Road safety is no accident

‘‘I WANT to see road safety taken as seriously as AIDS,” explained Mary Mwangangi in the New York Times. Mwangangi is traffic commandant in Kenya’s Police Department and a vocal advocate of road safety in the country. “It kills just like AIDS and malaria and tuberculosis.”

Road safety is more than a professional concern for Mwangangi. She speaks from a wheelchair — a road accident put her there.

Today, according to the World Health Organization (WHO), motor vehicle crashes kill about 1.2 million people each year. That is set to rise to 2 million by 2020 unless new safety measures are taken, making road traffic injuries the third largest cause of death and disability.

But even in the increasingly risk-averse developed world, people accept road death and injury as part of the price of living in modern societies. Most road safety experts put this attitude down to a widespread ignorance of the scope and extent of the problem and what can be done to address and prevent it.

To change people’s attitude, experts from the WHO and the World Bank published in 2004 a pioneering new report, World report on road traffic injury prevention that advocated road crashes be ranked along with cancer, heart disease and stroke as a major public health threat.

And nowhere is this threat greater than in developing countries.

Imperative for action

Reports, like meetings, are often dismissed as the international community’s alternative to action. But in the case of road safety, it is noticeable how the International Federation’s 1998 World Disasters Report published in 1999, helped to build awareness within the humanitarian and development community that death and injury on the roads were indeed a global disaster with the greatest impact on the developing world. As a result of the 1998 World Disasters Report, the International Federation was one of the few founding partners of the Global Road Safety Partnership (GRSP), and continues to host it today.

For international agencies, the imperative for action seemed clear, according to the 1998 report. On the eve of “massive growth in developing-world traffic,” it said, “crashes already cost the South almost as much as all the aid they receive.” Traffic accidents limit progress by killing and injuring the economically active, and were forecast to do more harm through death and disability than many other health threats given more attention.

The solution? A development strategy that incorporates road safety as a vital component.

But even as development surges in many countries, especially in Asia, rapidly pushing up “motorization” levels, road safety measures do not necessarily follow.

In China, for example, road traffic deaths more than tripled between 1975 and 1998, according to a study highlighted in the WHO and the World Bank report. In 2003, more than 250,000 people were killed in traffic accidents there. The government of Kenya estimates that some 2,600 people die each year in road crashes. The thousands of Kenyans injured in road accidents use up limited Medical resources and drain some US$ 76 million each year from the country’s fragile economy.

In the emerging economies in the western Pacific and South-East Asia regions, road traffic deaths account for more than half of all road deaths in the world. In Russia, road crashes are the second leading cause of death

With poverty directly linked to death and injury on the road, the WHO and the World Bank report offers a grim prediction that between 2000 and 2020, motor vehicle deaths will decline by 30 per cent in high-income countries but increase 80 per cent in poor ones.

Katherine Sierra, vice president for infrastructure at the World Bank, points out: “Road safety is a very important development challenge. It is one that is often overlooked, and which disproportionately impacts the poor. If we are to help reduce the very significant social and economic impacts of road traffic fatalities and injuries, then everyone must take them much more seriously and take preventative efforts accordingly.”

Dr. Etienne Krug, director of the department for injuries and violence prevention at WHO, explained it this way in a recent newspaper article: “All over the world, economic development is leading to more cars and more roads, but we’ve forgotten to match that with more safety.”

Red Cross and Red Crescent business

Road safety is prime territory for the Red Cross and Red Crescent. The Movement’s expertise in first aid leads naturally on to road safety and accident prevention.

Of all victims who are killed, 57 per cent die in the first minutes after the crash, before the arrival of the emergency services. First aid provided in these vital first minutes can save lives and help both victims and bystanders cope psychologically.

The Red Cross and Red Crescent has been instrumental in raising standards in road safety through first-aid courses. Many National Societies in developing countries, like Ghana for example (see box), which lack a proper ambulance service, are targeting first-aid training at drivers — almost by definition the first people to arrive at the scene of an accident.

Road safety covers activities which “in one way or another are the business of all the National Red Cross and Red Crescent Societies in virtually every country in the world”, according to Christopher Lamb, special adviser on international representation at the International Federation.

