GLOBALSTATUSREPORTONROADSAFETY2013SUPPORTING A DECADE OF ACTION
GLOBALSTATUSREPORTONROADSAFETY2013SUPPORTING A DECADE OF ACTION
WHO Library Cataloguing-in-Publication Data:Global status report on road safety 2013: supporting a decade of action.1.Acci...
CONTENTSPreface.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...
Increasing seat-belt use. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...
PrefaceProgress is being made to make the world’s roads safer, but this criticalwork must be intensified and accelerated.I...
AcknowledgementsThe Global status report on road safety 2013 benefited from the contributions of a number of WHO staff:Tam...
Executive summaryRoad traffic injuries are the eighth leadingcause of death globally, and the leadingcause of death for yo...
comprehensive legislation on key riskfactors (speed, drink–driving, motorcyclehelmets, seat-belts and child restraints) fo...
safety audits to assess safety levels ofboth existing and new road infrastructureprojects. The report also outlines progre...
BackgroundApproximately 1.24 million people dieevery year on the world’s roads, andanother 20 to 50 million sustain non-fa...
In order to guide countries on takingconcrete, national-level actions to achievethis goal, a Global Plan of Action wasdeve...
SECTION1The current state ofglobal road safety
Many countries havesuccessfully reduced thenumber of deaths on theirroads, while deaths areincreasing in othersThis report...
Figure 5Population, road traffic deaths, and registered motorized vehiclesa, by country income status■ High-income■ Middle...
Half of all road traffic deathsare among pedestrians,cyclists1and motorcyclistsHalf of the world’s road traffic deaths occ...
income status. Low-income countries havethe highest proportion of deaths amongvulnerable road users (pedestrians, cyclists...
A significant proportion of patientswho sustain a road traffic injury incurpermanent disability, through amputation,head i...
Figure 10Proportion of countries providing access to emergency medicaltraining for doctors and nurses, by WHO regionPercen...
Figure 11Trends in the number of road traffic deaths per year in IndonesiaNumberofdeaths35 00030 00025 00020 00015 00010 0...
SECTION2NEW ROAD SAFETY LAWS:PROGRESS TO DATE
Encouraging a culture of safe roadbehaviour that in turn achieves sustainedreductions in road traffic injuries requiresper...
Progress to reduce excessivespeed has stalledSpeeding is a major road safety problemin all countries. Faster driving speed...
National urban speed limits ≤50 km/h and can be modifiedNational urban speed limits ≤50 km/h and cannot be modifiedUrban s...
Speed limits need strongerenforcementAlthough most countries have enactednational speed limit laws, theirenforcement is of...
Drink–drive laws shouldbe based on blood alcoholconcentration levelsDrinking and driving increases the riskof being involv...
high-income, 77% of middle-income, and45% of low-income countries adoptingthis practice. Despite global progress instrengt...
Head injuries amongmotorcyclists are a growingconcernRapid growth in the use of motorized two-wheeled vehicles in many cou...
“Protect yourself from heftyfines and serious headinjuries. Wear a helmet.”19SUPPORTINGADECADEOFACTION
Taken together, this means that 90countries meet both the criteria consideredhere as essential for comprehensivehelmet leg...
21SUPPORTINGADECADEOFACTION
Seat-belts reduce the risk of a fatal injury by up to50% for front seat occupants, and up to 75% forrear seat occupants.Pr...
number of countries do not apply theselaws to both front and rear seat occupants.Comprehensive seat-belt laws covering all...
“Seat-belt wearing ismandatory by law. There isno exemption for anybody,including me.”Governor of AfyonkarahisarFigure 18P...
More thanhalf of allcountries haveimplemented achild restraintlaw, but theserepresentjust 32% ofthe world’spopulation.More...
restraint laws as “good” (8 or above ona scale of 0 to 10). Even in high-incomecountries, enforcement of child restraintla...
Involving multiple sectors innational road safety effortsis criticalCountries need a lead agency for roadsafety, which sho...
28GLOBALSTATUSREPORTONROADSAFETY,2013
SECTION3Transport policiesneglect pedestriansand cyclists
Governments need to makewalking and cycling safeRapid economic development in many low-and middle-income countries has led...
••••••••••31SUPPORTINGADECADEOFACTION
Safer roads reduce crashlikelihood and severityRoad infrastructure projects are generallyassociated with increasing the mo...
and cyclists, while countries’ roads areassessed for the percentage that meetcertain star ratings for each type of roaduse...
34GLOBALSTATUSREPORTONROADSAFETY,2013
35SUPPORTINGADECADEOFACTION
36GLOBALSTATUSREPORTONROADSAFETY,2013
Conclusions andrecommendationsThis report shows that road traffic injuriesremain a critical public health concern, asappro...
public understanding of and support forlegislative measures.›	 Reducing road traffic deathsrequires more consideration of ...
References1.	 Murray CJL et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010:...
Global Status Report on road safety 2013 WHO
Global Status Report on road safety 2013 WHO
Global Status Report on road safety 2013 WHO
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Global Status Report on road safety 2013 WHO
Global Status Report on road safety 2013 WHO
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Global Status Report on road safety 2013 WHO
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Global Status Report on road safety 2013 WHO
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Global Status Report on road safety 2013 WHO
Global Status Report on road safety 2013 WHO
Global Status Report on road safety 2013 WHO
Global Status Report on road safety 2013 WHO
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Global Status Report on road safety 2013 WHO
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Global Status Report on road safety 2013 WHO
Global Status Report on road safety 2013 WHO
Global Status Report on road safety 2013 WHO
Global Status Report on road safety 2013 WHO
Global Status Report on road safety 2013 WHO
Global Status Report on road safety 2013 WHO
Global Status Report on road safety 2013 WHO
Global Status Report on road safety 2013 WHO
Global Status Report on road safety 2013 WHO
Global Status Report on road safety 2013 WHO
Global Status Report on road safety 2013 WHO
Global Status Report on road safety 2013 WHO
Global Status Report on road safety 2013 WHO
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Global Status Report on road safety 2013 WHO

  1. 1. GLOBALSTATUSREPORTONROADSAFETY2013SUPPORTING A DECADE OF ACTION
  2. 2. GLOBALSTATUSREPORTONROADSAFETY2013SUPPORTING A DECADE OF ACTION
  3. 3. WHO Library Cataloguing-in-Publication Data:Global status report on road safety 2013: supporting a decade of action.1.Accidents, Traffic - statistics and numerical data. 2.Accidents, Traffic - trends. 3.Wounds and injuries - epidemiology. 4.Safety. 5.Data collection.6.Programme evaluation. I.World Health Organization.ISBN 978 92 4 156456 4 (NLM classification: WA 275)© World Health Organization 2013All rights reserved. Publications of the World Health Organization are available on the WHO web site (www.who.int) or can be purchased from WHOPress, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857;e-mail: bookorders@who.int).Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed toWHO Press through the WHO web site (http://www.who.int/about/licensing/copyright_form/en/index.html).The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part ofthe World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of itsfrontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World HealthOrganization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products aredistinguished by initial capital letters.All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, thepublished material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of thematerial lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use.Design and layout by L’IV Com Sàrl, Villars-sous-Yens, Switzerland.Printed in Luxembourg.Made possible through funding from Bloomberg Philanthropies.
