Making a public health case for safer roads


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On recent visits to Moscow and Tbilisi, and driving from Baku to the Sheki and Agdash regions in Azerbaijan, I observed challenges and progress in making roads safer. Why should this matter to public health folks? Or should this be only the concern of engineers?

If one of the goals of development is to improve health outcomes by reducing premature mortality, injuries and disability, then unsafe roads are a key public health challenge.

In Eastern Europe and Central Asia (ECA) the problem is acute. Road traffic deaths rank among the ten leading causes of death: people are 2-3 times more likely to die from road injuries than people in Western Europe. For every death, many more people have injuries that require medical care.

What is causing this problem? For sure, more people are driving because the number of cars has increased significantly due to rising incomes—the traffic jams in some ECA cities vividly reflect this change. Poor road conditions and spotty enforcement of speeding, drunk driving, and seatbelt and helmet laws are leading culprits. “Distracted driving,” due to the growing use of cell phones and texting, is also resulting in more car crashes.

The good news is that ECA governments are not sitting idle. As done in Georgia and Azerbaijan, they are improving the road infrastructure (e.g., constructing overpasses to facilitate safe pedestrian crossing).

Efforts to adopt and enforce laws to curtail risky driving behaviors and strengthen the health system response are as important as the modernization of road infrastructure. The Russian government, for instance, has adopted new blood (0.3 g/l) and breath (0.15 g/l) alcohol limits for driving; made drunk driving offenses punishable with prison sentences; increased fines tenfold for driving without a seatbelt; and now mandates license revocation for crossing into the lane of oncoming traffic. Anti-alcohol campaigns with the support of the Russian Orthodox Church are highlighting the risk of drunk driving. The reorganization of emergency medical services, both pre-and in-hospital, started in 2010, is concentrating on the most dangerous regional highways to reduce deaths and lasting disabilities after car crashes. And data collection and assessments by the police and health institutions are better monitoring the impact of road safety interventions and guiding policy making.

These countries’ experiences clearly demonstrate that road safety is not the responsibility of just one or two sectors but that road safety requires a concerted multisectoral effort. The new UN Decade of Action 2011-20 on road safety will help raise political commitment, mobilize funding, but more importantly, put in place strong institutional arrangements to plan, coordinate, implement, evaluate, and sustain interventions across different sectors.

More: Confronting “Death on Wheels”: Making Roads Safe in Europe and Central Asia


Patricio V. Marquez

Senior Associate, Johns Hopkins University Bloomberg School of Public Health

Eva Jarawan
October 20, 2011

It's great to see a blog on this subject and to read about the efforts and results in Russia.

This problem is not unique to ECA. While most high-income countries have had a substantial success in reducing road traffic deaths and injuries, the developing world is experiencing a worsening of the problem with economic development. A strong push, similar to what was done in Russia is needed for countries in Africa, Asia, and Latin America and the Caribbean.

However, in order for governments to make the needed political and economic commitments to address the problem, they need reliable estimates of the burden of road traffic injuries. They need as well to compare the magnitude of this problem with that of other pressing problems. In other words, to succeed in advocacy, we need good statistics.

I came across a very recent report (2011) that was prepared by the Harvard School of Public Health "Road Injuries in 18 Countries". It was commissioned by the World Bank Global Road Safety Facility to develop an injury metrics framework for deriving best estimates of the burden of road injuries in information poor settings and to implement the framework in 18 countries. The report shows that while national injury surveillance systems may be non-existent, most countries have a wide array of existing data sources that can be used to generate estimates of the national burden of road injuries. The report shows that even in some of the poorest countries like Mozambique, data sources were not scarce.

So, we have no excuse. The health sector has an important role to play in identifying data sources and in communicating the results to a wider audience of policy makers. Road safety is a public health issue and a social equity issue that we cannot continue to ignore.

Patricio V. Marquez
October 20, 2011

Indeed Eva. The time to act is now. The nature and characteristic of the road safety challenge are known. The UN Decade on road safety offers an unique opportunity to push forward the multisectoral agenda. And as we are advocating in the health sector for strong health systems, a comprehensive ‘safe system’ approach also needs institutional arrangements to help and sustain its implementation systematically over the medium term. The good news is that many countries in different regions already have structures and processes in place to achieve quick wins and begin to reduce ‘death on wheels’. So we need to build upon them as well.

November 03, 2011

It's time for effective steps to be taken now. Then only can road safety be ensured, I suppose

Daryl Loo
November 04, 2011

Thank you Patricio for blogging on this topic. Absolutely agree with the point that road safety should be regarded as an important health issue. I get reminded daily of this while crossing the roads in China -- there seems to be very little concern for pesdestrian safety among drivers, and I've hardly ever seen a car voluntarily give way to a human being. (one of the most extreme example I've witnessed was a car driving on a pesdestrian crossing as a spare lane to cut through a 5-lane junction).

It's worrying because China is the world's biggest car market and the car population is expected to go up dramatically, and the situation could get worse if driver education doesn't keep up.

Patricio V. Marquez
November 07, 2011

Your experience is China is the "new normal" in most of the world. Just this past weekend visiting health facilities in the interior of Azerbaijan put me face to face for several hours with the dreaded possibility of a head-on car collision. The zigzagging and passing of cars, from one lane to another, without much regard for incoming cars from the other direction, kept me awake and behaving like as a second driver. But change will not happen overnight or as a simple miracle of development. A systematic, well-funded effort is needed over the medium and long terms, supported as a political priority and a social imperative. Otherwise too many lives will continue to be lost unnecessarily.

Ford Scanner
April 02, 2012

More and more people are driving, because the number of cars has increased significantly, due to the rising incomes of the ECA in some cities, traffic congestion, and vividly reflect this change. Poor road conditions, speeding, drunk driving enforcement is uneven, the seat belt and helmet laws is a leading culprit.

Patricio V Marquez
June 16, 2012

In full agreement. Road safety is a complex multisectoral challenge. However, evidence from different country experiences shows that it can be effectively controlled with political will, strengthened instituional arrangements for effective road safety management, and more importantly with the enforcement of laws and regulations. Again, strong institutions and the rule of law are key factors.

T N Hamid
September 25, 2019

Very informative.