BRICS: opportunities to improve road safety
Adnan A Hyder a & Andres I Vecino-Ortiz a
a. International Injury Research Unit, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street (E-8132), Baltimore, MD 21205, United States of America.
Correspondence to Adnan A Hyder (email: email@example.com).
(Submitted: 02 November 2013 – Revised version received: 19 February 2014 – Accepted: 10 March 2014.)
Bulletin of the World Health Organization 2014;92:423-428. doi: http://dx.doi.org/10.2471/BLT.13.132613
In recent years, five major emerging economies – Brazil, the Russian Federation, India, China and South Africa, which are known collectively as BRICS – have experienced not only considerable growth in their macroeconomic indicators but also substantial social and political changes. These rapid developments have modified the distributions of many health risk factors and, consequently, the burdens of many diseases and injuries.1–3 For example, rapid urbanization, technological change and economic growth have led to substantial increases in vehicle densities and in the complexity of the traffic mix.4,5 As infrastructural development and levels of law enforcement have struggled to keep pace with the increasing traffic densities, it is not surprising that the incidences of fatal and non-fatal road traffic injuries have increased substantially in BRICS in recent years.6 These countries now need a comprehensive and cost-effective approach to road safety that addresses the recent changes in the risks of such injuries, at least in the short to medium term.
In terms of its road traffic injuries, the world could be facing a change similar to what economists have designated as the “Kuznets curve” – a phenomenon whereby middle-income countries, especially rapidly growing economies, face higher levels of mortality than low- or high-income countries.7,8 BRICS already account for approximately 20% of the world’s deaths from road traffic injuries and the associated economic losses –estimated at 1 to 3% of gross domestic products – are likely to increase unless investments to improve road safety are made.1,2
Any attempt by BRICS to address the increasing incidence of road traffic injury is likely to be hampered by budget and institutional constraints and by a paucity of accurate data on – and up-to-date monitoring of – the factors that determine road safety. In most middle-income countries, such factors are rarely investigated in systematic and rigorous observational studies designed to minimize the effects of reporting bias.9 At the national level, data on road safety and road traffic injuries are often collected inconsistently and are seldom reported by independent agencies.1,2 In this paper, we hope to contribute to the global health dialogue on BRICS by reviewing the relationship between economic growth and road traffic injuries, presenting evidence on the current status of road traffic injuries, and recommending improvement of road safety monitoring and evaluation.
Economic growth and motorization
Sustained economic growth is a leading factor in the increasing motorization in BRICS, mainly through two mechanisms: increasing per capita income and increasing urbanization. Dargay et al. predicted that by 2030, the number of working motor vehicles in the world will have grown – from the 800 million in existence in 2002 – to more than two billion, with China then possessing 20% of all the vehicles in the world.10
Per capita income appears to be the most important determinant of the ownership of a commercial or personal vehicle (Table 1).11–13 However, urbanization – at least in its early stages, when there is increasing suburban sprawl but little public transport – is also a very strong determinant of the growth of a country’s vehicle fleet.11
Table 1. Gross national product per capita in 2010 and change in the number of vehicles per capita between 2007 and 2010, in 15 selected countries
In areas with sustained economic growth, the growth of the vehicle fleet generally outpaces the growth of the institutions and resources needed to maintain road safety.11 This is a particular problem in booming developing economies, where there is limited institutional capacity to generate smart and effective traffic regulations and the resources needed to provide a safe infrastructure for the incoming flow of new vehicles and to adjust both urban and suburban space to match the higher demand for motorization.11,13,14
Another factor that contributes to the complexity of the effect of economic growth on motorization is the heterogeneity in economic growth across urban and rural areas. At the national level, road networks and the demand for motorization generally expand at the same rate as the mean per capita income.11 However, on a smaller scale, within urban areas, road networks often expand at lower rates than per capita income, while car ownership expands at higher rates than such income.11
Increased motorization is one of many challenges faced by BRICS as each country’s national income and urban population grows. It appears to be an inevitable short-term consequence of economic success. Between the start of 2009 and the end of 2010, Brazil’s and China’s vehicle fleets are estimated to have grown by 8% and 36%, respectively.15 By the end of 2010, Brazil held half of all the vehicles in continental Latin America excluding Mexico; China had 36 million vehicles on its roads, and the Russian Federation had 34 million.15 At the same time, India had only 13 million vehicles – although this represented a 10% increase since 2006 – and South Africa held 30% of all the vehicles, but only 5% of the people, in Africa.15,16
Risk factors for road traffic injuries
Important risk factors for road traffic injuries include failure to use seatbelts and child restraints in cars, speeding, failure to wear a helmet while travelling on a motorcycle, and driving while under the influence of alcohol. These so-called “five key risk factors” are the main focus of the global Decade of Action on Road Safety, which will end in 2020.1,2 In the United States of America, failure to use a seat-belt, driving while under the influence of alcohol and all of the five key risk factors combined accounted, respectively, for 40%, 43% and 61% of the person–years lost by vehicle occupants because of road traffic injuries between 1982 and 2001.17 The corresponding proportions in BRICS may be even higher because law enforcement in BRICS generally appears to be more lax than in the United States.
