Introduction
Road traffic accidents claim over 1.3 million lives annually and result in between 40 to 50 million injuries or disabilities. The majority of victims are vulnerable road users such as young males. According to the World Health Organization (WHO), road traffic fatalities are projected to rise by 83% in low- and middle-income countries by 2020, while high-income countries are expected to see a decrease of 27%. In the Arab region, road traffic injuries constitute a significant public health challenge, causing approximately 40,000 deaths annually and affecting around one million individuals—equivalent to the populations of Qatar and Bahrain combined. This imposes a substantial economic burden estimated at about 2.5% of the Arab National Products, including oil revenues. Despite ongoing conflicts in the Middle East resulting in numerous injuries, road traffic incidents remain the leading cause of death among youth in the region and are anticipated to escalate in the coming decade.
This report, prepared by YASA International, focuses on the escalating death toll in many developing countries, where more than one million lives are lost each year and over 40 million people suffer severe injuries due to road traffic incidents. YASA International urges all developing nations to examine the successful strategies of highly motorized developed countries and implement targeted interventions aimed at reducing casualties in response to the increasing levels of road trauma. In a rapidly changing world increasingly shaped by globalization and interdependence, threats to health and safety are becoming increasingly international in nature.
- A significant health threat globally is the rapid increase in unintentional injuries, which impose substantial economic and social burdens on societies, particularly in developing regions.
- Despite the relatively low individual risk per journey, road users face daily and weekly risks due to frequent travel. Anyone can be involved in a traffic crash at any time, regardless of race, creed, social status, age, or gender. Both the elderly and the young, wealthy and poor, men and women are susceptible to crashes and related injuries.
- The term “accident,” commonly used worldwide, implies events that are unavoidable and unpredictable. Therefore, newer road safety documents prefer to use “crash” instead of “accident.” Historically, injury prevention was neglected because injuries were seen as random occurrences. Today, it is widely acknowledged that injuries can be prevented through measures such as helmet use, seat belts, child seats, and pedestrian bridges.
- Developed countries have conducted sustained national campaigns for over four decades to reduce road traffic injuries (RTI). Consequently, the number of fatalities and injuries from traffic crashes has significantly declined in these countries, albeit at varying rates. Many institutions have adopted Sweden’s “Vision Zero” initiative, aiming for zero road crash fatalities. In June 2003, a new European road safety charter was launched with the goal of reducing injury burdens.
- Fatal injuries affect people across all socioeconomic groups, but individuals with lower incomes tend to have higher death rates from injuries. The economically disadvantaged often face challenges in fully recovering from injuries due to lack of resources.
- In most developing countries, effective traffic safety campaigns have not been implemented.
- Despite the increasing number of road accident victims in most developing countries, road safety is generally perceived as a low-priority issue by governments and citizens.
- There has been insufficient sustainable effort to reduce road crashes in developing countries. International agencies have made minimal successful attempts to assist these countries in addressing the burden of injuries. Even the 2002 World Summit on Sustainable Development in South Africa did not prioritize traffic safety as an international issue. The United Nations Development Programme (UNDP), dedicated to promoting sustainable human development in developing countries, only recently began considering efforts to combat road accidents as part of its mission and policy.
Relevance and Objective of the Report
The primary goal of this report is to bolster international efforts aimed at enhancing road safety. It seeks to disseminate crucial information on preventing road traffic injuries to a broader audience, particularly in developing countries where the toll of such injuries is often underestimated. This report aims to catalyze action among various institutions—including media, specialized non-governmental organizations, and governmental agencies—to earnestly address the pressing need for improved road safety. Few studies have approached this subject from such a comprehensive perspective.
Additionally, non-governmental organizations in developing countries have historically lacked robust support from their governments compared to counterparts in developed countries. Many of these organizations express dismay over governmental agencies’ inadequate attention to road safety issues.
Establishing a reliable, transparent system to track accident victims and injuries could compel governmental agencies to formulate and implement national strategies aimed at mitigating the burden of injuries. The economic impact of deaths and disabilities resulting from injuries represents a significant loss of productivity globally. Furthermore, treating and rehabilitating the injured consumes a substantial portion of national health budgets, while the personal toll on victims and their loved ones is incalculable.
