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Global Road Safety Crisis Remedy Sought
1.2 Million Killed, 50 Million Injured Annually
Thomas B. Cole, MD, MPH
JAMA. 2004;291:2531-2532.
For many individuals living in rural Africa, there is no safe way to travel.
In Malawi, for example, a bus ticket, even for minibuses that cram 2 dozen riders and their baggage into a vehicle built to seat nine, is priced out of reach for many rural Malawians. So travelers turn to less expensive alternatives, such as walking or open-bed pickup trucks that operate like taxis.
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A chaotic mass of automobiles, buses, motorcycles, vans, bicycles, and other forms of transport jam a street in Hyderabad, India, posing a daily hazard to pedestrians. (Photo credit: Ranganayakulu Bodavala)
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"Passengers jump in the back of the pickup, give the driver some money, and jump out when they get where they want to go," says Thomas J. Vitaglione, MPH, a senior fellow at the North Carolina Child Advocacy Institute, who spent time in Malawi last year to assist with an orphan care project that he helped to establish in 1995.
However, traveling in pickup trucks is a dangerous practice; when the vehicle hits a bump, some of the riders may be tossed out and injured. Those who cannot afford to ride in the back of a pickup truck must walk—and the easiest place to walk is along the road, where they are at risk of being injured by a passing vehicle.
A WORLDWIDE PROBLEM
It comes as no surprise to Vitaglione and others who have spent time in Malawi and other African countries that Africa has the highest road traffic death rate in the world: 28.3 deaths per 100 000 population, according to World Report on Road Traffic Injury Prevention, a 2004 report from the World Health Organization (http://www.who.int/world-health-day/2004/infomaterials/world_report/en/). By comparison, the road traffic death rate in 2000 was 15.2 per 100 000 for the United States and 11.9 per 100 000 for the European Union. But traffic hazards are by no means confined to Africa; poor road safety is a worldwide problem that is getting worse.
In response, the World Health Organization designated road safety as the theme for World Health Day in April; hundreds of organizations around the world hosted events to help raise awareness about road traffic injuries.
VULNERABLE ROAD USERS
Poor individuals in developing countries are at greatest risk of traffic death, as the United Nations report emphasizes. These "vulnerable road users" are pedestrians, cyclists, motorcyclists, or users of public transportation who do not own or have access to a private car, says Murray Mackay, PhD, professor emeritus of transport safety at the University of Birmingham, Edgbaston, England. As increasing populations of vulnerable road users share poorly designed transportation systems with more and more motorized vehicles, traffic deaths rates are likely to increase, warns the United Nations report.
There are many reasons that vulnerable road users in developing countries have such high traffic death rates, says Mackay, including vehicle speed, lack of use of personal protective equipment, and lack of enforcement of safety regulations. However, he cautions, traffic safety interventions that have achieved success in industrialized countries may not be applicable in developing nations.
For example, Mackay is skeptical of the power of behavioral change programs to persuade drivers and passengers to wear helmets and use seat belts in the absence of effective enforcement, except in countries such as Malaysia where personal and collective responsibility for safety is part of the public culture. He is also concerned that enforcement may never be adequate as long as police officers are underpaid. In many countries, says Mackay, "the local police have to survive on bribes or they can't make a living."
DESIGNING ROADS
While interventions such as helmet and seat belt use may be difficult to achieve in many poor countries, it is possible to design roads and communities to minimize traffic injuries. Illuminating traffic intersections, removing poles and other "road furniture" that impair visibility, and separating vulnerable road users from speeding cars can substantially improve road safety.
Unfortunately, road designers often disregard safety, says Mackay. "In Iraq and Iran, roads have been built on the premise of getting oil from the oil fields to the ports," he explains. "These roads go straight through villages and divide them as if there is a main river there, with the shops on one side and the houses on the other."
Uninterrupted streams of cars, motorcycles, and three-wheeled jitneys called tuk-tuks can paralyze pedestrian traffic, says David L. Parker, MD, MPH, a physician and photographer who has traveled extensively in the developing world. In cities such as Calcutta, Mumbai (Bombay), and New Delhi, he notes, two things make travel particularly unpleasant: air pollution and unrelenting traffic. Parker, who says he has just missed being a traffic casualty on many occasions, once took a taxi in Kathmandu just to cross the street.
