01 piarc scope of the road safety problem 2015-10-20 v1

8/15/2019 01 Piarc Scope of the Road Safety Problem 2015-10-20 v1

1/26©World Road Association (PIARC) / Association mondiale de la Route (AIPCR) - 20/10/2015 1/26

ROAD SAFETY MANUALA GUIDE FOR PRACTITIONERS !

STRATEGIC GLOBAL PERSPECTIVE

SCOPE OF THE ROAD SAFETY PROBLEM

Introduction

Impact on Public HealthSocio-Economic CostsRoad Safety ContextReferences

World Road Association (PIARC)

Version 1 - 20/10/2015



1. SCOPE OF THE ROAD SAFETY PROBLEM

KEY MESSAGESRoad traffic injury is a major global public health problem. Rapid motorisation in low and middle-

income countries (LMICs) along with the poor safety quality of road traffic systems and the lack of institutional capacity to manage outcomes contribute to a growing crisis.More than 1.24 million people die each year on the world’s roads. Many more suffer permanent

disability, and between 20 and 50 million suffer non-fatal injuries. These are mainly in LMICs,amongst vulnerable road users and involve the most socio-economically active citizens.Road traffic injury is a leading cause of death globally for children and was the leading cause of

death for young people aged 15–29 in 2010. Without urgent action, it is forecast that road trafficinjury will be the 7th leading cause of death for all by 2030.

In socio-economic terms, countries around the world are paying a high price for motorised mobility.

Country estimates indicate that the value of preventing road death and injury is equivalent tobetween 1% and 7% of Gross Domestic Product.Death and serious injury from road crashes is preventable if crash energies are managed so that

they do not exceed human tolerances for serious and fatal injury and through effective, results-focused and resourced road safety management.

The Safe System goal and strategy focus on providing a road traffic system free from death and

serious injury. It does this by addressing unintentional error and human vulnerabilities. The Safe System guides the planning, design and management of the operation and use of the road

traffic system so as to provide safety in spite of human fallibility. It places a shared accountabilityacross all elements of the system.

Preventing road trauma on public roads and in the course of work is a core responsibility for

government, its agencies and employers and requires shared responsibility and leadership. The scale of the road safety challenge and the diversity of the effects of road traffic injury underline

the importance of exploring synergies with other societal goals and priorities.A UN Decade of Action for Road Safety 2011–2020 has been announced with an ambitious global

target and plan to reduce deaths in road traffic crashes.

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1.1 INTRODUCTION

This chapter outlines the growing global crisis of road traffic injury and the substantial value of preventingdeath and serious injury in road crashes. It also introduces the key road safety concepts that underpin thismanual’s guidance for implementing affordable and effective interventions to achieve results that may be

required in any given context. The first of these concepts is the challenging Safe System long-term goaland strategy, which is recommended to all countries regardless of their socioeconomic status and level of infrastructure development.

Secondly, this chapter highlights the planned, systematic approach needed for successful road safetymanagement to produce road safety results. As discussed more fully in later chapters, these approachesprovide a foundation and implementation framework for road safety investment programmes anddemonstration projects. It is emphasised that these programmes and projects need to seek targetedresults for the shortto medium-term, appropriate to the learning and management capacity of the countryconcerned. Affordable, effective intervention is required that better addresses the needs of all road users,including those most vulnerable. The chapter highlights the importance of aligning road safety with otherimportant societal objectives, given the significant potential for shared benefits and in order to maximisecost-effective investment.

ROAD SAFETY AS A GLOBAL PROBLEM

Economic development makes an important contribution to increased mobility and motorisation. It isforecast that over the first 30 years of the 21st century, more motor vehicles will be produced globallythan in the first 100 years of motorisation. The majority of these vehicles will be used in low- and middle-income countries (LMICs)1 (Bliss, 2011).

Alongside rapidly increasing rates of motorisation in LMICs, premature death and disability is occurring ona disastrous scale. Global road deaths increased by 46% between 1990 and 2010 (Mathers et al., 2012).Some 90% of road traffic deaths occur in LMICs and the victims are predominantly vulnerable road users,males, and include the most socio-economically active citizens (WHO, 2013a). Apart from the sheer scaleof human misery involved, the often underestimated socio-economic value of preventing these tragedies issubstantial (Jacobs et al., 2000; OECD, 2008; McInerney, 2012).

The road safety performance gap between rich and poor countries is set to widen further. It is projectedthat, by 2030, around 96% of global road deaths will occur in LMICs with 4% of deaths occurring in high-income countries (HICs). Forecasts of global mortality trends to 2030 indicate that road traffic injury is setto increase from the 9th to the 7th cause of death (WHO, 2013b). Without new initiatives, forecasts indicate

that more than 50 million deaths and 500 million serious injuries on the world’s roads can be anticipatedwith some certainty over the first 50 years of the 21st century (Bhalla et al., 2008). This can be comparedwith only an estimated 1% probability that over the same period, more than 40 million people could bekilled in mega-wars or by a virulent influenza epidemic and around 4 million people by volcanoes ortsunamis (Smil, 2008).

In response to these developments, the widely endorsed recommendations of the World Report (Peden etal., 2004; see Box 1.1 )and other initiatives, the United Nations General Assembly proclaimed a Decade of Action for Road Safety between 2011 and 2020. The Decade’s ambitious goal is ‘to stabilize and thenreduce the forecast level of road traffic deaths’ around the world (UN, 2010). If this goal is met, then 5

million lives would be saved and 50 million serious injuries would be avoided for an estimated socio-economic benefit of over US$3 trillion by 2020 (WHO, 2013a).

