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ROAD SAFETY
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Youth and road safety in Europe Policy briefing
The World Health Organization was established in 1948 as the specialized agency of the United Nations responsible for directing and coordinating authority for international health matters and public health. One of WHO’s constitutional functions is to provide objective and reliable information and advice in the field of human health. It fulfils this responsibility in part through its publications programmes, seeking to help countries make policies that benefit public health and address their most pressing public health concerns. The WHO Regional Office for Europe is one of six regional offices throughout the world, each with its own programme geared to the particular health problems of the countries it serves. The European Region embraces some 880 million people living in an area stretching from the Arctic Ocean in the north and the Mediterranean Sea in the south and from the Atlantic Ocean in the west to the Pacific Ocean in the east. The European programme of WHO supports all countries in the Region in developing and sustaining their own health policies, systems and programmes; preventing and overcoming threats to health; preparing for future health challenges; and advocating and implementing public health activities. To ensure the widest possible availability of authoritative information and guidance on health matters, WHO secures broad international distribution of its publications and encourages their translation and adaptation. By helping to promote and protect health and prevent and control disease, WHO’s books contribute to achieving the Organization’s principal objective – the attainment by all people of the highest possible level of health.
Youth and road safety in Europe Policy briefing By: Dinesh Sethi, Francesca Racioppi and Francesco Mitis
WHO European Centre for Environment and Health, Rome WHO Regional Office for Europe
Youth and road safety in Europe, Policy briefing. Abstract Each year 32 000 people younger than 25 years in the WHO European Region lose their lives to road traffic injuries, making this the third leading cause of death. Among them, about half those younger than 15 years die as pedestrians, whereas those 15–24 years old predominantly die as car or motorcycle users. Children and young adults need special consideration as vulnerable and inexperienced road users. This booklet highlights some of the factors that put young people at increased risk of serious road crashes. These include speed, alcohol, not being conspicuous, not using crash helmets, seat-belts and child passenger restraints and road and vehicle designs that do not have built-in safety features increase the likelihood. To counteract this relentless daily toll, many cost-effective interventions have been proposed. There are a wealth of experience in the European Region and opportunities to learn from it. Keywords 1. accidents, traffic - prevention and control 2. wounds and injuries - prevention and control 3. safety 4. adolescent 5. child 6. World Health Organization 7. Europe ISBN 978 92 890 2199 9 Address requests about publications of the WHO Regional Office for Europe to: Publications WHO Regional Office for Europe Scherfigsvej 8 DK-2100 Copenhagen Ø, Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office web site (http://www.euro. who.int/pubrequest). © World Health Organization 2007 All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Where the designation “country or area” appears in the headings of tables, it covers countries, territories, cities, or areas. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The World Health Organization does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use. The views expressed by authors or editors do not necessarily represent the decisions or the stated policy of the World Health Organization. Photo credits: Martin Sedlák: cover, double-spread p. viii-1, p. 11 Box 5 Istockphoto: p. 2, 12, 14, 21 European Commission Audiovisual Library: p. 4 WHO/Cristina Piza Lopez: p. 11 Box 6 Kevin Brown: p. 15 US Center for Disease Control and Prevention/NCIPC: p.16 WHO/Marco Pierfranceschi: p. 17 WHO/Nicoletta Di Tanno: p. 19 Printed in Italy
Contents Acknowledgements
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Acronyms
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Foreword
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Executive summary
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1. Why this policy briefing?
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2. How great is the problem of road traffic injuries among young people in Europe? 2.1 From childhood to young adulthood: changing vulnerability 2.2 Road safety among young people: inequality in the Region 2.3 Socioeconomic inequality in road crash deaths within countries 2.4 Fear of unsafe roads: lack of physical activity and increasing obesity 2.5 Road safety among young people: risk differs among modes of road transport
3. What can be done? Risk factors and strategies for prevention 3.1 Reducing risks among young drivers 3.2 Speeding and the risk of severe injury and death 3.3 Increasing the use of helmets 3.4 Measures to reduce driving under the influence of alcohol and other drugs 3.5 Using seat-belts and child restraints 3.6 Improving the road environment 3.7 Safer vehicle design for protecting people in crashes 3.8 Improving conspicuousness and visibility 3.9 Improving the quality of trauma care
4. A framework for further action 4.1 Strengthening national plans and agencies for road safety 4.2 Improving surveillance 4.3 Strengthening national capacity – the role of professionals 4.4 Promoting evidence-based practice by facilitating the exchange of knowledge 4.5 Recognizing gaps in knowledge and promoting research on protecting vulnerable people 4.6 Promoting multisectoral approaches to policy-making
4 4 6 9 9 10 12 12 13 14 15 16 17 17 18 18 19 19 20 20 20 20 20
5. Conclusions
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references
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Annex 1. Methods used
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Annex 2. Additional results
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policy briefing
Acknowledgements
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any international experts and WHO staff have contributed to the development of this booklet, and we are very thankful for their support and guidance.