Regrettably, many developing countries remain unaware of the myriad negative impacts of road traffic injuries—including pain, hospitalizations, and frustration among tourists due to chaotic traffic—on their GDP and sustainable development goals.
This report strives to equip policymakers in developing countries with both scientific tools and practical experiences to devise and implement effective road safety programs. It underscores the success of international cooperation in reducing road traffic injuries in developed countries, advocating for similar collaborative approaches. Implementing shared learning strategies is highlighted as a particularly efficient method to mitigate the impact of road traffic injuries.
Fundamentals of Road Safety
Each injury incident is a complex interaction of various factors, including the host, agent, and physical and socio-cultural environment. Dr. William Haddon, a pioneer in injury prevention theory, developed the Haddon Matrix to describe these interactions during three phases: pre-event (before the injury occurs), event (while the injury is occurring), and post-event (after the injury has occurred). This matrix helps professionals assess the different elements of an injury and identify opportunities for prevention. Historically, injuries were often viewed as “accidents” or random events, leading to their neglect in public health. However, in recent decades, public health officials have recognized that injuries are preventable and have developed scientific methods for their prevention.
Road traffic injuries are a leading cause of injuries worldwide. Recent estimates indicate that injuries are among the top causes of death and disability globally, affecting all populations regardless of age, sex, income, or geographic region. An injury is defined as “a bodily lesion at the organic level, resulting from acute exposure to energy in amounts that exceed the threshold of physiological tolerance.” In some cases, injuries result from an insufficiency of a vital element.
Despite the significant social and economic costs of unintentional injuries, investment in injury prevention and safety promotion research has been relatively negligible compared to other health issues such as HIV/AIDS, malaria, and diarrheal diseases. According to the World Health Organization (WHO), deaths from road traffic injuries (RTI) account for about 25% of all injury-related deaths, with more than 1.2 million fatalities and over 40 million serious injuries annually due to traffic crashes.
YASA International estimates that over two million people die yearly from road traffic crashes when considering deaths from serious injuries within the first year after the crash. A study by the Scientific Research Foundation (SRF) in the Middle East found that over 55% of road traffic victims are economically productive males. Road crashes are the leading cause of death for individuals aged 1 to 40 in most countries. Road traffic injuries are the leading cause of injury-related death and the ninth leading cause of all deaths globally.
By 2020, WHO projected that RTIs would account for about 2.3 million deaths, with 90% occurring in less motorized countries (LMC), making it the third most significant burden of disease. Although men are more likely to suffer fatal injuries than women (men accounted for two-thirds of injury-related deaths worldwide in 1998), injuries are a leading cause of death for both sexes and all age groups.
Combined data from Australia, the Netherlands, New Zealand, Sweden, and the United States show that for every person killed by injury, about 30 times as many are hospitalized, and 300 times as many are treated in emergency rooms and then released. Many more are treated in other healthcare facilities, such as family doctors’ offices and first-aid clinics.
Unfortunately, injury prevention has been taken seriously primarily in high-income countries. Approximately 75% of the global burden of traffic injuries occurs in developing countries, contrasting with the fact that over 75% of the world’s vehicles are in developed countries (vehicles in low-income countries are generally less safe than those in high-income countries). According to YASA International, the number of road victims will increase in the next two decades in most low-income countries, especially in the Middle East. Many advocacy organizations recommend that all governments address the growing number of road tragedies and work to reduce fatalities and injuries caused by road crashes.
Reducing the burden of injury is a major public health challenge. Many prevention strategies, such as using seat belts, child seats in cars, and helmets for motorcyclists, have proven effective. Injury prevention requires a multidisciplinary approach and should be treated as a major public health issue. Effective collaboration among physicians, sociologists, psychologists, lawyers, politicians, engineers, designers, human rights experts, journalists, and other professionals from the public and private sectors is essential to develop and promote the right injury prevention strategies.
The objective of road safety work throughout the eight decades following 1923 remains the same: to reduce the number of casualties and the diverse impacts of road accidents. The most important and challenging element of achieving this objective lies in the “how” phase of the improvement process. Developed countries have answered this challenge through sustainable planning, programming, and implementing road safety campaigns.
