Violence and Injury Prevention

Q & A

How is this report different from the World report on road traffic injury prevention you released in 2004?

In 2004, WHO and the World Bank published the World report on road traffic injury prevention. The report brought together all that was known about the magnitude of road traffic injuries, described the principles of prevention, the major risk factors and determinants. It recommended a comprehensive approach to road safety, with participation by several sectors, including transport, police, health, industry, civil society and special interest groups. It made six recommendations, which were endorsed by the UN General Assembly and the World Health Assembly.

The new global status report documents how well these key recommended strategies are being applied in each country and provides a starting point for measuring progress over time.

How often will you be tracking progress?

Legislative and policy development takes time, as does fostering a cultural shift relating to road safety behaviour. However, we do need regular monitoring of the implementation of a number of road safety measures, so we aim to measure progress every 3 or 4 years.

How can countries compare themselves with others?

Comparison between countries is easy because a standard method has been applied to the collection of all information.

For example, the report contains an annex of tables showing reported deaths (adjusted to a definition of death within 30 days of the crash), number of deaths based on a statistical model, the existence of each of the key laws and perceived enforcement levels, as well as other indicators studied in the report. There are also colour-coded world maps for each of the five risk factors so that countries can easily see how they rank in terms of the extent or "comprehensiveness" of their legislation.

What are the strengths of this report?

This is the first time there has been a global assessment of road safety around the world. The report uses a standardized method for collecting information which means that country comparisons can be made. The level of participation of countries was very high, with 178 countries taking part - accounting for 98% of the world’s population. Road safety is an area that involves a number of sectors - health, transport, police and the method used here involved experts from multiple sectors collectively agreeing on which data best represented their country's situation.

How was the information collected?

A questionnaire exploring six main areas was developed through wide consultation with road safety experts from around the world, and this was pilot tested first. Coordinators in each country were trained and then led a consensus meeting involving up to eight experts from various sectors, including health, transport, law enforcement, academics and nongovernmental organizations. Each expert completed the questionnaire independently before the group discussed each of the answers and agreed on a final country response, which was then submitted to WHO.

What are the limitations of this report?

The project did not analyse the reliability and validity of the death and non-fatal data cleared by countries and submitted to WHO. In some cases, issues of underreporting, lack of completeness or coverage might have been present. For this reason, WHO developed a statistical model which tries to accommodate for some of these potential problems and came up with a "modelled number of road traffic deaths" for each country. The comparability of some of the other information collected from countries may be limited because of different interpretation of terms used in the questionnaire, such as “rural road” or “highway.”

The comparability of some of the other information collected from countries may be limited because of different interpretation of terms used in the questionnaire, such as “rural road” or “highway.”

Finally, we collected national level data, whereas laws are often enacted at a subnational (regional or local) level and enforcement often varies considerably across a country.

How reliable are the deaths statistics?

The reliability of the fatality data vary considerably. Death data are underreported to varying degrees in many countries, particularly very large countries or those without formal vital registration (death certificates) systems. Consequently, we used a mathematical model to come up with country, regional and global numbers of road traffic deaths and these are included in the statistical annex.

Why is it so difficult to get accurate statistics on road deaths?

In many countries road safety is not a political priority, and so there is little attention or resources allocated to building good data collection systems that would provide an accurate picture of the road traffic injury problem. In addition, road safety is an issue that involves a number of sectors and this leads to a number of other problems. For example, in some countries the definition used for a road traffic death differs between sectors, while the lack of linkages of data collected by the police and by hospitals/the health sector is a widespread problem.

In this report we present how only 80 of the 178 countries use the same definition - died within 30 days of the crash - to define a road traffic death. Underreporting is also a big problem in the provision of accurate statistics on road traffic deaths. This is further complicated by variation in the degree of access that people have to hospitals.

For example, Mr X (unknown at the time of the crash) was severely injured in a motor vehicle collision on a rural road. The police at the scene indicated on their "accident report form" that he was "non-fatally injured" and he was flown to the nearest teaching hospital. Unfortunately, Mr X (since identified as Mr John Doe) did not survive his injuries despite the best efforts of the doctors involved and died on day 28.

The Police, who are supposed to follow up all their crash statistics, were never informed that the patient had been identified and also were too busy/too far/too disinterested etc. His crash remained a "non-fatal severe injury" in the Police database, while in the Health database he was classified as "died".

Were there any surprises in the findings?

The enthusiasm for this survey and the high level of participation by countries was a pleasant surprise. We were also encouraged to see how many countries have followed up on a number of the recommendations outlined in the 2004 World report on road traffic injury prevention. On the other hand, there were surprisingly few countries that could really "tick all the boxes" of what is recommended as good practice.

In terms of the global findings, this was the first time we have had a global picture of the breakdown of road traffic deaths, and to find that almost half are not those riding in a car is probably contrary to popular perception. An interesting finding for us was also how overrepresented low-income countries are in terms of road traffic deaths, relative to their vehicle ownership.