We are particularly grateful to the following WHO staff: • kidist bartolomeos for help with the WHO Global Burden of Disease data and to remigijus prochorskas and caroline warming for providing advice on the European mortality database. We are particularly indebted to margie peden, tamitza toroyan and etienne krug of WHO for the thorough and extensive comments on the manuscript and for sharing the draft manuscript of the global report Youth and road safety, and to: • nicoletta di tanno for her support as photo editor; • manuela gallitto for administrative support. We wish to thank martine campoy from the United Nations Economic Commission for Europe (UNECE) who supplied data from the UNECE transport database. We are particularly grateful to external peer reviewers for their very helpful comments and for contributing to improving the completeness and accuracy of this publication: • john arild jenssen, Ministry of Transport and Communications, Oslo, Norway; • marie-noëlle poirier, United Nations Economic Commission for Europe, Geneva, Switzerland; • jean-paul repussard, European Commission, Brussels, Belgium; • wim rogmans, Consumer Safety Institute, Amsterdam, Netherlands; • maria-teresa sanz-villegas, European Commission, Brussels, Belgium; • christopher smith, United Nations Economic Commission for Europe, Geneva, Switzerland; • colin stacey, Joint Organisation for Economic Co-operation and Development/European Conference for Ministers of Transport, Transport Research Centre, Paris, France; • elizabeth towner, University of the West of England, Bristol, United Kingdom; • divera twisk, Institute of Road Safety Research SWOV (Stichting Wetenschappelijk Onderzoek Verkeersveiligheid), Leidschendam, Netherlands; and • joel valmain, European Commission, Brussels, Belgium. Warm thanks also go to the following for contributing examples of European case studies: • brigitte chaudry, European Federation of Road Traffic Victims and RoadPeace, London, United Kingdom; • armin kaltenegger, martin winkelbauer and rupert kisser, Austrian Road Safety Board, Vienna, Austria; • martin sedlák, Consultant paediatrician, Kroměříž, Czech Republic. Thanks also to: • david breuer for stylistic editing; • l’iv com sàrl for graphic design.
dinesh sethi, francesca racioppi
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youth and road safety in europe
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francesco mitis
Acronyms CIS ECMT ETSC EU FEVR ICD OECD UNECE
Commonwealth of Independent States European Conference of Ministers of Transport European Transport Safety Council European Union European Federation of Road Traffic Victims International Classification of Diseases Organisation for Economic Co-operation and Development United Nations Economic Commission for Europe
policy briefing
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Foreword
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pectacular public health successes were achieved during the 20th century in fighting infectious disease, the historical killer of children and young adults in Europe. However, at the dawn of the new millennium, society confronts another threat to the well-being of people younger than 25 years, who make up one third of the population of the WHO European Region. Road traffic injuries kill as many as 32 000 people younger than 25 years old in the Region every year and injure or maim millions more. This burden is not equally distributed and is a source of growing inequality in health in the Region, both between countries and within countries, with socioeconomically disadvantaged groups being more at risk. These deaths and the millions of injuries and disabilities experienced by survivors are largely preventable. Children and young adults have the right to safety on the streets. In order to safeguard this, society needs to confront this growing challenge and coordinate its efforts to defeat this public health threat. This policy briefing is being published during the First United Nations Global Road Safety Week (23–29 April 2007), a week dedicated to young road users. The briefing has been written to complement the global report Youth and road safety and highlights the European problem and proposes solutions for the European context. It aims to provide its European audience of policy-makers and practitioners from the health, transport and other sectors, nongovernmental organizations and other members of civil society with a tool to advocate for the road safety of young people in Europe. We hope that, by highlighting the magnitude of the problem and the opportunities for prevention, this publication can be useful to those demanding action to protect the safety of young people in Europe. Such advocacy will add to the debate that started on World Health Day in 2004, which was dedicated to road safety. WHO proposed a public health and multisectoral approach to preventing road traffic injuries. The current publication highlights the burden among young people in Europe and proposes actions to protect their safety on our roads. By tackling road safety, we can make our society more equitable.
