CHAPTER 1 The fundamentals CHAPTER 1. THE FUNDAMENTALS •3 Introduction all levels – including among governments, Road traffi c injuries are a major but neglected global professional sectors and international agencies public health problem, requiring concerted efforts – so that strategies scientifi cally proven to be for effective and sustainable prevention. Of all the effective in preventing road injuries can be systems that people have to deal with on a daily implemented. Any effective response to the basis, road transport is the most complex and the global challenge of reducing traffi c casualties most dangerous. Worldwide, the number of people will necessarily require a large mobilization killed in road traffi c crashes each year is estimated of effort by all those concerned, at the inter- at almost 1.2 million, while the number injured national, national and local levels. could be as high as 50 million – the combined • To provide a sound justifi cation for the change population of fi ve of the world’s large cities. The in thinking that has taken place in recent years, tragedy behind these fi gures regularly attracts less especially where signifi cant research has been media attention than other, less frequent but more undertaken, about the nature of the road traffi c unusual types of tragedy. injury problem and what constitutes successful What is worse, without increased efforts and new prevention. The perception that it is the price initiatives, the total number of road traffi c deaths to be paid for achieving mobility and economic worldwide and injuries is forecast to rise by some development, needs to be replaced by a more 65% between 2000 and 2020 (1, 2), and in low- holistic ideology that places the emphasis on income and middle-income countries deaths are the total system of road traffi c. expected to increase by as much as 80%. The majority • To help strengthen institutions and create of such deaths are currently among “vulnerable road effective partnerships to deliver safer road users” – pedestrians, pedal cyclists and motorcyclists. traffi c systems. Such partnerships should In high-income countries, deaths among car occu- exist horizontally between different sectors of pants continue to be predominant, but the risks per government and vertically between different capita that vulnerable road users face are high. levels of government, as well as between gov- This is the fi rst major report on road injury pre- ernments and nongovernmental organizations. vention jointly issued by the World Health Organi- At governmental level this means establishing zation (WHO) and the World Bank, and under- a close collaboration between the sectors of scores the concern that the two bodies share about transport, public health, fi nance, the judiciary the detrimental impact of an unsafe road transport and others concerned. system on public health and global development. It The report is thus principally aimed at policy- is the contention of the report, fi rst, that the level of makers and key professionals in all sectors and at road deaths and injuries is unacceptable, and sec- all levels, with an objective to provide a strategic ond, that it is to a large extent avoidable. framework for action. Universal principles are set There is thus an urgent need to recognize the out, rather than a single action plan with worldwide worsening situation in road deaths and injuries applicability. This is because local conditions must and to take appropriate action. Road traffi c injury always be taken into account, so that best practices prevention and mitigation should be given the same proven elsewhere can be refi ned and adapted into attention and scale of resources that is currently relevant and successful local interventions. paid to other prominent health issues if increasing human loss and injury on the roads, with their dev- astating human impact and large economic cost to A public health concern society, are to be averted. Road deaths, disability and injury The report has three main aims: Every day around the world, almost 16 000 people • To create a greater level of awareness, com- die from all types of injuries. Injuries represent mitment and informed decision-making at 12% of the global burden of disease, the third most 4 • WORLD REPORT ON ROAD TRAFFIC INJURY PREVENTION important cause of overall mortality and the main 1 183 492 annually – representing over 3000 lives cause of death among 1–40-year-olds (3). The cat- lost daily (see Statistical Annex, Table A.2). egory of injuries worldwide is dominated by those Around 85% of all global road deaths, 90% of incurred in road crashes. According to WHO data, the disability-adjusted life years lost due to crashes, deaths from road traffi c injuries account for around and 96% of all children killed worldwide as a 25% of all deaths from injury (4). result of road traffi c