Part I "Strategic Global Perspective" introduces the wide range of problems facing road safety professionals around the world and looks at the strategic issues involved in developing a management system.
This chapter outlines the global crisis of road traffic injury and the substantial value of preventing death and serious injury in road crashes. It also introduces the key road safety concepts that underpin this manual’s guidance for implementing affordable and effective interventions to achieve results that may be required in any given context. The first of these concepts is the challenging Safe System long-term goal and strategy, which is recommended to all countries regardless of their socioeconomic status and level of infrastructure development.
Secondly, this chapter highlights the planned, systematic approach needed for effective road safety management to produce successful road safety results. As discussed more fully in later chapters, these approaches provide a foundation and implementation framework for road safety investment programmes and demonstration projects. It is emphasised that these programmes and projects need to seek targeted results for the short to medium-term, appropriate to the learning and management capacity of the country concerned. Affordable, effective intervention is required that better addresses the needs of all road users, including those most vulnerable. The chapter highlights the importance of aligning road safety with other important societal objectives, given the significant potential for shared benefits and in order to maximise cost-effective investment.
Economic development makes an important contribution to increased mobility and motorisation. It is forecast that over the first 30 years of the 21st century, more motor vehicles will be produced globally than in the first 100 years of motorisation. The majority of these vehicles will be used in low- and middle-income countries (LMICs)1 (Bliss, 2011).
Alongside rapidly increasing rates of motorisation in LMICs, premature death and disability is occurring on a disastrous scale. Global road deaths increased by 46% between 1990 and 2010 (Mathers et al., 2012). More than 90% of road traffic deaths occurred in LMICs and the victims are predominantly vulnerable road users, males, and include the most socio-economically active citizens (WHO, 2013a). Apart from the sheer scale of human misery involved, the often underestimated socio-economic value of preventing these tragedies is substantial (Jacobs et al., 2000; OECD, 2008; McInerney, 2012).
The road safety performance gap between rich and poor countries is set to widen further. It is projected that, by 2030, around 96% of global road deaths will occur in LMICs with 4% of deaths occurring in high-income countries (HICs). Forecasts of global mortality trends indicate that road traffic crashes are the twelfth leading leading cause of death (WHO, 2023) and is set to increase to the 7th leading cause of death by 2030 (WHO, 2013b). Without new initiatives, forecasts indicate that more than 50 million deaths and 500 million serious injuries on the world’s roads can be anticipated with some certainty over the first 50 years of the 21st century (Bhalla et al., 2008). This can be compared with only an estimated 1% probability that over the same period, more than 40 million people could be killed in mega-wars or by a virulent influenza epidemic and around 4 million people by volcanoes or tsunamis (Smil, 2008).
It is now widely accepted that serious health losses in road traffic crashes are largely preventable and predictable – a human-made problem open to rational analysis and effective road safety management (Peden et al, 2004). Road traffic systems can be developed that reduce the likelihood of serious or fatal crashes occurring and to minimise injury severity in the event of a crash. This is supported by a substantial body of knowledge on how to achieve significant lessening of the costly, adverse impacts of motorisation. In European Union countries, for example, the overall volume of traffic tripled between 1970 and 2000, while the number of people killed per million inhabitants decreased by 50% (CEC, 2003). (See key overviews by Peden et al., 2004; OECD, 2008; GSRF, 2009).
In the 1990s there were two major and complementary developments that informed modern best-practice to road safety and how to more effectively manage for better results. The first was led by Sweden (Vision Zero) (Tingvall, 1995) and the second Netherlands (Sustainable Safety) (Koornstra et al., 1992), both representing a paradigm shift towards the ambitious Safe System goal (see Box 1.1)
A Safe System approach places road safety in the mainstream of road traffic system planning, design and operation. Building on the best of previous approaches, Safe System better addresses the needs of vulnerable road users and is particularly relevant to the needs of LMICs. As discussed in The Safe System Approach, firmly establishing a Safe System in national road safety work requires strong political backing and underwriting in legislation (OECD, 2008; Belin et al., 2012).
More recently, the World Bank, the OECD, and the International Standards Organization (ISO) have underlined that effective road safety management is a systematic process. Road safety does not just occur, but has to be produced. The safety performance produced by countries active in road safety has been achieved following years of sustained investment in road safety management and governmental leadership. The road safety management system is the productive capacity to deliver key institutional management functions, which produce and enable effective, system-wide interventions that are designed to produce results – with the Safe System goal and strategy representing the most ambitious approach (OECD, 2008; GRSF, 2009; ISO, 2012). These holistic concepts are the common threads running throughout this manual. They represent the summation of effective multi-disciplinary road safety knowledge and successful practice across the road traffic system, which have been built up over decades.
The gradual and increasingly more successful path towards these shifts in road safety thinking and practice are briefly outlined in Box 1.2 and are discussed in more detail in Key Developments in Road Safety. LMICs are being urged to avoid the evolutionary path of industrialised countries and to take key steps to move directly to affordable, effective Safe System approaches noted in Phase 4. High-income countries which are now setting increasingly ambitious road safety goals and targets are also advised to adopt this approach (OECD, 2008; GRSF, 2009; PIARC, 2012; WHO, 2013a). The implications for current practice in a variety of settings are recurrent themes in this manual and specific guidance is provided on appropriate steps for different road safety contexts.
This manual outlines a suggested path for jurisdictions to move from weak to stronger institutional capacity, particularly in their governmental lead agency and coordination arrangements and results management. The aim is to provide state-of-the-art guidance to assist all those involved in the safe planning, design, operation and use of the road network in accordance with national, regional and global goals.
This section describes the current and forecast burden of road traffic injuries in more detail, both globally and regionally.
The Global Status Report on Road Safety is the central publication for periodic monitoring and evaluation of the Decade of Action for Road Safety goals (WHO, 2013a) . While crash injury data is incomplete and often substantially under-reported in many countries in both the health and transport sectors, the latest available estimates referred to in this manual provide a comprehensive strategic overview of the emerging crisis in LMICs.