  4. 4. CONTENTSPreface.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vAcknowledgements.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viExecutive summary.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viiBackground. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1The Decade of Action for Road Safety. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1The purpose of this report.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Methodology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Section 1. The current state of global road safety. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Many countries have successfully reduced the number of deaths on their roads, while deaths are increasing in others. . . . . . . . . 4Middle-income countries are hardest hit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4The African Region has the highest road traffic fatality rate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Half of all road traffic deaths are among pedestrians, cyclists and motorcyclists. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Almost 60% of road traffic deaths are among 15–44 year olds. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Non-fatal crash injuries are poorly documented.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Harmonizing data collection on road traffic deaths . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Section 2. New road safety laws: progress to date. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Reducing speed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Progress to reduce excessive speed has stalled. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Reducing urban speeds protects pedestrians and cyclists. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Speed limits need stronger enforcement.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Reducing drinking and driving.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Drink–drive laws should be based on blood alcohol concentration levels. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Strong drink–drive laws protect almost 70% of world’s population. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16More stringent drink–drive laws for high-risk drivers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Drink–drive laws need stronger enforcement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Almost half of all countries lack of data on alcohol-related road traffic deaths. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Increasing motorcycle helmet use.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Head injuries among motorcyclists are a growing concern. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18More effort is needed to promote helmet standards and quality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Data on helmet use is weak. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
  5. 5. Increasing seat-belt use. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22Progress has been made in tightening up seat-belt laws. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22Enforcing seat-belt laws needs more emphasis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23Only half of countries collect seat-belt wearing data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23Increasing the use of child restraints. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25More countries need to adopt child restraint use. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25Encouraging child restraint use. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26Lead agencies are vital to developing a national road safety strategy . . . . . . . . . . . . . . . . . . . . . . . . . . 27Involving multiple sectors in national road safety efforts is critical. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27National road safety strategies should include targets to minimize injuries, deaths and key risk factors. . . . . . . . . . . . . . . . 27Section 3. Transport policies neglect pedestrians and cyclists. . . . . . . . . . . . . . . . . . 29Governments need to make walking and cycling safe. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30Safer roads reduce crash likelihood and severity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32Action is needed to make vehicles safer for non-car road users. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33Public transport can make mobility safer and reduce congestion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33Conclusions and recommendations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39Explanatory notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41Methodology, data collection and validation.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42Country profile explanations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45Estimating global road traffic deaths.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48Country Profiles.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53Statistical Annex. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
  6. 6. PrefaceProgress is being made to make the world’s roads safer, but this criticalwork must be intensified and accelerated.In 2010 the governments of the world declared 2011–2020 as the Decade of Action for Road Safety. They invited the World HealthOrganization to prepare this report as a baseline to assess the state of global road safety at the onset of the Decade, and to be ableto monitor progress over the period of the Decade. The unanimous support for this Decade of Action from Member States indicates agrowing awareness that the devastating scale of road traffic injuries is a global public health and development concern.This report shows that 1.24 million people were killed on the world’s roads in 2010. This is unacceptably high. Road traffic injuries takean enormous toll on individuals and communities as well as on national economies. Middle-income countries, which are motorizingrapidly, are the hardest hit.There is a sound body of scientific evidence behind road safety interventions. Adopting and enforcing legislation relating to importantrisk factors – speed, drink–driving, motorcycle helmets, seat-belts and child restraints – has been shown to lead to reductions in roadtraffic injuries. This report illustrates some of the progress made in a number of countries to address these risk factors since publicationof the first Global status report on road safety (2009). Since 2008, 35 countries have passed new laws or amended existing legislationcovering one or more of these risk factors. Nevertheless, in many countries these laws are either not comprehensive in scope or arelacking altogether. Governments must do more to ensure that their national road safety laws meet best practice, and do more to enforcethese laws.Road safety was recognized in global environmental policy deliberations at the recent Rio+20 UN Conference on SustainableDevelopment. A clear link was made between road safety and sustainable development. Encouraging sustainable transport policy mustinclude making non-motorized forms of transport accessible and safe: this report shows that 27% of global road traffic deaths are amongpedestrians and cyclists. To date, these road users have been neglected in transport and planning policy. The world must now increaseits focus on making walking and cycling safer, and protecting these road users from high-speed traffic.The benefits of such a move will be far greater than purely the health benefits of reduced road traffic injuries. Benefits will includereduced air pollution and greenhouse gas emissions, reductions in traffic congestion, and the health outcomes that come from increasedphysical activity.This report shows that, with sufficient political will, road traffic deaths can be averted. In supportingthe Decade of Action for Road Safety, governments around the world have shown their politicalcommitment to make the world’s roads safer. The Decade offers a unique platform upon which toaddress this issue. The challenge is to keep this pledge and enhance the pace of change. Only thencan the goal of the Decade of Action for Road Safety be met.Dr Margaret ChanDirector-GeneralWorld Health OrganizationvSUPPORTINGADECADEOFACTION
  7. 7. AcknowledgementsThe Global status report on road safety 2013 benefited from the contributions of a number of WHO staff:Tami Toroyan coordinated and wrote the report, with data management and statistical analysis conducted by Kacem Iaych; Margie Pedenprovided strategic and technical oversight; data collection was facilitated by WHO Representatives and staff at country level; at regionallevel, trainings, data collection and validation were carried out by: Martial Missimikim and Martin Ekeke Monono (Africa); Astrid Arca,Alessandra Senisse Pajares and Eugênia Rodrigues (the Americas); Rania Saad, Hala Sakr and Hala Youssef (Eastern Mediterranean);Francesco Mitis and Dinesh Sethi (Europe); Rania Saad and Chamaiparn Santikarn (South-East Asia); and Krishnan Rajam, MayetDarang and Xiangdong Wang (Western Pacific). Other WHO staff who contributed to the development and production of the reportinclude Ala Alwan, Nicholas Banatvala, Oleg Chestnov, Manjul Joshipura, Doris Ma Fat, Evelyn Murphy, Etienne Krug, Jon Passmore,Pascale Lanvers-Casasola, Colin Mathers, Florence Rusciano and Jelica Vesic.Country level data could not have been obtained without the invaluable input of:• the National Data Coordinators (see Table A1 in the Statistical Annex);• all respondents and attendees of the consensus meetings in countries;• government officials who provided clearance of the information for inclusion in the Report.WHO also wishes to thank the following contributors whose expertise made this document possible:• Jennifer Ellis, Kelly Henning and Kelly Larson from Bloomberg Philanthropies;• Adnan Hyder, Olive Kobusingye, Junaid Razzak and David Ward, who provided expert advice and review comments;• Claudia Adriazola-Steil, Abdulgafoor Bachani, Madhav Pai, Nagi Shafik, David Ward, Esti Widiastuti,Gde Yogadhita for providing information for boxes;• Alison Harvey for preparing and checking country profiles; • Angela Burton who edited and proofread the report;• Drew Blakeman for valuable editorial input;• Graphic designers from L’IV Com Sàrl who produced the design and layout.Finally the World Health Organization wishes to thank Bloomberg Philanthropies for its generous financial support for the developmentand publication of this report.viGLOBALSTATUSREPORTONROADSAFETY,2013