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BOX 1.1: THE WORLD REPORT ON ROAD TRAFFIC INJURY PREVENTION

The World Health Organization (WHO) and the World Bank jointly issued the World Report on Road Traffic Injury Prevention on World Health Day 2004 (Peden et al., 2004). The report was developed withthe assistance of global experts from low-, middle- and high-income countries. Its general findings andrecommendations, endorsed in UN Resolution, are widely accepted as the blueprint for road safety

intervention.

The report’s publication signalled a growing concern in the global community about the scale of thehealth losses associated with escalating motorisation, and a recognition that urgent measures have tobe taken to sustainably reduce their economic and social costs. Implementing the report’srecommendations has become a high priority for low- and middle-income countries and guidance wasissued by the World Bank in 2009, updated in 2013, to provide a country framework to assist thisprocess (GRSF, 2009; 2013).

A related five pillar Global Plan encourages LMICs with the assistance of aid agencies, to move straightaway to the implementation of effective Safe System approaches (UNRSC, 2011a).

With the planning, design, operation and use of the road network as its main focus, this manual addressesthree out of the five pillars: Road safety management (Pillar 1); Safer roads and mobility (Pillar 2); andSafer road users (Pillar 4). Safer speeds, which are embedded in several of the pillars of the Global Plan arealso addressed.

CONCEPTUAL FOUNDATIONS

It is now widely accepted that serious health losses in road traffic crashes are largely preventable andpredictable – a human-made problem open to rational analysis and effective road safety management(Peden et al, 2004). Road traffic systems can be developed that reduce the likelihood of serious or fatalcrashes occurring and to minimise injury severity in the event of a crash. This is supported by a substantialbody of knowledge on how to achieve significant lessening of the costly, adverse impacts of motorisation.In European Union countries, for example, the overall volume of traffic tripled between 1970 and 2000,while the number of people killed per million inhabitants decreased by 50% (CEC, 2003). (See keyoverviews by Peden et al., 2004; OECD, 2008; GSRF, 2009).

Over the last 15 years, two major and complementary developments have informed approaches to roadsafety and how to more effectively manage for better results by using holistic approaches. The first wasled by Sweden (Vision Zero) (Tingvall, 1995) and the Netherlands (Sustainable Safety) (Koornstra et al.,1992), which was a paradigm shift during the 1990s to the ambitious Safe System goal (see Box 1.2)

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.

BOX 1.2: THE SAFE SYSTEM GOAL AND STRATEGY

The Safe System goal for the long-term is the elimination of death and serious injury, supported in theinterim by periodic, quantitative casualty reduction targets (OECD, 2008). The aim is to work towardsthe design of a system which minimises death and serious injury, while accepting that crashes withminor outcomes might still occur. The ethical Safe System goal has effectively re-defined what is meantby ‘safety’ in road safety management goals in effective practice (DaCoTa 2012c).

The Safe System strategy aims to ensure that in the event of a crash, the impact energies remain belowthe threshold likely to produce either death or serious injury. The aim is to address known humancharacteristics by accommodating common, unintentional error, and to take better account of thevulnerability of the human body in the planning, design, operation and use of the road traffic system tobenefit all road users. Safe System intervention addresses all elements of the road traffic system andtheir linkages — road infrastructure, vehicles, the emergency medical system, and road users.

Source: Koornstra et al.,1992; Tingvall, 1995; OECD, 2008; DaCoTa, 2012c.

In a Safe System approach, mobility is a function of safety, rather than the other way around. It placesroad safety in the mainstream of road traffic system planning, design and operation. Building on the bestof previous approaches, Safe System better addresses the needs of vulnerable road users and isparticularly relevant to the needs of LMICs. As discussed in The Safe System Approach, firmly establishinga Safe System in national road safety work requires strong political backing and underwriting in legislation(OECD, 2008; Belin et al., 2012).

More recently, the World Bank, the OECD, and the International Standards Organization (ISO) haveunderlined that effective road safety management is a systematic process. Road safety does not justoccur, but has to be produced. The safety performance produced by countries active in road safety hasbeen achieved following years of sustained investment in road safety management and governmentalleadership. The road safety management system is the productive capacity to deliver key institutionalmanagement functions, which produce and enable effective, system-wide interventions that are designedto produce results – with the Safe System goal and strategy representing the most ambitious approach(OECD, 2008; GRSF, 2009; ISO, 2012).

These holistic concepts are the common threads running throughout this manual. They represent thesummation of effective multi-disciplinary road safety knowledge and successful practice across the roadtraffic system, which have been built up over decades. This knowledge base can be applied systematicallyto any country, regardless of its road safety performance, socio-economic status or level of infrastructuredevelopment.

The gradual and increasingly more successful path towards these shifts in road safety thinking andpractice are briefly outlined in Box 1.3 and are discussed in more detail in Key Developments in RoadSafety. LMICs are being urged to avoid the costly evolutionary path of industrialised countries shown inBox 1.3, and to take key steps to move directly to affordable, effective Safe System approaches noted inPhase 4. High-income countries which are now setting increasingly ambitious road safety goals and targets

are also advised to adopt this approach (OECD, 2008; GRSF, 2009; PIARC, 2012; WHO, 2013a). Theimplications for current practice in a variety of settings are recurrent themes in this manual and specificguidance is provided on appropriate steps for different road safety contexts.

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BOX 1.3: THE PROGRESSIVE SHIFTS IN THINKING AND PRACTICE ABOUT HOW TO MANAGE ROAD SAFETY

- Phase 1: 1950s thinking and practice focused on driver intervention and a ‘blame the victim’approach. Safety management was characterised by dispersed, uncoordinated, and insufficientlyresourced units performing isolated single functions.

