Executive Summary An estimated 1.35 million people die each year from road traffic injuries (RTI) and more than 50 million are injured or disabled despite a first decade of action and care high-level world. This series of 3 papers highlights the challenges and opportunities for the second Decade of Action for Road Safety (2021-2030) with the hope that this will be a decade of implementation and delivery that leads to a substantial decrease in risk and burden of global health. Global road mortality is a leading cause of death in many low- and middle-income countries. Data are urgently needed to support priority setting under current resource constraints to achieve the Sustainable Development Goal (SDG). This Series paper estimates the potential number of lives saved if each country implemented interventions to address risk factors for road injuries. We did a systematic review of all available evidence-based preventive interventions for mortality reduction that focused on the four main risk factors for road injuries (i.e., speeding, driving under the influence of alcohol, use of a helmet and use of a seat belt or child restraint system). We use literature review variables and consider three key country-level variables (gross domestic product per capita, population density, and government effectiveness) to generate country-specific estimates of the attributable annual potential number of lives that would be saved by interventions focused on these four risk factors in 185 countries. Our results suggest that the implementation of evidence-based road safety interventions that address the four main risk factors for road safety could prevent between 25% and 40% of all fatal road injuries worldwide . Interventions that address speed could save around 347,258 lives worldwide per year, and at least 16,304 lives would be saved through interventions on alcohol-impaired driving . Implementing seat belt interventions could save around 121,083 lives, and helmet interventions could save 51,698 lives. We identified country-specific estimates of the potential number of lives saved that would be attributable to these interventions. Our results show the potential effectiveness of implementing and scaling these interventions. This document presents key evidence for prioritizing road safety interventions and shows a path to achieve them. |
Road traffic injuries (RTI) are the eighth leading cause of death worldwide, accounting for 1.35 million deaths each year.
Comments
New global and national estimates suggest that routine use of helmets and seat belts, compliance with speed limits and avoiding drunk driving could save between 347,000 and 540,000 lives worldwide each year.
Additionally, improving post-accident emergency response, trauma care, and clinical interventions to control bleeding and early resuscitation could save up to 200,000 lives per year in low- and middle-income countries.
Road deaths hit the youngest and poorest hardest: Almost half of teenagers killed in traffic accidents in 2019 lived in low-income countries, up from around a quarter in 1990.
Despite global progress, not enough has been done at the national level to address road safety as a public health crisis. The authors call for immediate political and financial commitments to address one of the world’s biggest development challenges.
Improving road safety by adopting proven interventions targeting four key risk factors for road injuries (speeding, drunk driving, lack of helmets and seat belt use) in 185 countries could save up to half a million lives a year and offers enormous potential to improve the health and development of individuals and nations, according to a new Series published in The Lancet .
These new data are vital to spur the next big effort in global road safety, ensuring that evidence-based interventions are successfully implemented on a global scale, the authors say.
Road traffic accidents kill more than 1.35 million people each year, and more than 90% of those deaths occur in low- and middle-income countries (LMICs). However, despite global efforts to prioritize road safety over the last decade, and a growing body of evidence to support proven interventions, many national governments have not made road safety a priority and adequate funding has not been received. for implementation in LMIC, leaving a gap between testing and action.
The Lancet Series on road safety, published ahead of the first UN High-Level Meeting on Road Safety, calls for greater political and financial commitments and for road safety to be included in mainstream development policies, arguing that it is essential to achieve the objectives of the UN. Sustainable Development Goals (SDGs), including the goal of halving road traffic deaths and injuries by 2030.
“Most traffic deaths are preventable , but unfortunately the number of deaths continues to rise in low-income countries, while progress in high-income countries has slowed over the last decade,” says the Professor Adnan Hyder, Series Coordinator, George Washington University, USA. “With the second United Nations Decade of Action for Road Safety (2021-2030) underway, our work for this series clearly shows that proven road safety measures can save lives in all countries, rich and poor alike. . For the first time, we provide decision makers and donors with evidence in one place on the value of implementing targeted interventions in all countries around the world.”
Adopting proven road safety interventions could prevent 40% of road deaths
An analysis of data from 74 studies in 185 countries estimates that focusing on four key risk factors for road injuries and deaths – speeding, drink-driving, and failure to use protective helmets and seat belts – could prevent among 25% (assuming full overlap between interventions) and 40% (assuming no overlap between deaths if the intervention had been fully implemented in 2018) of all fatal road injuries worldwide each year.
For example, interventions to reduce speeding, such as infrastructure changes and electronic speed monitoring, could save an estimated 347,258 lives worldwide each year, while measures to address speeding such as enhanced drunk driving enforcement, could save an additional 16,304 lives. Additionally, it is estimated that 121,083 and 51,698 lives could be saved if regulations on the use of seat belts and motorcycle helmets were approved and enforced, respectively.
