Key to the development of public health policies and strategies is the accurate definition of the problem(s) under review. Accurate problem definition fences off undesirable circumstances, highlighting some aspects and throwing others in the shadow. Widely accepted definitions of traffic crashes focus on vehicle crashes (sometimes further restricted to motor vehicle crashes) occurring on public roads. These definitions exclude incidents such as pedestrians slipping, tripping or colliding with objects resulting in falls in public spaces leading to injury or death. Such incidents are hereafter denoted in short as Pedestrian Falls (PFs) The current definition is understandable from a historical perspective, but it may no longer be accurate or justifiable. The exclusion of PFs by definition and, subsequently, in statistics is likely to lead to biased conclusions in transport and safety policies, which do not serve public health interests. This paper focuses on the problem regarding definition only and not on reporting issues even though these are important as evidenced from frequently missing single-bicycle crashes (which, unlike PFs, are defined as traffic crashes in most countries). The current definition of traffic crashes emerged in the early 20th century when motorisation led to increasing numbers of people losing their lives in motor vehicle crashes. As a consequence, traffic crashes were defined and measured as (motor) vehicle crashes. Indeed, Norman (1962) described that in the United States in 1957, deaths following motor vehicle crashes exceeded the combined deaths from all infectious and communicable diseases at all ages. The risk of pedestrian-motor vehicle crashes was particularly high, with pedestrian deaths following motor vehicle crashes in New York City in 1959 amounting to 70% of all officially recorded traffic crash deaths. It is likely that, compared to the number of official traffic crash deaths, the number of deaths following PFs was negligible. Nowadays, PFs no longer appear to be a negligible problem, especially in developed countries with their ageing populations as older people have a high risk of serious PFs. Currently in the Netherlands more elderly people are fatally injured from a pedestrian fall in public space than from pedestrian-vehicle collisions. (Author/publisher)
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