  8. 8. Executive summaryRoad traffic injuries are the eighth leadingcause of death globally, and the leadingcause of death for young people aged15–29 (1, 2). More than a million peopledie each year on the world’s roads, and thecost of dealing with the consequences ofthese road traffic crashes runs to billionsof dollars (3). Current trends suggest thatby 2030 road traffic deaths will becomethe fifth leading cause of death unlessurgent action is taken (2).Strategies exist that are proven toreduce road traffic injuries and a numberof countries have successfully usedthese strategies to reduce their roadtraffic deaths. In 2004, the World HealthOrganization (WHO) and the World Banklaunched the World report on road trafficinjury prevention (4). The World reportprovides extensive information on leadingrisk factors for road traffic injuries andevidence on effective interventions, andmakes recommendations to countrieson how to improve national roadsafety. Progress in implementing therecommendations of the World report wasfirst reported in the Global status report onroad safety: time for action (2009) (5).In 2010 the United Nations GeneralAssembly unanimously adopted aresolution calling for a Decade of Actionfor Road Safety 2011–2020, and for furtherGlobal status reports on road safety tomonitor the impact of the Decade atnational and global levels. This reportbuilds on the 2009 report, and providesadditional data in a number of importantareas. It serves as the baseline formonitoring the Decade.The report shows that there has beenno overall reduction in the number ofpeople killed on the world’s roads: about1.24 million deaths occur annually.However, this plateau should be consideredin the context of a corresponding 15%global increase in the number of registeredvehicles, suggesting that interventions toimprove global road safety have mitigatedthe expected rise in the number ofdeaths. Eighty-eight countries – in whichalmost 1.6 billion people live – reducedthe number of deaths on their roadsbetween 2007 and 2010, showing thatimprovements are possible, and that manymore lives will be saved if countries takefurther action. However, of concern isthat 87 countries saw increases in thenumbers of road traffic deaths over thesame period. The report also shows thatthe highest road traffic fatality rates are inmiddle-income countries, particularly theAfrican Region. More than three-quartersof all road traffic deaths are among youngmales. The report notes the need forstandardized data collection on fatalitiesand the need for improvement in thequality of road safety data on road trafficdeaths, non-fatal injuries and disability. Italso stresses the importance of good post-crash care, both in terms of providing quickaccess for road traffic victims to healthcare, and in ensuring the quality of trainedhospital trauma care staff in mitigating thenegative outcomes associated with roadtraffic crashes.The first Global status report onroad safety highlighted the lack ofEighty-eight countries have reduced the numberof deaths on their roads – but the total number ofroad traffic deaths remains unacceptably high at1.24 million per year.viiSUPPORTINGADECADEOFACTION
  9. 9. comprehensive legislation on key riskfactors (speed, drink–driving, motorcyclehelmets, seat-belts and child restraints) forroad traffic injuries (5). Between 2008 and2011, 35 countries, representing almost10% of the world’s population, passedlaws to address one or more of thesefive key risk factors. The action taken bythese countries to implement new lawsindicates that – with country commitment– progress is possible. However, therehas been no increase in the numberof countries with adequate legislationon all five key risk factors – the 28countries (representing 7% of the world’spopulation) with comprehensive lawsremain unchanged from the last evaluationin 2009. The report also highlights thatenforcement of these laws, which iscritical to their success, is inadequate.The report serves as a strong warningto governments to address the needs ofnon-motorized road users. Twenty-sevenper cent of all road traffic deaths occuramong pedestrians and cyclists. In low-and middle-income countries, this figureis closer to a third of all road deaths, butin some countries is more than 75%. Asthe world continues to motorize, walkingand cycling need to be made safe andpromoted as healthy and less expensivemobility options. However, only 68countries have national or subnationalpolicies to promote walking and cycling,and just 79 countries have policies thatprotect pedestrians and cyclists byseparating them from motorized andhigh-speed traffic. Although governmentsincreasingly recognize the need to promotealternative forms of mobility, moreemphasis needs to be given to makingthese modes of transport safe. Addressingthe safety of pedestrians, cyclists andmotorcyclists is critical to successfullyreducing the total number of global roadtraffic deaths.The report further highlights the importantrole that road infrastructure can playin reducing injuries among all roadusers, including pedestrians, cyclistsand motorcyclists. It recommends thatgovernments implement regular roadOnly 28 countries, representing 449 million people(7% of the world’s population), have adequatelaws that address all five risk factors (speed, drink–driving, helmets, seat-belts and child restraints).viiiGLOBALSTATUSREPORTONROADSAFETY,2013
  10. 10. safety audits to assess safety levels ofboth existing and new road infrastructureprojects. The report also outlines progressthat has been made to implementminimum vehicle safety standards, andencourages governments to work withvehicle manufacturers to ensure thatever-larger proportions of their fleets meetthese standards.Real progress has been made towardsimproving road safety and saving lives,but what this report shows is that fasterand more concerted action is neededto prevent many more lives beingOver a third of road traffic deaths in low- andmiddle-income countries are among pedestriansand cyclists. However, less than 35% of low- andmiddle-income countries have policies in place toprotect these road users.needlessly lost on the world’s roads.Therefore the report makes the followingrecommendations:› Governments urgently need to passcomprehensive legislation that meetsbest practice on all key risk factorsto address this preventable cause ofdeath, injury and disability.› Governments should invest sufficientfinancial and human resources in theenforcement of these laws, as anessential component for their success.Raising public awareness can bean important strategy in increasingunderstanding of and support for suchlegislative and enforcement measures.› Concerted effort is needed tomake road infrastructure safer forpedestrians and cyclists. The needs ofthese road users must be taken intoconsideration earlier, when road safetypolicy, transport planning and landuse decisions are made. In particular,governments need to consider hownon-motorized forms of transport canbe integrated into more sustainableand safer transport systems.ixSUPPORTINGADECADEOFACTION
  11. 11. BackgroundApproximately 1.24 million people dieevery year on the world’s roads, andanother 20 to 50 million sustain non-fatal injuries as a result of road trafficcrashes. These injuries and deaths havean immeasurable impact on the familiesaffected, whose lives are often changedirrevocably by these tragedies, and on thecommunities in which these people livedand worked.Road traffic injuries are estimated to bethe eighth leading cause of death globally,with an impact similar to that caused bymany communicable diseases, such asmalaria (1). They are the leading cause ofdeath for young people aged 15–29 years,and as a result take a heavy toll on thoseentering their most productive years (2).Economically disadvantaged families arehardest hit by both direct medical costsand indirect costs such as lost wagesthat result from these injuries. At thenational level, road traffic injuries result inconsiderable financial costs, particularly todeveloping economies. Indeed, road trafficinjuries are estimated to cost low- andmiddle-income countries between 1–2 %of their gross national product, estimatedat over US$ 100 billion a year (3).Despite the enormous toll exacted byroad traffic injuries, they have for manyyears been neglected by global health anddevelopment agendas, and funding forinterventions has not been commensuratewith the scale of the problem. This isdespite the fact that road traffic injuries arelargely preventable and that the evidencebase for effective interventions is extensive.Road traffic injuries are increasing,notably in low- and middle-incomecountries, where rates are twicethose in high-income countries. This ispartly attributable to the rapid rate ofmotorization in many developing countriesthat has occurred without a concomitantinvestment in road safety strategies andland use planning. While road trafficfatality rates are decreasing in somehigh-income countries, the rapid increasein road traffic crashes in low- and middle-income countries has driven an overallglobal increase in deaths and injuries.Indeed, current trends suggest that roadtraffic injuries will become the fifth leadingcause of death by 2030, with the disparitybetween high- and low-income countriesfurther accentuated (2).Nonetheless, evidence from manycountries shows that dramatic successesin preventing road traffic injuries can beachieved through concerted efforts atnational level. A number of countries,such as Australia, Canada, France, theNetherlands, Sweden and the UnitedKingdom have achieved steady declinesin road traffic death rates throughcoordinated, multisectoral responsesto the problem. Such responses involveimplementation of a number of provenmeasures that address not only the safetyof the road user, but also vehicle safety,the road environment and post-crash care.The Decade of Action forRoad SafetyIn 2010, the United Nations GeneralAssembly adopted resolution 64/2551,which proclaimed a Decade of Actionfor Road Safety. The goal of the Decade(2011–2020) is to stabilize and reduce theincreasing trend in road traffic fatalities,saving an estimated 5 million lives overthe period (see Figure 1).1 http://www.who.int/roadsafety/about/resolutions/download/en/index.htmlFigure 1Goal of the Decade of Action for Road Safety 2011–2020Numberofdeaths(millions)2011 202020192018201720162015201420132012Year5 million lives savedProjectedreduction ifaction takenProjectedincreasewithout action2.01.81.61.41.21.00.80.60.40.201SUPPORTINGADECADEOFACTION
  12. 12. In order to guide countries on takingconcrete, national-level actions to achievethis goal, a Global Plan of Action wasdeveloped (5). This provides a practicaltool to help governments and othernational stakeholders develop national andlocal plans of action, while simultaneouslyproviding a framework for coordinatingactivities at regional and global levels.National activities are based around fivekey pillars, as indicated (Figure 2).The UN General Assembly resolutionalso called for regular monitoring ofglobal progress toward meeting targetsidentified in the Global Plan of Action.These targets are, in part, based on datahighlighted in the first Global status reporton road safety in 2009,1and to this end,the resolution calls for the publication offurther reports to provide and disseminatethis information (6). This report, the secondGlobal status report on road safety, meetsthis request and will provide the baselinedata (from 2010) for monitoring progressthrough the Decade of Action.1 The Global status report on road safety: time foraction (2009) legislation data were collected for 2008and fatality data for 2007; in both cases these werethe most recent data available. The current reportprovides legislation data updated for 2011 and fatalitydata updated for 2010. Thus comparisons on fatalitydata relate to 2007 and 2010.The purpose of this reportThe specific objectives of this secondGlobal status report on road safety are:› to describe the burden of road trafficinjuries and implementation of effectiveinterventions in all Member Statesusing a standardized methodology, andassess changes since the publication ofthe first Global status report in 2009;› to indicate gaps in road safetynationally across a number of domains(institutional management, policies,legislation, data collection) to stimulateand prioritize road safety activities;› to serve as a baseline for monitoringactivities relating to the Decade ofAction for Road Safety at national andinternational levels.MethodologyThe methodology used to generate thedata and information presented in thisreport involved collecting data fromeach country, coordinated by a NationalData Coordinator (see Statistical Annex,Table A1). Data collection in turnwas driven by a number of individualrespondents from different sectors withina country, each of whom completed aself-administered questionnaire withinformation on key variables. This groupwas then required to come to a consensuson the data that best represented theircountry, which is presented here. Moredetail on the methodology can be found onpage 42. The report highlights data from182 countries/areas, covering 6.8 billionpeople (98.6% of the world’s population).Response rates by region covered between95% of the population in the AfricanRegion, to 100% in the South-East AsiaRegion. Data collection was carried out in2011: thus, while data on legislation andpolicies relate to 2011, data on fatalitiesrelate to 2010, the most recent year forwhich data were available.Pillar 2Safer roads andmobilityPillar 3Safer vehiclesPillar 1Road safetymanagementPillar 4Safer road usersPillar 5Post-crashresponseNational activitiesFigure 2The five pillars that guide national road safety plans and activities over theDecade of Action2GLOBALSTATUSREPORTONROADSAFETY,2013
