Traffic accidents - a global public health problem
Road traffic accidents in low- and middle income countries are a growing public health problem. The number of fatalities and long-term disabilities worldwide can be given an equal status with infectious diseases. Yet in countries receiving aid, little of the support is given to road-safety projects.
What kind of assistance do low-income countries need to combat traffic accidents? The situation varies from country to country but many of them have one thing in common - they lack good data and causal analysis as the basis for prioritizing appropriate measures.
More people die in traffic than from malaria
Worldwide, approximately 1.2 million people die in road traffic accidents each year, making traffic accidents the main cause of death in the 15 to 29 age group. Over 90 per cent of the fatalities occur in low-and middle-income countries. In addition to those killed, between 20 and 50 million are injured. In high-income countries, the number of fatalities per year has declined in recent decades, while there has been a sharp increase in low-and middle-income countries.
If this trend continues, 2.4 million people will be killed in traffic accidents in 2030, which will make traffic accidents the fifth leading cause of death worldwide. Already, more people die in traffic accidents than from malaria (0.66 million in 2011), almost levelling in numbers with deaths caused by tuberculosis (1.4 million in 2011). When lost quality of life due to injuries and disabilities are taken into account, traffic accidents rank ahead of tuberculosis.
Substance abuse is a major cause
The main causes of serious road accidents are speeding, substance abuse (especially alcohol) and failure to use a seat belt or motorcycle helmet. Often there is a combination of several factors. Globally, it can be assumed that every third traffic fatality is related to drink driving. In some African countries the figure is presumed to be 60 per cent or more. However, information about the causes is lacking for most countries.
Some sobering figures are available though. In Ghana, a study showed that 5.5 per cent of drivers in normal traffic had a blood alcohol level of over 0.8 grams /litre. In Norway, less than 0.1 per cent of drivers in traffic have such high levels. The cause of this might be due to several factors such as differences in legislation, law-enforcement as well as public attitudes. Public acceptance levels for drink driving may in turn be related to lack of information and low awareness among politicians about the causes of traffic accidents.. This is mainly due to a lack of surveillance and information about the causes.
Local surveillance is required
Norway has invested in influencing public attitudes regarding drink driving, but other substances also affect driving ability. Surveillance has shown that there is a much greater incidence of driving under the influence of illegal drugs and medicines than from alcohol among Norwegian drivers. These substances, either alone or in combination with alcohol, are detected in approximately two thirds of samples taken from drivers killed in single vehicle accidents. Although Norway has one of the lowest levels of traffic fatalities by population in the world, surveillance shows that intoxication is a frequent cause of accidents. This has led to an amendment of the Road Traffic Act 2012 with the introduction of legal limits for 20 illegal and medicinal drugs, which equate driving while intoxicated by drugs with drink driving.
Substance abuse varies between countries but it is likely that knowledge and experience from Norway and other high-income countries can also be applied to low-income countries. However, it is essential to have knowledge of local conditions. Road safety measures and legislation must be adapted to each country.
Call for action
There is an international consensus that high-income countries must take more responsibility for helping low-income countries with surveillance of accident causes and information about the risks of driving while under the influence of alcohol or drugs. This work has begun but requires resources and professional collaboration across countries and continents. In 1936, Norway was the first country to introduce a fixed blood alcohol limit. Norwegian researchers in the fields of public health, substance abuse and traffic have since then conducted research in order to identify substance abuse among drivers, measuring the impact on road safety and developing proposals for preventive measures.
Traffic accidents are a growing global public health problem. Relatively small measures can provide great health benefits, and save many lives in the countries that are now facing an increase in traffic fatalities.
Feature article by Anne Bergh, Asbjørg S. Christophersen, Hallvard Gjerde, Ingebjørg Gustavsen, Jørg Mørland, Per Trygve Normann and Vigdis Vindenes
Department of International Public Health and Division of Forensic Medicine and Drug Abuse Research at the Norwegian Institute of Public Health