Introduction

Around the world, almost 16 000 people die from injuries every day. Of these deaths, road traffic injuries (RTIs) take the greatest toll. Road traffic injuries are an emerging challenge to public health in the world. They kill about 3 000 people and about 30 000 are injured and disabled for life every day. Developing countries account for 90% of global road traffic deaths, while accounting for only 20% of cars being driven worldwide. Therefore, the epidemic of road traffic injuries in developing countries is still in its early stages. However, it threatens to grow exponentially unless swift action is taken to counter it.

Road traffic injuries are the ninth leading cause of deaths globally, and are estimated to rank sixth by the year 2020. However, if the burden of disease (represented by Disability Adjusted Life Years or DALYs) is taken into account, road traffic on data disaggregated into categories as mentioned above.

The burden of road traffic injuries has been rising rapidly in South-East Asia (SEA) as countries are getting increasingly motorized. An estimate shows that SEA is the Region that will experience a sharp rise (more than 144%) in road traffic deaths by the year 2020 if the current trend continues. On the other hand, high-income countries will register a decline of 27% by 2020.

Countries of the SEA Region are mostly motorizing countries, where transportation and mobility are considered to be developmental issues. Despite available estimates, only limited information is disaggregated by countries, by categories of victims, and the level of motorization.

This paper examines the pattern of injuries in the SEA Region in general, based Bhutan, Democratic People’s Republic of Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste.

Methods

The most recent global burden of disease database published in the World Health Organization’s website for World Health Report 2003 was accessed. The database is an estimate based on the global burden of disease assessment tool. The World Health Report divides deaths and disabilities first into three broad groups: communicable diseases, maternal and perinatal conditions and nutritional deficiencies; noncommunicable conditions/diseases, and injuries. Next, deaths and disabilities within each of these groups are divided into categories. For example, injuries are divided into unintentional and intentional. Road traffic injuries (RTIs) are a sub-category of unintentional injuries as per this classification.

The mortality statistics are estimated for the Region, based on the mortality statistics submitted by Member countries to the World Health Organization. Necessary adjustments have been made for under-reporting, based on the findings of surveys. The burden of disease, measured by DALYs lost, includes the total number of premature years of life lost and total number of years lived with disabilities. DALYs therefore, are the summary measure that take account of death, illness and disability. The mortality rate has been calculated per 100 000 population per year.

The South-East Asia Region of WHO comprises 11 Member States: Bangladesh, injuries are estimated to rank as the third leading cause of death by 2020.

Results

RTIs account for 20% of all injury-related deaths (Figure 1) and 23% of injury-related burden of disease in South-East Asia. The proportion of mortality and burden of disease from RTIs is higher than any other single external cause of injuries. In terms of figures, RTIs accounted for 296 000 deaths and 10 million DALYs lost in the SEA Region. Of these, most injuries and deaths are reported from the most productive age group: 15 to 59 years. Males account for three times the number of deaths of females.

Figure 1:Injury-related mortality in the
SEA Region, 2002 estimates

Source: WHO, Geneva, The World Health Report, 2003

Discussion

The mortality rate from RTIs in the SEA Region is among the highest in all regions. Of all WHO regions, the South-East Asia and Western Pacific Regions account for almost equal number of deaths. However, the burden of disease is higher in the SEA Region than the Western Pacific Region. Globally, males have a higher road traffic injury rate and young males have a higher rate than females or children and older persons of the same age group. In India, road traffic deaths are ranked as the seventh leading cause of death for all ages. For children aged 5-14 years, road traffic deaths are ranked as the second leading cause of death, next only to childhood diseases. For the age group: 15 to 29 years as well, there were 73 000 road traffic deaths ranking second only to deaths from HIV/AIDS. In other countries of South-East Asia, road traffic injury was the leading cause of death for the same age-group, as per the World Health Report, 2003. Therefore, prevention of road traffic injuries needs urgent attention from public health authorities.

This increase in road traffic fatalities are estimated by: (1) taking account of the historical trend of motorization and road fatalities that will continue if no interventions were taken; (2) incorporating the future increase in population, and (3) change in income level of countries. The estimates also take into account the different levels of under-reporting of road traffic fatalities.

