Injured by Design: A Global Perspective on Urban Design and Road Transport Injury

Abstract

Background: The design of cities has been heavily influenced by the needs of private motor vehicles, resulting in significant population and planetary health challenges. Death and injury due to motor vehicle crashes is now the world's 5th leading cause of mortality and morbidity and motor vehicle-related air pollution accounts for 4.2 million deaths per year. This study highlights the global importance of urban design as an approach to mitigating the challenges associated with rapid motorisation and road transport injury. Methods: Urban characteristics were obtained from sample maps for 1692 cities capturing one third of the world's population. Applying a combined convolutional neural network and graph-based approach, cities were classified into unique groupings based on selected urban design characteristics represented in sample maps. Associations between identified city types and the burden of road transport injury were estimated using data from the most recent Global Burden of Disease (GBD) study. Findings: For the first time, 9 city types (urban designs) have been identified that capture the diversity of land transport and are associated with the burden of road transport injury. The burden of road transport injury was 2-fold higher (RR=2.13) for the poorest performing city types as opposed to the best performing city type. A total of 9 million DALYs lost per year to road transport injury can be attributed to urban design/city types. Interpretation: With more than a 2-fold difference observed in the total estimated burden of road transport injury between the best performing city type and the worst performing city types, prevention efforts need to be focused up-stream to deliver urban design that supports transport mode shift that places people within lower risk transport modes such as rail and advocates for increased safe active transport. Such an approach will reduce the considerable health burden associated with cities operating predominantly private motor vehicle-oriented transport systems. Funding Statement: JT is supported by an Australian Research Council Discovery Early Career Research Award [Grant No. DE180101411]. MS is supported by a National Health and Medical Research Council (Australia) Fellowship [Grant No. APP1136250]. The work of JS was funded by a McKenzie Postdoctoral Fellowship from the University of Melbourne, Australia. CM is supported by the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health under Award Number K01AA026327. RS work is supported by the Australian Research Council discovery DP160101598 grant, centre of excellence CE170100023 scheme and the National Environment Science Program Clean Air and Urban Landscape hub. Declaration of Interests: Nothing to disclose. Ethics Approval Statement: No human or animal participants were involved in the study. The study did not require approval from the University of Melbourne’s Human Research Ethics Committee.