Last week, the 3rd Global Ministerial Conference on Road Safety was held in Stockholm, Sweden (19-20 February 2020). The new proposed target is to reduce road deaths and serious injuries by 50%  in a new decade of SDG action for road safety to 2030, #50by30. To accelerate progress, major funding has been committed to the cause.

The conference also highlighted the looming end of Decade of Action for Road Safety 2011-20. There is a lot to celebrate. The Decade for Action, built a strategic framework and momentum in many countries for road safety, however, gains in terms of reducing road injury deaths is not exactly joyful – it is a plateaued graph. I left the conference wondering what it would take to halve this number ? Can we expect different, momentous gains in reducing road injury deaths, if we do more of the same? Prof AA Hyder, in his recent Lancet commentary laid out seven points introspecting challenges for the ministers, one of those alluded to equity (1).

Equity indeed lies at the heart of road safety much alike any public policy

“Recall the face of the poorest and weakest person you have seen and ask yourself

if this step you contemplate is going to be any use to him.”  MK Gandhi

Inequities in Burden

There are significant social inequalities in road crashes, injuries, and deaths between and within countries. Within countries and cities, motor vehicle injury and death rates vary according to individual and neighbourhood socio-economic status, with greater rates among the least well off.

Some fact checks :  90% of the road deaths are from low- and middle-income countries; 50% of crash victims are vulnerable road users (pedestrians, cyclists, and motorcyclists); road traffic crashes are the leading cause of death for children and youth. The proportion of deaths among vulnerable road users increased from 46 to 54% in the last decade (2). In Europe, pedestrians and bicyclists account for 70% of all road injury deaths. Road injuries are also a leading cause of death among adolescents, and of the total 2.2% of development assistance for health spent on adolescent health, only 0.3% is spent for road injuries (3).

Impact of transportation- road safety inequities

While differential risk, differential exposure and differential treatment is well understood in the domain of public health what is not well recognised is that it is not only “differential” but also “perpetual”. Lower socio-economic status is a major risk factor for road injuries,.but also one-third of those who experience injury are pushed deeper into poverty (4,5).

Transportation influences upper social determinants of health. Several life choices like education, living and work, access barrier to health services are all influenced by transportation (6). As such, transport policies have important health consequences through their effects on injuries, air pollution, climatic change, noise, and their ability to create (or not) safe conditions across gender, age, for differently abled, and mode for transport (7).

Bringing global health discourse to road safety

Almost 90% of road safety research continues to be from high-income countries (8). Yes, some truths are universal( for example, speed kills) but for many its not. What have we learnt about context and complexity in public health? Understanding context is key – for road design, trauma care systems and vehicles design in road safety.

Embedded in inequities of burden and research, is role of “foreign gaze”(9). As in global health, foreign gaze is inevitable.  However we need to unpack this foreign gaze in road safety (10,11). We, global road safety champions and the community as whole need to reflect on what context relevant evidence do we have? What impact does advocating/ implementing interventions without good local evidence mean? How do we fair on the principle of “Do no harm”? Who is benefiting from this research, from power structures to powerless stakeholders?  We need to ask what is being really funded? What is the political economy of transportation and related research, and how is it impacting policies and practice? How do we build transformative and democratic methodologies and practices to break power structures embedded in research? How do we engineer meaningful representation and inclusion of affected groups, beyond advocates?

Embracing sustainable agenda- Leave no one behind

The narrative on safety is expanding, with social and economic impacts, sustainable mobility, innovation and gender being talked about. It is important for the global road safety community to take congizance of the fact that we are accountable partners in the pledge of leaving no one behind.

The message at the conference was loud and clear “Compell to act”. So we need to act- act with concrete, collective and focused actions to ensure that road safety indeed includes every person, everywhere. We need to be disruptive and bring the voice of 13-year-old girl, who bikes to school on a high-speed mixed traffic road, with a lurking fear of gender-based harassment , in 47 degrees, has a mask on, but the poor air quality still makes her susceptible to respiratory diseases. Her challenges on the road are multiple, and so are the challenges for the road safety community.

About the Author:

Jagnoor Jagnoor is a global injury researcher, leading a team at The George Institute for Global Health and she tweets @JJagnoor.

Competing Interests:

I have read and understood BMJ policy on declaration of interests and declare that I no relevant conflicts of interests to declare.

References

1. Hyder AA. Another summit on global road safety? Key questions to ask ministers. The Lancet. 2020;395(10223):477-9.
2. Peden MM, Puvanachandra P. Looking back on 10 years of global road safety. International Health. 2019;11(5):327-30.
3. Li Z, Li M, Patton GC, Lu C. Global Development Assistance for Adolescent Health From 2003 to 2015. JAMA Network Open. 2018;1(4):e181072-e.
4. Sehat M, Naieni KH, Asadi-Lari M, Foroushani AR, Malek-Afzali H. Socioeconomic Status and Incidence of Traffic Accidents in Metropolitan Tehran: A Population-based Study. Int J Prev Med. 2012;3(3):181-90.
5. Silverman A. Rights of Way- Child Poverty and Road Traffic Injury in the SDGs. FIA Foundation UNICEF; 2016.
6. Church A, Frost M, Sullivan K. Transport and social exclusion in London. Transport Policy. 2000;7:195-205.
7. Khreis H, May AD, Nieuwenhuijsen MJ. Health impacts of urban transport policy measures: A guidance note for practice. Journal of Transport & Health. 2017;6:209-27.
8. Independent Council for Road Safety International (ICoRSI) Department of Global Public Health, Karolinska Institutet Campbell Collaboration. Globalising Vision Zero: Generating Scientific Evidence for the Road Ahead. (Unpublished data)
9. Abimbola S. The foreign gaze: authorship in academic global health.BMJ Global Health 2019;4:e002068.
10. Baker S, Thompson A. Are research links with the developing world still a one-way street? : Times Higher Education; 2020 [Available from: https://www.timeshighereducation.com/features/are-research-links-developing-world-still-one-way-street#survey-answer.]
11. Keikelame MJ, Swartz L. Decolonising research methodologies: lessons from a qualitative research project, Cape Town, South Africa. Global health action. 2019;12(1):1561175-.6

Editors Note : The article was updated on 2/03/2020 to add a missing reference.