By David Brown
Washington Post Staff Writer
Friday, April 20, 2007
Traffic injuries are the leading cause of death in people ages 10 to 24 around the world -- a huge, overlooked and largely preventable public health problem, the World Health Organization said yesterday.
In a new report, the organization promoted a long list of suggestions to developing countries, where most of the deaths and disabling injuries occur. The improvements include safer roads and vehicles, better urban planning, helmet laws, prosecution of speeders and drunken drivers, better education of the driving and walking public, and simple interventions such as putting reflective tape on backpacks.
"It is a big public health issue for kids, and we can do something about it," said Etienne Krug, a physician who heads WHO's department for injury and violence prevention.
As does most of the public health world, WHO eschews the term "traffic accidents." In a statement accompanying the report, the organization's new director-general, Margaret Chan, said that "road traffic crashes are not 'accidents.' We need to challenge the notion that they are unavoidable."
About 30 percent of all traffic deaths worldwide -- roughly 400,000 each year -- are of people younger than 25. Although teenage and young-adult drivers are at greatest risk, younger age groups also have high mortality. In 2002, traffic injuries were the third leading cause of death for children ages 5 to 9, behind pneumonia and AIDS. About 46 percent of traffic deaths in sub-Saharan Africa occurred in that age group that year.
"Vulnerable road users" -- pedestrians, motorcyclists, bicyclists, and public transit riders -- account for a much higher fraction of youthful traffic fatalities in low-income countries than in rich ones. But even within that generalization there are big differences. In Mozambique, about 65 percent of road injuries and deaths involved pedestrians. In Cambodia, about 75 percent were motorcyclists.
For all countries, the annual cost of road injuries in medical care, disability and property damage is $518 billion, according to the report. In low- and middle-income countries, the cost is larger than the amount received from rich countries as development aid.
"It is a very big economic problem, a very big development problem. It kills breadwinners and throws entire families into poverty," Krug said.
WHO is asking the World Bank and other institutions making loans for road building in the developing world to require that 10 percent of the money go for safety features, such as guardrails, barrier-protected lanes for bicyclists or pedestrians, speed bumps, traffic- calming roundabouts and lighting.
The authors of the report also said towns need to plan for the consequences of better roads. Dirt roads carrying slow traffic are often used as playgrounds. When the roads are tarred, children need other places to play, Krug said.
Many developing countries are addressing the problem. An African Road Safety Conference was recently held in Ghana, with 200 people attending. South Africa has a program called "Drive Alive," whose activities include everything from consciousness-raising about safe driving to distributing reflective backpacks to school children.
The report was accompanied by a second publication, which described 31 people killed or hurt in crashes around the world. It consisted of interviews with those injured and with family members of those killed.
The collection of those stories, called "Faces Behind the Figures," was produced with the help of Rochelle Sobel, of Potomac, whose son Aron, 25, was killed in a bus crash in Turkey in 1995, two weeks before he was to graduate from medical school. She subsequently founded the Association for Safe International Road Travel, which promotes traffic safety.
Although heart attacks kill two to three times as many Americans abroad as road crashes, traffic deaths are a significant cause of mortality overseas and the biggest one for young people, said Stephen Hargarten, a professor of emergency medicine at the Medical College of Wisconsin.
From 2004 through 2006, there were 2,364 "unnatural" (that is, non-disease) deaths among Americans abroad, according to data gathered by the State Department. Motor vehicle crashes caused 740; homicides, 375; suicides, 270; drownings, 264; and miscellaneous injuries causing the rest.
An analysis of the data, produced by Hargarten and Bella Dinh-Zarr of Make Roads Safe, will be presented in Washington next week as part of the U.N.-designated Global Traffic Safety Week.