1. 1. GLOBALSTATUSREPORTONROADSAFETY2013SUPPORTING A DECADE OF ACTION
2. 2. GLOBALSTATUSREPORTONROADSAFETY2013SUPPORTING A DECADE OF ACTION
3. 3. WHO Library Cataloguing-in-Publication Data:Global status report on road safety 2013: supporting a decade of action.1.Accidents, Traffic - statistics and numerical data. 2.Accidents, Traffic - trends. 3.Wounds and injuries - epidemiology. 4.Safety. 5.Data collection.6.Programme evaluation. I.World Health Organization.ISBN 978 92 4 156456 4 (NLM classification: WA 275) World Health Organization 2013All rights reserved. Publications of the World Health Organization are available on the WHO web site (www.who.int) or can be purchased from WHOPress, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857;e-mail: bookorders@who.int).Requests for permission to reproduce or translate WHO publications whether for sale or for noncommercial distribution should be addressed toWHO Press through the WHO web site (http://www.who.int/about/licensing/copyright_form/en/index.html).The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part ofthe World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of itsfrontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.The mention of specific companies or of certain manufacturers products does not imply that they are endorsed or recommended by the World HealthOrganization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products aredistinguished by initial capital letters.All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, thepublished material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of thematerial lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use.Design and layout by LIV Com Srl, Villars-sous-Yens, Switzerland.Printed in Luxembourg.Made possible through funding from Bloomberg Philanthropies.
4. 4. CONTENTSPreface.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vAcknowledgements.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viExecutive summary.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viiBackground. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1The Decade of Action for Road Safety. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1The purpose of this report.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Methodology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Section 1. The current state of global road safety. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Many countries have successfully reduced the number of deaths on their roads, while deaths are increasing in others. . . . . . . . . 4Middle-income countries are hardest hit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4The African Region has the highest road traffic fatality rate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Half of all road traffic deaths are among pedestrians, cyclists and motorcyclists. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Almost 60% of road traffic deaths are among 1544 year olds. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Non-fatal crash injuries are poorly documented.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Harmonizing data collection on road traffic deaths . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Section 2. New road safety laws: progress to date. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Reducing speed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Progress to reduce excessive speed has stalled. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Reducing urban speeds protects pedestrians and cyclists. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Speed limits need stronger enforcement.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Reducing drinking and driving.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Drinkdrive laws should be based on blood alcohol concentration levels. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Strong drinkdrive laws protect almost 70% of worlds population. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16More stringent drinkdrive laws for high-risk drivers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Drinkdrive laws need stronger enforcement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Almost half of all countries lack of data on alcohol-related road traffic deaths. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Increasing motorcycle helmet use.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Head injuries among motorcyclists are a growing concern. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18More effort is needed to promote helmet standards and quality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Data on helmet use is weak. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
5. 5. Increasing seat-belt use. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22Progress has been made in tightening up seat-belt laws. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22Enforcing seat-belt laws needs more emphasis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23Only half of countries collect seat-belt wearing data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23Increasing the use of child restraints. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25More countries need to adopt child restraint use. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25Encouraging child restraint use. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26Lead agencies are vital to developing a national road safety strategy . . . . . . . . . . . . . . . . . . . . . . . . . . 27Involving multiple sectors in national road safety efforts is critical. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27National road safety strategies should include targets to minimize injuries, deaths and key risk factors. . . . . . . . . . . . . . . . 27Section 3. Transport policies neglect pedestrians and cyclists. . . . . . . . . . . . . . . . . . 29Governments need to make walking and cycling safe. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30Safer roads reduce crash likelihood and severity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32Action is needed to make vehicles safer for non-car road users. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33Public transport can make mobility safer and reduce congestion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33Conclusions and recommendations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39Explanatory notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41Methodology, data collection and validation.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42Country profile explanations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45Estimating global road traffic deaths.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48Country Profiles.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53Statistical Annex. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
6. 6. PrefaceProgress is being made to make the worlds roads safer, but this criticalwork must be intensified and accelerated.In 2010 the governments of the world declared 20112020 as the Decade of Action for Road Safety. They invited the World HealthOrganization to prepare this report as a baseline to assess the state of global road safety at the onset of the Decade, and to be ableto monitor progress over the period of the Decade. The unanimous support for this Decade of Action from Member States indicates agrowing awareness that the devastating scale of road traffic injuries is a global public health and development concern.This report shows that 1.24 million people were killed on the worlds roads in 2010. This is unacceptably high. Road traffic injuries takean enormous toll on individuals and communities as well as on national economies. Middle-income countries, which are motorizingrapidly, are the hardest hit.There is a sound body of scientific evidence behind road safety interventions. Adopting and enforcing legislation relating to importantrisk factors speed, drinkdriving, motorcycle helmets, seat-belts and child restraints has been shown to lead to reductions in roadtraffic injuries. This report illustrates some of the progress made in a number of countries to address these risk factors since publicationof the first Global status report on road safety (2009). Since 2008, 35 countries have passed new laws or amended existing legislationcovering one or more of these risk factors. Nevertheless, in many countries these laws are either not comprehensive in scope or arelacking altogether. Governments must do more to ensure that their national road safety laws meet best practice, and do more to enforcethese laws.Road safety was recognized in global environmental policy deliberations at the recent Rio+20 UN Conference on SustainableDevelopment. A clear link was made between road safety and sustainable development. Encouraging sustainable transport policy mustinclude making non-motorized forms of transport accessible and safe: this report shows that 27% of global road traffic deaths are amongpedestrians and cyclists. To date, these road users have been neglected in transport and planning policy. The world must now increaseits focus on making walking and cycling safer, and protecting these road users from high-speed traffic.The benefits of such a move will be far greater than purely the health benefits of reduced road traffic injuries. Benefits will includereduced air pollution and greenhouse gas emissions, reductions in traffic congestion, and the health outcomes that come from increasedphysical activity.This report shows that, with sufficient political will, road traffic deaths can be averted. In supportingthe Decade of Action for Road Safety, governments around the world have shown their politicalcommitment to make the worlds roads safer. The Decade offers a unique platform upon which toaddress this issue. The challenge is to keep this pledge and enhance the pace of change. Only thencan the goal of the Decade of Action for Road Safety be met.Dr Margaret ChanDirector-GeneralWorld Health OrganizationvSUPPORTINGADECADEOFACTION
7. 7. AcknowledgementsThe Global status report on road safety 2013 benefited from the contributions of a number of WHO staff:Tami Toroyan coordinated and wrote the report, with data management and statistical analysis conducted by Kacem Iaych; Margie Pedenprovided strategic and technical oversight; data collection was facilitated by WHO Representatives and staff at country level; at regionallevel, trainings, data collection and validation were carried out by: Martial Missimikim and Martin Ekeke Monono (Africa); Astrid Arca,Alessandra Senisse Pajares and Eugnia Rodrigues (the Americas); Rania Saad, Hala Sakr and Hala Youssef (Eastern Mediterranean);Francesco Mitis and Dinesh Sethi (Europe); Rania Saad and Chamaiparn Santikarn (South-East Asia); and Krishnan Rajam, MayetDarang and Xiangdong Wang (Western Pacific). Other WHO staff who contributed to the development and production of the reportinclude AlaAlwan, Nicholas Banatvala, Oleg Chestnov, Manjul Joshipura, Doris Ma Fat, Evelyn Murphy, Etienne Krug, Jon Passmore,PascaleLanvers-Casasola, Colin Mathers, Florence Rusciano and Jelica Vesic.Country level data could not have been obtained without the invaluable input of: the National Data Coordinators (see Table A1 in the Statistical Annex); all respondents and attendees of the consensus meetings in countries; government officials who provided clearance of the information for inclusion in the Report.WHO also wishes to thank the following contributors whose expertise made this document possible: Jennifer Ellis, Kelly Henning and Kelly Larson from Bloomberg Philanthropies; Adnan Hyder, Olive Kobusingye, Junaid Razzak and David Ward, who provided expert advice and review comments; Claudia Adriazola-Steil, Abdulgafoor Bachani, Madhav Pai, Nagi Shafik, David Ward, Esti Widiastuti,Gde Yogadhita for providing information for boxes; Alison Harvey for preparing and checking country profiles; Angela Burton who edited and proofread the report; Drew Blakeman for valuable editorial input; Graphic designers from LIV Com Srl who produced the design and layout.Finally the World Health Organization wishes to thank Bloomberg Philanthropies for its generous financial support for the developmentand publication of this report.viGLOBALSTATUSREPORTONROADSAFETY,2013
