DOI Number: 10.5958/0974-1283.2019.00192.0 Road Traffic Accidents: Development’s Collateral Damage and a Major Public Health and Economic Concern Lena Ashok1, Zinnia Sharma2, Trupti Kambe Zodge3, Pranav V4, Namesh Malarout5, Alric D’Souza6, Sagarika Kamath7 1Associate Professor, 2Intern, Public Health Evidence South Asia, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India, 3Manager, Clinical Services, Sapphire Hospitals Private Limited Thane, 4Project Coordinator, Amrita Institute of Medical Sciences, Kochi, Kerala, 5Scholar, Manipal Institute of Technology, Manipal Karnataka, 6Assistant Professor, Prasanna School of Public Health, Manipal academy of Higher Education, Manipal, Karnataka, India, 7Assistant Professor, School of Management, Manipal Academy of Higher Education Abstract Road construction is viewed as a core development activity.The unfortunate downside of this is the increasing burden of Road traffic Injuries(RTIs). 50 years ago, the WHO was called upon to do something about the heavy human toll of RTIs. However, RTIs remain a very significant contributor to human morbidity and mortality. It is significant to note that the burden of RTIs has shifted to low and middle income countries (LMICs), which despite having only about 50% of the world’s motor vehicles, account for 90% of the burden of 12.5 lakh road traffic deaths and 2 to 5 crore non fatal road traffic injuries. UN Sustainable development goal (SDG) target 3.6 is to reduce by 50% the number of deaths and injuries from road traffic crashes across the globe by 2020.This implies the saving of 50 lakh lives,the prevention of 5 crore serious injuries, and an economic benefit to the tune of over US$3 trillion.This is a major challenge. The WHO says that RTIs have a significant negative macroeconomic impact in LMICs.The loss to national GDP ranges from 1.03 percent in South Korea to 2.9 percent in Vietnam.Reducing RTI morbidity and mortality by 50% over a 24 year timeline can generate an additional flow of income equivalent to 22.2 % GDP(2014) in Thailand, 15% in China, 14% in India,7.2% in the Philippines and 7.1% in Tanzania. RTI deaths in India have consistently increased year on year from 1990 to 2015. Key words: Road traffic accidents,public health concern, economic burden Introduction mortality.It is significant to note that the burden of RTIs has shifted to low and middle income countries(LMICs), Road construction is viewed as a core development which despite having only about 50% of the world’s activity. The unfortunate downside of this is the motor vehicles, account for 90% of the burden of 12.5 increasing burden of Road traffic Injuries (RTIs). 50 years lakh road traffic deaths and 2 to 5 crore non fatal road ago,the WHO was called upon to do something about traffic injuries.UN Sustainable development goal(SDG) the heavy human toll of RTIs. However, RTIs remain target 3.6 is to reduce by 50% the number of deaths a very significant contributor to human morbidity and and injuries from road traffic crashes across the globe by 2020.This implies the saving of 50 lakh lives,the prevention of 5 crore serious injuries,and an economic Corresponding author: benefit to the tune of over US$3 trillion. This is a major Ms. Zinnia Sharma, challenge. The dramatic increase in vehicle density and Intern, Public Health Evidence South Asia, Prasanna traffic volumes in LMICs has naturally increased the School of Public Health, Manipal Academy of Higher opportunities for crashes.1 Education, Manipal, Karnataka, India Medico-legal Update, July-December 2019, Vol.19, No. 2 303 With the increase in road construction in rural impact in LMICs. The loss to national GDP ranges from areas, the burden of RTI mortality and morbidity has 1.03 percent in South Korea to 2.9 percent in Vietnam.4 also increased sharply.2 LMICs also suffer from the Reducing RTI morbidity and mortality by 50% over a 24 phenomenon of a death rate per vehicle sharply higher year timeline can generate an additional flow of income than in high income settings. This can be attributed to equivalent to 22.2 % GDP(2014) in Thailand,15% in the lack of ability or political will in the LMIC settings China,14% in India,7.2% in the Philippines and 7.1% to fund traffic regulations enforcement, maintenance of in Tanzania.RTI deaths in India have consistently roads and improvements in road design.Drastic increases increased year on year from 1990 to 2015.Official Indian in RTI mortality were noticed by the mid 1970s in statistics probably under report severe injuries by 50% countries like Panama,Guatemala, Jamaica and Peru.3 and mortality by between 10 and 30%.4 Notwithstanding The trend in high income countries has been the exact the downward curve since about 2005 in China’s RTI opposite.From 1990 to 2015, the average mortality from data,2013 is estimated to have witnessed more than 2.6 RTIs in the OECD countries came down from 22 to 8 per lakh RTI deaths.There is an economic loss associated 1 lakh population. An outstanding example