ROAD SAFETY MANUAL

A GUIDE FOR PRACTITIONERS !

STRATEGIC GLOBAL PERSPECTIVE
SCOPE OF THE ROAD SAFETY PROBLEM
Introduction
Impact on Public Health
Socio-Economic Costs
Road Safety Context
References

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1. SCOPE OF THE ROAD SAFETY PROBLEM

KEY MESSAGES

Road traffic injury is a major global public health problem. Rapid motorisation in low and middleincome countries (LMICs) along with the poor safety quality of road traffic systems and the lack of
institutional capacity to manage outcomes contribute to a growing crisis.
More than 1.24 million people die each year on the worlds roads. Many more suffer permanent
disability, and between 20 and 50 million suffer non-fatal injuries. These are mainly in LMICs,
amongst vulnerable road users and involve the most socio-economically active citizens.
Road traffic injury is a leading cause of death globally for children and was the leading cause of
death for young people aged 1529 in 2010. Without urgent action, it is forecast that road traffic
injury will be the 7th leading cause of death for all by 2030.
In socio-economic terms, countries around the world are paying a high price for motorised mobility.
Country estimates indicate that the value of preventing road death and injury is equivalent to
between 1% and 7% of Gross Domestic Product.
Death and serious injury from road crashes is preventable if crash energies are managed so that
they do not exceed human tolerances for serious and fatal injury and through effective, resultsfocused and resourced road safety management.
The Safe System goal and strategy focus on providing a road traffic system free from death and
serious injury. It does this by addressing unintentional error and human vulnerabilities.
The Safe System guides the planning, design and management of the operation and use of the road
traffic system so as to provide safety in spite of human fallibility. It places a shared accountability
across all elements of the system.
Preventing road trauma on public roads and in the course of work is a core responsibility for
government, its agencies and employers and requires shared responsibility and leadership.
The scale of the road safety challenge and the diversity of the effects of road traffic injury underline
the importance of exploring synergies with other societal goals and priorities.
A UN Decade of Action for Road Safety 20112020 has been announced with an ambitious global
target and plan to reduce deaths in road traffic crashes.

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1.1 INTRODUCTION
This chapter outlines the growing global crisis of road traffic injury and the substantial value of preventing
death and serious injury in road crashes. It also introduces the key road safety concepts that underpin this
manuals guidance for implementing affordable and effective interventions to achieve results that may be
required in any given context. The first of these concepts is the challenging Safe System long-term goal
and strategy, which is recommended to all countries regardless of their socioeconomic status and level of
infrastructure development.
Secondly, this chapter highlights the planned, systematic approach needed for successful road safety
management to produce road safety results. As discussed more fully in later chapters, these approaches
provide a foundation and implementation framework for road safety investment programmes and
demonstration projects. It is emphasised that these programmes and projects need to seek targeted
results for the shortto medium-term, appropriate to the learning and management capacity of the country
concerned. Affordable, effective intervention is required that better addresses the needs of all road users,
including those most vulnerable. The chapter highlights the importance of aligning road safety with other
important societal objectives, given the significant potential for shared benefits and in order to maximise
cost-effective investment.

ROAD SAFETY AS A GLOBAL PROBLEM

Economic development makes an important contribution to increased mobility and motorisation. It is
forecast that over the first 30 years of the 21st century, more motor vehicles will be produced globally
than in the first 100 years of motorisation. The majority of these vehicles will be used in low- and middleincome countries (LMICs)1 (Bliss, 2011).
Alongside rapidly increasing rates of motorisation in LMICs, premature death and disability is occurring on
a disastrous scale. Global road deaths increased by 46% between 1990 and 2010 (Mathers et al., 2012).
Some 90% of road traffic deaths occur in LMICs and the victims are predominantly vulnerable road users,
males, and include the most socio-economically active citizens (WHO, 2013a). Apart from the sheer scale
of human misery involved, the often underestimated socio-economic value of preventing these tragedies is
substantial (Jacobs et al., 2000; OECD, 2008; McInerney, 2012).
The road safety performance gap between rich and poor countries is set to widen further. It is projected
that, by 2030, around 96% of global road deaths will occur in LMICs with 4% of deaths occurring in highincome countries (HICs). Forecasts of global mortality trends to 2030 indicate that road traffic injury is set
to increase from the 9th to the 7th cause of death (WHO, 2013b). Without new initiatives, forecasts indicate
that more than 50 million deaths and 500 million serious injuries on the worlds roads can be anticipated
with some certainty over the first 50 years of the 21st century (Bhalla et al., 2008). This can be compared
with only an estimated 1% probability that over the same period, more than 40 million people could be
killed in mega-wars or by a virulent influenza epidemic and around 4 million people by volcanoes or
tsunamis (Smil, 2008).
In response to these developments, the widely endorsed recommendations of the World Report (Peden et
al., 2004; see Box 1.1 )and other initiatives, the United Nations General Assembly proclaimed a Decade of
Action for Road Safety between 2011 and 2020. The Decades ambitious goal is to stabilize and then
reduce the forecast level of road traffic deaths around the world (UN, 2010). If this goal is met, then 5
million lives would be saved and 50 million serious injuries would be avoided for an estimated socioeconomic benefit of over US$3 trillion by 2020 (WHO, 2013a).