injuries occur in low-income Estimates of the annual number of road deaths and middle-income countries. Over 50% of deaths vary, as a result of the limitations of injury data col- are among young adults in the age range of 15–44 lection and analysis, problems of underreporting years (6). Among both children aged 5–14 years, and differences in interpretation. The fi gure ranges and young people aged 15–29 years, road traf- from around 750 000 (5) (probably an underesti- fi c injuries are the second-leading cause of death mate, since it is made on the basis of 1998 data) to worldwide (see Table 1.1). TABLE 1.1 Leading causes of deaths by age group, world, 2002 Rank 0−4 years 5−14 years 15−29 years 30−44 years 45−59 years *60 years All ages 1Lower respiratory Childhood cluster HIV/AIDS HIV/AIDS Ischaemic heart Ischaemic heart Ischaemic heart infections diseases 707 277 1 178 856 disease disease disease 1 890 008 219 434 1 043 978 5 812 863 7 153 056 2Diarrhoeal diseasesRoad traffi c injuries Road traffi c injuries Tuberculosis Cerebrovascular Cerebrovascular Cerebrovascular 1 577 891 130 835 302 208 390 004 disease disease disease 623 099 4 685 722 5 489 591 3Low birth weightLower respiratory Self-infl icted Road traffi c injuries Tuberculosis Chronic obstructive Lower respiratory 1 149 168 infections injuries 285 457 400 704 pulmonary diseases infections 127 782 251 806 2 396 739 3 764 415 4Malaria HIV/AIDS Tuberculosis Ischaemic heart HIV/AIDS Lower respiratory HIV/AIDS 1 098 446 108 090 245 818 disease 390 267 infections 2 818 762 231 340 1 395 611 5Childhood cluster Drowning Interpersonal Self-infl icted Chronic obstructive Trachea, bronchus, Chronic obstructive diseases 86 327 violence injuries pulmonary diseases lung cancers pulmonary diseases 1 046 177 216 169 230 490 309 726 927 889 2 743 509 6Birth asphyxia and Malaria Lower respiratory Interpersonal Trachea, bronchus, Diabetes mellitus Diarrhoeal diseases birth trauma 76 257 infections violence lung cancers 749 977 1 766 447 729 066 92 522 165 796 261 860 7HIV/AIDSTropical cluster Fires Cerebrovascular Cirrhosis of the liver Hypertensive heart Childhood-cluster 370 706 diseases 90 845 disease 250 208 disease diseases 35 454 124 417 732 262 1 359 548 8Congenital heart Fires Drowning Cirrhosis of the liver Road traffi c injuries Stomach cancer Tuberculosis anomalies 33 046 87 499 100 101 221 776 605 395 1 605 063 223 569 9Protein–energy Tuberculosis War Lower respiratory Self-infl icted Tuberculosis Trachea, bronchus, malnutrition 32 762 71 680 infections injuries 495 199 lung cancers 138 197 98 232 189 215 1 238 417 10 STDs excluding HIV Protein–energy Hypertensive Poisonings Stomach cancer Colon and rectum Malaria 67 871 malnutrition disorders 81 930 185 188 cancers 1 221 432 30 763 61 711 476 902 11 Meningitis Meningitis Maternal haemor- Fires Liver cancer Nephritis and Road traffi c injuries 64 255 30 694 rhage 67 511 180 117 nephrosis 1 183 492 56 233 440 708 12 Drowning Leukaemia Ischaemic heart Maternal Diabetes mellitus Alzheimer and Low birth weight 57 287 21 097 disease haemorrhage 175 423 other dementias 1 149 172 53 870 63 191 382 339 13 Road traffi c injuries Falls Poisoning War Lower respiratory Liver cancer Diabetes mellitus 49 736 20 084 52 956 61 018 infections 367 503 982 175 160 259 14 Endocrine disorders Violence Childhood cluster Drowning Breast cancer Cirrhosis of the liver Hypertensive heart 42 619 18 551 diseases 56 744 147 489 366 417 disease 48 101 903 612 15 Tuberculosis Poisonings Abortion Liver cancer Hypertensive heart Oesophagus cancer Self-infl icted 40 574 18 529 43 782 55 486 disease 318 112 injuries 129 634 874 955 Source: WHO Global Burden of Disease project, 2002, Version 1 (see Statistical Annex). CHAPTER 1. THE FUNDAMENTALS •5 In low-income countries and TABLE 1.2 regions – in Africa, Asia, the Change in rank order of DALYs for the 10 leading causes of the global Caribbean and Latin America burden of disease – the majority of road deaths are 1990 2020 among pedestrians, passengers, Rank Disease or injury Rank Disease or injury cyclists, users of motorized two- 1Lower respiratory infections 1 Ischaemic heart disease wheelers, and occupants of buses 2Diarrhoeal diseases 2Unipolar major depression and minibuses (7, 8). The leading 3Perinatal conditions 3 Road traffi c injuries 4Unipolar major depression 4 Cerebrovascular disease casualties in most high-income 5Ischaemic heart disease 5 Chronic obstructive pulmonary disease countries, on the other hand, are 6Cerebrovascular disease 6Lower respiratory infections among the occupants of cars. 7Tuberculosis 7Tuberculosis However, when it comes to 8Measles 8War comparative fatality rates (deaths 9Road traffi c injuries 9 Diarrhoeal diseases for any measure of exposure) 10 Congenital abnormalities 10 HIV for all users in the traffi c system, DALY: Disability-adjusted life year.