Unit 1

Magnitude and
impact of road
traffic injuries

1 WHO, 2007

Road traffic injuries are a huge public health and

development problem
1.2 million deaths a year
20-50 million are injured
or disabled
11th leading cause of
death
account for 2.1% of all
deaths globally

2 WHO, 2007

Copyright Etienne Creux, Pretoria News

Distribution of global injury mortality by cause

Road traffic injuries
account for 23% of all
injury deaths
worldwide

Source: WHO Global Burden of Disease project, 2002, Version 1

3 WHO, 2007

Road traffic injury mortality rate (per 100 000 population) in WHO
regions, 2002
WHO region

Low- and middle-

High-income

income countries

countries

African Region

28.3

Region of the Americas

16.2

14.8

South-East Asia Region

18.6

European Region

17.4

11.0

Eastern Mediterranean Region

26.4

19.0

Western Pacific Region

18.5

12.0

The African Region has the highest mortality rate.

4 WHO, 2007

Road traffic injury mortality rates (per 100 000

population) in WHO regions, 2002

The majority of road traffic deaths occur in low- and middle-income countries.
5 WHO, 2007

WHO predicts that road traffic injuries will rise to

eighth place by 2030 as a cause of death
2002
Disease or injury

2030
Disease or injury

1. Ischaemic heart disease

1. Ischaemic heart disease

2. Cerebrovascular disease

2. Cerebrovascular disease

3. Lower respiratory infections

3. HIV/AIDS

4. HIV/AIDS

4. Chronic obstructive pulmonary disease

5. Chronic obstructive
pulmonary disease

5. Lower respiratory infections

6. Perinatal conditions

6. Diabetes mellitus

7. Diarrhoeal diseases

7. Trachea, bronchus, lung cancers

8. Tuberculosis

8. Road traffic injuries

9. Trachea, bronchus, lung

cancers

9. Tuberculosis

10. Road traffic injuries

6 WHO, 2007

10. Perinatal conditions

The World Bank predicts that road traffic deaths will increase by
67% worldwide between 2000 and 2020

Source: Kopits E, Cropper M., 2003.

7 WHO, 2007

Fatality rate per 100 000 population

Downward trends in road traffic fatalities

in high-income countries
35
30
25
20
15
10
5
0

Years
UK

8 WHO, 2007

Australia

USA

Most of those killed are vulnerable road users

Australia
Ghana
Delhi, India
Bandung, Indonesia
Japan
Kenya
Malaysia
Netherlands
South Africa
Colombo, Sri Lanka
Thailand
USA
0%
Pedestrians

Bicyclists

20%

Motorized 2-wheelers

Source: Various WHO collaborators in countries

9 WHO, 2007

40%

60%

80%

Motorized 4-wheelers

100%
Other

Young adults and males are at greatest risk

Half of all global road traffic deaths occur among young adults
between 15 and 44 years of age.
73% of all global road traffic fatalities are males.
In Africa, a third of all road traffic deaths occur among those
aged 5-14 years.
Males takes more risks as drivers or pedestrians.
In high-income countries young drivers are disproportionately
represented.
In low- and middle-income countries, most young victims are
vulnerable road users.
10 WHO, 2007

Economic costs of road traffic injuries to households

Loss of main household income generator (male)
Loss of earnings
Medical bills, funeral costs, legal bills
Rehabilitation costs

11 WHO, 2007

Key points (1)

Worldwide, about 1.2 million persons are killed in
road traffic crashes every year.
20 million to 50 million more are injured or disabled
in these crashes.
Road traffic injuries account for 2.1% of global
mortality and 23% of all injury deaths worldwide.
Road traffic injuries are predicted to rise from tenth
place in 2002 to eighth place in 2030 as a cause of
death.
12 WHO, 2007

Key points (2)

There are downward trends in road traffic deaths in

high-income countries and increases in most low- and
middle-income countries.
The global economic cost of road traffic injuries is
about US $ 518 billion per year.

13 WHO, 2007

Unit 2
Risk factors
for
road traffic injuries

WHO, 2007

Public health approach

1) Surveillance
What is the
problem?

4) Implementation
How is it done?

2) Risk factor
identification
What are the
causes?

3) Develop and
evaluate
interventions
What works?