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BOX 1.1: THE WORLD REPORT ON ROAD TRAFFIC INJURY PREVENTION

The World Health Organization (WHO) and the World Bank jointly issued the World Report on Road
Traffic Injury Prevention on World Health Day 2004 (Peden et al., 2004). The report was developed with
the assistance of global experts from low-, middle- and high-income countries. Its general findings and
recommendations, endorsed in UN Resolution, are widely accepted as the blueprint for road safety
intervention.
The reports publication signalled a growing concern in the global community about the scale of the
health losses associated with escalating motorisation, and a recognition that urgent measures have to
be taken to sustainably reduce their economic and social costs. Implementing the reports
recommendations has become a high priority for low- and middle-income countries and guidance was
issued by the World Bank in 2009, updated in 2013, to provide a country framework to assist this
process (GRSF, 2009; 2013).

A related five pillar Global Plan encourages LMICs with the assistance of aid agencies, to move straight
away to the implementation of effective Safe System approaches (UNRSC, 2011a).
With the planning, design, operation and use of the road network as its main focus, this manual addresses
three out of the five pillars: Road safety management (Pillar 1); Safer roads and mobility (Pillar 2); and
Safer road users (Pillar 4). Safer speeds, which are embedded in several of the pillars of the Global Plan are
also addressed.

CONCEPTUAL FOUNDATIONS
It is now widely accepted that serious health losses in road traffic crashes are largely preventable and
predictable a human-made problem open to rational analysis and effective road safety management
(Peden et al, 2004). Road traffic systems can be developed that reduce the likelihood of serious or fatal
crashes occurring and to minimise injury severity in the event of a crash. This is supported by a substantial
body of knowledge on how to achieve significant lessening of the costly, adverse impacts of motorisation.
In European Union countries, for example, the overall volume of traffic tripled between 1970 and 2000,
while the number of people killed per million inhabitants decreased by 50% (CEC, 2003). (See key
overviews by Peden et al., 2004; OECD, 2008; GSRF, 2009).
Over the last 15 years, two major and complementary developments have informed approaches to road
safety and how to more effectively manage for better results by using holistic approaches. The first was
led by Sweden (Vision Zero) (Tingvall, 1995) and the Netherlands (Sustainable Safety) (Koornstra et al.,
1992), which was a paradigm shift during the 1990s to the ambitious Safe System goal (see Box 1.2)

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.
BOX 1.2: THE SAFE SYSTEM GOAL AND STRATEGY

The Safe System goal for the long-term is the elimination of death and serious injury, supported in the
interim by periodic, quantitative casualty reduction targets (OECD, 2008). The aim is to work towards
the design of a system which minimises death and serious injury, while accepting that crashes with
minor outcomes might still occur. The ethical Safe System goal has effectively re-defined what is meant
by safety in road safety management goals in effective practice (DaCoTa 2012c).
The Safe System strategy aims to ensure that in the event of a crash, the impact energies remain below
the threshold likely to produce either death or serious injury. The aim is to address known human
characteristics by accommodating common, unintentional error, and to take better account of the
vulnerability of the human body in the planning, design, operation and use of the road traffic system to
benefit all road users. Safe System intervention addresses all elements of the road traffic system and
their linkages road infrastructure, vehicles, the emergency medical system, and road users.
Source: Koornstra et al.,1992; Tingvall, 1995; OECD, 2008; DaCoTa, 2012c.

In a Safe System approach, mobility is a function of safety, rather than the other way around. It places
road safety in the mainstream of road traffic system planning, design and operation. Building on the best
of previous approaches, Safe System better addresses the needs of vulnerable road users and is
particularly relevant to the needs of LMICs. As discussed in The Safe System Approach, firmly establishing
a Safe System in national road safety work requires strong political backing and underwriting in legislation
(OECD, 2008; Belin et al., 2012).
More recently, the World Bank, the OECD, and the International Standards Organization (ISO) have
underlined that effective road safety management is a systematic process. Road safety does not just
occur, but has to be produced. The safety performance produced by countries active in road safety has
been achieved following years of sustained investment in road safety management and governmental
leadership. The road safety management system is the productive capacity to deliver key institutional
management functions, which produce and enable effective, system-wide interventions that are designed
to produce results with the Safe System goal and strategy representing the most ambitious approach
(OECD, 2008; GRSF, 2009; ISO, 2012).
These holistic concepts are the common threads running throughout this manual. They represent the
summation of effective multi-disciplinary road safety knowledge and successful practice across the road
traffic system, which have been built up over decades. This knowledge base can be applied systematically
to any country, regardless of its road safety performance, socio-economic status or level of infrastructure
development.
The gradual and increasingly more successful path towards these shifts in road safety thinking and
practice are briefly outlined in Box 1.3 and are discussed in more detail in Key Developments in Road
Safety. LMICs are being urged to avoid the costly evolutionary path of industrialised countries shown in
Box 1.3, and to take key steps to move directly to affordable, effective Safe System approaches noted in
Phase 4. High-income countries which are now setting increasingly ambitious road safety goals and targets
are also advised to adopt this approach (OECD, 2008; GRSF, 2009; PIARC, 2012; WHO, 2013a). The
implications for current practice in a variety of settings are recurrent themes in this manual and specific
guidance is provided on appropriate steps for different road safety contexts.