The Global Status Report brings together data based on survey information collected for 182 countries, and makes estimates, where appropriate, to account for varying levels of data quality in order for data to be comparable across countries. This includes use of the 30-day definition of a road traffic death and involves point estimates of road traffic deaths in LMICs, which are sometimes far in excess of officially reported deaths. Data have been extrapolated for all 195 countries and territories in the world. Full details of the methodology used to develop comparative estimates are provided in WHO (2013a, p.42).
The Global Status Report notes the urgent need for standardised data collection on road traffic fatalities and the need for improvement in the quality of safety data on road traffic deaths, disability and other non-fatal injuries. See Effective Management And Use Of Safety Data for full discussion and guidance on the establishment, management and use of data, and determining levels of under-reporting.
In 2016, the number of road traffic deaths had climbed to 1.35 million (WHO, 2018) That's nearly 3,700 people dying on the world's roads every day.. Road traffic injury is a leading cause of death and serious health loss (expressed in terms of disability adjusted life years lost (DALYs)1 (see Box 1.3 ). For every road traffic death, at least 20 people sustain non-fatal injuries (ranging from those that can be treated immediately and for which medical care is not needed or sought, to those that result in a permanent disability (Peden et al., 2004). On an annual basis, between 20 and 50 million people are disabled or injured as a result of road traffic crashes (WHO, 2018).
Key insights from the Global status report on road safety 2018:
Source: WHO, (2018)
In some regions, road traffic injury was the leading cause of death for certain age groups, as shown in Table 1.1. For HICs in general, road traffic injury was the leading cause of death for children aged 5–14 years (IHME, 2013). A study in four LMICs indicated that 17% of children attending an emergency department following a road traffic crash sustained disabilities lasting six weeks or more (WHO, 2008).
| Region | 1–4 years | 5–9 years | 10–14 years |
|---|---|---|---|
North America | 1 | 1 | 1 |
Central Europe | 3 | 1 | 1 |
Australasia | 2 | 1 | 1 |
Western Europe | 2 | 2 | 1 |
North Africa and Middle East | 4 | 1 | 1 |
Latin America | 4 | 1 | 1 |
In 2016, the global road traffic fatality rate was 18 per 100,000. With and average of 27.5 deaths per 100,000 population. The risk is more than three times higher in low-income countries than in high-income countries where the average rate is 8.3 deaths per 100,000 (WHO 2018).
More than 90% of road traffic deaths occur in rapidly motorising low and middle-income countries, which account for 82% of the world’s population and 54% of the world’s registered vehicles. As shown in Figure 1.2, these countries have a high proportion of road traffic fatalities relative to their level of motorisation (WHO, 2018). Details on individual country performance can be found in the periodic Global Status Reports.
Figure 1.1 Proportion of population, road traffic deaths, and registered motor vehicles by country income category*, 2016 (Source: WHO, 2018)
There has been more progress in reducing the number of road traffic deaths among middle- and high-income countries than low-income countries. Between 2013 and 2016, no reductions in the number of road traffic deaths were observed in any low-income country, while some reductions were observed in middle- and high-income countries (see Figure 1.2).
Figure 1.2 Number of countries where a change in the number of road traffic deaths has been observed between 2013 and 2016* (Source: WHO, 2018)
Between 2013 and 2016, the number of road traffic deaths decreased in 48 middle and high-income countries. Over the same period, 104 countries saw increases in the numbers of road traffic deaths (WHO, 2018).
In most LMICs, a much higher proportion of road users are pedestrians, cyclists and users of motorised two- or three-wheeled vehicles when compared with HICs. Over half of the global road traffic deaths occur among vulnerable road users – pedestrians and cyclists represent 26% of all deaths with those using motorized two- and three-wheelers comprising another 28%. Car occupants make up 29% of all deaths and the remaining 17% are unspecified road users (WHO 2018).
Low-income countries have the highest proportion of fatally injured casualties among vulnerable road users at 57%, as opposed to 51% in middle-income countries, and 39% in high-income countries (WHO, 2013a). Figure 1.3 provides further detail on road deaths by road user type for low-, middle- and high-income countries.
Figure 1.3 Proportion of road traffic deaths by road user type and country status; 2010 - Source: WHO, (2013a).
Figure 1.4 Indicates that nearly half (46%, WHO, 2015) of all the fatalities on a global scale continue to be vulnerable road users. The figure shows that regardless of the region vulnerable roads users are a disproportionately high total of the road user death.
Figure 1.4 Reported deaths by type of road user (%), by WHO region and income group* (Source: WHO, 2015)
Even in HICs, vulnerable road users are often vastly over-represented when rates of death and serious injury are compared. For example, when the distances travelled (billion miles) by different modes of road use were compared, more than 10 times as many pedestrians and cyclists than car drivers lost their lives on Great Britain’s roads in 2011. For motorcyclists, the rate was around 40 times higher (Department for Transport, 2012). The gap is even wider when considering the risk of death or serious injury by billion vehicle miles. For each car driver in Great Britain, more than 20 times as many pedestrians and around 40 times as many cyclists were killed or suffered a serious injury from a road traffic crash. Motorcyclists were exposed to the greatest risk, as they were 75 times more likely to be killed or seriously injured than a car driver (Department for Transport, 2012).
Young adults aged between 15 and 44 years account for 59% of global road traffic deaths (see Figure 1.5); and more than three-quarters (77%) of all road traffic deaths occur among men. In high-income countries, the proportion of deaths among those over 70 years is noticeably greater than in LMICs. Key exposure factors, such as longevity in these countries, combined with the greater risk posed by increased frailty, will contribute to these outcomes (WHO, 2013a).
Figure 1.5 Proportion of road traffic deaths by age range and country income status - Source: WHO, (2013a).