8. 8. Executive summaryRoad traffic injuries are the eighth leadingcause of death globally, and the leadingcause of death for young people aged1529 (1,2). More than a million peopledie each year on the worlds roads, and thecost of dealing with the consequences ofthese road traffic crashes runs to billionsof dollars (3). Current trends suggest thatby 2030 road traffic deaths will becomethe fifth leading cause of death unlessurgent action is taken (2).Strategies exist that are proven toreduce road traffic injuries and a numberof countries have successfully usedthese strategies to reduce their roadtraffic deaths. In 2004, the World HealthOrganization (WHO) and the World Banklaunched the World report on road trafficinjury prevention (4). The World reportprovides extensive information on leadingrisk factors for road traffic injuries andevidence on effective interventions, andmakes recommendations to countrieson how to improve national roadsafety. Progress in implementing therecommendations of the World report wasfirst reported in the Global status report onroad safety: time for action (2009) (5).In 2010 the United Nations GeneralAssembly unanimously adopted aresolution calling for a Decade of Actionfor Road Safety 20112020, and for furtherGlobal status reports on road safety tomonitor the impact of the Decade atnational and global levels. This reportbuilds on the 2009 report, and providesadditional data in a number of importantareas. It serves as the baseline formonitoring the Decade.The report shows that there has beenno overall reduction in the number ofpeople killed on the worlds roads: about1.24million deaths occur annually.However, this plateau should be consideredin the context of a corresponding 15%global increase in the number of registeredvehicles, suggesting that interventions toimprove global road safety have mitigatedthe expected rise in the number ofdeaths. Eighty-eight countries in whichalmost 1.6 billion people live reducedthe number of deaths on their roadsbetween 2007 and 2010, showing thatimprovements are possible, and that manymore lives will be saved if countries takefurther action. However, of concern isthat 87 countries saw increases in thenumbers of road traffic deaths over thesame period. The report also shows thatthe highest road traffic fatality rates are inmiddle-income countries, particularly theAfrican Region. More than three-quartersof all road traffic deaths are among youngmales. The report notes the need forstandardized data collection on fatalitiesand the need for improvement in thequality of road safety data on road trafficdeaths, non-fatal injuries and disability. Italso stresses the importance of good post-crash care, both in terms of providing quickaccess for road traffic victims to healthcare, and in ensuring the quality of trainedhospital trauma care staff in mitigating thenegative outcomes associated with roadtraffic crashes.The first Global status report onroad safety highlighted the lack ofEighty-eight countries have reduced the numberof deaths on their roads but the total number ofroad traffic deaths remains unacceptably high at1.24million per year.viiSUPPORTINGADECADEOFACTION
9. 9. comprehensive legislation on key riskfactors (speed, drinkdriving, motorcyclehelmets, seat-belts and child restraints) forroad traffic injuries (5). Between 2008 and2011, 35 countries, representing almost10% of the worlds population, passedlaws to address one or more of thesefive key risk factors. The action taken bythese countries to implement new lawsindicates that with country commitment progress is possible. However, therehas been no increase in the numberof countries with adequate legislationon all five key risk factors the 28countries (representing 7% of the worldspopulation) with comprehensive lawsremain unchanged from the last evaluationin 2009. The report also highlights thatenforcement of these laws, which iscritical to their success, is inadequate.The report serves as a strong warningto governments to address the needs ofnon-motorized road users. Twenty-sevenper cent of all road traffic deaths occuramong pedestrians and cyclists. In low-and middle-income countries, this figureis closer to a third of all road deaths, butin some countries is more than 75%. Asthe world continues to motorize, walkingand cycling need to be made safe andpromoted as healthy and less expensivemobility options. However, only 68countries have national or subnationalpolicies to promote walking and cycling,and just 79 countries have policies thatprotect pedestrians and cyclists byseparating them from motorized andhigh-speed traffic. Although governmentsincreasingly recognize the need to promotealternative forms of mobility, moreemphasis needs to be given to makingthese modes of transport safe. Addressingthe safety of pedestrians, cyclists andmotorcyclists is critical to successfullyreducing the total number of global roadtraffic deaths.The report further highlights the importantrole that road infrastructure can playin reducing injuries among all roadusers, including pedestrians, cyclistsand motorcyclists. It recommends thatgovernments implement regular roadOnly 28countries, representing 449million people(7%of the worlds population), have adequatelaws that address all five risk factors (speed, drinkdriving, helmets, seat-belts and child restraints).viiiGLOBALSTATUSREPORTONROADSAFETY,2013
