Road traffic injuries & fatalities in India – a modern epidemic
The United Nations General Assembly adopted a resolution on road safety on October 26, 2005 which invites Member States to implement the recommendations of the World Report on Road Traffic Injury Prevention; to participate in the first United Nations Global Road Safety Week; and to recognize the third Sunday in November of every year as the World Day of Remembrance for Road Traffic Victims’. This resolution follows the publication of The World Report on Road Traffic Injury Prevention by the World Health Organization in 20042. This report highlights the fact that all over the world working age people are more likely to suffer hospitalization, permanent disability and death due to road traffic injuries than most other diseases. The situation in India is not very different.
About 82,000 persons were killed on Indian roads in 2002(3). Official statistics regarding serious injuries are not reliable as they underestimate the actual number4; but it is estimated that the number of people hospitalized may be 15-20 times the number killed5. In a do-nothing scenario, it is possible that India will have 1,20,000 – 1,30,000 road traffic fatalities in the year 2008 and possibly 1,50,000 – 1,75.000 in 2015. Our vision should aim at reducing the fatalities to less than 1,00,000 in the short term (2008) and less than 70,000 in the long term (2015).
Over the past three decades most of the high income countries have been somewhat successful in reducing the carnage on the their roads and it is worth learning a lesson from their experience. Among the rich countries, the United States of America has about the worst record with 145 deaths per million population and the lowest record of 49-58 fatalities per million population belongs to The Netherlands. Sweden, United Kingdom, Norway and Japan. It is remarkable that with similar knowledge and technologies citizens of the USA are three times more likely to die of a car crash than citizens of UK and Japan. Therefore, it is important that we look more closely at the experience and polices of The Netherlands, Sweden, United Kingdom, Norway and Japan rather than the USA.
Every single country that has been successful in controlling road traffic fatalities established a national agency for collecting and analysing data, making safety policies and promoting research. India has no such agency as yet and there are no formally trained safety professionals in any of our road building and policy making agencies. A statutory national road safety agency needs to be established that is independent of the road building agency and the police data collection systems need to be modified so that essential base line data become available to policy makers and researchers for meaningful analysis. Traffic injury surveillance systems also need to be established at selected hospitals and medical colleges around the country according to international guidelines suggested by the WHO6,7. Along with these developments three or four research institutions should be selected in different regions of India for the establishment of multidisciplinary crash investigation teams and personnel trained for the same.
Safety measures for the near future
Pedestrian and bicyclist safety. (i) Free left turns must be banned at all signalised junctions. This will give a safe time for pedestrians and bicyclists to cross the road; (ii) speed control in urban areas. Maximum speed limits of 50 km/h on arterial roads need to be enforced by police monitoring, and 30 km/h in residential areas and by judicious use of speed breakers, dead end streets and mini roundabouts. In the short term of three years, a target of covering 10 per cent of the roads can be attempted; and (iii) increasing the conspicuity of bicycles by fixing of reflectors on all sides and wheels and painting them in yellow, white or orange colours. Initially voluntary drives and encouragement, and later mandating the same can achieve this on a national scale.
Motorcyclist safety: (i) Notification of mandatory helmet laws by every State. The Motor Vehicles Act of India8 specifies that all motorised two-wheeler riders must wear a helmet in the country. However, since transportation is a State subject, most States are not enforcing this regulation. Helmets are available, as the manufacturing capability already exists in the country; and (ii) mandatory daytime headlights use by two-wheeler riders. When two-wheeler riders keep their headlights on in the daytime, crashes are known to reduce by 10-20 per cent2. Malaysia and Singapore have already adopted this law and showed success.
Motor vehicle occupants: (i) Enforcement of seatbelt use laws countrywide; (ii) restricting travel in front seat of cars by children has the potential of reducing injuries dramatically; and (iii) bus and truck occupant injuries, fatalities, and injuries caused to other road users can be reduced significantly by enforcing strict observance of speed limit regulations on highways. Ensuring that bus timetables and truck movement schedules make it possible for drivers to observe speed limits with ease. Random speed checking on highways would help ensure such measures.