- Phase 2: 1960s–1970s thinking and practice focused on system-wide interventions encompassinginfrastructure, vehicles and users in the pre-crash, in-crash and post-crash stages, but not yetemphasising institutional management responsibilities.

- Phase 3: 1980s–1990s thinking and practice focused on system-wide interventions and targetedresults, and saw the beginnings of institutional leadership and accountability for the implementation of targeted plans, which led to increasingly significant reductions in deaths and serious injuries duringthese decades.

- Phase 4: Since the 1990s, thinking and practice has focused on increasingly holistic approaches,generically known as the Safe System approach, seeking the long-term elimination of death and serious

injury. This goal is supported by interim targets and system-wide interventions (foreseen in the 1960sand 1970s, and used increasingly in the 1980s and 1990s). These pay greater attention to human errorand vulnerabilities, with renewed emphasis on speed management, better road and vehicle crashprotection, and post-crash care. This is underpinned by shared responsibility and strengthened,accountable institutional leadership.

Source: OECD, 2008; GRSF, 2009.

This manual outlines a suggested path for jurisdictions to move from weak to stronger institutionalcapacity, particularly in their governmental lead agency and coordination arrangements and resultsmanagement. The aim is to provide state-of-the-art guidance to assist all those involved in the safeplanning, design, operation and use of the road network in accordance with national, regional and globalgoals.

FOOTNOTES

1.The World Bank categorises countries into low-, medium- and high-income groups based on gross

national income (GNI) per capita, where low-income in 2011 = $1,025 or less; middle income =$1,026–$12,475; and high income = $12,476 or more(http://data.worldbank.org/about/country-classifications)

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1.2 THE IMPACT ON PUBLIC HEALTH

This section describes the current and forecast burden of road traffic injuries in more detail, both globallyand regionally.

The Global Status Report on Road Safety is the central publication for periodic monitoring and evaluationof the Decade of Action for Road Safety goals (WHO, 2013a) . While crash injury data is incomplete andoften substantially under-reported in many countries in both the health and transport sectors, the latestavailable estimates referred to in this manual provide a comprehensive strategic overview of the emergingcrisis in LMICs.

The Global Status Report brings together data based on survey information collected for 182 countries,and makes estimates, where appropriate, to account for varying levels of data quality in order for data tobe comparable across countries. This includes use of the 30-day definition of a road traffic death andinvolves point estimates of road traffic deaths in LMICs, which are sometimes far in excess of officiallyreported deaths. Data have been extrapolated for all 195 countries and territories in the world. Full detailsof the methodology used to develop comparative estimates are provided in WHO (2013a, p.42).

The Global Status Report notes the urgent need for standardised data collection on road traffic fatalitiesand the need for improvement in the quality of safety data on road traffic deaths, disability and other non-fatal injuries. See Effective Management And Use Of Safety Data for full discussion and guidance on theestablishment, management and use of data, and determining levels of under-reporting.

GLOBAL ESTIMATES

In 2010, at least 1.24 million people lost their lives in road traffic crashes (WHO, 2013a). Road traffic injury

is a leading cause of death and serious health loss (expressed in terms of disability adjusted life years lost(DALYs)1 (see Box 1.4 ). For every road traffic death, at least 20 people sustain non-fatal injuries (rangingfrom those that can be treated immediately and for which medical care is not needed or sought, to thosethat result in a permanent disability (Peden et al., 2004). On an annual basis, between 20 and 50 millionpeople are disabled or injured as a result of road traffic crashes (WHO, 2013a).

BOX 1.4: ROAD TRAFFIC INJURY AS A LEADING CAUSE OF DEATH AND SERIOUS HEALTH LOSS

Road traffic injury in 2010 was the:

9th leading cause of death, overtaking tuberculosis and malaria as causes

leading cause of death for young people aged 15–29 years

leading cause of death for males aged 5–14 years

leading cause of serious health loss for men aged 15–49 years

2nd leading cause of death for those aged 15–49 years.

Source: WHO, (2013a); WHO (2013b); IHME, (2013)

In some regions, road traffic injury was the leading cause of death for certain age groups, as shown inTable 1.1. For HICs in general, road traffic injury was the leading cause of death for children aged 5–14years (IHME, 2013). A study in four LMICs indicated that 17% of children attending an emergency

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department following a road traffic crash sustained disabilities lasting six weeks or more (WHO, 2008).

Region 1–4 years 5–9 years 10–14 years

North America 1 1 1

Central Europe 3 1 1

Australasia 2 1 1

Western Europe 2 2 1

North Africa and Middle East 4 1 1

Latin America 4 1 1

DEATH RATES

In 2010, the global road traffic fatality rate was 18 per 100,000 population in low income countries, withthe highest annual road traffic fatality rates averaging at 20.1 per 100,000 in middle-income countries,and the lowest average rate in high-income countries at 8.7 per 100,000 (see Figure 1.1).

Figure 1.1 Road traffic deaths per 100,000 population, by country income status; 2010 - Source: WHO, (2013a).

Some 80% of road traffic deaths occur in rapidly motorising middle-income countries, which account for72% of the world’s population and 52% of the world’s registered vehicles. As shown in Figure 1.2, thesecountries have a high proportion of road traffic fatalities relative to their level of motorisation (WHO,2013a). Details on individual country performance can be found in the periodic Global Status Reports

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(WHO, 2009, 2013a).