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BOX 1.3: THE PROGRESSIVE SHIFTS IN THINKING AND PRACTICE ABOUT HOW TO MANAGE ROAD SAFETY

- Phase 1: 1950s thinking and practice focused on driver intervention and a blame the victim
approach. Safety management was characterised by dispersed, uncoordinated, and insufficiently
resourced units performing isolated single functions.
- Phase 2: 1960s1970s thinking and practice focused on system-wide interventions encompassing
infrastructure, vehicles and users in the pre-crash, in-crash and post-crash stages, but not yet
emphasising institutional management responsibilities.
- Phase 3: 1980s1990s thinking and practice focused on system-wide interventions and targeted
results, and saw the beginnings of institutional leadership and accountability for the implementation of
targeted plans, which led to increasingly significant reductions in deaths and serious injuries during
these decades.
- Phase 4: Since the 1990s, thinking and practice has focused on increasingly holistic approaches,
generically known as the Safe System approach, seeking the long-term elimination of death and serious
injury. This goal is supported by interim targets and system-wide interventions (foreseen in the 1960s
and 1970s, and used increasingly in the 1980s and 1990s). These pay greater attention to human error
and vulnerabilities, with renewed emphasis on speed management, better road and vehicle crash
protection, and post-crash care. This is underpinned by shared responsibility and strengthened,
accountable institutional leadership.
Source: OECD, 2008; GRSF, 2009.

This manual outlines a suggested path for jurisdictions to move from weak to stronger institutional
capacity, particularly in their governmental lead agency and coordination arrangements and results
management. The aim is to provide state-of-the-art guidance to assist all those involved in the safe
planning, design, operation and use of the road network in accordance with national, regional and global
goals.

FOOTNOTES

1.The World Bank categorises countries into low-, medium- and high-income groups based on gross
national income (GNI) per capita, where low-income in 2011 = $1,025 or less; middle income =
$1,026$12,475; and high income = $12,476 or more
(http://data.worldbank.org/about/country-classifications)

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1.2 THE IMPACT ON PUBLIC HEALTH

This section describes the current and forecast burden of road traffic injuries in more detail, both globally
and regionally.
The Global Status Report on Road Safety is the central publication for periodic monitoring and evaluation
of the Decade of Action for Road Safety goals (WHO, 2013a) . While crash injury data is incomplete and
often substantially under-reported in many countries in both the health and transport sectors, the latest
available estimates referred to in this manual provide a comprehensive strategic overview of the emerging
crisis in LMICs.
The Global Status Report brings together data based on survey information collected for 182 countries,
and makes estimates, where appropriate, to account for varying levels of data quality in order for data to
be comparable across countries. This includes use of the 30-day definition of a road traffic death and
involves point estimates of road traffic deaths in LMICs, which are sometimes far in excess of officially
reported deaths. Data have been extrapolated for all 195 countries and territories in the world. Full details
of the methodology used to develop comparative estimates are provided in WHO (2013a, p.42).
The Global Status Report notes the urgent need for standardised data collection on road traffic fatalities
and the need for improvement in the quality of safety data on road traffic deaths, disability and other nonfatal injuries. See Effective Management And Use Of Safety Data for full discussion and guidance on the
establishment, management and use of data, and determining levels of under-reporting.

GLOBAL ESTIMATES
In 2010, at least 1.24 million people lost their lives in road traffic crashes (WHO, 2013a). Road traffic injury
is a leading cause of death and serious health loss (expressed in terms of disability adjusted life years lost
(DALYs)1 (see Box 1.4 ). For every road traffic death, at least 20 people sustain non-fatal injuries (ranging
from those that can be treated immediately and for which medical care is not needed or sought, to those
that result in a permanent disability (Peden et al., 2004). On an annual basis, between 20 and 50 million
people are disabled or injured as a result of road traffic crashes (WHO, 2013a).
BOX 1.4: ROAD TRAFFIC INJURY AS A LEADING CAUSE OF DEATH AND SERIOUS HEALTH LOSS

Road traffic injury in 2010 was the:

9th leading cause of death, overtaking tuberculosis and malaria as causes

leading cause of death for young people aged 1529 years
leading cause of death for males aged 514 years
leading cause of serious health loss for men aged 1549 years
2nd leading cause of death for those aged 1549 years.

