Projecting the Health and Economic Impact of Road Safety Initiatives: A Case Study of a Multi-country Project

Figures & data

Table I Literature review of effectiveness studies for selected road safety interventions

Type of intervention (1st is primary intervention)	Source	Intervention	Main findings	Country
Speeding
Speed-enforcement; drink-driving + speeding enforcement	Poli de Figueiredo, L. F., S. Rasslan, et al. (2001). “Increases in fines and driver licence withdrawal have effectively reduced immediate deaths from trauma on Brazilian roads: first-year report on the new traffic code.” Injury 32(2): 91–4.; Liberatti, C. L, S. M. Andrade, et al. (2001). “The new Brazilian traffic code and some characteristics of victims in southern Brazil.” Inj Prev 7(3): 190–3.	New Traffic Code for Brazil: increased fines, point system and raised speed limits.	Poli paper reduces deaths by 25% reduces admissions by 33% so in 10,000 popGet .512 lives saved and 4.549 YLDs saved	Brazil
Speed-enforcement; drink-driving + speeding enforcement; seatbels enforcement; enforcement-general	Maffei de Andrade S, Soares DA, Matsuo T, Barrancos Liberatti CL, Hiromi Iwakura ML. “Road injury-related mortality in a medium-sized Brazilian city after some preventive interventions”. Traffic Inj Prev. 2008 Oct;9(5):450–5.	Speed control, seatbelts, new traffic code and prehospital attention for road traffic victirms in Londrina (Brazil)	Seatbelts, radar (end of 1995 and 1996), and introduction of prehospital attention (starting in June 1996). Small impact on mortality among victims of road traffic injuries, which continued at + 35 per 100,000 population. In 1999, the year after a new national road traffic code had been implemented, a larger reduction in mortality levels was observed (to 27.2 per 100,000). However, this downward trend was not maintained over subsequent years, with mortality levels continuing at 23 to 29 per 100,000 population.	Brazil
Speed-enforcement; drink-driving + speeding enforcement; enforcement-general	Bishai D, Asiimwe B, Abbas S, Hyder AA, Bazeyo W. “Cost-effectiveness of traffic enforcement: case study from Uganda”. Inj Prev. 2008 Aug;14(4):223–7.	Enforcement of traffic laws (speed through scale up of police resources (20 policemen, radars, and 4 mobile units) in Kampala	17% drop in road deaths after the intervention. $603 per death averted or $27 per life year saved discounted at 3%	Ghana
Drink Driving
Drink enforcement	Guanche Garcell H, Su´rez Enriquez T, Gutiérrez García F, Martínez Quesada C, Peña Sandoval R, S´nchez Villalobos J. “Impact of a drink-driving detection program to prevent traffic accidents (Villa Clara Province, Cuba)”. Gac Sanit. 2008 Jul–Aug;22(4):344–7.	Alcohol testing checkpoints during weekends at Villa Clara province (pop 833,424)	Comparing to previous year (2002), accidents were reduced by 29.9%, deaths by 70.8%, and injuries by 58.7%.	Cuba
Helmets
Helments-enforcement	Espitia-Hardeman V, Vélez L, Muñoz E, Gutiérrez-Martínez Ml, Espinosa-Vallín R, Concha-Eastman A. “Impact of interventions directed toward motorcyclist death prevention in Cali, Colombia: 1993–2001”. Salud Publica Mex. 2008;50 SuppM:S69–77.	Series of laws that made mandatory a) helmet in motorcycle drivers; b) helmet in passengers; c) forbade motorcycle traffic during Christmas holidays; and d) use of reflecting vests. The study also examined the impact of a reduction in police personnel.	Between 1993 and 2001, 52% reduction in mortality rates amongst motorcycle drivers from 9.7 to 3.6. According to the ARIMA (adj) model, helmet in drivers reduced rate by 3.8, and helmet in passengers by 3.3 (mortality rates seem to be per 100,000 inhabitants).	Colombia
Helments-enforcement	Ichikawa M, Chadbunchachai W, Marui E. “Effect of the helmet act for motorcyclists in Thailand”. Accid Anal Prev. 2003 Mar;35(2):183–9.	National helmet law of Thailand	41% reduction in head injuries and 21% reduction in deaths	Thailand
Speeding
Helments-enforcement	Passmore J, Tu NT, Luong MA, Chinh ND, Nam NP. “Impact of mandatory motorcycle helmet wearing legislation on head injuries in Viet Nam: results of a preliminary analysis”. Traffic Inj Prev. 2010Apr;11(2):202–6. PubMed PMID: 20373241	National helmet law, requiring all motorcycle riders and passengers to wear helmets at all times.	16% reduction in road traffic injuries and 18% reduction in road traffic deaths (both significant at p<0.05).	Vietnam
Seatbelts
