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Why is so little being done to stop traffic killing 1.25m people per year, and costing 3% of global GDP? Good new paper.

May 4, 2017
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Part of my purpose in life is to puff good new papers from the ODI, and it’s been a while, so here goes.Road Safety cover

Work in the aid business and you regularly hear grisly tales of deaths, injuries and near misses of colleagues and partners on the roads of the developing world. In Peru, I once had the disorienting experience of seeing the rear wheel of my jeep bouncing ahead of us into the night, ending up in Lake Titicaca (the wheel, that is, not me). But the carnage from Road Traffic Accidents (RTAs) is much worse for poor people, communities and children.

The issues has been recognized in the SDGs, which may or may not make any difference – I’m a sceptic, and if you want to find out more, check out an excellent new literature review by Joseph Wales at the ODI. Some excerpts;

Road safety is a major international health issue, but one that rarely receives the attention it merits. Every year, an estimated 1.25 million people are killed on the world’s roads and up to 50 million people incur non-fatal injuries. This makes road traffic collisions the ninth leading cause of death across all age groups globally and the main cause of death among those aged 15-29 years. On current trends, collisions will become an even more prominent global health challenge, rising to become the seventh leading cause of death by 2030.

Some 90% of road traffic fatalities occur in low- and middle-income countries, where pedestrians, cyclists and motorcyclists make up the bulk of those affected. Working age males make up a large proportion of those killed and injured; but children, adolescents and the elderly are also disproportionately affected in many contexts. The effects of road traffic collisions are particularly felt by households from poorer socio-economic groups. They are both more likely to have a member fall victim to a collision and less able to bear the considerable costs of a funeral, medical treatment and lost income resulting from extended periods of recovery or permanent disability. For some households, the loss or injury of a member in a road traffic collision can be the difference between financial stability and poverty. At a national level, the economic costs of road traffic collisions alone are substantial – estimated at 5% of gross domestic product (GDP) in low- and middle-income countries, and totalling up to 3% of global GDP. The estimated costs of initiatives to improve road safety are dwarfed by the scale of economic and social damage currently caused by road traffic collisions.

Historically, initiatives to improve road safety have often been structured around the collision itself. Broadly, initiatives aimed to either (i) reduce the incidence of collisions; or (ii) reduce the severity of collisions – generally with a strong focus on changing user behaviour – whether through public information campaigns (e.g. on drink driving), legislation (e.g. speed limits) or the physical road infrastructure (e.g. speed bumps). However, there has been increased recognition that the immediate causes of road traffic collisions, fatalities and injuries cannot be viewed in isolation from each other or the broader context, and that combinations of interventions demonstrate greater cost-effectiveness. This has resulted in a growing focus on system level issues and the use of simultaneous interventions at multiple levels to address the causes of road traffic collisions in an integrated and coherent manner. The ‘Safe Systems’ approach that underlies the UN Decade of Action for Road Safety (2011-20) is based on this broader understanding of how to improve road safety.

road traffic statsInterventions to reduce road traffic collisions, deaths and fatalities are therefore broad and involve initiatives that focus not only on roads and road design, but other issues within the broader transport system and beyond. These can be broadly divided into five groups:

  1. Improvements in land use and the built environment (e.g. land zoning, traffic calming measures, cycle paths)
  2. Improvements in education, legislation and enforcement of traffic regulations (e.g. speed limits, advertising public campaigns to reduce drink driving)
  3. Improved vehicle and safety standards (e.g. regulations on manufacturing standards, compulsory safety features)
  4. Improved availability and quality of public transport
  5. Improved post-collision emergency response and care

This shift towards a ‘Safe Systems’ approach has also helped to highlight the importance of politics and state capacity to the successful creation and implementation of road safety policies. Successful implementation requires political momentum to initiate a range of policies to promote road safety, but also the enforcement of regulations and laws carried out in practice, as well as coherent and coordinated action between the different agencies and organisations at national and local level that have influence over road safety. This approach requires improving the functionality and coordination of a wide range of actors and so the task is of a different order than more traditional, technical interventions. There is strong empirical evidence that countries with well-functioning and capable state institutions experience lower levels of road traffic collisions, deaths and injuries compared to those that are weaker and less coherent.

