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Articles & Lectures

Charles Sorbie

United Nations Steering Committee on Global Road Safety 

by Prof Charles Sorbie

The first plenary session ever held to discuss global road safety in the United Nations General Assembly took place on 14 and 15 April 2004. I was invited to participate, having helped to promote, when President of SICOT, trauma symposia in Nairobi, Kenya and Taipei, Taiwan. It had become obvious to orthopaedic surgeons that there was a huge burden of pain, disability and economic disaster resulting from road traffic accident injuries. The steadily increasing numbers of these accidents, particularly in the developing countries, made preventive action imperative.

I had attended, with Prof Bruce Browner, Chairman of the Department of Orthopaedic Surgery at the University of Connecticut, a meeting of the World Bank Global Road Safety Initiative Committee in Washington in 2001. The World Bank was waking up to the fact that some countries were spending several, in one instance five, times the amount of money they received in development aid, on the treatment of road trauma victims. The spreading knowledge of the economic effects and humanitarian tragedies of road trauma has led to the commitment of the United Nations, the World Bank and the World Health Organisation to reversing the rising trend. The highest rates of road trauma are seen in developing countries which are rapidly becoming industrialised, especially in Eastern Asia and Africa.

Orthopaedic surgeons, face to face with this human disaster, have sought to influence governments and administrators of both health and transport, to react to these avoidable injuries and work to reduce the occurrence of road accidents. The surgeons have helped to improve the rescue and rehabilitation of the injured, but cannot do much to create the conditions that would lower accident rates. Everyone in the world makes mistakes on the road whether as a pedestrian, cyclist or driver. It seems important, knowing this fact, that the builders and maintainers of roads and the manufacturers of vehicles that use them take into account human error and increase the margins of safety during road travel.

The Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT) has seen its continuing role in this crisis to be improving the education and skills of the surgeons who deal with road accidents. It runs congresses and conferences which feature trauma care. It has introduced an international SICOT Diploma Examination to set standards of knowledge. It has provided for all its members and their residents arrangements for access to the HYPERGUIDE, an internet orthopaedic and trauma education system. It has opened its first orthopaedic SICOT Education Centre in Lahore, Pakistan. But these efforts are post hoc, after the accidents have happened.

What the United Nations General Assembly is seeking are mechanisms to reduce the risk of accidents. It brought together in the Assembly ambassadors or their representatives from member nations to pass Resolution 58/289. A wide variety of nations responded to the call and supported the resolution. The World Health Organisation is moving the position of road accidents to a higher level, third, on the list of fatal diseases. The UN resolution was supported by Mr Julian Robert Hunte, President of the 58th Session of the General Assembly; Mr Kofi Annan, Secretary General of the UN; Dr Lee Jong-Wook, Director General, WHO; Mr James Wolfensohn, President of the World Bank; Ms Carol Bellamy, Director, UN Children’s Fund; and Mr Mark Malloch-Brown, Administrator of the UN Development Programme.

The Assembly gathering and the meeting on the day that followed heard a number of speakers. They included Ministers of Transport from several countries, representatives from the US National Highway Traffic Safety Administration, British Petroleum, Michelin Tyres, General Motors, Ford, the Asian Development Bank, UNICEF, the Association for Safe International Road Transport and Dr Steve Blount, from the US Centres for Disease Control and Prevention. Our man, Prof Browner, representing the Bone and Joint Decade, gave a lucid account of how the movement for road safety was started and where it is going. Dr Wahid Al-Kharusi from Oman, a participant who had the support of the Sultan of Oman, most instrumental in promoting the UN meeting, also gave a very informative talk. His slides of camels with only their legs protruding forward from the smashed front windshields of fast cars, into which their entire bodies had been squeezed, were unforgettable (getting closer to passing through the eye of a needle?).
There is ample evidence that road traffic injuries are a huge public health and development problem:
  • Road traffic crashes kill almost 1.2 million people a year or an average of 3,242 every day.
  • Road traffic crashes injure or disable between 20 million and 50 million people each year.
The majority of injuries affect people in low-income and middle-income countries, especially young males and vulnerable road users:
  • 90% of road traffic deaths occur in low-income and middle-income countries.
  • Countries in the WHO Western Pacific region and the WHO South-East Asia region account for more than half of all road traffic deaths in the world.
  • More than half of all road traffic deaths occur among young adults between 15 and 44 years of age; 73% of all fatalities are male.
  • In low-income and middle-income countries, the most vulnerable road users are pedestrians, cyclists, users of motorised two-wheelers and passengers on public transport.
Without appropriate action, the problem will only worsen:
  • Road traffic deaths are predicted to increase globally 67% by 2020. The predicted rise in low-income and middle-income countries is 83% while deaths are predicted to decrease in the developed countries by 27%. 
The costs of road traffic injuries are enormous:
  • Estimated costs of road traffic crashes globally are USD 1.8 billion each year.
  • Every year, road traffic crashes cost, on average, USD 65 million in low-income and middle-income countries exceeding the total amount received in development assistance. This is between 1 and 1.5% of gross national product in low-income and middle-income countries.
Fatalities vary in different countries:
  • In the United States, it is 6.6 per 10,000 crashes, in Kenya 1,786 and in Vietnam 3,181. The economic costs vary in different countries and if compared with the gross domestic product (GDP) it is in India 1%, the United Kingdom 2%, and the United States 5%.
Safety costs money but it may be much less than the effects of its absence. If one accepts, and we all must, that human life and health are paramount, all countries must protect their citizens by making road safety an integral part of the work of the health sector. Although the United States spends USD 230 billion annually for the treatment of road traffic injuries, it has improved its safety record. Countries that are not so wealthy can introduce low cost measures, for example, enforcing the road traffic laws. Dr Prakash Heda recounted to the UN meeting the suggestion made at the 1998 SICOT Road Trauma Symposium in Nairobi, Kenya that road safety laws should be enforced: President Daniel Arap Moi agreed and the Kenyan road accident rate dropped from September 1998 to December 1998 by 15%. Another inexpensive example, which would help, is governments insisting that all contracts with the private sector have guarantees of safe travel for their employees before the contracts are signed.

Road manufacturers are constantly looking at designs that will make cars safer. They appear to be genuinely motivated to keep more drivers safe and alive (actual altruism, not merely to maintain the customer base!). At present at least 30 different vehicle systems are being tested for their benefits.

SICOT should consider how to have a greater role in the Global Road Safety Initiative. We have much to offer by our particular involvement in, and knowledge of, the results of uncontrolled road trauma.

(SICOT Newsletter - June 2004 - Issue No. 87 - page 10 continued)