PEDESTRIANS IN PERIL
In rural areas of the developing world, pedestrians not only cross roadways used by motorized vehicles, but also may walk along the roads for great distances. In Malawi, for example, where visiting family members is a national pastime, it is easier to walk from place to place along the roads than on paths through fields. Sometimes, says Vitaglione, it seems "as though the whole country is walking on the roads."
They walk the roads at considerable risk. When a truck or minibus approaches a file of pedestrians, the driver sounds the horn, the pedestrians step off on to the shoulder, and then they step back on the road as the vehicle passes. Cars typically pass at a rate of one per minute, says Vitaglione, but if two cars are traveling close together, a pedestrian may hear the horn, step off the road, and step back on the road in front of the second car.
"Kids do that all the time," explains Vitaglione. "When I returned to Malawi in 2003, a child was killed in this way right in front of the compound where I was working."
Expending resources to separate pedestrians from vehicles may seem unreasonably ambitious for developing nations that are challenged to meet their citizens' most basic needs for food and shelter. Yet simple, inexpensive engineering solutions may go a long way toward reducing traffic injury rates, says Mackay. He recommends designated lanes for traffic "rather than just open asphalt with ill-defined edges and no line down the middle," stop signs, and traffic junctions where priorities are made explicit.
Some drivers may not respect traffic markers, he concedes. "But it would certainly be an improvement over having nothing—a sort of free-for-all," he says. "You can do a hell of a lot with tins of white paint."
| WHO Report: Remedies to Curb Road Traffic Carnage
Worldwide, as many as 1.2 million individuals are killed and an additional 50 million are injured on roadways each year, with injury rates rising as developing countries become increasingly motorized. To reverse this trend, the World Health Organization's World Report on Road Traffic Injury Prevention recommends tried and true safety measures for drivers and vehicles, as well as strategies for designing transportation systems.
Much of the report addresses the emerging traffic safety problems of the developing world, where walking, cycling, motorcycling, and the use of public transportation are the predominant forms of transportation. These travelers are vulnerable to injury by motorized vehicles, which share the same routes but travel at much greater speeds.
According to the report, increased injury rates are rising in countries with growing economies and expanding vehicle fleets, such as Thailand, where the number of registered motor vehicles increased from 4.9 million in 1987 to 17.7 million in 1997, and China, where the number of motor vehicles quadrupled between 1990 and 2002 to more than 55 million. In the 30 member countries of the Organisation for Economic Co-operation and Development, the number of motor vehicles is projected to increase by up to 62% between 2003 and 2012. Consequently, the report warns, without a renewed commitment to traffic safety, injury rates may increase by 65% over the next 20 years.
An increase in road traffic injuries of this magnitude may be avoided, however, if traffic planners take into consideration the mix of different vehicle types and patterns of road use rather than designing road networks largely from the perspective of motor vehicle users. A safer system would involve determining a road's particular function in the road network and designing it in such a way that compliance with the recommended speed limit would be a natural choice for drivers.
Suggested remedies include
- Designing higher-speed roads such as multilane divided highways with such features as restricted access, horizontal and vertical curves of large radius, crashworthy shoulders, median barriers, and grade-separated junctions with entry and exit ramps. Many low- and middle-income countries should also have separate lanes for motorized two-wheelers.
- Designing rural roads to exclude such roadside hazards as trees and utility poles and to include periodic lanes for passing other vehicles and for turning across oncoming traffic, median barriers (to prevent passing) in hazardous stretches, roundabouts, lighting at junctions, advisory speed limit signs before sharp bends, and regular signs to remind drivers of speed limits.
- Designing transitional roads (roads that connect higher- and lower-speed roads or areas) to include signs and other design features such as speed bumps to encourage drivers to slow down in good time.
- Ensuring that pedestrian and bicycle paths that connect to a public transportation system have sections that are separate from roads as well as sections running alongside roads, with particular attention paid to safe crossings at junctions.
According to the report, road traffic system planning pays off. Widespread experience with road safety management in Europe has resulted in reductions in crashes and injuries of 15% to 80%.—T.B.C.
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