What kind of improvements can be made in high-income countries? Could it be that death rates have flattened there because they are already doing everything they can?

No, death rates in some countries have plateaued at levels that can be reduced further. In some of the top performing countries where there has been effort to separate road users, the focus now is on increasing priority of vulnerable road users when you cannot separate road users, in particular by decreasing speed.

Furthermore, some top performing countries have set themselves a target of eliminating road traffic deaths. Also, a number of high-income countries which may rate well in terms of ranking their death rates can also do much more to reduce non-fatal road traffic injuries. Another major issue is that blood-alcohol concentration limits should be brought down to 0.05 and strictly enforced. Some high income countries have not done this.

What are the financial costs associated with road crashes?

Global losses due to road traffic injuries are estimated to be well over US$500 billion. A number of research studies have estimated that they cost governments between 1% and 3% of their gross national product. However, in this study the data we collected on costs of road traffic injuries were not comparable at a global level and this is one area where much more work is required.

Why are so many pedestrians dying? Do they really use roads much? How can countries better protect pedestrians?

So far pedestrians, cyclists and motorcyclists have not been given sufficient attention and priority when planning roads and transport systems. In many low- and middle-income countries walking, cycling and using motorcycles are main modes of transport. An important way to reduce road traffic injuries among pedestrians is to reduce their exposure to the risk of a crash.

For example, infrastructural measures can be used (like building safe crossings, pavements, and separate lanes for different road users. Reducing speed, such as having 30 km/h zones in urban areas, is also effective. There are a number of vehicle features that can also be used to protect pedestrians (e.g. collision friendly fronts on lorries, or automatic speed limiters).

Are these WHO judgements of the performance?

Not at all. WHO provided the tool for countries to assess performance, but the data in this global status report are what are provided by a group of road safety experts within the 178 countries and have been cleared by the responsible government authorities. WHO is of course encouraging countries to use these data to identify gaps in their road safety performance and build on the success already begun.

Why are poor people most affected by road crashes?

Poorer people are disproportionately affected, even in high-income countries, for a number of reasons. Firstly, their exposure to the risk of a crash is higher - e.g. they are more likely to live in an area with fast-moving traffic or a high volume of traffic, and less likely to be able to afford to use safer modes of travel.

In addition, they are less likely to have benefited from prevention efforts - e.g. investment in building pavements or safe crossings where they live, and are less likely to be able to afford protection measures such as buying a helmet or a child seat. People from lower socioeconomic groups around the world are likely to have less access to good health services than more affluent groups do.

Once a traffic crash has occurred, poorer people are also less able to absorb the costs related to a crash - funeral costs, health care costs and potentially the loss of the family breadwinner.

Why are most of the deaths occurring in poor countries? Isn’t it because they have higher populations, so would be contributing more to the overall number?

Yes, of course in countries like India and China where there are high populations there are also high numbers of deaths. However, aside from high population levels, a number of poor countries have higher road traffic death rates too, that is deaths per 100 000 population. This is in part due to a different mix of road users and traffic - for example, high speed traffic, lorries, bicycles and pedestrians all using the same roads, and the lack of infrastructure to separate these different groups.

Pedestrians, cyclists and motorcyclists make up a large proportion of road users in many poor countries and they are at increased risk of a traffic crash. There is also less comprehensive legislation in many low income countries and enforcement is lower, in part because enforcing laws demands a lot of human and financial resources. Health services are also less able to respond to the high numbers of road traffic crashes that occur in many poor countries.

What does WHO recommend?

WHO has a number of recommendations as a result of this report. Firstly, governments need to take into consideration the needs of all road users when they make policy decisions that affect people's safety on the roads, such as land use planning and transport policy. In particular, the needs of pedestrians, cyclists and motorcyclists, which have been neglected in many countries, should be given increased emphasis.

WHO also encourages governments to enact road safety laws that are consistent with what is known to be "good practice" and to improve the enforcement of these laws. Finally, governments need to take steps to improve the quality of data relating to road traffic injuries, which is incomplete in many countries. For these steps to be achieved, close collaboration is required among relevant national bodies or agencies who are involved in road safety. Success also requires that these agencies have sufficient human and financial resources to act effectively.

Are there any low- or middle-income countries that are showing improvements in road safety based on the recommendations WHO makes?

A number of low- and middle-income countries are implementing the recommendations that were in the World report on road traffic injury prevention, which WHO launched along with the World Bank in 2004. For example, Malaysia has been working on helmet wearing programmes for some time, while Viet Nam recently enacted a comprehensive helmet wearing law for motorcyclists. Ghana has put into place a number of measures to reduce speed, while 4 Mexican states have begun work to reduce drink-driving.

Some countries provided us with trend data which show clearly the progress they have made in reducing their road traffic deaths - for example, Rwanda has adopted a comprehensive approach to road safety including tightening up enforcement on a number of the key risk factors and the effectiveness of their efforts can be seen in the downward fatality trends. Serbia's data also suggests that efforts to make roads safer have been successful.

Global status report on road safety 2009



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