Traffic Fatalities a Growing Threat Worldwide, WHO Reports
By David Brown
Washington Post Staff Writer
Wednesday, April 7, 2004
Page A26
Road traffic crashes of all types are an enormous, largely overlooked world health problem, second only to childhood infections and AIDS as the killers of people between the ages of 5 and 30, according to a major report released today.
Each year, about 1.2 million drivers, passengers, cyclists and pedestrians of all ages are killed on the roads, according to the study prepared by the World Health Organization and the World Bank. That is about one in every 50 deaths worldwide, and about the same as the mortality from malaria. As a cause of premature death or disability, traffic injury ranks ninth, with 90 percent of the mayhem occurring outside the industrialized world.
"It is already huge, but if nothing happens it is expected to rise," said Etienne Krug, director of WHO's department of injuries and violence prevention.
Prepared over 18 months by 100 experts worldwide, the report sketches a grim picture of one of the costs of growing prosperity in the developing world, where traffic deaths are expected to rise by 80 percent by 2020 as hundreds of millions of cars are added to the roads.
The report is the first global look at the health consequences of road crashes since 1962. Unlike that earlier report, titled "Road Traffic Accidents," the new one never uses the word "accident," believing that suggests the deaths and injuries were largely unavoidable.
The 217-page document lays out things that rapidly developing countries -- India, China and southeast Asia especially -- can do to try to lessen the carnage. They include stricter enforcement of traffic laws, including ones against drunken driving; more use of seat belts; better design of roads, especially to protect pedestrians and cyclists; and improved design and inspection of vehicles.
The essential first steps, however, are to create a single government agency responsible for road safety and to gather crash and injury statistics so that the size of the problem is known and the effects of interventions are measurable.
"The main problem is it is not on the agenda in the low- and middle-income countries," Krug said.
Most industrialized countries began to recognize traffic injuries as a major health problem about 40 years ago. (In the United States, the National Highway Traffic Safety Administration was created in 1970.) Between 1975 and 1998, traffic fatality rates fell by 63 percent in Canada, 58 percent in Sweden and 27 percent in the United States, while rising 80 percent in India and more than doubling in China.
By 2020, deaths are expected to fall an additional 30 percent in the industrialized world, while rising 80 percent elsewhere. According to one model, India's traffic death rate is not expected to decline until 2042 unless major changes are made.
Today, Britain, Sweden and the Netherlands have the safest roads, with six to seven deaths per 100,000 inhabitants. This is in part because of cultural norms. In Sweden, where the legal blood-alcohol concentration limit is 0.02 percent (compared with 0.08 or 0.10 percent in the United States), drinking and driving spells social ostracism.
"It's a country full of designated drivers," Krug said.
In the United States, the mortality rate is 15 per 100,000. It is 16 in China (where, in 1999, there were 80 motor vehicles of all types for every 1,000 people, compared with nearly 800 for every 1,000 people here). In Africa, where estimates are crude, the rate is about 28.
Some of the highest mortality is in Latin America. In El Salvador, for example, the annual traffic mortality is 42 per 100,000 people.
The nature of the victims also varies greatly by country.
In the United States, 80 percent of fatalities occur in passengers in four-wheel vehicles. In Thailand, 70 percent of victims are motorcyclists. In New Delhi, slightly more than 40 percent of victims are pedestrians.
The report outlines unusual strategies for reducing traffic injuries. In the Australian state of Victoria, for example, the Traffic Accidents Commission compensates victims regardless of fault through an insurance plan funded by annual vehicle registration.
The commission determined that the expense of improving high-risk stretches of road there, conducting a public education campaign and helping police buy enforcement technology "would be more than offset by reduced payments in compensation," according to the report.
Among the people who helped in the planning of the report is Rochelle Sobel, president of the Association for Safe International Road Travel in Potomac. Sobel, an elementary school teacher, founded the organization after her son, Aron, was killed in a bus crash in Turkey in May 1995, a week before he would have graduated from the University of Maryland School of Medicine.
"For us, this is really a dream," she said yesterday from the airport as she prepared to fly to Paris, where she will be part of the official presentation of the report on World Health Day today.
"When my son was killed, I called a number of health organizations to talk about this subject, and they all said, 'Well, it's not a disease,' " she recalled. "To have WHO take this on is truly a tremendous milestone, an incredible first step in putting it in the eye and mind of people."
Among other things, Sobel's organization is working in Turkey with Rotary clubs to get local jurisdictions to paint lines on roads, trim vision-blocking trees, enforce seat belt use and improve emergency response. In Kenya, where the association has an office, it is working with the transportation ministry to improve safety requirements of matatus, the ubiquitous overcrowded minivans of that country, she said.
***
© 2004 The Washington Post Company
