Transcript Document 7275624

Confronting “Death on Wheels”
Making Roads Safe in Europe and Central
Asia
ESTABLISHING MULTISECTORAL PARTNERSHIPS TO ADDRESS A SILENT EPIDEMIC
PATRICIO MARQUEZ AND GEORGE BANJO
THE WORLD BANK
MARCH 17, 2010
Outline: Challenges and Opportunities
in Addressing Road Safety in the ECA Region*,
with particular attention to Poland
1.
The problem: trends, size, characteristics, causes
2.
Effective measures to improve road safety
3.
Current international road safety policy
4.
Possible strategies and actions by the World Bank with partners
*Baltic,
Balkans, EE, CIS, Turkey.
Road Traffic Injury (RTI) Mortality Rate Trends
Europe, EU-27 and CIS Countries, per 100,000, 1980–2007
large, increasing disparities
30
25
CIS
20
European Region
EU
CIS
15
European Region
10
EU-27
5
1980
1990
2000
2010
CIS countries: Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, the Republic of Moldova, Russia,
Tajikistan, Turkmenistan, Ukraine, and Uzbekistan.
EU-27 countries: Austria, Belgium, Bulgaria, Cyprus, the Czech Republic, Denmark, Estonia, Finland,
France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, the
Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, and the United Kingdom.
Source: WHO EURO Health for All Data Base (2009).
RTI Death Rates in WHO-EURO Member Countries, per 100,000 Population, 2007
Kazakhstan
Russian Federation
Kyrgyzstan
Ukraine
Montenegro
Turkmenistan
Latvia
Georgia
Belarus
Slovakia
Rep. of Moldova
Greece
Estonia
Poland
Slovenia
Tajikistan
Albania
Armenia
Croatia
Turkey
Average-WHO-EURO
Bulgaria
Azerbaijan
Romania
Hungary
Czech Republic
Bosnia & Herzegovina
Portugal
Cyprus
Kazakhstan
30.6
Russian Federation
Kyrgyzstan
25.2
22.8
22.4
Lithuania
Ukraine
Montenegro
21.5
20.4
Turkmenistan
Latvia
18.6
17.9
Georgia
16.8
Belarus
Slovakia
15.7
15.1
15.1
Republic of Moldova
Greece
14.9
14.7
Estonia
Poland
Slovenia
14.7
14.6
14.1
Tajikistan
Albania
13.9
13.9
Armenia
Croatia
Turkey
13.6
13.4
13.4
WHO EURO
Bulgaria
13.2
13.0
Azerbaijan
Romania
Hungary
12.7
12.3
12.0
Czech Republic
Bosnia and Herzegovina
10.9
10.4
Portugal
Cyprus
Belgium
10.4
10.2
10.0
Iceland
Serbia
9.8
9.7
Uzbekistan
Italy
Spain
9.6
9.3
Ireland
Austria
8.5
8.3
France
7.5
Finland
MKD*
7.2
6.9
Germany
Israel
6.0
5.7
5.4
United Kingdom
Sweden
Norway
5.2
5.0
4.9
Switzerland
Netherlands
Malta
4.8
3.4
San Marino
3.2
0.0
5
10
15
High-income countries
Low- and middle-income countries
Belgium
Iceland
Serbia
Uzbekistan
Italy
Spain
Ireland
Austria
France
Finland
Fmr Yugoslav Rep. of Macedonia
Germany
Israel
UK
Sweden
Norway
Switzerland
Netherlands
Malta
Source: WHO-EURO, 2009
San Marino
20
Deaths per 100 000 population
25.0
25
30.0
30
35.0
Ukraine
Uzbekistan
Death Rates 2007
Turkmenistan
Turkey
Tajikistan
Slovenia
Slovakia
Serbia
Russia
Romania
Rep of Macedonia
Poland
Montenegro
GDP per capita US$
Moldova
Lithuania
Latvia
Kyrgyzstan
Kazakhstan
Hungary
Georgia
Estonia
Czech Republic
Croatia
Bulgaria
Bosnia&Herze.
Belarus
Azerbaijan
Armenia
Albania
GDP Per Capita (US$)
Higher GDP does not guarantee
lower mortality
GDP Per Capita and Mortality Rate by Country in ECA
Mortality Rate
25000
35
20000
30
25
15000
20
10000
15
10
5000
5
0
0
Trends in progress towards road
fatality targets in Poland
(source IRTDA 2009)
7000
6000
5827
5534
5712
5259
5124
5000
Number of facilities
5640
5583
5444
5243
5437
4903
4744
4571
4392
4262
4067
4000
3974
3765
3705
3486
3455
3228
3000
3221
3003
2989
2800
2767
2000
1000
2001
2002
2003
2004
2005
2006
National Target GAMBIT Program
2007
2008
2009
Real number of fatalities
2010
2011
EU target
2012
2013
The situation in Poland

Although road safety in Poland has improved over the last decade,
Poland still lags behind other European Union countries.

