• public health
• safe community
• Motor vehicle - occupant

Scientific evidence generated from injury research around the world, clearly identifies the importance of the spatial variable as a determinant of injury occurrence and its prevention. The implementation of injury prevention programmes on these contexts, not always follows the mechanisms originally proposed and depends of the relationship between institutions that participate on achieving the objectives. In this editorial, I focus on public space in urban areas and establish the importance of governance as a variable to understand injury prevention in this specific space, analysing road traffic injuries case.

First, to clarify the two concepts highlighted on this paper; urban space and governance: urban space is referred to a concentration of a large number of people in a defined geopolitical unit, where the population is more or less concentrated, but the size, density, diversity and especially the complexity of urban space poses great challenges to the health of its inhabitants. Injuries are one of the critical health challenges in urban settings.1 Governance is defined as ‘The exercise of political, economic and administrative authority to manage the affairs of the nation. It is a complex of mechanisms, processes, relationships, and institutions through which citizens and groups articulate their interests, exercise their rights and obligations, and mediate their differences. It transcends the state and includes civil society organisations and the private sector’.2 Governance involves the establishment of agreements between all sectors of society to solve a common problem. On this paper, I decided focus on the urban areas because the implementation of public policies designed for particular contexts in order to generate improvements in the quality of life of its inhabitants is more relevant every day due to the constant growth of the population and urban complexities. The level of governance and power of local authorities, it is considered that, in a way, are linked with the success or failure of these policies.

Thus, urban governance implies that state authorities and other actors (including private and social sectors) work together with authentic community participation as needed to meet the challenges to achieve urban health. In this context, addressing the problem of injury is critical. In urban space, injuries can occur for various external causes (falls, burns, even interpersonal violence, etc), but on this paper, I would like to discuss around road traffic injuries that occur on urban areas as an example to apply the governance concept in terms of the implementation of the safe system approach which has been proposed as the best preventive strategy, to assure road safety, mostly at urban spaces, for injury prevention. Both concepts present similarities, among others, the interactions among all the sectors in the solution to the common problem, (like on this case, to confront the absence of road safety) and the assignment of responsibilities of each on them.

Safe system approach assumes a holistic and inclusive view of the road transport system and aims to deliver mobility of all road users under safe conditions.3 This concept is often referred to as shared responsibility. The multisectoral nature of road safety means that any of the areas, sectors, ministries and agencies involved, participates in the required leadership for policy design and implementation. It implies that governments, the private sector and civil society all share responsibility with road users for making the transport system safe.4 The safe system approach is guided by core elements for planning, implementation, evaluation, and monitoring and overseen by a lead agency for governance and management.5. It is clear that elements like the inclusion of public, social and private sectors, working around a common problem are included at the concept of governance and it is clearly explicit into the safe system approach.

Hysing6 refers that the safe system approach demands a clear process of governance in which social actors are mobilised and persuaded to assume responsibility for their actions in support of public values (eg, road safety or decarbonisation) and incorporate these values into their operations and actions. As part of governance efforts, the safe system approach determines how priorities, roles and responsibilities are allocated both within and outside the state. Clearly and explicitly considers that public actors need to take the lead, in one side, by setting a good example and by providing leadership during policy implementation, and by the other hand, taking responsibility for their own actions. The situation here is, who gives responsibility to Whom? for what? and how is the interaction among actors? (vertical, horizontal?). Lack on definition of responsibilities between all those involved on the safe system approach in urban space, hamper effective governance.6 It is important to recognise that on the safe system approach implementation, the use the theoretical bases of governance such as: integration of competencies and responsibilities, look for a suitable setting for coordination of various actors, definition of public policies related with road safety, etc, may help on this task.

One of the most frequent risks is to leave the responsibility for safe system performance to just one player (eg, the state authority) reducing the importance of major public health problems, the definition of public policies and the level and quality of political debates.7 Added to this, in some countries a kind of competition is perceived between the health and transport sectors when defining the leadership in road safety.8 This situation has been created a weak relationship between stakeholders and a poorly functional bicephalic leadership.9 Without a clear leadership no achievements of significance can be made due to that one most critical issue on the success of the implementation of the safe system approach is getting commitment from decision makers. Bicephalic nature of the leadership contributes to undermine effectiveness of the Road safety interventions.

The concept of governance highlights the interdependence or association between governmental and social actors as the condition without which it is not possible for there to be direction of society; implies a decentralised idea of social direction, and in the practice requires the pooling or exchange of various resources (informational, cognitive, economic, technological, moral, political) that are dispersed in the hands of different actors, for the resolution of community problems.6Scientific evidence shows us that successful strategies in one country do not ensure the same result in another which are context dependent to the social, cultural and political realities of a country.10 The implementation of the safe system approach would require having clearly defined governance mechanisms, particularly in low-income and middle-income countries, where the leadership is not necessarily located at Government level. The analysis of the existence of urban governance on a specific context or region might be considered as an indispensable element on the implementation of the safe system approach, especially the kind of relationship among the actors involved.

The directionality between the actors involved and the necessary agreements, are important too on the establishment of road safety approach, which not always might be transversal, and works based on the type of organisations that exist in a certain context, so these can be from the top down but also from the bottom up. As an example, I focus on the México’s experience, where since 2008 (14 years ago) a number of Road safety Laws initiatives were promoted by the Health and Transport ministries (Public sector) in some cases together or separately in some others, but including only to actors at the highest level of decision and mostly located at the public sector. Since then, three different initiatives were discussed at the legislative chamber but they were never approved. In 2019, a group of civil organisations promote an initiative involving all the sectors and after a long lobbing process, a National Law od Mobility and Road Safety was approved on 15 May 2022 and published at the official journal.11 This law is based on the safe system approach and with a clear leadership at the official sector. It is one example that direction of the governance process might be horizontal among different sectors and actors involved. Now will come a long way to assure the implementation at state and municipal level where again the existence of governance mechanisms will be the key.

To finalise, it is clear that, planning, implementation and evaluation of an injury prevention programme, like on this case, using the safe system approach, will depend that leadership ensures the political will of the highest level, to grant the needed resources for its operation It is important to assure the existence of governance at least at the local level with a clear vision and commitment of each of the actors that need to be involved, and not generate bi or multi-head leaderships that might produce fragmented results. The existence of governance mechanisms needs to be considered as a primary issue to be included on injury research to evaluate the implementation, like on this case, the safe system approach and for preventive programmes on the injury field in general, especially those occurred at urban settings.