1. Road-TrafficDeaths in Brazil: A Burden on Public Health
Issue
Road-traffic deaths are among the top 10 causes of death in the world, coming in
at number nine, with more than 1.27 million mortalities around the world, each year
(Chandran, 2012). While it is a major public health challenge and developmental crisis,
it often goes neglected compared to other public health concerns (WHO, 2004). To put
it in perspective, road-traffic deaths and injuries have a comparable ‘burden of disease’
to malaria and TB, and while they have been included in the Millennium Development
Goals, road-traffic deaths have not been (Global Road Safety). Although road systems
are something that is used every day by many people, they can be dangerous and not as
easily navigated as one would think. This is especially true in countries that do not have
well-structured road systems and are lacking in road safety laws, which tend to be low
to middle income countries.
Over 90 percent of road-traffic deaths and over 92 percent of road-traffic crash
associated disability-adjusted life years (DALYs) occur in low to middle income countries
even though these countries have only 48 percent of the world’s registered vehicles
(Chandran, 2012). One of these countries experiencing high rates of road-traffic deaths
is Brazil, an upper middle-income country (World Bank). In Brazil, road-traffic deaths
rank eighth out of the top 50 causes of death with 42,071 mortalities in 2010 (World
Health Rankings). There are several underlying issues of road-traffic deaths that Brazil
faces. Some of the major problems are drink-driving (more commonly known in the
United States as drunk-driving), motorcyclists, and pedestrian safety. Efforts are

2. currently being employed by WHO and other global organizations to address this large,
although preventable, public health burden on the people of Brazil.
Burdenon Health
The burden of road traffic fatalities in Brazil has quite a history, first being
researched in the 1970’s (Reichenheim, 2011). Mortality rates peaked by 1996 and
1997 with 28.1 deaths per 100,000 people in the population. By the very next year,
1998, Brazil saw a significant decrease, down to 23 deaths per 100,000 inhabitants. This
could possibly be attributed to the enactment of the Brazilian Traffic Code that year,
which included stricter enforcement of seatbelt use, drinking and driving laws, and
severe sanctions for offending drivers (Reichenheim, 2011). Over the next decade, rates
stayed in the low twenties, although steadily rose from 2000-2008, reaching
20.7/100,000 in 2008, or 39,211 deaths (Chandran, 2012). The latest numbers coming
from the Brazil Ministry of Health (2008) DATASUS indicates that the number of deaths
from road traffic crashes has increased to 43,908, representing 3.86% of deaths in the
country (Andrade, 2014).
There are certain populations being more affected than others concerning road
traffic deaths in Brazil. Vulnerable road users (VRUs) are defined as slow-moving
exposed/unprotected road users that are at a higher risk of injury when involved in a
crash (Chandran, 2012). The people included in this category are pedestrians,
motocyclists, and bicyclists. In 2008, VRU fatalities made up 51 percent of all road
traffic deaths, with an equal distribution between pedestrian and motorcycle occupant
fatalities (Chandran, 2012). Pedestrian mortalities totaled to 9,474 resulting in a rate of

3. 5.0/100,000. The elderly (80+) group was greatly affected compared to other age
groups and males were more affected than females, in any other age group. In 2008,
motorcycle fatalities totaled nearly 9,000 deaths, with substantially increasing rates
from the last decade (Chandran, 2012). People in the age group 20-29 years old are the
most affected, with a huge percentage of motorcycle deaths occurring in males (89.6%).
Again in 2008, bicycle fatalities totaled over 1,600 deaths, with the highest number
happening in the 40-49 year old age group (Chandran, 2012). While the rate per
100,000 in the population is not nearly as high as the other VRUs, it has been shown to
be increasing.
While not country specific, the WHO put out a world report on road traffic and
injury prevention, highlighting that in 2002, an estimated 38.4 million DALYs (disability-
adjusted life years) were lost because of road crashes, or 2.6% of all DALYs lost (WHO,
2004). They also projected that from 1999 to 2020, road traffic injuries will rise to
become the third leading cause of DALYs lost, globally. The reason that there isn’t
specific data on DALYs in Brazil might be that their reporting systems are somewhat
lacking in thoroughness and completeness, and that the proper coding for isn’t always
used in injuries or deaths from traffic-related events.
Context
Many different factors come into play when analyzing the underlying causes for
such high mortality rates from road-traffic deaths in Brazil. A place to start is the human
factor; the choices people make as well as their behaviors have an impact on those
around them. Driving under the conditions of being stressed, fatigued, or drowsy can

4. impact one’s mental clarity and their ability to focus on the road. For example, in taxi,
lorry, bus, and ambulance drivers, long, exhausting hours of work can lead to a form of
impaired driving, which could result in more accidents and therefore more fatalities
(Reichenheim, 2011). There is also the major issue of drinking and driving. Brazil is
known for their carnival festival and heavy partying. This includes alcohol being widely
available and for cheap. Combine this with the relaxed attitude about drinking and
driving, especially around the time of carnival and we see some of the highest recorded
levels of road injuries and accidents (Reichenheim, 2011). Another facet of this is the
lack of enforcement of existing laws. What has been done to address these issues will
be discussed in the next section.
There are also the roadways themselves that have an impact on higher rates of
road traffic injuries and deaths in Brazil. Some of the road conditions common in Brazil
include deficient traffic signs and poor road maintenance, bad or non-existent lighting,
poor maintenance of the road surface, lack of highway shoulders, and inadequate
inclines, embankments, and curves (Reichenheim, 2011). In addition, there are also
vehicle-related factors such as not getting maintenance done and poor safety design
that could contribute to road traffic deaths. Another aspect to consider is the differing
regions of Brazil. In more populated regions there are more cars and perhaps more
drinking and driving which could lead to higher numbers of death, however in the more
rural regions numbers are highest, possibly due to the increase in new introduction of
cars and worse-off road conditions.

