Addressing the human toll from motor vehicle traffic crashes

Motor vehicle traffic crashes remain the leading cause of death in the world, despite tremendous advances in injury prevention and control. According to the World Health Organization, approximately 1.35 million people die each year as a result of motor vehicle traffic crashes, accounting for about 3% of the gross domestic products of countries. Amazingly, over half of all motor vehicle traffic crash deaths involve vulnerable road users including pedestrians, drivers, occupants, cyclists, and motorcyclists (https://www.who.int/news-room/fact-sheets/detail/road-traffic-injuries). In addition to the demographic characteristics of age, gender, and socioeconomic status, many other risk factors related to the environments and the vehicles as well as the behaviours of pedestrians, drivers, occupants, cyclists, and motorcyclists have been implicated as contributing to this carnage on our roads. Several articles in the current issue of the Journal focus on motor vehicle traffic crashes, stressing on strategies and approaches aimed at reducing the human toll from motor vehicle traffic crashes (Arafa, El-Setouhy, & Hirshon, 2019; Bakhtiyari et al., 2019; Fletcher, McDowell, Thompson, & James, 2019; Zabihi, Davoodi, & Nordfjaern, 2019).

The article by Zabihi et al. (2019) researched the role of perceived risk, reasons for non-seat belt use, and demographic characteristics for seat belt use on urban and rural roads. Their findings corroborated those of earlier research findings regarding the factors affecting seat belt use separately for drivers on urban and rural roads. These findings could be useful for policy-makers to enhance seat belt use rates. Specifically, the authors found that perceived risk of being ticketed was not a predictor of seat belt use on both urban and rural roads, while controlling for age and gender. However, the influence of being ticketed and discomfort were predictors of seat belt use on urban roads. Meanwhile, increasing age, having been ticketed in the past three years, having vehicle crashes in the past three years, and perceived discomfort were the sole predictors of seat belt use on rural roads. A limitation to this study, however, was the focus on drivers only apparently because the authors argued that drivers and other occupants (passengers) behave differently with different seat belt use rates. Nonetheless, it is obvious that seat belt use continues to be low in many settings of the world and needs to be seriously addressed to alleviate the huge human toll from motor vehicle traffic crashes.

Another study also estimated the avoidable burden and population attributable fraction of human risk factors of road traffic injuries using penalized modelling, bias reduction, and sparse data analysis. The most important human factors uncovered to influence traffic-related deaths were over-speeding (OR = 9.6, 95% CI: 2.5–37.7), reckless overtaking (OR = 8.6, 95% CI: 1.8–40.7), and fatigue and drowsiness (OR = 6.7, 95% CI: 1.8–25.0). The total population attributable fraction for all the studied risk factors was found to be about 56% (PAF = 0.56, 95% CI: 0.37–0.70). The greatest avoidable burden was related to fatigue and drowsiness, over-speeding, and not fastening seatbelt. The authors concluded that by considering the high contribution of human risk factors in occurrence of fatal traffic injuries, appropriate legislation and prevention programmes for these risk factors would decrease half of such deaths (Bakhtiyari et al., 2019). The low usage of seat belts was seen in this study as were other important risk factors for motor vehicle traffic crashes such as speeding and driving while fatigued and drowsy which also need to be addressed.

Fletcher et al. (2019) studied helmet use among motorcycle accident victims in the north-east region of Jamaica over a 28-month period. Study subjects included individuals who presented to the Accident and Emergency Department of a regional hospital with injuries sustained from motorcycle crashes. Helmet use was found to be only 29 percent. Among the reasons cited for not wearing a helmet were riding for a short distance and not owning a helmet. Increasing age correlated with increased helmet use compliance. In addition to finding low helmet usage rates, particularly among young individuals, we also encounter a misconception about traffic crashes in this study: that traffic crashes occur on highways over long distances. Therefore, interventions to promote helmet use compliance ought to take these factors into consideration, along with ensuring law enforcement.

Driver behaviour and road traffic crashes among professional and non-professional drivers was studied in Egypt, which has one of the highest traffic crash rates in the world (Arafa et al., 2019). The authors interviewed 518 professional and non-professional drivers using the Arabic version of the Driver Behavior Questionnaire. Professional drivers were found to have more lapses and violations. Most importantly, involvement in road traffic crashes was associated with females, younger age, illiteracy, eating while driving, and not using seat belt. Here again not using seat belt, despite its proven effectiveness, was found to be associated with increased risk of road traffic crashes, while driving lapses, errors and violations were not found to be associated with increased risk of road traffic crashes.

Addressing the human toll from motor vehicle traffic crashes requires a new paradigm such as the safe system approach. The safe system approach to road safety has been designed to ensure a safe transportation for all road users, including drivers, occupants, cyclists, and pedestrians. The approach recognizes that the system must work as a whole to reduce the net injury risk to road users to an acceptable level, including the four system cornerstone areas of roadways, speeds, vehicles, and people (Bambach & Mitchell, 2015). Therefore, safe roads and roadsides, safe speed, safe vehicles, and safe road users remain the tenets of this sound approach aimed at reducing the human toll from motor vehicle traffic crashes. For example, according to a World Health Organization report, an increase in the average speed of a vehicle is directly related to both the likelihood of a crash and the severity from the crash (https://www.who.int/news-room/fact-sheets/detail/road-traffic-injuries).

Developing a safe system approach requires proper planning and basically involves reframing the way in which road safety is viewed and managed. The Victorian Safe System approach to road safety, for example, evolved slowly through a careful combination of the Swedish Vision Zero philosophy and the Sustainable Safety model developed by the Dutch. Strong institutional leadership and close cooperation among all the key agencies were required, which was catalyzed by the existence of a long history of strong interagency mechanisms in Victoria (Muir, Johnston, & Howard, 2018). The safe system approach ultimately lies in the hands of policy-makers amidst the political environment of the specific setting. Indeed, sustained efforts must be continued to achieve bumper-to-bumper safe vehicles, uncomplicated safe roads and roadsides, realistic safe speed, and alert and compliant road users in our quest to address the human toll from motor vehicle traffic crashes.

Samuel N. Forjuoh
Department of Family & Community Medicine
Baylor Scott & White Health
Texas A&M HSC College of Medicine
1402 West Ave H, Temple, TX 76504, USA
[email protected]