Poland’s progress towards the achievement of the EU and the
national (GAMBIT Program) road fatality reduction targets by
2010 and 2013, respectively, shows a substantial gap between
the projected progress and actual outcomes.

To achieve these targets, Poland needs to reduce road fatalities by
50 percent from the current level.

In 2008, 5,437 people died and 62,097 were injured in 49,054
road accidents in Poland. If Polish roads were made as safe as the
average EU country, over 2000 lives could be saved each year
compared to the level achieved in 2008.
Deaths, disability and damage –
who bears the brunt?
4-wheel vehicle occupants: 40-75% of RTI deaths in ECA
Young adults, especially men:
55% of road traffic deaths in ECA countries are people aged 15–44,
mostly 15–29; > 80% of deaths are men
Cyclists, motorcyclists at high risk (but small % of total)
Motorcyclists, pedestrians at 7-9 times greater risk of death if in
an road crash than people in vehicles
Pedestrians – more likely to be children or elderly, and
people with lower incomes
In Albania, Belarus, Kyrgyzstan, Tajikistan, and Ukraine, pedestrians are ≥
40% of all road fatalities, 31-38% in all ECA
Deaths, disability and damage – extent

80,000 road traffic deaths, 820,000 injuries in ECA in 2007
(Data underestimate and underreport – especially non-fatal injuries, and differ in availability, quality, and
completeness)

Economic Impact: 1-2% of GDP (health care & rehabilitation costs, insurance, legal,
lost productivity, property damage)
Globally, costs to governments > US$500 billion annually
Highest costs in ECA: large economies with big populations:
Russia (US$34 billion per year, 33,308 deaths in 2007)
Turkey (US$14 billion)
Poland (US$10 billion)
Ukraine (US$5 billion)

Air pollution, noise

Greenhouse gas emissions contribute to global warming

Fear deters walking, biking. Less mobility and physical activity reduces health, increases
risks for cardiovascular diseases, strokes, diabetes, obesity
Road Traffic Injury Causes

Lack of data /problem awareness

Inadequate response, resources
“Are you in a hurry to reach us?"
Roads

Bad road design (no crossings, walkways, poor visibility)

Roadside hazards (trees, poles, signs)

Mixing traffic and pedestrians
Vehicles

Unsafe vehicles, without airbags & other crash protection devices

Huge increase in vehicle numbers (poor public transport)
Behaviors
 Inadequate laws/rules + poor enforcement

Bad driving (speeding, recklessness, alcohol, some medications)

Not using seatbelts, helmets (cyclists, motorbikes)

Mobile phone texting
WHAT TO DO?

INTERVENTIONS ALONE WILL NOT
SUFFICE
Current Road Safety Policy –
Holistic “Safe Systems” approach
Principles:
• Cannot prevent all road crashes, can
reduce traffic injuries
• Design road traffic systems to take
account of human error and vulnerability
of human body
• Responsibility and accountability for road
safety shared by road and car designers
and road users

Effective Approaches
Action Areas:



Prevent road traffic crashes and injury
Minimize injuries when crashes occur
Recovery: reduce injury severity afterwards
The Haddon Matrix: a holistic framework for intervention focusing
on road transport and its risks

Car crashes divided into 3 phases: before, during and after to
highlight when crashes can be prevented or their effects
minimized
Haddon`s Matrix
Adopting a Road Safety Management System
Source: Bliss and Breen, building on the frameworks of Land Transport Safety Authority, 2000; Wegman, 2001; Koornstra et al, 2002; Bliss, 2004
Institutional management functions

Delivered by government entities, in
partnership with civil society and business
entities to achieve RESULTS
RESULT FOCUS

A foremost and pivotal institutional management
function

It is a programmatic specification of targets and
means to achieve them with accountability

Provides cohesion and direction, strategic orientation
linking interventions with results, analyzes what could
be achieved over time

Sets a performance management framework for
delivery of interventions and their intermediate and
final outcomes
FUNCTIONS (i)

Coordination: horizontally and vertically,
partnerships

Legislation: the legal instruments for
governance; defines responsibilities,
accountabilities, interventions, and related
institutional management functions
FUNCTIONS (ii)

Funding and resource allocation: how to
finance interventions and related
management functions on a sustainable
basis