“An increase in the tragic loss of life resulting from road accidents is a global problem of great concern to the Movement,” says Dr. Mohammed al-Hadid, president of the Jordan Red Crescent Society and chairman of the Standing Commission. “The most vulnerable are pedestrians, cyclists and users of non-motorized vehicles. Treatment of the injured is such a drain on under-funded medical services that in some countries it is holding back development.”

From Oman to Eritrea to Austria, the Movement is bringing together its collective resources to tackle this crisis. To achieve worldwide progress, the International Federation was a founding partner in a global initiative to raise awareness of road safety issues.

Ghana’s commercial first-aiders

It was only a short international wire story, but last December it reported to the world one of the worst accidents many Ghanaians could remember for some time. Twenty-four people, four of them children, had been killed in a head-on collision on the road between the second-largest city, Kumasi, and Sunyani. A bus driver had tried to overtake a taxi and lost control, smashing into another oncoming bus, according to police.

Traffic accidents “occur frequently in Ghana”, said the news agency, due to the “poor condition” of the roads and the “willful ignorance” of most motorists of traffic laws.

But in Kumasi itself, a bustling, commercial city, with some of the worst traffic jams in Africa, that has been changing gradually. The Ghana police have reported some success in getting taxi drivers to stick to the rules about how many people they can carry, and the local Red Cross branch has been providing special training in first aid to drivers of the city’s commercial vehicles — most of them minibuses.

The course is designed for the low-tech environment of West Africa and “long pre-hospital times”, according to the project outline. The key first-aid actions to be taught in the course are: the recovery position for keeping an injured person’s airway clear during prolonged transport with no medical equipment; safe extraction and simple precautions to protect the spine; bleeding control and splinting; triage, mass-casualty and scene management.

In the first year of the project, more than 60 per cent of the taxi drivers trained had actually used their skills.

Without a proper ambulance service, Kumasi’s commercial drivers are very often the first at the scene of crashes, and just over 70 per cent of all casualties are taken to hospital in some kind of commercial vehicle — usually a taxi.

The Kumasi project was a joint effort by the Ashanti chapter of the Ghana Red Cross Society, the Kwame Nkrumah University of Science and Technology, the Ghana Private Road Transport Union and the University of Washington (UW). Before it began, only 13 per cent of the city’s commercial drivers had any kind of formal first-aid training. Now some 500 individuals do.

“It just bugs me to see people being killed senselessly, when small things could prevent it,” says Dr. Charles Mock, a trauma surgeon at UW who has been closely involved with the Kumasi project. He believes injuries and death from trauma and especially traffic accidents are “a huge problem that’s been grossly ignored throughout the world”. AW

International partnership

Empirical data shows that by introducing some basic road safety management, national or local authorities can reduce crashes and injuries by 80 per cent. If the car industry introduces more safety measures the reduction could be even greater. For example, Dr. Krug explains: “We have to persuade car manufacturers to stop using speed as a selling point.” He adds: “While the private sector has achieved a great deal with things like seat belts, air bags and advanced braking systems, there’s a long way to go before everything that’s technically possible has actually been done.”

Following the publication of the 1998 World Disasters Report, the International Federation and the World Bank initiated an international partnership, the Global Road Safety Partnership (GRSP), with business, civil society and governments. The partnership’s mission is to advocate for greater awareness of road safety and to bring about a sustainable reduction of road crashes in developing and transition countries.

Currently, some 200 organizations take part in GRSP activities, and it is active in over ten countries. David Silcock, chief executive of GRSP, describes it as “part of a growing coalition of transport and public health professionals who are pressing for greater priority and resources for road safety”. GRSP has an “active programme of projects and a growing pool of knowledge and experience”, he adds.

The latest GRSP initiative is a US$ 10 million programme funded by seven of the world’s largest oil and auto companies. It will be implemented by GRSP, and will focus on key road safety themes, training road safety professionals in developing countries, and provide seed money to support pilot programmes to improve road safety in several developing countries.

In Asia, the GRSP concentrates its efforts in a few “focus countries”. In the last ten years, vehicle populations in two of the GRSP Asian “focus countries”, India and Thailand, more than doubled; in the third, Viet Nam (see box below), it more than tripled, with motorcycles increasing by nearly 70 per cent in the last two years alone. According to David Silcock: “Road traffic in Asia’s urban areas has become a vast mix of pedestrians, animal-drawn carts, old and modern motor vehicles and two-wheelers.” Helmet use is low; the proportion of victims who are motorcyclists is high — as much as 80 per cent in one province of Thailand. “There are few quick wins in road safety, but the single actions most likely to have an early and substantial impact are helmet wearing, use of safety belts, controlling drink driving and effective speed management. The Red Cross and Red Crescent Movement has a lot to offer in advocacy and prevention programmes in the affected communities” says Silcock.