roberto bertollini
Director, Special Programme for Health and Environment WHO Regional Office for Europe
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youth and road safety in europe
Executive summary
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ach year 32 000 people younger than 25 years in the WHO European Region lose their lives to road traffic injuries, making this the third leading cause of death. Deaths are the tip of the iceberg, and road traffic injuries are also a leading cause of hospital attendance and disability and high societal costs. Among the young people who are killed, about half those younger than 15 years die as pedestrians, whereas those 15–24 years old predominantly die as car or motorcycle users. Children and young adults need special consideration as vulnerable and inexperienced road users, as they may not have the necessary skills and experience to handle road environments that have been designed for adults. A failure to safeguard the roads compromises their fundamental right to safety. The Region has great disparity in deaths from road traffic injuries, with an eight-fold difference between the countries with the highest and lowest rates. The burden of road traffic injuries is unequally distributed according to socioeconomic class within countries, which is a growing concern. The inequality in the Region reflects important differences in exposure to risk, environmental risk factors and enforcement practices. Such inequity in health is an important area of social justice that should be addressed. This briefing, along with the global report Youth and road safety, highlights some of the risk factors that put young people at increased risk. Although also relevant to all ages, factors such as speed, alcohol, not being conspicuous, not using crash helmets, seat-belts and child passenger restraints and road and vehicle designs that do not have inherent safety features built in increase the likelihood of serious road crashes. To counteract this relentless daily toll, many cost-effective and equitable interventions have been proposed. There is a wealth of experience in the Region and opportunities to learn from this. However, the implementation and enforcement of safety measures requires political and financial commitment. Policy-makers, practitioners and advocates need to work together to respond to this public health threat to protect young people in Europe.
policy briefing
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Why this policy briefing?
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ach year 127 000 people die from road crashes in the WHO European Region (Peden et al., 2004). The nonfatal consequences are also severe: more than 2 million injured people require hospital admission and millions more require medical attention, with a large proportion permanently disabled (UNECE, 2006). Road traffic injuries in the Region result in an annual loss of 3.6 million years of healthy life due to premature death or disability (disability-adjusted life-years). The loss of national productivity is an economic threat, resulting in high societal costs equivalent to about 2% of gross domestic product. For the European Region, this translates into hundred of billions of euros, including health service costs to treat and rehabilitate injured people. Road crashes can affect anyone, but children and young people pay a heavy toll; road traffic injuries kill an estimated 32 000 people younger than 25 years annually (Box 1). The high number of years of life lost due to premature mortality
youth and road safety in europe
box 1. The reasons for focusing on people younger than 25 years S Road traffic injuries are the leading cause of death
among people 5–24 years old.
S Europe has great inequality in death from road traffic
injury between and within countries; addressing inequity is an important area for social justice. S Young people make up many of the pedestrians, cyclists and motorbike riders, who are vulnerable as road users. S Young and novice drivers are more susceptible to risk factors such as alcohol and speeding. S Children and young adults need advocates in this important area of health and social policy. S Providing safer environments for pedestrians and cyclists will have other beneficial effects, including helping to promote physical activity and to counteract obesity and other noncommunicable diseases in Europe.
among young people, coupled with the severe and life-long disability, results in a disproportionately higher burden of injuries (Sethi et al., 2006a). There have been global calls for action to combat this rising epidemic that threatens the social and economic development of societies (Peden et al., 2004; Toroyan & Peden, 2007). This publication highlights the problem and potential solutions of road safety faced by young people in Europe. It accompanies the global report, Youth and road safety (Toroyan & Peden, 2007). The briefing is a tool to promote awareness in the 53 Member States in the WHO European Region. Its purpose is to highlight the burden of road traffic injuries among road users aged 0–24 years, to discuss the risk factors that are of special concern in this age group, to present examples of preventive programmes from the countries of the Region and to emphasize priorities for policy and research (Box 2).
box 2. The right to safety and a healthy life for children and young adults Children are not just small adults. Childhood encompasses different stages of emotional, neural and physical development ranging from newly born babies to adolescents. Each stage requires a different response, whether these are for preventive policies or services (Aynsley-Green et al., 2000). Children cannot speak for themselves or are not given an opportunity to express their views. They therefore need advocates as road users, whether as pedestrians, cyclists, motorbike riders or car occupants. Similarly, young adults need special consideration as road users not yet experienced enough to respond appropriately to situations that put them and others at risk. In promoting road safety for these groups of road users, policy-makers and practitioners need to take these special circumstances into account. Failure to do so compromises the fundamental rights of children (and young adults) to safety and a full, healthy and productive life in accordance with the United Nations Convention on the Rights of the Child (United Nations, 1989).
policy briefing
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How great is the problem of road traffic injuries among young people in Europe?