  13. 13. SECTION1The current state ofglobal road safety
  14. 14. Many countries havesuccessfully reduced thenumber of deaths on theirroads, while deaths areincreasing in othersThis report shows that there were 1.24million deaths on the world’s roads in2010,1similar to the number of deathsin 2007. This plateau in the number ofglobal road deaths needs to be viewedin the context of a corresponding 15%global increase in the number of registeredmotorized vehicles.1 These data are based on information collected inthis survey for 182 countries, and estimated whereappropriate to account for varying levels of dataquality to make data comparable across countries.Data have been extrapolated to all 195 countriesand territories in the world. Full details of themethodology used to develop comparative estimatesare explained on page 42.Although the aim of reducing the annualburden of road traffic deaths has yet tobe realized, the lack of increase suggeststhat interventions to improve global roadsafety may have mitigated deaths thatwould otherwise have occurred. Between2007 and 2010, the number of roadtraffic deaths decreased in 88 countries,suggesting that progress can be madewith sufficient national commitment. Ofthese 88 countries, 42 are high-incomecountries, 41 are middle-income, and fiveare low-income (see Figure 3).Nonetheless, there is a major, persistingconcern in the 87 countries that sawincreases in the numbers of road trafficdeaths over the same period.The number of road traffic deaths each year has notincreased – but remains unacceptably high at1.24 million per year.Middle-income countries arehardest hitThe overall global road traffic fatality rateis 18 per 100 000 population. However,middle-income countries have the highestannual road traffic fatality rates, at 20.1per 100 000, while the rate in high-incomecountries is lowest, at 8.7 per 100 000 (seeFigure 4).Eighty per cent of road traffic deathsoccur in middle-income countries, whichaccount for 72%2of the world’s population,but only 52% of the world’s registeredvehicles. This indicates that thesecountries bear a disproportionately highburden of road traffic deaths relative totheir level of motorization (see Figure 5).2 This proportion reflects the 14 countries that havemoved from low- to middle-income status since thepublication of the first Global status report on roadsafety.Figure 4Road traffic death rates per100 000 population, by countryincome statusRoadtrafficdeathsper100 000population2520151050High-incomeMiddle-incomeLow-income8.720.118.340 4020 20 6060Figure 3Countries with changes in numbers of road traffic deaths (2007–2010),by country income statusaNumber of countriesa See Table A2 in Statistical Annex for information on income-level classificationsCountries with decreasingnumbers of deathsCountries with increasingnumbers of deaths0High-incomeMiddle-incomeLow-income4GLOBALSTATUSREPORTONROADSAFETY,2013
  15. 15. Figure 5Population, road traffic deaths, and registered motorized vehiclesa, by country income status■ High-income■ Middle-income■ Low-income1%Population72% 80%52%16%12% 8%12%47%Road traffic deaths Registeredmotorized vehiclesaThe African Region has thehighest road traffic fatalityrateThere are large disparities in road trafficdeath rates between regions (see Figure 6).The risk of dying as a result of a road trafficinjury is highest in the African Region (24.1per 100 000 population), and lowest in theEuropean Region (10.3 per 100 000).There is also considerable disparity inrates between countries within the sameregion. The European Region has thehighest inequalities in road traffic fatalityrates, with low-income countries havingrates nearly three times higher thanhigh-income countries (18.6 per 100 000population compared to 6.3 per 100 000)– these are similar to rates in South EastAsia and Western Pacific Regions.a Registered vehicle data provided only for countries participating in the survey.5SUPPORTINGADECADEOFACTION
  16. 16. Half of all road traffic deathsare among pedestrians,cyclists1and motorcyclistsHalf of the world’s road traffic deaths occuramong motorcyclists (23%), pedestrians(22%) and cyclists (5%) – i.e. “vulnerableroad users” – with 31% of deaths amongcar occupants and the remaining 19%among unspecified road users.However, this global analysis maskssignificant differences regarding who ismost at risk by country income statusand by WHO region. In most low- andmiddle-income countries, a much higherproportion of road users are pedestrians,cyclists and users of motorized two- orthree-wheeled vehicles than in high-income countries. In much of the AfricanRegion, for example, walking and cyclingare important forms of mobility for alarge proportion of the population, whilein many South-East Asia and WesternPacific countries, motorcycles are used1 The term cyclist refers to users of two- or three-wheeled pedal cycles, but does not include thoseriding motorcycles or E-bikes.frequently because they are relativelyaffordable to buy and run. These differenttraffic mixes are reflected in road trafficfatality breakdowns. For example, 38% ofall African road traffic deaths occur amongpedestrians, while 36% of road trafficdeaths in the Western Pacific Region areamong motorcyclists (see Figure 7).Comparing the proportion of deathsamong different road user typesFigure 6Road traffic deaths per 100 000 population, by WHO regionRoadtrafficdeathsper100000population302520151050WesternPacificRegionSouth-EastAsiaRegionEuropeanRegionEasternMediterraneanRegionRegion ofthe AmericasAfricanRegion24.121.318.510.318.516.1between regions conceals thesubstantial range seen within regions.For example, while the Americas Regionhas the lowest proportion of vulnerableroad user deaths (41%), this figureranges from 22% in Venezuela to 75%or more in Costa Rica, Colombia and theDominican Republic.Figure 8 shows the breakdown of roadfatalities by road user type and countryFigure 7Road traffic deaths by type of road user, by WHO regionWesternPacific23%8%36%25%8%South-EastAsia33%15%4%36%12%Africa43%7%38%5%7%EasternMediterranean37%3%18%28%14%Europe27%12%7%50%4%The Americas42%15%23%3%17%■ Car occupants■ Motorized 2-3 wheelers■ Cyclists■ Pedestrians■ OtherWORLD23%31%5%19%22%6GLOBALSTATUSREPORTONROADSAFETY,2013
  17. 17. income status. Low-income countries havethe highest proportion of deaths amongvulnerable road users (pedestrians, cyclistsand motorcyclists combined) at 57%, withthis figure lower in both middle-income(51%) and high-income countries (39%).Almost 60% of road trafficdeaths are among 15–44year oldsYoung adults aged between 15 and 44years account for 59% of global roadtraffic deaths. More than three-quarters(77%) of all road traffic deaths occuramong men, with this figure highest in theWestern Pacific Region.Regional variations are evident but mostlyfollow the same pattern (see Figure 9),except in high-income countries, wherethe proportion of deaths among thoseover 70 years is noticeably greater thanin low- and middle-income countries.This difference is most likely related tolongevity in these countries, combinedwith the greater risk posed by reducedmobility and increased frailty.Non-fatal crash injuries arepoorly documentedFor every road traffic fatality, at least 20people sustain non-fatal injuries (4). Theseverity of injuries sustained ranges fromthose that can be treated immediately andfor which medical care is not needed orsought, to those that result in a permanentdisability. Reliably assessing injury severityrequires clinical experience; police in manycountries who record official informationon injuries often do not have sufficienttraining to reliably categorize injuries.Different definitions of injury severityfurther complicate reporting of injuries.Information on the extent of non-fatalinjuries is important in assessing the typeof medical care needed. Some countrieshave hospitals with injury surveillancesystems in place. Data from these systemsindicate the severity of the problem, whatstaff are required and what treatmentis provided, as well as identify primaryprevention measures that could beimplemented.Unfortunately, even in high-incomecountries, this information is rarelynational in scope because of the workloadassociated with high numbers of patientsseen in hospital emergency rooms eachday, and the complexities of accuratelycollecting this information. Consequently,many countries use systems that collectthis information from a geographicsample, and then generalize results tothe whole country (7). In most low- andmiddle-income countries, sophisticatedinjury information systems are even rarer– only 77 countries reported having anational injury surveillance system (47%of high-income and 46% of middle-incomecountries, but only 24% of low-incomecountries). The ability to accurately countthe actual number of non-fatal injuriesworldwide thus remains a challenge.Figure 9Proportion of road traffic deaths by age range and country income statusProportionofroadtrafficdeaths353025201510500—4 5—14 15—29 30—44 45—59 60—69 70+Age range (years)■ High-income■ Middle-income■ Low-income40Figure 8Proportion of road traffic deaths among road user types, by countryincome statusPercentage(%)roadtrafficdeaths706050403020100■ Car occupants■ Motorized 2-3wheelers■ Cyclists■ Pedestrians■ Other/unspecified9080100Low-income Middle-income High-income7SUPPORTINGADECADEOFACTION
  18. 18. A significant proportion of patientswho sustain a road traffic injury incurpermanent disability, through amputation,head injury or spinal cord injury. However,data on the number of people who incur apermanent disability as a result of thesecrashes is not well documented – rangingfrom <1% in some countries (e.g. Croatia,Mexico and the Russian Federation), toas high as 25% in Poland, but averagingaround 5% overall (or 1 in 20 of thoseinjured). This large range may be a resultof different definitions used and differentstudy methodologies.Documenting the number of people whoincur a non-fatal injury and/or disability asa result of a road traffic crash is important••••statistics on road traffic fatalities remaininconsistent, but there has been progress:92 countries (51%) now use a 30-dayfatality definition, an increase from the80 countries using this measure in 2008.Police are the source of official roadtraffic fatality data in 71% of countries.Data from police sources tend to havehigher levels of underreporting thanhealth sector data, particularly in low- andmiddle-income countries, because it canbe difficult for police to follow up on theoutcomes of road traffic crash victims (11).Vital registration data are generated by thehealth sector, and report officially registereddeaths and deaths for which certificatesto guide a country’s planning services, i.e.making sure that these casualties receivethe best possible care (see Boxes 1, 2) (8, 9).Harmonizing data collectionon road traffic deathsTo harmonize surveillance data of roadtraffic deaths and allow cross-countrycomparisons to be made, a 30-daydefinition is recommended for road trafficdeaths.1Definitions used for official1 A road traffic fatality should be defined as “any personkilled immediately or dying within 30 days as a resultof a road traffic accident” (10). The choice of 30 daysis based on research that shows that most peoplewho die as a result of a crash succumb to their injurieswithin 30 days of sustaining them, and that whileextension of this 30-day period results in a marginalincrease in numbers, it requires a disproportionatelylarge increase in surveillance efforts.8GLOBALSTATUSREPORTONROADSAFETY,2013
