Increasing RTI results from rapid growth in motorization, without adequate improvements in road infrastructure (despite significant road investments) and weak regulations on vehicle safety and driving, and weak enforcement of existing regulations. People in CIS countries drive far less than in Western Europe (800 km/per capita by car, compared to 12,000km/per capita) accident injury and death rates are far higher, with little of the improvement in road safety that concerted efforts in Western Europe have achieved.
Direct costs include emergency treatment, initial medical costs, rehabilitation costs, long-term care and treatment, insurance administration expenses, legal costs, and employer/workplace costs. Indirect costs include productivity costs in the workplace due to temporary and permanent disability and decreases in household productivity emanating from these disabilities. Property damage and travel delay and crash costs are estimated for injury and non-injury crashes (Blincoe and others 2002).
Sources for cost effectiveness estimates: ETSC 2003, SWOV 2001, and U.S. National Center for Injury Prevention and Control 2000
In ECA - WHO subregionsEurB and EurC—pedestrians are particularly vulnerable road users (31 to 38% of fatal RTIs), with car drivers (43%) and car passengers (24%). Risk factors -excessive speed (21 to 22%) and driving under the influence of alcohol (16 to 21%) contribute the most to the overall death toll: 97 per 1 million and 248 per 1 million population (in each case, the first number refers to subregionEurB, the second to EurC). Compared to no intervention, legislation and enforcement of bicycle helmet use by children is the most cost-effective strategy in EurB (I$10,395 per DALY saved), followed by roadside breath testing for alcohol-impaired driving (I$12,691 per DALY saved). In EurC, breath testing is the most cost-effective strategy (I$5,825 per DALY saved). Results for all single and combined interventions are shown in Figure 5. Combining roadside enforcement strategies—against alcohol-impaired driving, speeding, and non-use of seatbelts, for example—offers the prospect of major synergies on the cost side. Countries in the WHO European Region with low child and adult mortality (EurB) are: Albania, Armenia, Azerbaijan, Bosnia and Herzegovina, Bulgaria, Georgia, Kyrgyzstan, Poland, Romania, Slovakia, Tajikistan, The Former Yugoslav Republic of Macedonia, Turkey, Turkmenistan, and Uzbekistan. Countries in the WHO European Region with low child and high adult mortality (EurC) are: Belarus, Estonia, Hungary, Kazakhstan, Latvia, Lithuania, Republic of Moldova, Russia, and Ukraine.
Confronting Death on Wheels Making Roads Safe in Europe and ...
Confronting “Death on Wheels”Making Roads Safe in Europe and Central Asia <br />establishing multisectoral partnerships to address a silent epidemic<br />January 2010<br />
Outline: Challenges and Opportunities in Addressing Road Safety in the ECA Region*<br />The problem: trends, size, characteristics, causes<br />Effective measures to improve road safety <br />Current international road safety policy<br />Possible strategies and actions by the World Bank with partners<br />*Baltic, Balkans, EE, CIS, Turkey.<br />
30<br />25<br />20<br />European Region<br />EU <br />CIS<br />15<br />10<br />5<br />1980<br />1990<br />2000<br />2010<br />Road Traffic Injury (RTI) Mortality Rate Trends Europe, EU-27 and CIS Countries, per 100,000, 1980–2007large, increasing disparities <br />CIS<br />European Region<br />EU-27<br />CIS countries: Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, the Republic of Moldova, Russia, Tajikistan, Turkmenistan, Ukraine, and Uzbekistan. <br />EU-27 countries: Austria, Belgium, Bulgaria, Cyprus, the Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, the Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, and the United Kingdom. <br />Source:WHO EURO Health for All Data Base (2009).<br />
Deaths, disability and damage – who bears the brunt?<br />4-wheel vehicle occupants: 40-75% of RTI deaths in ECA<br />Young adults, especially men: <br />55% of road traffic deaths in ECA countries are people aged 15–44, mostly 15–29; > 80% of deaths are men <br />Cyclists, motorcyclists at high risk (but small % of total)<br />Motorcyclists, pedestrians at 7-9 times greater risk of death if in an road crash than people in vehicles<br />Pedestrians – more likely to be children or elderly, and people with lower incomes<br />In Albania, Belarus, Kyrgyzstan, Tajikistan, and Ukraine, pedestrians are ≥ 40% of all road fatalities, 31-38% in all ECA<br />
Deaths, disability and damage – extent<br />80,000 road traffic deaths, 820,000 injuries in ECA in 2007<br />(Data underestimate and underreport – especially non-fatal injuries, and differ in availability, quality, and completeness)<br />Economic Impact: 1-2% of GDP (health care & rehabilitation costs, insurance, legal, lost productivity, property damage)<br />Globally, costs to governments > US$500 billion annually <br />Highest costs in ECA: large economies with big populations: <br />Air pollution, noise<br />Greenhouse gas emissions contribute to global warming<br />Fear deters walking, biking. Less mobility and physical activity reduces health, increases risks for cardiovascular diseases, strokes, diabetes, obesity <br />Russia (US$34 billion per year, 33,308 deaths in 2007) <br />Turkey (US$14 billion)<br />Poland (US$10 billion) <br />Ukraine (US$5 billion) <br />