Road measures – initiation of good practices: (i) Traffic calming in urban areas and on rural highways passing through towns and villages. These measures use road design features to prevent vehicle users from speeding; (U) improvement of existing traffic circles by bringing them in accordance with modern roundabout practices and substituting existing signalised junctions with roundabouts; (Hi) provision of segregated bicycle lanes and disabled friendly pedestrian paths; and (iv) mandatory road safety audit for all road building and improvement projects.
Pre-hospital care, treatment and rehabilitation: (i) Modern knowledge regarding pre-hospital care to be made available widely: and (H) training of specialists in trauma care.
Road safety strategies – Long term
Traffic calming and speed control: (i) Aim at implementing speed control and traffic calming measures in all urban areas and at appropriate locations on rural highways by altering road design, vehicle monitoring through intelligent transport systems, and vehicle design by the year 2015. This measure is likely to give us the maximum savings in terms of lives and serious injuries; and (iii) segregated lanes for vulnerable road users and buses in urban areas. Non-motorized transport and buses must be provided segregated lanes on all major arterial roads in urban areas. India specific designs need to be developed and phase wise implementation plans drawn up for all cities.
Safer design of 4/6 lane highways: (i) Provision of service lanes on high speed highways for slow and non-motorized traffic; and (ii) provision of at surface tunnels at frequent intervals for local traffic.
Vehicle safety: (i) All vehicles sold in India should meet international crashworthiness standards by 2010; (ii) all buses and trucks should meet pedestrian impact standards by 2010; (iii) all urban buses to have low floors and automatic closing doors; (iv) crashworthiness standards must be developed for all indigenous vehicles by 2010 and implemented by 2012; (v) installation of Intelligent Transport Systems (ITS) and other modern safety devices for assisting and controlling drivers; and (vi) driving under the influence of alcohol and other drugs. A long term strategy to reduce drinking and driving incidence to less than 10 per cent of all crashes needs to be drawn up for the next 10 yr. Sensitization of the public to the extent of the problem. Institution of random roadblocks and checking on urban roads and rural highways. Ignition interlock on cars.
Road user based strategies: (i) Helmet use by all bicyclists; (ii) graduated driver licensing schemes to be introduced on a trial basis by 2008 and implemented country wide by 2010; and (iii) schools to identify and arrange safe routes for children walking and bicycling to school.
Pre-hospital care, treatment and rehabilitation: (i) Trauma care specialists to be trained and employed in all general and specialty hospitals; and (ii) specialized rehabilitation centres to be set up in all regions of the country.
If all the short term and long term measures are implemented then we have a possibility of reducing the traffic injury mortality to 60,000 – 70,000 persons by the year 2015. This is a conservative estimate. If there are new unforeseen developments and inventions helping road safety, we can be luckier.
1. www.who.int/violence_injury_prevention/publications/ road_traffic/en/, accessed on December 14, 2005.
2. Peden M, Scurfield R, Sleet D, Mohan D, Hyder AA, Jarawan E, et al. World report on road traffic injury prevention. Geneva: World Health Organization; 2004.
3. Accidental deaths and suicides in India 2002. New Delhi, National Crime Records Bureau, Ministry of Home Afffairs; 2004 p. 1-288.
4. Gururaj G, Thomas AA, Reddi MN. Under reporting of road traffic injuries in Bangalore: Implications for road safety policies and programmes. In: Proceedings of the 5th World conference on injury prevention and control. Delhi: Macmillan India Ltd.; 2000 p. 54-5.
5. Mohan D. The road ahead: Traffic injuries and fatalities in India. New Delhi: Transportation Research and Injury Prevention Programme, Indian Institute of Technology; 2004 p. 1-30.
6. Holder Y, Peden M, Krug E, Lund J, Gururaj G, Kobusingye O, editors. Injury surveillance guidelines. Geneva : World Health Organization; 2001.
7. Sethi D, Habibula S, McGee K, Peden M, Bennett S, Hyder AA, Klevens J, Odero W, Suriyawongpaisal P, editors. Guidelines for conducting community surveys on injuries and violence. Geneva : World Health Organization; 2004.
8. Government of India, Ministry of Road Transport and Highways. Motor Vehicles Act, 1988. 59 of 1988, New Delhi; 1988.
Transportation Research & Injury
Indian Institute of Technology
New Delhi 110016, India
Copyright Indian Council of Medical Research Jan 2006
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