SUPPLEMENT ARTICLE
Why a Decade of Road Traffic Safety? Herman Johal, MD, MPH,* Emil H. Schemitsch, MD, FRCSC,† and Mohit Bhandari, MD, PhD, FRCSC‡
Summary: Each year, 1.24 million people die as a result of road traffic collisions around the world, and millions more are left to suffer the resultant disabilities of their nonfatal typically musculoskeletal injuries. The most productive members of society are the ones affected the most, and the subsequent economic impact cannot be ignored. Reducing the morbidity and mortality associated with road traffic injuries will reduce suffering and increase available resources that can be used more effectively. Road traffic injuries are preventable, and the impact of those that do occur can be mitigated. Adequate national and global funding, strategy, and measurable targets are fundamental to a sustainable response to road safety. Over the last decade, the United Nations and World Health Organization have been part of the gaining momentum toward addressing this issue, through resolutions and coordinating global efforts. This is what brought about the “Decade of Action for Road Traffic Safety,” and as orthopaedic surgeons, our involvement is key for the collaborative public health response toward this effort. Key Words: road traffic safety, road traffic injuries, public health, orthopaedic surgery (J Orthop Trauma 2014;28:S8–S10)
INTRODUCTION Over 3000 lives are lost daily on the world’s roads. For every road-related death, there are up to an additional 40 individuals who suffer temporary or permanent disability, typically as a result of bone and joint injuries.1–3 Orthopaedic surgeons witness the impact of road traffic injuries first-hand and work to limit the associated morbidity and mortality on a daily basis. Despite these efforts, road traffic injuries are the eighth leading cause of death globally and projected to rise to the fifth by 2030, surpassing most of the infectious and chronic diseases that typically garner more political and public attention (Fig. 1A).1–5 This has mobilized groups such as the United Nations and World Health Organization to partner with governments around the world to curtail the impact of Accepted for publication March 13, 2014. From the *Division of Orthopaedic Surgery, Department of Surgery, Health Sciences Centre, University of Calgary, Calgary, Alberta, Canada; †Division of Orthopaedic Surgery, St. Michael’s Hospital, Toronto, Ontario, Canada; and ‡Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada. The authors report no conflict of interest. Reprints: Herman Johal, MD, MPH, Division of Orthopaedic Surgery, Department of Surgery, Health Sciences Centre, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, Canada T2N 4N1 (e-mail: [email protected]). Copyright © 2014 by Lippincott Williams & Wilkins
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road traffic injuries. As those left to control the end impact of these injuries, orthopaedic surgeons need to be part of the collective action against this rising disease entity.
BACKGROUND In this year’s John Border Lecture at the OTA annual meeting, Dr Bruce Browner drew attention to the road traffic injury epidemic.6 He gave an excellent overview of the timeline of collaborative efforts by the UN and WHO (see Fig. 2A, Supplemental Digital Content, http://links.lww.com/BOT/A150) and underscored the importance of the OTA and its membership joining in the “Decade of Action.” The WHO and World Bank began the global effort against road traffic injuries on April 7, 2004, with the first World Health Day themed “Road safety is no accident,” and release of the World report on road traffic injury prevention, the first global review of the magnitude, determinants, and risk factors of road traffic injuries.3,7 This not only drew initial attention to the issue but also laid out a blueprint of potential strategies that governments could use to reduce the burden of death and disability caused by these injuries.3,7 Soon after, the UN General Assembly held a plenary session dedicated to the global crisis of road traffic injuries, which lead to resolution 58/289, challenging all governments to address road safety as an urgent matter.8,9 The WHO took on the lead coordinating role, under which the UN established a Road Safety Collaboration, a working group of 42 agencies committed to improve road safety through data collection, research, advocacy, and policy.8 In 2005, the UN encouraged Member States to contribute to the data collection efforts and implement the recommendations from the 2004 WHO report. The WHO first reported on the progress of these initial actions in 2009 with the Global status report on road safety: time for action.4 They showed that despite growing awareness and political attention, the devastating scale of road traffic injuries remained a global public health concern. In 2010, the UN and its Member States adopted resolution 6/255 and declared 2011–2020 as the “Decade of Action for Road Safety.”5 The aim of this resolution was to stabilize and decrease the rising trend in road traffic fatalities and save an estimated 5 million lives over the 10-year period (Fig. 1B).5 A set of guidelines was provided through the Global Plan to give governments and other stakeholders a practical tool and framework for developing local level road safety programs.10 The actions outlined are based on system level interventions and focus on 5 key areas, including “postcrash response,” where partnerships with organizations such as the OTA and other local orthopaedic associations are fundamental to success.