Seatbelts-Enforcement	Harris GT, Olukoga IA. “A cost benefit analysis of an enhanced seat belt enforcement program in South Africa”. Inj Prev. 2005 Apr;11(2):102–5	Seatbelt law	Increase of seatbelt usage by 16%; reduction of injuries by 9.5%. 13.6 million rand in societal savings. However, 9.5% reduction estimate results assumes increases seatbelt usage and the impact of such usage similar to those from meta-analyses from US.	South Africa
Seatbelts-Enforcement; seatbelts-social marketing; enforcement-general	Soori H, Royanian M, Zali AR, Movahedinejad A. “Road traffic injuries in Iran: the role of interventions implemented by traffic police”. Traffic Inj Prev. 2009. Aug;10(4):375–8.	The four interventions simultaneously put into place in 2005 were (1) enforcement of laws on the mandatory fastening of seat belts, (2) enforcement of the laws on use of motorcycle helmets, (3) enforcement of general traffic laws, and (4) mass media educational campaigns on national radio and television.	Significant decrease in RTI-related death and morbidity rates in Iran, after intervention (P < 0.001). Death rate decreased from 38.2 per 100,000 in 2004 to 31.8 in 2007 (OR = 0.83, 95% Cl = 0.82–0.85). The death rate per 10,000 vehicles also showed a significant decline from 24.2 to 13.4 (OR = 0.56, 95% Cl = 0.55–0.57). Similar reductions were seen among nonfatal RT	Iran
Seatbelts-Enforcement; seatbelts-social marketing; enforcement-general	Stevenson M, Yu J, Hendrie D, Li LP, Ivers R, Zhou Y, Su S, Norton R. “Reducing the burden of road traffic injury: translating high-income country interventions to middle-income and low-income countries”. Inj Prev. 2008 Oct;14(5):284–9.	Enhanced police training and enforcement, social marketing, and health educaiton. Intervention rolled out Sept 2005–August 2006.	12% increase (from 50% to 62%) in intervention city, and considerable narrowing of confidence intervals. Based on demonstrated effectiveness of seatbelt usage on probability of death (=0.45), the authors calculate 7% death reduction based on simple formula. Authors estimate also $418 per DALY saved.	China
Seatbelts-social marketing; speed-social marketing; social marketing-general	Salvarani CP, Colli BO, Carlotti Junior CG. “Impact of a program for the prevention of traffic accidents in a Southern Brazilian city: a model for implementation in a developing country”. Surg Neurol. 2009 Jul;72(1):6–13	Brazilian adaptation of “Think First”, an educational program targeted at overall popuolation (particular focus on adolescents and young adults). Key themes are alcohol, helmets, speed and seatbelt. The intervention lasted for 1 year and was implemented at a variety of places.	During implementation year, total nr. of accidents increased by 1.6%, but the number of fatal injuries was reduced by 23.6% .	Brazil
Social marketing
Social marketing-general	Rahimi-Movaghar V. “Controlled evaluation of injury in an international Safe Community: Kashmar, Iran”. Public Health. 2010 Apr;124(4):190–7.	Intervention is Safe Community model from WHO. Therefore, road-safety intervention seems a bit unclear.	No effect was found of Safe Community intervention on road safety .	Iran
Helmets-social marketing	Law TH, Umar RS, Zulkaurnain S, Kulanthayan S. “Impact of the effect of economic crisis and the targeted motorcycle safety programme on motorcycle-related accidents, injuries and fatalities in Malaysia”. Int J Inj Contr Saf Promot. 2005 Mar;12(1):9–21.	Intervention aimed at modifying use of motorcycle user behavior in: helmet use, lack road conspicuity, and speed	27% reduction in motorcyle-related deaths	Malaysia

Table II Estimate of lives saved and their value for RS-10 sites

Country	Population receiving intervention (persons)	Risk of injury death (per 100,000)	Lives saved over 5 years, discounted	Value of these life years @ 3 × GNI /LYS($)	Value of these saved lives using VSL ($)
Brazil	7,510,000	24.4	1857	1,378,615,088	697,378,540
Cambodia	6,932,000	12.1	980	119,038,820	27,908,701
China	14,606,000	15.4	1975	926,689,883	414,234,667
Egypt	19,482,000	14.7	2411	1,018,868,595	378,369,689
India	3,618,000	25.8	1568	308,942,625	89,304,298
Kenya	1,377,000	6.6	135	9,033,373	3,075,128
Mexico	4,400,000	29.7	995	1,037,213,269	605,578,089
Russia	1,275,000	22.8	181	209,205,483	164,841,888
Turkey	1,352,000	13.3	120	118,760,697	69,000,141
Vietnam	380,000	19.0	88	17,582,567	4,749,056
Total	60,934,000	19.9	10,310	5,143,950,399	2,454,440,197

Figure 1 Tornado diagram for road safety estimates, VSL calculations (color figure available online).