Different mechanisms adopted in various
countries
Financing Sources
Traditional funding sources:
Alternative financing sources:
• General tax revenues
• Price/tax policy (fiscal incentives for
private and business investments in
safety measures such as retrofitting
older vehicles with safety belts)
• Road funds (fuel taxes, vehicle
registration and licensing fees, and
heavy vehicle road use charges)
• Road user fees (driver’s and car
license fees, vehicle inspection fees)
• Vehicle insurance premium levies
• Earmarked charges (eg revenue
from traffic fines used to finance road
safety activities)
• Insurance premiums (higher
premiums for less safe vehicles, and
drivers with poor safety records; payas-you-drive or pay-as-you-speed
mechanisms, spread costs of risks for
injury-causing crashes more fairly;
assign total cost of car crashes to the
person who caused it)
• Financial options (make unsafe
behavior more expensive and give
financial reward for safe behavior)
Source: Adapted from OECD (2002) and Aeron-Thomas and others (2002), cited in Peden and others (2004);
ECORYS (2006).
FUNCTIONS (iii)

Promotion: sustained communication of road
safety as core business for government and
society to support interventions

Monitoring and evaluation: the systematic
and ongoing measurement of outputs and
outcomes, and impact evaluation—did
results were achieved? Need for registries
for vehicles and drivers, crash databases, and
survey work
FUNCTIONS (iv)

Research and Development and
Knowledge Transfer: the systematic and
ongoing creation, codification, transfer and
application of knowledge that contributes
to improved efficiency and effectiveness
of road management system.

Knowledge transfer must be evidencebased and grounded in practice by a
learning by doing process.
Classification of Interventions
Intervention types
Standards and rules
Compliance
Planning, design, operation and
use of the road network
Standards and rules cover the
safe planning, design,
construction, operation and
maintenance of the road
network; and govern how it is
to be used safely by setting
speed and alcohol limits,
occupant restraint and helmet
requirements, and restrictions
on other unsafe behaviors.
Compliance aims to make road
builders and operators, the
vehicle and transport industry,
road users and emergency
medical and rehabilitation
services adhere to safety
standards and rules, using a
combination of education,
enforcement and incentives.
Conditions of entry and exit of
vehicles and road users to the
road network
Standards and rules also address
vehicle safety standards and
driver licensing requirements
Recovery and rehabilitation of
crash victims from the road
network
Standards and rules can also be
set for the delivery of
emergency medical and
rehabilitation services to crash
victim
Source: Bliss, 2004
Effective proven measures
Better road design









Remove roadside hazards (trees, poles)
Install crash barriers
Clear, helpful, safely placed road signs
Central islands, “pedestrian refuge”
Well-designed pedestrian crossings
Separate vehicles from pedestrians and cyclists
Audible road edge-lining, seal shoulders, construct passing lanes
Better road markings
Traffic calming (speed bumps, cameras)
Effective proven measures (2)
Improve vehicle safety




In-vehicle crash protection (airbags, seatbelts, child car seats)
Vehicle licensing and inspection to enforce roadworthy standards
Daytime running lights
Require and enforce helmet use with bicycles, motorbikes
Effective proven measures (3)
Behavior change - education, law/regulation enforcement







Lower speed limits: 30 km/hr in residential areas, 50 km/hr in other
urban areas
Enforcing blood alcohol level limit of ≤0.05g/dl could prevent 540% of RTI deaths (random breath testing better than set checkpoints,
taxes and marketing, sales regulations are effective)
Mandatory, enforced seat belt use
Prevention of distracting driving due to use of phones and
texting
Media coverage, education campaigns + tough sanctions
Graduated driving licenses (curfew, passenger restrictions) and more
training during learner period reduce deaths among young drivers (US)
Better public transport and land use reduces car travel
Health Sector Response