J Orthop Trauma Volume 28, Number 6 Supplement, June 2014
J Orthop Trauma Volume 28, Number 6 Supplement, June 2014
Why a Decade of RTS?
FIGURE 1. The burden of road traffic injuries. A, Leading causes of mortality, 2004 and 2030, compared. Adapted from Global Burden of Disease (2008) and WHO Global Status Report on Road Safety: time for action (2009).2,4 B, Number projected road traffic deaths with and without action taken from road traffic safety. C, Population, road traffic deaths, and registered motor vehicles by country income status. Adapted from WHO Global Status Report on Road Safety 2013: supporting a decade of action.5 D, Proportion of road traffic deaths among different road users by country income status. Adapted from Global Burden of Disease (2008), WHO Global Status Report on Road Safety: time for action (2009), and WHO Global Status Report on Road Safety 2013: supporting a decade of action.2,4,5
The “Decade” officially launched on March 11, 2011, and governments around the world initiated steps toward implementing suggested actions. The most recent WHO global status report, released in October 2013, indicates that there has been no overall reduction in the number of people who die on the world’s roads since 2009; however, there has been an increase in the amount of global motorization.5 This suggests that initial interventions may be having an effect on the number of deaths, but much work remains in reaching the overall goals for road traffic safety over the remainder of the decade.
DEMOGRAPHICS AND SIGNIFICANCE An estimated 1.24 million people die each year as a result of road traffic collisions, and an additional 20–50 million are left to suffer with nonfatal injuries.5 Globally, it Ó 2014 Lippincott Williams & Wilkins
is the leading cause of death among young adults aged 15–29 years, and those aged between 15 and 44 years account for the majority of road traffic deaths overall (59%).2 This results in a large impact on those entering their most economically productive years.5 Additionally, males outnumber females over 3:1 regarding road traffic fatalities, which is particularly significant for low- and middle-income countries, where men are still the primary wage earners for a family. As a consequence, most families are burdened with the direct medical costs consumed by road traffic injuries and the indirect costs of lost income.5 This impact is amplified on a national scale because of utilization of health resources and lost productivity, with developing economies suffering the greatest impact. It is estimated that the cost of road traffic injuries is between 1% and 3% of the global gross national product, reaching a total over US $500 billion each year.10,11 A second group of individuals aged older than 70 is emerging among road traffic www.jorthotrauma.com |
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J Orthop Trauma Volume 28, Number 6 Supplement, June 2014
fatalities in high-income countries, possibly because of increased longevity in combination with increased frailty.5 This is notable because targeted interventions in highincome countries need to take this group into account, and as low- and middle-income countries continue their economic development, they may be confronted with a similar problem. Low- and middle-income countries make up a disproportionately large number of road traffic deaths relative to their degree of motorization (Fig. 1C).5,10 Overall, the global road traffic fatality rate is 18 per 100,000 population, with middleincome countries having the highest rates (20.1 per 100,000), followed by low-income countries (18.3 per 100,000), and high-income countries having the lowest rates (8.7 per 100,000).5 At first glance, this seems paradoxical because 92% of road traffic fatalities occur in low- and middle-income countries, which account for 84% of the world’s population, but only 53% of the world’s registered vehicles. This is partially explained by the fact that only 31% of road traffic deaths are reported to occur among vehicle occupants.5 The remaining majority of fatalities are split between nonmotorized or vulnerable road users such as motorcyclists (23%), pedestrians (22%), cyclists (5%), and unspecified road users (19%). There are substantial regional differences in traffic mix and subsequent traffic deaths when breaking these figures down by country income status.5 Low- and middle-income countries have a much higher proportion of pedestrians, cyclists, and users of motorized 2/3wheeled vehicles when compared with high-income countries, and this is reflected in the proportion of road traffic deaths among these vulnerable road users (Fig. 1D). These variations need to be taken into consideration as targeted regional actions for road traffic safety are developed in the future.