15 WHO, 2007

Understand the four inter-related steps of the public

health approach
What is the problem?
- Determine the magnitude, scope and characteristics
of the problem.
What are the causes?
- Identify factors that increase the risk of disease,
injury or disability.
- Determine factors that are potentially modifiable.
16 WHO, 2007

Understand the four interrelated steps of the public

health approach
What works?
- Assess measures that can be taken to prevent
the problem.
- Pilot test and evaluate interventions.
How is it done?
- Implement proven and effective interventions.
- Evaluate effectiveness of interventions.
17 WHO, 2007

Haddon Matrix
Factors
Phase

Pre-crash

Vehicles and equipment

Environment

Information

Roadworthiness

Attitudes

Lighting

Road design and

road layout

Impairment

Braking

Speed limits

Police enforcement

Handling

Pedestrian
facilities

Human

Crash
prevention

Speed management
Crash

Post-crash

Injury
prevention
during the
crash

Use of restraints

Occupant restraints

Impairment

Other safety devices

Life
sustaining

First-aid skill

Ease of access

Rescue facilities

Access to medics

Fire risk

Congestion

18 WHO, 2007

Crash-protective
roadside objects

Crash protective design

Systems approach

Understand the system as a whole.

Understand interactions between different components.
Consider not only underlying factors, but also role of
different agencies and actors in prevention efforts.

19 WHO, 2007

Road and transport system

System
approach

Road users

Road and
environment

Vehicle

Desired output
Undesired
outputs

Mobility

Road traffic crashes

Other
consequences
of transport

Work
School
Leisure

System of trips

Shopping
Others

20 WHO, 2007

Human
factors

Vehicle
factors

Road and
environmental
factors

Crashes and crash factors

Major risk factors are identifiable

Factors influencing exposure to risk
economic factors
demographic factors
land-use planning practices
traffic mix
road function versus design and layout

21 WHO, 2007

Major risk factors are identifiable

Risk factors influencing crash involvement
speed
alcohol or drugs
fatigue
male
vehicle defects
youth driving together
vulnerable road users

22 WHO, 2007

Major risk factors are identifiable

Risk factors influencing crash severity
speed
seat-belts, child restraints
helmets
Non-crash protective roadside objects
insufficient vehicle crash protection
alcohol and other drugs

23 WHO, 2007

Major risk factors are identifiable

Risk factors influencing post-crash outcome of injuries
delay in detecting crash
delay in transport to a health facility
fire resulting from collision
leakage of hazardous materials
alcohol and other drugs
rescue, extraction, evacuation
poor trauma care and rehabilitation

24 WHO, 2007

Key points (1)

A road traffic collision is the outcome of the interaction among a
number of factors, some of which may not appear to be directly
related to road traffic injuries.
The public health approach is helpful in the analysis of risk
factors and guiding decision-making.
The Haddon matrix helps to identify human, vehicle and
environmental factors during pre-, crash- and post-crash phases.

25 WHO, 2007

Key points (2)

The systems approach considers all factors contributing to road
traffic injuries as well as the role of different agencies and actors
in prevention efforts.
Main risk factors can be categorized into four groups:
factors influencing exposure to risk
factors influencing crash involvement
factors influencing crash and injury severity
factors influencing post-crash injury outcomes
26 WHO, 2007

Unit 3
The importance
of evidence as
a foundation for
prevention

Why collect reliable data on road traffic injuries?

Describe the burden of road traffic injuries.
Assess risk factors.
Establish priorities and allocate resources for
prevention.
Develop and evaluate interventions.
Provide information for policy-makers and
decision-makers.
Raise awareness.
28 WHO, 2007

What are the main sources and types of data?

Police

Number of road traffic incidents,

fatalities and injuries
Type of road users involved
Age and sex of casualties
Type of vehicles involved
Police assessment of causes
Location and sites of crashes
Prosecutions
Cause/responsibility e.g. alcohol,
speed, vehicle factors

29 WHO, 2007

What are the main sources and types of data?

Health
facility
settings

Fatal and non-fatal injuries

Age and sex of casualties
Road user categories
Cost of treatment
Alcohol or drug involvement
Severity and type of injuries
Outcome e.g. disability

Insurance
firms

Fatal and non-fatal injuries

Damage to vehicles
Cost of claims
Cost to victims

30 WHO, 2007

What are the main sources and types of data?

Government
departments and
agencies

Population denominators
Income and expenditure data
Health indicators
Exposure data
Pollution data
Energy consumption
Literacy levels

31 WHO, 2007

What are the main sources and types of data?

Special interest
groups

Number of road traffic incidents,

fatal and non-fatal injuries
Type of road users involved

e.g.