  19. 19. Figure 10Proportion of countries providing access to emergency medicaltraining for doctors and nurses, by WHO regionPercentage (%) of countries0 20 40 60 80 10010 30 50 70 90Western Pacific RegionSouth-East Asia RegionEuropean RegionEastern Mediterranean RegionRegion of the AmericasAfrican Region■ Nurses■ Doctorshave been completed by medical doctors (orwhere certificates do not exist, from verbalautopsy surveys) (13). Vital registration dataoften cover an undefined time period sothat, for example, a death that may haveoccurred as a result of a road traffic crash isrecorded as a road traffic fatality even if thedeath occurs a year or more after the crash.In general, vital registration death data aremore complete and have greater coveragethan police data. However, vital registrationdata are currently not available from anumber of countries.While the use of a 30-day definition isrecommended for police and transportdata, and allows comparisons of roadtraffic deaths to be made over time andacross countries, collecting data on roadtraffic deaths from vital registrationsystems also allows countries to compareroad traffic deaths with other causes ofdeath within their country (10,13).1Linking data sources can improve officialroad traffic fatality estimates, but thisprocess remains underused, with only 17%countries reporting the use of combined1 In this survey, reported data have been adjustedusing correction factors to bring them into line with a30-day definition, and are shown as such in StatisticalAnnex y. These figures are shown side by side withthe comparative estimates, which incorporate acountry’s vital registration data where they exist andare considered to be complete.sources for their official road traffic fatalitydata. A number of countries have takensignificant steps to improve the qualityof their road traffic fatality data. Box 3illustrates how Indonesia has taken stepsto validate police data with other sourcesand thus reduce underreporting.9SUPPORTINGADECADEOFACTION
  20. 20. Figure 11Trends in the number of road traffic deaths per year in IndonesiaNumberofdeaths35 00030 00025 00020 00015 00010 0005 00002003 2004 2005 2006 2007 2008 2009 2010 201110GLOBALSTATUSREPORTONROADSAFETY,2013
  21. 21. SECTION2NEW ROAD SAFETY LAWS:PROGRESS TO DATE
  22. 22. Encouraging a culture of safe roadbehaviour that in turn achieves sustainedreductions in road traffic injuries requirespersistent attention. Nonetheless, manycountries have, within a relatively shorttimeframe, implemented and enforcedeffective legislation to reduce speedingand drink–driving, and increase useof motorcycle helmets, seat-belts andchild restraints. Sustaining high levelsof enforcement and maintaining a highperception of enforcement among thepublic are essential to the success of suchlegislative measures (4).This report shows that road safetylegislation has been strengthened in35 countries, representing almost 10% ofthe world’s population. These countriespassed laws to address one or more keyrisk factors affecting road traffic injuriesand fatalities – speed, drink–driving,motorcycle helmet use, seat-belts, andchild restraints.While 94 countries now have nationallaws that address all five key risk factorsto some degree, there has been noincrease since the end of 2008 in thenumber of countries with comprehensivelaws covering all five risk factors: only28 countries (with just 7% of the world’spopulation) have comprehensive lawsin all five areas (see Figure 12). Of these28 countries, only four (Estonia, Finland,France and Portugal) also rate theirenforcement of these laws as “good”,1showing that much more work is needed toensure the effectiveness of these laws.1 Defined as 8 or more on a scale of 0 to 10.See Explanatory Note 2, page 45.Extending coverage of comprehensivelegislation that addresses all five key riskfactors has stalled since 2008. Unlessthe pace of change is accelerated, theUnited Nations’ General Assemblytarget of having 50% of countries withcomprehensive legislation by 2020 will notbe reached.New road safety laws have been passed in35 countries – but only 7% of the world’spopulation is covered by comprehensivelegislation for all five risk factors.Figure 12Increase in the percentage of world population covered by“comprehensive” legislation on five key road safety risk factors since 2008Percentage(%)ofworld’spopulation6050403020100Helmets Seat-belts All fiverisk factorsDrink–driving Child restraintsSpeed908070■ 2008■ 201112GLOBALSTATUSREPORTONROADSAFETY,2013
  23. 23. Progress to reduce excessivespeed has stalledSpeeding is a major road safety problemin all countries. Faster driving speedsincrease the likelihood of a crashoccurring, and the severity of the crashconsequences. Interventions to reducespeed can lead to significant reductions inroad traffic injuries. In urban areas, withhigh concentrations of pedestrians andcyclists, measures to reduce speed arecritical to the safety of these road users.Excessive speed is a worldwide problemaffecting the entire road network(motorways and highways, and ruraland urban roads). Speed limits vary byroad type and most of the best practiceidentified in this area has come fromREDUCING SPEEDhigh-income countries (4, 14). At present,even in high-performing countries, there isdiversity in speed limits used for particularroad types, but most countries follow ahierarchical approach and adopt speedlimits within the following levels:› Higher speed roads: motorways,expressways and multi-lane dividedhighways ideally ensure no contactbetween motorized and non-motorizedtraffic and have barriers to separateopposing directions of traffic. In generalthey have the lowest rates of roadinjuries because of these features. Inmost high-income countries, speedlimits are set at between 90–130 km/h.› Rural roads: single lane carriagewaysin rural areas include many differenttypes of roads, and speed limits inhigh-performing countries vary from70–100 km/h. These roads havemuch higher rates of injuries thanhigher speed roads, because of largedifferences in speed between varioustypes of user. However, the widerange of definitions used to classifyrural roads, and the fact that theirspeed needs to be adapted to differentcircumstances along the length of ruralroads, makes it difficult to comparerural road safety across countries.› Urban roads: roads in towns and citiesare usually shared by pedestrians,cyclists, users of public transport aswell as higher speed traffic. While50 km/h is considered best practicefor urban speed limits, there is much13SUPPORTINGADECADEOFACTION
  24. 24. National urban speed limits ≤50 km/h and can be modifiedNational urban speed limits ≤50 km/h and cannot be modifiedUrban speed laws at subnational levelUrban speed laws not comprehensiveData not availableNot applicableevidence to support reducing theselimits to 30 km/h as a way of trafficcalming in areas with high pedestrianconcentration. However, achieving thisrequires local authorities to have theauthority allowing them to reduce speedlimits that are set at a national level.Reducing urban speedsprotects pedestrians andcyclistsSetting speed limits according to thedesignated function of particular roads isan effective measure to reduce road trafficinjuries. A number of countries consideredleaders in road safety, such as Australiaand Sweden, have adopted universal urbanspeed limits of 50 km/h, based on theeffectiveness of this measure in reducinginjuries and deaths. Although well overhalf of all countries (114) apply this urbanspeed limit, these countries represent lessFigure 13Urban speed laws by country/areathan half (47%) of the world’s population(see Figure 13). Between 2008 and2011, six countries improved their urbanspeeding laws, protecting an additional246 million people, but more effort isneeded to encourage governments toadopt maximum urban speed limits of50 km/h.Pedestrians and cyclists are especially atrisk of an injury as a result of excessivevehicle speeds. This vulnerabilitymeans particular attention needs to bepaid to speed limits in areas with highconcentrations of these road users,such as around schools or in residentialneighbourhoods (4, 14).Traffic calming measures that reducevehicle speeds in these areas are proveneffective in reducing road traffic injuries.For example, introducing 30 km/h zonesin residential areas in the UK resultedin overall vehicle speed reductions of15 km/h and cut vehicle crashes with childpedestrians and cyclists by 67% (15).However, nearly half of all countries (82)lack enabling legislation that permitslocal authorities to modify nationalspeed limits, thus limiting the ability ofsubnational governments to implementeffective road safety measures within theirjurisdictions. This is further reflected inthe low proportion of countries (37%) thathave urban speed limits of 30 km/h or lessaround schools.Taken together, this means that just59 countries both implement nationalurban speed limits of less than or equalto 50 km/h and allow local authoritiesto further reduce these limits whereappropriate. These countries represent2.67 billion people, or just 39% of theworld’s population.14GLOBALSTATUSREPORTONROADSAFETY,2013
  25. 25. Speed limits need strongerenforcementAlthough most countries have enactednational speed limit laws, theirenforcement is often lacking: only26 countries rate enforcement of theirnational speed limits at “good” (8 or aboveon a scale of 0 to 10). Even in high-incomecountries, which tend to have more financialresources to dedicate to enforcement,speed law enforcement remains weak,with only 20% of high-income countriesreporting good enforcement. Enforcementof speed limits is essential for successfullydeveloping safer driving behaviour andneeds to be given increasing emphasis inmost countries.Only 59 countries, covering just 39% of the world’spopulation (2.67 billion people), have implementedan urban speed limit of 50 km/h or less and allowlocal authorities to reduce these limits.15SUPPORTINGADECADEOFACTION
