Road traffic injury: a big problem for global health

A major review published today in The Lancet has revealed the enormous burden of road traffic injuries in countries that can least afford to meet the health and economic costs.

The authors of the review, from The George Institute for International Health in Sydney, the University of Auckland, New Zealand and the National Institute of Public Health in Mexico, believe that while motorisation has enhanced the lives of many individuals and societies, the benefits have come with a high price, highlighting a critical need to address road traffic injuries as a public health priority.

Professor Robyn Norton, of The George Institute for International Health, University of Sydney, reported that: “Although the number of lives lost in road crashes in high-income countries has decreased in recent decades, for the majority of the world’s population the burden of road traffic injury is increasing dramatically in terms of societal and economic costs.”

In 2002, 1.2 million people were killed and 50 million injured in road traffic crashes worldwide, costing an estimated US$518 billion. In low and middle income countries, the economic costs of road crashes are estimated to exceed the total amount of development assistance these countries receive annually. “Without appropriate action, road traffic injuries are predicted to escalate from being the ninth leading contributor to the global burden of disease in 1990 to the third leading contributor by 2020,” Professor Norton added.

“The World Bank reports that in 20 years the global road death toll will increase by 66%, although this figure hides a significant divergence between rich and poor nations. While a 28% reduction in fatalities is expected in high-income countries, increases in fatalities of 92% and 147% are anticipated in China and India, respectively.”

The Lancet paper identifies the vulnerability of some road user groups, particularly pedestrians and two-wheeler users, who are vastly over-represented among crash victims at a global level. Studies in Asia show that motorcyclists have particularly high rates of injury whereas in Africa pedestrians are the most frequently injured road users. However with the rates of motorization increasing dramatically in countries such as India and China, the proportion of motor vehicle occupants at risk of injury is likely to increase.

“Recognition of road crashes as a major public health problem that is predictable and preventable is essential in addressing this emerging epidemic,” said Norton. “Many high income countries, such as Australia, have had dramatic successes in reducing the incidence of road traffic injuries in recent decades despite increases in motorization. Australian expertise can thus play an important role in helping countries in the region to modify and implement intervention strategies that are known to be effective.”

Many strategies to produce safer people, safer roads and safer vehicles had shown success in reducing fatalities and casualties, Norton said. For example, introducing graduated driver licensing systems reduced road crash injury rates among 16-year-olds by 28% in wealthier regions; the introduction of speed humps in Ghana showed a 55% reduction in all road traffic deaths; use of daytime running lights for motorised two-wheelers led to a 15 % reduction in fatal daytime crashes in Singapore; and use of seatbelts has been shown to reduce the risk of serious injury by 40% and fatal injury by 65%, although vehicles in many low and middle income countries often lack functioning seatbelts.

The authors also emphasise the importance of establishing surveillance systems that will monitor patterns of injuries and impacts of preventive strategies. Such surveillance systems must capture not only deaths but also non-fatal outcomes, given the potentially catastrophic impacts of non-fatal injuries on families and communities who must care for these individuals.

“A continuing global commitment to address the growing problem of road traffic injuries is required,” said Norton. “This must recognise the disparities in the experience of road injury based on income and social context, between and within countries.”