Road Crashes are Causing Hugh Losses
If steps are not taken now to find effective solutions to traffic problems, road injuries and loss of human lives will continue to increase. This is a global issue, although significant changes have occurred in some developing countries, and road safety is now considered a high-priority transport and public health issue in most developed nations.
While mortality due to road traffic injuries has always existed, its recognition as a public health problem only emerged in the last decades of the twentieth century. Policymakers and safety professionals in many countries find it challenging to implement changes that significantly reduce fatalities. This difficulty arises because public sectors and individuals often do not easily adhere to road safety instructions.
Efforts to educate people face numerous challenges due to the wide variations between individuals’ knowledge and actual behavior. This makes injury prevention and safety promotion a complex process. Consequently, there is a societal and moral responsibility to design vehicles, roads, and traffic laws to make safe behavior more convenient without compromising individuals’ ability to earn a living or fulfill other societal obligations. Better designs, rules, and regulations will reduce the likelihood of people harming themselves or others. However, such systems can only function if there is societal and political agreement on the ethical and moral responsibility of governments and civil society organizations to ensure the right to life, which includes living in good health. Recognizing injury control as a public health problem and accepting our ethical responsibility to ensure individual safety will help address the global issue of injuries.
Innovative techniques are required for injury control work. Current mechanisms for interdisciplinary research collaboration, technique sharing between states, and interaction between scientists and the public are still weak. Improved structures and methodologies will become apparent only through conscious evaluation of experiences, successes, and failures across diverse societies and settings.
Road safety is a multifaceted issue, encompassing human, economic, social, and equity dimensions. It disproportionately affects poor people. While collaboration between individuals and countries has succeeded in many environmental issues, it is urgently necessary to enhance international collaboration efforts to reduce road traffic injuries caused by various types of accidents, especially traffic crashes.
The European Commission emphasizes placing users at the heart of transport policy. Among all transport modes, road transport is the most dangerous and costly in terms of human lives. In many developing countries, road accidents have only recently elicited strong reactions. Road safety should be a central focus of domestic and international transport policies.
Studies indicate that drivers in Europe (as in most developed countries) expect stricter road safety measures, such as improved road quality, better driver training, enforcement of traffic regulations, vehicle safety checks, and road safety campaigns. In most developing countries, however, these recommendations remain a low priority.
In the European Union, the 1990s saw the promulgation of many directives related to technical standardization to develop safe motor vehicle equipment and accessories. These included the compulsory use of seatbelts, regulations for transporting dangerous goods, speed limitation devices in lorries, standardized driving licenses, and vehicle roadworthiness testing. The Maastricht Treaty in 1992 provided the legal means to establish a framework and introduce measures in the field of road safety.
In the battle for road safety, the European Union set an ambitious goal to reduce the number of road fatalities by half between 2000 and 2010. This involved a series of recommendations such as harmonization of penalties and the promotion of new technologies to improve road safety. In developing countries, the situation is very different. The funds allocated to improving road safety do not reflect the severity of the issue, and efforts to prevent road accidents remain inadequate.
WHO’s Response
In recent years, the sharp rise in road traffic injuries, especially in developing countries, has prompted the WHO to address this significant public health concern more urgently.
The WHO Director-General announced that the annual World Health Day in 2004 would be dedicated to “Road Safety.” During this event, they launched the “World Report on Road Traffic Injury Prevention,” which the WHO prepared in collaboration with the World Bank. Despite sporadic efforts since the World Health Assembly’s 1974 call to action, the WHO’s renewed determination to tackle this issue is clear.
A key outcome of this renewed commitment was the production of the “Five-year WHO Strategy for Road Traffic Injury Prevention.” Developed in 2001 with experts from health, transport, police, NGOs, and the private sectors, this document covers epidemiology, prevention, and advocacy. It outlines strategies for building capacity at local and national levels to monitor road traffic injuries, incorporating road traffic injury prevention into national public health agendas, and promoting action-oriented policies and programs to prevent these injuries.