THE SYSTEMS APPROACH TO ROAD SAFTEY Infectious disease and chronic health conditions have dominated the focus of traditional public health efforts; however, it is clear that road traffic safety deserves more attention. Unfortunately, road traffic injuries have typically been seen as “accidents,” implying that they are inherently random and uncontrollable. This makes it difficult to argue for resource allocation against other disease processes that may have a lower burden of illness but are viewed as well-defined and manageable entities that benefit from systematic interventions. Road traffic injuries need to be thought of in a similar framework. They can be understood as a predictable link between an agent (the human subject), host (vehicle), and vector (acute transfer of energy), much like any other disease process. The field of injury control was first described in this manner by Haddon, who showed that the periods immediately before, during, and after a collision can be studied to identify causative factors and areas for intervention.7,9,12 He developed a matrix identifying human, vehicle, and environment level solutions within each of the 3 periods surrounding a collision (see Fig. 2B, Supplemental Digital Content, http://links.lww.com/BOT/A150). This approach aims to create a road system that can accommodate human error and take into consideration the limitations of the human body in terms of kinetic energy.10 It attempts to shift responsibility away from the users and harmonize roads, vehicles, and response systems to mitigate the effect of those collisions or prevent them
S10
| www.jorthotrauma.com
from occurring at all.10 This was the basis for the WHO’s 5-key pillars, each of which aim to address a different area within the Haddon matrix (see Fig. 2C, Supplemental Digital Content, http://links.lww.com/BOT/A150). Interventions can be targeted at the individual environment or system level; however, increased coordination among multiple sectors and agencies is required, as the scope of the intervention broadens. As orthopaedic care providers, our collaboration is essential in developing interventions targeted toward the post-collision phase (see Fig. 2C, Supplemental Digital Content, http://links. lww.com/BOT/A150). From providing individual fracture care to bolstering organized trauma systems care, there are multiple opportunities for orthopaedic surgeons to be involved.
CONCLUSIONS Given that there are over a million deaths each year, and millions more who suffer long-term or permanent disability, road traffic injuries are an entity deserving of a global spotlight. They impact the most productive members of society and result in large-scale economic losses for a country. The “Decade for Road Traffic Safety” provides a time frame, allowing for political and resource commitment toward multilevel interventions that are required to address this epidemic. Coordinated efforts across borders, sectors, and disciplines are required to be truly effective. As orthopaedic surgeons, we are frequently involved in the care of these patients and are therefore well situated to support the “Decade for Road Traffic Safety” across multiple facets over the next decade, and beyond. REFERENCES 1. Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012; 380:2095–2128. 2. World Health Organization. Global Burden of Disease, 2008. Geneva, Switzerland: World Health Organization; 2011. Available at: http://www. who.int/healthinfo/global_burden_disease/estimates_regional/en/index. html. Accessed October 26, 2013. 3. Peden M, Scurfield R, Sleet D, et al. World Report on Road Traffic Injury Prevention. Geneva, Switzerland: World Health Organization; 2004. Available at: http://www.who.int/world-health-day/2004/infomaterials/ world_report/en/summary_en_rev.pdf. Accessed October 26, 2013. 4. World Health Organization. Global Status Report on Road Safety: Time for Action. Geneva; World Health Organization: 2009. 5. World Health Organization. Global Status Report on Road Safety 2013: Supporting a Decade of Action. Geneva; World Health Organization: 2013. 6. Browner B. John Border Lecture, OTA Annual Meeting. Phoenix, AZ. 2013. 7. Hyder AA. Road safety is no accident: a call for global action. Bull World Health Organ. 2004;82:240. 8. Ameratunga S, Hijar M, Norton R. Road-traffic injuries: confronting disparities to address a global-health problem. Lancet. 2006;367:1533–1540. 9. Koptis E, Cropper M. Traffic Fatalities and Economic Growth (Policy research working Paper No 3035). Washington, DC: The World Bank; 2003. Available at: http//www.ntl.bts.gov/lib/2400/24400/24490/25935_ wps3035.pdf. Accessed October 26, 2013. 10. World Health Organization. Global Plan for the Decade of Action for Road Safety, 2011–2020. Geneva, Switzerland: World Health Organization; 2011. Available at: www.who.int/roadsafety/decade_of_action/ plan/plan_english.pdf. Accessed October 26, 2013. 11. Jacobs G, Aeron-Thomas A, Astrop A. Estimating Global Road Fatalities. Crowthorne: Transport Research Laboratory; 2000. TRL Report 445. 12. Haddon W. A logical framework for categorizing highway safety phenomena and activity. J Trauma. 1972;12:193–197.
