No more declarations — we need real action on road safety

Last week the United Nations convened its High-Level Meeting of the General Assembly on Global Road Safety — which has been called the largest political gathering of its kind on road safety. And yet, road traffic injuries (RTIs) are now the eighth leading cause of death worldwide, amounting to 1.35 million deaths and 50 million injuries each year.

While 90 percent of the fatalities on roads occur in low- and middle-income countries, nations like the United States are by no means immune. Once a leader in road safety, traffic-related deaths in the U.S. have recently reached a 16-year high. Between 2020 and 2021, traffic fatalities increased 11 percent overall — 13 percent for pedestrians and 15 percent for interstate travel. This trend has compelled Transportation Secretary Pete Buttigieg to rightfully characterize the problem as a national crisis.

In the midst of this urgent global epidemic, the U.N. has nobly declared a second Decade of Action for Road Safety 2021-2030 to reach its Sustainable Development Goal (SDG) of a 50 percent reduction in road traffic injuries and deaths worldwide.

Yet, we’ve been down this road before.

As the name implies, there was a first Decade of Action from 2011-2020. That decade was unable to decrease the number of road traffic injuries globally, which is why we now find ourselves renewing efforts to solve this problem. But declaring action is not enough this time; taking action is what is needed now.

What’s important to understand about this crisis is that nearly all of these traffic-related injuries and deaths are preventable and predictable. But in order to prevent them, the nations of the world must prioritize road safety and implement evidence-based, systematic-level interventions able to save hundreds of thousands of lives.

The good news is we already know a great deal about what works. In a series of papers just published in The Lancet, together with colleagues, we examined four risk factors — lack of helmet use, lack of seatbelt use, speeding and drunk driving — that dramatically increase road fatalities. (There are several risk factors that increase fatalities, but our paper focused on four.) We found that if we implemented road safety interventions around these four key risks, up to 540,000 lives could be saved globally. We also showed that improving emergency response and trauma care in low- and middle-income countries could save approximately 200,000 lives each year.

Though we have a growing body of evidence, fatalities continue to rise in low-income countries while progress on road safety has slowed in higher-income countries like the U.S. Why? Many countries and cultures remain in thrall to the automobile. As public health practitioners, we study how industry activities harm public health, what we call commercial determinants of health. Similar to the role Big Tobacco and Big Sugar played in their respective health crises, the auto (and alcohol) industry play a role in this public health crisis.

A car-centric environment affects everything from our infrastructure choices and automobile design to how we perceive so-called road traffic “accidents.” (Yes, we must confront and rethink even the language we use to describe car crashes. Calling something an “accident” connotes a blameless world that fails to account for predictable risks and generations of car-centric policy decisions and design.)

Like the Vision Zero campaign, which seeks to eliminate all traffic fatalities and severe injuries, we need a safety-first mentality that prioritizes protecting people both inside and outside of cars. Pedestrians, cyclists and motorcyclists make up more than half of crash victims globally. In the U.S., Black Americans die at more than four times the rate of white Americans while cycling, and more than two times the rate while walking. Installing better street lighting, bike lanes, sidewalks and crosswalks in all communities, while truly enforcing lower speed limits and stiffer penalties for driving under the influence, would significantly improve road safety.

We must also rethink safety for people inside their automobiles. New and advanced safety technology features — from adaptive headlights and blind spot detection to cameras — should be required rather than optional. In fact, the Biden administration has made steps in the right direction on infrastructure and car safety in its National Roadway Safety Strategy but there is much work to be done.

Finally, continuous monitoring and evaluation of road safety measures are crucial to maintaining a safety-first approach. In this instance, what we don’t know truly can hurt us.

It is long past time to rethink how we’re trying to solve this problem and to learn from past failures. We believe that we can make the next 10 years safer. It will take meaningful political and financial commitments from each country to make that happen. But we have to act differently in this next decade.

Adnan A. Hyder is the director of the Center on Commercial Determinants of Health (CCDH) and a professor of global health at the George Washington University’s Milken Institute School of Public Health. Nino Paichadze is the associate director of the CCDH and an assistant research professor of global health at GW’s Milken Institute School of Public Health.