The ninth leading cause of death in the world is road-traffic injuries, and it is predicted that by 2020 such accidents will become the third leading cause of death and disability. Assessing the distribution of health states in population groups across and within countries is important for the pursuit of equity in health. Documenting differences in health status between socioeconomic groups and exploring relations with poverty allow for a better understanding of the determinants of road-traffic injuries and a more directed approach to solutions. 90% of deaths related to road-traffic injury occur in low-income and middle-income countries, with the highest absolute numbers of deaths in Asia and the highest death rates in Africa. Most of these deaths occur in vulnerable road users—pedestrians, bicyclists, and motorcyclists. The relation between traffic fatalities and economic growth shows that traffic-fatality rates have a rising trend with increasing per-capita national income up to a threshold and then decrease (an inverted U-shaped curve). This trend suggests that fatalities from road-traffic injuries will increase in low-income countries, especially in those with large populations such as India and China. These countries in general are undergoing rapid urbanisation and motorisation, resulting in increasing exposure to determinants of road-traffic injuries, such as unsafe public transportation, higher speeds, and a diverse vehicle mix on the roads. In addition, differential access to medical services in developing countries has an important role in death and disability from road-traffic injuries. Critical action issues for prevention of road-traffic injuries and control at the national level include: changing the disproportionate risks among vulnerable subgroups of a population; altering differential consequences of injuries by interventions such as appropriate financial protections, pro-poor distribution of emergency resources, and availability of rehabilitative services; and explicitly addressing the inequitable impact of any intervention, to prevent negative effects on the poor. Appropriate national institutions, a public-health approach, and a strengthened civil society are all important factors for such an approach. The declaration by WHO of the 2004 World Health Day on road safety offers an opportunity for focused attention on this issue. It is time for global action to prevent the yearly million deaths from road-traffic injuries.
Samenvatting