An important if often overlooked part of public health is injury prevention. Some 1,000 safety experts from around the world met in Merida, Mexico, recently to discuss ways of preventing injuries from falls, burns, drowning, homicide, and domestic violence. And as Philip Graitcer reports, one area that received a lot of attention was road traffic safety, and in particular its impact in developing countries.
Worldwide, road traffic crashes kill about 1.2 million people a year. "Road traffic crashes are among the leading causes of deaths in the world. They also contribute to a huge amount of injuries that don't kill but cause an enormous amount of disability and suffering," says Dr. Etienne Krug, who heads the World Health Organization's injury prevention program.
Krug says most of these injuries, nearly 90 percent, occur in low- and middle-income countries. "Everyday around the world we see new roads being built, new cars, new drivers taking the road. This is all a good thing, to a certain extent, but unfortunately these developments are not being matched with safety measures."
And according to the coordinator of India's Transportation Research Program, Prof. Dinesh Mohan, this isn't likely to change. "The situation is getting worse largely because of the way we want to develop into motorized societies. We are following the model of living and eating and sleeping where you separate living places and not encourage walking and bicycling by most people."
Mohan says that the impact of road traffic crashes in low-income countries is particularly devastating. "It's a real, real tragedy because when a family member gets hurt, they really get destroyed. At times they lose their jobs, family money, sometimes have to sell their homes to get treated."
But simple measures used in high-income countries can reduce traffic injuries in poorer countries, and the World Health Organization is trying to promote them, says Etienne Krug.
"We try to promote helmet-wearing for motorcyclists, seatbelt-wearing, combating drinking and driving and excessive speeds, which are interventions that have been implemented in many high-income countries, but in many low- and middle-income countries are not taking place yet."
Two countries – Vietnam and Mexico – were singled out to receive special technical and financial support from the World Health Organization.
"So in Vietnam," Krug notes, "we started working very actively with local partners on improving helmet-wearing for motorcyclists, and we've seen a dramatic change in the last few months where helmet-wearing has increased from about 10-15 percent to almost 100 percent."
In Mexico, increasing urbanization and the fast-growing economy have contributed to increased numbers of road traffic injuries and deaths. Dr. Arturo Cervantes heads Mexico's injury program.
"The first cause of death in children aged 5 to 15 years of age is road traffic injuries. The first cause of death in youth from 15 to 30 years of age is road traffic injuries."
These numbers have grown so rapidly that the President of Mexico, Felipe Calderon, has made traffic safety a national priority and wants to reduce traffic deaths by 40 percent in the next five years.
Mexico has started a campaign to make its roads safer and to reduce traffic deaths and injuries. A national safety committee with health, police, private companies, and the media has established priorities. Cervantes says laws are inconsistent from state to state and sometimes traffic laws aren't enforced at all.
"We have to work closely with authorities at the municipal and state levels so that where there are laws, we follow them," said Cervantes.
Mexico has started road safety projects in five states. Each state will try its own approach to enforce laws, increase helmet use, and control speeding and drunk driving.
The WHO's Etienne Krug hopes that other countries will start similar projects and that governmental and non-governmental international development agencies will invest in traffic safety. "It's important to realize that road traffic crashes kill as many people as malaria, for instance, another important public health problem but for which investments are much, much bigger compared to what's being invested for road safety."
And with the total economic costs of traffic injuries now higher than governments receive in development assistance, traffic safety programs may be a timely investment.