“The character of the individual GRSP programmes in Asia is in many ways a reflection of the political culture in each country,” says Silcock. “There is strong political pressure for road safety improvements in Thailand and a GRSP foundation has been registered there.” Progress is possible.

Another GRSP focus country, well placed to display the special problems of transition economies and where, in addition, the Movement is active in road safety is Poland.

Transition: good cars, bad roads

The point of Poland’s “transition” from a communist to a free-market system can clearly be seen on a graph of the number of vehicles on the roads. In 1989 the line turns sharply upwards, reaching a peak two years later that has yet to be exceeded.

“Our roads are a major disaster,” says Katarzyna Stepinska, the senior officer in the Polish Red Cross (PRC) coordinating its efforts in the area. “And you can sum up the reason quite easily,” she adds. “Good cars on bad roads.” When you put your foot down in a Polski Fiat 126, the car people saved for years to buy under socialism, she explains, nothing much happened. Now, like everywhere else in the old Soviet bloc, today the vehicles of choice are powerful German or Japanese cars, any of which will exceed the urban 50 kilometres per hour speed limit in not much more than a blink of the driver’s eye.

Everyone agrees: excessive speed is the number-one killer on Poland’s roads.

Poland’s essentially pre-Second World War road system has been described as one of the most dangerous of any OECD (Organisation for Economic Co-operation and Development) country. “Our roads are fantastic,” Andrzej Grzegorczyk, head of the government’s National Road Safety Council, says ironically, “but only if you’re in a tank.”

Grzegorczyk also sees the crisis on Poland’s roads as being fundamentally a transition issue, pointing to a decade of liberalization and motorization, and what he calls a new “king-of-the-road” mentality in, above all, young men. “In the old days,” he says, “it was fathers who drove, not sons, and they were very careful with the car they had worked hard for and could not easily replace.”

But recently, the Polish death toll has fallen while motorization has continued to rise, implying that preventive measures are working. “Point number one in our strategy is expanded first aid,” says Scholastyka Sniegowska, secretary general of the PRC, whose 16-hour course is now certified to European Red Cross standards. (It has been estimated 70 per cent of Poles who die at the scene of a crash could be saved.) The PRC, which has a written agreement with the fire brigade on accident and disaster preparedness, has also nagged the government for years to bring first-aid training in civilian driving courses up to scratch.

There are also familiar political arguments over restraining cars and drivers. “In democratic Poland,” says one expert, “every driver is also a voter.” Three separate bills to bring in a national speed limit, for example, died on the floor of the lower house of the National Assembly.

Death on the roads: the human toll

Road traffic injuries are a huge public health and development problem:
• They kill 1.2 million people a year or an average of 3,242 people every day.
• They injure or disable up to 50 million people a year.
• They rank as the 11th cause of death and account for 2.1 per cent of all deaths globally.
Ninety per cent of road traffic injuries affect people in low- and middle-income countries, especially in Asia:
• More than half of all road traffic deaths occur among young adults between 15 and 44 years of age, the most productive group in any society.
• Seventy-three per cent of all road traffic fatalities are male.
• The most vulnerable road users are pedestrians, cyclists, users of motorized two-wheelers and passengers on public transport.
Without action the problem will get worse in the developing world:
• Road traffic injuries are predicted to become the third-largest contributor to the global burden of disease by 2020.
• Road traffic deaths are predicted to increase by 83 per cent in low- and middle-income countries, and decrease by 30 per cent in high-income countries.
It is estimated that every year, road traffic crashes cost:
• US$ 518 billion globally.
• US$ 65 billion in low- and middle-income countries, more than total development assistance.
• Between 1 and 1.5 per cent of gross national product in low- and middle-income countries.
• Two per cent of gross national product in high-income countries.
Many countries have shown sharp reductions in the number of crashes and casualties by:
• Enforcing laws governing speed limits, alcohol, seat-belts, child restraints and crash helmets.
• Implementing transport and land-use policies that promote fewer, shorter and safer trips; encouraging safer modes of travel such as public transport; incorporating injury-prevention measures into traffic management.
• Making vehicles safer for occupants, pedestrians and cyclists, and more visible using daytime running lights, high-mounted brake lights, reflective materials on cycles, carts, rickshaws and other non-motorized forms of transport.

