The point of the study was not to make news, or prove that visiting New York streets is relatively safe for pedestrians.  It was to discover where the vulnerabilities were and re-engineer and redesign the pathways shared by vehicles and pedestrians to improve safety for all. Of the many things I gained from my year in that fellowship was an interest in learning more about the intersect of transportation, safety and health – thanks to Janette. In that pursuit, I came in contact with an international medical organization dedicated to global road safety called The Bone and Joint Decade (4). Here’s what I learned.

Some of the greatest opportunity for gains in public health can be found in a surprising place — the world’s roadways. In 2004, Dr. LEE Jong-wook, director-general of the World Health Organization, noted that “too often, road safety is treated as a transportation issue, not a public health issue, and road-traffic injuries are called accidents, though most could be prevented. As a result, many countries put far less effort into understanding and preventing road-traffic injuries than they do into understanding and preventing diseases that do less harm.”(5)

It is estimated that 140,000 injuries occur on roads worldwide each day. Fifteen thousand people are disabled as a result, and 3,000 die. (4) In the year 2000, 1.26 million people were killed in roadway accidents, accounting for 25 percent of all deaths from injury that year.(6)

Roadway safety is not just a transportation issue. It is a public health issue that is getting worse. In 1990, roadway injuries were the ninth-leading cause of death and disability worldwide. But by 2020, that ranking is projected to shoot to number three, just behind ischemic heart disease and unipolar depression. The change in rank is based on a projection that roadway injuries will increase by 60 percent in 30 years if current trends continue.(7)

The burden of unsafe roads falls most heavily on the most vulnerable. The death rate from road injuries in high-income countries was 12.6 deaths per 100,000 citizens in 2002. The rate in low-income and middle-income countries was 60 percent higher at 20.2 deaths per 100,000 citizens, which accounted for 90 percent of death and disability from roadway injuries in 2002. And children, especially poor children who often use roads as play areas, are at great risk. More than 180,000 children die from roadway injuries every year. In 2002, 96 percent of these deaths occurred in low-income or middle-income countries.(4)

How roads are used, and by whom, varies widely from country to country. Roads in high-income countries are dominated by cars, while low- and middle-income nations utilize roads as shared space. In this shared space there are large numbers of more vulnerable roadway users, such as pedestrians, bicyclists, and motorbike riders. Intermixed with passenger vans, mini buses, cars, and trucks, these more vulnerable users suffer a rate of injury and death many times greater than drivers of cars, thus contributing to the higher death rates in low-income countries. (4,8)

The Bone and Joint Decade captured the imagination of the world health community by declaring “Road Safety is No Accident” as the official slogan of World Health Day 2004. As Kofi Annan, secretary-general of the United Nations at the time stated, “Improving road safety requires strong political will on the part of governments. In a systems approach, not only the driver, but also the environment (infrastructure) and the vehicle are seen as part of the system in which road traffic injuries occur.” (6)

As we’ve seen time and time again, good health makes good financial sense as well. The estimated cost of roadway injuries worldwide is $520 billion per year. In low-income and middle-income countries, roadway injuries cost $65 billion, which is more than developing countries receive in development aid. (4)

The causes of roadway accidents are increasingly clear, as are the solutions. Mixed roadway use and poor road design play a significant role, especially in poor and urban environments. Excessive speed, reckless driving, and poor visibility contribute to the likelihood of disaster. And the lack of reasonable regulation and enforceable laws results in poor vehicle maintenance, failure to use seat belts, air bags, and helmets, and improper handling of hazardous materials. Lastly, the absence of adequate health infrastructure and trauma care maximizes the impact of injury. (4,8,9)

The solution lies in a highly coordinated, research based, multifaceted planning and execution effort involving governments, public-health leaders, corporations, communities, and citizens. Under Ms. Sadik-Khan’s leadership, New York City is doing just that.

For Health Commentary, I’m Mike Magee.

References:
1. David Rockefeller Fellowship. http://www.pfnyc.org/drf.html
2. NYC Press Release. NYC Comprehensive Pedestrian Safety Study.
3. Grynbaum MM. Walking in city? Beware of men turning left. New York Times. A1, August 17, 2010.
4..World Health Organization. “Road Safety is No Accident: A Brochure for World Health Day 7 April 2004.” Geneva, Switzerland; 2004.
5.United Nations moves towards action on Road Traffic Safety following Bone and Joint Decade proposal. [press release]. Bone and Joint Decade. September 16, 2003. Available at: http://www.boneandjointdecade.org.
6.UN Road Safety Collaboration.  Annan urges commitment to Road Safety.
7.Murray CJL, Lopez AD, eds. The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. Boston, Harvard University Press, 1996.
8.Nantulya VM, Reich, MR. Equity dimensions of road traffic injuries in low- and middle-income countries. Injury Control and Safety Promotion. 2003;10:13-20.M
9.Afukaar FK. Speed control in developing countries: issues, challenges and opportunities in reducing road traffic injuries. Injury Control and Safety Promotion. 2003;10:77-81.