Bumps in the Road: The Many Levels of Road Traffic Safety and Injury

By: Dr. Janet Pruv Bettger

Crossing busy and congested Kira Road on my way up to Mulago Hospital I found myself thinking of the recent WHO facts sheet on road traffic injuries. This detailed summary of facts and prevention strategies was an important reminder of the decade long commitment to road safety by 110 countries. I was distracted from my thoughts suddenly as two taxis—vehicle versus motorcycle boda boda—fought for space on the road in front of me. I didn’t want to be a statistic that day. I stayed focused, crossed the road and I was fortunate. However, 3,400 other people died that day and are dying every day around the world due to avoidable road traffic accidents.

How much is broken?

Not all road traffic accidents result in death. An estimated 50 million people experience non-fatal road traffic injuries each year. Unfortunately the story doesn’t end with survival. A cascade of challenges can result when a system to deal with injuries is not fully in place. Individuals with traumatic brain injury or orthopedic trauma as a result of road traffic accidents for example need specialized emergency care, sometimes surgery and most often rehabilitation. Access to the services available in most countries requires a form of health insurance or payment and transportation both in an emergency and for needed after care. The fragmentation between acute hospital care and community-based services and support can be so extreme in some regions that families and road traffic victims are left to their own creativity for solutions day-to-day management. Physical and cognitive impairment can affect the ability to care for others, return to work, even feed and clothe oneself. Lost wages from delays or inability to return to work can be magnified by the need for others who now also need to leave school, jobs and their own homes to provide care and assistance. What starts as issues of health care availability, access, fragmentation and the need for long-term services and supports quickly spirals into a web of social and economic complexities. A coordinated multi-system strategy is needed to support life after a road traffic injury.

Unfortunately many more people die from road traffic injuries than live. Ninety percent of 1.25 million resulting deaths are in LMICs and the 2015 global status report showed that 50% of deaths in Africa are among pedestrians (39%), cyclists (4%) and 2-3 wheel motorcycles (7%). Tragic sudden loss of life has far reaching effects particularly for families as they need to put their grief on hold to be able to organize childcare after losing a parent and income after losing a wage earner. In some cases older siblings become the responsible “adult” taking on household chores and employment at a young age. In other cases, youth and new parents are lost too early. Road traffic accidents are the leading cause of death among young adults ages 15-29 years.

A socioecological perspective on prevention strategies

To achieve the sustainable development goal (SDG) that by 2020, the number of global deaths and injuries from road traffic accidents will be halved, an international community of advocates and leaders have mobilized to enact or amend laws addressing key risk factors. Without question these laws on safe speeds, drink-driving, distracted driving, helmet use, seat-belts and child restraints can make a difference. The sustainability and impact of this important work to-date will be greatest in those regions with a multi-level approach.

Can laws and policies alone influence individual behavior? To consider a socioecological perspective to addressing road safety, where different spheres of influence are engaged in the solution, planners will need to partner with stakeholders at many levels, including for example: road traffic engineers to redesign roads, shared space for cyclists, and safe and well-marked crosswalks; employers to alter work hours that can change commute times and ease congestion; schools to incorporate education direct to children and strategies such as those advocated for with Safe to School Safe to Home; and social networks that can influence group norms for policy adherence such as motorcycle taxi drivers and the SafeBoda initiative in Uganda and faith-based communities and the appeal to ministries from officials in Ghana.

Concluding Thoughts

Addressing road traffic safety, injury prevention and treatment to meet aggressive SDG 2020 targets will require multiple-levels of engagement. Partnerships to influence grassroots culture change to environmental redesign to enforced policies can and will make the difference.

References

World Health Organization. Road traffic injuries. [Fact Sheet]. May 2016. Available at: http://www.who.int/mediacentre/factsheets/fs358/en/

United Nations Road Safety Collaboration. Global plan for the decade of action for road safety 2011-2020. Available in different languages from: http://www.who.int/roadsafety/decade_of_action/plan/en/

World Health Organization. Global status report on road safety. 2015. Available in different languages from: http://www.who.int/violence_injury_prevention/road_safety_status/2015/en/

United Nations. Sustainable development goals. 2015. Available from: http://www.un.org/sustainabledevelopment/sustainable-development-goals/

Global Road Safety Partnership. Safe to school safe to home. Available from: http://www.grsproadsafety.org/content/safe-school-safe-home

“SafeBoda.” Available from: http://www.safeboda.com/home/

“Churches urged to devote part of sermon to road safety issues.” Modern Ghana News. November 2011. Available from: https://www.modernghana.com/news/361097/churches-urged-to-devote-part-of-sermon-to-road-safety-issue.html