Improving Global Road Safety (web article)

April 23-29 will mark the United Nations First Global Road Safety Week. The Office of Communications and Public Affair spoke with Adnan A. Hyder, MD, PhD, MPH, an international road safety expert, about Global Road Safety Week and the state of road safety worldwide.

Hyder, an associate professor in Bloomberg School of Public Health’s departments of International Health and Health Policy and Management, has studied the global impact of traffic-related injuries and road safety policies. He is also a core faculty of the Bloomberg School’s Center for Injury Research and Policy and co-editor of the “World Report on Road Traffic Injury Prevention.”

Question: Tell us about the First United Nations Global Road Safety Week.

Answer: The “World Report on Road Traffic Injury Prevention” was released by the World Health Organization (WHO) and the World Bank in 2004. Since then there has been a global movement to make road safety more prominent. The United Nations designated April 23-29 as a time to remember all the victims who have died on roads around the world, but also as a time to plan and to move forward with road safety programs.

We will have a lunchtime seminar here at the Bloomberg School of Public Health on April 23 where students and faculty will present their contribution to global road safety. Events are also planned in Geneva and in many other places around the world.

Question: Why is road safety such a problem worldwide?

Answer: I think there are several facts about road safety that most people are not aware of. First, road traffic injuries kill more than one million people each year. That makes traffic injuries one of the top 10 leading causes of death worldwide.

Second, roughly 85-90 percent of the road traffic deaths occur in low- and middle-income countries. Therefore, the disproportionate burden of road traffic deaths is shared by developing countries. For every death that occurs on the road, there are 10 to 15 people who are injured. Some of these people are going to be disabled for life. The treatment of injuries is a burden on the country’s health system and economy, which is why road traffic injury is also among the top 10 disease burdens in the world.

Not only is the current situation bad, but if conditions remain the same, road traffic is projected to become the third leading disease burden in the world by 2020. In other words, if nothing is done about road safety, the death and disability will continue to increase and we’ll have a huge problem in the next 10 to 15 years.

Question: How much do road traffic injuries cost the global economy?

Answer: The cost to the global economy is over $500 billion per year, according to one estimate. The figure I appreciate more is that road traffic injuries cost low- and middle-income countries about 1 to 2 percent of their GNP (Gross National Product), which is a huge loss for these countries.

Question: What factors are contributing to the global road safety problem?

Answer: Speed is an important issue. Speeding is one of the leading risk factors of road traffic injury and death. Another issue is the mix of vehicles and people on roads in developing countries. A large proportion of road deaths in developing countries are not made up of people in vehicles, but of pedestrians on the roads. Alcohol--drinking and driving--is an important factor for both developing and developed countries. There is also a lack of enforcement of traffic safety rules and a lack of safety interventions in many developing countries.

Question: As countries grow economically, people buy more cars and vehicles. What kind of impact does this have on traffic injuries?

Answer: Economic development will bring more vehicle traffic and more injuries. That’s what’s happening in countries such as China, India and Malaysia. Each one of those countries is reporting very high rates of injury and public health officials are very concerned.

For me, road safety is really a social justice issue. In the United States and Western Europe, we have 50 years of experience to show us that traffic injuries occur with economic development. We don’t need to wait another 50 years for developing countries to learn these same lessons. We already know that helmets and seatbelts save lives and how to build better roads. It seems that if 90 percent of the problem is occurring in developing countries we need to respond and help save some of those lives.

We also need more evidence to determine if the interventions that have been tried in the developed countries will work in developing countries. We need to know how to get the Vietnamese child to wear a bicycle helmet or how to make African drivers reduce speeding and not drink and drive. These are questions that have not yet been answered and call for urgent research.

Question: Tell me more about some of the safety interventions that could reduce traffic injuries?

Answer: There are specific and cost-effective interventions that can reduce the burden of road traffic injuries globally. For example, here in the United States, we assume that every car should be equipped with seatbelts, but that not the case in some developing countries. We assume there should be speed bumps and circles to slow the flow of traffic, but that’s not always the case in low income nations. And we assume that there should be traffic lights, and that streets should have adequate lighting to see at night, but that’s not the case in many parts of the world. Speed control, alcohol reduction, traffic law enforcement and pedestrian safety are available and have been estimated to be some of the most cost-effective interventions in the field of public health, according to the National Institutes of Health, WHO and World Bank Disease Control Priorities Project.

Question: What can be done to improve global road safety?

Answer: Action should be taken on multiple levels. On a global level, we need to raise the profile of road safety so that people in the transportation sector and in the health sector know they have a role to play in reducing traffic deaths and injuries. The United Nations Global Road Safety Week is one way to help raise awareness of this issue.

On a national level, governments need to designate agencies to develop and implement national road safety plans. These agencies need to be given sufficient authority and funding to carry out these plans. At the global and national levels, it’s really about recognition of the problem and investing in solutions.

The programs will need to be implemented on the local level. Communities should get involved to make sure speed bumps are made, that seatbelts and helmets are worn and that there are sidewalks, crosswalks and other safety measures.

As researchers, our role is to provide the scientific evidence of the burden of traffic injuries and provide evidence that safety measures are working. We need to test these interventions so that money is spent on useful solutions. Testing of appropriate interventions and economic evaluation of road safety programs comprise an important research agenda.--Tim Parsons