10. 10. safety audits to assess safety levels ofboth existing and new road infrastructureprojects. The report also outlines progressthat has been made to implementminimum vehicle safety standards, andencourages governments to work withvehicle manufacturers to ensure thatever-larger proportions of their fleets meetthese standards.Real progress has been made towardsimproving road safety and saving lives,but what this report shows is that fasterand more concerted action is neededto prevent many more lives beingOver a third of road traffic deaths in low- andmiddle-income countries are among pedestriansand cyclists. However, less than 35% of low- andmiddle-income countries have policies in place toprotect these road users.needlessly lost on the worlds roads.Therefore the report makes the followingrecommendations: Governments urgently need to passcomprehensive legislation that meetsbest practice on all key risk factorsto address this preventable cause ofdeath, injury and disability. Governments should invest sufficientfinancial and human resources in theenforcement of these laws, as anessential component for their success.Raising public awareness can bean important strategy in increasingunderstanding of and support for suchlegislative and enforcement measures. Concerted effort is needed tomake road infrastructure safer forpedestrians and cyclists. The needs ofthese road users must be taken intoconsideration earlier, when road safetypolicy, transport planning and landuse decisions are made. In particular,governments need to consider hownon-motorized forms of transport canbe integrated into more sustainableand safer transport systems.ixSUPPORTINGADECADEOFACTION
11. 11. BackgroundApproximately 1.24 million people dieevery year on the worlds roads, andanother 20 to 50 million sustain non-fatal injuries as a result of road trafficcrashes. These injuries and deaths havean immeasurable impact on the familiesaffected, whose lives are often changedirrevocably by these tragedies, and on thecommunities in which these people livedand worked.Road traffic injuries are estimated to bethe eighth leading cause of death globally,with an impact similar to that caused bymany communicable diseases, such asmalaria (1). They are the leading cause ofdeath for young people aged 1529 years,and as a result take a heavy toll on thoseentering their most productive years (2).Economically disadvantaged families arehardest hit by both direct medical costsand indirect costs such as lost wagesthat result from these injuries. At thenational level, road traffic injuries result inconsiderable financial costs, particularly todeveloping economies. Indeed, road trafficinjuries are estimated to cost low- andmiddle-income countries between 12 %of their gross national product, estimatedat over US$ 100 billion a year (3).Despite the enormous toll exacted byroad traffic injuries, they have for manyyears been neglected by global health anddevelopment agendas, and funding forinterventions has not been commensuratewith the scale of the problem. This isdespite the fact that road traffic injuries arelargely preventable and that the evidencebase for effective interventions is extensive.Road traffic injuries are increasing,notably in low- and middle-incomecountries, where rates are twicethose in high-income countries. This ispartly attributable to the rapid rate ofmotorization in many developing countriesthat has occurred without a concomitantinvestment in road safety strategies andland use planning. While road trafficfatality rates are decreasing in somehigh-income countries, the rapid increasein road traffic crashes in low- and middle-income countries has driven an overallglobal increase in deaths and injuries.Indeed, current trends suggest that roadtraffic injuries will become the fifth leadingcause of death by 2030, with the disparitybetween high- and low-income countriesfurther accentuated (2).Nonetheless, evidence from manycountries shows that dramatic successesin preventing road traffic injuries can beachieved through concerted efforts atnational level. A number of countries,such as Australia, Canada, France, theNetherlands, Sweden and the UnitedKingdom have achieved steady declinesin road traffic death rates throughcoordinated, multisectoral responsesto the problem. Such responses involveimplementation of a number of provenmeasures that address not only the safetyof the road user, but also vehicle safety,the road environment and post-crash care.The Decade of Action forRoad SafetyIn 2010, the United Nations GeneralAssembly adopted resolution 64/2551,which proclaimed a Decade of Actionfor Road Safety. The goal of the Decade(20112020) is to stabilize and reduce theincreasing trend in road traffic fatalities,saving an estimated 5 million lives overthe period (see Figure 1).1http://www.who.int/roadsafety/about/resolutions/download/en/index.htmlFigure 1Goal of the Decade of Action for Road Safety 20112020Numberofdeaths(millions)2011 202020192018201720162015201420132012Year5 million lives savedProjectedreduction ifaction takenProjectedincreasewithout action2.01.81.61.41.21.00.80.60.40.201SUPPORTINGADECADEOFACTION
12. 12. In order to guide countries on takingconcrete, national-level actions to achievethis goal, a Global Plan of Action wasdeveloped (5). This provides a practicaltool to help governments and othernational stakeholders develop national andlocal plans of action, while simultaneouslyproviding a framework for coordinatingactivities at regional and global levels.National activities are based around fivekey pillars, as indicated (Figure 2).The UN General Assembly resolutionalso called for regular monitoring ofglobal progress toward meeting targetsidentified in the Global Plan of Action.These targets are, in part, based on datahighlighted in the first Global status reporton road safety in 2009,1and to this end,the resolution calls for the publication offurther reports to provide and disseminatethis information (6). This report, the secondGlobal status report on road safety, meetsthis request and will provide the baselinedata (from 2010) for monitoring progressthrough the Decade of Action.1The Global status report on road safety: time foraction (2009) legislation data were collected for 2008and fatality data for 2007; in both cases these werethe most recent data available. The current reportprovides legislation data updated for 2011 and fatalitydata updated for 2010. Thus comparisons on fatalitydata relate to 2007 and 2010.The purpose of this reportThe specific objectives of this secondGlobal status report on road safety are: to describe the burden of road trafficinjuries and implementation of effectiveinterventions in all Member Statesusing a standardized methodology, andassess changes since the publication ofthe first Global status report in 2009; to indicate gaps in road safetynationally across a number of domains(institutional management, policies,legislation, data collection) to stimulateand prioritize road safety activities; to serve as a baseline for monitoringactivities relating to the Decade ofAction for Road Safety at national andinternational levels.MethodologyThe methodology used to generate thedata and information presented in thisreport involved collecting data fromeach country, coordinated by a NationalData Coordinator (see Statistical Annex,Table A1). Data collection in turnwas driven by a number of individualrespondents from different sectors withina country, each of whom completed aself-administered questionnaire withinformation on key variables. This groupwas then required to come to a consensuson the data that best represented theircountry, which is presented here. Moredetail on the methodology can be found onpage 42. The report highlights data from182 countries/areas, covering 6.8 billionpeople (98.6% of the worlds population).Response rates by region covered between95% of the population in the AfricanRegion, to 100% in the South-East AsiaRegion. Data collection was carried out in2011: thus, while data on legislation andpolicies relate to 2011, data on fatalitiesrelate to 2010, the most recent year forwhich data were available.Pillar 2Safer roads andmobilityPillar 3Safer vehiclesPillar 1Road safetymanagementPillar 4Safer road usersPillar 5Post-crashresponseNational activitiesFigure 2The five pillars that guide national road safety plans and activities over theDecade of Action2GLOBALSTATUSREPORTONROADSAFETY,2013
13. 13. SECTION1The current state ofglobal road safety
14. 14. Many countries havesuccessfully reduced thenumber of deaths on theirroads, while deaths areincreasing in othersThis report shows that there were 1.24million deaths on the worlds roads in2010,1similar to the number of deathsin 2007. This plateau in the number ofglobal road deaths needs to be viewedin the context of a corresponding 15%global increase in the number of registeredmotorized vehicles.1 These data are based on information collected inthis survey for 182 countries, and estimated whereappropriate to account for varying levels of dataquality to make data comparable across countries.Data have been extrapolated to all 195 countriesand territories in the world. Full details of themethodology used to develop comparative estimatesare explained on page 42.Although the aim of reducing the annualburden of road traffic deaths has yet tobe realized, the lack of increase suggeststhat interventions to improve global roadsafety may have mitigated deaths thatwould otherwise have occurred. Between2007 and 2010, the number of roadtraffic deaths decreased in 88 countries,suggesting that progress can be madewith sufficient national commitment. Ofthese 88 countries, 42 are high-incomecountries, 41 are middle-income, and fiveare low-income (see Figure 3).Nonetheless, there is a major, persistingconcern in the 87 countries that sawincreases in the numbers of road trafficdeaths over the same period.The number of road traffic deaths each year has notincreased but remains unacceptably high at1.24 million per year.Middle-income countries arehardest hitThe overall global road traffic fatality rateis 18 per 100 000 population. However,middle-income countries have the highestannual road traffic fatality rates, at 20.1per 100 000, while the rate in high-incomecountries is lowest, at 8.7 per 100 000 (seeFigure 4).Eighty per cent of road traffic deathsoccur in middle-income countries, whichaccount for 72%2of the worlds population,but only 52% of the worlds registeredvehicles. This indicates that thesecountries bear a disproportionately highburden of road traffic deaths relative totheir level of motorization (see Figure 5).2 This proportion reflects the 14 countries that havemoved from low- to middle-income status since thepublication of the first Global status report on roadsafety.Figure 4Road traffic death rates per100000 population, by countryincome statusRoadtrafficdeathsper100000population2520151050High-incomeMiddle-incomeLow-income8.720.118.340 4020 20 6060Figure 3Countries with changes in numbers of road traffic deaths (20072010),by country income statusaNumber of countriesa See Table A2 in Statistical Annex for information on income-level classificationsCountries with decreasingnumbers of deathsCountries with increasingnumbers of deaths0High-incomeMiddle-incomeLow-income4GLOBALSTATUSREPORTONROADSAFETY,2013
15. 15. Figure 5Population, road traffic deaths, and registered motorized vehiclesa, by country income status High-income Middle-income Low-income1%Population72% 80%52%16%12% 8%12%47%Road traffic deaths Registeredmotorized vehiclesaThe African Region has thehighest road traffic fatalityrateThere are large disparities in road trafficdeath rates between regions (see Figure 6).The risk of dying as a result of a road trafficinjury is highest in the African Region (24.1per 100 000 population), and lowest in theEuropean Region (10.3 per 100 000).There is also considerable disparity inrates between countries within the sameregion. The European Region has thehighest inequalities in road traffic fatalityrates, with low-income countries havingrates nearly three times higher thanhigh-income countries (18.6 per 100 000population compared to 6.3 per 100 000) these are similar to rates in South EastAsia and Western Pacific Regions.aRegistered vehicle data provided only for countries participating in the survey.5SUPPORTINGADECADEOFACTION