Figure 1.2 Population, road traffic deaths and registered motor vehicles by country income status; 2010 - Source: WHO,(2013a).

Compared with the baseline data (2007, 2010) collected by the WHO to allow periodic monitoring of theDecade’s goal (which commenced in 2011), most HICs are reported as achieving decreasing numbers of deaths from road traffic crashes. Most LMICs are experiencing increasing numbers of fatalities, although

just under a half of the middle-income countries have achieved decreases (see Figure 1.3).

Figure 1.3 Countries with changes in numbers of road traffic deaths (2007–2010) by country income status - Source: WHO,(2013a).

Between 2007 and 2010, the number of road traffic deaths decreased in 88 countries, of which 42 werehigh-income countries, 41 were middle-income countries, and five were low-income countries. Over thesame period, 87 countries saw increases in the numbers of road traffic deaths (WHO, 2013a).

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THE MAIN ROAD CASUALTY GROUPS

In most LMICs, a much higher proportion of road users are pedestrians, cyclists and users of motorisedtwo- or three-wheeled vehicles when compared with HICs. Over half of the global road traffic deaths occuramong vulnerable road users – motorcyclists (23%), pedestrians (22%) and cyclists (5%), with theremaining share distributed as 31% of deaths among car occupants and 19% among unspecified road

users. Low-income countries have the highest proportion of fatally injured casualties among vulnerableroad users at 57%, as opposed to 51% in middle-income countries, and 39% in high-income countries(WHO, 2013a). Figure 1.4 provides further detail on road deaths by road user type for low-, middle- andhigh-income countries.

Figure 1.4 Proportion of road traffic deaths by road user type and country status; 2010 - Source: WHO, (2013a).

Even in HICs, vulnerable road users are often vastly over-represented when rates of death and seriousinjury are compared. For example, when the distances travelled (billion miles) by different modes of roaduse were compared, more than 10 times as many pedestrians and cyclists than car drivers lost their liveson Great Britain’s roads in 2011. For motorcyclists, the rate was around 40 times higher (Department for

Transport, 2012). The gap is even wider when considering the risk of death or serious injury by billionvehicle miles. For each car driver in Great Britain, more than 20 times as many pedestrians and around 40times as many cyclists were killed or suffered a serious injury from a road traffic crash. Motorcyclists wereexposed to the greatest risk, as they were 75 times more likely to be killed or seriously injured than a cardriver (Department for Transport, 2012).

Young adults aged between 15 and 44 years account for 59% of global road traffic deaths (see Figure1.5); and more than three-quarters (77%) of all road traffic deaths occur among men. In high-incomecountries, the proportion of deaths among those over 70 years is noticeably greater than in LMICs. Key

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exposure factors, such as longevity in these countries, combined with the greater risk posed by increasedfrailty, will contribute to these outcomes (WHO, 2013a).

Figure 1.5 Proportion of road traffic deaths by age range and country income status - Source: WHO, (2013a).

REGIONAL ANALYSES

There is substantial variation in the road traffic death rates between different regions and within regions(see Figure 1.6). The reported risk of fatal injury is greatest in Africa at 24.1 per 100,000 populations andlowest in the European region at 10.3 per 100,000 population. Within regions, taking under-reporting of road fatalities into account, it is estimated that over half of African countries may have death rates of 30per 100,000 population or more (AfDB, 2012). The lowest recorded global country death rates for 2010were in Iceland (2.5 per 100,000 populations) and Sweden (2.8 per 100,000 population) (IRTAD, 2012).

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Figure 1.6 Road traffic deaths per 100,000 populations by WHO region - Source: WHO, (2013a).

As shown in Figure 1.7, in four out of six WHO regions, car occupants are the largest fatal casualty group.

Figure 1.7 Road traffic deaths by road user type and WHO region; 2010 - Source: WHO, (2013a).

In Africa, Europe and the Americas, most deaths from road traffic crashes involve car occupants and

pedestrians. In South East Asia and the Western Pacific, deaths amongst users of motorised two- andthree-wheelers contribute a large proportion of total fatal casualties in road crashes (WHO, 2013a).

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FUTURE TREND FORECASTS

Modelling of historic global trends indicates that if LMICs choose to follow the costly evolutionary path of HICs in reducing deaths and serious injuries as they built knowledge, then the road death toll in LMICs islikely to increase very substantially (Kopits and Cropper, 2003; WHO 2013b). Latest forecasts indicate that,based on current trends, 96% of the global total of road deaths by 2030 are likely to occur in LMICs (WHO,

2013b).

The highest projected regional death rates (deaths per 100,000 persons) to 2030 are in Sub Saharan Africa(38), South Asia (29) and the Middle East and North Africa region (28) with decreasing rates between 2015and 2030 in the East Asia and Pacific and Latin America and Caribbean regions and, most sharply, in theEuropean and Central Asia regions (See Table 1.2). There is large regional variation in LMICs in thenumber of deaths per 100,000 persons with the highest rates being 4 times higher than the lowest. By2015, the death rate from road traffic crashes is forecast to be around 8 per 100,000 persons in HICsdecreasing to 6 by 2030 but nearly 20 in 100,000 persons in LMICs (WHO, 2013b).

World (World Bank regions) Deaths per 100,000persons

2015 2030

South Asia 21 29

East Asia and Pacific 22 18

Sub-Saharan Africa 25 38

Middle East and North Africa 26 28

Latin America and Caribbean 20 19

European and Central Asia 14 9

High-income countries 8 6

Global total 20 22

Source: WHO, (2013b).