5. Brazil’s high rate of road traffic accidents and deaths has had a significant impact
on their economy. Not even taking into account the impacts of human misery,
disability, and death, road traffic collisions alone have cost Brazil close to US$32 billion a
year, according to the Institute of Applied Economic Research. In 2006, they found that
in urban areas alone, the total annual cost of traffic-related injuries was about US$9.9
billion, or the equivalent of 1.2% of Brazil’s gross domestic product that year. This total
looked at federal highways, state highways, and municipal roadways, and the
percentage of costs between lost productivity and patient treatment from the traffic-
related injuries.
Solutions
With road-traffic deaths being such a preventable issue, and with Brazil receiving
much attention from their high rates, much has been done to slow and decrease the
number of fatalities. Many organizations have stepped in and stepped up, including the
Brazilian government itself, to take action against this public health issue. In 2008, the
government pushed through legislation called the Lei Seca (Dry Law), which makes it a
criminal offense to drive with a blood-alcohol concentration of 6 decigrams per litre or
higher (WHO, 2011). The consequences for breaking the law are six months to three
years imprisonment, in addition to fines and driving bans. Even then, the Brazilian
government wanted to set even more of an example by calling for a zero tolerance,
meaning a blood-alcohol concentration of 0.0. While it was meant to send a powerful
message, it wasn’t realistic to enforce, as there are other reasons why someone may
test for alcohol in their blood, such as the alcohol in mouthwash. While all of Brazil’s

6. jurisdictions embraced the law, only two, Rio de Janeiro and the federal capital Brasília,
have really enforced it (WHO, 2011). Since the implementation of the law, the state of
Rio de Janiero saw a 32 percent decline in road-traffic deaths compared to 6.2%
reduction in states where there hasn’t been as much enforcement (WHO, 2011). I think
this clearly highlights its effectiveness where it is made a priority.
Brazil was also one of the countries included in the Road Safety in 10 Countries
project (RS10) funded by Bloomberg Philanthropies Global Road Safety Programme and
coordinated by WHO. It was being conducted over five years (2010-2014), and aimed to
develop interventions to help with road safety. Brazil specifically chose to focus on
drunk driving and speed management. Other aspects are to improve road collision data
to help create road safety campaigns and increase education on the importance of being
a safe driver. This is crucial in changing the attitudes of young people and is happening
by enforcement officers getting out into the community, schools, bars, etc., to spread
awareness. I think this community-based approach is one that will be most effective as
it brings individuality to the message and I believe could create more personal
accountability. An advocate, Andrade, has seen change in behavior from this,
commenting that people are now looking to public transit when they want to go out
drinking (WHO, 2011).
WHO has also been very active in legislation reform, through identifying gaps
and facilitating collaborations to formulate evidence-based policies, mostly targeting
speeding and drunk driving. Mass media campaigns have been launched after extensive
research to prevent drunk driving. Workshops geared towards general road safety

7. concepts have been organized to inform the media in Brazil about raising awareness
among the general public and policy makers concerning road safety. I believe this is a
smart strategy as the media tends to have a large influence in shaping public opinion
and is really the main source of where people get their information. Targeting this
outlet could have a huge impact on the public and bring this public health issue to the
forefront of people’s minds.
Conclusion
While much work still needs to be done, and evaluations of programs and
policies that have been put in place need to be conducted, great strides have been
made in decreasing rates of road-traffic deaths in Brazil. It will be interesting to see
what the next five to ten years of reported data will show and hopefully, there is a
declining trend in this burden on Brazil’s health. I believe with the involvement of WHO
and others, great accomplishments will be made and roads will become safer for drivers
and VRUs. Brazil may just set the example for other countries struggling with high
numbers of road-traffic deaths. Time and data will show the effects of their efforts.
References
1 Aruna Chandran , Tanara Rosângela Vieira Sousa , Yayi Guo , David Bishai , Flavio
Pechansky & The Vida No Transito Evaluation Team (2012) Road Traffic Deaths in
Brazil: Rising Trends in Pedestrian and Motorcycle Occupant Deaths, Traffic
Injury Prevention, 13:sup1, 11-16.
2 Brazil targets drink driving on the road to fewer deaths. Bulletin of the World
Health Organization (2011); 89:474–475.
http://www.who.int/bulletin/volumes/89/7/11-020711/en/

8. 3 Incidence of road injuries in Brazil (2009)
http://roadinjuries.globalburdenofinjuries.org/brazil#TOC-Overview-of-data-
sources
4 Brazil’s struggle to cut deaths on chaotic roads (2012)
http://www.bbc.com/news/world-radio-and-tv-19623271
5 Ameratunga S., Hijar M., Norton R. Road-traffic injuries: confronting disparities
to address a global-health problem. Lancet (2006)
http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(06)68654-6.pdf
6 Reichenheim M, et al. Violence and injuries in Brazil: the effect, progress made,
and challenges ahead. Lancet (2011)
http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(11)60053-6.pdf
7 World Health Rankings: Health Profile: Brazil. (2010).
http://www.worldlifeexpectancy.com/country-health-profile/brazil
8 World Bank Data: Brazil. (2015) http://data.worldbank.org/country/brazil
9 World report on road traffic injury prevention: summary. (2004)
http://www.who.int/violence_injury_prevention/publications/road_traffic/worl
d_report/summary_en_rev.pdf
10 Commission for Global Road Safety: Make Roads Safe: Recommendations of the
Commission for Global Road Safety.
http://www.who.int/violence_injury_prevention/publications/road_traffic/worl
d_report/summary_en_rev.pdf
Word count and student ID number
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