Dear Editor

Jeffrey et al's [1] evidence of a serious underestimation of road injuries is worrying for the year-by-year comparisons that are taken as evidence for the state of road safety. The UK figures for death and serious injury are reported to have followed a downward trend for forty years or so, which has generally been taken as evidence - if no more than implicitly - that a culture of safety on the roads is steadily developing [2]. However, Jeffrey et al's study raises the issue of just how much change there has been in the standards of recording casualties over the years. It follows also that the proposing of explanations for the reported changes must be guarded.

Even overlooking this last point, the safety-culture argument is itself unconvincing. We well know that there are persistent problems concerning, for example, speeding, drink-driving and "jumping" level crossings, along with more recent issues of drugs and mobile-phone use. Regarding speeding, it is estimated that 50% of drivers exceed the limit on urban and suburban roads [3].

Alternative factors to explain the falling casualties include the following: (a) NHS spending on trauma care, by which the consequences of a given level of trauma are less serious than previously; (b) increasing cases of road congestion, which lowers speed and the incidence of overtaking, and hence the severity of crashes; (c) the avoidance of the road by vulnerable road users [4]. This last issue is coupled with the high rates of reported pedestrian casualties in Britain [3]; evidence from Scotland suggests that children in the lowest socio-economic classes are particularly at risk [5]. In the light of Jeffrey et al's evidence that casualties among cyclists have been most affected by underestimation, with pedestrians also notable in this regard, vulnerable road-users seem to be getting a worse deal than the official figures suggest. Furthermore, there are the health issues of a society that has become inactive through its heavy dependence on cars.

If walking and cycling are really to be developed to the level that applies for example in the Netherlands and Denmark - and bearing in mind the importance of walking and cycling for accessing public transport - there is much work to be done in Scotland, and by extrapolation across the UK as a whole.

References

1. Jeffrey S, Stone D H, Blamey A, et al. An evaluation of police reporting of road casualties. Injury Prevention 2009; 15: 13-18.

2. Donneley R R (2008). Scottish road strategy: Consultation document. Edinburgh: The Scottish Government.

3. Department for Transport (2008). Road safety compliance consultation. London: TSO.

4. Reinhardt-Rutland A H, Thomson J, Foot H, Elliott M (2008). Response to the Scottish Government consultation: Scottish road safety strategy. Leicester: British Psychology Society.

5. White D, Raeside R, Barker D (2000). Road accidents and children living disadvantaged areas. Edinburgh: The Scottish Government.