That’s bacteria for you. They always find a way! Resistance will occur; that’s how evolution works. (CREDIT: Creative Commons)
A new series published in The Lancet highlights the growing problem of road traffic injuries and lays out some opportunities for preventing injuries and saving lives. The series comes at the same time as the United Nations General Assembly launches a high-level meeting on global road safety June 30-July 1 in New York. The series offers a comprehensive analysis of this rising public health threat.
An estimated 1.35 million people lose their lives and more than 50 million are injured or disabled as a result of road traffic injuries every year. “The death toll from traffic injuries around the world is far too high,” Adnan Hyder, professor of global health at the George Washington University Milken Institute School of Public Health, said. “Despite a United Nations goal to reduce this heavy burden, people everywhere continue to be at great risk of injury and death unless current road traffic strategies are changed to put protections in place.”
Hyder, who is Senior Associate Dean for Research and also the Director of the Center on Commercial Determinants of Health at the GW Milken Institute School of Public Health, serves as the lead author of an analytic commentary and is the senior author on two other papers published as part of the three-part series.The analytic commentary reviews events that occurred from 1999 to the present and describes ten challenges that provide an opportunity to make faster progress on road safety.
Three other papers address the issue of road safety around the world. In the first, Junaid Razzak at the Weill Cornell Medical Center, Hyder and their colleagues looked at trauma care for road injuries. They found that approximately 200,000 lives per year could be saved with improved trauma systems in low and middle income countries.
In the second paper, Hyder, Nino Paichadze from GW, Andres Vecino-Ortiz at the Johns Hopkins University and their colleagues studied four road safety risk factors–speed, drunk driving, helmet and seatbelt use. They found that full implementation of already proven road safety interventions targeting those four main areas could save up to 540,000 lives around the world.
In the United States, a total of about 43,000 lives could be saved by focusing on those four road safety areas, including more than 22,000 lives saved by restricting speed and more than 5100 with interventions on drunk driving. Another 14,000 and 2400 lives could be saved with better use of seatbelts and helmets, respectively.
In the analytic commentary, Hyder and his colleagues outline some of the pitfalls that must be overcome to make the roadways safer. They point out that road safety involves many sectors, including health, transportation and other areas; and suggest addressing commercial determinants of road safety. To address road safety the roles of each sector must be clear and one sector should take the lead on developing a strategy, Hyder said. The authors recommend reframing road safety so that the issue resonates with the public and political leaders. At the same time, there must be the political will to put enough resources toward this problem to address it, Hyder said.
Road injuries are killing young people, and it’s hardly slowing down
In the third paper led by UNSW Sydney reveals traffic-related fatalities and injuries are the biggest killers of young people worldwide – causing more deaths than communicable and non-communicable diseases or self-harm. The findings are published in The Lancet Public Health in the first global analysis of transport and unintended injury-related morbidity and mortality of young people aged 10-24.
Using the latest data from the Global Burden of Disease (GBD) 2019 Study, the researchers analysed deaths and Disability-Adjusted Life Years (DALYs) from transport and unintentional injuries in adolescents across 204 countries in the past three decades. They found that despite transport injury death rates falling by a third since 1990, the number of deaths attributed to road fatalities for adolescents still increased in some countries.
“We’ve seen a high increase in the absolute number of injury-related deaths and DALYs, specifically in low and low-middle income countries. It indicates neglect for a growing population at risk of injury,” says lead author Dr Amy Peden, research fellow with the School of Population Health at UNSW Medicine & Health.
Prevention progress stalling
According to the research, reductions in transport injury and death rates in high-income countries have slowed in the most recent decade. They dropped just 1.7 per cent a year between 2010 and 2019 compared to the fall of 2.4 per cent a year between 1990 and 2010.
“In high-income countries like Australia, there’s been a real decline in progress. In the past 10 years, we’ve seen reductions in rates of road transport injury essentially stall, showing a lack of attention to the issue,” Dr Peden says.
Adolescents are particularly vulnerable to injury risk due to increasing independence and risk-taking tendencies. However, there has been little research to date that has examined injury patterns in this vulnerable age group.
As other causes of mortality in young adults get more focus, Dr Peden says the lack of progress in reducing transport injury deaths only becomes more apparent.
“Despite being the leading cause of death in adolescents globally, it’s been relatively neglected when you consider the strong action on other non-injury causes of death among adolescents,” Dr Peden says.
There is also a growing burden of transport injuries in low-income countries, where the proportion of deaths almost doubled from 28 per cent in 1990 (74,713 of 271,772) to 47 per cent in 2019 (100,102 of 214,337).
Dr Peden says the shift in the burden of transport injury toward lower-income countries needs urgent assistance from the global community.
“Low socio-demographic index (SDI) countries are dealing with the challenges that come with rapid urbanisation, and as such, young people are at a greater risk of road traffic and other types of injury,” Dr Peden says.
Global action on road safety
Making roads safer doesn’t necessarily require radical solutions, Dr Peden says. It just needs a stronger commitment globally to promote safety behaviours.
“The prevention of road traffic injury is still not very well resourced compared to other causes of death of adolescents. So, the findings show a lack of investment in the issue from the global health community,” Dr Peden says.
Graduated driver licensing, minimum drinking age laws, lower blood alcohol content levels for novice drivers, seat belt and helmet laws, and school zones have all shown to be effective in reducing injury-related harms when imposed. All-age interventions such as speed enforcement and drink driving enforcement are also effective in reducing road traffic deaths and should have increased focus, Dr Peden says.
The research also recommends promoting active transport infrastructure to prioritise alternative travel options and designing streets with the road safety needs of children and adolescents at the forefront of the planning.
“There are simple, affordable and proven interventions to reduce road traffic injuries that are not being applied or enforced,” Dr Peden says. “Now is the time to step up global action on road safety and renew our efforts to safeguard adolescents from preventable injury.”
The United Nations General Assembly is convening a high-level meeting on improving global road safety this month, focusing on investment in road safety.
“We have ambitious but necessary targets set out in the Decade for Action for Road Safety 2021-2030 to prevent at least 50 per cent of road traffic deaths and injuries by 2030,” says Professor Rebecca Ivers, Head of UNSW School of Population Health and co-author of the paper.
“What we need now is the political will for change, backed by measurable action, financial support and the right mechanisms to implement solutions, especially in communities where the burden of road traffic injuries is greatest. This week’s high-level meeting is an important step to give road safety the attention that’s needed so we can save lives,” Professor Ivers says.
“This entirely preventable public health issue does not occur in silos – having safe transport systems is also directly linked to the kind of inter-sectoral action that can lead to sustainable cities and communities and to mitigate the impact of the climate crisis.”
The next stage of the research will investigate the economic case for governments to invest in injury prevention interventions for adolescents and policy change worldwide, Dr Peden says.
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