The relative importance of road traffic injury to other disease burdens is also predicted to increase steeply.Forecasts of global mortality trends to 2030 indicate that road traffic injury is set to increase from the 9thto the 7th cause of death, as shown in Figure 1.8 (WHO, 2013b).

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Figure 1.8 Forecasts of global mortality trends to 2030 - Source: WHO, (2013b).

WHERE DO DEATHS AND SERIOUS INJURIES OCCUR?

Country road safety management capacity reviews and other studies reveal that the majority of roaddeaths and serious injuries occur on a relatively small proportion of the road network. Such roads usuallyhave both urban and rural sections. In India, around two-thirds of deaths occur on national and statehighways, which account for just 6% of the network (Mohan et al., 2009). In Bangladesh, just 3% of arterialroads account for 40% of the road deaths (Hoque, 2009). Statistics from a wide range of countries showthat typically, around 50% of deaths occur on just 10% of the road network (McInerney, 2012). Theseroads have high strategic priority, attract large investment, and are particularly amenable to targeted roadsafety treatments (GRSF, 2013).

Typically, in the main road network, traffic volumes and vehicle speeds are high, with a mix of motorisedtraffic and non-motorised users, and mixed speed road environments (Commission for Global Road Safety,

2011; GRSF, 2006–2013; UNRSC, 2011b). A key problem is that many road standards used in road projectsin LMICs do not provide for the degree of human vulnerability involved in the use of the road network.Furthermore, the efficient and effective police enforcement of safety behaviours, which contribute to theoverall safety performance of road safety engineering standards in high-income countries, is lacking.

Junction design standards and the management of road use from low- to high-speed environments expectvulnerable road users to compete successfully against faster, bigger vehicles, with tragic consequences(GRSF, 2010, 2011). While new roads bring new opportunities for development, many increase the risk of death and serious injury where roads are not restricted to through-traffic, where linear settlements are notavoided, and where there is no first class provision for pedestrians, cyclists and other vulnerable roadusers (UNRSC, 2011b). Specific global guidance to assist with project design for the road safetymanagement of corridors is provided in Targets and Strategic Plans and in Planning, Design & Operation of this manual as well as global references on this issue (e.g. UNRSC, 2011b; GRSF, 2009, 2013; Breen et al.,2013).

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WHAT ARE THE MAIN ROAD TRAFFIC CRASH TYPES?

The main crash types on the world’s roads have been identified as follows (UNRSC, 2011b):

Walking and cycling across or along the road. A vulnerable road user’s risk increases steeply in mixedspeed traffic when traffic speeds are greater than 30 km/h.

Head-on crashes typically kill and seriously injure occupants even in the best designed vehicles at speedsgreater than 70 km/h.

Side impacts at intersections typically kill and seriously injure occupants even in the best designedvehicles at speeds greater than 50 km/h.

Run-off-road crashes into rigid fixed objects produce a high number of fatal and serious outcomes atspeeds greater than 70 km/h for frontal impacts and 50 km/h for side impacts even in the best designedvehicles.

Further information is provided on the main crash types in Section Crash Causes and in Part Planning,Design & Operation.

WHAT ARE THE KEY ROAD SAFETY PROBLEMS?

Road safety problems in low-, middle- and high-income countries are found across road safetymanagement systems, including in:

the quality of institutional management arrangements: in leadership and results focus, coordination,

legislation, funding, promotion, monitoring and evaluation, research and development, and knowledge

transfer, which provide the foundation for producing intervention and improved road safety results;the scope and quality of the intervention set: in the planning, design, operation and use of the road

network; in the safety quality of vehicles and emergency medical response; insufficient attention to theevidence-base or to addressing the needs and vulnerabilities of all users;the level of road safety results achieved for final outcomes: e.g. levels of deaths, serious injuries, costs;

intermediate outcomes (e.g. level of safety quality of roads and vehicles, emergency medical systemresponse, levels of drinking and driving, speeding, seat belt and crash helmet use); and institutionaloutputs (e.g. numbers of speed checks, breath tests).

LMICs present some particularly complex challenges for road safety work. Weak road safety managementcapacity in many countries presents a large barrier to road safety progress (GRSF, 2006–2013). Road

safety progress will be linked to other development priorities such as:

broad institutional development and governance;

the establishment or improvement of health systems;

infrastructure network development;

police and judicial reform.

Country road safety investments in LMICs will have to be sustained over a long period and across a rangeof sectors, directed by appropriately resourced governmental lead agency arrangements.

A full discussion and guidance is provided in subsequent sections on critical success factors for addressingkey road safety problems. This will address the needs of LMICs with their own special challenges. It willalso provide guidance for HICs that are currently in the process of addressing strict Safe Systemparameters, which include new speed thresholds as well as the broader environmental and public health

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drive for more active transport solutions.

FOOTNOTES

1.Disability-adjusted life years lost (DALYs) is the sum of years lost due to premature death and years

lived with disability. DALYs are also defined as years of health life lost.

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1.3 SOCIO-ECONOMIC COSTS OF ROAD

TRAFFIC CRASHES

EVALUATING COSTS AND THE VALUE OF INJURY PREVENTIONEvaluation of the direct and indirect socio-economic costs of the outcomes of road traffic crashes isimportant. This allows measurement of the burden that road traffic crash injury imposes on society, andhighlights the return on investment in road safety and the relative benefits and costs of different policyoptions in the allocation of resources1

Inadequacies in data collection, serious under-reporting of road traffic injuries, and the lack of an adoptedglobal method in valuing the prevention of death and serious injury, do not allow precise estimates to bemade of the socio-economic value of their prevention in LMICs. However, approximate and conservativeestimates have been made at global and regional levels. In many HICs, effective practice provides more

reliable estimates involving periodic updating of economic values for preventing different injury severitiesusing the willingness to pay method (see Prioritisation & Assessment for further discussion).