  26. 26. Drink–drive laws shouldbe based on blood alcoholconcentration levelsDrinking and driving increases the riskof being involved in a crash, as well asthe severity of resulting injuries. Drivingstarts to be impaired at very low levelsof alcohol consumption, with the risk ofcrash involvement growing rapidly asconsumption increases. The vast majorityof adult drivers are affected or impairedwith a blood alcohol concentration (BAC)1of 0.05 g/dl, while at a BAC level of0.1 g/dl the crash risk is approximately fivetimes higher than that of someone witha BAC level of zero (16, 17). Young andnovice drivers who drink and drive have agreatly increased risk of a crash comparedto more experienced drivers (4, 18).The effects of alcohol impairment aremagnified when combined with fatigue.This explains why alcohol is considereda particular risk for commercial drivers,who spend long hours on the road andalso have legal responsibilities for thepassengers or cargo they carry.1 The amount of alcohol present in the bloodstream,usually measured in grams per decilitre (g/dl).Since 2008, 10 countries haveimproved their drink–drivinglaws to meet best practice(blood alcohol concentrationof 0.05 g/dl or less), helpingprotect 186 million people.REDUCING DRINKINGAND DRIVINGStrong drink–drive lawsprotect almost 70% ofworld’s populationA variety of BAC limits are in place acrossthe world. Setting and enforcing legislationon BAC limits of 0.05 g/dl can lead tosignificant reductions in alcohol-relatedcrashes (4, 19, 20). Since 2008, there hasbeen progress in strengthening drink–driving legislation: 89 countries, covering66% of the world’s population (4.55 billionpeople), now have a comprehensivedrink–driving law, defined as a BAC limitof 0.05 g/dl or less, which is in line withbest practice (see Figure 14). High-incomecountries are more likely to have a legalBAC limit of 0.05 g/dl or less (67%) than aremiddle- or low-income countries (49% and21%, respectively). Even in the 17 countrieswhere alcohol consumption is legallyprohibited, a drink–driving law based ona BAC of less than or equal to 0.05 g/dl isrecommended, and is already in place in anumber of countries, such as Mali, Moroccoand the United Arab Emirates. Nonetheless,there remains a need for more action in thisarea: 34 of the world’s countries either haveno drink–driving law at all, or implement alaw based on measures that are less robustthan BAC (such as assessing a person’slevel of intoxication, using clinical signs andsymptoms) (see Figure 14).More stringent drink–drivelaws for high-risk driversInexperienced young adults driving witha BAC level of 0.05 g/dl are more thantwice as likely to have a road trafficcrash than are more experienced drivers(18, 21), while commercial drivers are alsoconsidered a high-risk group for alcohol-related crashes. Setting lower BAC limits(0.02 g/dl or less) for both groups is aneffective means of reducing crashes relatedto drink–driving (19): 42 countries (23%)apply BAC limits of 0.02 g/dl or less amongyoung and novice drivers, while the figurefor commercial drivers is slightly higher, at27%. High-income countries are more likelyto have these laws in place than are low- ormiddle-income countries (see Figure 15).Drink–drive laws needstronger enforcementEnforcement of drink–driving laws hasbeen shown to be more effective when itincludes random breath tests for all drivers(not just those suspected of drinking),and when it is carried out at times andin locations when drink–driving is morelikely to occur (22, 23, 24). Such measuresthat increase drivers’ perception of thelikelihood of being apprehended are key tothe success of this intervention (22, 25).Random breath testing is used by 74%of the world’s countries to help enforcedrink–driving laws, but this figure varieswith country income status, with 88% of16GLOBALSTATUSREPORTONROADSAFETY,2013
  27. 27. high-income, 77% of middle-income, and45% of low-income countries adoptingthis practice. Despite global progress instrengthening drink–driving legislation,only 39 countries rate their enforcement as“good” (8 or above on a scale of 0 to 10),indicating that better implementation ofthese laws needs urgent attention.Almost half of all countrieslack data on alcohol-relatedroad traffic deathsAssessing the contribution of drink–drivingto road traffic crashes in a country is animportant tool in designing and targetingdrink–driving prevention work. However,Figure 15Proportion of countries with lower blood alcohol concentration (BAC) limitsfor high-risk groups of driversPercentage(%)ofcountries302520151050454035High-income Middle-income Low-income50■ BAC young/novice ≤0.02 g/dl■ BAC commercial ≤0.02 g/dlin many countries this information isunavailable or unreliable. Where data arecollected, different methodologies areused. For example, some countries testall drivers killed in a road traffic crashfor blood alcohol, while others test asample from particular hospitals whichmay include those both injured and killed.These variations can both distort alcohol-related figures and make comparing thisinformation across countries problematic.Testing all fatally injured drivers for bloodalcohol levels is considered best practice,but this occurs in only 73 countries. Just52% of countries surveyed could providesome data on alcohol-related fatal roadcrashes.Blood alcohol concentration ≤0.05 g/dlAlcohol consumption legally prohibitedBlood alcohol concentration >0.05 g/dlNo drink-drive law/not based on blood alcohol concentrationDrink-drive law at subnational level Data not availableNot applicableFigure 14Drink–drive laws, by country/area17SUPPORTINGADECADEOFACTION
  28. 28. Head injuries amongmotorcyclists are a growingconcernRapid growth in the use of motorized two-wheeled vehicles in many countries hasbeen accompanied by increases in injuriesand fatalities among their users (26).Motorcyclists comprise a third of all roadtraffic deaths in the South-East Asia andWestern Pacific Regions, but are alsoincreasingly represented among deaths inAfrica and the Americas, which are seeingrapid increases in motorcycle use. Headand neck injuries are the main cause ofsevere injury, disability and death amongmotorcycle users. In European countries,head injuries contribute to approximately75% of deaths among motorcycle users; insome low- and middle-income countries,head injuries are estimated to account forup to 88% of such fatalities. Wearing astandard, good quality motorcycle helmetcan reduce the risk of death by 40% andthe risk of serious injury by over 70% (27).Introducing and enforcing legislationon helmet use is effective at increasinghelmet-wearing rates and reducing headinjuries (28, 29).More effort is needed topromote helmet standardsand qualityAbout half of all participating countries(98) apply a helmet standard. Helmetsmust meet recognized safety standardswith proven effectiveness in reducinghead injuries to reduce the impact ofroad traffic crashes. While there are anumber of internationally recognizedstandards, it is important that aparticular government’s helmet standardis suitable for the traffic and weatherconditions of the country, and is bothaffordable and available to users (26).Furthermore, governments need to ensurethat mandatory helmet laws are linkedto the helmet standard used, whetheran international or country-specificstandard. In this way, use of substandardhelmets can be a violation of the law,and thereby incur penalties that will actas a deterrent. As illustrated in the VietNam case study (see Box 5), enforcinghelmet standards can be complicated,and countries need to provide training toenforcement officers on how to identifysubstandard helmets.90 countries, representing 77% of the world’spopulation, have a comprehensive helmet lawcovering all riders, all roads and all engine types,and apply a helmet standard.INCREASING MOTORCYCLEHELMET USEProgress has been made in the number ofcountries whose helmet laws apply bothto motorcycle drivers and passengers, onall road types and regardless of enginetype. This figure has risen from 131countries in 2008 to 155 countries in 2011(covering 88% of the world’s population).High-income countries are more likelyto have enacted comprehensive helmetlaws than are middle- and low-incomecountries. To effectively reduce the headinjuries associated with motorcycleuse, countries need to review theirhelmet legislation and tighten provisionsthat limit the coverage and potentialeffectiveness of such laws, so that allthose using motorcycles are protected bythe use of a helmet, at all times, on allroads and on all engine types.To be effective, helmet legislation needsto be supported by strong enforcementand social marketing campaigns (30) (seeBox 4). While there has been progressin adopting helmet legislation globally,only about one-third of countries rateenforcement of helmet laws as “good”(8 or above on a scale of 0 to 10), showingthat this critical component of road trafficsafety remains neglected.18GLOBALSTATUSREPORTONROADSAFETY,2013
  29. 29. “Protect yourself from heftyfines and serious headinjuries. Wear a helmet.”19SUPPORTINGADECADEOFACTION
  30. 30. Taken together, this means that 90countries meet both the criteria consideredhere as essential for comprehensivehelmet legislation to be met, that is, theyhave implemented a helmet law thatcovers all road users, all road types andall engine types, and they apply a nationalor international helmet standard. In theWestern Pacific and South East Asiaregions, which have the highest proportionof motorcyclist deaths, the proportion ofcountries covered by such laws is 56% and64% respectively.Data on helmet wearing isweakCountries need to implement measuresto periodically assess helmet wearingrates, to target efforts and resourceseffectively, and to evaluate the effects ofhelmet programmes, including the impactof mandatory helmet legislation. In mostcountries, these data come from periodicobservational studies conducted accordingto an acceptable study design that ensuresthe reliability and validity of results.Only 69 countries have any type of dataon rates of helmet wearing, either ondrivers, passengers or both, with wearingrates ranging from under 10% in Ghanaand Jamaica to almost 100% in theNetherlands and Switzerland. In particular,there is a lack of data on helmet-wearingrates from low-income countries inthe African, Eastern Mediterraneanand Western Pacific regions. Given theincreasingly high proportion of motorcycledeaths globally, governments need tosupport data collection efforts that providegood estimates of helmet wearing rates ona regular basis in their countries.Comprehensive helmet law and standardComprehensive helmet law but no/unknown standardHelmet law at subnational levelHelmet law not comprehensiveData not availableNot applicableFigure 16Motorcycle helmet laws and helmet standards, by country/area20GLOBALSTATUSREPORTONROADSAFETY,2013
  31. 31. 21SUPPORTINGADECADEOFACTION
  32. 32. Seat-belts reduce the risk of a fatal injury by up to50% for front seat occupants, and up to 75% forrear seat occupants.Progress has been made intightening up seat-belt lawsFailure to use a seat-belt is a major riskfactor for road traffic injuries and deathsamong vehicle occupants. When a motorvehicle crash occurs, a car occupantwithout a seat-belt will continue to moveforward at the same speed at which thevehicle was travelling before the collisionand will be catapulted forward into thestructure of the vehicle – most likely intoINCREASINGSEAT-BELT USEthe steering wheel column if driving, thedashboard if a front seat passenger, orthe back of the front seats if a rear seatpassenger (31, 32, 33). Alternatively,failure to use a seat-belt can cause driversor passengers to be completely ejectedfrom the vehicle, greatly increasing the riskof serious injury or death (4, 20, 34).Wearing a seat-belt reduces the riskof a fatal injury by 40–50% for driversand front seat occupants, and between25–75% for rear seat occupants (20, 35).Seat-belt wearing rates vary greatlybetween countries, and to a large extentare governed by the existence andenforcement of mandatory seat-belt laws.In many countries, drivers and front seatpassengers are legally obliged to use seat-belts, but this does not always apply torear seat occupants.While the vast majority of countries havelegislation on mandatory seat-belt use, aNational seat-belt law applies to all occupantsSeat-belt law at subnational levelNo seat-belt law or law does not apply to all occupantsData not availableNot applicableFigure 17Seat-belt laws, by country/area22GLOBALSTATUSREPORTONROADSAFETY,2013
  33. 33. number of countries do not apply theselaws to both front and rear seat occupants.Comprehensive seat-belt laws covering alloccupants are in place in 111 countries,meaning 69% of the world’s population(4.8 billion people) are fully protected bythese laws (see Figure 17). Ten countries,covering 182 million people, put in placecomprehensive seat-belt laws since 2008.But more needs to be done to convincepolitical leaders and police authorities thatseat-belt use can save lives, and to work tostrengthen seat-belt legislation in line withbest practice (see Box 6).Enforcing seat-belt lawsneeds more emphasisTo effectively increase seat-belt wearingrates, governments need to supportProgress has been made to protect rear-seatcar occupants through implementation ofcomprehensive seat-belt laws: 111 countries(69% of the world’s population) now havecomprehensive seat-belt laws covering all occupants.legislation with strong and sustainedpolice enforcement. Despite improvementsin seat-belt legislation in many countries,much more is needed to improveenforcement: only a quarter of all countriesrate their seat-belt enforcement as “good”(8 or above, on a scale of 0 to 10), showingthat improved enforcement and publicawareness campaigns on seat-belt useare needed to increase compliance withlegislation.Only half of countries collectseat-belt wearing dataCollecting information on seat-beltwearing rates is an important mechanismfor countries to target resources andevaluate the effectiveness of seat-beltprogrammes. The ability to show anincrease in seat-belt use is important tosustain political and community supportfor enforcement measures.Just under half of all countries havedata on seat-belt wearing rates, withthis number disproportionately lower inlow- and middle-income countries (6%and 43%, respectively) compared tohigh-income countries (80%). Data thatare disaggregated to show wearing ratesamong rear seat occupants separatelyfrom front seat occupants are useful fortargeting programmes aimed at increasingrates among rear seat passengers.23SUPPORTINGADECADEOFACTION
  34. 34. “Seat-belt wearing ismandatory by law. There isno exemption for anybody,including me.”Governor of AfyonkarahisarFigure 18Proportion of all occupants wearing seat-belts inAfyonkarahisar, TurkeyProportionofalloccupantswearingseat-belts6050403020100Nov2010Apr2011Jul2011Nov2011May2012Oct2012Governor issued a decreeencouraging all occupantsto wear seat-belts24GLOBALSTATUSREPORTONROADSAFETY,2013
  35. 35. More thanhalf of allcountries haveimplemented achild restraintlaw, but theserepresentjust 32% ofthe world’spopulation.More countries need toadopt child restraint lawsChild restraint systems protect infantsand young children from injury during acrash. Infants and children need childrestraint systems that can accommodatetheir size and weight, and that can adaptto different stages of their development.Child restraints reduce the likelihood of afatal crash by approximately 70% amonginfants and between 54% and 80% amongyoung children (20, 36).Child restraints are not automaticallyinstalled in vehicles – unlike seat-belts –and must be purchased and fitted byparents. This makes it more challengingto achieve high usage rates, especiallyin low- and middle-income countries.Appropriate child restraint use maybe limited by access and cost, or beimpractical because of large familysize. In addition, parents must make anumber of decisions about what typeof child restraint to choose, where toplace it and how to install it, which canalso limit uptake. A lack of awarenessabout the benefits of appropriate andcorrectly used restraints can restricttheir effectiveness too.Over the past decade, vehicle safetytechnology has made an importantcontribution in improving correctinstallation of child restraints. In particular,to make the fitting of child restraints incars both simpler and more secure, theISOFIX system of child restraints usesplug-in attachments rather than adult beltsto secure the seat (37, 38).1This requiressockets in vehicles and specially designed1 ISOFIX (International Organisation forStandardisation), 1999.seats, which is becoming standard invehicle design across industrializedcountries and has been an importantfactor in contributing to improved crashperformance of cars (see Box 10, page 35).Ninety-six countries have a law requiringchild restraints. The majority of high-income countries have child restraintlaws in place, while such laws are farless common in low- and middle-incomecountries (see Figure 21). Most of the51 European countries have enacted childrestraint laws, but only one of 11 South-East Asia countries has passed such alaw. Seven countries have passed a childrestraint law since 2008.Enforcement of child restraint laws remainslow in most countries: only 17 countries(9%) rate their enforcement of childINCREASING THE USE OFCHILD RESTRAINTSFigure 19Proportion of countries with child restraint laws and good enforcement,by country income statusProportionofcountries(%);[numberofcountries]7060504030201009080100a <8 on a scale of 0 to 10, or no answer as reported by countries, see Explanatory note 2, page 46.High-income Middle-income Low-income■ % Countries with no lawor no data■ % Countries with law butinadequate enforcementa■ % Countries with law andgood enforcement[6][12][31][57][5][38][23][10]25SUPPORTINGADECADEOFACTION
  36. 36. restraint laws as “good” (8 or above ona scale of 0 to 10). Even in high-incomecountries, enforcement of child restraintlaws is lacking, with just 12 countries (24%)rating enforcement of their laws as good(see Figure 20).Encouraging child restraintuseIncreasing the use of child restraintscalls for adoption and enforcement ofspecific legislation mandating restraintsappropriate for different age groups, aswell as efforts to raise public awarenessabout risks associated with non-use ofrestraints. However, given that cost andaccessibility can limit child restraintuse, governments need to explore waysto feasibly encourage uptake. Theseare particularly important in low- andmiddle-income countries, and may includemechanisms such as loan schemes, orthe subsidized distribution of restraints inmaternity wards.Governments need to take steps towards:› adopting and enforcing specificlegislation relating to restraintsappropriate for different age groups;› raising public awareness about the risksassociated with non-use of restraints;› exploring mechanisms to encourageuptake of child restraints, given issuesof cost and accessibility particularly inlow- and middle-income countries;› encouraging marketing of childrestraints by vehicle manufacturers andretailers;› collecting data on the extent of use ofdifferent types of child restraints.National child restraint lawChild restraint law at subnational levelNo child restraint lawData not availableNot applicableFigure 20Child restraint law, by country/areaThe majority of high-income countries (88%) havechild-restraint laws in place, while such laws are farless common in low- and middle-incomecountries (30% and 43%, respectively).26GLOBALSTATUSREPORTONROADSAFETY,2013
  37. 37. Involving multiple sectors innational road safety effortsis criticalCountries need a lead agency for roadsafety, which should have the authorityto make decisions, manage resourcesand coordinate efforts of all participatinggovernmental sectors, including thoseof health, transport, education and lawenforcement. Lead agencies may take theform of a designated stand-alone bureau,or a committee or cabinet representingseveral different government agencies (4).One hundred and sixty-two countries(89%) have a lead agency for road safety,of which 122 are funded. Most of theselead agencies (81%) fulfill coordinationfunctions, while 80% fulfill legislativefunctions and 71% are involved inestablishing data systems to monitor roadsafety and disseminate national statistics.National road safetystrategies should includetargets to minimize injuries,deaths and key risk factorsThe development of a national roadsafety strategy with precise targetsand funding for implementation is akey element of sustained road trafficinjury prevention efforts. Each countryshould have a road safety strategythat is multisectoral – involvingagencies concerned with transport,health, law enforcement, educationand other relevant sectors – andalso multidisciplinary, involving bothgovernment and nongovernmentstakeholders. Currently, 139 countrieshave a single or multiple nationalstrategies on road safety. Governmentsalso need to ensure sufficient resourcesto effectively develop, implement andmonitor activities included in theirnational strategies: of 139 countries withnational strategies, 119 are partially orfully funded.Setting targets to improve and assessroad safety performance has becomeincreasingly important in a number ofhigh-income countries (39). Targets thatare realistic, attainable and time-boundcan motivate stakeholders and hold roadsafety leaders accountable for achievingdefined results (40). While 112 countries(62%) include fatality targets in theirnational strategies, only 62 countries (34%)include targets on non-fatal injuries – inpart due to the difficulty in defining andcounting non-fatal injuries (see Section 1,page 7). Governments should also includetargets on intermediate outcomes in theirstrategies (e.g. increases in helmet wearing,reductions in drink–driving) (40, 41): only athird of countries have data on all five keyrisk factors. Setting interim targets can bevery helpful in obtaining and sustainingcommunity and political support forlonger-term road safety measures as wellas in identifying emerging issues (seeBox 7), but requires that countries haveand can continue to collect data on theinterim measures.LEAD AGENCIES ARE VITAL TO DEVELOPINGA NATIONAL ROAD SAFETY STRATEGY©photocredit27SUPPORTINGADECADEOFACTION
  38. 38. 28GLOBALSTATUSREPORTONROADSAFETY,2013
  39. 39. SECTION3Transport policiesneglect pedestriansand cyclists
  40. 40. Governments need to makewalking and cycling safeRapid economic development in many low-and middle-income countries has led toincreased motorization. Since 2007, therehas been a 15% worldwide increase in thenumber of motorized vehicles. Globally,there are now more than 1.6 billionregistered vehicles – 47% of which arein high-income countries, 52% in middle-income countries and 1% in low-incomecountries (see page 5). Middle-incomecountries are motorizing most rapidly andnow have more than half of the world’sregistered vehicles, compared with 39%just three years ago. With increases inmotorization, governments must balancetheir desire for increasing mobility withensuring the safety of road users inside –as well as outside – motorized vehicles.The increasing number of motorizedvehicles makes roads more dangerousfor those road users who use alternativemodes of transport – notably thosewho walk, cycle and use motorcycles.In planning road construction projects,there has been insufficient attention givento preventing the negative effects ofmotorization from falling most heavily onthese road users most at risk. For example,new multi-lane roads are often built to cutthrough communities without provision ofsafe routes and crossings for pedestrians,slowing traffic speeds, or dedicated lanesfor cyclists (45).In the context of rapid global motorization,governments must work to increase safety andmobility for all road users, especially thosemost at risk.In a number of countries, there is agrowing policy interest in encouraging abetter balance between private motorizedtransport and non-motorized transport.While such policies may be national, theyare usually implemented at the subnationalor municipal level. For example, somecountries have national transport policiesthat aim to reduce traffic volume in urbanareas by promoting walking and cycling,which mitigates congestion and thusimproves mobility (see Box 8).Policies to encourage walking and cyclingneed additional criteria to ensure thesafety of these road users. Encouragingchildren to walk to school without providingpavements or safe places to cross the road,or reducing the speed of traffic, could infact lead to increased injuries. Promotingcity cycling to reduce congestion cannotbe encouraged if cyclists repeatedly findthat their lanes cut across oncoming traffic.Measures to separate walkers and cyclistsfrom other road users in conjunction withspeed management interventions areparticularly important if such policies are tobe successful.There has been some progress inimplementing national or subnationalpolicies to promote walking and cycling,with 68 countries having such policies(compared to 57 in 2008). However, only79 countries have policies to protectvulnerable road users by physicallyseparating them from high-speed roadusers.1As a result, many countriesattempting to encourage walking andcycling as viable alternatives to motorizedtransport do not have infrastructurepolicies in place to ensure that walkingand cycling are safe, and could potentiallyincrease risks for road traffic injuries (seeFigure 21).Infrastructure measures separatingroad users are also important to protectmotorcyclists and are thus highly relevantto many low- and middle-incomecountries with high proportions of deathsamong these road users. For example, athird of road traffic deaths in the WesternPacific Region occur among motorcycleusers, yet only 36% of this region’sMember States have policies in place toprotect motorcyclists by separating themfrom high-speed traffic.Countries that can effectively reduceprivate motorized vehicle use, increase theappeal of walking and cycling and makeassociated infrastructure improvements toprotect pedestrians and cyclists can reducethe risk of road traffic injuries. Additionalco-benefits can also result from suchpolicies, including reduced air pollutionand greenhouse gas emissions, reductionsin traffic congestion, and beneficial healthoutcomes associated with increasedphysical activity from walking and cycling.1 Such measures include pedestrian lanes that have aprotective barrier beside them, and lanes for cyclists,but may also include separate lanes that keepmotorcycles away from high-speed traffic. As suchthey can impact all three types of vulnerable roaduser.30GLOBALSTATUSREPORTONROADSAFETY,2013
