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 Intervention: Principles and elements Taking action for road safety Conclusions

The worlds first death by Motor vehicle on 17 August 1896 in London

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 140 yrs. Old) Death from RTIs account for around 25% of all deaths from injury
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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
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Lower Respiratory infection Diarrhoeal disease Perinatal conditions Unipolar major depression Ischaemic heart disease Cerebrovascular disease Tuberculosis Measles Road Traffic Injuries Congenital Abnormalities 1. 2. 3. 4. 5.

2020 Disease or Injury

Ischaemic heart disease Unipolar major depression Road Traffic Injuries Cerebrovascular disease Chronic obstructive pulmonary disease 6. Lower Respiratory infection 7. Tuberculosis 8. War 9. Diarrrhoeal disease 10. HIV

Injury: A Leading Cause of Burden in the Region, 2000

Types of Injury Number of Death Total

Low income (18) Countries

War Injuries RTIs Interpersonal Violence Self Inflected Injuries Drowning 163116 70677 54217 39388 16845

High Income (104) Countries

1825 923 486 643 161 164941 71600 54703 40031 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%

13% 35% 11%

Western Pacific African Americas South-East Asia European Eastern Mediterranean

Risk Factors
1.
In the road traffic, risk is a function of four elements: The exposure the amount of movement or travel within the system by different users or a given population density. The underlying probability of a crash, given a particular exposure. The probability of injury The outcome of injury

2.
3. 4.

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 At Local levels:

2.

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

Principles:

Intervention
Road Users Road infrastructure

Cont

Multisectoral strategic plans address the three prime elements of the traffic system: Prevention Strategies and policies need to adapt to local conditions

vehicle

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

Principles:

Intervention

Cont

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
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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
Chain of help for injured people Pre-hospital care The hospital setting Rehabilitation

5. Delivering post-crash care:

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
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Taking Action for Road Safety

What Governments can do

Cont

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

Taking Action for Road Safety

What Governments can do

Cont

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

Taking Action for Road Safety

What Governments can do

Cont

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 twowheelers Set and enforce appropriate speed limits

Taking Action for Road Safety

What Public can do

Cont

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.

Taking Action for Road Safety

What Public can do

Cont

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.

Taking Action for Road Safety

What Public can do

Cont

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

Taking Action for Road Safety

What donors can do

Cont

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

Taking Action for Road Safety

What vehicle manufacturers can do

Cont

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

Taking Action for Road Safety

Encourage governments to make the roads safe Identify local safety problems

Cont

What Communities, civil societies & individual can do

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

Taking Action for Road Safety

Cont

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