Reversing the trend

Few concerted attempts by the Red Cross and Red Crescent to tackle road safety have been more successful than the campaign by the National Societies of the European Union, now entering its third year with the leadership role passing from the German to the British Red Cross.

Some 9,000 teachers and hundreds of thousands of children took part directly in campaign activities, which last year culminated in the publication in 13 different languages of a Good Practice Guide in CD and printed form. Luc Henskens, director of the Red Cross/EU Office in Brussels, says the contribution of the accession states was crucial “in terms of the volume and quality of activity”.

The 2005 phase of the campaign includes a four-vehicle tour traveling through each participating country in the summer, converging on Brussels for a final event in September.

The British Red Cross (BRC), like so many other National Societies, advocates the inclusion of first aid in the overall test of proficiency for driving licences. The French Red Cross has launched an aggressive road safety campaign that combines graphic television spots of road accidents with the promotion of first aid as a life-saving technique. BRC first-aid adviser Anita Kerwin-Nye argues that: “within us all there is the ability to learn simple life-saving skills, which if administered at the scene of a road accident, could have such an impact.”

Staying alive

Tackling road safety means taking on some of the most intractable problems of modern society: alcohol and drug abuse, under-development and ignorance. The Red Cross and Red Crescent Movement has some basic tactics to fight this global crisis: prevention and first aid.

But this is a fight that must be fought on many levels. Governments, businesses, the media and civil society need to build on joint initiatives like GRSP. Reversing this worrisome trend, which could lead to millions more people dying on the road, requires moving beyond projects like GRSP to making road safety a top public health emergency. As the WHO and the World Bank report concludes: “Road traffic injury prevention and mitigation should be given the same attention and scale of resources that is currently paid to other prominent health issues if increasing human loss and injury on the roads, with their devastating human impact and large economic cost to society, are to be averted.”

Viet Nam: a tale of two cities

Viet Nam is “poor”, but getting richer fast. Its average annual gross domestic product growth of 7.5 per cent between 1991 and 2000 would delight European governments.

But a direct consequence of this is an exponential increase in road use, and road accidents are by far the greatest cause of death for people between 18 and 50 years of age — the country’s most productive.

Viet Nam, in fact, is a classic case of a developing country paying a high price in death and injury on the roads for the “motorization” — much of it in the form of small, inexpensive two-wheeled vehicles — that goes hand-in-hand with development. In the past decade, road deaths have increased fourfold from 3,000 to almost 13,000 — a daily average toll of 36 lives lost on Viet Nam’s roads.

In 1995 there were 4 million vehicles on the road; now there are 12 million, the overwhelming majority of them motorcycles. Mandatory helmet use is the most urgent measure the government can take if the road deaths are to be brought down significantly.

Now, a joint project between the French Red Cross and the Red Cross Society of Viet Nam worth nearly a quarter of a million dollars, will adopt a twin-track approach to improving road safety: first aid at key intersections in the main cities of Hanoi, the capital, and Ho Chi Minh City, and media campaigns.

The project agreement was signed in October 2004 during the state visit to Viet Nam by French President Jacques Chirac and is intended “to reduce the rising mortality rate on the roads”, according to a joint press release by the National Societies. Over the past 3 years France has substantially increased its efforts to reduce the number of road accidents with significant success. The French Red Cross is one of the most experienced National Societies in the field.

In Viet Nam, the Red Cross first-aid effort is targeted specifically at the dangerous urban entry points in neighbourhoods where the national highways begin. In Hanoi these are on the Thang Long motorway on the way to the airport, in the Dong Anh suburb to the north, in Trau Quy in the east and Van Dien to the south. There will be 500 volunteers equipped with first-aid kits and a stretcher at each of the four locations.

In Ho Chi Minh City, to start with, 160 volunteers will stand watch at one of the four entry points regarded as the most dangerous. In both cities, the Red Cross is also organizing media and poster campaigns to get people to drive more slowly, encourage helmet-use among motorcyclists and prevent drink-driving.