16. 16. Half of all road traffic deathsare among pedestrians,cyclists1and motorcyclistsHalf of the worlds road traffic deaths occuramong motorcyclists (23%), pedestrians(22%) and cyclists (5%) i.e. vulnerableroad users with 31% of deaths amongcar occupants and the remaining 19%among unspecified road users.However, this global analysis maskssignificant differences regarding who ismost at risk by country income statusand by WHO region. In most low- andmiddle-income countries, a much higherproportion of road users are pedestrians,cyclists and users of motorized two- orthree-wheeled vehicles than in high-income countries. In much of the AfricanRegion, for example, walking and cyclingare important forms of mobility for alarge proportion of the population, whilein many South-East Asia and WesternPacific countries, motorcycles are used1 The term cyclist refers to users of two- or three-wheeled pedal cycles, but does not include thoseriding motorcycles or E-bikes.frequently because they are relativelyaffordable to buy and run. These differenttraffic mixes are reflected in road trafficfatality breakdowns. For example, 38% ofall African road traffic deaths occur amongpedestrians, while 36% of road trafficdeaths in the Western Pacific Region areamong motorcyclists (see Figure 7).Comparing the proportion of deathsamong different road user typesFigure 6Road traffic deaths per 100000 population, by WHO regionRoadtrafficdeathsper100000population302520151050WesternPacificRegionSouth-EastAsiaRegionEuropeanRegionEasternMediterraneanRegionRegion ofthe AmericasAfricanRegion24.121.318.510.318.516.1between regions conceals thesubstantial range seen within regions.For example, while the Americas Regionhas the lowest proportion of vulnerableroad user deaths (41%), this figureranges from 22% in Venezuela to 75%or more in Costa Rica, Colombia and theDominican Republic.Figure 8 shows the breakdown of roadfatalities by road user type and countryFigure 7Road traffic deaths by type of road user, by WHO regionWesternPacific23%8%36%25%8%South-EastAsia33%15%4%36%12%Africa43%7%38%5%7%EasternMediterranean37%3%18%28%14%Europe27%12%7%50%4%The Americas42%15%23%3%17% Car occupants Motorized 2-3 wheelers Cyclists Pedestrians OtherWORLD23%31%5%19%22%6GLOBALSTATUSREPORTONROADSAFETY,2013
17. 17. income status. Low-income countries havethe highest proportion of deaths amongvulnerable road users (pedestrians, cyclistsand motorcyclists combined) at 57%, withthis figure lower in both middle-income(51%) and high-income countries (39%).Almost 60% of road trafficdeaths are among 1544year oldsYoung adults aged between 15 and 44years account for 59% of global roadtraffic deaths. More than three-quarters(77%) of all road traffic deaths occuramong men, with this figure highest in theWestern Pacific Region.Regional variations are evident but mostlyfollow the same pattern (see Figure 9),except in high-income countries, wherethe proportion of deaths among thoseover 70 years is noticeably greater thanin low- and middle-income countries.This difference is most likely related tolongevity in these countries, combinedwith the greater risk posed by reducedmobility and increased frailty.Non-fatal crash injuries arepoorly documentedFor every road traffic fatality, at least 20people sustain non-fatal injuries (4). Theseverity of injuries sustained ranges fromthose that can be treated immediately andfor which medical care is not needed orsought, to those that result in a permanentdisability. Reliably assessing injury severityrequires clinical experience; police in manycountries who record official informationon injuries often do not have sufficienttraining to reliably categorize injuries.Different definitions of injury severityfurther complicate reporting of injuries.Information on the extent of non-fatalinjuries is important in assessing the typeof medical care needed. Some countrieshave hospitals with injury surveillancesystems in place. Data from these systemsindicate the severity of the problem, whatstaff are required and what treatmentis provided, as well as identify primaryprevention measures that could beimplemented.Unfortunately, even in high-incomecountries, this information is rarelynational in scope because of the workloadassociated with high numbers of patientsseen in hospital emergency rooms eachday, and the complexities of accuratelycollecting this information. Consequently,many countries use systems that collectthis information from a geographicsample, and then generalize results tothe whole country (7). In most low- andmiddle-income countries, sophisticatedinjury information systems are even rarer only 77 countries reported having anational injury surveillance system (47%of high-income and 46% of middle-incomecountries, but only 24% of low-incomecountries). The ability to accurately countthe actual number of non-fatal injuriesworldwide thus remains a challenge.Figure 9Proportion of road traffic deaths by age range and country income statusProportionofroadtrafficdeaths3530252015105004 514 1529 3044 4559 6069 70+Age range (years) High-income Middle-income Low-income40Figure 8Proportion of road traffic deaths among road user types, by countryincome statusPercentage(%)roadtrafficdeaths706050403020100 Car occupants Motorized 2-3wheelersCyclistsPedestrians Other/unspecified9080100Low-income Middle-income High-income7SUPPORTINGADECADEOFACTION
18. 18. A significant proportion of patientswho sustain a road traffic injury incurpermanent disability, through amputation,head injury or spinal cord injury. However,data on the number of people who incur apermanent disability as a result of thesecrashes is not well documented rangingfrom 0.05 g/dlNo drink-drive law/not based on blood alcohol concentrationDrink-drive law at subnational level Data not availableNot applicableFigure 14Drinkdrive laws, by country/area17SUPPORTINGADECADEOFACTION
