Confronting “Death on Wheels”Confronting “Death on Wheels”Making Roads Safe in Europe and Making Roads Safe in Europe and

Central Asia Central Asia

ESTABLISHING MULTISECTORAL PARTNERSHIPS TO ADDRESS A SILENT EPIDEMIC

PATRICIO MARQUEZ AND GEORGE BANJO

THE WORLD BANK

MARCH 17, 2010

Outline: Challenges and Opportunities Outline: Challenges and Opportunities in Addressing Road Safety in the ECA in Addressing Road Safety in the ECA Region*, with particular attention to Region*, with particular attention to

PolandPoland1. The problem: trends, size, characteristics, causes

2. Effective measures to improve road safety

3. Current international road safety policy

4. Possible strategies and actions by the World Bank with partners

*Baltic, Balkans, EE, CIS, Turkey.

Road Traffic Injury (RTI) Mortality Rate Road Traffic Injury (RTI) Mortality Rate Trends Trends

Europe, EU-27 and CIS Countries, per 100,000, 1980–2007Europe, EU-27 and CIS Countries, per 100,000, 1980–2007large, increasing disparities large, increasing disparities

CIS countries: Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, the Republic of Moldova, Russia, Tajikistan, Turkmenistan, Ukraine, and Uzbekistan.

EU-27 countries: Austria, Belgium, Bulgaria, Cyprus, the Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, the Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, and the United Kingdom.

Source: WHO EURO Health for All Data Base (2009).

5

10

15

20

25

30

1980 1990 2000 2010

European RegionEU CIS

CIS

European Region

EU-27

RTI Death Rates in WHO-EURO Member Countries, per RTI Death Rates in WHO-EURO Member Countries, per 100,000 Population, 2007100,000 Population, 2007

3.2

3.4

4.8

4.9

5.0

5.2

5.4

5.7

6.0

6.9

7.2

7.5

8.3

8.5

9.3

9.6

9.7

9.8

10.0

10.2

10.4

10.4

10.9

12.0

12.3

12.7

13.0

13.2

13.4

13.4

13.6

13.9

13.9

14.1

14.6

14.7

14.7

14.9

15.1

15.1

15.7

16.8

17.9

18.6

20.4

21.5

22.4

22.8

25.2

30.6

0.0 5 10 15 20 25.0 30.0 35.0

San Marino

Malta

Netherlands

Switzerland

Norway

Sweden

United Kingdom

Israel

Germany

MKD*

Finland

France

Austria

Ireland

Spain

Italy

Uzbekistan

Serbia

Iceland

Belgium

Cyprus

Portugal

Bosnia and Herzegovina

Czech Republic

Hungary

Romania

Azerbaijan

Bulgaria

WHO EURO

Turkey

Croatia

Armenia

Albania

Tajikistan

Slovenia

Poland

Estonia

Greece

Republic of Moldova

Slovakia

Belarus

Georgia

Latvia

Turkmenistan

Montenegro

Ukraine

Lithuania

Kyrgyzstan

Russian Federation

Kazakhstan

Deaths per 100 000 population

High-income countries

Low- and middle-income countries

Source: WHO-EURO, 2009

KazakhstanRussian FederationKyrgyzstanUkraineMontenegroTurkmenistanLatviaGeorgiaBelarusSlovakiaRep. of MoldovaGreeceEstonia PolandSloveniaTajikistanAlbaniaArmeniaCroatiaTurkeyAverage-WHO-EUROBulgariaAzerbaijanRomaniaHungaryCzech RepublicBosnia & HerzegovinaPortugalCyprus

BelgiumIcelandSerbiaUzbekistanItalySpain IrelandAustriaFranceFinlandFmr Yugoslav Rep. of MacedoniaGermanyIsraelUKSwedenNorwaySwitzerlandNetherlandsMaltaSan Marino 302

5

Higher GDP does not Higher GDP does not guarantee lower mortalityguarantee lower mortality

Trends in progress towards Trends in progress towards road fatality targets in road fatality targets in Poland Poland (source IRTDA 2009)(source IRTDA 2009)

The situation in PolandThe situation in Poland Although road safety in Poland has improved over the

last decade, Poland still lags behind other European Union countries.

Poland’s progress towards the achievement of the EU and the national (GAMBIT Program) road fatality reduction targets by 2010 and 2013, respectively, shows a substantial gap between the projected progress and actual outcomes.

To achieve these targets, Poland needs to reduce road fatalities by 50 percent from the current level.

In 2008, 5,437 people died and 62,097 were injured in 49,054 road accidents in Poland. If Polish roads were made as safe as the average EU country, over 2000 lives could be saved each year compared to the level achieved in 2008.