Ó 2014 Lippincott Williams & Wilkins
Why a Decade of Road Traffic Safety? Herman Johal, MD, MPH,* Emil H. Schemitsch, MD, FRCSC,† and Mohit Bhandari, MD, PhD, FRCSC‡
Summary: Each year, 1.24 million people die as a result of road traffic collisions around the world, and millions more are left to suffer the resultant disabilities of their nonfatal typically musculoskeletal injuries. The most productive members of society are the ones affected the most, and the subsequent economic impact cannot be ignored. Reducing the morbidity and mortality associated with road traffic injuries will reduce suffering and increase available resources that can be used more effectively. Road traffic injuries are preventable, and the impact of those that do occur can be mitigated. Adequate national and global funding, strategy, and measurable targets are fundamental to a sustainable response to road safety. Over the last decade, the United Nations and World Health Organization have been part of the gaining momentum toward addressing this issue, through resolutions and coordinating global efforts. This is what brought about the “Decade of Action for Road Traffic Safety,” and as orthopaedic surgeons, our involvement is key for the collaborative public health response toward this effort. Key Words: road traffic safety, road traffic injuries, public health, orthopaedic surgery (J Orthop Trauma 2014;28:S8–S10)
INTRODUCTION Over 3000 lives are lost daily on the world’s roads. For every road-related death, there are up to an additional 40 individuals who suffer temporary or permanent disability, typically as a result of bone and joint injuries.1–3 Orthopaedic surgeons witness the impact of road traffic injuries first-hand and work to limit the associated morbidity and mortality on a daily basis. Despite these efforts, road traffic injuries are the eighth leading cause of death globally and projected to rise to the fifth by 2030, surpassing most of the infectious and chronic diseases that typically garner more political and public attention (Fig. 1A).1–5 This has mobilized groups such as the United Nations and World Health Organization to partner with governments around the world to curtail the impact of Accepted for publication March 13, 2014. From the *Division of Orthopaedic Surgery, Department of Surgery, Health Sciences Centre, University of Calgary, Calgary, Alberta, Canada; †Division of Orthopaedic Surgery, St. Michael’s Hospital, Toronto, Ontario, Canada; and ‡Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada. The authors report no conflict of interest. Reprints: Herman Johal, MD, MPH, Division of Orthopaedic Surgery, Department of Surgery, Health Sciences Centre, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, Canada T2N 4N1 (e-mail: [email protected]). Copyright © 2014 by Lippincott Williams & Wilkins
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| www.jorthotrauma.com
road traffic injuries. As those left to control the end impact of these injuries, orthopaedic surgeons need to be part of the collective action against this rising disease entity.
BACKGROUND In this year’s John Border Lecture at the OTA annual meeting, Dr Bruce Browner drew attention to the road traffic injury epidemic.6 He gave an excellent overview of the timeline of collaborative efforts by the UN and WHO (see Fig. 2A, Supplemental Digital Content, http://links.lww.com/BOT/A150) and underscored the importance of the OTA and its membership joining in the “Decade of Action.” The WHO and World Bank began the global effort against road traffic injuries on April 7, 2004, with the first World Health Day themed “Road safety is no accident,” and release of the World report on road traffic injury prevention, the first global review of the magnitude, determinants, and risk factors of road traffic injuries.3,7 This not only drew initial attention to the issue but also laid out a blueprint of potential strategies that governments could use to reduce the burden of death and disability caused by these injuries.3,7 Soon after, the UN General Assembly held a plenary session dedicated to the global crisis of road traffic injuries, which lead to resolution 58/289, challenging all governments to address road safety as an urgent matter.8,9 The WHO took on the lead coordinating role, under which the UN established a Road Safety Collaboration, a working group of 42 agencies committed to improve road safety through data collection, research, advocacy, and policy.8 In 2005, the UN encouraged Member States to contribute to the data collection efforts and implement the recommendations from the 2004 WHO report. The WHO first reported on the progress of these initial actions in 2009 with the Global status report on road safety: time for action.4 They showed that despite growing awareness and political attention, the devastating scale of road traffic injuries remained a global public health concern. In 2010, the UN and its Member States adopted resolution 6/255 and declared 2011–2020 as the “Decade of Action for Road Safety.”5 The aim of this resolution was to stabilize and decrease the rising trend in road traffic fatalities and save an estimated 5 million lives over the 10-year period (Fig. 1B).5 A set of guidelines was provided through the Global Plan to give governments and other stakeholders a practical tool and framework for developing local level road safety programs.10 The actions outlined are based on system level interventions and focus on 5 key areas, including “postcrash response,” where partnerships with organizations such as the OTA and other local orthopaedic associations are fundamental to success.