is Australia, with each year that LMICs fail to act to enhance road where obvious interventions like fining and prosecuting safety. drunk driving,strict imposition of driving speed limits The Global plan for the decade of action for road safety and the use of road and vehicle safety devices drastically 2011-20 has identified the following 5 action areas4:1. brought down the RTI mortality rate by 83% from 30 Road safety management capacity.2.infrastructure per 1 lakh population in 1970 to 5 per 1 lakh population safety.3.vehicle safety.4.road user behaviour.5.post- in 2010.In 1993, the World bank estimated that 74 % of crash care.A WHO report on road safety made global RTI deaths were in LMICs.4 recommendations to operationalize the global plan7:1. Despite the knowledge of solutions to lower RTI Identification of a nodal agency in the national rates,the global burden of RTIs continues to rise.With government to head the country level effort.2.Assessment government attention and investment divided across a of country specific RTI related problems and policies. plethora of issues and concerns,road safety seems to end up Assessment of the capacity for RTI prevention in each as a low priority concern.The evidence,however,suggests country.3.Preparation of a country level road safety that RTIs are not just a public health concern,but also strategy. Preparation of a country level plan of action.4. an economic one.The WHO says that RTIs account for Allocation of adequate financial resources to tackle the the largest share of long term disability and mortality in problem.Allocation of adequate human resources to the 15-29 age group.They also account for a significant tackle the problem.5.The implementation of specific chunk of morbidity and mortality in the 15-64 age approaches to prevent road traffic crashes and to minimize group.4Men account for 75% of RTI deaths. This places RTIs and the consequences of RTIs. The evaluation tremendous financial strain on families, especially in of the impact of these actions.The implementation societies where men are generally the primary source of these recommendations at a country level would of income.Rural areas suffer a disproportionately high require that the initiatives to strengthen institutions burden of morbidity and mortality from RTIs.This can are sequenced in a manner appropriate to the learning worsen already existing deficiencies in human resources and absorptive capacity of the concerned country.8 The in places that are productive economically but seeing role of institutional management functions, especially migration to urban areas.5 that of the lead agency is critical.Only interventions will not be enough to sustain improvements in road Discussion safety.9 Institutional management functions can be built RTIs are catastrophic for low income households and through doing the following: Enhancing institutional households moving out of poverty,in particular in settings capacity,including nodal institutional capacity for RTI without universal health coverage requiring high out of prevention.Evidence based training of stakeholders in the pocket payments. Experts have wrestled with significant traffic police, transport, justice and health departments; concerns in evaluating and describing the economic pay senior policy makers, stakeholders in ministry nodal 4 off in having accident rates decline.6 The WHO says points and managers in relevant sectors. that RTIs have a significant negative macroeconomic 304 Medico-legal Update, July-December 2019, Vol.19, No. 2 Political support can be obtained if communities to a 600% decrease in deaths from motorcycle crashes that suffer the burden of RTIs put across their demands. and a 39% decrease in the number of motorcycle crashes This can be facilitated by civil society and private themselves. With a view to reduce average vehicular sector participation. National traffic injury surveillance speeds through traffic calming measures, simple systems need to be improved with the objectives engineering measures such as crosswalks, speed breakers of better mapping of injuries and their causes and and raised intersections were introduced in China.Of the consequences. These surveillance systems will also 4 intervention sites, it was observed that the average play a very significant role in generating the data that is speed dropped by 9 percent in 3 of them.It was observed needed to evaluate the effectiveness of RTI mitigation that there was a drop of 60% in the overall number of efforts.Several policies and interventions that have casualties.Speed control measures,implementation very promising potential to reduce the incidence of of revised traffic rules,use of seat belts and improved RTIs are very cost-effective: The reduction of speed emergency and prehospital care were implemented limits, improvements in road design,diligent traffic rules in Brazil,which were seen to result in a significant enforcement,public awareness campaigns on road safety, reduction in mortality.