Deaths, disability and damage – Deaths, disability and damage – who bears the bruntwho bears the brunt??

4-wheel vehicle occupants: 40-75% of RTI deaths in ECAYoung adults, especially men:

55% of road traffic deaths in ECA countries are people aged 15–44, mostly 15–29; > 80% of deaths are men

Cyclists, motorcyclists at high risk (but small % of total)

Motorcyclists, pedestrians at 7-9 times greater risk of death if in an road crash than people in vehicles

Pedestrians – more likely to be children or elderly, and people with lower incomesIn Albania, Belarus, Kyrgyzstan, Tajikistan, and Ukraine,

pedestrians are ≥ 40% of all road fatalities, 31-38% in all ECA

Deaths, disability and damage – Deaths, disability and damage – extentextent

80,000 road traffic deaths, 820,000 injuries in ECA in 2007(Data underestimate and underreport – especially non-fatal injuries, and differ in

availability, quality, and completeness)

Economic Impact: 1-2% of GDP (health care & rehabilitation costs, insurance, legal, lost productivity, property damage)Globally, costs to governments > US$500 billion annually Highest costs in ECA: large economies with big populations:

Air pollution, noise

Greenhouse gas emissions contribute to global warming

Fear deters walking, biking. Less mobility and physical activity reduces health, increases risks for cardiovascular diseases, strokes, diabetes, obesity

Russia (US$34 billion per year, 33,308 deaths in 2007) Turkey (US$14 billion)Poland (US$10 billion) Ukraine (US$5 billion)

Russia (US$34 billion per year, 33,308 deaths in 2007) Turkey (US$14 billion)Poland (US$10 billion) Ukraine (US$5 billion)

Road Traffic Injury Road Traffic Injury CausesCauses

Lack of data /problem awareness Inadequate response, resources

Roads Bad road design (no crossings, walkways, poor visibility) Roadside hazards (trees, poles, signs) Mixing traffic and pedestrians

Vehicles Unsafe vehicles, without airbags & other crash protection devices Huge increase in vehicle numbers (poor public transport)

Behaviors Inadequate laws/rules + poor enforcement Bad driving (speeding, recklessness, alcohol, some medications) Not using seatbelts, helmets (cyclists, motorbikes) Mobile phone texting

“Are you in a hurry to reach us?"

WHAT TO DO?WHAT TO DO?

INTERVENTIONS ALONE WILL NOT SUFFICE

Current Road Safety Policy – Current Road Safety Policy –

Holistic “Safe Systems” Holistic “Safe Systems” approachapproachPrinciples: • Cannot prevent all road crashes,

can reduce traffic injuries• Design road traffic systems to

take account of human error and vulnerability of human body

• Responsibility and accountability for road safety shared by road and car designers and road users

Effective ApproachesEffective Approaches

Action Areas: Prevent road traffic crashes and injury Minimize injuries when crashes occur Recovery: reduce injury severity afterwards

The Haddon Matrix: a holistic framework for intervention focusing on road transport and its risks

Car crashes divided into 3 phases: before, during and after to highlight when crashes can be prevented or their effects minimized

Haddon`s Matrix

Adopting a Road Safety Management Adopting a Road Safety Management SystemSystem

Source: Bliss and Breen, building on the frameworks of Land Transport Safety Authority, 2000; Wegman, 2001; Koornstra et al, 2002; Bliss, 2004

Institutional management Institutional management functionsfunctions

Delivered by government entities, in partnership with civil society and business entities to achieve RESULTS

RESULT FOCUSRESULT FOCUSA foremost and pivotal institutional

management function

It is a programmatic specification of targets and means to achieve them with accountability

Provides cohesion and direction, strategic orientation linking interventions with results, analyzes what could be achieved over time

Sets a performance management framework for delivery of interventions and their intermediate and final outcomes

FUNCTIONS (i)FUNCTIONS (i)Coordination: horizontally and

vertically, partnerships

Legislation: the legal instruments for governance; defines responsibilities, accountabilities, interventions, and related institutional management functions

FUNCTIONS (ii)FUNCTIONS (ii)

Funding and resource allocation: how to finance interventions and related management functions on a sustainable basis

Different mechanisms adopted in various countries

Financing SourcesFinancing Sources

Source: Adapted from OECD (2002) and Aeron-Thomas and others (2002), cited in Peden and others (2004); ECORYS (2006).