Road Traffic Injury Causes<br />“Are you in a hurry to reach us?"<br />Lack of data /problem awareness<br />Inadequate response, resources<br />Roads<br />Bad road design (no crossings, walkways, poor visibility)<br />Roadside hazards (trees, poles, signs)<br />Mixing traffic and pedestrians<br />Vehicles<br />Unsafe vehicles, without airbags & other crash protection devices<br />Huge increase in vehicle numbers (poor public transport)<br />Behaviors <br />Inadequate laws/rules + poor enforcement <br />Bad driving (speeding, recklessness, alcohol, some medications)<br />Not using seatbelts, helmets (cyclists, motorbikes)<br />Mobile phone texting<br />
Effective Approaches<br />Action Areas:<br />Prevent road traffic crashes and injury <br />Minimize injuries when crashes occur<br />Recovery: reduce injury severity afterwards<br />Cost effectiveness:<br />Savings vary from $1 (motorcycle helmets) to $36 (random alcohol level testing) per dollar spent on interventions <br />
Effective Approaches<br />Elements of Success:<br />Plan long term, demonstrate short term gains<br />Measure outcomes, monitor performance<br />Make road safety integral to transport policy<br />Competent lead agency coordinates actions by transport, interior, police, health, education etc<br />Ensure adequate financing<br />Good public transport options<br />
Effective proven measures (2)<br />Improve vehicle safety<br />In-vehicle crash protection (airbags, seatbelts, child car seats)<br />Vehicle licensing and inspection to enforce roadworthy standards<br />Daytime running lights<br />Require and enforce helmet use with bicycles, motorbikes<br />
Effective proven measures (3)<br />Behavior change - education, law/regulation enforcement<br />Lower speed limits: 30 km/hr in residential areas, 50 km/hr in other urban areas <br />Enforcing blood alcohol level limit of ≤0.05g/dl could prevent 5-40% of RTI deaths (random breath testing better than set checkpoints, taxes and marketing, sales regulations are effective)<br />Mandatory, enforced seat belt use<br />Prevention of distracting driving due to use of phones and texting<br />Media coverage, education campaigns + tough sanctions<br />Graduated driving licenses (curfew, passenger restrictions) and more training during learner period reduce deaths among young drivers (US)<br />Better public transport and land use reduces car travel<br />
Cost-effectiveness – depends on risk factors, and distribution of fatalities/injuries by road user group <br />Average cost per disability-adjusted life (DALY) year saved, adjusted for purchasing power parity<br />
Earmarked charges (eg revenue from traffic fines used to finance road safety activities)</li></ul>Alternative financing sources:<br /><ul><li>Price/tax policy (fiscal incentives for private and business investments in safety measures such as retrofitting older vehicles with safety belts)
Insurance premiums (higher premiums for less safe vehicles, and drivers with poor safety records; pay-as-you-drive or pay-as-you-speed mechanisms, spread costs of risks for injury-causing crashes more fairly; assign total cost of car crashes to the person who caused it)
Financial options (make unsafe behavior more expensive and give financial reward for safe behavior)</li></ul>Source:Adapted fromOECD (2002) and Aeron-Thomas and others (2002), cited in Peden and others (2004); ECORYS (2006).<br />
Health Sector Response<br />Public health actions: collect and analyze data, research causes of RTI, advocate effective action, define and implement protective policies and practices and preventive interventions<br />Primary health care providers: medical assessments of elderly/impaired drivers, advice on alcohol use and effects on driving of medications <br />Emergency medical services: communication for rapid response, initial emergency care and stabilization, transport to health facility, well-trained teams with medicines and equipment, quality assurance<br />Safe blood supply &transfusion<br />Rehabilitation services<br />
Current Road Safety Policy – Holistic “Safe Systems” approach<br />Principles: <br /><ul><li>Cannot prevent all road crashes, can reduce traffic injuries
Design road traffic systems to take account of human error and vulnerability of human body
Responsibility and accountability for road safety sharedby road and car designers and road users</li></ul>Haddon’s Matrix for Crash and Injury Prevention<br />
ECA Efforts to Prevent Road Transport Injuries <br />Of 29 countries in ECA: <br /><ul><li>27 have a lead agency for road safety
many require formal audits for major new road construction projects and regular audits of existing roads,
many promote public transportation, walking, and cycling</li></ul>But<br /><ul><li>Only 8 countries have seatbelt used at least 70% (in front seats)
