Reducing road dangers

Abstract

Next week sees the launch of the first Decade of Action for Road Safety 2011–2020, with events planned across the world to promote safety for all road users. With the increasing burden of death and disability caused by road-traffic accidents, it was the impetus given by a ministerial conference hosted in Russia in November, 2009, which led to the Decade of Action being announced by the UN General Assembly in March, 2010.To support governments to develop and implement national plans to improve road safety, a global plan has been issued by WHO to provide a framework for worldwide action and to facilitate local activities. The goal is to stabilise and then to reduce forecasted road-traffic deaths around the world by 2020. Specifically, over the decade the goals are to save 5 million lives, 50 million serious injuries, and the equivalent of US$5 trillion.3000 people die each day in accidents on the roads worldwide—nearly 1·3 million people a year. In addition, 20–50 million people are injured each year, many of whom end up with lifelong disabilities. 90% of road-traffic deaths occur in low-income and middle-income countries, despite fewer vehicles in these countries. Without concerted action, road-traffic injuries are predicted to be the fifth leading cause of death by 2030 (after ischaemic heart disease, cerebrovascular disease, chronic obstructive pulmonary disease, and lower respiratory infections)—a leap from being the ninth ranked cause of death in 2004. In those aged 15–29 years, road-traffic injuries are the leading cause of death. Just over half of all deaths on the roads are in those not travelling in a car.These numbers are stark, but do not take into account the epidemic of chronic disease and obesity, or the effects on air pollution and climate change, which result from increasing reliance on motorised vehicles. Conversion of a road-traffic injury epidemic to one of obesity or heart disease needs to be avoided.Road-traffic injuries, and their direct consequences, can be prevented by a combination of vehicle design, road planning and safety management, legal measures, education, and emergency responses. Five pillars of action are outlined in the global plan: developing national road-safety strategies, with funding for implementation and monitoring; improving the safety of roads for all users, including pedestrians, bicyclists, and motorcyclists; improving vehicle safety by design and ensuring harmonisation of global standards; changing road users' behaviours by education and enforcement (such as seat-belt and helmet wearing, or speed restrictions); and improving the post-crash response.Only 15% of countries have laws in place to support the wearing of seat belts or helmets, use of child restraints, and limits on alcohol consumption or driving speed. Protecting the most vulnerable—those not in cars—by improving access to public transport or building cycle lanes and footpaths is another major focus of the plan. Building an infrastructure that supports walking and cycling has additional public health benefits through obesity prevention and a reduction in air pollution.Care of trauma patients before transfer to and when in hospital dramatically affects survival and morbidity. Building sustainable emergency response and trauma-care systems are essential, yet often neglected, components of health care in low-income countries. In all countries, providing the best evidence-based care for trauma victims, such as giving tranexamic acid to reduce the risk of death from blood loss as shown in the CRASH-2 study, should receive greater emphasis.The plan calls for governments to ensure that funds are allocated to improving road safety, but donors—both individual and institutional—are needed. Michael Bloomberg, the Mayor of New York City, has given $125 million to support road safety initiatives in low-income and middle-income countries. Other innovative solutions are sought—for example, for each new car sold in developed countries, a contribution to a fund to support road safety in developing countries could be made.For the momentum to be maintained throughout the decade and beyond, injury prevention needs clinicians to take the stage and promote best practice. There is a continuing need for conduct and dissemination of high-quality research, and trauma specialists are well placed to take a leading role. Thinking beyond injury prevention to the wider public health benefits of reducing car use in favour of walking and cycling warrants passionate advocacy. An approach to reduce all road dangers will be the subject of a forthcoming Lancet Series.Making towns and cities safer for pedestrians and cyclists, or promoting use of seat belts or helmets, might not be as cutting edge as stem-cell research but will save more lives this decade. Next week sees the launch of the first Decade of Action for Road Safety 2011–2020, with events planned across the world to promote safety for all road users. With the increasing burden of death and disability caused by road-traffic accidents, it was the impetus given by a ministerial conference hosted in Russia in November, 2009, which led to the Decade of Action being announced by the UN General Assembly in March, 2010. To support governments to develop and implement national plans to improve road safety, a global plan has been issued by WHO to provide a framework for worldwide action and to facilitate local activities. The goal is to stabilise and then to reduce forecasted road-traffic deaths around the world by 2020. Specifically, over the decade the goals are to save 5 million lives, 50 million serious injuries, and the equivalent of US$5 trillion. 