 4HIS SITUATION MUST CHANGE SO THAT
RESPONSIBILITY IS CLEARLY ASSIGNED SPECIlC ROLES ARE
ALLOCATED TO SPECIlC AGENCIES DUPLICATION IS AVOIDED
AND A lRM COMMITMENT IS FORTHCOMING TO PRODUCE
AND IMPLEMENT A GLOBAL PLAN FOR ROAD SAFETY
4HERE lRST NEEDS TO BE A FORUM WHERE THOSE
INVOLVED CAN MEET AND DISCUSS THE DEVELOPMENT
OF SUCH A GLOBAL PLAN 4HE PLENARY MEETING OF THE
5NITED .ATIONS 'ENERAL !SSEMBLY TAKING PLACE ON
!PRIL IS A MILESTONE IN THIS DIRECTION !
FOLLOW
UP PROCESS THOUGH IS NEEDED 4HIS PROCESS
SHOULD INCLUDE REGULAR MEETINGS OF RELEVANT GOVERN
MENT MINISTERS SO AS TO DEVELOP AND ENDORSE A GLOBAL
PLAN OF ACTION OR CHARTER FOR ROAD SAFETY CONSISTENT
WITH OTHER GLOBAL INITIATIVES SUCH AS THE -ILLENNIUM
$EVELOPMENT 'OALS
&INALLY INTERNATIONAL NONGOVERNMENTAL ORGANIZA
TIONS AND THE PRIVATE SECTOR CAN HELP RAISE AWARENESS
LOCALLY AND GLOBALLY AS COMMITTED CITIZENS EMPLOY
ERS AND SOCIALLY RESPONSIBLE CORPORATE ENTITIES
#ONCLUSION
4HIS REPORT ATTEMPTS TO CONTRIBUTE TO THE BODY OF
KNOWLEDGE ON ROAD SAFETY )T IS HOPED THAT IT WILL
INSPIRE AND FACILITATE INCREASED COOPERATION INNO
VATION AND COMMITMENT TO PREVENTING ROAD TRAFlC
CRASHES AROUND THE WORLD
2OAD TRAFlC CRASHES ARE PREDICTABLE AND THERE
FORE PREVENTABLE )N ORDER TO COMBAT THE PROBLEM
THOUGH THERE NEEDS TO BE CLOSE COORDINATION AND
COLLABORATION USING A HOLISTIC AND INTEGRATED AP
PROACH ACROSS MANY SECTORS AND MANY DISCIPLINES
7HILE THERE ARE MANY INTERVENTIONS THAT CAN SAVE
LIVES AND LIMBS POLITICAL WILL AND COMMITMENT ARE
ESSENTIAL AND WITHOUT THEM LITTLE CAN BE ACHIEVED
4HE TIME TO ACT IS NOW 2OAD USERS EVERYWHERE DE
SERVE BETTER AND SAFER ROAD TRAVEL
2EFERENCES
-URRAY #*, ,OPEZ !$ EDS 4HE GLOBAL BURDEN OF DISEASE A
COMPREHENSIVE ASSESSMENT OF MORTALITY AND DISABILITY FROM DISEASES
INJURIES AND RISK FACTORS IN AND PROJECTED TO "OSTON
-! (ARVARD 3CHOOL OF 0UBLIC (EALTH
*ACOBS ' !ERON 4HOMAS ! !STROP ! %STIMATING GLOBAL
ROAD FATALITIES #ROWTHORNE 4RANSPORT 2ESEARCH ,ABORA
TORY 42, 2EPORT .O
!D (OC #OMMITTEE ON (EALTH 2ESEARCH 2ELATING TO
&UTURE )NTERVENTION /PTIONS )NVESTING IN HEALTH RESEARCH
AND DEVELOPMENT 'ENEVA 7ORLD (EALTH /RGANIZATION
4$2'EN
2OAD TRAFlC ACCIDENTS EPIDEMIOLOGY CONTROL AND PREVENTION 'E
NEVA 7ORLD (EALTH /RGANIZATION
,OIMER ( 'UARNIERI - !CCIDENTS AND ACTS OF 'OD A
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n
.ADER 2 5NSAFE AT ANY SPEED ND ED .EW 9ORK .9
'ROSSMAN 0UBLISHERS
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n
4RINCA ' ET AL 2EDUCING TRAFlC INJURY THE GLOBAL CHALLENGE
-ELBOURNE 2OYAL !USTRALASIAN #OLLEGE OF 3URGEONS
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-EDICINE 3UPPL n
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)NJURY #ONTROL AND 3AFETY 0ROMOTION n
,AmAMME , $IDERICHSEN & 3OCIAL DIFFERENCES IN TRAF
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n
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n
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MENT FUTURE CONCERNS )NTERNATIONAL *OURNAL OF %PIDEMIOL
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*OURNAL n
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BOURNE 'LOBAL 4RAFlC 3AFETY 4RUST n
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