• road traffic crashes
• World Health Day

Road traffic crashes are not just a highway safety problem—they are a public health problem. With over a million people killed each year on the world’s roads, and tens of millions more injured, road traffic crashes are a leading cause of death and the ninth leading cause of disability adjusted life years (DALYs) lost worldwide. By 2020, road traffic injuries are projected to become the third leading cause of DALYs. This is all the more tragic because we could prevent so many of these deaths, so many of these injuries, and so much of this suffering.

In the United States, road traffic injuries accounted for more than 42 000 deaths in 2002 and almost three million non-fatal injuries.¹ They are the leading cause of death for people ages 1–34 years and the leading cause of injury related death. The cost of motor vehicle crashes exceeded $230 billion in 2000.² The United States has the most motor vehicles per capita of any country in the world (765 motor vehicles per 1000 population).³ Therefore, we had to begin addressing the problem of road traffic safety many years ago. What are some of the lessons we have learned? For this commentary, we will focus on just three: the importance of having an agency devoted to road traffic safety; the importance of linking health and transportation sectors; and the usefulness of good data in defining the problem and determining the solutions.

First, in the United States, since 1970 we have had an agency devoted to road traffic safety (the National Highway Traffic Safety Administration, NHTSA)—with a mission that includes setting and enforcing safety performance standards for motor vehicles and investigating defects in motor vehicle equipment, as well as developing interventions based on sound research. This has helped government and industry work together to improve safety.

Second, in the United States, road traffic safety is both a public health and a transportation responsibility. Given the enormity of the problem, the tools of any one sector will not solve it alone. This partnership extends from the collection of data about the impact of road traffic crashes to the research on prevention tools to the implementation of programs. The Centers for Disease Control and Prevention (CDC) in the Department of Health and Human Services and the NHTSA in the Department of Transportation have collaborated for many years at the national level on high priority projects and encourage such partnerships at state and local levels.

Third, high quality data are essential for ensuring that resources are used to achieve maximal benefit. At the national level, surveillance data define the extent of the problem and also can be used to identify specific emerging issues such as the potential impact of airbags on children sitting in the front seats of cars. At the state and local levels, they can identify locations where crashes frequently occur and require interventions. The use of geographic information system technologies has been particularly beneficial in that regard. Special studies have resulted in regulations, standards, laws, and other intervention approaches. For example, intense, short duration, high visibility safety belt enforcement campaigns, coupled with paid media, have resulted in raising safety belt use in the United States. In fact, in 2003 safety belt use increased four percentage points (from 75% to 79%),⁴ reducing societal costs by more than $3 billion and saving more than 1000 lives.⁵ A non-Federal Task Force on Community Preventive Services, associated with CDC, has been using stringent standards and methods to evaluate interventions for a variety of public health problems, including many related to road traffic safety.⁶ Interventions found to be highly effective include child safety seat laws, primary enforcement of seat belt laws, minimum age drinking laws, community-wide information and enforcement campaigns, and sobriety checkpoints.

Despite the fact that the highest per capita rates of motor vehicle use are in developed countries, 90% of motor vehicle deaths in the world occur in low to middle income countries. The projections of future motor vehicle deaths as these countries continue to gain vehicles and roads are frightening, making it even more imperative that we mobilize now. The World Health Organization and the World Bank are to be commended for taking a bold step forward in addressing road traffic injuries as a preventable global health problem. Their leadership on this issue has the potential to put road traffic crashes alongside other diseases and illnesses we classify as predicable and preventable.

CDC, NHTSA, and many others actively participated in the development of the World Report on Road Traffic Injury Prevention.⁷ The six recommendations in the report center on recognizing the global burden of traffic injuries; documenting the burden through effective surveillance systems; identifying the risk factors; and developing and disseminating effective interventions. These are consistent with our experience in the United States and we believe they will be effective elsewhere as well.

The downward trend in motor vehicle death rates in the United States from 21.7 deaths per 100 million vehicle miles traveled in 1923 to 1.51 in 2002—a 93% reduction¹—occurred despite an increased number of vehicles, drivers, miles traveled, and a growing population. In recent years, other industrialized nations have registered even greater declines. Since 1979, traffic fatalities have declined by 50% in Canada, 46% in Great Britain, 48% in Australia,⁸ and 16% in the United States.¹ These successes only hint at what could be achieved if road traffic safety were made a higher priority globally. World Health Day 7 April 2004 is an important opportunity for all of us in public health and transportation safety to join hands and lend support to one another in our efforts to reduce this global burden. Together, we can save lives and reduce suffering.