To identify effective and cost-efficient strategies for preventing road traffic injuries, the WHO has commissioned the Cochrane Injuries Group to conduct a systematic review of best practices in this area. The Cochrane Injuries Group, based at the London School of Hygiene and Tropical Medicine, is an international network dedicated to preparing, maintaining, and promoting high-quality, peer-reviewed systematic reviews.
The Department of Violence and Injury Prevention of the WHO is supported by a network of WHO Collaborating Centers and National Institutions. These institutions are designated by the WHO Director-General to form an international network that undertakes activities in line with WHO’s program priorities. Seventeen such bodies have been designated as WHO Collaborating Centers on Injury Prevention and Control, including five in developing countries. Discussions are in progress to create additional centers.
In November 2002, the Department of Violence and Injury Prevention hosted the 12th Meeting of WHO Collaborating Centers on Injury Prevention and Control. With participation from VIP staff, regional advisors, and representatives of collaborating centers, the meeting provided an opportunity to update participants on the current work of WHO and the collaborating centers in injury prevention and control.
The Resolution of the General Assembly of the United Nations 57/309
A significant milestone in the improvement of road safety worldwide occurred on 22 May 2003, when the Fifty-eighth session of the General Assembly of the United Nations adopted resolution 57/309. This resolution addressed road traffic injuries and the challenges of preventing road crashes and mitigating their impacts. It emphasized that road traffic injuries now constitute a global public health crisis that demands urgent action at both national and international levels.
The Mission of YASA International
YASA International is an active International Non-Governmental Organization dedicated to raising safety awareness and fostering commitment from individuals worldwide to reduce the global burden of unintentional injuries. The organization supports strategies to enhance international cooperation for safety promotion and injury prevention.
Launched in Lebanon in 2002, YASA International initiated the Middle East Campaign for Accident Prevention (MECAP). This campaign successfully forged effective partnerships with numerous public and private agencies in the region, particularly with media and educational institutions.
YASA International advocates for policy-makers and decision-makers to recognize the urgent need to treat Injury Prevention as a major public health issue. It promotes the adoption of the universal concept of the 6Es, based on cross-sectoral collaboration, as a new approach to reducing road traffic injuries.
In addition, YASA International provides social support to bereaved families, encouraging their active participation in the safety promotion movement in the Middle East.
Gender and Road Traffic Injuries
Globally, almost three times as many males as females die from road traffic crashes, representing the largest sex differential in mortality rates from unintentional injury. In Barcelona, Spain, a large six-hospital study found that 7 out of 10 road traffic injury cases above the age of 14 were among males, with the overall death rate being more than three times higher for men than for women (Plasencia 1995). In several developing countries, injury and fatality rates for males are higher in every category of road injury victim.
The higher risk of road traffic injuries and fatalities among males is significantly associated with greater exposure to driving and high-risk driving behaviors. Conversely, higher male pedestrian injury and fatality rates persist regardless of time spent walking on the road and are attributable to alcohol use and risky behavior.
Social and Economic Costs
Experiences from high-income countries clearly demonstrate that “economic assessment of the costs involved is an essential element in planning the implementation phases” of road safety improvement programs. Such assessments have played a crucial role in motivating political leadership in developed countries to take vigorous action to enhance road safety. This response has led to the declaration of road safety as a national strategic goal and the allocation of adequate funding for this purpose.
Currently, the socioeconomic and environmental costs of road accidents worldwide are not fully known. However, Retting estimated the global economic impact of motor vehicle injuries and property damage to exceed $300 billion annually. Using similar calculation principles, SRF estimated in 2000 that the global economic impact is over $500 billion annually.
In the United Kingdom, despite a decrease in road fatalities, the estimated economic costs of road traffic injuries rose from £230 million in 1961 to £2,820 million in 1985, representing a percentage increase of 1,126%. In the United States, the estimated economic cost of road accidents involving 34,501 fatalities in 1940 was $1.6 billion. By 1990, this figure had increased to $95 billion and is estimated to have exceeded $400 billion by 2015.
Medical Costs
There is an urgent need to invest more in improving and upgrading the quality of pre-hospital care for road traffic victims. This includes enhancing emergency medical transport options such as medical ambulances and helicopters, as well as better preparing rescue teams in emergency medicine.
