1. GLOBALSTATUSREPORTONROADSAFETY2013SUPPORTING A DECADE OF
ACTION
2. GLOBALSTATUSREPORTONROADSAFETY2013SUPPORTING A DECADE OF
ACTION
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
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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. 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. 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. 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. 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. 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. 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. SECTION1The current state ofglobal road safety
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. 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. 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. 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. 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
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
29. Protect yourself from heftyfines and serious headinjuries.
Wear a helmet.19SUPPORTINGADECADEOFACTION
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
31. 21SUPPORTINGADECADEOFACTION
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
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
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
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