Sunday, November 23, 2003

They say death doesn’t discriminate, but when it comes to road accidents, the evidence indicates otherwise.

Some people are much more likely to be killed, injured or disabled for life by traffic accidents, depending on their age, sex, economic status and home country, the United Nations and the World Health Organization say in a report.

“Road traffic injuries involve issues of equity,” said the report, which was based on information from the year 2000 gathered in countries all over the world.

Age and sex are determining factors. Young adults are affected disproportionately, with traffic injuries among their leading causes of death. About 60 percent of those killed in motor vehicle accidents around the world are between 15 and 44 years old.

Worldwide, the traffic mortality among men is nearly three times as high as it is for women, especially in places like China and India.

“In many countries, men drink more alcohol and have more access to cars. … They also tend to take more risks [while] driving,” said Etienne Krug, director of the U.N. Department of Injuries and Violence Prevention.

Street use also is a factor. In developing countries, most traffic victims are pedestrians, cyclists, children, users of public transportation or others not inside cars.

In developed countries, the victims tend to be automobile drivers and passengers. Children of lower socioeconomic status are more likely to die on the roads than those of more affluent parents.

“A further inequality issue is that poorer socioeconomic groups have less access to medical services, leading to disparities in chances of recovery or survival,” said the U.N.-WHO document.

Charles Mock, associate professor of surgery at the University of Washington in Seattle, said a study showed that among seriously injured patients, the mortality rate is 65 percent in Ghana (a low-income country), 50 percent in Mexico (middle income) and 30 percent in the United States (high income).

Life-threatening injuries that were treatable were fatal in 36 percent of cases in Ghana, compared with 6 percent in the United States.

Even weight and size matter. Britain’s Royal Automobile Club Foundation for Motorists said a study in the United States showed that people weighing between 220 and 238 pounds are almost 2 times more likely to die than people weighing less than 132 pounds.

A different study in New Zealand reached a similar conclusion, but also found that thin people are less protected by body fat, and thus have an increased risk of bone fracture that raises their injury rate.

The chances of injury in a road accident are higher for people living in low- to middle-income countries, where about 90 percent of the injuries occur. In 2000, the report shows, road injuries killed more than 1 million people in low- to middle-income countries, compared with 125,000 in high-income countries.

The U.S. Department of Transportation’s Federal Highway Administration reported 41,800 highway fatalities in the United States in 2000. That number was a third of the U.N.-WHO total for high-income countries that year.

Southeast Asia had the highest proportion of road fatalities. The 435,000 fatalities in that region in 2000 represented more than one-third around the world.

Disparities also are shown when factoring in the death rate per number of vehicles. While Sweden has a relatively low rate of 1.3 deaths per 10,000 cars, in some African nations the rate goes up to more than 100 deaths per 10,000 cars.

The use of safety devices — air bags, seat belts, child restraints and other equipment — reduces the severity of injuries, but only for vehicle occupants. They “will not protect the vulnerable road users,” the report said.

Even in developed countries, the use of safety devices varies. The devices saved 14,164 lives last year in the United States, but that number would have been 21,317 if the usage rate equaled those in other countries, according to statistics from the National Highway Traffic Safety Administration.

The United Nations considers road accidents a “global public health crisis.”

With estimates of 1.26 million people killed every year on the road or from subsequent injuries, crashes resulting in loss of life rank as the ninth leading cause of mortality (2.8 percent of deaths worldwide), said Mr. Krug, head of the U.N. Department of Injuries and Violence Prevention.

Projections suggest that by 2020, road-related fatalities could rank third — killing more people than malaria, tuberculosis or HIV/AIDS.

The consequences are a drain on national economies, the report said. “In developing countries, the costs are estimated at $100 billion [per year], twice the annual amount of development assistance. Worldwide, the costs rise to $518 billion, including direct medical costs and indirect long-term costs.”

Traffic accidents especially damage the economies of nations struggling with poverty, because those most frequently killed or disabled are in economically active groups and are family breadwinners.

Other consequences range from older people who avoid venturing outdoors, to a general decline in walking that leads to sedentary lifestyles.

However, the problem is not taken seriously enough in many countries, Mr. Krug said. For that reason, the U.N. General Assembly decided on Nov. 5 to devote a session next year to increase awareness of road traffic injuries.

The report noted that the causes of traffic accidents can be modified by intervention, said Mr. Krug. A reduction in speeding is a priority.

“A decrease in speed of 1 percent decreases the occurrence of injury by 2 to 3 percent and the occurrence of fatal accidents by approximately twice as much,” said the report. From the perspective of pedestrians, speed is also decisive. As a car’s speed increases from 18 to 31 mph, the likelihood of causing a pedestrian death rises by a factor of eight.

Both drivers and pedestrians are likely to be more severely injured with any level of alcohol in their bodies.

Helmets and security devices, which greatly reduce the severity of injuries, often are not used because they are considered uncomfortable or expensive.

Lack of timely and effective pre-hospital care and long intervals between crash and hospital admission, as well as lack of trained personnel, medicine and supplies in emergency rooms, also contribute to fatal consequences from road crashes.

“Better signs and marking … are highly effective and low-cost ways of improving road safety,” said the report. It urged coordination of minimum standards (speed limits, licensing and others), enforcement of the rules, and road design and maintenance.

Cars need to be designed to make their front ends less hazardous, the report said. About 80 percent of serious pedestrian injuries are caused by blows from bumpers and hoods.

The document also recommended inspection programs to promote proper maintenance of motor vehicles.

“Road crashes can be prevented. To date, however, efforts to address the problem of road traffic have frequently been ineffective,” the report said.

Sharing the responsibility, the report said, are those who build and manage infrastructure.

Countries with sustained strategies have reduced their road-injury burden by up to 50 percent in recent decades. In Finland, for example, fatalities fell by 50 percent over 30 years, despite a tripling of traffic volume.

For developing countries, it’s more complicated. There, motorization grows so rapidly that road safety efforts can’t keep pace.

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