CONTENTS Foreword vii Preface ix Contributors xiii Acknowledgements xvii Introduction xix 1. The fundamentals Introduction 3 A public health concern 3 Road deaths, disability and injury 3 The social and economic costs of road traffic injuries S Changing fundamental perceptions 7 The predictability and preventability of road crash injury 7 The need for good data and a scientific approach 8 Road safety as a public health issue 8 Road safety as a social equity issue 10 Systems that accommodate human error 10 Systems that account for the vulnerability of the human body 11 Technology transfer from high-income countries 11 The new model 12 A systems approach 12 Developing institutional capacity 13 Achieving better performance 18 Shared responsibility 18 Setting targets 22 Partnerships in the public and private sectors 23 Conclusion 25 References 25 2. The global impact 31 Introduction 33 Sources of data 33 Magnitude of the problem 33 Global estimates 33 Regional distribution 34 Country estimates 35 Trends in road traffic injuries 36 Global and regional trends 36 Trends in selected countries 36 Projections and predictions 37 Motorization, development and road traffic injury 39 Profile of people affected by road traffic injuries 41 Types of road user 41 Occupational road traffic injuries 44 Sex and age 44 Socioeconomic status and location 46 Other health, social and economic impacts 47 Health and social impacts 48 Economic impact 50 Data and evidence for road traffic injury prevention 52 Why collect data and build evidence on road traffic injuries? 52 Sources and types of data 52 Data linkages 55 Analysis of data 56 Data issues and concerns 56 Other issues 59 Limitations of the data sources used in this chapter 59 Conclusion 60 References 61 3. Risk factors 69 Introduction 71 Factors influencing exposure to risk 72 Rapid motorization 72 Demographic factors 74 Transport, land use and road network planning 74 Increased need for travel 75 Choice of less safe forms of travel 75 Risk factors influencing crash involvement 76 Speed 76 Pedestrians and cyclists 78 Young drivers and riders 79 Alcohol 80 Medicinal and recreational drugs 83 Driver fatigue 84 Hand-held mobile telephones 85 Inadequate visibility 85 Road-related factors 86 Vehicle-related risk factors 88 Risk factors influencing injury severity 88 Lack of in-vehicle crash protection 88 Non-use of crash helmets by two-wheeled vehicle users 90 Non-use of seat-belts and child restraints in motor vehicles 91 Roadside objects 93 Risk factors influencing post-crash injury outcome 93 Pre-hospital factors 94 Hospital care factors 94 Conclusion 94 References 95 4. Interventions 107 A road traffic system designed for safe, sustainable use 109 Managing exposure to risk through transport and land-use policies 109 Reducing motor vehicle traffic 109 Encouraging use of safer modes of travel 111 Minimizing exposure to high-risk scenarios 111 Shaping the road network for road injury prevention 113 Safety-awareness in planning road networks 113 Incorporating safety features into road design 114 Remedial action at high-risk crash sites 118 Providing visible, crash-protective, smart vehicles 119 Improving the visibility of vehicles 119 Crash-protective vehicle design 120 Intelligent vehicles 124 Setting and securing compliance with key road safety rules 126 Setting and enforcing speed limits 127 Setting and enforcing alcohol impairment laws 128 Medicinal and recreational drugs 131 Drivers' hours of work in commercial and public transport 131 Cameras at traffic lights 132 Setting and enforcing seat-belt and child restraint use 132 Setting and enforcing mandatory crash helmet use 135 The role of education, information and publicity 137 Delivering post-crash care 138 Chain of help for patients injured in road crashes 138 Pre-hospital care 139 The hospital setting 140 Rehabilitation 141 Research 142 Conclusion 143 References 143 5.Conclusions and recommendations 155 Main messages from the report 157 Recommended actions 160 Conclusion 164 Statistical annex 165 Glossary 199 Index 203