Investigation of the reported prevalences of the main risk factors for road traffic injuries in BRICS (Table 2) reveals two clear issues. First, a person living in one of the BRICS countries is at a relatively high risk of having a fatal road traffic injury because of one or more – often avoidable – risk factors.18 Second, there is a paucity of nationally representative and systematically collected data on the risk factors for road traffic injuries in BRICS.19 This gap in knowledge needs to be filled quickly.20,21
Table 2. Prevalence of key risk factors for road traffic injuries, Brazil, the Russian Federation, India, China and South Africa (BRICS), 2009
In BRICS, little improvement has been noted recently in the levels at which either existing road-safety rules are enforced or interventions for the improvement of road safety have been implemented.1 When the World Health Organization scored levels of law enforcement for speeding on a scale of 1–10 – with 10 representing the highest level – Brazil and the Russian Federation scored 6, China scored 4 and India and South Africa only scored 3.1 There is clearly room for improvement in the enforcement of traffic laws throughout BRICS. The often low levels of such enforcement indicate that many of people who live in BRICS are not recorded when they do break traffic laws and thus increase their risks of a road traffic injury.
Health outcomes and road traffic injuries
At the current stage of development, the BRICS countries are experiencing accelerated economic growth – leading to higher volumes of traffic – but have not had the time to build the institutional capacity to cope with such growth or to invest adequately in the systems needed to maintain or increase road safety. As a result, a recent and substantial increase in the numbers of both injuries and deaths from road traffic accidents has occurred. In general, the four middle-income countries among BRICS have higher traffic-related mortality (Fig. 1) and non-fatal injury (Fig. 2) rates than some low- and high-income countries.
Fig. 1. Fatal road traffic injuries and gross national product, 15 selected countries, 2009
Fig. 2. Non-fatal road traffic injuries and gross national product, 15 selected countries, 2009
Table 3 shows the numbers of fatal and non-fatal road traffic injuries reported in 2009 and 2013 in each of the five countries. Only the Russian Federation showed a reduction in fatal road traffic injuries between 2009 and 2013 (Table 3) and a reduction in disability-adjusted life years lost from road traffic injuries between 1990 and 2010 (Table 4). Given that many non-fatal road traffic injuries go unreported, the numbers of such injuries that were reported in BRICS in 2009 are high. In general, road traffic injuries are now a much more severe problem in Brazil, China, India and South Africa than they were in 1990 (Table 4). The situation in the Russian Federation seems more encouraging and merits further exploration.
Table 3. Key demographics and numbers of road traffic injuries, Brazil, the Russian federation, India, China and South Africa (BRICS), 2009 and 2013
Table 4. Global burden of disease attributable to road traffic injuries, Brazil, the Russian Federation, India, China and South Africa (BRICS), 2010
In this paper, we present data revealing the need for BRICS to reduce the burden posed by road traffic injuries – much of which can be associated with their recent, rapid economic growth. The increased number of vehicles, the increased complexity of the traffic mix and rapid urbanization appear to be key factors in the increasing incidence of traffic-related injuries. Road safety in BRICS needs to be improved through investment in interventions targeted at the key risk factors and collection of more reliable data to establish baseline values and track temporal changes in more detail.22–25 There needs to be regular, large-scale systematic monitoring of the factors that influence road safety. This would then allow the cost–effectiveness of interventions for the improvement of road safety to be rigorously assessed and any temporal changes in road safety to be detected rapidly.26
The Russian Federation appears to have had some recent success in reducing the incidence of road traffic injuries. The monitoring and interventions implemented in the Russian Federation could perhaps be rolled out elsewhere. In a population-based survey, over 60% of adults who travel in motor vehicles in the Russian Federation claimed to wear seatbelts – either because they perceived such restraints to be potentially life-saving or because the law requires that they be worn.19 Effective investment on reducing the prevalence of risk factors – via, for example, enforcement, social marketing or changes to roads and road layouts – can make a difference. However, if the road safety targets it has set itself are to be effectively translated into lives saved, the Russian Federation still has much work to do.27
The effective monitoring of road safety in BRICS will require increases in traffic law enforcement and related research capacity. The development of good and sustainable traffic research capacity will, in turn, require technical and financial investments by the BRICS countries and probably technical assistance from international organizations and donors.28 The increasing incidence of road traffic injuries in these countries is a real challenge that is likely to impact economic development, especially in the long term. However, BRICS could tackle the problem soon, while it is still on the rise.