19. 28. Head injuries amongmotorcyclists are a growingconcernRapid growth in the use of motorized two-wheeled vehicles in many countries hasbeen accompanied by increases in injuriesand fatalities among their users(26).Motorcyclists comprise a third of all roadtraffic deaths in the South-East Asia andWestern Pacific Regions, but are alsoincreasingly represented among deaths inAfrica and the Americas, which are seeingrapid increases in motorcycle use. Headand neck injuries are the main cause ofsevere injury, disability and death amongmotorcycle users. In European countries,head injuries contribute to approximately75% of deaths among motorcycle users; insome low- and middle-income countries,head injuries are estimated to account forup to 88% of such fatalities. Wearing astandard, good quality motorcycle helmetcan reduce the risk of death by 40% andthe risk of serious injury by over 70%(27).Introducing and enforcing legislationon helmet use is effective at increasinghelmet-wearing rates and reducing headinjuries (28,29).More effort is needed topromote helmet standardsand qualityAbout half of all participating countries(98) apply a helmet standard. Helmetsmust meet recognized safety standardswith proven effectiveness in reducinghead injuries to reduce the impact ofroad traffic crashes. While there are anumber of internationally recognizedstandards, it is important that aparticular governments helmet standardis suitable for the traffic and weatherconditions of the country, and is bothaffordable and available to users (26).Furthermore, governments need to ensurethat mandatory helmet laws are linkedto the helmet standard used, whetheran international or country-specificstandard. In this way, use of substandardhelmets can be a violation of the law,and thereby incur penalties that will actas a deterrent. As illustrated in the VietNam case study (see Box 5), enforcinghelmet standards can be complicated,and countries need to provide training toenforcement officers on how to identifysubstandard helmets.90 countries, representing 77% of the worldspopulation, have a comprehensive helmet lawcovering all riders, all roads and all engine types,and apply a helmet standard.INCREASING MOTORCYCLEHELMET USEProgress has been made in the number ofcountries whose helmet laws apply bothto motorcycle drivers and passengers, onall road types and regardless of enginetype. This figure has risen from 131countries in 2008 to 155 countries in 2011(covering 88% of the worlds population).High-income countries are more likelyto have enacted comprehensive helmetlaws than are middle- and low-incomecountries. To effectively reduce the headinjuries associated with motorcycleuse, countries need to review theirhelmet legislation and tighten provisionsthat limit the coverage and potentialeffectiveness of such laws, so that allthose using motorcycles are protected bythe use of a helmet, at all times, on allroads and on all engine types.To be effective, helmet legislation needsto be supported by strong enforcementand social marketing campaigns (30) (seeBox 4). While there has been progressin adopting helmet legislation globally,only about one-third of countries rateenforcement of helmet laws as good(8or above on a scale of 0 to 10), showingthat this critical component of road trafficsafety remains neglected.18GLOBALSTATUSREPORTONROADSAFETY,2013
20. 29. Protect yourself from heftyfines and serious headinjuries. Wear a helmet.19SUPPORTINGADECADEOFACTION
21. 30. Taken together, this means that 90countries meet both the criteria consideredhere as essential for comprehensivehelmet legislation to be met, that is, theyhave implemented a helmet law thatcovers all road users, all road types andall engine types, and they apply a nationalor international helmet standard. In theWestern Pacific and South East Asiaregions, which have the highest proportionof motorcyclist deaths, the proportion ofcountries covered by such laws is 56% and64% respectively.Data on helmet wearing isweakCountries need to implement measuresto periodically assess helmet wearingrates, to target efforts and resourceseffectively, and to evaluate the effects ofhelmet programmes, including the impactof mandatory helmet legislation. In mostcountries, these data come from periodicobservational studies conducted accordingto an acceptable study design that ensuresthe reliability and validity of results.Only 69 countries have any type of dataon rates of helmet wearing, either ondrivers, passengers or both, with wearingrates ranging from under 10% in Ghanaand Jamaica to almost 100% in theNetherlands and Switzerland. In particular,there is a lack of data on helmet-wearingrates from low-income countries inthe African, Eastern Mediterraneanand Western Pacific regions. Given theincreasingly high proportion of motorcycledeaths globally, governments need tosupport data collection efforts that providegood estimates of helmet wearing rates ona regular basis in their countries.Comprehensive helmet law and standardComprehensive helmet law but no/unknown standardHelmet law at subnational levelHelmet law not comprehensiveData not availableNot applicableFigure 16Motorcycle helmet laws and helmet standards, by country/area20GLOBALSTATUSREPORTONROADSAFETY,2013
22. 31. 21SUPPORTINGADECADEOFACTION