In the European Union, based on the current definition of injured road traffic victims and the evaluation of total medical expenses, the average cost per injured victim is approximately €3,000. This translates to an annual expense of €15 for each European citizen. Consequently, the total annual medical expenses in Europe amount to €4.5 billion. This represents only 3% of the total annual socioeconomic costs of road crashes, which total €150 billion.
Increasing medical expenses by, for example, 30%—which would only represent 1% of the total socioeconomic costs of road traffic crashes—could significantly reduce the 20% to 40% of “avoidable deaths” occurring in hospitals.
People Disable
According to the WHO, disability is a major public health issue affecting at least 10% of the world’s population. Among these individuals, more than 20 million people are severely disabled due to road traffic crashes. Proper treatment and care for these disabled individuals would place a significant burden on public health services. Consequently, much of the care is often left to families, self-help groups, and charities, or the victims are abandoned and left to fend for themselves.
The most tragic situation involves those with mental disabilities resulting from brain trauma, who will require continuous care and assistance for the rest of their lives. Individuals with motor disabilities, often due to spinal trauma, may be able to undertake some activities and gain a degree of independence after rehabilitation. However, they still require essential equipment such as wheelchairs and artificial limbs, as well as adapted environments to support their mobility. This includes modifications to pavements, buses, trains, doors, lifts, and toilets.
Providing these accommodations can enable them to access education, receive professional training, and eventually find employment.
Indirect Effects
There are also significant indirect effects of road traffic injuries. The impact can extend beyond those directly involved in crashes, affecting the wider community. For example, fear of road traffic injuries may deter elderly individuals from going outside. In many high-income countries, the increasing use of cars has led to a general decline in walking and a rise in sedentary lifestyles. This shift has contributed to higher rates of obesity and cardiovascular health issues.
Conclusion
Road traffic injuries are a devastating global issue, claiming the lives of 1.3 million people each year. An additional 30 to 50 million individuals are seriously injured on the roads, with some suffering permanent disabilities. The vast majority of these incidents occur in developing countries, affecting pedestrians, cyclists, motorcyclists, and users of public and school transport—many of whom cannot afford private motor vehicles.
This research focuses on the requirements and policies necessary to address the global underestimation of road safety. There is an urgent need to prevent these needless deaths and disabilities and to alleviate the immense loss and suffering caused by road traffic injuries (RTI). Over the past five decades, numerous programs and policies have been implemented in developed countries to prevent road traffic crashes.
Recently, some developing countries have begun to implement interventions aimed at reducing traffic injuries. These efforts include strategies to address speed and alcohol consumption, promote the use of airbags, helmets, and seat belts, and enhance the visibility of pedestrians and cyclists. A concerted effort by governments and their partners to improve road safety can make a significant difference.
Preventing road crashes requires a shift from the outdated approach that placed responsibility primarily on the road user. This approach is largely absent in developed countries but still prevalent in many developing nations. This research advocates for an approach that acknowledges not only the fallibility of road users but also the crucial roles of emergency systems, law enforcement, and infrastructure.
Public and private organizations working in road safety should foster sustainable cooperation at local, regional, and international levels. By sharing experiences and learning from both successful and unsuccessful interventions, whether in developed or developing countries, they can work towards reducing the global burden of road traffic injuries. Such cooperation will help spread the message that road traffic injuries are preventable.
Low-income countries should benefit from the extensive research and studies conducted in industrialized nations on traffic safety measures. Both civil society organizations and governmental agencies can draw from the successes and failures of road safety campaigns in developed countries.
International organizations such as the WHO, the World Bank, and UNICEF are recognizing their critical role in road safety. In early September 2003, UN Secretary-General Kofi Annan urged United Nations agencies to integrate road safety into other policies, such as those related to sustainable development, the environment, gender, children, and the elderly. He also emphasized that road safety requires strong political will from governments.
Strong political advocacy is essential, as road safety is a political issue that often involves conflicts between different sectors of society. For example, improving the rights of vulnerable road users may conflict with interests advocating for increased motorized travel.