Publications

Nearly 30% of all road traffic deaths reported to WHO involve powered two- and three-wheeled vehicles, such as motorcycles, mopeds, scooters and electrical bikes (e-bikes). As these vehicles become increasingly widespread, particularly in low-and middle-income countries, the proportion of deaths involving them is increasing. 

The second edition of the Powered- Two and Three-Wheeler Safety Manual offers guidance to help decision makers and practitioners put in place the comprehensive set of laws, regulations and actions needed to save lives. Rooted in new case studies and evidence, including from low- and middle-income countries, it includes guidelines on developing safer roads, ensuring safer mobility for all road users, vehicle safety standards, and actions to improve emergency responses to crashes.

This report summarizes the findings of a long and meticulous journey of data gathering and analysis to quantify the health losses from road deaths and injuries worldwide, as part of the path-finding Global Burden of Disease (GBD) study. It is important, first, to acknowledge the profound contribution made by the lead authors and global team of injury prevention professionals to estimate the disease burden of road trauma, before absorbing their findings and recommendations. Without their dedication and tenacity, the way forward would be less certain.

The first GBD study, published nearly two decades ago, signaled an emerging road safety crisis in developing regions of the world. It triggered a remarkable program of global advocacy that culminated in the United Nations decade of action for road safety and a global plan to bring road safety outcomes under control in these regions by 2020. However, limited investment has been mobilized so far to implement the UN initiative. The second GBD studies, and related analyses presented in this report, confirm the importance of road safety as a global development priority and the urgency with which it must be addressed.

The report's findings highlight the growth in road deaths and injuries globally, and their substantial impacts on maternal and child health, despite sustained reductions over the last three to four decades in high-income countries. Combined with the deaths arising from vehicle pollution, the road transport death toll exceeds that of, for example, HIV/AIDS, tuberculosis, malaria, or diabetes. This statistic further reinforces the call for global action. Without these GBD estimates, we would not have a clear picture of the true situation because official country data in the developing world vastly understate the scale of road transport health losses.

What is this toolkit?
This toolkit sets out the key elements of effective post-crash emergency response. The toolkit covers:

• reasons for taking action
• the main elements of post-crash response
• examples of best practice
• helpful resources.

Who is this toolkit for?
The toolkit is for all stakeholders with an interest in post-crash response. This includes:

• government departments and policymakers
• local and regional government
• emergency service managers and professionals
• paramedics and community responders
• laypeople and members of the community
• crash survivors, families, and organizations representing them.

How to use it

The toolkit describes basic good practices for organizing an effective post-crash response. It is a starting point for dialogue and discussion, aimed at identifying goals for improving post-crash services. Every country has different structures and challenges, so the toolkit is not “one-size-fits-all.” However, certain elements of good post-crash response apply everywhere: the need for strategic planning and investment, good coordination, communication, equipment, and training.

To learn more about this project, click here.

Based on 2018 findings of the World Health Organization (WHO), the number of deaths due to road crashes is 1.35 million deaths per year. While this number is quite high and increasing every year, the rate of road crash deaths per 100,000 of population has remained constant, at around 18 deaths, over the years. This rate of deaths is however not distributed proportionately amongst the different regions and countries. The high-income countries have recorded lowest average rate at 8.3 per 100,000. In contrast to this number, low-income countries have the highest annual road traffic fatality rates averaging at 27.5 deaths per 100,000– more than three times the average for high-income countries.

ROAD CRASH AND IMPACT

Most of the deaths and injuries from road crashes are of the working age population, which negatively impacts both the economy and the demography of the region. Road traffic injuries are currently the 8th leading cause for death for all age groups, and further compounding the demographic impact is the fact that road crashes are the leading cause of death for children and young adults, between the ages of 5 and 29 years.

Road traffic crashes have a high economic impact, costing 3 percent of a country’s GDP on average. They also cause a significant impact on the individuals as well as their families. Injuries arising due to road crashes can lead to trauma for the individual and loss in productivity. Along with costs of treatment, economic challenges may further be increased due to temporary or permanent loss of income as well. Along with the victim, road crashes take an emotional toll on the immediate family members and caregivers during the treatment process or any deaths and add to the economic burden as they may need to take time off work or school to care for the injured. 

