Saving lives through vehicle safety
Authors: Margaret Peden
Journal: The Lancet Global Health (2020)

In the first two decades of the 21st century, more than 25 million people lost their lives to road traffic collisions—approximately 1·35 million per year or a death rate of 18·2 per 100 000 population.1WHOGlobal status report on road safety 2018. World Health Organization, Geneva2018Google Scholar During the same time period the number of vehicles in circulation has steadily increased to well above the 2 billion mark, with death rates per 100 000 vehicles declining from 135 to 64 while rates per 100 000 population have remained static.1WHOGlobal status report on road safety 2018. World Health Organization, Geneva2018Google Scholar These figures show that some small improvements have been possible, but much more action is required if we are to make progress towards to the new 50 by 30 target (an extension of Sustainable Development Goal 3.6) called for by ministers who attended the 3rd Global Ministerial Conference in Stockholm (Sweden) in February, 2020.2Declaration S Third global ministerial conference on road safety: achieving global goals 2030 Stockholm, Sweden.https://www.roadsafetysweden.com/contentassets/b37f0951c837443eb9661668d5be439e/stockholm-declaration-english.pdfDate: 19–20 February 2020Date accessed: April 14, 2020Google Scholar The world report on road traffic injury prevention published by WHO and the World Bank in 2004 moved away from the old paradigm of blaming the road user to one of promoting a safe system.3Peden M Scurfield R Sleet D et al.WHOWorld report on road traffic injury prevention. World Health Organization, Geneva, Switzerland2004Google Scholar This approach was endorsed by both World Health Assembly and United Nations General Assembly resolutions. The safe systems approach, sometimes also referred to as vision zero, recognises that humans are fallible and thus promotes a shared responsibility between road users, vehicles, and infrastructure to ensure a high level of safety.4Kristianssen A-C Andersson R Belin M-Å Nilsen P Swedish Vision Zero policies for safety—a comparative policy content analysis.Saf Sci. 2018; 103: 260-269Crossref Scopus (53) Google Scholar Vehicle safety technology plays an important role in reducing trauma from road traffic crashes5Ward D Truong J Global enhancement of vehicle safety-the urgency of now.J Australas Coll Road Saf. 2016; 27: 48Google Scholar, 6WHOSave LIVES: a road safety technical package. World Health Organization, Geneva, Switzerland2017Google Scholar and was recognised in the UN Decade of Action for Road Safety global plan as pillar 3—safer vehicles.7WHOGlobal plan for the decade of action for road safety 2011–2020. World Health Organization, Geneva, Switzerland2011Google Scholar Vehicles that are well designed with appropriate safety technologies can accommodate human error through crash avoidance technologies, such as automatic breaking systems, electronic stability control, and through limiting the effects of kinetic energy on the human body through crashworthiness technologies, such as seatbelts, airbags, and pedestrian protection. However, not all cars and motorcycles around the world are assembled, sold, and operated with the same level of safety despite the promotion of eight priority safety standards by the UN.6WHOSave LIVES: a road safety technical package. World Health Organization, Geneva, Switzerland2017Google Scholar In fact, only 40 (mainly high-income) countries have implemented seven or eight of these standards, while 124 (mainly low-income and middle-income) countries apply none, or only one, of these standards.1WHOGlobal status report on road safety 2018. World Health Organization, Geneva2018Google Scholar Unfortunately, it is in low-income and middle-income countries for which numbers of vehicle ownerships and collisions are growing the fastest and thus account for around 90% of road traffic deaths worldwide.1WHOGlobal status report on road safety 2018. World Health Organization, Geneva2018Google Scholar Most high-income countries have had safety standards in place for many decades and have shown how effective they are at saving lives. In the USA, for instance, technologies associated with the US federal motor vehicle safety standards prevented more than 600 000 deaths between 1960 and 2012.8US Department of Transportation National Highway Traffic Safety AdministrationLives saved by vehicle safety technologies and associated federal motor vehicle safety standards, 1960 to 2012–Passenger cars and LTVs. 2015. Washington, DC.https://www-esv.nhtsa.dot.gov/proceedings/24/files/24ESV-000291.PDFDate accessed: April 14, 2020Google Scholar Up until now, little robust evidence has been available on how many lives could be saved in low-income and middle-income countries. Kavi Bhalla and Kevin Gleason's study in The Lancet Global Health used counterfactual analysis to assess whether nine proven vehicle technologies would save lives if they were made widely available in Latin America. They found that electronic stability control would have the largest benefit in terms of both reductions in deaths and injuries. Increasing the use of seatbelts and child restraints and improving side and front impact through design modification would save further deaths. Improved vehicle design would result in 28·1% (12·8–39·2%) fewer deaths and 29·1% (13·5%–39·8%) fewer DALYs in the Latin and Caribbean region. By extrapolation, this important piece of research means that if every vehicle in the world was upgraded to the safest in its class, approximately a quarter to a third of road traffic deaths and injuries could be averted.9Bhalla K Gleason K Effect of improvements in vehicle safety design on road traffic deaths, injuries, and public health burden in the latin american region: a modelling study.Lancet Glob Health. 2020; 8: 819-828Summary Full Text Full Text PDF Scopus (13) Google Scholar Recognising this potential, the academic expert group to the 3rd Ministerial Conference on road safety recommended that “…vehicle manufacturers, governments and fleet purchasers ensure that all vehicles produced for every market be equipped with recommended levels of safety performance, that incentives for use of vehicles with enhanced safety performance be provided where possible, and that the highest possible levels of vehicle safety performance be required for vehicles used in private and public vehicle fleets”.10Road Safety SwedenSaving Lives Beyond 2020: The Next Steps. Swedish Transport Administration, Stockholm, SwedenOct, 2019https://www.roadsafetysweden.com/contentassets/c65bb9192abb44d5b26b633e70e0be2c/200113_final-report-single.pdfDate accessed: April 14, 2020Google Scholar Likewise, ministers attending the conference agreed to ensure “…that all vehicles produced and sold for every market by 2030 are equipped with appropriate levels of safety performance, and that incentives for use of vehicles with enhanced safety performance are provided where possible”.2Declaration S Third global ministerial conference on road safety: achieving global goals 2030 Stockholm, Sweden.https://www.roadsafetysweden.com/contentassets/b37f0951c837443eb9661668d5be439e/stockholm-declaration-english.pdfDate: 19–20 February 2020Date accessed: April 14, 2020Google Scholar Improving the safety of vehicles around the world is one of the most sustainable road safety interventions available. Making the public aware of vehicle safety through new car assessment programmes is crucial. Improving awareness of vehicle safety, coupled with the promise from governments to ensure that all their vehicles, including motorcycles, are equipped with the highest safety standards by 2030, could save millions of lives and dollars. I declare no competing interests. Effects of vehicle safety design on road traffic deaths, injuries, and public health burden in the Latin American region: a modelling studyRegulating and encouraging the use of proven vehicle safety technologies in LMICs would have large gains and needs to be prioritised in the SDG agenda for 2030. Full-Text PDF Open Access