The political salience of road safety is generally low, especially when given the high number of deaths due to road traffic collisions. Most interventions have road safety 1tended to focus on preventing injuries to vehicle occupants, despite pedestrians being more likely to be victims and to be severely injured or killed. These trends are partly due to many interventions originating in high-income countries where vehicle occupants make up a higher proportion of victims. They are also related to challenges of mobilisation due to collective action and coordination issues, poor data availability and the challenge of attributing causes. This is particularly the case where the individuals involved in collisions may be blamed for causing them, or where there is no clear individual, institution, policy or design feature whose impact or negligence can be mobilised around.’

My takeaways from this are that RTAs act as a lens on the modern world, highlighting issues of power, inequality, and the importance of thinking about systems, not just linear interventions. And that the lack of attention to something that costs this much, and is readily easy to address, is unforgiveable.

What might help take this forward is to dig into the politics a lot more – what would a power analysis of RTAs look like? Who are the likely blockers as well as the drivers of reform?

In terms of building a campaign around this, you would think a building a cross class coalition would be pretty straightforward, since rich people as well as poor get mown over by drunk drivers and the rest. But are there high profile villains that could galvanize a public campaign? Urban developers refusing to invest in safety measures? Booze firms blocking breathalysers? Car companies? What are the successes we can learn from, like the Good Samaritans movement in India?

Here’s the UN Decade video, starring Kevin Watkins


  1. Hi Duncan – thanks for profiling this! Just to let you know this is the first output in a new project we are doing with the World Resources Institute on how to tackle political will and buy-in issues to get traction on this issue. We will be releasing the three case studies (Nairobi, Bogota and Mumbai), plus a synthesis report and snazzy website, towards the end of the year.

  2. Hi Duncan – thanks for the kind words and for highlighting the review. This is the first stage of our research on this issue, with the next phase being precisely to dig further into the politics and dynamics of reform (and its absence). We are collaborating with the World Resources Institute to conduct case studies in Bogota, Mumbai and Nairobi over the next few months to investigate how and why successful reforms have been possible in some contexts, and why blockages persist elsewhere. We hope the synthesis will then demonstrate an approach others can use to do similar analysis on road safety issues.

    We’re also interested in exploring whether a similar analytical approach could then be used for other complex urban public health issues, such as air pollution, that share similar characteristics in terms of being externalities produced by everyday activities and having low political salience, enforcement challenges and the need for coordination across multiple agencies and levels of government etc.

  3. I believe the heart of the matter is to develop a universal risk consciousness. Not just in terms of traffic, but even other risks from devastating disasters to everyday incidents, such as fires. That will take time, but what we in the western world tend to forget is that what we today take for granted, e.g. insuring our homes or teach children to use safety belts, was not so common just a few decades ago. If you do not teach people why they should behave in a certain way, the impact of other measures will be limited. In Laos, knowledge among UN drivers on the risks of drink driving or high speed were limited, to say the least. Or another common sight in many countries: Motorcyclists wearing helmets, but do not bother to fasten them.

  4. Good post and much needed research in terms of how we assess the most serious risks facing different countries. The political trade-off issue in terms of investment in road safety v. terrorism prevention has been examined by a number of scholars in Israel with interesting results.

  5. I saw a TED talk today that focused on the value of mapping and systems thinking, and of stepping back and looking at a problem from a systems level. It looks like this is beginning to happen. I included the TED talk in this blog article.

    In it I focused on the challenges and costs of building a knowledge base, and the challenges and costs of the ongoing marketing needed to get more people to look at the data, and to build a public will to do something. Finally I also focused on the role of intermediaries who try to connect the knowledge and the people who need to be using it. I think these apply to the issue you’ve describe here. Here’s the link.

  6. Like anti-smoking measures I think funding road safety measures would not be seen as an appropriate use of overseas aid by lots of taxpayers/voters in the UK.
    Can aid agencies not do more in their messages to the public to show the reality of life in developing countries and how important these issues are ?

  7. The excerpts you took from the lit review talk about improvements in education and law enforcement but not norms. I think norms are a critical part of the picture, especially in countries where police forces are riddled with corruption, and thus being stopped by the police is viewed as an encounter with a predatory state rather than merited punishment for dangerous driving. In such an environment enforcement will only change behaviour where there is a perceived risk of enforcement (where police with speed guns are known to hang out), and then only change behaviour targeted by the police (speeding and over-taking) and not others (cutting corners when turning). Obviously education is a big part of changing norms, but I think it requires a much broader, more holistic effort than is implied by the term education.

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