Traditional funding sources:

•General tax revenues

•Road funds (fuel taxes, vehicle registration and licensing fees, and heavy vehicle road use charges)

•Road user fees (driver’s and car license fees, vehicle inspection fees)

•Vehicle insurance premium levies

•Earmarked charges (eg revenue from traffic fines used to finance road safety activities)

Alternative financing sources:

•Price/tax policy (fiscal incentives for private and business investments in safety measures such as retrofitting older vehicles with safety belts)

•Insurance premiums (higher premiums for less safe vehicles, and drivers with poor safety records; pay-as-you-drive or pay-as-you-speed mechanisms, spread costs of risks for injury-causing crashes more fairly; assign total cost of car crashes to the person who caused it)

•Financial options (make unsafe behavior more expensive and give financial reward for safe behavior)

FUNCTIONS (iii)FUNCTIONS (iii)Promotion: sustained communication

of road safety as core business for government and society to support interventions

Monitoring and evaluation: the systematic and ongoing measurement of outputs and outcomes, and impact evaluation—did results were achieved? Need for registries for vehicles and drivers, crash databases, and survey work

FUNCTIONS (iv)FUNCTIONS (iv)Research and Development and

Knowledge Transfer: the systematic and ongoing creation, codification, transfer and application of knowledge that contributes to improved efficiency and effectiveness of road management system.

Knowledge transfer must be evidence-based and grounded in practice by a learning by doing process.

Classification of InterventionsClassification of Interventions

Intervention types Standards and rules Compliance

Planning, design, operation and use of the road network

Standards and rules cover the safe planning, design, construction, operation and maintenance of the road network; and govern how it is to be used safely by setting speed and alcohol limits, occupant restraint and helmet requirements, and restrictions on other unsafe behaviors.

Compliance aims to make road builders and operators, the vehicle and transport industry, road users and emergency medical and rehabilitation services adhere to safety standards and rules, using a combination of education, enforcement and incentives.

Conditions of entry and exit of vehicles and road users to the road network

Standards and rules also address vehicle safety standards and driver licensing requirements

Recovery and rehabilitation of crash victims from the road network

Standards and rules can also be set for the delivery of emergency medical and rehabilitation services to crash victimSource: Bliss, 2004

Effective proven Effective proven measuresmeasures

Better road design Remove roadside hazards (trees, poles) Install crash barriers Clear, helpful, safely placed road signs Central islands, “pedestrian refuge” Well-designed pedestrian crossings Separate vehicles from pedestrians and cyclists Audible road edge-lining, seal shoulders, construct

passing lanes Better road markings Traffic calming (speed bumps, cameras)

Effective proven measures (2)Effective proven measures (2)

Improve vehicle safety In-vehicle crash protection (airbags, seatbelts, child car

seats) Vehicle licensing and inspection to enforce roadworthy

standards Daytime running lights Require and enforce helmet use with bicycles,

motorbikes

Effective proven measures (3)Effective proven measures (3)

Behavior change - education, law/regulation enforcement

Lower speed limits: 30 km/hr in residential areas, 50 km/hr in other urban areas

Enforcing blood alcohol level limit of ≤0.05g/dl could prevent 5-40% of RTI deaths (random breath testing better than set checkpoints, taxes and marketing, sales regulations are effective)

Mandatory, enforced seat belt use Prevention of distracting driving due to use of phones

and texting Media coverage, education campaigns + tough sanctions Graduated driving licenses (curfew, passenger restrictions) and

more training during learner period reduce deaths among young drivers (US)

Better public transport and land use reduces car travel

Health Sector ResponseHealth Sector Response Public health actions: collect and analyze data,

research causes of RTI, advocate effective action, define and implement protective policies and practices and preventive interventions

Primary health care providers: medical assessments of elderly/impaired drivers, advice on alcohol use and effects on driving of medications

Emergency medical services: communication for rapid response, initial emergency care and stabilization, transport to health facility, well-trained teams with medicines and equipment, quality assurance

Safe blood supply &transfusion Rehabilitation services

Cost-effectiveness – depends on risk Cost-effectiveness – depends on risk factors, and distribution of factors, and distribution of fatalities/injuries by road user group fatalities/injuries by road user group

$- $10,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000

Enforcement of speed limits (via fixed/mobile cameras)

Drink-drive legislation & enforcement (breath-testing)

Legislation & primary enforcement of seat belt use

Legislation & enforcement of helmet use by motorcyclists

Legislation & enforcement of helmet use by bicyclists

Speed cameras + breath-testing

Seatbelts + motorcycle helmets

Speed cameras + breath-testing + seatbelts

Speed cameras + breath-testing + motorcycle helmets

Seatbelts + motorcycle helmets + breath-testing

Seatbelts + motorcycle helmets + speed cameras

Seatbelts + motorcycle helmets + speed cameras + breath-testing

Seatbelts + motorcycle helmets + speed cameras + breath-testing + bicycle helmets