There is substantial variation in the road traffic death rates between different regions and within regions (see Figure 1.6). The reported risk of fatal injury is greatest in Africa at 26.6 per 100,000 populations and lowest in the European region at 9.3 per 100,000 population. Within regions, taking under-reporting of road fatalities into account, it is estimated that over half of African countries may have death rates of 30 per 100,000 population or more (AfDB, 2012).
Figure 1.6 Rates of road traffic death per 100,000 population by WHO regions: 2013, 2016 (Source: WHO 2018)
As shown in Figure 1.6, in four out of six WHO regions, car occupants are the largest fatal casualty group.
Figure 1.7 Distribution of road traffic deaths by road user type by WHO Region (Source: WHO, 2018)
In Africa, Europe, the Americas, and Eastern Mediterranean most deaths from road traffic crashes involve car occupants. Africa has the highest proportion of pedestrian and Cyclist fatalities representing 44% of deaths. In South-East Asia and Western Pacific, the majority of deaths are riders of motorized two- and three-wheelers with 43% and 36% respectively (WHO, 2018).
Modelling of historic global trends indicates that if LMICs choose to follow the costly evolutionary path of HICs in reducing deaths and serious injuries as they built knowledge, then the road death toll in LMICs is likely to increase very substantially (Kopits and Cropper, 2003; WHO 2013b). Latest forecasts indicate that, based on current trends, 96% of the global total of road deaths by 2030 are likely to occur in LMICs (WHO, 2013b).
The highest projected regional death rates (deaths per 100,000 persons) to 2030 are in Sub Saharan Africa (38), South Asia (29) and the Middle East and North Africa region (28) with decreasing rates between 2015 and 2030 in the East Asia and Pacific and Latin America and Caribbean regions and, most sharply, in the European and Central Asia regions (See Table 1.2). There is large regional variation in LMICs in the number of deaths per 100,000 persons with the highest rates being 4 times higher than the lowest. By 2015, the death rate from road traffic crashes was forecast to be around 8 per 100,000 persons in HICs decreasing to 6 by 2030 but nearly 20 in 100,000 persons in LMICs (WHO, 2013b).
| World (World Bank regions) | Deaths per 100,000 persons | |
|---|---|---|
| 2015 | 2030 |
South Asia | 21 | 29 |
East Asia and Pacific | 22 | 18 |
Sub-Saharan Africa | 25 | 38 |
Middle East and North Africa | 26 | 28 |
Latin America and Caribbean | 20 | 19 |
European and Central Asia | 14 | 9 |
High-income countries | 8 | 6 |
Global total | 20 | 22 |
Source: WHO, (2013b).
The relative importance of road traffic injury to other disease burdens is also predicted to increase steeply. Forecasts of global mortality trends to 2030 indicate that road traffic injury is set to increase from the 9th to the 7th cause of death, as shown in Figure 1.8 (WHO, 2013b).
Country road safety management capacity reviews and other studies reveal that most road deaths and serious injuries occur on a relatively small proportion of the road network. Such roads usually have both urban and rural sections. In India, around two-thirds of deaths occur on national and state highways, which account for just 6% of the network (Mohan et al., 2009). In Bangladesh, just 3% of arterial roads account for 40% of the road deaths (Hoque, 2009). Statistics from a wide range of countries show that typically, around 50% of deaths occur on just 10% of the road network (McInerney, 2012). These roads have high strategic priority, attract large investment, and are particularly amenable to targeted road safety treatments (GRSF, 2013).
Typically, in the main road network, traffic volumes and vehicle speeds are high, with a mix of motorised traffic and non-motorised users, and mixed speed road environments (Commission for Global Road Safety, 2011; GRSF, 2006–2013; UNRSC, 2011b). A key problem is that many road standards used in road projects in LMICs do not provide for the degree of human vulnerability involved in the use of the road network. Furthermore, the efficient and effective police enforcement of safety behaviours, which contribute to the overall safety performance of road safety engineering standards in high-income countries, is lacking. Junction design standards and the management of road use from low- to high-speed environments expect vulnerable road users to compete successfully against faster, bigger vehicles, with tragic consequences (GRSF, 2010, 2011). While new roads bring new opportunities for development, many increase the risk of death and serious injury where roads are not restricted to through-traffic, where linear settlements are not avoided, and where there is no first class provision for pedestrians, cyclists and other vulnerable road users (UNRSC, 2011b). Specific global guidance to assist with project design for the road safety management of corridors is provided in Targets and Strategic Plans and in Planning, Design & Operation of this manual as well as global references on this issue (e.g. UNRSC, 2011b; GRSF, 2009, 2013; Breen et al., 2013).
The main crash types on the world’s roads have been identified as follows (UNRSC, 2011b):
Further information is provided on the main crash types in Section Crash Causes and in Part Planning, Design & Operation.
Road safety problems in low-, middle- and high-income countries are found across road safety management systems, including in:
LMICs present some particularly complex challenges for road safety work. Weak road safety management capacity as well as the lock of road safety research facilities in many countries presents a large barrier to road safety progress (GRSF, 2006–2013, PIARC 2023). Road safety progress will be linked to other development priorities such as:
Country road safety investments in LMICs will have to be sustained over a long period and across a range of sectors, directed by appropriately resourced governmental lead agency arrangements. Such government-led road safety policy may find its foundation in strong local academic research. Universities and institutes play a critical role in transforming international knowledge about Safe System concepts and principles towards evidence-based measures for the local LMIC context, taking into account local traffic conditions and safety culture (PIARC, 2023)
Full discussion and guidance are provided in subsequent sections on critical success factors for addressing key road safety problems. This will address the needs of LMICs with their own special challenges. It will also provide guidance for HICs that are currently in the process of addressing strict Safe System parameters, which include new speed thresholds as well as the broader environmental and public health drive for more active transport solutions.
Evaluation of the direct and indirect socio-economic costs of the outcomes of road traffic crashes is important. This allows measurement of the burden that road traffic crash injury imposes on society and highlights the return on investment in road safety and the relative benefits and costs of different policy options in the allocation of resources1.
