EDITORIALS
How safe are the world's roads?
Tami Toroyan*; Margie Peden
Department of Violence and Injury Prevention and Disability, World Health Organization, 20 avenue Appia, 1211 Geneva 27, Switzerland
Road traffic injuries are a leading public health problem, resulting in over 1.2 million deaths each year.1 They affect all age groups but their impact is most striking among the young: they are the leading cause of death globally for those between the ages of 15 and 29. While road traffic death rates in many high-income countries have stabilized or declined in recent decades, data suggest that in most regions of the world they are increasing as a result of rapidly increasing motorization combined with insufficient prevention activities. It has been estimated that, unless immediate action is taken, road deaths will rise to become the fifth leading cause of death by 2030, resulting in an estimated 2.4 million fatalities per year.1,2
The attention given by policymakers and funders to this epidemic on the world's roads has been far from commensurate with the disease burden caused by road traffic injuries. Efforts to strengthen advocacy efforts and position road safety higher up political and development agendas and to secure long-term funding for sustained investment in road safety are assisted by the ability to make reliable statements about the magnitude of the problem, improved monitoring of global and regional trends, and identification of the gaps in action that are needed at the national, regional and international levels. This in turn requires a global assessment of road safety measures using a standard method that allows monitoring of trends of several road safety indicators over time, and that enables countries to compare their road safety situation with other countries. Such assessments are common in other health related topics: alcohol, tobacco control, and tuberculosis all have tools and indicators that allow them to assess the global status of their particular topic on a regular basis and to use this data for advocacy purposes. This year for the first time such a survey was conducted in 178 countries: the results presented in the Global status report on road safety provide the first global overview of road safety, and offer governments, donors, practitioners and researchers the information they need to make evidence-based decisions around road safety.3
The report presents several key findings that have important policy implications. It confirms previous research that road traffic fatality rates are much higher in low- and middle-income countries (21.5 and 19.5 per 100 000 respectively) than in high-income countries (10.3. per 100 000). It highlights that while developing countries represent over 90% of road traffic deaths, they account for less than half of the world's registered vehicles. This links to another finding that shows that almost half of those killed in road traffic crashes are pedestrians, cyclists and motorcyclists: this proportion of deaths of vulnerable road users is higher in the poorer economies of the world, many of which are still lacking road safety prevention measures and emergency medical services that can cope with the consequences of increasing crashes. Halting or reversing the trend in global road traffic fatalities therefore necessitates a broad perspective involving the protection of all road users, in particular, consideration of the needs of vulnerable road users in land use and transport planning decisions. For example, infrastructure developments can separate motorized and non-motorized road users who share road space; investment in public transport can reduce the risk among vulnerable road users; and strategies can be used to encourage safe walking and cycling, already major modes of transport in some low- and middle-income countries. Reducing dependency on individual forms of motorized transport can also have many associated health and environmental benefits due to reduced air pollution and the health consequences that result from increased levels of physical activity.
The report provides some striking trends of national fatalities in several middle-income countries that have undergone rapid urbanization and motorization. These suggest that many low- and middle-income countries that are yet to undergo this transition could see their road traffic death rates rise further unless immediate and decisive action is taken to put into place and sustain several road safety measures.
The report provides some important new data on interventions in place at a country level: it shows that a mere 15% of countries have laws that conform with good practice based on sound evidence of their effectiveness, in spite of evidence on the effectiveness of applying and enforcing legislation relating to key risk factors excessive speed, drink-driving, and the use of seat-belts, child restraints and motorcycle helmets. Enforcement of legislation is critical to the success of such measures and the data presented in the report suggest levels of enforcement are inadequate in many countries.
Finally, the report suggests that there are huge gaps in the quality and coverage of data that many countries collect and report on road traffic injuries, with underreporting of deaths a widespread problem, along with lack of data for monitoring and evaluating interventions.
The Global status report on road safety provides the first global baseline of road safety against which future efforts can be measured. The results of the report can be used to inform policy decisions in road safety and to leverage political support and resources for safer road transportation for all road users. 
References
1. The global burden of disease 2004 update. Geneva: World Health Organization; 2008. Available from: http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_AnnexA.pdf [accessed on 8 September 2009] .
2. World health statistics 2008. Geneva: World Health Organization; 2008. Available from: http://www.who.int/whosis/whostat/EN_WHS08_Full.pdf [accessed on 8 September 2009] .
3. Global status report on road safety: time for action. Geneva: World Health Organization; 2009. Available from: http://www.who.int/violence_injury_prevention/road_safety_status/ [accessed on 8 September 2009] .
* Correspondence to Tami Toroyan (e-mail: toroyant@who.int).