Average cost per DALY saved

EurB

EurC

Average cost per disability-adjusted life (DALY) year saved, adjusted for purchasing power parity

Safety TargetSafety TargetFinal outcomes Final outcomes can be expressed as a

long term vision of the future safety of the road traffic system (e.g., as in Vision Zero and Sustainable Safety) and as more short to medium-term targets expressed in terms of social costs, fatalities and serious injuries presented in absolute terms and also in terms of rates per capita, vehicle and volume of travel

Intermediate outcomes Intermediate outcomes are linked to improvements in final outcomes and typical measures include average traffic speeds, the proportion of drunk drivers in fatal and serious injury crashes, seatbelt-wearing rates, helmet-wearing rates, the physical condition or safety rating of the road network and the standard or safety rating of the vehicle fleet.

Outputs Outputs represent physical deliverables that seek improvements in intermediate and final outcomes and typical measures include kilometers of engineering safety improvements, the number of police enforcement operations required to reduce average traffic speeds and the number of vehicle safety inspections, or alternatively they can correspond to milestone showing a specific task has been completed.

Source: Bliss, 2004

ECA Efforts to Prevent Road Transport ECA Efforts to Prevent Road Transport Injuries Injuries

Good Examples: Poland: public education on road safety, seat-belt use, drunk driving; training for

professional drivers; road signs warning of black spots; improved pre-hospital care

Armenia: dramatic improvements in seatbelt use by enforcing seatbelt lawRussia: fines for not using a seatbelt increased 10x, new law against crossing

into an oncoming lane punishable by revoking driver’s license, anti-alcohol campaigns launched

much more is possible

Of 29 countries in ECA: •27 have a lead agency for road safety•19 allocate funds in the national budget•19 have a strategy with clear targets, 16 of these are funded•25 set blood alcohol limits at/below recommended level (0.05g/dl)•27 do spot checks for alcohol levels•many require formal audits for major new road construction projects and regular audits of existing roads, •many promote public transportation, walking, and cycling

But•Only 8 countries have seatbelt used at least 70% (in front seats)•Urban speed limits are 60km/h in 15 countries, 70 km/h in 1 (higher than recommended)•Quality of formal, publicly available pre-hospital post-crash care systems varies•Enforcement is often lacking

World Bank Support (to date)World Bank Support (to date)

Practical guidelines to help countries implement these recommendations

Global Road Safety Facility generates funding and Technical Assistance for country road safety efforts

Road safety management capacity reviews done in many ECA countries

World Bank-supported road safety investments in transport and health projects

Information and policy dialogue

What more could the World Bank do in What more could the World Bank do in ECA?ECA?

2004 World Report identifies 6 key steps for success:

1.Identify a lead agency in government2.Assess road traffic injury problems, policies and institutions, and capacity for prevention

3.Prepare a national road safety strategy and plan of action4.Allocate financial and human resources 5.Implement specific actions and evaluate their impact 6.Support national capacity and international cooperation.

Principles: systematic, sustained, successful effort has 3 parts:

Institutional management

interventions Results

What more could the World Bank do in What more could the World Bank do in ECA? (1)ECA? (1)

1. Build institutional management capacity Provide training and information for policy makers,

practitioners Support existing networks of people responsible for road

safety Help countries improve data on RTIs and causes Specify lead agency reforms needed

2. Help countries choose interventions well Review national road safety management capacity - assess

the situation, propose strategies and actions with realistic targets and budgets

3. Support a safe system approach + results focus aiming to end road deaths and serious injuries (see next slide for specifics)

What more could the World Bank do in What more could the World Bank do in ECA? (2)ECA? (2)

3. Support a safe system approach + results focus aiming to end road deaths and serious injuries:

4. Analyze planned road investments for safety, improve design5. Review road sections where many crashes occur to target

investments6. Lower urban speed limits to 50 km/h; 30 km/h in residential

areas; enforce – speed cameras are cost effective7. Enforce alcohol limits with systematic police enforcement

(breath tests, high-visibility random road checks), high-profile media campaigns, and swift severe penalties

8. Enforce use of seat belts – campaigns, penalties, car restraint specifications

9. Reduce young driver risk – graduated licensing scheme, extended training

10.Reduce pedestrian risk – barriers, traffic “calming”, more pedestrian facilities

11.Improve speed and quality of emergency care (at crash site and after) – evaluate, identify and fix weak areas, train