Inadequacies in data collection, serious under-reporting of road traffic injuries, and the lack of an adopted global method in valuing the prevention of death and serious injury, do not allow precise estimates to be made of the socio-economic value of their prevention in LMICs. However, approximate and conservative estimates have been made at global and regional levels. In many HICs, effective practice provides more reliable estimates involving periodic updating of economic values for preventing different injury severities using the willingness to pay method (see Prioritisation & Assessment for further discussion).
Road traffic crashes cost most countries around 3% of their gross domestic product. Low-and middle-income countries are estimated to experience even greater economic losses, losing up to 5% of their gross domestic product (GDP) each year (WHO, 2015). Global costs are even higher if under representation of deaths and injuries in available statistics and the social costs of pain and suffering are fully accounted for. The International Road Assessment Programme has calculated that serious road trauma now costs the world more than US$2.2 trillion per year, or US$6.1 billion every day (iRAP, 2023) (See Box 1.4).
More than 3600 people are killed in road crashes every day. Road crashes are the leading cause of death for young people.
But this is just the tip of the iceberg. More than 100,000 people suffer injuries every day, including severe brain injury, quadriplegia, fractures, internal injuries and burns. Road crashes often result in life-long suffering and disability and place a huge toll on families and communities.
Apart from the emotional impact of serious crashes, the cost of emergency response, trauma wards and long-term health care is immense. Australia's Transport Accident Commission (TAC) claim data shows that more than falf of all cost occur more than two years after a crash, buried deep within health and social welfare systems.
However, there is a signficiant gap in evidence and data about road crash injuries and their costs worldwide. To help support debate about the scale of response to this enormous level of trauma and cost, iRAP has drawn on data from the WHO, TAC, Institute for Health Metrics and Evaluation, and the International Monetary Fund (IMF) to make simple, high-level esitmates of golobal injury types and their costs.
Figure 1.8 Estimated daily road crash deaths, injuries and consts
© ARRB Group
The large burden of costly injuries is borne by society in general. However, a large part of the burden is particularly within the health sector in terms of costs to the emergency medical system, with employers in terms of premature loss or disablement of the world’s most economically active citizens, and with households in terms of loss of the main wage earner. A summary of some of those directly bearing the cost of road injury and death is provided below:
A high price in socio-economic terms is being paid for motorised mobility in all countries of the world. In particular, road traffic injuries in LMICs are a financial drain they can ill afford, which inhibits their desired social and economic development (FIA Foundation for the Automobile and Society, 2005). Road safety investment in both LMIC and HICs needs to be scaled up to match the high socio-economic values of preventing death and serious injury in road crashes (WHO, 2009; DaCoTa, 2012c).
Improving global road safety is now linked with the broader vision of sustainable development and priorities addressing the s of the child, public health, poverty reduction and social inclusion, and occupational health and safety.
Following five successive UN resolutions on ‘Improving road safety’ since 2004, the UN Rio Conference of world leaders highlighted in discussion of the Future We Want (UN, 2012) ‘the importance of the efficient movement of people and goods, and access to environmentally sound, safe and affordable transportation as a means to improve social equity, health, resilience of cities, urban-rural linkages and productivity of rural areas. In this regard, we consider road safety as a part of our efforts to achieve sustainable development’ (UN, 2012).
Road safety is now formally recognised as part of the 2030 Agenda for Sustainable Development with two targets in the Sustainable Development Goal (SDG) framework that specifically address road safety: SDG target 3.6 on halving the number of global deaths and injuries from road traffic crashes: and SDG target 11.2 on providing access to safe, affordable, accessible and sustainable transport systems as well as improve road safety for all. Importantly, road safety also has links to any related targets, such as SDG target 1 on poverty, SDG target 5 on gender equality, and SDG target 8 on decent work and economic growth (United Nations, 2016). The World Health Organization (WHO) has also collaborated with other United Nations agencies and regional commissions and the UNRSC to develop12 voluntary Global Road Safety Performance Targets (WHO, 2017).
In national transport policy, safe, clean and affordable mobility goals are set increasingly to realise the associated co-benefits of integrated initiatives (see Box 1.5).
Similar national transport policy statement incorporating safe, clean and affordable mobility goals are increasingly being adopted in LMICs to guide efforts towards safe and sustainable road transport systems (see Box 1.6)
Despite the rapid growth in motorised traffic, the main modes of travel in LMICs are likely to remain walking, motorcycling, cycling and public transport (Kopits & Cropper, 2003). This highlights the importance of planning and providing for the safety needs of these road users (particularly for pedestrians, as the most vulnerable road users), who sustain a high proportion of road traffic injuries, as well as integrating safety into developing road networks for cars, vans, buses, and trucks.
Significant co-benefits can be achieved for the environment and public health. For example, land use and transportation planning, the provision of safer infrastructure facilities to promote increased walking and cycling, and measures to reduce vehicle speeds, will also result in less greenhouse gas emissions and local air pollution, greater energy security, and improved physical wellbeing (GRSF, 2009). Other means include reducing the volume of motor vehicle traffic by providing for public transport and pursuing livable city policies; providing efficient networks where the shortest or quickest routes coincide with the safest routes; and encouraging road users and freight to switch from higher risk to lower risk modes of transport (Peden et al., 2004).
In some instances, road safety policy can be in conflict (or be perceived to be in conflict) with other societal needs and policies. However, safe, clean and affordable mobility goals for transport policy provide a means for seeking integrated solutions that address competing societal goals, such as public health (Peden et al., 2004), the of the child and citizen (see Box 1.5), poverty reductions, social equity priority, occupational health and safety, and educational goals (Watkins & Sridhar, 2009).
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World Health Organization WHO (2015), Global Status Report on Road Safety, World Health Organization, Geneva.
World Health Organization WHO (2018), Global Status Report on Road Safety, World Health Organization, Geneva.