Age and sex of casualties

research institutes,
NGOs, transport
unions, transport
companies, consulting
firms

Type of vehicles involved

Interaction of victims with vehicles
Causes
Location and sites of crashes
Social and psychological impacts
Interventions and evaluation
Damage and losses
Legal issues, insurance claims
Operational data

32 WHO, 2007

How are data on road traffic injuries collected?

Injury surveillance systems: set up in hospitals and other
appropriate institutions for ongoing systematic collection,
analysis, interpretation and dissemination of information.
Community-based surveys: data collected from households
and/or communities.
Academic studies on selected topics: provide information
on specific topics and may include case-control studies, indepth crash analysis and complementary investigations.
33 WHO, 2007

It is not enough just to collect data

link and share
Data collected and stored by a range of agencies.
Ensure access, harmonization and linkage between
different data sources and users to obtain maximum
value from the information.
Tackle the problem of coordination and sharing of
information among different users.

34 WHO, 2007

Analyse, disseminate and use information

Analyse data to answer questions on magnitude, patterns,
risk factors, interventions and their effectiveness.
Several software packages to use e.g. Epi Info and SPSS.
Ensure that you share and disseminate information with
colleagues, researchers, policy-makers and the public.
Use various strategies to disseminate information: journal
articles, reports, policy briefs, fact sheets, web page and
newspapers.

35 WHO, 2007

Indicators to measure the problem

Number of injuries
Description

Absolute figure indicating the number of people

injured in road traffic crashes

- Useful for planning at local levels for

emergency medical services
Use and
limitations

- Useful for calculating costs of medical

care
- Not very useful for making comparisons
- A large proportion of slight injuries are
not reported
- Misclassification of severity of injury

36 WHO, 2007

Indicators to measure the problem

Number of deaths
Description

Use and
limitations

Absolute figure indicating the number of people

who die as a result of a road traffic crash

- Gives a partial estimate of the magnitude of

the road traffic injury problem, in terms of
death
- Useful for planning at the local level for
emergency medical services
- Not very useful for making comparisons

37 WHO, 2007

Indicators to measure the problem

Fatalities per 10 000 vehicles
Description

Use and
limitations

Relative figure showing ratio of fatalities to

number of motor vehicles

-Shows probability of vehicle involvement in

fatal crashes
-A limited measure for assessing safety in a
society because it omits non-motorized
transport and other indicators of exposure
- Usually declines with motorization

38 WHO, 2007

Indicators to measure the problem

Fatalities per 100 000 population
Description

Use and
limitations

Relative figure showing ratio of fatalities to

population

- Shows the impact of road traffic crashes on

human population as a public health problem
- Useful for comparing road traffic injuries as a
health problem in different communities
- Useful for estimating severity of crashes

39 WHO, 2007

Indicators to measure the problem

Fatalities per vehicle-kilometre travelled

Description

Use and
limitations

40 WHO, 2007

Number of deaths per billon kilometres travelled

- Useful for some international comparisons,

decreases with motorization
- Does not take into account non-motorized
travel

Indicators to measure the problem

Disability-adjusted life years (DALYs)

Description

Use and
limitations

41 WHO, 2007

Measures healthy life years lost to disability and

mortality. One disability-adjusted life year lost is
equal to one year of healthy life lost, either due
to premature death or disability

- DALYs combine both mortality and disability

- DALYs do not include all the health
consequences associated with injury such as
mental health consequences

Problems and concerns

Definitions and standardization of data.

Under-reporting.
Unavailability of certain specific data.
Scientific soundness.
Lack of information, data collection or evaluation
of interventions.

42 WHO, 2007

Continue to conduct research and invest in

research capacity
A basis for generating data and evidence.
A basis for informed decision-making.
Develop national research capacity.
National and community research vital to identify local
problems.
Independence of research essential to ensure quality
and minimize political pressure.

43 WHO, 2007

Key points
Evidence is needed for decision-making and planning.
Reliable data and evidence are essential.
Police departments and hospitals are major sources of road
traffic injury data.
Ensure access, harmonization and linkages between different
data sources and users.
Several problems and concerns with road traffic injury data.
A need for continuous research and research capacity
development.
44 WHO, 2007

Unit 4
Implementing
specific
interventions to
prevent road traffic
injuries

Energy transfer is basic to road traffic injury

control

Human
body

Transfer of
energy

Injuries

46 WHO, 2007

Environment

Energy transfer is basic to road traffic injury

control
Injuries are due to transfer of energy between the
human body and the environment.
Damage and severity are proportional to amount of
energy available and exchanged during a crash.