Source: WHO, (2013a); WHO (2013b); IHME, (2013)

In some regions, road traffic injury was the leading cause of death for certain age groups, as shown in
Table 1.1. For HICs in general, road traffic injury was the leading cause of death for children aged 514
years (IHME, 2013). A study in four LMICs indicated that 17% of children attending an emergency

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department following a road traffic crash sustained disabilities lasting six weeks or more (WHO, 2008).
Region

14 years

1014 years

59 years

North America

Central Europe

Australasia

Western Europe

North Africa and Middle East

Latin America

DEATH RATES
In 2010, the global road traffic fatality rate was 18 per 100,000 population in low income countries, with
the highest annual road traffic fatality rates averaging at 20.1 per 100,000 in middle-income countries,
and the lowest average rate in high-income countries at 8.7 per 100,000 (see Figure 1.1).

Figure 1.1 Road traffic deaths per 100,000 population, by country income status; 2010 - Source: WHO, (2013a).

Some 80% of road traffic deaths occur in rapidly motorising middle-income countries, which account for
72% of the worlds population and 52% of the worlds registered vehicles. As shown in Figure 1.2, these
countries have a high proportion of road traffic fatalities relative to their level of motorisation (WHO,
2013a). Details on individual country performance can be found in the periodic Global Status Reports

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(WHO, 2009, 2013a).

Figure 1.2 Population, road traffic deaths and registered motor vehicles by country income status; 2010 - Source: WHO,
(2013a).

Compared with the baseline data (2007, 2010) collected by the WHO to allow periodic monitoring of the
Decades goal (which commenced in 2011), most HICs are reported as achieving decreasing numbers of
deaths from road traffic crashes. Most LMICs are experiencing increasing numbers of fatalities, although
just under a half of the middle-income countries have achieved decreases (see Figure 1.3).

Figure 1.3 Countries with changes in numbers of road traffic deaths (20072010) by country income status - Source: WHO,
(2013a).

Between 2007 and 2010, the number of road traffic deaths decreased in 88 countries, of which 42 were
high-income countries, 41 were middle-income countries, and five were low-income countries. Over the
same period, 87 countries saw increases in the numbers of road traffic deaths (WHO, 2013a).

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THE MAIN ROAD CASUALTY GROUPS

In most LMICs, a much higher proportion of road users are pedestrians, cyclists and users of motorised
two- or three-wheeled vehicles when compared with HICs. Over half of the global road traffic deaths occur
among vulnerable road users motorcyclists (23%), pedestrians (22%) and cyclists (5%), with the
remaining share distributed as 31% of deaths among car occupants and 19% among unspecified road
users. Low-income countries have the highest proportion of fatally injured casualties among vulnerable
road users at 57%, as opposed to 51% in middle-income countries, and 39% in high-income countries
(WHO, 2013a). Figure 1.4 provides further detail on road deaths by road user type for low-, middle- and
high-income countries.

Figure 1.4 Proportion of road traffic deaths by road user type and country status; 2010 - Source: WHO, (2013a).

Even in HICs, vulnerable road users are often vastly over-represented when rates of death and serious
injury are compared. For example, when the distances travelled (billion miles) by different modes of road
use were compared, more than 10 times as many pedestrians and cyclists than car drivers lost their lives
on Great Britains roads in 2011. For motorcyclists, the rate was around 40 times higher (Department for
Transport, 2012). The gap is even wider when considering the risk of death or serious injury by billion
vehicle miles. For each car driver in Great Britain, more than 20 times as many pedestrians and around 40
times as many cyclists were killed or suffered a serious injury from a road traffic crash. Motorcyclists were
exposed to the greatest risk, as they were 75 times more likely to be killed or seriously injured than a car
driver (Department for Transport, 2012).
Young adults aged between 15 and 44 years account for 59% of global road traffic deaths (see Figure
1.5); and more than three-quarters (77%) of all road traffic deaths occur among men. In high-income
countries, the proportion of deaths among those over 70 years is noticeably greater than in LMICs. Key

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exposure factors, such as longevity in these countries, combined with the greater risk posed by increased
frailty, will contribute to these outcomes (WHO, 2013a).

Figure 1.5 Proportion of road traffic deaths by age range and country income status - Source: WHO, (2013a).

REGIONAL ANALYSES
There is substantial variation in the road traffic death rates between different regions and within regions
(see Figure 1.6). The reported risk of fatal injury is greatest in Africa at 24.1 per 100,000 populations and
lowest in the European region at 10.3 per 100,000 population. Within regions, taking under-reporting of
road fatalities into account, it is estimated that over half of African countries may have death rates of 30
per 100,000 population or more (AfDB, 2012). The lowest recorded global country death rates for 2010
were in Iceland (2.5 per 100,000 populations) and Sweden (2.8 per 100,000 population) (IRTAD, 2012).

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Figure 1.6 Road traffic deaths per 100,000 populations by WHO region - Source: WHO, (2013a).

As shown in Figure 1.7, in four out of six WHO regions, car occupants are the largest fatal casualty group.

Figure 1.7 Road traffic deaths by road user type and WHO region; 2010 - Source: WHO, (2013a).