World Health Organization WHO (2013b), Global Health Estimates Summary Tables: Projection of Deaths by Cause, Age and Sex by various regional grouping. Geneva, World Health Organization, 2013. Available at http://www.who.int/healthinfo/global_burden_disease/projections/en/index.html.
This chapter discusses important new global directions in road safety for low, middle and high-income countries. It charts the establishment of road traffic injury prevention as an international development priority; the adoption of a global target, plan and agreement on the urgent need to scale-up investment in road safety. The paradigm shift to the Safe System is explored further and its promotion by key international development organisations to all countries is noted. Finally, this chapter notes the emphasis in international development being given to encouraging governmental leadership and building the necessary management capacity in order to achieve improved road safety outcomes.
In international development, road safety is being linked with the broader vision of sustainable development through the 2030 Agenda for Sustainable Development and Sustainable Development Goals (SDGs). SDGs are a call to action to end poverty and inequality, protect the planet, and ensure that all people enjoy health, justice and prosperity. Addressing the risk of death and injury in road traffic is fundamental to achieving the SDGs. Within the SDG framework there are two targets that specifically address road safety. However, road safety also has links to many related targets (see Box 2.1)
The SDGs build on decades of work. In June 1992, at the Earth Summit in Rio de Janeiro, Brazil, more than 178 countries adopted a comprehensive plan of action to build a global partnership for sustainable development to improve human lives and protect the environment. Member State unanimously adopted the Millennium Declaration at the Millennium Summit in September 2000 which led to the elaboration of eight Millennium Development Goals (MDGs) 11 to reduce extreme poverty by 2015 (UN, 2023)
Previously, international development had a narrow focus on income and spending. However, current approaches promote higher living standards for all, with an emphasis on improved health, education and people’s ability to participate in the economy and society. Development seeks to foster an investment climate, which can encourage increased growth, productivity and employment; and to empower and invest in people so that they are included in the process (Stern et al., 2005; Bliss, 2011a).
While no Millennium Development Goal was set for addressing the prevention of deaths and serious injuries in road crashes to 2015, road safety priorities align with other MDGs, particularly for environmental sustainability, public health, and poverty reduction. As the MDGs era came to a conclusion at the end of 2015, the new year ushered in the official launch of the 17 Sustainable Development Goals (WHO, 2023).
In September 2020, the UN General Assembly adopted resolution A/RES/74?299 "Improving global road safety", proclaiming the Decade of Action for Road Safety 2021-2030, with the explicit target to reduce road traffic deaths and injuries by at least 50% by 2030.
WHO and the UN regional commissions, in cooperation with other partners in the UN Road Safety collaboration, have developed a Global Plan for the Decade of Action (WHO, 2021). The Global Plan describes the actions needed to achieve that target. This includes accelerated action to make walking, cycling and using public transport safe, as they are also healthier and greener modes of transport: to ensure safe roads, vehicles and behaviours; and to provide timely and effective emergency care.
The Global Plan outline recommended actions drawn from proven and effective interventions, as well as best practices for preventing road trauma (see Box 2.2). Te various recommendations outlined under each area are designed to support and strengthen the implementation of a Safe System (WHO, 2021).
The Global Plan includes recommendations in the following areas:
Multimodal transport and land-use planning: (8 recommended actions):
Multimodal transport and land use planning is an important starting point for implementing a Safe System. Land use planning must include consideration of travel demand management, mode choice and the provision of safe and sustainable journeys for all, particularly for the healthiest and cleanest modes of transport that are often most neglected: walking, cycling and public transport.
Safe road infrastructure: (7 recommended actions):
Road infrastructure must be planned, designed, and operated to eliminate or minimize risks for all road-users, not just drivers, starting with the most vulnerable. Key elements include developing a functional road classification, minimum technical infrastructure standards and undertaking road safety audits. Infrastructure design must also incorporate speed management to ensure the safety of all road users.
Vehicle Safety: (2 recommended actions):
Vehicles should be designed so as to ensure the safety of people inside them as well as outside. Key actions to improve vehicle safety include the application of harmonized legislative standards to ensure that safety features are integrated into vehicle design to avoid crashes (active safety) or to reduce the injury risk for occupants and other road users when a crash occurs (passive safety).
Safe road user: (4 recommend actions):
Speeding, drink-driving, driver fatigue, distracted driving, and non-use of safety belts, child restraints and helmets are among the key behaviours contributing to road injury and death. The design and operation of the road transport system must therefore take into account these behaviours through a combination of legislation, enforcement and education. Action must also be taken to support safe behaviours through road infrastructure, speed management and vehicle safety features.
Post-crash response: (5 recommended actions):
Efficient post-crash care is critically important to survival: delays of minutes can make the difference between life and death. For this reason it is important to develop systems and mechanisms to ensure appropriate, integrated and coordinated care is provided as soon as possible after a crash occurs as well as the provision of rehabilitation services and comprehensive support systems for victims and their families.
Source: WHO, (2021): Decade of Action for Road Safety 2021-2030
The global voluntary performance targets and indicators adopted in 2017 provide a useful framework to assess progress towards the implementation of this plan
Following a request of the World Health Assembly (WHA) in 2016, the World Health Organization (WHO) collaborated with other United Nations agencies and regional commissions and the United National Road Safety Collaborations (UNRSC) to develop 12 voluntary Global Road Safety Performance Targets. Consensus on the targets among United Nations Member State was achieved in 2017.
These 12 targets are shown in Box 2.3 below. Each target represents a specific goal to be achieved at the global level, based on combined efforts of individual countries that wish to contribute to the global objectives. It should be noted that the time horizon for all targets is 2030, except for the first target where it is 2020. The baseline for all targets is 2018.