Reduce and/or manage excess energy that may

contribute to the occurrence of a crash and severity of
injuries.

47 WHO, 2007

Haddon's ten strategies for RTI prevention

1) Prevent the initial
aggregation of the particular
energy form:
discouraging the use
of vehicles
encouraging
alternative travel

48 WHO, 2007

modes

2) Reduce the amount of

energy aggregated:
setting speed limits
making less powerful
engines

Haddon's ten strategies for RTI prevention

3) Prevent the inappropriate
release of energy:
road users shouldn't be
able to make mistakes
easily
better brakes, safer
intersections,
roundabouts

49 WHO, 2007

4) Alter the rate or spatial

distribution of release of the
energy from its source:
make rounded and
flatter surfaces
appropriate
crashworthiness of
vehicles

Haddon's ten strategies for RTI prevention

5) Separate susceptible
structures from the energy
being released by means of
space or time:
separated lanes
daytime curfews for
trucks in cities

50 WHO, 2007

6) Interpose a material barrier

to separate the released
energy from susceptible
structures:
road dividers on
highways

Haddon's ten strategies for RTI prevention

7) Modify contact surfaces or
basic structures that can be
impacted:
softer car and bus
fronts
breakaway poles on
highways
use of helmets by twowheeler riders

51 WHO, 2007

8) Strengthen human beings

who are susceptible by the
energy transfer:
treatment of
osteoporosis in older
road users

Haddon's ten strategies for RTI prevention

9) Quickly detect and evaluate
damage, and prevent its
continuation or extension:
efficient systems for
extraction of victims
from vehicles

10) Carry out all necessary

measures between the
emergency period
immediately following
damage and ultimate
stabilization of the process:

emergency care

intermediate and longterm repair

management of crash
sites

rehabilitation

52 WHO, 2007

What interventions can be implemented?

Reducing exposure to risk through transport and land-use policies
reducing the volume of motor vehicle traffic
providing efficient networks
encouraging people to switch to lower-risk modes of transport, e.g.
mass transit systems in Curitiba, Sao Paulo, Bogota and Beijing
placing restrictions on motor vehicle users
promoting safety-centred planning, design and operation

53 WHO, 2007

What interventions can be implemented?

Shaping the road network for road traffic injury prevention
classifying roads and setting speed limits by their function, e.g. the
Dutch sustainable safety policy with different speeds for three road
categories: flow roads, distributor roads and residential access
roads
improving safety of single-lane carriageways
implementing traffic-calming measures, e.g. speed bumps in Ghana
reduced crashes by 35% at a high-risk crash site

54 WHO, 2007

What interventions can be implemented?

Improving visibility of road users
use of daytime running lights
use of reflective and protective clothing
illuminating crosswalks

55 WHO, 2007

What interventions can be implemented?

Promoting crash-protective vehicle design
stronger passenger compartment
head-rests to prevent whiplash injury
collapsible steering column
laminated windscreens
padded instrument panels
door locks
crash-resistant roofs
side protection bars on doors
front end design
56 WHO, 2007

What interventions can be implemented?

Setting and securing compliance with road safety rules
setting and enforcing speed limits
enacting and enforcing laws on alcohol impairment (e.g. alcohol law in
Thailand)
enacting and enforcing laws on the use of seat-belts (e.g. in Costa Rica)
and child restraints
enacting and enforcing laws on the use of helmets (e.g. Malaysian
helmet law and programme)

57 WHO, 2007

Tools for action on helmets and alcohol

http://www.who.int/violence_injury_prevention/publications/

58 WHO, 2007

The role of education

Education is a key component of road safety
it improves knowledge
it provides basic skills
it brings about a culture of concern
but programmes providing highway safety education need to
be linked and used in combination with other approaches
there must be a balanced approach to the role of education
and publicity
59 WHO, 2007

Key points
Injuries are caused by a transfer of energy between the human
body and the environment.
There is no standard package of interventions suitable for all
contexts and countries.
Several good practices can be followed:
- reducing exposure to risk through transport and land-use
policies;
- shaping the road network for road traffic injury prevention;
- improving visibility of road users;
- promoting crash-protective vehicle design;
- setting and securing compliance with key rules;
- delivering post-crash care.
60 WHO, 2007