GLOBAL ESTIMATES

It was estimated over a decade ago that the average annual socio-economic cost of road traffic crashesrepresents 1% of GNP in low-income countries, 1.5% in middle-income countries, and 2% in high-incomecountries (Jacobs et al., 2000)23. While reflecting a mixture of direct economic costs and indirect costs,these remain the best estimates of average costs for different country settings. However, the global costsare likely to be significantly higher, especially if under representation of deaths and injuries in availablestatistics and the social costs of pain and suffering are fully accounted for. More recently, the InternationalRoad Assessment Programme has calculated that serious road trauma now costs the world more thanUS$1.5 trillion per year (iRAP, 2012).

REGIONAL AND NATIONAL ESTIMATES

Few estimates have been made of the socio-economic costs of injury at the regional level, particularly inlow- and middle-income countries where data collection and analysis is not systematically carried out.Estimates for the European Union (EU27) range from €134 billion to €172 billion; with an annual costequivalent to around 2% of GDP over the last decade (ETSC, 2011). Considerable variations in socio-economic valuations are reported for different countries. A survey of OECD countries suggested that the

socio-economic cost of road crashes using different methods of evaluation amounted to between 1.5–5%of GDP (OECD, 2008). In Africa, the International Road Assessment Programme estimates indicate annualcosts of up to 7% of GDP (McInerney, 2012).

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© ARRB Group

WHO BEARS THE COST?

The large burden of costly injuries is borne by society in general. However, a large part of the burden is

particularly within the health sector in terms of costs to the emergency medical system, with employers interms of premature loss or disablement of the world’s most economically active citizens, and withhouseholds in terms of loss of the main wage earner. A summary of some of those directly bearing the costof road injury and death is provided below:

Health system: In LMICs, road traffic-related injuries represent a particularly heavy drain on emergency

medical system resources. For example, in India, road traffic injury patients represent between 20–50%of emergency room registrations, 10–30% of hospital admissions and 60–70% of people hospitalised withtraumatic brain injury (Gururaj, 2008). Despite continuing progress in HICs, involvement in road crashescontinues to be a leading cause of death and hospital admission, and a significant drain on emergencymedical systems. For example, road traffic injury is the leading cause of hospital admission for citizens of the European Union aged 45 years or below (European Commission, 2009)Employers: Work-related road crashes and injuries present substantial costs for employers (DaCoTa,

2012b). The real costs of road crashes to organisations are nearly always significantly higher than theresulting insurance claims (ORSA, 2011). Crash costs include lost work time, lost orders and productionlosses; emergency medical costs; vehicle repair and maintenance costs; damage to employer reputation– especially when vehicles bearing the company name are involved; and environmental costs due tospillages of dangerous substances.Households: Research shows that road traffic crashes have disproportionate costs for low income

households (Aeron-Thomas et al., 2004; Graham et al., 2005). The loss of the major family wage earneras a result of a road traffic crash can push households into poverty, and limit the ability of victims to

cope with the consequences. Costs can include immediate and long-term costs associated with medicaltreatment and care, and the value of lost earnings where a family member has to give up paid work andcare for the crash victim. The financial impact on families has been shown to result in increased financialborrowing and debt, and even a decline in food consumption (WHO, 2013a).

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A high price in socio-economic terms is being paid for motorised mobility in all countries of the world. Inparticular, road traffic injuries in LMICs are a financial drain they can ill afford, which inhibits their desiredsocial and economic development (FIA Foundation for the Automobile and Society, 2005). Road safetyinvestment in both LMIC and HICs needs to be scaled up to match the high socio-economic values of preventing death and serious injury in road crashes (WHO, 2009; DaCoTa, 2012c).

FOOTNOTES

1.Note that road safety policy is not always best directed by cost-benefit analyses. Important

considerations that may justify departing from the policy priorities implied by cost-benefit analysesinclude the aim of reducing disparities in risk, thus giving high priority to measures benefitingpedestrians and cyclists; or the need to reduce speed give priority to those measures that provide thelargest reductions in the number of road deaths and serious injuries, which may not always be the mostcost-beneficial (DaCoTa, 2012a)2.According to the World Bank, gross domestic product (GDP) is calculated as the value of the total final

output of all goods and services produced in a single year within a country's boundaries. Gross NationalProduct (GNP) is GDP plus incomes received by residents from abroad minus incomes claimed by non-residents3.Note that costs are calculated differently, with some including direct economic costs and others also

including indirect costs comprising a valuation for pain, grief and suffering

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1.4 ROAD SAFETY IN CONTEXT

Improving global road safety is now linked with the broader vision of sustainable development andpriorities addressing the s of the child, public health, poverty reduction and social inclusion, andoccupational health and safety.

SAFE, CLEAN AND AFFORDABLE MOBILITY GOALS

Following five successive UN resolutions on ‘Improving road safety’ since 2004, the UN Rio Conference of world leaders highlighted in discussion of the Future We Want (UN, 2012) ‘the importance of the efficientmovement of people and goods, and access to environmentally sound, safe and affordable transportationas a means to improve social equity, health, resilience of cities, urban-rural linkages and productivity of rural areas. In this regard, we take into account road safety as a part of our efforts to achieve sustainabledevelopment’ (UN, 2012). There are also calls for road safety to be recognised and included in the post-2015 Sustainable Development Goals framework (Commission for Global Road Safety, 2013; UN Open

Working Group on Sustainable Development Goals, 2014). In national transport policy, safe, clean andaffordable mobility goals are set increasingly to realise the associated co-benefits of integrated initiatives(see Box 1.5).