J Orthop Trauma Volume 28, Number 6 Supplement, June 2014
J Orthop Trauma Volume 28, Number 6 Supplement, June 2014
Why a Decade of RTS?
FIGURE 1. The burden of road traffic injuries. A, Leading causes of mortality, 2004 and 2030, compared. Adapted from Global Burden of Disease (2008) and WHO Global Status Report on Road Safety: time for action (2009).2,4 B, Number projected road traffic deaths with and without action taken from road traffic safety. C, Population, road traffic deaths, and registered motor vehicles by country income status. Adapted from WHO Global Status Report on Road Safety 2013: supporting a decade of action.5 D, Proportion of road traffic deaths among different road users by country income status. Adapted from Global Burden of Disease (2008), WHO Global Status Report on Road Safety: time for action (2009), and WHO Global Status Report on Road Safety 2013: supporting a decade of action.2,4,5
The “Decade” officially launched on March 11, 2011, and governments around the world initiated steps toward implementing suggested actions. The most recent WHO global status report, released in October 2013, indicates that there has been no overall reduction in the number of people who die on the world’s roads since 2009; however, there has been an increase in the amount of global motorization.5 This suggests that initial interventions may be having an effect on the number of deaths, but much work remains in reaching the overall goals for road traffic safety over the remainder of the decade.
DEMOGRAPHICS AND SIGNIFICANCE An estimated 1.24 million people die each year as a result of road traffic collisions, and an additional 20–50 million are left to suffer with nonfatal injuries.5 Globally, it Ó 2014 Lippincott Williams & Wilkins
is the leading cause of death among young adults aged 15–29 years, and those aged between 15 and 44 years account for the majority of road traffic deaths overall (59%).2 This results in a large impact on those entering their most economically productive years.5 Additionally, males outnumber females over 3:1 regarding road traffic fatalities, which is particularly significant for low- and middle-income countries, where men are still the primary wage earners for a family. As a consequence, most families are burdened with the direct medical costs consumed by road traffic injuries and the indirect costs of lost income.5 This impact is amplified on a national scale because of utilization of health resources and lost productivity, with developing economies suffering the greatest impact. It is estimated that the cost of road traffic injuries is between 1% and 3% of the global gross national product, reaching a total over US $500 billion each year.10,11 A second group of individuals aged older than 70 is emerging among road traffic www.jorthotrauma.com |
S9
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J Orthop Trauma Volume 28, Number 6 Supplement, June 2014
fatalities in high-income countries, possibly because of increased longevity in combination with increased frailty.5 This is notable because targeted interventions in highincome countries need to take this group into account, and as low- and middle-income countries continue their economic development, they may be confronted with a similar problem. Low- and middle-income countries make up a disproportionately large number of road traffic deaths relative to their degree of motorization (Fig. 1C).5,10 Overall, the global road traffic fatality rate is 18 per 100,000 population, with middleincome countries having the highest rates (20.1 per 100,000), followed by low-income countries (18.3 per 100,000), and high-income countries having the lowest rates (8.7 per 100,000).5 At first glance, this seems paradoxical because 92% of road traffic fatalities occur in low- and middle-income countries, which account for 84% of the world’s population, but only 53% of the world’s registered vehicles. This is partially explained by the fact that only 31% of road traffic deaths are reported to occur among vehicle occupants.5 The remaining majority of fatalities are split between nonmotorized or vulnerable road users such as motorcyclists (23%), pedestrians (22%), cyclists (5%), and unspecified road users (19%). There are substantial regional differences in traffic mix and subsequent traffic deaths when breaking these figures down by country income status.5 Low- and middle-income countries have a much higher proportion of pedestrians, cyclists, and users of motorized 2/3wheeled vehicles when compared with high-income countries, and this is reflected in the proportion of road traffic deaths among these vulnerable road users (Fig. 1D). These variations need to be taken into consideration as targeted regional actions for road traffic safety are developed in the future.