Public health actions: collect and analyze data, research causes of
RTI, advocate effective action, define and implement protective
policies and practices and preventive interventions
Primary health care providers: medical assessments of
elderly/impaired drivers, advice on alcohol use and effects on
driving of medications
Emergency medical services: communication for rapid response,
initial emergency care and stabilization, transport to health facility,
well-trained teams with medicines and equipment, quality
assurance
Safe blood supply &transfusion
Rehabilitation services
Cost-effectiveness – depends on risk factors, and
distribution of fatalities/injuries by road user group
Average cost per disability-adjusted life (DALY) year saved, adjusted for purchasing
Average cost per DALY saved
power parity
$-
$10,000
$20,000
$30,000
$40,000
$50,000
$60,000
Enforcement of speed limits (via fixed/mobile cameras)
Drink-drive legislation & enforcement (breath-testing)
Legislation & primary enforcement of seat belt use
Legislation & enforcement of helmet use by motorcyclists
Legislation & enforcement of helmet use by bicyclists
Speed cameras + breath-testing
Seatbelts + motorcycle helmets
Speed cameras + breath-testing + seatbelts
Speed cameras + breath-testing + motorcycle helmets
Seatbelts + motorcycle helmets + breath-testing
Seatbelts + motorcycle helmets + speed cameras
EurB
Seatbelts + motorcycle helmets + speed cameras + breath-testing
EurC
Seatbelts + motorcycle helmets + speed cameras + breath-testing + bicycle helmets
$70,000
Safety Target
Final outcomes
Final outcomes can be expressed as a long term
vision of the future safety of the road traffic
system (e.g., as in Vision Zero and Sustainable
Safety) and as more short to medium-term
targets expressed in terms of social costs,
fatalities and serious injuries presented in
absolute terms and also in terms of rates per
capita, vehicle and volume of travel
Intermediate outcomes
Intermediate outcomes are linked to
improvements in final outcomes and typical
measures include average traffic speeds, the
proportion of drunk drivers in fatal and serious
injury crashes, seatbelt-wearing rates, helmetwearing rates, the physical condition or safety
rating of the road network and the standard or
safety rating of the vehicle fleet.
Outputs
Outputs represent physical deliverables that seek
improvements in intermediate and final
outcomes and typical measures include
kilometers of engineering safety improvements,
the number of police enforcement operations
required to reduce average traffic speeds and the
number of vehicle safety inspections, or
alternatively they can correspond to milestone
showing a specific task has been completed.
Source: Bliss, 2004
ECA Efforts to Prevent Road Transport Injuries
Of 29 countries in ECA:
• 27 have a lead agency for road safety
• 19 allocate funds in the national budget
• 19 have a strategy with clear targets, 16
of these are funded
• 25 set blood alcohol limits at/below
recommended level (0.05g/dl)
• 27 do spot checks for alcohol levels
• many require formal audits for major
new road construction projects and
regular audits of existing roads,
• many promote public transportation,
walking, and cycling
But
• Only 8 countries have seatbelt used at
least 70% (in front seats)
• Urban speed limits are 60km/h in 15
countries, 70 km/h in 1 (higher than
recommended)
• Quality of formal, publicly available prehospital post-crash care systems varies
• Enforcement is often lacking
much more is
possible
Good Examples:
Poland: public education on road safety, seat-belt use, drunk driving; training for professional drivers;
road signs warning of black spots; improved pre-hospital care
Armenia: dramatic improvements in seatbelt use by enforcing seatbelt law
Russia: fines for not using a seatbelt increased 10x, new law against crossing into an oncoming lane
punishable by revoking driver’s license, anti-alcohol campaigns launched
World Bank Support (to date)
 Practical guidelines to help countries implement these
recommendations
 Global Road Safety Facility generates funding and Technical Assistance
for country road safety efforts
 Road safety management capacity reviews done in many ECA
countries
 World Bank-supported road safety investments in transport and
health projects
 Information and policy dialogue
What more could the World Bank do in ECA?
2004 World Report identifies 6 key steps for success:
1.
2.
3.
4.
5.
6.
Identify a lead agency in government
Assess road traffic injury problems, policies and institutions,
and capacity for prevention
Prepare a national road safety strategy and plan of action
Allocate financial and human resources
Implement specific actions and evaluate their impact
Support national capacity and international cooperation.
Principles: systematic, sustained, successful effort has 3 parts:
Institutional
management
interventions
Results
What more could the World Bank do in ECA? (1)
1.
Build institutional management capacity
 Provide training and information for policy makers, practitioners
 Support existing networks of people responsible for road safety
 Help countries improve data on RTIs and causes
 Specify lead agency reforms needed
2.
Help countries choose interventions well
 Review national road safety management capacity - assess the
situation, propose strategies and actions with realistic targets and
budgets
3.
Support a safe system approach + results focus aiming to end
road deaths and serious injuries (see next slide for specifics)
What more could the World Bank do in ECA? (2)
3.
Support a safe system approach + results focus aiming to end
road deaths and serious injuries:










Analyze planned road investments for safety, improve design
Review road sections where many crashes occur to target investments
Lower urban speed limits to 50 km/h; 30 km/h in residential areas; enforce –
speed cameras are cost effective
Enforce alcohol limits with systematic police enforcement (breath tests, highvisibility random road checks), high-profile media campaigns, and swift severe
penalties
Enforce use of seat belts – campaigns, penalties, car restraint specifications
Reduce young driver risk – graduated licensing scheme, extended training
Reduce pedestrian risk – barriers, traffic “calming”, more pedestrian facilities
Improve speed and quality of emergency care (at crash site and after) –
evaluate, identify and fix weak areas, train
Include road safety as a key “performance attribute” of transport
Demonstration projects, with strong evaluation
Focus areas for World Bank support
that is evidence-based, cost-effective, and follows international best practice:
A.
Capacity reviews – to ensure country commitment, customization, consensus
B.
Ensure lead agency has capacity, mandate, and funding to manage for results
C.
Invest in management capacity to deliver results in stages
D.
Learn by doing demonstration projects that rapidly achieve safety
improvements in high-risk areas, then build on success
Key Partners:

International Road Assessment Program (iRAP) - engineering safety

RoadPOL - traffic police peer-to-peer services

International Road Traffic Accident Database Group - data

World Health Organization (WHO) - technical support in traffic injury
prevention, injury surveillance, emergency trauma services & care

Ministries: transport, health, law enforcement, finance, interior, education

Private sector: insurance, auto makers, media, regulatory agencies

CSOs: consumer organizations, faith-based organizations

Parliaments
World Bank support in Poland
Poland Third Road Maintenance and
Rehabilitation Project: it builds on the
success of two previous road project safety
components under the National Road Safety
Council (NRSC).
 Project supports road safety campaigns on
alcohol and drunk driving, speeding, and child and
pedestrian safety.
 Finances technical assistance to the NRSC
Secretariat.
 Contributes to the program of road safety
initiatives co-financed by the European
Commission and the European Investment Bank.

Effective Road Safety Program Building Blocks
Intervention Area
1. Institutional capacity building
2. National road safety policies,
strategies, plans; organizational &
co-ordination arrangements
Investments and actions
Establish, organize and strengthen management and operational capacity of a lead agency for
road safety, resource it adequately, make it publicly accountable.
Training programs for all official involved in management and design of road safety programs
and implementation of road safety programs.
Technical assistance for developing/updating legislative framework, policies, strategies and
plans with targets to halve RTI fatality rates by 2020.
3. Create safer road
environments
Investments to improve safety in demonstration road corridors and beyond (e.g. guard rails,
signaling and marking, reengineering most critical crossroads in urban areas). Technical
assistance to do network safety rating surveys and road safety audits and inspections.
4. Enforcement: equip and train
traffic police to deter risky
behavior
5. Public information and
education campaigns
Acquire radar equipment, speed cameras, and breath analyzers, to enable roadside checks to
control and monitor speed, alcohol, and seatbelt use.
6. Improve health promotion and
prevention programs, emergency
medical services, and
rehabilitation services
As part of health system reforms and modernization, technical assistance to strengthen
public health programs, national and regional road safety strategies, and organizational
arrangements for first aid emergency responses; funding for ambulances, medical equipment
and other inputs; training of medical personnel on basic and advanced life support systems;
communication systems investments; and technical assistance and investments to
develop/strengthen trauma centers, safe blood transfusion services, and rehabilitation
programs.
7. Monitoring and evaluation
Investments in computerized information systems for data collection, assessment and
sharing information for decision-making and program management across sectors.
Technical assistance and funding to develop public IEC programs to support enforcement of
laws and regulations for speed-control, seatbelt use, and deterring drinking and driving.
What else needs to be done in
Poland?






Results Focus: improving institutional management functions for road safety in
Poland would require: (i) strengthening institutions and governance capacity for
RTI prevention, including the Ministry of Infrastructure (MOI) that has legal
responsibility on behalf of the government for road safety and the National Road
Safety Council (NRSC) which is in practice the lead agency.
Coordination: improving coordination among participating agencies and with
regional governments, private sector, non-governmental agencies.
Legislation: improving the main legislative road safety requirements so that
they further align to European norms
Funding: securing sustainable funding as road safety in Poland is reliant on
international donor assistance
Monitoring and Evaluation: Improving nationwide traffic injury surveillance
systems and supporting national road safety reviews are a sound basis for
formulating policies and plans, particularly at the regional level;
Emergency Medical Services: improving the delivery of emergency medical
services by adopting new organizational and governance models for operating
post-vehicle crash and trauma care services at health facilities
Take Away Messages:

Safe, clean, affordable transport is a development priority.

Preventing road traffic injuries is a major public health priority.

Proven, effective, cost-effective “good practices” can save lives and
money, prevent disability, improve other health outcomes and the
environment.

A “safe system” needs well-coordinated, cooperative action by
transport, health and policing/enforcement sectors. Interventions
alone will not suffice.

The World Bank could do more, with partners, to help countries
in Eastern Europe and Central Asia make roads safer. Specific
areas for action are clear.
Thank you!