Road traffic injuries--a neglected pandemic.

Abstract

Road traffic injuries (RTIs) are the only public health problem for which society and decision-makers still accept death and disability among young people on a large scale. This human sacrifice is deemed necessary to maintain high levels of mobility and is seen as a justifiable externality of doing business: the only discussion revolves around the number of deaths and injuries that are acceptable. The sole departure from this mode of thinking is "Vision Zero", a campaign that originated in Sweden with the aim that eventually no one would be killed or seriously injured nil the roads. In October 1997, the Road Traffic Safety Bill founded on Vision Zero was passed by a large majority in the Swedish Parliament but, even in Sweden, the believers are few. Deaths front causes that were commonplace in the early twentieth century--such as Fatalities among workers in factories, mines, railroads and dockyards--are no longer accepted as inevitable today. Nowadays, many societies do not apply a death penalty no matter how serious the crime. Recently, about a hundred deaths caused by the spread of severe acute respiratory syndrome (SARS) mobilized international efforts to arrest the disease; and millions of demonstrators came out on the streets in many countries to protest against a war in their belief that nothing justifies the deaths of innocent individuals. So why is this attitude absent when it comes to road traffic? Recent estimates suggest that RTIs result in one million fatalities worldwide every year. A vast majority of these deaths involve people who are less than 50 years old. Another 20-30 million people suffer injuries that need hospitalization or expert medical treatment. It must not be assumed that individuals and decision-makers are not concerned about RTIs: governments in high-income countries have spent a great deal of effort in establishing road safety agencies and standards and have undertaken some research, but governments in low- and middle-income countries--despite showing concern for more than two decades--have not yet established effective agencies or spent any money on research. The attitude of all governments, however, is similar: injuries and deaths will always occur, and the best one can hope for is to reduce them. Citizens of low-income countries, however, express greater intolerance of road traffic deaths than their counterparts in the industrialized world. In many African and Asian countries, hardly a day goes by when an angry crowd does not attempt to lynch a driver or burn a vehicle involved in a crash with a pedestrian. On their own initiative, villagers have constructed thousands of "sleeping policemen" (speed humps) to slow down vehicles speeding through their neighbourhoods. So where does the problem lie? Mainly, with the persistent focus on fault. If human error is seen as the root cause of RTIs, it follows that the solution must be the education of road users and that those who do "wrong" may suffer injuries. This mindset has continued in the face of all scientific evidence that educating road users is not the most effective way to reduce RTIs. A second difficulty is that work on road safety is still not recognized as a scientific occupation in our academic institutions and among decision-makers. The result is a large turnover of "experts"--for whom road safety is rarely the dominant area of activity--who repeatedly "reinvent the wheel". It has been known for over 25 years that driver education does not significantly reduce the incidence of RTIs, but each new batch of experts goes patiently through the same processes to arrive at the same conclusion. An offshoot of this fixation is the dogged belief among road safety consultants that people in poorer countries are in special need of road traffic education. Equating developing countries with "needing education" flies in the Face of research findings and simple logic: not a single study from a low- or middle-income country has demonstrated a correlation between lack of knowledge and RTI rates. …