In countries of the SEA Region, rapid motorization of two-wheelers and four-wheelers, inadequate safety features for mixed traffic (slow and fast, motorized and non-motorized, heavy and light vehicles), inadequate legislation for and enforcement of compulsory seat belts, measures to restrain drunken driving, poor consideration for safety measures in road engineering and road rehabilitation, speeding and lack of speed control measures are some of the major factors responsible for the increasing RTIs. Though countries in the SEA Region have laws/regulations for wearing of seat belts and helmets, they are poorly enforced. The level of utilization of seat belts and helmets for motorcycle riders (except in capital cities of some countries) is very low.

Measures that have proved successful in reducing road fatalities in high-income countries need to be adapted by developing countries, and local measures need to be identified. This is because the incidence of RTIs is disporportionately high among pedestrians, motorcyle and bicycle riders, public vehicle occupants and other vulnerable road users.

Public health authorities in developed countries have been showing keen interest in mitigating the RTI challenge since many years. The World Health Assembly, as early as 1974, endorsed a resolution urging Member States to tackle RTIs as an emerging public health problem. Several developed countries took up the issue and have since tried several approaches towards mitigating the problem. Through failures and successes, new strategies have been developed and implemented. As a result, far less number of deaths now result from road traffic injuries in these countries than in developing countries, both by population and by the level of motorization. Several efforts are under way to further reduce traffic deaths and injuries. The success of all these efforts is visible by the fact that road traffic deaths and injuries are how important these accomplishments are or how difficult they were to achieve.

The following are the two predominant approaches that led to these advancements:

1.      Focus by national governments on setting international norms that created a body of knowledge and understanding of prevention measures and approaches, and their commitment to support the implementation of this knowledge, and

2.      Implementing, sustaining and monitoring of public health prog-rammes according to international guidance, by governments, non-governmental organizations and civil society with adequate back-up of infrastructure and skills.

The response to preventing road traffic injuries cannot and should not be different from other public health responses. Enhancing public health response to include road traffic injuries requires obtaining commitment from professions in addition to public health, one that incorporates many more people and sectors of society than are currently engaged. It also requires the development of comprehensive and strategic approaches that can only be accomplished by using a far broader array of tactics than currently in use.

The momentum of response to RTIs as a global crisis needs serious attention, and we must search for more effective strategies to end the pandemic of road traffic injuries. The commitment from Heads of State, WHO, the World Bank, United Nations and the international community from around the globe has provided a platform on which we can work together. The action deserves no delay, as every hour is witness to the scourge of deaths, injuries and disabilities on the road.

References

      The Global Burden of Disease Book,

      World Health Report 2003

      Injuries in South-East Asia: Priority for Action

      Global Burden of Disease: Article in the American Journal of Public Health

1.       The World Health Report 2003- Shaping the future. Geneva, World Health Organization, 2003

2.      Global road safety crisis: Report of the Secretary-General. A/58/228, New York, United Nations General Assembly, 2003 (http://www.who.int/world-health-day/2004/infomaterials/un_report/en/index.html (accessed on Feb 11, 2003))

3.       WHO Regional Committee for South-East Asia: Report of the Fifty-sixth session (SEA/RC56/22). New Delhi, World Health Organization, 2003

4.       Peden M, Scurfield R, Sleet D, Mohan D, Hyder AA, Jarawan E, Mathers C (eds.). The World Report on Road Traffic Injury Prevention. Geneva, World Health Organization, 2004.

5.       Murray CJL, Lopez AD, eds. The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. Boston, HarvardUniversity Press, 1996.

6.       Kopits E, Cropper M. Traffic fatalities and economic growth. Washington, DC, The World Bank, 2003 (Policy Research Working Paper No. 3035).

7.       Jacobs G, Aeron-Thomas A, Astrop A. Estimating global road fatalities. Crowthorne, Transport Research Laboratory, 2000 (TRL Report, No. 445).

8.       Peden M et al. A 5-year WHO strategy for road traffic injury prevention. Geneva, World Health Organization, 1001 (http://whqlibdoc.who.int/hq/ 2001/WHO_NMN_VIP_01.03.pdf).