THE WORLD REPORT ON ROAD TRAFFIC INJURY PREVENTION: GETTING

PUBLIC HEALTH TO DO MORE

Dr Margie Peden
Coordinator, Unintentional Injury Prevention
Department of Injuries and Violence Prevention
WHO, Geneva, Switzerland



Abstract
Worldwide, nearly 1.2 million people are killed in road traffic crashes every years and
20 million to 50 million more are injured or disabled. These injuries account for 2.1% of
global mortality and 2.6% of all DALYs lost. Low- and middle-income countries account
for about 85% of the deaths and 90% of the DALYs lost annually. Without appropriate
action, by 2020, road traffic injuries are predicted to be the third leading contributor to
the global burden of disease.

The economic cost of road traffic crashes is enormous. Globally it is estimated that
US$ 518 billion is spent on road traffic crashes with low- and middle-income countries
accounting for US$ 65 billion more than these countries receive in development
assistance. But these costs are just the tip of the iceberg. For everyone killed, injured
or disabled by a road traffic crash there are countless others deeply affected. Many
families are driven into poverty by the expenses of prolonged medical care, loss of a
family breadwinner, or the added burden of caring for the disabled.

Since 2000, WHO has stepped up its response in this area by firstly developing a 5-
year strategy for road traffic injury prevention and following this by dedication World
Health Day 2004 to Road Safety. At the global event held in Paris on the 7th April
2004, WHO and the World Bank launched the joint World report on road traffic injury
prevention. This report emphasizes the role of public health in the prevention of road
traffic injuries. It offers countries six recommendations for action on road safety at a
national and international level.
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The report calls for a systems approach to road safety which looks at the system as a
whole and also the interaction between the road, vehicle, and road user in order to
identify where there is potential for intervention. In particular, the systems approach
recognises that humans make mistakes and as such a safe road traffic system is one
that accommodates their weaknesses.

The report further emphasises that road safety is a multisectoral issue which requires
shared responsibility between governments, industry, nongovernmental organizations
and international agencies.

Introduction
Every year the World Health Organization (WHO) hosts an event, usually on the 7th
April, to celebrate the anniversary of its founding in 1946. The event focuses on one
health issue in order to promote awareness, understanding, discussion and debate
about the issue and how it may be prevented or treated.

World Health Day (WHD) on the 7
th
April 2004 focused on road traffic injuries and how
these may be prevented. The slogan for the day was Road Safety is NO Accident
suggesting that road safety does not happen accidentally, but requires deliberate
efforts by government and its partners as well as political will.

Hundreds of events were celebrated around the world. These events ranged from
simple advocacy campaigns to the passing of new laws. Events were held from as far
north as Sweden where there was a candle lighting ceremony to commemorate victims
of road traffic collisions to down south where the World report on road traffic injury
prevention
1
was handed over to the South African minister of health. In Brazil there
was a safety belt campaign while a road safety manual was launched by the Australian
government.

World Health Day was a huge success. More than 500 newspapers around the world
carried stories on road safety in the days leading up to WHD, on the day and shortly
thereafter. More than a dozen scientific articles, commentaries and editorials have
been published on the subject this year. In addition, the WHD website received more
than a quarter of a million hits on the 7
th
April and over a million in the three weeks
following WHD. This trend has continued.
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The world report on road traffic injury prevention

The WHO/World Bank World report on road traffic injury prevention
1
was launched on
World Health Day at the global event in Paris, France. The World Report attempts to
bring together all we know about the causes, risks and interventions for road traffic
injuries. It also offers countries six recommendations.

The report took 18 months to develop and included more than 200 experts from health,
transport, education, law enforcement and social sciences from more than 80 countries
around the world. Experts were engaged from international organizations,
governments, academia, private enterprises, foundations and nongovernmental
organizations. J ust over 40% of all the contributors were from developing countries.

The full report and its companion summary and fact sheets are all available off the
WHO website at:

http://www.who.int/world-health-day/2004/infomaterials/world_report/en/.

The summary is available in Arabic, Chinese, English, French, Russian, Spanish,
Vietnamese and Farsi.

Main messages
The following is a short summary of the main messages of the World Report.


1. Road traffic injuries are a huge public health and development problem
Road traffic injuries are a major public health and development challenge that require
concerted efforts by multiple partners for effective and sustainable prevention.
Worldwide, nearly 1.2 million people are killed in road crashes each year (a rate of 19.0
per 100 000 people) and between 20 million and 50 million more are injured or
disabled.
1
These injuries account for 2.1% of the global mortality and 2.6% of all
disability-adjusted life years (DALYs) lost.
1


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2. The majority of road traffic injuries occur in low- and middle-income
countries
The rates of road traffic death vary considerably between regions (Table 1) and even
between countries within regions. In general, however, rates are higher in low-and
middle-income countries. Altogether, low- and middle-income countries account for
about 85% of the deaths and for 90% of the annual DALYs lost because of road traffic
crashes.
1
The South-East Asia and Western Pacific Regions of WHO account for more
than half of all road traffic deaths in the world.

Table 1: Road traffic injury mortality rates (per 100 000 population) in WHO regions, 2002
WHO region Low- and middle-income
countries
High-income countries
African Region 28.3
Region of the Americas 16.2 14.8
South-East Asia Region 18.6
European Region 17.4 11.0
Eastern Mediterranean Region 26.4 19.0
Western Pacific Region 18.5 12.0
Source: reference 1

3. Without appropriate action the problem is expected to worsen
Projections show that, between 2000 and 2020, road traffic deaths will decline by about
27% in high-income countries but will increase by more than 80% in low- and middle-
income countries (Table 2).
2,3
Without appropriate action, by 2020, road traffic injuries
are predicted to be the third leading contributor to the global burden of disease.
2

Table 2: Predicted road traffic fatalities by region (in thousands), adjusted for under-
reporting, 19902020
Region Number of countries
surveyed
2000 2020 Change (%)
20002020
East Asia and Pacific 15 188 337 79
East Europe and Central Asia 9 32 38 19
Latin America and Caribbean 31 122 180 48
Middle East and North Africa 13 56 94 68
South Asia 7 135 330 144
Sub-Saharan Africa 46 80 144 80
Sub-total 121 613 1 124 83
High-income countries 35 110 80 27
Total 156 723 1 204 67
Source: reference 3
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4. Most of those injured are vulnerable road users
Pedestrians, cyclists and motorised two-wheeler and three-wheeler riders are the most
vulnerable road users.
4
In low- and middle-income countries they account for the
largest proportion of road traffic and also for most of the road traffic deaths (Figure 1).
By comparison, in high-income countries, car owners and drivers account for the
majority or road users and consequently the majority of road traffic deaths.
Nevertheless, even in these countries, vulnerable road users have a much higher risk
of death per kilometre travelled.

Figure 1: Road users killed in various modes of transport as a proportion of all traffic
deaths


0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Delhi, India
Bandung, Indonesia
Colombo, Sri Lanka
Thailand
Malaysia
U.S.A.
Australia
Norway
J apan
Netherlands
Pedestrians Bicyclists Motorized 2-wheelers Motorized 4-wheelers Other

Source: reference 4

5. The cost of road traffic injuries is enormous
The economic cost of road crashes and injuries is enormous. Estimates suggest that
they cost low- and middle-income countries between 1% and 1.5% of their gross
national product (GNP) and high-income countries 2% of GNP.
5
A conservative global
cost is estimated to be US$ 518 billion per year with low- and middle-income countries
accounting for US$ 65 billion
5
- more than these countries receive in development
assistance.
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But economic costs are just the tip of the iceberg. For everyone killed, injured or
disabled by a road traffic crash there are countless others deeply affected. Many
families are driven deeper into poverty by the expenses of prolonged medical care, loss
of a family breadwinner or the added burden of caring for the disabled.
6


6. Major risk factors are identifiable and amenable to intervention
The world report on road traffic injury prevention categorises risk factors for road traffic
collisions into four groups. These are:


Factors influencing exposure to risk, such as economic and demographic
factors, the level of motorization, modes of travel, the volume of unnecessary
trips and land-use planning practices.


Factors influencing crash involvement such as excessive speed, drinking and
driving, unsafe vehicles, unsafe road design and the related lack of effective law
enforcement and safety regulations.



Factors influencing crash severity such as the non-use of seat-belts, child
restraints or crashes helmets, insufficient vehicle crash protection both inside
and outside the vehicles, unforgiving roadside objects and human tolerance
factors.


Factors that influence the severity of post-crash injuries including delays in
detecting a crash and providing life-saving measures and psychological
assistance, delayed or poor emergency care on the spot or transport to a health
facility, and inadequate trauma care and rehabilitation following the collision.


7. Road traffic injuries can be prevented
In high-income countries such as Australia, the United Kingdom and the United States
of America an established set of interventions has contributed to significant reductions
in the incidence and impact of these injuries (Figure 2).

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Figure 2: Road traffic fatality trends in three high-income countries
0
5
10
15
20
25
30
35
1
9
6
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Source: reference 1

8. Road safety should be addressed using a " systems approach"
Countries that have been most successful have been those that have good political will
and have embraced a "systems approach" to road safety, i.e. one that looks at the
system as a whole and also the interaction between the road, the vehicle, and the road
user in order to identify where there is potential for intervention. In particular, the
systems approach recognises that humans make mistakes and as such a safe road
traffic system is one that accommodates their weaknesses. The Swedish Vision Zero
and the Dutch Sustainable Safety are good examples of the systems approach to road
safety.
7,8

9. Road safety is a shared responsibility
In addition, the countries that have been most successful have also been those that
have engaged many different groups from government, civil society, nongovernmental
organizations, the media, and industry in a coordinated programme on road safety.

10. Road traffic injuries are a public health problem
Traditionally road safety has been assumed to be the responsibility of the transport
sectors and public health has been slow to become involved. But the health sector
would greatly benefit from better road traffic injury prevention in terms of fewer hospital
admissions and reduced severity of injuries. It would also be the health sector's gain if
more people were to adopt a healthier lifestyle of walking or cycling, without fearing for
their safety.
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The health sector is only one of many bodies involved in road safety but it has
important roles to play particularly in:


The systematic collection of data through surveillance and surveys;

Researching the causes of road traffic crashes and injuries;

Exploring ways of preventing and reducing the severity of injuries;

Helping to implement interventions;

Working to persuade policy-makers and decision-makers of the necessity to
address injuries in general as a major issue;

Translating effective science-based information into policies and practices; and

Promoting capacity building in all these areas.

11. Solutions can be adapted in low- and middle-income countries
A variety of approaches can be used to tackle road safety. There is no blue print. But
there are a few interventions that we know work in most settings. These include
legislation, enforcement and education related to speed, alcohol, seat-belts, child
restraints and helmets as well as visibility. Using the systems approach, WHO and its
partners will focus on these issues in the coming years. Although the exact solutions
for low- and middle-income countries may differ from those that have had a longer
history of motorisation, the basic principles will be the same. The challenge will be to
adapt and evaluate existing solutions, or else create new solutions in low- and middle-
income countries.

Recommendations
The report concludes by offering six recommendations. These recommendations
should be considered as flexible guidelines for adaptation to local circumstances, and
should be applied across a wide range of sectors and disciplines.

1. Identify a lead agency in government to guide the national road traffic
safety effort.
This recommendation stresses the need for institutional leadership. It suggests
that a lead agency on road safety be designated. There are a number of
different institutional models which could be implemented, but primarily the lead
agency should have the authority and responsibility to make decisions, control
resources and coordinate efforts by all sectors of government including
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health, transport, education and the police. The lead agency should be
adequately financed and should be publicly accountable for its actions. The
effectiveness of lead agencies is enhanced by strong and sustained political
support.

2. Assess the problem, policies, institutional settings and capacity relating
to road traffic injury
This recommendation underscores the need for reliable data and effective
institutional structures as the building blocks for a sustained road safety
programme. Data can be obtained from the police, ministries of health or
transport, health care facilities, insurance companies, motor vehicle
manufacturers, or government agencies. Where data is not available, simple,
cost-effective information systems which comply with international standards for
recording and classifying road deaths and injuries should be established. In
addition, an appraisal of the human capacity to implement effective injury
prevention measures should be made. The lack of data, should not, however,
dissuade governments from commencing preventive road safety actions.

3. Prepare a national road safety strategy and plan of action
This recommendation outlines the need for a multisectoral, multidisciplinary
national road safety strategy. The strategy should take into account the needs
of all road users and engage all stakeholders. It should have sufficient funding
to develop, implement, manage, monitor and evaluate actions over at least five
years. It should be linked to strategies in other sectors and set ambitious but
realistic safety targets. A national action plan which specifies interventions,
timeframes, and resource should be developed.
4. Allocate financial and human resources to address the problem
This recommendation contends that well-targeted investments of financial and
human resources can reduce road traffic injuries and deaths considerably.
Cost-benefit analyses from worldwide experiences in specific interventions, can
help to set priorities for the use of scarce financial and human resources.
However, in order to sustain long-term intervention strategies and achieve
reduction targets, new funding sources may need to be found.
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In addition, priority should be given to training programmes which build human
capacity across a range of disciplines. The participation in global, regional and
national training networks and conferences can contribute to this process.

5. Implement specific actions to prevent road traffic crashes, minimize
injuries and their consequences and evaluate the impact of these actions
This recommendation suggests that countries implement scientifically sound
actions to prevent road traffic crashes and to minimize their consequences. It
summarises a range of "good practice" interventions which, if implemented,
could have a significant impact on reducing fatalities, injuries and disability from
motor vehicle collisions. Specific country-based intervention should, however,
be culturally appropriate and tested locally. There is no standard package of
interventions suitable for all contexts and countries.

6. Support the development of national capacity and international
cooperation
This recommendation calls for increased collaboration and coordination at an
international level. Currently there are a number of United Nations agencies,
nongovernmental organizations, multinational corporations, foundations and
donors which are active in promoting road safety but there is little large-scale,
coordinated planning among them. Roles and responsibilities must be clearly
assigned to ensure a firm, collective commitment to fund, create and implement
a global plan for road safety that is consistent with other global initiatives.

Conclusion
Following World Health Day and the launch of the World Report two historic resolutions
were passed. The United Nations general assembly passed resolution 58/289 on
improving global road safety on the 14
th
April 2004.
9
This resolution takes note of the
recommendations contained in the World report on road traffic injury prevention; invites
WHO, working in close cooperation with the United Nations regional commissions, to
act as a coordinator on road safety issues within the UN system; requests the
Secretary-General to report back at the 60
th
UN general assembly; and underlines the
need for further strengthening of international cooperation.
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After nearly thirty years, the 57
th
World Health Assembly overwhelmingly adopted
Resolution 57/10 on road safety and health.
10
This resolution urges Member States to
take up the road safety challenge by specifically addressing issues related to data
collection, capacity development, financial and human resources, implementing
specific measures to reduce deaths and injuries related to road traffic collisions, the
need for multi-sectoral collaboration and government leadership. It furthermore accepts
the United Nations resolution invitation to WHO to act as a coordinator for UN activities
in road safety. This role will involve organizing meetings of relevant global and regional
bodies of the United Nations system, establishing joint United Nations activities aimed
at implementing the recommendations of the WHO/World Bank World report on road
traffic injury prevention, and disseminating information on progress made toward those
objectives.

These two resolutions are just the first step in implementing Recommendation 6 of the
World Report. On 1 October 2004 a UN collaborating meeting was held in conjunction
with the UN regional commissions to discuss ways in which UN and other global road
safety organisations can work together to reduce the carnage on the world roads. A
number of concrete products were agreed on including a set of "how to" manuals which
will guide governments on how to implement the recommendations of the World Report
particularly those with regard to speed, alcohol, helmets, seat-belts and conspicuity.
Other joint products would include a dynamic web-based global database of road
safety laws and regulations, an annual world day for victims of road safety collisions,
and a follow up regional road safety stakeholders meetings. The next UN coordination
meeting will be held in March 2005 (see http://www.who.int/violence_injury_prevention/
road_traffic/un_roadsafety_collab/en/ for more information about these meetings).

Road safety is a shared responsibility. Reducing the risks on the worlds roads requires
commitment by governments, industry, nongovernmental organizations and
international agencies as well as by many different disciplines such as road engineers,
motor vehicle designers, law enforcers, educators, health professionals and community
groups. As the Director-General of WHO said during his World Health Day speech "We
must now use every day to act on road safety, and implement effective sustainable
action to prevent injury and death on the world's roads".
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Acknowledgements
I acknowledge, with thanks, the contributions of my co-editors of the World Report on
Road Traffic Injury Prevention as well as the writers of the report and members of the
advisory committee, technical committees, reviewers, and donors.

References
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