23. 32. Seat-belts reduce the risk of a fatal injury by up to50% for front seat occupants, and up to 75% forrear seat occupants.Progress has been made intightening up seat-belt lawsFailure to use a seat-belt is a major riskfactor for road traffic injuries and deathsamong vehicle occupants. When a motorvehicle crash occurs, a car occupantwithout a seat-belt will continue to moveforward at the same speed at which thevehicle was travelling before the collisionand will be catapulted forward into thestructure of the vehicle most likely intoINCREASINGSEAT-BELT USEthe steering wheel column if driving, thedashboard if a front seat passenger, orthe back of the front seats if a rear seatpassenger (31,32,33). Alternatively,failure to use a seat-belt can cause driversor passengers to be completely ejectedfrom the vehicle, greatly increasing the riskof serious injury or death (4,20,34).Wearing a seat-belt reduces the riskof a fatal injury by 4050% for driversand front seat occupants, and between2575% for rear seat occupants (20,35).Seat-belt wearing rates vary greatlybetween countries, and to a large extentare governed by the existence andenforcement of mandatory seat-belt laws.In many countries, drivers and front seatpassengers are legally obliged to use seat-belts, but this does not always apply torear seat occupants.While the vast majority of countries havelegislation on mandatory seat-belt use, aNational seat-belt law applies to all occupantsSeat-belt law at subnational levelNo seat-belt law or law does not apply to all occupantsData not availableNot applicableFigure 17Seat-belt laws, by country/area22GLOBALSTATUSREPORTONROADSAFETY,2013
24. 33. number of countries do not apply theselaws to both front and rear seat occupants.Comprehensive seat-belt laws covering alloccupants are in place in 111 countries,meaning 69% of the worlds population(4.8billion people) are fully protected bythese laws (see Figure 17). Ten countries,covering 182 million people, put in placecomprehensive seat-belt laws since 2008.But more needs to be done to convincepolitical leaders and police authorities thatseat-belt use can save lives, and to work tostrengthen seat-belt legislation in line withbest practice (see Box 6).Enforcing seat-belt lawsneeds more emphasisTo effectively increase seat-belt wearingrates, governments need to supportProgress has been made to protect rear-seatcar occupants through implementation ofcomprehensive seat-belt laws: 111 countries(69% of the worlds population) now havecomprehensive seat-belt laws covering all occupants.legislation with strong and sustainedpolice enforcement. Despite improvementsin seat-belt legislation in many countries,much more is needed to improveenforcement: only a quarter of all countriesrate their seat-belt enforcement as good(8 or above, on a scale of 0 to 10), showingthat improved enforcement and publicawareness campaigns on seat-belt useare needed to increase compliance withlegislation.Only half of countries collectseat-belt wearing dataCollecting information on seat-beltwearing rates is an important mechanismfor countries to target resources andevaluate the effectiveness of seat-beltprogrammes. The ability to show anincrease in seat-belt use is important tosustain political and community supportfor enforcement measures.Just under half of all countries havedata on seat-belt wearing rates, withthis number disproportionately lower inlow- and middle-income countries (6%and 43%, respectively) compared tohigh-income countries (80%). Data thatare disaggregated to show wearing ratesamong rear seat occupants separatelyfrom front seat occupants are useful fortargeting programmes aimed at increasingrates among rear seat passengers.23SUPPORTINGADECADEOFACTION
25. 34. Seat-belt wearing ismandatory by law. There isno exemption for anybody,including me.Governor of AfyonkarahisarFigure 18Proportion of all occupants wearing seat-belts inAfyonkarahisar, TurkeyProportionofalloccupantswearingseat-belts6050403020100Nov2010Apr2011Jul2011Nov2011May2012Oct2012Governor issued a decreeencouraging all occupantsto wear seat-belts24GLOBALSTATUSREPORTONROADSAFETY,2013
26. 35. More thanhalf of allcountries haveimplemented achild restraintlaw, but theserepresentjust 32% ofthe worldspopulation.More countries need toadopt child restraint lawsChild restraint systems protect infantsand young children from injury during acrash. Infants and children need childrestraint systems that can accommodatetheir size and weight, and that can adaptto different stages of their development.Child restraints reduce the likelihood of afatal crash by approximately 70% amonginfants and between 54% and 80% amongyoung children (20,36).Child restraints are not automaticallyinstalled in vehicles unlike seat-beltsand must be purchased and fitted byparents. This makes it more challengingto achieve high usage rates, especiallyin low- and middle-income countries.Appropriate child restraint use maybe limited by access and cost, or beimpractical because of large familysize. In addition, parents must make anumber of decisions about what typeof child restraint to choose, where toplace it and how to install it, which canalso limit uptake. A lack of awarenessabout the benefits of appropriate andcorrectly used restraints can restricttheir effectiveness too.Over the past decade, vehicle safetytechnology has made an importantcontribution in improving correctinstallation of child restraints. In particular,to make the fitting of child restraints incars both simpler and more secure, theISOFIX system of child restraints usesplug-in attachments rather than adult beltsto secure the seat (37,38).1This requiressockets in vehicles and specially designed1 ISOFIX (International Organisation forStandardisation), 1999.seats, which is becoming standard invehicle design across industrializedcountries and has been an importantfactor in contributing to improved crashperformance of cars (see Box 10, page 35).Ninety-six countries have a law requiringchild restraints. The majority of high-income countries have child restraintlaws in place, while such laws are farless common in low- and middle-incomecountries (see Figure 21). Most of the51European countries have enacted childrestraint laws, but only one of 11 South-East Asia countries has passed such alaw. Seven countries have passed a childrestraint law since 2008.Enforcement of child restraint laws remainslow in most countries: only 17countries(9%) rate their enforcement of childINCREASING THE USE OFCHILD RESTRAINTSFigure 19Proportion of countries with child restraint laws and good enforcement,by country income statusProportionofcountries(%);[numberofcountries]7060504030201009080100a