12.Include road safety as a key “performance attribute” of transport

13.Demonstration projects, with strong evaluation

Focus areas for World Bank support Focus areas for World Bank support that is evidence-based, cost-effective, and follows international best that is evidence-based, cost-effective, and follows international best practice: practice:

A. Capacity reviews – to ensure country commitment, customization, consensus

B. Ensure lead agency has capacity, mandate, and funding to manage for results

C. Invest in management capacity to deliver results in stages

D. Learn by doing demonstration projects that rapidly achieve safety improvements in high-risk areas, then build on success

Key Partners:

A. International Road Assessment Program (iRAP) - engineering safety

B. RoadPOL - traffic police peer-to-peer services

C. International Road Traffic Accident Database Group - data

D. World Health Organization (WHO) - technical support in traffic injury prevention, injury surveillance, emergency trauma services & care

E. Ministries: transport, health, law enforcement, finance, interior, education

F. Private sector: insurance, auto makers, media, regulatory agencies

G. CSOs: consumer organizations, faith-based organizations

H. Parliaments

World Bank support in World Bank support in PolandPolandPoland Third Road Maintenance

and Rehabilitation Project: it builds on the success of two previous road project safety components under the National Road Safety Council (NRSC).

Project supports road safety campaigns on alcohol and drunk driving, speeding, and child and pedestrian safety.

Finances technical assistance to the NRSC Secretariat.

Contributes to the program of road safety initiatives co-financed by the European Commission and the European Investment Bank.

Effective Road Safety Program Building Effective Road Safety Program Building BlocksBlocks

Intervention Area Investments and actions1. Institutional capacity building

Establish, organize and strengthen management and operational capacity of a lead agency for road safety, resource it adequately, make it publicly accountable.Training programs for all official involved in management and design of road safety programs and implementation of road safety programs.

2. National road safety policies, strategies, plans; organizational & co-ordination arrangements

Technical assistance for developing/updating legislative framework, policies, strategies and plans with targets to halve RTI fatality rates by 2020.

3. Create safer road environments

Investments to improve safety in demonstration road corridors and beyond (e.g. guard rails, signaling and marking, reengineering most critical crossroads in urban areas). Technical assistance to do network safety rating surveys and road safety audits and inspections.

4. Enforcement: equip and train traffic police to deter risky behavior

Acquire radar equipment, speed cameras, and breath analyzers, to enable roadside checks to control and monitor speed, alcohol, and seatbelt use.

5. Public information and education campaigns

Technical assistance and funding to develop public IEC programs to support enforcement of laws and regulations for speed-control, seatbelt use, and deterring drinking and driving.

6. Improve health promotion and prevention programs, emergency medical services, and rehabilitation services

As part of health system reforms and modernization, technical assistance to strengthen public health programs, national and regional road safety strategies, and organizational arrangements for first aid emergency responses; funding for ambulances, medical equipment and other inputs; training of medical personnel on basic and advanced life support systems; communication systems investments; and technical assistance and investments to develop/strengthen trauma centers, safe blood transfusion services, and rehabilitation programs.

7. Monitoring and evaluation

Investments in computerized information systems for data collection, assessment and sharing information for decision-making and program management across sectors.

What else needs to be done What else needs to be done in Poland?in Poland? Results Focus: improving institutional management functions

for road safety in Poland would require: (i) strengthening institutions and governance capacity for RTI prevention, including the Ministry of Infrastructure (MOI) that has legal responsibility on behalf of the government for road safety and the National Road Safety Council (NRSC) which is in practice the lead agency.

Coordination: improving coordination among participating agencies and with regional governments, private sector, non-governmental agencies.

Legislation: improving the main legislative road safety requirements so that they further align to European norms

Funding: securing sustainable funding as road safety in Poland is reliant on international donor assistance

Monitoring and Evaluation: Improving nationwide traffic injury surveillance systems and supporting national road safety reviews are a sound basis for formulating policies and plans, particularly at the regional level;

Emergency Medical Services: improving the delivery of emergency medical services by adopting new organizational and governance models for operating post-vehicle crash and trauma care services at health facilities

Safe, clean, affordable transport is a development priority.

Preventing road traffic injuries is a major public health priority.

Proven, effective, cost-effective “good practices” can save lives and money, prevent disability, improve other health outcomes and the environment.

A “safe system” needs well-coordinated, cooperative action by transport, health and policing/enforcement sectors. Interventions alone will not suffice.

The World Bank could do more, with partners, to help countries in Eastern Europe and Central Asia make roads safer. Specific areas for action are clear.

Thank you!

Take Away Messages:Take Away Messages: