Road Safety is No Accident

World Health Day 2004

By: Dr. Awatif Alam
Assoc. Professor, Dept. of Family &
Community Medicine, KSU-Riyadh
 Contents
Public health concern Global
Burden of RTIs
Projected trends in road crashes
Leading contributors to the global
burden of disease
Injury related deaths
Comparison in the future
Financial costs of the RTIs
Statistics from the EMRO
Risk factors
Situation in the EMRO
The worlds first death by Motor vehicle on
Intervention: Principles and 17 August 1896 in London
elements
Taking action for road safety
Conclusions
 Public Health Concern
RTIs are a major but neglected global public health
problem
The number of people killed in RT crashes/year is
estimated at almost 1.2 million and the number
injured could be as high as 50 million
Every day, almost 16,000 people die (from all types
of injuries).
Injuries represent 12% of global burden of disease
(the third most important cause of death among 1-
40 yrs. Old)
Death from RTIs account for around 25% of all
deaths from injury
Cont..
 Cont..

Public Health Concern

Estimates of the annual no. of road deaths
range from 750,000 to 1,183,492 representing
over 3000 lives lost daily
Around 85% of all global road deaths
95% of the DALYs lost due to crashes
95% of all children killed due to RTIs
occur in low-middle income countries.
Over 50% of deaths are among young adults
(15-44 yrs.)
Among children (5-14 yrs.) and young people
(15-29 yrs.) RTIs are the second leading cause
of death.
 What are the Projected Trends in
Road Crashes?
By the year 2020, if current trends continue, the
annual numbers of deaths and disabilities will
have risen by more then 60% and RTIs will rank
third on WHOs list of leading contributors to the
global burden of disease and injury.
They were number Nine on the list in 1990.
 Top 10 Leading Contributors to the
Global Burden of Disease
1990 Disease or Injury 2020 Disease or Injury
1. Lower Respiratory infection 1. Ischaemic heart disease
2. Diarrhoeal disease 2. Unipolar major depression
3. Perinatal conditions 3. Road Traffic Injuries
4. Unipolar major depression 4. Cerebrovascular disease
5. Ischaemic heart disease 5. Chronic obstructive pulmonary
6. Cerebrovascular disease disease
7. Tuberculosis 6. Lower Respiratory infection
8. Measles 7. Tuberculosis
9. Road Traffic Injuries 8. War
10. Congenital Abnormalities 9. Diarrrhoeal disease
10. HIV
Injury: A Leading Cause of Burden
in the Region, 2000
Types of Injury Number of Death Total
Low income High Income
(18) Countries (104) Countries
War Injuries 163116 1825 164941

RTIs 70677 923 71600

Interpersonal 54217 486 54703

Violence
Self Inflected 39388 643 40031
Injuries
Drowning 16845 161 17006

Total 344243 4038 348218

How will Countries Compare in the
Future?
By 2020, if current trends continue, the annual
nos of RT deaths and disabilities in high-income
countries may have lowered by as much as 30%
(due to improved road safety) and will have
increased by 60% in low-middle income
countries
WHY?
More rapid increase in population
Migration to urban areas
More reliance on motorized transport
Inadequate road safety measures
 What are the Financial Cost of
RTIs?
Global estimates = US $ 520 billion
In Low-middle income countries, they cost
us $ 65 billion i.e. 1% to 2% of GNP
In high-income countries they cost an
average estimate of 2% of GNP
 Statistics from the EMRO
Scarce and poor quality data
Underreporting
Lack of sound database
Lack of information system based on
scientific evidence
Differences in interpretation

Poor Policies and Interventions for Road Safety

 Total No. of Deaths = 1,260,000

7%
10% 24%

Western Pacific
African
Americas
South-East Asia
European
13%
Eastern Mediterranean
35%

11%
 Risk Factors
In the road traffic, risk is a function of four
elements:
1. The exposure the amount of movement or
travel within the system by different users or
a given population density.
2. The underlying probability of a crash, given
a particular exposure.
3. The probability of injury
4. The outcome of injury
 Some of the main Risk Factors for
Road Traffic Crashes and Injuries
Factors influencing exposure to road traffic:
Economic Factors such as level of economic
development
Demographic factors such as age, gender and
place of residence
Land use planning practices which influence how
long people travel and by which means
Mixture of vulnerable road users and high speed
motorized traffic
Lack of consideration of the ways in which roads
will be used when determining speed limits, road
design and layout
 Some of the main Risk Factors for Road
Traffic Crashes and Injuries
Risk factors influencing being involved in a crash:
Inappropriate and excessive speed
Presence of alcohol and other drugs
Fatigue
Being young and male
Being vulnerable road user in an urban or
residential area
Traveling in darkness
Poor vehicle maintenance
Road design, layout and maintenance defects
Inadequate visibility due to weather conditions
Poor eyesight
 Some of the main Risk Factors for Road
Traffic Crashes and Injuries
Risk factors influencing the severity of a crash:
Individual characteristics such as age which
influence the ability of a person to tolerate a crash
Inappropriate and excessive speed
Non use of seat belts and child restraints by
vehicle users
Non use of crash helmets by two-wheeler
Unforgiving roadside objects such as concrete
pillars
Insufficient vehicle crash protection such as air
bags for occupants and vehicle soft fronts for
those who may be struck by vehicles
 Some of the main Risk Factors for Road
Traffic Crashes and Injuries
Risk factors influencing the consequences
of injuries sustained as a result of crash:
Delayed crash detection and transport to a
health facility
Rescue and evacuation
Lack of appropriate care prior to arriving at
a health facility
Post collision fire
Leakage of hazardous material
 Situation in the EMRO
Range:
8 deaths/100,000 population in Yemen
24 deaths/100,000 population in Oman
Cumulatively 132,000 deaths in region (out of a
population of more then 492 million) occurring due
to RTAs in 2002
Almost twice the figure from Europe which was
68000 (out of a population of more then 874
million) in 2002
There has been substantial increase in RTA victims
in EMRO in recent years i.e. indicating acceleration
of the problem and alarming predictions.
 What is being done in the EMRO?
[Overall growing realization of escalating problem
of RTIs]
1. At global level, countries put forward RTIs prevention for
discussion in the UN,
Sultan Qaboos assumed a leading role
Road Safety is no accident, World Health Day 2004
2. At Local levels:
Traffic laws being reviewed and strengthened
In Saudi Arabia, KFSH has taken the lead in road safety efforts
with the formation of a special high level committee for road safety
(minister of interior), Multi-sectoral efforts.
National campaign for prevention of RTA in Egypt 1997 to raise
public awareness, new traffic law, seat belts, free emergency care.
Growing awareness of the seriousness of the problem in Iran.
Fines increased to 10 folds, training traffic officers.
 Intervention
Principles:

RT deaths and serious injuries are to a great

extent preventable
RT injury needs to be considered alongside
heart disease, cancer and stroke as a
preventable public health problem that responds
well to targeted interventions.
The provision of safe, sustainable and affordable
means of travel is a key objective in the planning
and design of road traffic systems.
To achieve the objective, it requires a firm
political will, and an integrated approach
involving close collaboration of many sectors.

Cont
 Cont

Principles:
Intervention
Road
Multisectoral strategic plans Users
address the three prime
Road
elements of the traffic system: infra-
vehicle
Prevention Strategies and structure

policies need to adapt to local

conditions
Substantial research and development over the last
3 decades have proved that a range of interventions
exist to prevent road crashes and injuries
There is a gap between what is known to be
effective and what is actually practiced
 Cont

Principles:
Intervention
As with other areas of public health, road
injury prevention requires effective
management to put in place evidence based
measures, overcoming obstacles to their
implementation
Legislation are of crucial importance, but laws
are never sufficient in themselves
Laws can only work when the public is
convinced that the laws will be enforced
In countries where enforcement is loose, if it
exists at all, levels of compliance are low.
 Elements of Intervention
1. Managing exposure to risk:
Reducing motor vehicle traffic
Minimizing exposure to high risk
2. Shaping the road network for road injury
prevention
Safety awareness in planning roads
Incorporating safety features into road design
Action at high-risk crash site
3. Providing Visible, crash-protective, Smart
vehicles:
Improving the visibility of vehicles
Crash-protective vehicle design
Intelligent Vehicles
Cont
 Cont
Elements of Intervention
4. Setting and securing compliance with key road
safety rules:
Enforcing speed limits
Enforcing seat-belt and child restraint use
Enforcing alcohol impairment laws
The role of education, information and publicity
5. Delivering post-crash care:
Chain of help for injured people
Pre-hospital care
The hospital setting
Rehabilitation
 Taking Action for Road Safety
What Governments can do
Institutional Development:
Make road safety a political priority
Appoint a lead agency for road safety, give it
resources and make it accountable
Set appropriate road safety targets and establish
national road safety plans
Develop mechanisms that promote a multi
disciplinary approach to road safety
Support the development of safety advocacy
groups

Cont
 Cont
Taking Action for Road Safety
What Governments can do
Policy Legislation and Enforcement:
Ensure the road safety is viewed to be a serious
political issue
Set and enforce strong and uniform vehicle
safety standards
Enact and enforce legislation requiring the use
of seat-belts and motorcycle helmets, speed
limits and control of alcohol impaired driving
Enforce safety laws already in existence
 Cont
Taking Action for Road Safety
What Governments can do

Policy Legislation and Enforcement:

Ensure that road safety considerations are
embedded in environmental and other assessments
for new projects and the analysis of transport
policies and plan
Establish data collection systems designed to
collect, analyze & use these data to improve safety
Make funding of road infrastructure conditional upon
compliance with safety standards
Create budget lines for road safety and increase
investment in demonstrably effective road safety
activities
 Cont
Taking Action for Road Safety
What Governments can do
Policy Legislation and Enforcement:
Support the development of safety advocacy groups
Establish appropriate design standards for roads
that promote safety for all
Manage infrastructure to promote safety standards
Provide efficient, safe and affordable public
transport services
Encourage walking & the use of non-motorized two-
wheelers
Set and enforce appropriate speed limits
 Cont
Taking Action for Road Safety
What Public can do
Include road safety in heath promotion and disease
prevention efforts
Systematically collect health-related data on the
magnitude, characteristics and consequences of
road traffic crashes
Support research to increase knowledge about risk
factors and the development, implementation,
monitoring and evaluation of effective counter
measures
Promote capacity building in all areas of road safety
and the management of survivors of road traffic
crashes.
 Cont
Taking Action for Road Safety
What Public can do

Translate effective science-based information into

policies and practices that protect vehicle occupants
and vulnerable road users

Strengthen pre-hospital and hospital care as well as

rehabilitation services for all trauma victims

Develop trauma care skills of medical personnel at

the primary health care, district and tertiary health
care levels.
 Cont
Taking Action for Road Safety
What Public can do

Promote the development of policies aiming at

greater integration of health and safety concerns
into transport policies and facilitate this by further
developing methods and tools to this effect (e.g.
integrated assessments)

Invest in Medical research to improve the care of

trauma survivors

Advocate for greater attention to road safety in view

of the health impact and costs
 Cont
Taking Action for Road Safety
What donors can do

Make funding for road safety part of grants for

health, transport, environmental or educational
programmes
Support road safety research, programmes, and
policy in low income and middle income countries
Make funding for transport infrastructure projects
conditional on the completion of a safety audit and
follow up
Generate mechanisms for providing funding for
knowledge sharing and safety promotion in
developing countries
 Cont
Taking Action for Road Safety
What vehicle manufacturers can do

Ensure that all major vehicles meet minimum safety

standards, regardless of where a vehicle is makde,
sold or used including the provision of seat-belts
and other basic safety equipment

Begin to manufacture vehicles with safer vehicle

fronts to reduce injury for vulnerable road users

Advertise and market vehicles responsibly by

emphasizing safety
 Cont
Taking Action for Road Safety
What Communities, civil societies & individual can do

Encourage governments to make the roads safe

Identify local safety problems

Help plan safe and efficient transportation systems

that accommodate drivers as well as vulnerable
road users like cyclists and pedestrians

Encourage safety programmes for school children

Demand safety features e.g. seat belts in cars

 Cont
Taking Action for Road Safety
What Communities, civil societies & individual can do

Encourage strong enforcement of traffic safety laws

and regulations, and advocate for strong and swift
punishment for traffic offenders

Behave responsibly by:

Abiding by the speed limit on roads
Never driving when over the legal alcohol limit
Always wearing a set-belt, and properly restraining
children, even on short trips
Always wearing crash helmet when riding a two-wheelers
 Conclusion
RTIs are a huge public health and development
problem
Limited usefulness of existing data sources (from
some countries)
Road safety is a shared responsibility
Road traffic crashes are predictable and can be
preventable
The adoption of system approach to road safety
resulted in sharp reduction in crashes and
casualty
More work is called for in all countries to find new
and better road safety measures.
 While there are many interventions that
can save lives and limbs,
Political will and commitment are essential
and without them little can be ACHIEVED
Thank You