I wasn’t quite sure whether to celebrate or mourn the inclusion of road safety as a Sustainable Development Goal (SDG), and more recently on the agenda of the recent 69th World Health Assembly in Geneva. I enjoy both driving and walking – though Delhi’s roads are getting increasingly hostile towards pedestrians – and it’s safe to say that road safety is an area I’ve been mildly “obsessed” about over the last decade. Road safety, inherently heterogeneous in its nature, has the potential to ping-pong between the multiple sectors responsible for it – from transport departments, to infrastructure, the automobile or the alcohol industry to others. Call it ‘domestic ping-pong diplomacy’, if done well. Sadly, that is rarely the case, and it’s not because we Indians generally suck at ping pong. Still, while I mourn the rising fatalities and disabilities caused by road traffic accidents, including in my country, it’s been heartening to see the issue steadily emerge on the health and development agenda. Road traffic injuries which have often been tackled in their traditional silos of infrastructure, engineering and urban planning, among others, would perhaps benefit immensely from a more holistic public health perspective – a perspective which I hope would also encourage a greater, much-needed interdisciplinary outlook and cooperation. But first, let’s go back in time a bit.
In 1949, RJ Smeed, a British statistician and transport researcher, proposed a theory, which is now known as Smeed’s Law. According to Smeed, as countries grow richer, and add more cars to their roads, they begin to pay more attention to things like safety issues. Today, traffic accidents lead to an estimated 1.2 million deaths annually or about 3242 people every day; 90% of fatalities occur in low-and-middle income (LMIC) countries which account for only forty eight percent of the world’s registered vehicles. Self-driving cars or other game changing innovations might change all that in the future, but for now, poor regulations, limited health systems capacity to address the post-crash phase of road accidents, and little or no organized emergency response systems are just a few of the factors which exacerbate the health impact of traffic crashes in LMICs. In addition, in LMIC settings it is often vulnerable road users, such as pedestrians and bicyclists who inequitably bear the brunt of road traffic injuries. Also, road Traffic Incidents (RTIs ) disproportionately affect the young: the majority of injuries and deaths occur among those between the ages of 15-29 years, among more men than women, having an impact on the overall wellbeing of the individual, as well as the household. Low health insurance, especially among poorer populations means the financial burden of medical care and sustenance in case of long-term disability can be disastrous. Studies on the impact of road traffic accidents on the financial wellbeing of a household indicate a long-term effect; almost 49% of households with an individual disabled in a traffic accident shift from house owners to renters.
Anyway, road safety got its due at WHA69 this year with the Assembly adopting a resolution to accelerate the implementation of the outcome document ‘Brasilia Declaration on Road Safety’ – towards achieving SDG 3.6 aimed at reducing road traffic deaths and injuries by 50% by the year 2020. Comments by member states highlight a few of the challenges which such a multidisciplinary issue presents, including, of course, generating funds – which Brazil highlighted as an impediment towards executing the United Nation’s Decade of Action for Road Safety (2011‒2020) more effectively. Countries such as Vietnam urged better inter-sectoral collaboration and improving the post-crash response, while Japan illustrated the impact of low-cost interventions such as using seat belts and helmets in protecting automobile riders in case of a crash. Other countries highlighted the issue of limited and poor quality data as a challenge.
The achievements, challenges and commitments presented by the member states were commendable, but much of what was presented viewed the issue of road safety from the point of view of those inside vehicles. As someone who typically drives a lot, but also loves to walk, especially in the city, enhancing road safety from the perspective of only car users simply doesn’t make sense. So I was relieved to hear one, slightly different point of view, one which resonated most with my perspective, that of the civil society organization, Medicus Mundi International. As the MMI representative said, we need a paradigm shift (another one, I hear you sigh…).
Yet, this one is actually urgent. Indeed, as already mentioned above, vulnerable road users, such as pedestrians and bicyclists, are most affected by road traffic injuries – and are often also the majority road users. Moreover, in many countries such as mine, cycling is not a choice; it’s possibly the only affordable means of transport – and that too if you’re lucky enough to be able to afford one cycle for the family. Large numbers of people in Indian cities cycle for miles and miles in extreme temperatures, walk on highways not designed for pedestrians, and tackle inefficient, uncomfortable, yet expensive, and often unsafe forms of public transport. So ‘the time is surely now’ to think about road safety from the viewpoint of the majority road users; from those who might benefit most from interventions. Advocating for safer mobility, improving the post-crash response and finding ways to prevent and reduce severity of injuries are some of the ways in which public health can play a role in reducing the burden of injuries and deaths from road traffic accidents.
In a recent article in the New York Times, Mark Rosekind of the National Highway Traffic Safety Administration was quoted on the semantics of the term ‘accident’ – whether the use of the word ‘accident’ implied that the event under discussion was one beyond anyone’s control. The article documents a shift in the use of terms for road traffic accidents: instead of ‘accidents’, the term ‘crashes’ is more favoured now. I will leave the discussion on the semantics of the word for you, the reader to explore in the article, or perhaps join the campaign ‘drop the A word’ – but I do think that perhaps viewing road safety from the perspective of crashes, and not accidents might help. Or maybe a step in the right direction would be to have an ordinary person, who cycles to work on roads with potholes, trucks, buses, cars and no bicycle lanes in 40 Celsius weather, instead of a motor sport executive as the UN’s special envoy for road safety?