In Africa, Europe and the Americas, most deaths from road traffic crashes involve car occupants and
pedestrians. In South East Asia and the Western Pacific, deaths amongst users of motorised two- and
three-wheelers contribute a large proportion of total fatal casualties in road crashes (WHO, 2013a).

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FUTURE TREND FORECASTS

Modelling of historic global trends indicates that if LMICs choose to follow the costly evolutionary path of
HICs in reducing deaths and serious injuries as they built knowledge, then the road death toll in LMICs is
likely to increase very substantially (Kopits and Cropper, 2003; WHO 2013b). Latest forecasts indicate that,
based on current trends, 96% of the global total of road deaths by 2030 are likely to occur in LMICs (WHO,
2013b).
The highest projected regional death rates (deaths per 100,000 persons) to 2030 are in Sub Saharan Africa
(38), South Asia (29) and the Middle East and North Africa region (28) with decreasing rates between 2015
and 2030 in the East Asia and Pacific and Latin America and Caribbean regions and, most sharply, in the
European and Central Asia regions (See Table 1.2). There is large regional variation in LMICs in the
number of deaths per 100,000 persons with the highest rates being 4 times higher than the lowest. By
2015, the death rate from road traffic crashes is forecast to be around 8 per 100,000 persons in HICs
decreasing to 6 by 2030 but nearly 20 in 100,000 persons in LMICs (WHO, 2013b).
Deaths per 100,000
persons

World (World Bank regions)

2015

2030

South Asia

21

29

East Asia and Pacific

22

18

Sub-Saharan Africa

25

38

Middle East and North Africa

26

28

Latin America and Caribbean

20

19

European and Central Asia

14

High-income countries

Global total

20

22

Source: WHO, (2013b).

The relative importance of road traffic injury to other disease burdens is also predicted to increase steeply.
Forecasts of global mortality trends to 2030 indicate that road traffic injury is set to increase from the 9th
to the 7th cause of death, as shown in Figure 1.8 (WHO, 2013b).

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Figure 1.8 Forecasts of global mortality trends to 2030 - Source: WHO, (2013b).

WHERE DO DEATHS AND SERIOUS INJURIES OCCUR?

Country road safety management capacity reviews and other studies reveal that the majority of road
deaths and serious injuries occur on a relatively small proportion of the road network. Such roads usually
have both urban and rural sections. In India, around two-thirds of deaths occur on national and state
highways, which account for just 6% of the network (Mohan et al., 2009). In Bangladesh, just 3% of arterial
roads account for 40% of the road deaths (Hoque, 2009). Statistics from a wide range of countries show
that typically, around 50% of deaths occur on just 10% of the road network (McInerney, 2012). These
roads have high strategic priority, attract large investment, and are particularly amenable to targeted road
safety treatments (GRSF, 2013).
Typically, in the main road network, traffic volumes and vehicle speeds are high, with a mix of motorised
traffic and non-motorised users, and mixed speed road environments (Commission for Global Road Safety,
2011; GRSF, 20062013; UNRSC, 2011b). A key problem is that many road standards used in road projects
in LMICs do not provide for the degree of human vulnerability involved in the use of the road network.
Furthermore, the efficient and effective police enforcement of safety behaviours, which contribute to the
overall safety performance of road safety engineering standards in high-income countries, is lacking.
Junction design standards and the management of road use from low- to high-speed environments expect
vulnerable road users to compete successfully against faster, bigger vehicles, with tragic consequences
(GRSF, 2010, 2011). While new roads bring new opportunities for development, many increase the risk of
death and serious injury where roads are not restricted to through-traffic, where linear settlements are not
avoided, and where there is no first class provision for pedestrians, cyclists and other vulnerable road
users (UNRSC, 2011b). Specific global guidance to assist with project design for the road safety
management of corridors is provided in Targets and Strategic Plans and in Planning, Design & Operation of
this manual as well as global references on this issue (e.g. UNRSC, 2011b; GRSF, 2009, 2013; Breen et al.,
2013).

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WHAT ARE THE MAIN ROAD TRAFFIC CRASH TYPES?

The main crash types on the worlds roads have been identified as follows (UNRSC, 2011b):
Walking and cycling across or along the road. A vulnerable road users risk increases steeply in mixed
speed traffic when traffic speeds are greater than 30 km/h.
Head-on crashes typically kill and seriously injure occupants even in the best designed vehicles at speeds
greater than 70 km/h.
Side impacts at intersections typically kill and seriously injure occupants even in the best designed
vehicles at speeds greater than 50 km/h.
Run-off-road crashes into rigid fixed objects produce a high number of fatal and serious outcomes at
speeds greater than 70 km/h for frontal impacts and 50 km/h for side impacts even in the best designed
vehicles.
Further information is provided on the main crash types in Section Crash Causes and in Part Planning,
Design & Operation.

WHAT ARE THE KEY ROAD SAFETY PROBLEMS?