BOX 1.5: EXAMPLES OF NATIONAL TRANSPORT POLICY GOAL STATEMENTS: SELECTED OECD COUNTRIES

Australia: ‘Australia requires a safe, secure, efficient, reliable and integrated national transport systemthat supports and enhances our nation’s economic development and social and environmental well-being.’ (National Transport Policy, Australian Transport Council, 2009).Canada: Transport Canada’s vision is for ‘A transportation system in Canada that is recognizedworldwide as safe and secure, efficient and environmentally responsible.’ (Transport Canada, 2011).

Netherlands: ‘The Netherlands should offer everyone an efficient, safe and sustainable traffic andtransportation system, whereby quality for individual users stands in a meaningful equilibrium withquality for the country as a whole.’ (National Traffic and Transport Plan, 2001–2020, Ministry of

Transport, Netherlands).New Zealand: ‘The government’s vision for transport in 2040 is that: ‘People and freight in New Zealandhave access to an affordable, integrated, safe, responsive and sustainable transport system’. (NewZealand Transport Strategy, 2008, Ministry of Transport).Norway: ‘The Government aims to provide an effective, universally accessible, safe andenvironmentally friendly transport system that covers the Norwegian society’s transport requirementsand advances regional development.’ (National Transport Plan, 2010–2019, Norwegian Ministry of

Transport and Communications).Sweden: ‘The objective of transport policy is to ensure the economically efficient and sustainableprovision of transport services for people and businesses throughout the country.’ Accessibility is thefunctional objective and health, safety and environment are the impact objectives. ‘The design, functionand use of the transport system will be adapted to eliminate fatal and serious accidents. It will alsocontribute to the achievement of the environmental quality objectives and better health conditions.’(Ministry of Enterprise, Energy and Communications, Stockholm, May 2009).United States: Legislation setting out the transportation needs for the 21st Century states that: ‘amongthe foremost needs that the surface transportation system must meet to provide for a strong andvigorous national economy are safe, efficient, and reliable transportation’ (Safe, accountable, flexible,efficient transportation equity act: a legacy for users, Public law 109–59, 2005).

Sources: Bliss and Breen, (2011).

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Despite the rapid growth in motorised traffic, the main modes of travel in LMICs are likely to remainwalking, motorcycling, cycling and public transport (Kopits & Cropper, 2003). This highlights theimportance of planning and providing for the safety needs of these road users (particularly for pedestrians,as the most vulnerable road users), who sustain a high proportion of road traffic injuries, as well asintegrating safety into developing road networks for cars, vans, buses, and trucks.

Significant co-benefits can be achieved for the environment and public health. For example, land use andtransportation planning, the provision of safer infrastructure facilities to promote increased walking andcycling, and measures to reduce vehicle speeds, will also result in less greenhouse gas emissions and localair pollution, greater energy security, and improved physical wellbeing (GRSF, 2009). Other means includereducing the volume of motor vehicle traffic by providing for public transport and pursuing liveable citypolicies; providing efficient networks where the shortest or quickest routes coincide with the safest routes;and encouraging road users and freight to switch from higher risk to lower risk modes of transport (Pedenet al., 2004).

In some instances, road safety policy can be in conflict (or be perceived to be in conflict) with othersocietal needs and policies. However, safe, clean and affordable mobility goals for transport policy provide

a means for seeking integrated solutions that address competing societal goals.

PUBLIC HEALTH PRIORITY

Following the publication of the World Report on Road Traffic Injury Prevention (Peden et al., 2004), theWorld Health Assembly adopted resolution WHA 5.710 on road safety and health, which called on WHOmember states to prioritise road safety as a public health issue and to take steps to implement measuresknown to be effective in reducing road traffic injuries.

RIGHTS OF THE CHILD AND CITIZEN

The widely supported Convention on the Rights of the Child, UN General Assembly Resolution 44/25(1989), requires governmental signatories to provide a safe environment and protection from injury andviolence. The Tylösand Declaration by Swedish road safety agencies and stakeholders in 2007 states thateveryone has the to use roads and streets without threat to life or health (see Box 1.6).

BOX 1.6: THE TYLÖSAND DECLARATION OF CITIZENS’ TO ROAD TRAFFIC SAFETY, SWEDEN (2007)

Articles

1. Everyone has the to use roads and streets without threats to life or health;2. Everyone has the to safe and sustainable mobility: safety and sustainability in road transport shouldcomplement each other;3. Everyone has the to use the road transport system without unintentionally imposing any threats tolife or health on others;4. Everyone has the to information about safety problems and the level of safety of any component,product, action or service with the road transport system;5. Everyone has the to expect systematic and continu¬ous improvement in safety: any stakeholderwithin the road transport system has the obligation to undertake corrective actions following thedetection of any safety hazard that can be reduced or removed.

Source: http://publikationswebbutik.vv.se/upload/3423/89044_Tylosandsdeklaration...

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POVERTY REDUCTION GOALS

Road safety improvements can contribute to poverty reduction goals given the scale of loss of GDP fromroad crashes. Crash victims typically involve the most economically active of citizens, often with adverseimpacts on their dependants.

SOCIAL EQUITY PRIORITY

The World Report (Peden et al., 2004) identified road safety as a social equity issue with vulnerable roadusers benefiting the least from policies designed for motorised travel, but bearing a disproportionate shareof the disadvantages of motorisation in terms of injury, pollution and the separation of communities.

