The horrifying statistics on road deaths around the world are the flipside of the global obsession with car culture. The numbers are staggering. Overall, 1.3 million people die on the roads annually, and these include a quarter of a million children, with road accidents now one of the biggest causes of death for people under the age of 18.
Even these figures are likely to be conservative estimates as many deaths in low-income countries go unreported. This is an issue of poverty. Just as in Britain, where poorer children are far more likely to be killed on the roads than their richer peers, most of this carnage is concentrated in developing countries that account for 90% of deaths. The death toll ranks on a scale with the rate from malaria or tuberculosis; without preventative action it is set to be even higher.
It was not until 2004 that the idea of road safety as a public health issue began to gain credence with the publication of a World Health Organisation (WHO) report on the subject. Since then, momentum has been gradually building. With only 15% of countries having basic road safety measures, the challenge globally is to turn road safety practice into policy.
Lack of laws
According to the WHO fewer than half of all countries impose a blood alcohol concentration limit of 0.05 grams per decilitre to reduce drink driving, demand child booster seats and seatbelts, or require drivers of motorbikes to wear helmets of a good standard.
Deaths are just the tip of the iceberg. According to a spokesman for the Global Road Safety Partnership, created by the World Bank to address road safety issues in developing countries, "conservative estimates indicate that between 30 and 45 injuries occur annually for every road death". Many of these involve permanent disability. Overall, in low- and middle-income countries, between 30% and 85% of admissions to hospital for trauma injuries are for road accident victims, placing an enormous burden on the system.
The United Nations has been galvanised into action by the sheer scale of the toll and pressure from the Make Roads Safe campaign. This was created by the road-safety charity Fia Foundation in 2006 and now encompasses more than 150 industry organisations and NGOs championing the cause. As a result, in 2009 the first ever United Nations Ministerial Conference on road safety was held in Moscow. The result has been a UN general assembly resolution and next year, the official UN "decade of action" on road safety will be launched.
Former UK defence secretary Lord Robertson, who is chairman of the global Make Roads Safe campaign, says that "we must signal a change in direction. We know how to make roads safe, better road design and speed management, helmets and seat belts, police enforcement."
The target on road deaths set in the UN's decade of action is relatively modest. The aim is not to reduce the number of deaths, or stop it rising, but rather to halve the increase in the death toll which statisticians predict will come from the growth of car use across the world. However, even that target is significant as it would save an estimated 5 million lives over the space of the decade because, unchecked, the number of deaths annually is expected to rise to a staggering 2.4m.
As the UN's partners formulate plans, both road builders and vehicle manufacturers are being targeted. The UN says that "vehicle manufacturers have a responsibility to produce safe cars. They must meet this obligation, in every market." However, at the moment manufacturers produce cars to national standards, which in some developing countries are far more lax than those in the west.
But will the UN efforts really lead to significant change? UN critics suggest that their efforts are concentrated on alleviating the effects of car culture, rather than challenging it. The UN document launching the campaign says that most road schemes built with international aid money are designed with no consideration for safety. Remedial measures, such as better-designed roads, can play some part in alleviating the problem.
Overall, it is estimated that road crashes in the developing world cost more than £100bn annually in terms of lost output, injury, death and other economic effects – roughly the same amount as these countries receive in aid from the west.
A development issue Projects in action
One of the leading organisations campaigning on road safety issues is Fédération Internationale de l'Automobile (Fia) Foundation, the governing body of world motorsport and the umbrella body for motoring organisations such as the AA and RAC. In 2006, the foundation was behind the launch of Make Roads Safe – an international campaign for global road safety.
One aspect uncovered by the campaign is that new roads funded by agencies such as the World Bank take no account of the fact that, due to their design, an increase in casualties is inevitable: "Typically, they have no pavements or crossing points. Schools may be on one side of the road, while people live on the other, and the result is inevitably a huge number of casualties," said Fia's director David Ward.
The new Mombasa road linking Nairobi with the Kenyan coast is typical. Over the past five years Kenya has been redeveloping this road with assistance from international donors including the World Bank and Chinese government. Now traffic flows at a much higher rate and at relatively high speeds.
Ward points out: "There's nothing to slow the traffic down near schools and business centres. There are also no crash barriers or even lane markings separating the traffic. The result is a very high rate of death and injury on this road – which could all be prevented if just a few simple safety measures were put in place."
The centrepiece of Make Roads Safe is for the budget of all road schemes funded by development agencies to include a 10% provision for road safety measures. This would pay for features such as pavements, barriers and crossings which, amazingly, are not usually included. Ward adds: "Of course it would be better if these features were built in from the start as part of the original design, but it does not actually cost that much to add them later. There is an established body of knowledge of how to mitigate the death toll. What is lacking is the political will to use it worldwide."
Targeting a problem 'An underfunded man-made crisis'
The Global Road Safety Partnership (GRSP), which promotes road safety projects around the world, especially in low- and middle-income countries, is a relatively new body created in 1999 by the World Bank and operating under the auspices of the Red Cross and Red Crescent societies. Sweden is currently the European champion in road safety.
Chief executive, Andrew Pearce, refers to the road safety issue as "an underfunded man-made crisis". The GRSP, which encompasses business, governments and civil society organisations – supports projects in the 25 countries in which it is now working. It has a budget of just $6m (£4m) – a third of the money spent by global organisations on road safety.
But dramatic results can be achieved by well-organised and relatively cheap processes. For example, on Sakhalin island off Russia's Pacific coast, seat-belt wearing rose from 3% to 80% through a concerted campaign of education and enforcement. In two cities in China the rate of drink-driving was cut by 65% whereas it kept rising in a third city where there was no project.
In Brazil, where the GRSP is working with 20 cities, projects have shown that increased motorisation does not inevitably lead to more casualties on the roads. In 2009, the GRSP nominated São José dos Campos – a city 91km from São Paulo with an estimated population of 645,000 – for a Prince Michael International Road Safety Award. The mayor of São José dos Campos and other political and community leaders saw the strong correlation between road trauma and a decrease in the quality of life. The GRSP project set targets and met them through changing people's behaviour and attitudes.
A very public system of independent monitoring and reporting is undertaken by GRSP, and monthly and quarterly progress reports are made.
Over the past three years the number of people killed and seriously injured in road crashes in São José dos Campos has decreased by 48%. The people of the city can see that better road safety is good for business and the community. It makes sense, and the investment gets good social and financial returns.
The key in all these types of projects is the ability to obtain the widespread support of the community to implement a series of small-scale projects that, ultimately, aim to reduce deaths and serious injuries to zero.
• This article was amended on 27 September 2010. The original said funding of the Global Road Safety Partnership was $6bn. This has been corrected.
