1. Road Safety is No Accident “World Health Day 2004” By: Dr. Awatif Alam Assoc. Professor, Dept. of Family & Community Medicine, KSU-Riyadh

2. Contents Public health concern “Global Burden of RTI’s” Projected trends in road crashes Leading contributors to the global burden of disease Injury related deaths Comparison in the future Financial costs of the RTI’s Statistics from the EMRO Risk factors Situation in the EMRO Intervention: Principles and elements Taking action for road safety Conclusions The world’s first death by Motor vehicle on 17 August 1896 in London

3. Public Health Concern RTI’s are a major but neglected global public health problem The number of people killed in RT crashes/year is estimated at almost 1.2 million and the number injured could be as high as 50 million Every day, almost 16,000 people die (from all types of injuries). Injuries represent 12% of global burden of disease (the third most important cause of death among 1- 40 yrs. Old) Death from RTI’s account for around 25% of all deaths from injury Cont..

4. Public Health Concern Estimates of the annual no. of road deaths range from 750,000 to 1,183,492 – representing over 3000 lives lost daily Around 85% of all global road deaths 95% of the DALY’s lost due to crashes 95% of all children killed due to RTI’s occur in low-middle income countries. Over 50% of deaths are among young adults (15-44 yrs.) Among children (5-14 yrs.) and young people (15-29 yrs.) RTI’s are the second leading cause of death. Cont..

5. What are the Projected Trends in Road Crashes? By the year 2020, if current trends continue, the annual numbers of deaths and disabilities will have risen by more then 60% and RTI’s will rank third on WHO’s list of leading contributors to the global burden of disease and injury. They were number Nine on the list in 1990.

6. Top 10 Leading Contributors to the Global Burden of Disease 1.Lower Respiratory infection 2.Diarrhoeal disease 3.Perinatal conditions 4.Unipolar major depression 5.Ischaemic heart disease 6.Cerebrovascular disease 7.Tuberculosis 8.Measles 9.Road Traffic Injuries 10.Congenital Abnormalities 1.Ischaemic heart disease 2.Unipolar major depression 3.Road Traffic Injuries 4.Cerebrovascular disease 5.Chronic obstructive pulmonary disease 6.Lower Respiratory infection 7.Tuberculosis 8.War 9.Diarrrhoeal disease 10.HIV 1990 Disease or Injury 2020 Disease or Injury

7. Injury: A Leading Cause of Burden in the Region, 2000 TotalNumber of DeathTypes of Injury High Income (104) Countries Low income (18) Countries 1649411825163116War Injuries 7160092370677RTI’s 5470348654217Interpersonal Violence 4003164339388Self Inflected Injuries 1700616116845Drowning 3482184038344243Total

8. How will Countries Compare in the Future? By 2020, if current trends continue, the annual no’s of RT deaths and disabilities in high-income countries may have lowered by as much as 30% (due to improved road safety) and will have increased by 60% in low-middle income countries –WHY? More rapid increase in population Migration to urban areas More reliance on motorized transport Inadequate road safety measures

9. What are the Financial Cost of RTI’s? Global estimates = US $ 520 billion In Low-middle income countries, they cost us $ 65 billion i.e. 1% to 2% of GNP In high-income countries they cost an average estimate of 2% of GNP

10. Statistics from the EMRO Scarce and poor quality data Underreporting Lack of sound database Lack of information system based on scientific evidence Differences in interpretation Poor Policies and Interventions for Road Safety

11. Total No. of Deaths = 1,260,000

12. Risk Factors In the road traffic, risk is a function of four elements: 1.The exposure – the amount of movement or travel within the system by different users or a given population density. 2.The underlying probability of a crash, given a particular exposure. 3.The probability of injury 4.The outcome of injury

13. Some of the main Risk Factors for Road Traffic Crashes and Injuries Factors influencing exposure to road traffic: Economic Factors such as level of economic development Demographic factors such as age, gender and place of residence Land use planning practices which influence how long people travel and by which means Mixture of vulnerable road users and high speed motorized traffic Lack of consideration of the ways in which roads will be used when determining speed limits, road design and layout