The Global Plan for the Decade of Action aligns with the "Stockholm Declaration", which is the outcome of the 3rd Global Ministerial Conference on Road Safety held in Stockhom, Sweden, in February 2020. The Stockholm Declaration calls for a global target to reduce road traffic deaths and injuries by 50% by 2030 and invites strengthened efforts on activities in all five pillars of the Global Plan: better road safety management: safe roads, vehicles and people; and enhanced post-crash care. It also calls for speeding up the shift to safe, affordable, accessible and sustainable modes of transport like walking, cycling and public transport (Government Offices of Sweden, 2020).
Building on the Moscow Declaration of 2009 and Brasilia Declaration of 2015, UN General Assembly and World Health Assembly resolutions, the Stockholm Declaration is ambitious and forward-looking and connects road safety to the implementation of the 2030 Agenda for Sustainable Development. The Stockholm Declaration also reflects the recommendation of the conference's Academic Expert Group and its independent and scientific assessments of progress made during the Decade of Action for Road Safety 2011-2020 and its proposals for a way forward (see Box 2.4).
A key development was the release of the World Report on Road Traffic Injury Prevention (see Box 2.5), which was jointly issued by the WHO and World Bank on World Health Day in 2004 (Peden et al., 2004). The World Report highlighted the growing public health burden and forecasts of road deaths and long-term injury and advocated urgent measures to address the problem as a global development and public health priority. Its findings and recommendations for country, regional and global intervention were endorsed by successive United Nations General Assembly and World Health Assembly resolutions (UN 2004-2)
Generally, in international development, road safety is being linked with the broader vision of sustainable development, poverty reduction, and the achievement of other worldwide goals. That vision was translated into eight Millennium Development Goals at the beginning of the new millennium. In 2015 the General Assembly of the UN adopted the 2030 Agenda for Sustainable Development. Goal 3.6 of the agenda calls for a reduction in the absolute number of road traffic deaths and injuries by 50% by 2020, relative to a baseline estimate from 2010. Target 11.2 aims to provide access to safe, affordable, accessible and sustainable transport systems for all by 2030 (UN, 2015).
In preparation for the UN Decade of Action for Road Safety (2011-2020) and its commencement, there was unprecedented agreement from leading international organisations and road safety experts on how to address the road safety crisis emerging in LMICs; the scale of ambitious action required to address this crisis; and the critical factors for successful implementation (Bliss & Breen, 2012; WHO, 2013).
A key development was the release of the World Report on Road Traffic Injury Prevention (see Box 2.5), which was jointly issued by the WHO and World Bank on World Health Day in 2004 (Peden et al., 2004). The World Report highlighted the growing public health burden and forecasts of road deaths and long-term injury and advocated urgent measures to address the problem as a global development and public health priority. Its findings and recommendations for country, regional and global intervention were endorsed by successive United Nations General Assembly and World Health Assembly resolutions (UN 2004-2010).
The initiative was followed by the creation of the World Bank's Global Road Safety Facility (GRSF), which supported the development of new road safety management guidelines to assist countries in implementing the World Report's recommendations. The GRSF funded road safety management capacity reviews and the establishment and support of international professional networks. It established a Memorandum of Understanding with iRAP and other international networks such as the International Road Federations (IRF), International Road Traffic and Accident Database (IRTAD), and the International Road Policing Organization (RoadPOL).
Further guidelines on interventions were produced under the umbrella of the newly created United Nations Road Safety Collaboration (UNRSC) which was called for by a UN General Assembly resolution in 2004 (A/Res/58/289). The international Road Assessment Programme (iRAP) was launched providing a key network safety assessment tool for LMICs. The launch of the OECD's Towards Zero report brought together and further reinforced the Safe System and new thinking on approaches to road safety management (OECD, 2008). The highly visible Make Roads Safe campaign and reports were launched by the Commission for Global Road Safety (2006, 2008, 2011) and caught worldwide media attention. Towards the end of the decade, the first ever global Ministerial Conference on Road Safety took place in Moscow, which provided formal endorsement at the highest level of the need for global action. In a series of statements, the Multilateral Development Banks (led by the World Bank) promised a coordinated response for scaled-up investment in road safety management capacity and for road safety to find its place in mainstream infrastructure projects (MDB, 2009, 2011, 2012).
The above mentioned initiatives resulted in the unanimous adoption of a resolution by the United Nations General Assembly in 2010 announcing the Decade of Action for Road Safety 2011-2020. This was followed by the launch of a Global Plan produced by the UN Road Safety Collaboration in 2011 (UN, 2010a; UNRSC, 2011a).
The goal that was set as part of the first Decade of Action aimed to stabilise and then reduce forecast road deaths by 2020 (WHO, 2013). This represented an estimated saving of 5 million lives (Figure 2.1) and 50 million fewer serious injuries, with an overall benefit of more than US$3 trillion (Guria, 2009).
Figure 2.1 Goal of the first Decade of Action for Road Safety 2011–2020 - Source: Adapted from Guria, (2009); WHO, (2013).
The Global Plan for the first Decade of Action adopted the Safe System approach and recommended that countries work within the five pillars of action, as summarised in Box 2.1. National road safety performance is monitored at an international level and periodic status reports are published by the WHO (WHO, 2009, 2013, 2015, 2018).
Pillar 1: Road safety management
This pillar highlights the need to designate a jurisdictional lead agency to develop and lead the delivery of targeted road safety activity and to provide capacity for this and related multi-sectoral coordination, which is underpinned by data collection and evidential research to assess countermeasure design and monitor implementation and effectiveness (see The Road Safety Management System )
Pillar 2: Safer roads and mobility
This pillar aims to raise the inherent safety and protective quality of road networks for the benefit of all road users, especially the most vulnerable (e.g. pedestrians, bicyclists and motorcyclists). This will be achieved through the implementation of road infrastructure assessment and improved safety-conscious planning, design, construction and operation of roads (see Road Safety Management of this manual).
Pillar 3: Safer vehicles
This pillar encourages universal deployment of improved vehicle safety technologies for both passive and active safety through a combination of harmonisation of relevant global standards, consumer information schemes, and incentives to accelerate the uptake of new technologies.
