Why is Road Traffic Injury a Difficult Problem to Solve?
By: Andrew Howard MD, MSc, FRCSC
1.3 million people will die on the roads this year across the world. The World Health Organization (WHO) declared a decade of action on road safety from 2011 to 2021, with the aim of decreasing road deaths by half. When the decade was declared, 1.2 million road deaths occurred per year with a projection of 1.9 million deaths per year by 2020. The WHO hopes to bring this number down to 0.9 million lives lost per year—an aim that would save a million lives annually and 5 million lives total before the decade is out.
Huge strides have been made in North America to make cars safer for occupants. The cars we drive can be driven into a rock face at 40 km/hour without hurting the driver, which perhaps explains the drop in driver and occupant deaths over the past decades in North America and Europe. Most of us probably feel quite safe on the road, so why does road traffic injury persist as a serious issue?
Car occupant deaths are a predominant problem in North America and Europe. However, 90% of road deaths occur in low- and middle-income countries, and vehicle occupant deaths are a minority of the total vehicle deaths in these countries. Non-occupants—specifically, pedestrians, cyclists, and motorcyclists—bear the brunt of road traffic injuries, although the proportions vary substantially by country.
Effective interventions exist for all types of road injuries. Reducing impact speed from 35 km/hour to 25 km/hour reduces the risk of killing a pedestrian by 80%. Better road and city design reduces pedestrian crashes by 25%. Seatbelts, child restraints, motorcycle helmets, and bicycle helmets reduce deaths and head injuries by more than 50%. Moreover, drunk-driving programs reduce crash rates, and graduated driver licensing reduces crash rates among the young.
Organized trauma systems reduce death rates even in high-income countries where good hospitals are available. Making trauma care available throughout low- and middle-income countries would massively reduce death and disability. Furthermore, provision of emergency and essential surgical care, including trauma care, has recently been shown to be highly cost effective when compared to widely accepted health interventions such as care of HIV, tuberculosis, and malaria.
Implementation of interventions to reduce pedestrian, cyclist, and motorcycle deaths and injuries is scattered across multiple jurisdictions—health, justice, and transport at a minimum. Even in well resourced and well governed countries, the prevention of trauma falls through huge cracks between jurisdictions.
The University of Toronto and Institute of Medical Science have considerable research output across the spectrum of road traffic injuries—from invention of innovative child safety seats based on detailed biomechanical analyses, to novel geographically based analyses of pedestrian safety interventions, to data on trauma system effectiveness. However, too much of our research is concentrated where the funding is concentrated—in high-income countries. We are a Canadian university with excellent international connections and a recently reasserted global outlook. We understand why road traffic injury is a difficult problem to solve—but we also understand that orienting our research towards low-income countries and aligning with international organizations will allow us to play our part in reducing road deaths this decade, and saving a million lives per year.
For more reading on road traffic injury prevention, please visit World Health Organization: Violence and Injury Prevention at www.who.int/violence_injury_prevention.
Andrew Howard MD, MSc, FRCSC
Pediatric Orthopedic Surgeon,
Hospital for Sick Children
Associate Member, IMS
World Health Organization. Global status report on road safety (2009). Available from: http://www.who.int/violence_injury_prevention/road_safety_status/2009/en/index.html
World Health Organization. One-year progress update: Decade of Action for Road Safety 2011-2020 (2012). Available from: http://www.who.int/roadsafety/decade_of_action/en/index.html
World Health Organization. World report on road traffic injury prevention (2004). Available from: http://www.who.int/violence_injury_prevention/publications/road_traffic/world_report/en/index.html