14. Some of the main Risk Factors for Road Traffic Crashes and Injuries Risk factors influencing being involved in a crash: Inappropriate and excessive speed Presence of alcohol and other drugs Fatigue Being young and male Being vulnerable road user in an urban or residential area Traveling in darkness Poor vehicle maintenance Road design, layout and maintenance defects Inadequate visibility due to weather conditions Poor eyesight

15. Some of the main Risk Factors for Road Traffic Crashes and Injuries Risk factors influencing the severity of a crash: Individual characteristics such as age which influence the ability of a person to tolerate a crash Inappropriate and excessive speed Non use of seat belts and child restraints by vehicle users Non use of crash helmets by two-wheeler Unforgiving roadside objects such as concrete pillars Insufficient vehicle crash protection such as air bags for occupants and vehicle soft fronts for those who may be struck by vehicles

16. Some of the main Risk Factors for Road Traffic Crashes and Injuries Risk factors influencing the consequences of injuries sustained as a result of crash: Delayed crash detection and transport to a health facility Rescue and evacuation Lack of appropriate care prior to arriving at a health facility Post collision fire Leakage of hazardous material

17. Situation in the EMRO Range: 8 deaths/100,000 population in Yemen 24 deaths/100,000 population in Oman Cumulatively 132,000 deaths in region (out of a population of more then 492 million) occurring due to RTA’s in 2002 Almost twice the figure from Europe which was 68000 (out of a population of more then 874 million) in 2002 There has been substantial increase in RTA victims in EMRO in recent years i.e. indicating acceleration of the problem and alarming predictions.

18. What is being done in the EMRO? [Overall growing realization of escalating problem of RTI’s] 1.At global level, countries put forward RTI’s prevention for discussion in the UN, “Sultan Qaboos assumed a leading role” “Road Safety is no accident, World Health Day 2004” 2.At Local levels: Traffic laws being reviewed and strengthened In Saudi Arabia, KFSH has taken the lead in road safety efforts with the formation of a special high level committee for road safety (minister of interior), Multi-sectoral efforts. National campaign for prevention of RTA in Egypt – 1997 to raise public awareness, new traffic law, seat belts, free emergency care. Growing awareness of the seriousness of the problem in Iran. Fines increased to 10 folds, training traffic officers.

19. Intervention RT deaths and serious injuries are to a great extent preventable RT injury needs to be considered alongside heart disease, cancer and stroke as a preventable public health problem that responds well to targeted interventions. The provision of safe, sustainable and affordable means of travel is a key objective in the planning and design of road traffic systems. To achieve the objective, it requires a firm political will, and an integrated approach involving close collaboration of many sectors. Principles: Cont…

20. Intervention Multisectoral strategic plans address the three prime elements of the traffic system: Prevention Strategies and policies need to adapt to local conditions Principles: Cont… Substantial research and development over the last 3 decades have proved that a range of interventions exist to prevent road crashes and injuries There is a gap between what is known to be effective and what is actually practiced Road Users Road infra- structure vehicle

21. Intervention As with other areas of public health, road injury prevention requires effective management to put in place evidence based measures, overcoming obstacles to their implementation Legislation are of crucial importance, but laws are never sufficient in themselves Laws can only work when the public is convinced that the laws will be enforced In countries where enforcement is loose, if it exists at all, levels of compliance are low. Principles: Cont…

22. Elements of Intervention 1.Managing exposure to risk:  Reducing motor vehicle traffic  Minimizing exposure to high risk 2.Shaping the road network for road injury prevention  Safety awareness in planning roads  Incorporating safety features into road design  Action at high-risk crash site 3.Providing Visible, crash-protective, “Smart” vehicles:  Improving the visibility of vehicles  Crash-protective vehicle design  “Intelligent” Vehicles Cont…

23. Elements of Intervention 4.Setting and securing compliance with key road safety rules:  Enforcing speed limits  Enforcing seat-belt and child restraint use  Enforcing alcohol impairment laws  The role of education, information and publicity 5.Delivering post-crash care:  Chain of help for injured people  Pre-hospital care  The hospital setting  Rehabilitation Cont…