All countries would benefit from increased road safety measures to varying degrees. For example:
- Improving seat belt use would have a particularly large effect on reducing road deaths in the US (saving about 14,121 lives each year) and China (13,228).
- The benefits of increasing motorcycle helmet use would be greatest in China (saving 13,703 lives a year), Brazil (5,802), and India (5,683), which have a high incidence of motorcyclist injuries.
- Tackling speeding would be the single most effective measure to reduce road deaths in most countries, preventing an estimated 88,374 deaths in China, 1,027 in Spain and 815 in the UK.
“We hope these new estimates provide a tangible impetus for the global road safety community to focus on implementing evidence-based interventions, especially in low- and middle-income countries,” says series co-author Dr. Andres Vecino. Ortiz from Johns Hopkins. Bloomberg School of Public Health, United States. “These estimates can be used by policymakers to conduct their own priority-setting analyzes to reduce road deaths.”
Improving post-crash care could save 200,000 lives a year
There is also a strong case for strengthening trauma care in low- and middle-income countries. Modeling for the series estimates that effective trauma systems that can treat all traffic victims as needed could save more than 200,000 lives per year in low- and middle-income countries, equivalent to a reduction in 17% in deaths. The most realistic scenario of 50% coverage could save more than 100,000 lives per year, which is equivalent to 8% fewer fatalities.
| For specific trauma clinical interventions, lives are more likely to be saved by focusing on damage control resuscitation (i.e., hemorrhage control strategies and early resuscitation) (more than 35,000 lives per year with 50% coverage). , followed by interventional radiology to control bleeding (more than 29,000), tranexamic acid for suspected bleeding (10,000), and prehospital tourniquet (more than 5,700). |
"While prevention remains the cornerstone for reducing traffic deaths, knowing which trauma interventions are likely to have the greatest life-saving impact will help make the best use of limited health resources," says co-author Dr. Junaid Razzak of Weill Cornell Medical Center, USA and Aga Khan University School of Medicine, Pakistan. “While strengthening trauma systems is the ultimate goal, simple clinical health system interventions are a practical starting point to save lives sooner.”
Teenage road deaths on the rise
A separate new analysis examined transportation injuries for adolescents in 204 countries from the 2019 Global Burden of Disease (GBD) study from the Institute for Health Metrics and Evaluation at the University of Washington School of Medicine and is published in The Lancet Public Health. These injuries include pedestrians, bicyclists, motorcyclists, motor vehicles, and other transportation-related incidents.
The findings reveal that although mortality rates among those aged 10 to 24 years fell by a third between 1990 and 2019 (from 17.5 to 11.5 per 100,000), the proportion of deaths that occurred in the sociodemographic index (SDI) low and medium-low [3] almost doubled from around 28% in 1990 (74,713 of 271,772) to around 47% in 2019 (100,102 of 214,337), with those in their 20s being the most affected at 24 years old. The largest increases in the transport injury mortality rate have occurred in Paraguay (+97%), Djibouti (+69%), Lesotho (+50%) and Seychelles (+41%).
The new GBD analysis also shows a slow pace of decline in transport injury deaths in high-SDI countries over the most recent decade, falling just 1.7% annually between 2010 and 2019 compared to the drop in 2.4% annually between 1990 and 2010.
“These new estimates reflect the chronic neglect and underinvestment by the global health community to prevent injury-related harm in adolescents,” says author Dr. Amy Peden of New York University. South Wales, Australia. “Unlike many other public health epidemics, there are simple, affordable and proven interventions to reduce traffic injuries that are simply not applied or enforced. “Progress has stalled in high-SDI countries and the growing burden of transportation injuries in low- and medium-SDI countries demands focused action, including global investment by donors, governments and industries in injury prevention.”
A sustainable approach to road safety
The authors of the series outline ten challenges that must be addressed to achieve the ambitious goal of preventing at least 50% of road traffic deaths and injuries by 2030. These include creating a stronger global movement on road safety that incorporate other health and environmental impacts into solutions (e.g. air pollution, sedentary lifestyles), as well as generate more and better data on what works in different LMICs, and the need for national funding and adequate donors. Road safety must also be integrated as a core component of global movements toward universal health coverage, maternal, newborn, child and adolescent health, and healthy aging.
"There have been many successes in road safety globally, including its inclusion in the Sustainable Development Goals, but the rhetoric has yet to deliver results on the ground," says series co-author Dr Margie Peden of the George Institute for Global Health. , UNITED KINGDOM. “The global road safety community must re-evaluate its strategy for this Second Decade of Action: a real and sustained decline in global road traffic injuries and deaths will only occur with a focus on the implementation of effective interventions and concerted action. of the countries".
A Lancet editorial accompanying the series says that “traffic injuries cannot be understood as an isolated problem. Health systems, sustainable urban development, local and global leadership, governance and the future of cities are all aspects of a movement that must be driven to improve the unnecessary burden of these injuries. But, as the series shows, with a coordinated multisector approach, road traffic injuries are treatable and preventable.”