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early 290 million people 0–24 years old live in the European Region, comprising one third of the population; 32 000 of these lost their lives to road traffic injury in 2002 (WHO, 2002) (Table 1). Road traffic injuries are the leading cause of death among people 5–24 years old. Deaths are the tip of the iceberg; for every person who dies, an estimated 20 more people require hospital admission for their serious injuries, 70 more people require outpatient treatment and many are permanently disabled (Gill et al., 2006; Roberts, 2005). Whereas these estimates are for all ages, the number of young nonfatal victims of road traffic injuries is likely to run into the millions. The impact on the lives of victims and families is devastating. In addition, there are both health service costs and costs to society, which have been estimated to be €1.7 million to €2.2 million per fatality (ECMT and OECD, 2006). The total costs for the European Region are therefore enormous.
youth and road safety in europe
2.1 From childhood to young adulthood: changing vulnerability Vulnerability to road crash deaths increases with age, being highest among people 20–24 years old (Fig. 1). Three fourths of the people 0–24 years old killed in road crashes are male, and the increased risk for males relative to females increases with age. The increase with age reflects changes in exposure to risk resulting from differences in travel patterns.
2.1.1 Deaths vary by age and type of road user Compared with the general population, more people younger than 25 years who die from road crashes die as car users (54% of road traffic deaths versus 47% for the general population) and as users of motorized twowheelers (17% of road traffic deaths versus 11% for the general population).
Table 1. Rank of the leading 10 causes of death and numbers of deaths among people aged 0–24 years in the WHO European Region, 2002 Rank
< 1 year
1–4 years
5–9 years
10–14 years
15–19 years
20–24 years
0–24 years
1
Perinatal conditions 65 635
Lower respiratory infections 6 467
Road traffic injuries 2 132
Road traffic injuries 2 560
Road traffic injuries 10 441
Road traffic injuries 15 001
Perinatal conditions 65 692
2
Congenital anomalies 26 085
Childhood-cluster diseases 3 142
Lower respiratory infections 2 111
Lower respiratory infections 1 682
Self-inflicted injuries 7 552
Self-inflicted injuries 12 056
Lower respiratory infections 38 459
3
Lower respiratory infections 25 504
Congenital anomalies 2 575
Drownings 1 382
Drownings 1 481
Violence 2 900
Violence 5 844
Road traffic injuries 31 830
4
Diarrhoeal diseases 10 560
Drownings 1 708
Leukaemia 855
Self-inflicted injuries 1 431
Drownings 2 174
Poisonings 4 283
Congenital anomalies 31 626
5
Meningitis 8 199
Road traffic injuries 1 387
Congenital anomalies 798
Leukaemia 910
Poisonings 1 643
War 3 474
Self-inflicted injuries 21 211
6
Upper respiratory infections 2 022
Diarrhoeal diseases 1 267
Cerebrovascular disease 400
Congenital anomalies 730
Lower respiratory infections 1 472
Drownings 3 037
Diarrhoeal diseases 12 242
7
Childhood-cluster diseases 1 770
Meningitis 1 114
Poisonings 367
Violence 505
Cerebrovascular disease 1 355
Tuberculosis 2 468
Meningitis 10 484
8
Endocrine disorders 795
Fires 764
Fires 327
Cerebrovascular disease 448
Leukaemia 1 314
Cerebrovascular disease 1 633
Violence 10 048
9
Inflammatory heart diseases 563
Poisonings 761
Epilepsy 306
Poisonings 443
War 852
Falls 1 446
Drownings 9 891
10
HIV/AIDS 397
Leukaemia 708
Lymphomas, multiple myeloma 267
Epilepsy 381
Falls 843
Drug use disorders 1 285
Poisonings 7 760
Source: WHO (2002).
Fig. 1. Mortality rates from road crashes among people 0–24 years old per 100 000 population by age and sex Males
40
Females
Deaths per 100 000 population
35 30 25 20 15 10 5 0