Road safety problems in low-, middle- and high-income countries are found across road safety
management systems, including in:

the quality of institutional management arrangements: in leadership and results focus, coordination,
legislation, funding, promotion, monitoring and evaluation, research and development, and knowledge
transfer, which provide the foundation for producing intervention and improved road safety results;
the scope and quality of the intervention set: in the planning, design, operation and use of the road
network; in the safety quality of vehicles and emergency medical response; insufficient attention to the
evidence-base or to addressing the needs and vulnerabilities of all users;
the level of road safety results achieved for final outcomes: e.g. levels of deaths, serious injuries, costs;
intermediate outcomes (e.g. level of safety quality of roads and vehicles, emergency medical system
response, levels of drinking and driving, speeding, seat belt and crash helmet use); and institutional
outputs (e.g. numbers of speed checks, breath tests).

LMICs present some particularly complex challenges for road safety work. Weak road safety management
capacity in many countries presents a large barrier to road safety progress (GRSF, 20062013). Road
safety progress will be linked to other development priorities such as:

broad institutional development and governance;

the establishment or improvement of health systems;
infrastructure network development;
police and judicial reform.

Country road safety investments in LMICs will have to be sustained over a long period and across a range
of sectors, directed by appropriately resourced governmental lead agency arrangements.
A full discussion and guidance is provided in subsequent sections on critical success factors for addressing
key road safety problems. This will address the needs of LMICs with their own special challenges. It will
also provide guidance for HICs that are currently in the process of addressing strict Safe System
parameters, which include new speed thresholds as well as the broader environmental and public health

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drive for more active transport solutions.

FOOTNOTES

1.Disability-adjusted life years lost (DALYs) is the sum of years lost due to premature death and years
lived with disability. DALYs are also defined as years of health life lost.

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1.3 SOCIO-ECONOMIC COSTS OF ROAD

TRAFFIC CRASHES
EVALUATING COSTS AND THE VALUE OF INJURY PREVENTION
Evaluation of the direct and indirect socio-economic costs of the outcomes of road traffic crashes is
important. This allows measurement of the burden that road traffic crash injury imposes on society, and
highlights the return on investment in road safety and the relative benefits and costs of different policy
options in the allocation of resources1
Inadequacies in data collection, serious under-reporting of road traffic injuries, and the lack of an adopted
global method in valuing the prevention of death and serious injury, do not allow precise estimates to be
made of the socio-economic value of their prevention in LMICs. However, approximate and conservative
estimates have been made at global and regional levels. In many HICs, effective practice provides more
reliable estimates involving periodic updating of economic values for preventing different injury severities
using the willingness to pay method (see Prioritisation & Assessment for further discussion).

GLOBAL ESTIMATES
It was estimated over a decade ago that the average annual socio-economic cost of road traffic crashes
represents 1% of GNP in low-income countries, 1.5% in middle-income countries, and 2% in high-income
countries (Jacobs et al., 2000)23. While reflecting a mixture of direct economic costs and indirect costs,
these remain the best estimates of average costs for different country settings. However, the global costs
are likely to be significantly higher, especially if under representation of deaths and injuries in available
statistics and the social costs of pain and suffering are fully accounted for. More recently, the International
Road Assessment Programme has calculated that serious road trauma now costs the world more than
US$1.5 trillion per year (iRAP, 2012).

REGIONAL AND NATIONAL ESTIMATES

Few estimates have been made of the socio-economic costs of injury at the regional level, particularly in
low- and middle-income countries where data collection and analysis is not systematically carried out.
Estimates for the European Union (EU27) range from 134 billion to 172 billion; with an annual cost
equivalent to around 2% of GDP over the last decade (ETSC, 2011). Considerable variations in socioeconomic valuations are reported for different countries. A survey of OECD countries suggested that the
socio-economic cost of road crashes using different methods of evaluation amounted to between 1.55%
of GDP (OECD, 2008). In Africa, the International Road Assessment Programme estimates indicate annual
costs of up to 7% of GDP (McInerney, 2012).

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 ARRB Group

WHO BEARS THE COST?

The large burden of costly injuries is borne by society in general. However, a large part of the burden is
particularly within the health sector in terms of costs to the emergency medical system, with employers in
terms of premature loss or disablement of the worlds most economically active citizens, and with
households in terms of loss of the main wage earner. A summary of some of those directly bearing the cost
of road injury and death is provided below:

Health system: In LMICs, road traffic-related injuries represent a particularly heavy drain on emergency
medical system resources. For example, in India, road traffic injury patients represent between 2050%
of emergency room registrations, 1030% of hospital admissions and 6070% of people hospitalised with
traumatic brain injury (Gururaj, 2008). Despite continuing progress in HICs, involvement in road crashes
continues to be a leading cause of death and hospital admission, and a significant drain on emergency
medical systems. For example, road traffic injury is the leading cause of hospital admission for citizens of
the European Union aged 45 years or below (European Commission, 2009)
Employers: Work-related road crashes and injuries present substantial costs for employers (DaCoTa,
2012b). The real costs of road crashes to organisations are nearly always significantly higher than the
resulting insurance claims (ORSA, 2011). Crash costs include lost work time, lost orders and production
losses; emergency medical costs; vehicle repair and maintenance costs; damage to employer reputation
especially when vehicles bearing the company name are involved; and environmental costs due to
spillages of dangerous substances.
Households: Research shows that road traffic crashes have disproportionate costs for low income
households (Aeron-Thomas et al., 2004; Graham et al., 2005). The loss of the major family wage earner
as a result of a road traffic crash can push households into poverty, and limit the ability of victims to
cope with the consequences. Costs can include immediate and long-term costs associated with medical
treatment and care, and the value of lost earnings where a family member has to give up paid work and
care for the crash victim. The financial impact on families has been shown to result in increased financial
borrowing and debt, and even a decline in food consumption (WHO, 2013a).

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A high price in socio-economic terms is being paid for motorised mobility in all countries of the world. In
particular, road traffic injuries in LMICs are a financial drain they can ill afford, which inhibits their desired
social and economic development (FIA Foundation for the Automobile and Society, 2005). Road safety
investment in both LMIC and HICs needs to be scaled up to match the high socio-economic values of
preventing death and serious injury in road crashes (WHO, 2009; DaCoTa, 2012c).

FOOTNOTES

1.Note that road safety policy is not always best directed by cost-benefit analyses. Important
considerations that may justify departing from the policy priorities implied by cost-benefit analyses
include the aim of reducing disparities in risk, thus giving high priority to measures benefiting
pedestrians and cyclists; or the need to reduce speed give priority to those measures that provide the
largest reductions in the number of road deaths and serious injuries, which may not always be the most
cost-beneficial (DaCoTa, 2012a)
2.According to the World Bank, gross domestic product (GDP) is calculated as the value of the total final
output of all goods and services produced in a single year within a country's boundaries. Gross National
Product (GNP) is GDP plus incomes received by residents from abroad minus incomes claimed by nonresidents
3.Note that costs are calculated differently, with some including direct economic costs and others also
including indirect costs comprising a valuation for pain, grief and suffering

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1.4 ROAD SAFETY IN CONTEXT

Improving global road safety is now linked with the broader vision of sustainable development and
priorities addressing the s of the child, public health, poverty reduction and social inclusion, and
occupational health and safety.

SAFE, CLEAN AND AFFORDABLE MOBILITY GOALS

Following five successive UN resolutions on Improving road safety since 2004, the UN Rio Conference of
world leaders highlighted in discussion of the Future We Want (UN, 2012) the importance of the efficient
movement of people and goods, and access to environmentally sound, safe and affordable transportation
as a means to improve social equity, health, resilience of cities, urban-rural linkages and productivity of
rural areas. In this regard, we take into account road safety as a part of our efforts to achieve sustainable
development (UN, 2012). There are also calls for road safety to be recognised and included in the post2015 Sustainable Development Goals framework (Commission for Global Road Safety, 2013; UN Open
Working Group on Sustainable Development Goals, 2014). In national transport policy, safe, clean and
affordable mobility goals are set increasingly to realise the associated co-benefits of integrated initiatives
(see Box 1.5).
BOX 1.5: EXAMPLES OF NATIONAL TRANSPORT POLICY GOAL STATEMENTS: SELECTED OECD COUNTRIES

Australia: Australia requires a safe, secure, efficient, reliable and integrated national transport system
that supports and enhances our nations economic development and social and environmental wellbeing. (National Transport Policy, Australian Transport Council, 2009).
Canada: Transport Canadas vision is for A transportation system in Canada that is recognized
worldwide as safe and secure, efficient and environmentally responsible. (Transport Canada, 2011).
Netherlands: The Netherlands should offer everyone an efficient, safe and sustainable traffic and
transportation system, whereby quality for individual users stands in a meaningful equilibrium with
quality for the country as a whole. (National Traffic and Transport Plan, 20012020, Ministry of
Transport, Netherlands).
New Zealand: The governments vision for transport in 2040 is that: People and freight in New Zealand
have access to an affordable, integrated, safe, responsive and sustainable transport system. (New
Zealand Transport Strategy, 2008, Ministry of Transport).
Norway: The Government aims to provide an effective, universally accessible, safe and
environmentally friendly transport system that covers the Norwegian societys transport requirements
and advances regional development. (National Transport Plan, 20102019, Norwegian Ministry of
Transport and Communications).
Sweden: The objective of transport policy is to ensure the economically efficient and sustainable
provision of transport services for people and businesses throughout the country. Accessibility is the
functional objective and health, safety and environment are the impact objectives. The design, function
and use of the transport system will be adapted to eliminate fatal and serious accidents. It will also
contribute to the achievement of the environmental quality objectives and better health conditions.
(Ministry of Enterprise, Energy and Communications, Stockholm, May 2009).
United States: Legislation setting out the transportation needs for the 21st Century states that: among
the foremost needs that the surface transportation system must meet to provide for a strong and
vigorous national economy are safe, efficient, and reliable transportation (Safe, accountable, flexible,
efficient transportation equity act: a legacy for users, Public law 10959, 2005).
Sources: Bliss and Breen, (2011).