Urban speed limits are 60km/h in 15 countries, 70 km/h in 1 (higher than recommended)
Quality of formal, publicly available pre-hospital post-crash care systems varies
Enforcement is often lacking</li></ul>much more is possible<br />Good Examples: <br />Poland: public education on road safety, seat-belt use, drunk driving; training for professional drivers; road signs warning of black spots; improved pre-hospital care<br />Armenia: dramatic improvements in seatbelt use by enforcing seatbelt law<br />Russia: fines for not using a seatbelt increased 10x, new law against crossing into an oncoming lane punishable by revoking driver’s license, anti-alcohol campaigns launched<br />
World Bank Support (to date)<br />Practical guidelines to help countries implement these recommendations<br />Global Road Safety Facility generates funding and Technical Assistance for country road safety efforts<br />Road safety management capacity reviews done in many ECA countries<br />World Bank-supported road safety investments in transport and health projects<br />Information and policy dialogue<br />
What more could the World Bank do in ECA?<br />2004 World Report identifies 6 key steps for success:<br />Identify a lead agency in government<br />Assessroad traffic injury problems, policies and institutions, and capacity for prevention <br />Prepare a national road safety strategy and plan of action<br />Allocate financial and human resources<br />Implement specific actions and evaluatetheir impact <br />Support national capacity and international cooperation. <br />Principles: systematic, sustained, successful effort has 3 parts: <br />Results<br />Institutional management<br />interventions<br />
What more could the World Bank do in ECA? (1)<br />Build institutional management capacity<br />Provide training and information for policy makers, practitioners<br />Support existing networks of people responsible for road safety<br />Help countries improve data on RTIs and causes<br />Specify lead agency reforms needed <br />Help countries choose interventions well<br />Review national road safety management capacity - assess the situation, propose strategies and actions with realistic targets and budgets<br />Support a safe system approach + results focus aiming to end road deaths and serious injuries (see next slide for specifics)<br />
What more could the World Bank do in ECA? (2)<br />Support a safe system approach + results focus aiming to end road deaths and serious injuries:<br />Analyze planned road investments for safety, improve design<br />Review road sections where many crashes occur to target investments<br />Lower urban speed limits to 50 km/h; 30 km/h in residential areas; enforce – speed cameras are cost effective<br />Enforce alcohol limits with systematic police enforcement (breath tests, high-visibility random road checks), high-profile media campaigns, and swift severe penalties <br />Enforce use of seat belts – campaigns, penalties, car restraint specifications<br />Reduce young driver risk– graduated licensing scheme, extended training<br />Reduce pedestrian risk – barriers, traffic “calming”, more pedestrian facilities <br />Improve speed and quality of emergency care (at crash site and after) – evaluate, identify and fix weak areas, train<br />Include road safety as a key “performance attribute” of transport<br />Demonstration projects, with strong evaluation<br />
Focus areas for World Bank support that is evidence-based, cost-effective, and follows international best practice: <br />Capacity reviews – to ensure country commitment, customization, consensus<br />Ensure lead agency has capacity, mandate, and funding to manage for results<br />Invest in management capacity to deliver results in stages<br />Learn by doing demonstration projects that rapidly achieve safety improvements in high-risk areas, then build on success<br />Key Partners: <br />International Road Assessment Program (iRAP) - engineering safety <br />RoadPOL - traffic police peer-to-peer services<br />International Road Traffic Accident Database Group - data<br />World Health Organization (WHO) - technical support in traffic injury prevention, injury surveillance, emergency trauma services & care<br />Ministries: transport, health, law enforcement, finance, interior, education<br />Private sector: insurance, auto makers, media, regulatory agencies<br />CSOs: consumer organizations, faith-based organizations<br />Parliaments<br />
Effective Road Safety Program Building Blocks<br />
Take Away Messages:<br /><ul><li>Safe, clean, affordable transport is a development priority.
Preventing road traffic injuries is a major public health priority.
Proven, effective, cost-effective “good practices” can save lives and money, prevent disability, improve other health outcomes and the environment.
A “safe system” needs well-coordinated, cooperative action by transport, health and policing/enforcement sectors.
The World Bank could do more, with partners, to help countries in Eastern Europe and Central Asia make roads safer. Specific areas for action are clear.</li></ul>Thank you!<br />