  41. 41. ••••••••••31SUPPORTINGADECADEOFACTION
  42. 42. Safer roads reduce crashlikelihood and severityRoad infrastructure projects are generallyassociated with increasing the mobilityof motorized vehicles. However, ensuringimplementation of a number of safetymeasures when road infrastructureprojects are designed – and facilitatingtheir implementation during constructionwith earmarked funding – can produceimportant safety gains for all road users.This is particularly true when roaddesign, construction and maintenanceare underpinned by a Safe Systemapproach, i.e. where allowances aremade that can help compensate forhuman error, and roads and roadsidesare built in such a way that their physicalcharacteristics minimize potential harmfulconsequences to all (40). This couldinclude incorporating speed managementmeasures in road infrastructure projects,such as traffic calming intended to limitthe impact of a crash.Road engineering and design can alsoinfluence the risk of crash involvementand the severity of crashes that do occur.The design of new road constructionprojects should be checked to ensure thatimplementation will meet safety standardsand to see if further design changescould prevent crashes. Already, 140countries (77%) carry out some type of roadsafety audit on new road infrastructureprojects. Existing road infrastructure shouldalso be assessed for safety at regularintervals, with a focus on roads with thehighest crash risk. An essential elementof the road safety audit process is thatit should be carried out separately by anindependent authority (i.e. separate fromthe road designer or construction company),so that there is no conflict of interest. Mostcountries (78%) carry out inspections onexisting infrastructure projects (either onall or parts of their networks), but only halfof these have assessments carried outby agencies independent from the bodiesinvolved in the construction.More needs to be done by governmentsto make their road infrastructures safer.Only 63 countries meet all three criteriaspecified here – that is, they carry outroad safety inspections on all new roadinfrastructure projects as well as onexisting road infrastructure projects,and they ensure that assessments areconducted by independent assessors.Best practice road safety audits includean assessment of safety for all roadusers, including pedestrians, cyclists andmotorcyclists. Crash risks for all vulnerableroad users (pedestrians, cyclists andmotorcyclists) should be reflected in roadsafety audit and assessment results.For example, the International RoadAssessment Programme (iRAP) safetyassessments use their road inspectiondata to provide star ratings for roads,with five-star roads indicating the highestperformance and lowest risk for injury.1Star ratings are provided for vehicleoccupants, motorcyclists, pedestrians1 http://www.irap.net/about-irap-2/star-ratings32GLOBALSTATUSREPORTONROADSAFETY,2013
  43. 43. and cyclists, while countries’ roads areassessed for the percentage that meetcertain star ratings for each type of roaduser. Data from low- and middle-incomecountries included in these assessmentsshow that about half the roads assessedin these countries are rated in the highestrisk categories (i.e. one or two stars),largely attributable to the fact that 84% ofthe roads assessed where pedestrians arepresent have no footpaths.Public transport can makemobility safer and reducecongestionSafe public transport systems areincreasingly viewed as important toimproving mobility safety, particularlyin urban areas with increasing trafficcongestion. In many high-income cities,there has been strong political emphasison decreasing individual car use throughinvestments in public transport systems(see Box 9). Investing in safe publictransport is also seen as a mechanism toencourage increased physical activity andthus promote health. However, a criticalissue associated with promoting suchmeasures is the need to ensure that thesemodes of transport are safe.Over 100 countries have national orsubnational policies to invest in publictransport (see Figure 21), althoughthe safety of public transport systemswas not evaluated. Public transport isconsiderably safer than private car travelin most high-income countries, but in manylow- and middle-income countries withrapidly developing economies, growth inunregulated and unsafe public transporthas led to increases in road traffic injuriesamong public transport users. Governmentsmust ensure that public transport systemsare safe, accessible and affordable. Inthis way reductions in congestion andimprovements in mobility can be achievedconcurrently with improvements in safety.Such a comprehensive approach isillustrated in a case study on Ahmedabad,India (see Box 9).Action is needed to makevehicles safer for non-carroad usersVehicle safety standards are one meansof protecting those outside the vehicle.However, until recently, most emphasisin vehicle safety has been on protectingthose within the vehicles (see Box 10).Since the late 1970s, crash engineershave known that, in addition to reducingvehicle speeds, changing the shapeand stiffness of vehicle fronts wouldsignificantly reduce the severity ofinjuries sustained by pedestrians, cyclistsand motorcyclists when hit by a vehicle.Now there is a global standard forpedestrian safety, as well as innovativetechnologies such as bonnet airbagsand crash avoidance systems (e.g.autonomous emergency braking) thatoffer the prospect of improved safety forvulnerable road users.Figure 21Proportion of countries with policies to encourage non-motorized modesof transport, by WHO regionPercentage(%)ofcountries706050403020100AfricanRegion8090WesternPacificRegionRegion ofthe AmericasEasternMediterraneanRegionEuropeanRegionSouth-EastAsiaRegion■ Policy to promotewalking and cycling■ Policy to promoteinvestment in publictransport■ Policy to separatevulnerable road usersfrom high-speed traffic33SUPPORTINGADECADEOFACTION
  44. 44. 34GLOBALSTATUSREPORTONROADSAFETY,2013
  45. 45. 35SUPPORTINGADECADEOFACTION
  46. 46. 36GLOBALSTATUSREPORTONROADSAFETY,2013
  47. 47. Conclusions andrecommendationsThis report shows that road traffic injuriesremain a critical public health concern, asapproximately 1.24 million deaths occurredon the world’s roads in 2010. However,it also illustrates the progress manycountries have made to reduce road trafficdeaths. This has occurred where politicalwill has been translated into concertedand coordinated multisectoral actions thatare based on evidence. But more action isneeded, particularly in the following areas:› The pace of legislative change istoo slow Countries need to increase adoptionof comprehensive legislation relatingto key risk factors for road trafficchange needs to rapidly accelerateif the target of the United NationsGeneral Assembly resolution is to bemet (i.e. 50% of countries to havecomprehensive legislation on key riskfactors by 2020).› Enforcement of strong road safetylaws is essential for success Sufficient resources need to beprovided to support enforcement ofroad safety laws to realize their fullbenefit: currently enforcement of lawsrelating to key risk factors is consideredpoor in most countries. The use ofstrong social marketing campaigns canplay an important role in increasinginjuries. There are minimum elementsneeded in national laws related to thekey risk factors (speed, drink–driving,motorcycle helmets, seat-belts andchild restraints), and these should berolled out in all countries. In addition,experience from high-performingcountries has demonstrated that acontinual process of legislative reviewto further strengthen laws can lead toadditional benefits. Between 2008 and2011, 35 countries adopted new lawsto address key risk factors, showingthat concrete progress can be made.However, only 15% of all countriescurrently have comprehensive laws inall five areas: the pace of legislative37SUPPORTINGADECADEOFACTION
  48. 48. public understanding of and support forlegislative measures.› Reducing road traffic deathsrequires more consideration of theneeds of pedestrians, cyclists, andmotorcyclists Reducing the total number ofglobal road traffic deaths requiresthat increased attention be paid toimproving the safety of pedestrians,cyclists and motorcyclists. Half of allroad traffic deaths occur among theseroad users, and yet less than onethird of all countries have put in placemeasures to promote forms of non-motorized transport that will be safe forthose using them. Governments mustactively address the safety and mobilityneeds of these more vulnerable roadusers, and consider how non-motorizedforms of transport can be safelyintegrated into more sustainable andsafer transport systems.In addition, there are a number of otherareas that governments need to address toensure the implementation of the Globalplan of Action for the Decade of Action forRoad Safety. These include making roadinfrastructure safer, intensifying work toimprove the proportion of vehicle fleetsthat meet international crash testingstandards, and improving post-crashcare. The recommendations outlined inthe Global plan of Action could serve asa basis for discussion and agreement onofficially endorsed targets and indicatorson these areas, which will assist with bothimplementation and future monitoring.The report has also highlighted the needfor continued efforts to be made towardimproving the quality of data on roadtraffic deaths, injuries, and on interimindicators. Coordination of these multipleefforts by a well-resourced lead agencyis recommended, such that activitiesare detailed in a multisectoral nationalstrategy that includes specific targets toallow accurate monitoring and evaluationof outcomes and outputs.The decision to proclaim a Decade ofAction for Road Safety was adoptedunanimously at the UN General Assemblyin 2010. While much progress has beenmade in improving road safety in a numberof countries, considerable work will beneeded for the goals and objectives ofthe Decade of Action to be realized.There is a strong evidence base onwhat interventions work – governmentaction is now the key to ensure theirimplementation.38GLOBALSTATUSREPORTONROADSAFETY,2013
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