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Despite the rapid growth in motorised traffic, the main modes of travel in LMICs are likely to remain
walking, motorcycling, cycling and public transport (Kopits & Cropper, 2003). This highlights the
importance of planning and providing for the safety needs of these road users (particularly for pedestrians,
as the most vulnerable road users), who sustain a high proportion of road traffic injuries, as well as
integrating safety into developing road networks for cars, vans, buses, and trucks.
Significant co-benefits can be achieved for the environment and public health. For example, land use and
transportation planning, the provision of safer infrastructure facilities to promote increased walking and
cycling, and measures to reduce vehicle speeds, will also result in less greenhouse gas emissions and local
air pollution, greater energy security, and improved physical wellbeing (GRSF, 2009). Other means include
reducing the volume of motor vehicle traffic by providing for public transport and pursuing liveable city
policies; providing efficient networks where the shortest or quickest routes coincide with the safest routes;
and encouraging road users and freight to switch from higher risk to lower risk modes of transport (Peden
et al., 2004).
In some instances, road safety policy can be in conflict (or be perceived to be in conflict) with other
societal needs and policies. However, safe, clean and affordable mobility goals for transport policy provide
a means for seeking integrated solutions that address competing societal goals.

PUBLIC HEALTH PRIORITY

Following the publication of the World Report on Road Traffic Injury Prevention (Peden et al., 2004), the
World Health Assembly adopted resolution WHA 5.710 on road safety and health, which called on WHO
member states to prioritise road safety as a public health issue and to take steps to implement measures
known to be effective in reducing road traffic injuries.

RIGHTS OF THE CHILD AND CITIZEN

The widely supported Convention on the Rights of the Child, UN General Assembly Resolution 44/25
(1989), requires governmental signatories to provide a safe environment and protection from injury and
violence. The Tylsand Declaration by Swedish road safety agencies and stakeholders in 2007 states that
everyone has the to use roads and streets without threat to life or health (see Box 1.6).
BOX 1.6: THE TYLSAND DECLARATION OF CITIZENS TO ROAD TRAFFIC SAFETY, SWEDEN (2007)

Articles
1. Everyone has the to use roads and streets without threats to life or health;
2. Everyone has the to safe and sustainable mobility: safety and sustainability in road transport should
complement each other;
3. Everyone has the to use the road transport system without unintentionally imposing any threats to
life or health on others;
4. Everyone has the to information about safety problems and the level of safety of any component,
product, action or service with the road transport system;
5. Everyone has the to expect systematic and continuous improvement in safety: any stakeholder
within the road transport system has the obligation to undertake corrective actions following the
detection of any safety hazard that can be reduced or removed.
Source: http://publikationswebbutik.vv.se/upload/3423/89044_Tylosandsdeklaration...

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POVERTY REDUCTION GOALS

Road safety improvements can contribute to poverty reduction goals given the scale of loss of GDP from
road crashes. Crash victims typically involve the most economically active of citizens, often with adverse
impacts on their dependants.

SOCIAL EQUITY PRIORITY

The World Report (Peden et al., 2004) identified road safety as a social equity issue with vulnerable road
users benefiting the least from policies designed for motorised travel, but bearing a disproportionate share
of the disadvantages of motorisation in terms of injury, pollution and the separation of communities.

OCCUPATIONAL HEALTH AND SAFETY

Work-related road safety can contribute to substantial reductions in employers costs, and impact on
national and organisational goals for occupational health and safety. Joint country strategies developed by
road safety lead agencies and the occupational health sector are being increasingly produced. A new ISO
39001 standard on road safety management systems in organisations has been produced to provide key
advice to employers towards these ends (see The Road Safety Management System).

EDUCATIONAL GOALS
While the effects of road traffic injury on educational goals have been little discussed, many thousands of
children see their prospects for education diminished by injury and disability from road traffic crashes
(Watkins & Sridhar, 2009).

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TOURISM IMPACTS
A report by the WHO (2007) concluded that risks of road traffic injuries are appreciably higher for tourists
than health risks such as epidemics (e.g. AIDS); illnesses (such as malaria and cholera); personal security
risks associated with international terrorism, violence and crime; travel injury risks on modes other than
road transport modes (e.g. aviation); and other personal injury risks such as drowning. Globally,
international tourist road fatalities are forecast to increase three-fold to around 75,000 per annum in 2030,
with implications for developing and mature economies alike (Commission for Global Road Safety, 2010).
Road traffic injury clearly has many societal impacts. The scale of the road safety challenge and the
diversity of the effects of road traffic injury underline the importance of exploring synergies with other
societal goals and priorities. When directed and assisted by accountable national road safety lead
agencies, country road safety coordination arrangements provide a valuable platform for integrating road
safety into other government policies to increase coverage and resourcing levels.

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