24. Taking Action for Road Safety Institutional Development: Make road safety a political priority Appoint a lead agency for road safety, give it resources and make it accountable Set appropriate road safety targets and establish national road safety plans Develop mechanisms that promote a multi disciplinary approach to road safety Support the development of safety advocacy groups What Governments can do Cont…

25. Taking Action for Road Safety Policy Legislation and Enforcement: Ensure the road safety is viewed to be a serious political issue Set and enforce strong and uniform vehicle safety standards Enact and enforce legislation requiring the use of seat-belts and motorcycle helmets, speed limits and control of alcohol impaired driving Enforce safety laws already in existence What Governments can do Cont…

26. Taking Action for Road Safety Policy Legislation and Enforcement: Ensure that road safety considerations are embedded in environmental and other assessments for new projects and the analysis of transport policies and plan Establish data collection systems designed to collect, analyze & use these data to improve safety Make funding of road infrastructure conditional upon compliance with safety standards Create budget lines for road safety and increase investment in demonstrably effective road safety activities What Governments can do Cont…

27. Taking Action for Road Safety Policy Legislation and Enforcement: Support the development of safety advocacy groups Establish appropriate design standards for roads that promote safety for all Manage infrastructure to promote safety standards Provide efficient, safe and affordable public transport services Encourage walking & the use of non-motorized two- wheelers Set and enforce appropriate speed limits What Governments can do Cont…

28. Taking Action for Road Safety Include road safety in heath promotion and disease prevention efforts Systematically collect health-related data on the magnitude, characteristics and consequences of road traffic crashes Support research to increase knowledge about risk factors and the development, implementation, monitoring and evaluation of effective counter measures Promote capacity building in all areas of road safety and the management of survivors of road traffic crashes. What Public can do Cont…

29. Taking Action for Road Safety Translate effective science-based information into policies and practices that protect vehicle occupants and vulnerable road users Strengthen pre-hospital and hospital care as well as rehabilitation services for all trauma victims Develop trauma care skills of medical personnel at the primary health care, district and tertiary health care levels. What Public can do Cont…

30. Taking Action for Road Safety Promote the development of policies aiming at greater integration of health and safety concerns into transport policies and facilitate this by further developing methods and tools to this effect (e.g. integrated assessments) Invest in Medical research to improve the care of trauma survivors Advocate for greater attention to road safety in view of the health impact and costs What Public can do Cont…

31. Taking Action for Road Safety Make funding for road safety part of grants for health, transport, environmental or educational programmes Support road safety research, programmes, and policy in low income and middle income countries Make funding for transport infrastructure projects conditional on the completion of a safety audit and follow up Generate mechanisms for providing funding for knowledge sharing and safety promotion in developing countries What donors can do Cont…

32. Taking Action for Road Safety Ensure that all major vehicles meet minimum safety standards, regardless of where a vehicle is makde, sold or used including the provision of seat-belts and other basic safety equipment Begin to manufacture vehicles with safer vehicle fronts to reduce injury for vulnerable road users Advertise and market vehicles responsibly by emphasizing safety What vehicle manufacturers can do Cont…

33. Taking Action for Road Safety Encourage governments to make the roads safe Identify local safety problems Help plan safe and efficient transportation systems that accommodate drivers as well as vulnerable road users like cyclists and pedestrians Encourage safety programmes for school children Demand safety features e.g. seat belts in cars What Communities, civil societies & individual can do Cont…

34. Taking Action for Road Safety Encourage strong enforcement of traffic safety laws and regulations, and advocate for strong and swift punishment for traffic offenders Behave responsibly by: –Abiding by the speed limit on roads –Never driving when over the legal alcohol limit –Always wearing a set-belt, and properly restraining children, even on short trips –Always wearing crash helmet when riding a two-wheelers What Communities, civil societies & individual can do Cont…

35. Conclusion RTI’s are a huge public health and development problem Limited usefulness of existing data sources (from some countries) Road safety is a shared responsibility Road traffic crashes are predictable and can be preventable The adoption of “system approach” to road safety resulted in sharp reduction in crashes and casualty More work is called for in all countries to find new and better road safety measures.

36. While there are many interventions that can save lives and limbs, Political will and commitment are essential and without them little can be ACHIEVED

37. Thank You