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U n i t 1

Magnitude and impact of road traffic injuries

By the end of this unit, the trainee should be able to: • describe the global magnitude and trends of road traffic fatalities; • discuss the global socioeconomic and health burden of road traffic injuries; • describe the magnitude and trends of road traffic injuries in his or her own country, region or city; • discuss the socioeconomic and health burden of road traffic injuries in his or her own country, region or city.

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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 Copyright Etienne Creux, Pretoria News

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Distribution of global injury mortality by cause

Other unintentional injuries 18.1% Suicide 16.9%

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

Drowning 7.3% Violence 10.8% Fires 6.2% Falls 7.5% Poisoning 6.7% Road traffic injuries 22.8%

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

War 3.4% Other intentional injuries 0.2% 4 │

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

WHO region Low- and middle income countries High-income countries African Region Region of the Americas South-East Asia Region European Region Eastern Mediterranean Region Western Pacific Region 28.3

16.2

18.6

17.4

26.4

18.5

– 14.8

– 11.0

19.0

12.0

The African Region has the highest mortality rate.

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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.

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WHO predicts that road traffic injuries will rise to eighth place by 2030 as a cause of death

2002 Disease or injury 1. Ischaemic heart disease 2. Cerebrovascular disease 3. Lower respiratory infections 4. HIV/AIDS 5. Chronic obstructive pulmonary disease 6. Perinatal conditions 7. Diarrhoeal diseases 8. Tuberculosis 9. Trachea, bronchus, lung cancers 10. Road traffic injuries 2030 Disease or injury 1. Ischaemic heart disease 2. Cerebrovascular disease 3. HIV/AIDS 4. Chronic obstructive pulmonary disease 5. Lower respiratory infections 6. Diabetes mellitus 7. Trachea, bronchus, lung cancers 8. Road traffic injuries 9. Tuberculosis 10. Perinatal conditions

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

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© WHO, 2007 Source: Kopits E, Cropper M., 2003.

Downward trends in road traffic fatalities in high-income countries

35 30 25 20 15 10 5 0 1960 1962 1964 1966 1968 1970 1972 1974 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002

Years

UK Australia USA

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Upward trends in road traffic fatalities in low-and middle income countries

Brazil

18 16 6 4 2 0 14 12 10 8 1961 1971 Years 1981 1991 10 │

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Upward trends in road traffic fatalities in low-and middle income countries

India

9 8 7 2 1 0 6 5 4 3 1971 1975 1981 1985 1991 1992 1993 1994 1995 1996 1997 1998 Years 11 │

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Upward trends in road traffic fatalities in low-and middle income countries

Trinidad and Tobago

25 20 15 10 5 0 1960 1965 1970 1975 1980 Years 1985 1990 1995 2000 12 │

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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% 20% 40% Pedestrians Bicyclists Motorized 2-wheelers Source: Various WHO collaborators in countries 60% 80% Motorized 4-wheelers 100% Other

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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.

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The costs of road traffic injuries are enormous

Region

Africa Asia Latin America and Caribbean Middle East Central and Eastern Europe Subtotal Highly motorized countries Total Source: Jacobs G, et al. 2000.

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GNP 1997 (US $ billion)

370 2 454 1 890 495 659 5 615 22 665

Estimated annual crash GNP (%)

1 1 1 1.5

1.5

2

Costs (US $ billion)

3.7

24.5

18.9

7.4

9.9

64.5

453.3

517.8

Economic costs of road traffic injuries to households

• Loss of main breadwinner • Loss of earnings • Medical bills, funeral costs, legal bills • Rehabilitation costs

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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.

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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.

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Task

Look at the table on the next slide which presents data on estimated road traffic fatalities per 100 000 population in the WHO African Region for 2002. Carefully study the table and write down key features related to the distribution of road traffic fatalities per 100 000 by sex and age.

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Estimated mortality a caused by road traffic injuries b in WHO African region

Age c in years

0 –4 5 –14 15 –29 30 –44 45 –59 60 and above

Total Males

18.6

42.6

27.2

53.4

65.7

81.9

39.3

Females

11.0

25.5

10.0

15.0

22.1

35.8

17.4

a Mortality is measured by number of road traffic fatalities per 100 000 population.

b Road traffic injury = ICD10 V01 –V89, V99, Y850 (ICD9 E810–E819, E826–E829, E929).

C Age-standardized.

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Expected results

The purpose of this exercise is to assist trainees to identify and summarize key elements in the distribution of road traffic fatalities per 100 000 population for the WHO African Region. They are to describe variations noted in this indicator by different age groups for males and females.

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Questions to think about

a) What challenges does your country face as a result of road traffic crashes? b) In most countries, road traffic injury costs exceed 1% of gross national product. This figure is generally considered to be an underestimate of national road traffic collision costs. What is the estimated cost of road traffic injuries in your country? How is this estimate derived? How often is this estimate updated?

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Questions to think about

c) Conduct a review of literature to establish how much research has been done on costs of road traffic injuries in your country. Look for published research on this issue in both local and international journals. This activity is meant to equip you with library research skills and capacity to examine existing literature. You can work on your own, or with two or three colleagues. Try to summarize the results and indicate gaps in knowledge that need to be filled. Consider preparing a manuscript based on your review to submit to a journal.

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Questions to think about

d) Identify a family you know where someone has been involved in a non-fatal road traffic collision recently. Seek permission to gather information on the economic costs of that crash for that family. Prepare a summary of the economic costs to the family and immediate society. Think of ways of using this information to enhance prevention of road traffic injuries in your local setting.

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