Work in the aid business and you regularly hear grisly tales of deaths, injuries and near misses of colleagues and partners on the roads of the developing world. In Peru, I once had the disorienting experience of seeing the rear wheel of my jeep bouncing ahead of us into the night, ending up in Lake Titicaca (the wheel, that is, not me). But the carnage from Road Traffic Accidents (RTAs) is much worse for poor people, communities and children.
The issues has been recognized in the SDGs, which may or may not make any difference – I’m a sceptic, and if you want to find out more, check out an excellent new literature review by Joseph Wales at the ODI. Some excerpts;
‘Road safety is a major international health issue, but one that rarely receives the attention it merits. Every year, an estimated 1.25 million people are killed on the world’s roads and up to 50 million people incur non-fatal injuries. This makes road traffic collisions the ninth leading cause of death across all age groups globally and the main cause of death among those aged 15-29 years. On current trends, collisions will become an even more prominent global health challenge, rising to become the seventh leading cause of death by 2030.
Some 90% of road traffic fatalities occur in low- and middle-income countries, where pedestrians, cyclists and motorcyclists make up the bulk of those affected. Working age males make up a large proportion of those killed and injured; but children, adolescents and the elderly are also disproportionately affected in many contexts. The effects of road traffic collisions are particularly felt by households from poorer socio-economic groups. They are both more likely to have a member fall victim to a collision and less able to bear the considerable costs of a funeral, medical treatment and lost income resulting from extended periods of recovery or permanent disability. For some households, the loss or injury of a member in a road traffic collision can be the difference between financial stability and poverty. At a national level, the economic costs of road traffic collisions alone are substantial – estimated at 5% of gross domestic product (GDP) in low- and middle-income countries, and totalling up to 3% of global GDP. The estimated costs of initiatives to improve road safety are dwarfed by the scale of economic and social damage currently caused by road traffic collisions.
Historically, initiatives to improve road safety have often been structured around the collision itself. Broadly, initiatives aimed to either (i) reduce the incidence of collisions; or (ii) reduce the severity of collisions – generally with a strong focus on changing user behaviour – whether through public information campaigns (e.g. on drink driving), legislation (e.g. speed limits) or the physical road infrastructure (e.g. speed bumps). However, there has been increased recognition that the immediate causes of road traffic collisions, fatalities and injuries cannot be viewed in isolation from each other or the broader context, and that combinations of interventions demonstrate greater cost-effectiveness. This has resulted in a growing focus on system level issues and the use of simultaneous interventions at multiple levels to address the causes of road traffic collisions in an integrated and coherent manner. The ‘Safe Systems’ approach that underlies the UN Decade of Action for Road Safety (2011-20) is based on this broader understanding of how to improve road safety.
Interventions to reduce road traffic collisions, deaths and fatalities are therefore broad and involve initiatives that focus not only on roads and road design, but other issues within the broader transport system and beyond. These can be broadly divided into five groups:
- Improvements in land use and the built environment (e.g. land zoning, traffic calming measures, cycle paths)
- Improvements in education, legislation and enforcement of traffic regulations (e.g. speed limits, advertising public campaigns to reduce drink driving)
- Improved vehicle and safety standards (e.g. regulations on manufacturing standards, compulsory safety features)
- Improved availability and quality of public transport
- Improved post-collision emergency response and care
This shift towards a ‘Safe Systems’ approach has also helped to highlight the importance of politics and state capacity to the successful creation and implementation of road safety policies. Successful implementation requires political momentum to initiate a range of policies to promote road safety, but also the enforcement of regulations and laws carried out in practice, as well as coherent and coordinated action between the different agencies and organisations at national and local level that have influence over road safety. This approach requires improving the functionality and coordination of a wide range of actors and so the task is of a different order than more traditional, technical interventions. There is strong empirical evidence that countries with well-functioning and capable state institutions experience lower levels of road traffic collisions, deaths and injuries compared to those that are weaker and less coherent.
The political salience of road safety is generally low, especially when given the high number of deaths due to road traffic collisions. Most interventions have tended to focus on preventing injuries to vehicle occupants, despite pedestrians being more likely to be victims and to be severely injured or killed. These trends are partly due to many interventions originating in high-income countries where vehicle occupants make up a higher proportion of victims. They are also related to challenges of mobilisation due to collective action and coordination issues, poor data availability and the challenge of attributing causes. This is particularly the case where the individuals involved in collisions may be blamed for causing them, or where there is no clear individual, institution, policy or design feature whose impact or negligence can be mobilised around.’
My takeaways from this are that RTAs act as a lens on the modern world, highlighting issues of power, inequality, and the importance of thinking about systems, not just linear interventions. And that the lack of attention to something that costs this much, and is readily easy to address, is unforgiveable.
What might help take this forward is to dig into the politics a lot more – what would a power analysis of RTAs look like? Who are the likely blockers as well as the drivers of reform?
In terms of building a campaign around this, you would think a building a cross class coalition would be pretty straightforward, since rich people as well as poor get mown over by drunk drivers and the rest. But are there high profile villains that could galvanize a public campaign? Urban developers refusing to invest in safety measures? Booze firms blocking breathalysers? Car companies? What are the successes we can learn from, like the Good Samaritans movement in India?
Here’s the UN Decade video, starring Kevin Watkins