Pillar 4: Safer road users
The aim of this pillar is to encourage the development of comprehensive programmes to improve road user behaviour, and sustained or increased enforcement of laws and standards, combined with public awareness/education to increase seat belt and helmet wearing rates, to reduce drink-driving, speed and other risk factors.
Pillar 5: Post-crash response
This pillar targets increased responsiveness to post-crash emergencies and improved ability of health and other systems to provide appropriate emergency treatment and longer-term rehabilitation for crash victims.
Source: UNRSC, (2011a).
Experience with regional targets indicates that they can play an important road safety role and provide a focus for regional and national intervention (ETSC, 2011). (see Box 2.2 and Box 2.3; UN, 2010b, UNRSC 2011b).
Asia and Pacific Region:
The Economic and Social Commission for Asia and the Pacific (ESCAP) developed regional road safety goals, targets and indicators for Asia and the Pacific as a follow-up to a Ministerial Declaration on Improving Road Safety. At subsequent road safety expert group meetings in 2009 and 2010 these goals, targets and indicators were further defined in order to align with the targets and indicators of the Global Plan of Action for Road Safety 2011-2020. Subsequently, ESCAP has resolved to develop a regional plan of action in line with the Second Decade of Action for Road Safety 2021-2030 and related Global Plan.
European Union:
Regional goals and targets have been set by the European Commission. These are that by 2050, the EU should move ‘close to zero fatalities’ in road transport and target halving road deaths for the interim by 2020. The EU has reaffirmed its ambitious long-term goal, to move close to zero deaths by 2050 with new intermediate targets to halve the number of fatalities and - for the first time - also the number of serious injuries on European roads by 2030, from a 2020 baseline. While highly ambitious aspirations, these are very important statements that road safety must have a priority status if EU countries are to continue to lead in global road safety, as desired by all the EU institutions.
Eastern Mediterranean Region:
Currently, more than 80% of countries in the Region report having an agency which leads national road safety efforts. In only 10 countries, lead agencies are funded and in seven countries they are fully functional in terms of coordination, legislation, monitoring and evaluation. Road safety strategies are present in about 80% of countries in the Region. Eleven countries have one national strategy while four countries have multiple strategies. In 52% of countries the strategies are partially or fully funded. Targets on fatal and non-fatal injuries exist in the strategies in 43% and 24% of countries, respectively.
Regions of the Americas:
The Pan American Health Organization in 2011 announced a Plan of Action on Road Safety with guidelines for Member States. The plan will help countries of the Americas meet the goals of the global Decade of Action for Road Safety 2011–2020.
Sources: ESCAP, (2015); EC, (2011a, 2011b, 2020); WHO (2013, 2015)
The Second African Road Safety Conference held in 2011 was organized by the UN Economic Commission for Africa, the Sub-Sahara Africa Transport Policy Program (SSATP) and the Government of Ethiopia, in collaboration with the International Road Federation (IRF), the African Union Commission (AUC), the African Development Bank (AfDB), and the World Bank. The objectives of the conference were to:
(i) examine and validate the African Road Safety Action Plan that would serve as a guiding document for the implementation of the Decade of Action;
(ii) propose and validate a resource-mobilisation strategy and a follow-up mechanism; and
(iii) learn from good practice and share experiences.
The United Nations Economic Commission for Africa (UNECA) requested that SSATP write the Road Safety Policy Framework to underpin an African Road Safety Action Plan, which was approved by the Ministers of Transport and vetted by the Heads of State in January 2012. The plan is organized around the five pillars of the Global Plan and aims to reduce forecasted fatalities for 2020 by 50%. This involves stabilising the number of deaths at 320,000, then gradually reducing them to 270,000. If the target is met, more than 1 million forecasted deaths and 10 million serious injuries will be prevented, with a social benefit of around US$340 billion.
Pursuant to the recommendations of the African Union Specialized Technical Committee on Transport, Transcontinental and Interregional Infrastructure, and Energy (STC-TTIIE) meeting in Cairo in 2019, UNECA and AUC formulated Africa's post-2020 Strategic Directions for Road Safety and prepared a draft of Africa's Road Safety Action Plan for the decade 2021-2030.
Taking not of these initial strategic directions, and the UN Resolution A/RES/74/299 "Improving global road safety", the STC-TTIIE adopted an updated versions of the "Strategic Directions for the post-2020 Decade: African common position" with the target to reduce road deaths and injuries by 50% by 2030 as well as to promote the implementation of the Safe System approach. The STC-TTIIE requested AUC to finalize the Action Plan in collaboration with ECA, taking into consideration the Global Action Plan for the Second Decade of Action for Road Safety.
Source: African Union, (2011, 2022).
National target-setting in road safety is an international success story. Setting challenging but achievable quantitative targets towards the Safe System goal in order to eliminate death and long-term injury has been identified as international best practice (OECD, 2008). Until sufficient management capacity and performance data are available in LMICs to set meaningful national targets, countries are advised to adopt the long-term Safe System goal and target reductions in specific corridors and areas using survey data of infrastructure safety quality (e.g. Road Assessment Programmes) and safety behaviours (e.g. speed, crash helmet and seatbelt use, drinking and driving). Full discussion and detailed guidance on national target-setting and the development of targeted strategies, plans and projects is provided in Targets and Strategic Plans.
Progressive shifts in road safety thinking and practice have taken place since the middle of the last century. As outlined briefly in Scope of the Road Safety Problem, an increasingly ambitious approach has been identified, which has culminated in the Safe System goal of eliminating road crash deaths and serious injuries (Peden et al., 2004; OECD, 2008; GRSF, 2009).
In the 1950s and 1960s, rapid motorisation took place in many OECD countries, accompanied by increasing numbers of road deaths and serious injuries. At that time, the emphasis in policy-making was on the driver. Legislative rules and penalties were established, supported by information and publicity, and subsequent changes in behaviour were expected. As experience has shown, it was wrongly believed that since human error contributed most to crash causation, educating and training road users to behave better could address the road safety problem effectively.