OCCUPATIONAL HEALTH AND SAFETY

Work-related road safety can contribute to substantial reductions in employers’ costs, and impact onnational and organisational goals for occupational health and safety. Joint country strategies developed byroad safety lead agencies and the occupational health sector are being increasingly produced. A new ISO39001 standard on road safety management systems in organisations has been produced to provide keyadvice to employers towards these ends (see The Road Safety Management System).

EDUCATIONAL GOALS

While the effects of road traffic injury on educational goals have been little discussed, many thousands of children see their prospects for education diminished by injury and disability from road traffic crashes(Watkins & Sridhar, 2009).

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TOURISM IMPACTS

A report by the WHO (2007) concluded that risks of road traffic injuries are appreciably higher for touriststhan health risks such as epidemics (e.g. AIDS); illnesses (such as malaria and cholera); personal securityrisks associated with international terrorism, violence and crime; travel injury risks on modes other thanroad transport modes (e.g. aviation); and other personal injury risks such as drowning. Globally,

international tourist road fatalities are forecast to increase three-fold to around 75,000 per annum in 2030,with implications for developing and mature economies alike (Commission for Global Road Safety, 2010).

Road traffic injury clearly has many societal impacts. The scale of the road safety challenge and thediversity of the effects of road traffic injury underline the importance of exploring synergies with othersocietal goals and priorities. When directed and assisted by accountable national road safety leadagencies, country road safety coordination arrangements provide a valuable platform for integrating roadsafety into other government policies to increase coverage and resourcing levels.

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1.5 REFERENCES

Aeron-Thomas A, Jacobs GD, Sexton B, Gururaj G & Rahman F (2004), The Impact of Crashes on the Poor .Study commissioned from TRL by GRSP with funding from the Swedish International DevelopmentCooperation Agency (Sida) and TRL, Crowthorne.

AfDB (2012), Road Safety in Africa: an overview, African Development Bank, MDBs Training InitiativeGlobal Road Safety Facility, Washington DC.

Belin M-A, Tillgren P & Vedung E (2012), Vision zero – a road safety policy innovation, International Journalof Injury Control and Safety Promotion Volume 19, Issue 2, 2012, pages 171-179

Bhalla K, Shahraz S, NaghavI M, & Murray C (2008), Estimating the potential impact of safety policies onroad traffic death rates in developing countries, 9th World Conference on Injury Prevention and SafetyPromotion, Merida, Mexico

Bliss T (2011), Global Directions in Road Safety, Strategic Road Safety Forum, Monash University AccidentResearch Centre, Melbourne

Bliss T & Breen J (2011), Improving Road Safety Performance: Lessons From International Experience aresource paper prepared for the World Bank , Washington DC for the National Transport DevelopmentPolicy Committee (NTDPC), Government of India, Delhi. (From following link, go to 'Papers received fromthe World Bank as technical assistance', and then go to 'WB Papers on the Highway Sector by Clell Harral,See Resource Paper 5.http://planningcommission.nic.in/sectors/index.php?sectors=National%20Transport%20Development%20Policy%20Committee%20(NTDPC)

Breen J, Humphries R & Melibaeva S (2013), Mainstreaming road safety in regional trade corridors, Sub-Sahara Africa Transport Programme (SSATP), Washington.

Commission for Global Road Safety (2010), Bad Trips: International tourism and road deaths in thedeveloping world, Makes Road Safe Campaign, London

Commission for Global Road Safety (2011), Make Roads Safe: Time for Action, London.

Commission for Global Road Safety (2013), Safe Roads for All, London.

Commission of the European Communities (CEC) (2003), European Road Safety Action Programme. Halvingthe number of road accident victims in the European Union by 2010: A shared responsibility COM(2003)311 final, 2.6.2003, Brussels.

DaCoTA (2012a), Cost-benefit analysis, Deliverable 4.8d of the EC FP7 project DaCoTA, Brussels.

DaCoTA (2012b), Work-related road safety , Deliverable 4.8v of the EC FP7 project DaCoTA, Brussels.

DaCoTa (2012c), Road Safety Management , Deliverable 4.8p of the EC FP7 project, DaCoTa, Brussels,http://safetyknowsys.swov.nl/Safety_issues/pdf/Road%20Safety%20Management.pdf (viewed March 2013).

Department for Transport (2012), Reported road accidents and casualties, Great Britain 2011, Table RAS30070, https://www.gov.uk/government/statistical-data-sets/ras30-reported-casualties-in-road-accidents.

European Commission (2009), Public consultation of the European Road Safety Action Programme 2011-

http://planningcommission.nic.in/sectors/index.php?sectors=National%20Transport%20Development%20Policy%20Committeehttp://planningcommission.nic.in/sectors/index.php?sectors=National%20Transport%20Development%20Policy%20Committeehttp://safetyknowsys.swov.nl/Safety_issues/pdf/Road%20Safety%20Management.pdfhttps://www.gov.uk/government/statistical-data-sets/ras30-reported-casualties-in-road-accidentshttps://www.gov.uk/government/statistical-data-sets/ras30-reported-casualties-in-road-accidentshttp://safetyknowsys.swov.nl/Safety_issues/pdf/Road%20Safety%20Management.pdfhttp://planningcommission.nic.in/sectors/index.php?sectors=National%20Transport%20Development%20Policy%20Committeehttp://planningcommission.nic.in/sectors/index.php?sectors=National%20Transport%20Development%20Policy%20Committee



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