This is a writeup of a shallow investigation, a brief look at an area that we use to decide how to prioritize further research.
In a nutshell
- What is the problem? Traffic injuries are a major cause of morbidity and mortality around the world, estimated to be responsible for 1.3 million deaths per year, especially prevalent in low- and middle-income countries.
- What are possible interventions? There are numerous strategies for improving traffic safety, ranging from national or international advocacy for governments to institute better policies to smaller-scale efforts such as distributing helmets to motorcycle riders. We do not have a strong sense of which approaches are likely to be most effective or cost-effective.
- Who else is working on it? The major philanthropic funders of global traffic safety work appear to be Bloomberg Philanthropies ($25 million/year) and the FIA Foundation ($7million/year), but we are not aware of an overall estimate of funding aiming to support traffic safety work in low- and middle-income countries.
1. What is the problem?
Road traffic injuries are a large and growing cause of death and disability. The Global Burden of Diseases (GBD) project estimates that traffic injuries killed 1.3 million people worldwide in 2010, slightly more than malaria.1 The World Health Organization projects that road traffic injuries will grow to be responsible for 1.9 million deaths in 2030, which would make it the 7th leading cause of death globally (up from 8th in the GBD 2010 estimate).2
Most road traffic deaths occur in middle-income countries, though traffic mortality rates are nearly as high in low-income countries.3 Traffic mortality rates are considerably lower in high-income countries, which may be due in part to more widespread adoption of some of the policies described below. Road traffic deaths are distributed relatively widely across ages, with nearly 60% falling amongst 15-44 year olds.4
2. What are possible interventions?
The World Health Organization has identified five major risk factors that affect road traffic mortality:5
- child restraints
- motorcycle helmets
- drinking and driving.
The WHO’s Unintentional Injury Prevention (UIP) Team works to address these risk factors by:6
- Advising ministers of health on areas related to road safety.
- Assisting with legislative reviews to determine how road safety laws and enforcement of these laws could be improved.
- Developing social marketing campaigns to encourage good behaviors and discourage negatives ones.
- Evaluating and improving the quality of post-accident care, from pre-hospital care to acute care to rehabilitation.
- Publishing a global status report every few years on the state of road safety around the world.
The vast majority of the Unintentional Injury Prevention Team’s funding comes from outside the WHO, and additional philanthropic funding could be used to expand their efforts to new locations.7
Other potential uses of philanthropic funding include:8
- helmet distribution and education
- police training and enforcement programs
- advocacy to governments to change road safety laws9
- road infrastructure improvements, including advocacy to major funders of infrastructure to better incorporate safety concerns10
- international advocacy to prioritize road safety more highly (e.g. the UN Decade of Action for Road Safety)11
- mass media campaigns (e.g. to encourage seatbelt or helmet use)12
- monitoring and evaluation of road safety issues13
We do not have a sense of which of these strategies is likely to be most effective or cost-effective.
Bloomberg Philanthropies commissioned a forward-looking projection for the potential impact of their $125-million, 5-year project to improve road safety in 10 countries.14 While acknowledging the limited evidence base to incorporate into their projections, the authors expect the Bloomberg Philanthropies program to save roughly 10,000 lives over five years.15 This implies a cost-per-life saved that is considerably higher than our estimates for the most cost-effective global health interventions (such as bednets to prevent the spread of malaria), though for a very different population (i.e. most of the lives projected to be saved by Bloomberg’s road safety work are adults in middle-income countries, while most of the lives projected to be saved by bednets are children in low-income countries).16 Because of the normative and empirical uncertainty underlying this comparison, we do not regard it as dispositive.
3. Who else is working on this?
The UN has declared 2011-2020 to be the UN Decade of Action for Road Safety.17 This has involved the creation of a Global Plan of Action to guide governments and national stakeholders in improving road safety in addition to regular monitoring of global progress towards road safety targets. 18
The two largest philanthropic funders of road safety work appear to be Bloomberg Philanthropies and the FIA Foundation.
Bloomberg Philanthropies are currently supporting a $125-million, 5-year project to improve road safety in 10 countries.19 Bloomberg Philanthropies works with a consortium of other groups, including:20
- Association for Safe International Road Travel
- Global Road Safety Partnership
- Johns Hopkins Bloomberg School of Public Health
- World Bank Global Road Safety Facility
- World Health Organization
- International Road Assessment Program (iRAP)
- Asia Injury Prevention Foundation
According to T. Bella Dinh-Zarr of the FIA Foundation, there are a a number of other organizations—typically smaller and more locally focused—working to address road safety issues.23
Our understanding is that government aid agencies (such as USAID or the UK’s DFID) and development banks, such as the World Bank, support some work on road safety as well, though we do not have a strong sense of how much.24
We are not aware of any overall estimates of resources devoted to improving road safety in low- and middle-income countries.25
4. Questions for further investigation
Our research in this area has been relatively limited, and many important questions remain unanswered by our investigation.
Amongst other topics, further research on this cause might address:
- How strong is the evidence in favor of the road safety interventions supported by the WHO? How cost-effective have historical efforts to implement those interventions been?
- What has the track record of Bloomberg Philanthropies’ support for traffic safety issues been? Our understanding is that monitoring and evaluation data is being collected for their efforts, and some portion of it may be available publicly within a year.26
- How should we weigh the differences in the populations typically aided by traffic safety improvements and other global health interventions?
5. Our process
We decided to look into road safety issues because we had heard that they were a large and growing cause of mortality globally and that they receive relatively little philanthropic funding. Our investigation mainly consisted of speaking with three individuals with knowledge of the field, including:
- Margie Peden, Coordinator, Unintentional Injury Prevention, World Health Organization
- T. Bella Dinh-Zarr, Director of Road Safety, FIA Foundation for the Automobile and Society
We also reviewed several documents that the individuals we spoke with shared with us and did some limited independent desk research.
|Esperato, Bishai, and Hyder 2012||Source (archive)|
|Global Status Report on Road Safety 2013: Supporting a Decade of Action||Source (archive)|
|Leading the Worldwide Movement to Improve Road Safety||Source (archive)|
|Lozano et al. 2012||Source (archive)|
|Notes from a conversation with Margie Peden, 8/13/13||Source|
|Notes from a conversation with T. Bella Dinh-Zarr, 8/2/13||Source|
|Projections of mortality and causes of death, 2015 and 2030||Source (archive)|