During the 1970s and 1980s, a systems perspective on interventions was evident. William Haddon, an American epidemiologist, developed a systematic framework for road safety based on a disease model that comprised infrastructure, vehicles and users in pre-crash, in-crash and post-crash stages (Haddon, 1968). Central to this approach was the understanding that the exchange of kinetic energy in a crash leads to injury, which needs to be managed to ensure that the thresholds of human tolerances to injury are not exceeded. This broadened the scope of intervention to highlight the need for system-wide delivery.
By the early 1990s, countries achieving good results had progressed towards implementing action plans with quantitative targets to reduce death and sometimes serious injuries (OECD, 1994, 2008; PIARC, 2012). The reductions achieved in different groupings of EU countries are presented in Figure 2.2.
Figure 2.2. Reduction in road deaths for different combinations of EU countries since 2000 – Source: ETSC (2017).
The 28 European Member States reduced the number of road deaths by 19% between 2010 and 2016, however, a reduction in progress had to be registered in recent years (ETSC, 2017). In many countries, casualty reductions have been achieved through system-wide intervention packages. Typically, four broad categories of interventions were responsible for the majority of safety gains achieved. These are:
By the late 1990s, two of the world’s best performing countries had determined that maintaining continuous improvement in performance would require a more ambitious, comprehensive and sustainable approach than had been adopted in previous practice. The Dutch Sustainable Safety and Swedish Vision Zero strategies aimed to make the road system intrinsically safe (Koornstra et al., 1992; Tingvall, 1995; Wegman & Elsenaar, 1997).
In both the Sustainable Safety and Vision Zero approaches, new emphasis is given to managing the exchange of kinetic energy in a crash to ensure that the thresholds of human tolerances to injury are not exceeded. Road deaths and serious injuries are no longer seen as a necessary price to be paid for improved mobility (Tingvall & Haworth, 1999).
The Safe System approach goes further than traditional approaches that focused on safer vehicles, safer roads and safer users. This newer approach now also addresses the critical interfaces between them. The ‘engineered’ elements of the system, i.e. vehicles and roads, can be designed to be compatible with the human element, recognising that while crashes might occur, the total system can be designed to minimise harm (Tingvall, 1995; Ydenius, 2010). This shared responsibility for better design is a key element of the Safe System approach.
In a sustainably safe road traffic system, infrastructure design inherently and drastically reduces crash risk. Should a crash occur, the process that determines crash severity is conditioned in such a way that severe injury is almost excluded.
Towards sustainably safe road traffic, Koornstra et al., (1992).
The Safe System approach:
Source: Bliss and Breen, 2012; OECD, (2008).
In-depth discussion of the Safe System approach, its scientific basis and scope is set out in Safe System Approach. An introduction to steps to implementing Safe System projects in low-income countries are set out in Institutional Management Functions in Management System Framework and Tools and discussed more fully in Safe System Approach and Targets and Strategic Plans.
Source: Observatoire National Interministériel de Sécurité Routière (2004); FIA Foundation (2006).
Managing road safety requires institutional leadership, cooperation and delivery capacity within government agencies, as well as with their industry, business sector and civil society partnerships over a sustained period. Road safety leadership and capacity at the jurisdictional level cannot be outsourced since the issues involved go to the core of government decision-making. Careful leadership and effective governance is essential to ensure that competing interests will not obscure this shared responsibility (GRSF, 2009; SSATP, 2014).”
The World Report on Road Traffic Injury Prevention (Peden et al., 2004) highlights the fundamental role of the lead agency for road safety. Its priority recommendation to countries is to establish leadership arrangements and guidance based on successful practice. Experience has demonstrated the need for the agency to be a governmental body and to be publicly accountable for its performance. Without this leadership to organise the actions of all agencies and stakeholders, experience shows that even the best strategies and plans will not be implemented.
Successful road safety management is a systematic process. This has been defined and effective practice has been translated into working management system models for jurisdictions and organisations to provide tools to help address the Decade’s goals (GRSF, 2009; GRSF, 2013 OECD, 2008; ISO, 2012). As illustrated in Figure 2.3, key institutional management functions produce effective, system-wide interventions designed to produce road safety results for the interim and the long-term. See Safety Management System for a further discussion of country and organisational road safety management system frameworks.
Figure 2.3 Road safety management is a systematic process - Source: GRSF (2009) (building on frameworks of LTSA, 2000; Wegman, 2001; Koornstra et al., 2002; Bliss, 2004).
The key challenge for LMICs and international development is how to successfully implement the Global Plan's recommendations where road safety management capacity is weak. The critical issues for success are:
Sources: Bliss & Breen, 2012
Road safety management capacity reviews conducted for the Global Road Safety Facility since 2006 indicate that a clearly defined results focus is often absent in LMICs.
Coordination arrangements should be effective and supporting legislation complete. Funding needs to be sufficient and well targeted, promotional efforts broadly directed, monitoring and evaluation systems developed and knowledge transfer unlimited. Where national targets and plans have been created, adequate capacity to implement them is needed to make sure they are effective (GRSF, 2006-2012). Sustained investments will be needed in governance and institutions, infrastructure, vehicle fleets, and related investments in the health and wellbeing of citizens to address their vulnerability to risks of death and injury.
Meeting the management challenges of the Decade of Action for Road Safety will require these critical success factors to be addressed, if its ambitious goal is to be achieved (Bliss & Breen, 2012).
Based on reviews of successful as well as unsuccessful practice, the World Bank’s Global Road Safety Facility has produced a country investment model in road safety management guidelines that is designed to assist LMICs and development aid agencies in addressing the issues outlined above (GRSF 2009, 2013). These guidelines outline a practical approach designed with tools that are described further in Safety Management System. Specific guidance on steps to be taken by roads authorities in relation to the safe planning, design, operation and use of the road network is outlined in Part Planning, Design & Operation.
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