The distribution of road users varies within different regions and income groups of countries. This impacts the variations in death rates amongst the users. The low- and middle-income countries have a significantly high proportion of pedestrians, cyclists and two- or three-wheeler motorized vehicles. Overall, the global road traffic deaths for pedestrians and cyclists is at 26% and another 28% for two- and three-wheeler motorcyclists, totaling nearly 54% of vulnerable road users. This proportion varies in comparison between the economic group of countries, with a high percentage of road crash victims being car occupants.

Globally, a significant percentage of road crash victims being car occupants is also an indicator of insufficient infrastructure for controlling traffic speeds and volumes. Furthermore, when people use private cars more for their daily activities, it results in a higher level of total vehicle-kilometers traveled (VKT). Choice of using personal vehicle over using non-motorized transport or public mass transport may be attributed to the car-centric planning and design of road infrastructure. Many countries lack adequate protected infrastructure for pedestrians and cyclists. This discourages users to walk or bicycle to their destinations.

Mode-choice plays a critical role in road safety. Public mass transit systems not only provide faster and safer transportation mode choices, they also help reduce dependency on privately owned vehicles on the road. Public mass transit services typically follow designated routes as well, thereby minimizing interferences between different types of road users. While many countries still have to develop mass transit infrastructure such as metro rails, public bus system is quite prevalent, with bus rapid transit (BRT) and bus only lane infrastructures being developed. Absence of proper first and last mile connectivity to the transit stations poses security threats for road users and discourages them from using public transport.

SAFE SYSTEM APPROACH

The Safe System approach derives from the Swedish Vision Zero and Dutch Sustainable Safety strategies that have a long-term goal for a road traffic system to be eventually free from fatalities and serious injuries. It represents a shift away from traditional approach of preventing collisions to a more forgiving approach of preventing fatalities and mitigating serious injuries in road crashes. The traditional approach emphasizes the responsibility of road users to avoid crashes rather than the responsibility of system designers to provide a safe mobility system.

The Safe System approach takes into account that humans are vulnerable and fallible, and errors are to be expected. It aims at ensuring these mistakes do not lead to a crash, and if a crash does occur, it is sufficiently controlled to not cause a death or a life-changing injury. Thereby with a “zero-harm goal”, it places a strong emphasis on road builder/operator and vehicle manufacturer accountability for road safety performance.

The Safe System approach emphasizes shared responsibility. Government agencies at different levels and a range of multisectoral agencies and stakeholders – including policy makers, road engineers, planners, vehicle manufacturers, enforcement officers, emergency medical agencies, road safety educators etc. – are accountable for the system’s safety and all road users – drivers, cyclists, and pedestrians are responsible for complying with the system rules.

Cycling has many health and environmental benefits. Yet every year 41 000 cyclists die in road traffic-related crashes worldwide. Many leave their homes as they would on any normal day – for school, work, worship, or meeting friends – never to return. Millions more people are injured in road traffic-related crashes while cycling, some of whom become permanently disabled. These incidents cause much suffering and grief, as well as economic hardship for families and loved ones.

However, the growing focus on sustainable mobility – an increasing effort to shift more travel from motorized transport to the use of public transport, walking and cycling – makes cyclists’ safety an increasingly important component of road safety efforts. Cyclist collisions, like other road traffic crashes, are predictable and preventable and therefore should not be accepted as inevitable.

Cyclist safety: an information resource for decision-makers and practitioners describes the magnitude of cyclist death and injury, the key risk factors, and effective interventions. The document stresses the importance of a comprehensive, holistic approach that includes legislation, enforcement and behavioral measures specifically for cyclists; design of the built environment; as well as integrating cyclist safety into overall road safety and transport strategies. It also draws attention to the benefits of cycling, which should be promoted as an important mode of transport given its potential to improve health and preserve the environment.

We hope that this resource, which is designed for a multidisciplinary audience including engineers, planners, law enforcement officers, public health professionals and educators, will contribute towards strengthening national and local capacity to implement cyclist safety measures in various settings worldwide. We encourage all to bring this resource to the attention of those who will use it to save the lives of cyclists.

The World Health Organization (WHO) coordinated the production of this resource. Soames Job, Head GRSF and Global Lead Road Safety, World Bank was one of the principal writers of this document. GRSF contributions to this document were supported by UK Aid.