3000 people die each day in accidents on the roads worldwide—nearly 1·3 million people a year. In addition, 20–50 million people are injured each year, many of whom end up with lifelong disabilities. 90% of road-traffic deaths occur in low-income and middle-income countries, despite fewer vehicles in these countries. Without concerted action, road-traffic injuries are predicted to be the fifth leading cause of death by 2030 (after ischaemic heart disease, cerebrovascular disease, chronic obstructive pulmonary disease, and lower respiratory infections)—a leap from being the ninth ranked cause of death in 2004. In those aged 15–29 years, road-traffic injuries are the leading cause of death. Just over half of all deaths on the roads are in those not travelling in a car. These numbers are stark, but do not take into account the epidemic of chronic disease and obesity, or the effects on air pollution and climate change, which result from increasing reliance on motorised vehicles. Conversion of a road-traffic injury epidemic to one of obesity or heart disease needs to be avoided. Road-traffic injuries, and their direct consequences, can be prevented by a combination of vehicle design, road planning and safety management, legal measures, education, and emergency responses. Five pillars of action are outlined in the global plan: developing national road-safety strategies, with funding for implementation and monitoring; improving the safety of roads for all users, including pedestrians, bicyclists, and motorcyclists; improving vehicle safety by design and ensuring harmonisation of global standards; changing road users' behaviours by education and enforcement (such as seat-belt and helmet wearing, or speed restrictions); and improving the post-crash response. Only 15% of countries have laws in place to support the wearing of seat belts or helmets, use of child restraints, and limits on alcohol consumption or driving speed. Protecting the most vulnerable—those not in cars—by improving access to public transport or building cycle lanes and footpaths is another major focus of the plan. Building an infrastructure that supports walking and cycling has additional public health benefits through obesity prevention and a reduction in air pollution. Care of trauma patients before transfer to and when in hospital dramatically affects survival and morbidity. Building sustainable emergency response and trauma-care systems are essential, yet often neglected, components of health care in low-income countries. In all countries, providing the best evidence-based care for trauma victims, such as giving tranexamic acid to reduce the risk of death from blood loss as shown in the CRASH-2 study, should receive greater emphasis. The plan calls for governments to ensure that funds are allocated to improving road safety, but donors—both individual and institutional—are needed. Michael Bloomberg, the Mayor of New York City, has given $125 million to support road safety initiatives in low-income and middle-income countries. Other innovative solutions are sought—for example, for each new car sold in developed countries, a contribution to a fund to support road safety in developing countries could be made. For the momentum to be maintained throughout the decade and beyond, injury prevention needs clinicians to take the stage and promote best practice. There is a continuing need for conduct and dissemination of high-quality research, and trauma specialists are well placed to take a leading role. Thinking beyond injury prevention to the wider public health benefits of reducing car use in favour of walking and cycling warrants passionate advocacy. An approach to reduce all road dangers will be the subject of a forthcoming Lancet Series. Making towns and cities safer for pedestrians and cyclists, or promoting use of seat belts or helmets, might not be as cutting edge as stem-cell research but will save more lives this decade. Rebecca Ivers: driving down the toll of injuryRoad injury is the ninth leading cause of death in the world, and will be the fifth leading cause by 2030 if existing trends continue. Rebecca Ivers aims to be part of a worldwide drive to prevent this. “Governments worldwide need to invest in the immense potential of injury prevention programmes, that will benefit individuals and families and also the economy by reducing the productivity impact, for example, of road crashes in young men of working age”, she says. Full-Text PDF