THE SYSTEMS APPROACH TO ROAD SAFTEY Infectious disease and chronic health conditions have dominated the focus of traditional public health efforts; however, it is clear that road traffic safety deserves more attention. Unfortunately, road traffic injuries have typically been seen as “accidents,” implying that they are inherently random and uncontrollable. This makes it difficult to argue for resource allocation against other disease processes that may have a lower burden of illness but are viewed as well-defined and manageable entities that benefit from systematic interventions. Road traffic injuries need to be thought of in a similar framework. They can be understood as a predictable link between an agent (the human subject), host (vehicle), and vector (acute transfer of energy), much like any other disease process. The field of injury control was first described in this manner by Haddon, who showed that the periods immediately before, during, and after a collision can be studied to identify causative factors and areas for intervention.7,9,12 He developed a matrix identifying human, vehicle, and environment level solutions within each of the 3 periods surrounding a collision (see Fig. 2B, Supplemental Digital Content, http://links.lww.com/BOT/A150). This approach aims to create a road system that can accommodate human error and take into consideration the limitations of the human body in terms of kinetic energy.10 It attempts to shift responsibility away from the users and harmonize roads, vehicles, and response systems to mitigate the effect of those collisions or prevent them
S10
| www.jorthotrauma.com
from occurring at all.10 This was the basis for the WHO’s 5-key pillars, each of which aim to address a different area within the Haddon matrix (see Fig. 2C, Supplemental Digital Content, http://links.lww.com/BOT/A150). Interventions can be targeted at the individual environment or system level; however, increased coordination among multiple sectors and agencies is required, as the scope of the intervention broadens. As orthopaedic care providers, our collaboration is essential in developing interventions targeted toward the post-collision phase (see Fig. 2C, Supplemental Digital Content, http://links. lww.com/BOT/A150). From providing individual fracture care to bolstering organized trauma systems care, there are multiple opportunities for orthopaedic surgeons to be involved.
CONCLUSIONS Given that there are over a million deaths each year, and millions more who suffer long-term or permanent disability, road traffic injuries are an entity deserving of a global spotlight. They impact the most productive members of society and result in large-scale economic losses for a country. The “Decade for Road Traffic Safety” provides a time frame, allowing for political and resource commitment toward multilevel interventions that are required to address this epidemic. Coordinated efforts across borders, sectors, and disciplines are required to be truly effective. As orthopaedic surgeons, we are frequently involved in the care of these patients and are therefore well situated to support the “Decade for Road Traffic Safety” across multiple facets over the next decade, and beyond. REFERENCES 1. Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012; 380:2095–2128. 2. World Health Organization. Global Burden of Disease, 2008. Geneva, Switzerland: World Health Organization; 2011. Available at: http://www. who.int/healthinfo/global_burden_disease/estimates_regional/en/index. html. Accessed October 26, 2013. 3. Peden M, Scurfield R, Sleet D, et al. World Report on Road Traffic Injury Prevention. Geneva, Switzerland: World Health Organization; 2004. Available at: http://www.who.int/world-health-day/2004/infomaterials/ world_report/en/summary_en_rev.pdf. Accessed October 26, 2013. 4. World Health Organization. Global Status Report on Road Safety: Time for Action. Geneva; World Health Organization: 2009. 5. World Health Organization. Global Status Report on Road Safety 2013: Supporting a Decade of Action. Geneva; World Health Organization: 2013. 6. Browner B. John Border Lecture, OTA Annual Meeting. Phoenix, AZ. 2013. 7. Hyder AA. Road safety is no accident: a call for global action. Bull World Health Organ. 2004;82:240. 8. Ameratunga S, Hijar M, Norton R. Road-traffic injuries: confronting disparities to address a global-health problem. Lancet. 2006;367:1533–1540. 9. Koptis E, Cropper M. Traffic Fatalities and Economic Growth (Policy research working Paper No 3035). Washington, DC: The World Bank; 2003. Available at: http//www.ntl.bts.gov/lib/2400/24400/24490/25935_ wps3035.pdf. Accessed October 26, 2013. 10. World Health Organization. Global Plan for the Decade of Action for Road Safety, 2011–2020. Geneva, Switzerland: World Health Organization; 2011. Available at: www.who.int/roadsafety/decade_of_action/ plan/plan_english.pdf. Accessed October 26, 2013. 11. Jacobs G, Aeron-Thomas A, Astrop A. Estimating Global Road Fatalities. Crowthorne: Transport Research Laboratory; 2000. TRL Report 445. 12. Haddon W. A logical framework for categorizing highway safety phenomena and activity. J Trauma. 1972;12:193–197.
Ó 2014 Lippincott Williams & Wilkins