In the long term, BRICS must start considering and investing in systems of public transport that reduce individual car ownership. Public transport has its own risks and the vehicles and drivers used must meet minimum standards. Investment in risk-reducing changes to the road infrastructure – such as the creation of separate lanes for private motorized vehicles, bicycles, pedestrians and perhaps buses – also need to be considered. The provision of efficient and affordable systems of mass transport and the separation of private motorized vehicles from all other forms of road traffic should reduce congestion and environmental degradation. Each of these issues is likely to become a mid- to long-term threat to the health and economic development of the BRICS countries.
This study was partly supported by the Global Road Safety Program of the Bloomberg Philanthropies.
- Global status report on road safety. Supporting a decade of action. Geneva: World Health Organization; 2013.
- Global status report on road safety. Time for action. Geneva: World Health Organization; 2009.
- The global burden of disease: generating evidence, guiding policy. Seattle: Institute for Health Metrics and Evaluation; 2013.
- Road traffic injury prevention. Training manual. Geneva: World Health Organization; 2006.
- 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.
- Luoma J, Sivak M. Road safety management in Brazil, Russia, India and China. Ann Arbor: University of Michigan Transportation Research Institute; 2012. Available from: http://deepblue.lib.umich.edu/bitstream/handle/2027.42/89427/102786.pdf?sequence=1 [cited 2014 March 13].
- Dinda S. Environmental Kuznets curve hypothesis: a survey. Ecol Econ. 2004;49:431-55. http://dx.doi.org/10.1016/j.ecolecon.2004.02.011
- Bishai D, Quresh A, James P, Ghaffar A. National road casualties and economic development. Health Econ. 2006;15:65-81. http://dx.doi.org/10.1002/hec.1020 pmid: 16145717
- Ozkan T, Puvanachandra P, Lajunen T, Hoe C, Hyder AA. The validity of self-reported seatbelt use in a country where levels of use are low. Accid Anal Prev. 2012; 47:75-7. . http://dx.doi.org/10.1016/j.aap.2012.01.015 pmid: 22326412
- Dargay J, Gately D, Sommer M. Vehicle ownership and income growth, worldwide: 1960–2030. Energy J (Camb Mass). 2007;28:143-70.
- Ingram GK, Liu Z. Motorization and the provision of roads in countries and cities. Washington (DC): World Bank; 1999. http://dx.doi.org/http://dx.doi.org/10.1596/1813-9450-1842 http://dx.doi.org/10.1596/1813-9450-1842
- Kopits E, Cropper M. Traffic fatalities and economic growth. Washington (DC): World Bank; 2003. http://dx.doi.org/http://dx.doi.org/10.1596/1813-9450-3035 http://dx.doi.org/10.1596/1813-9450-3035
- Moniruzzaman S, Andersson R. Economic development as a determinant of injury mortality - a longitudinal approach. Soc Sci Med. 2008;66:1699-708. http://dx.doi.org/10.1016/j.socscimed.2007.12.020 pmid: 18308440
- Ingram GK, Liu Z. Determinants of motorization and road provision. Washington (DC): World Bank; 1999.
- Ward’s Automative Group 2011 [Internet]. Southfield (MI): WardsAuto; 2012. Available from: www.wardsauto.com [cited 2013 Oct 1].
- Data indicators [Internet]. Washington (DC): World Bank; 2012. Available from: www.data.worldbank.org [cited 2013 Oct 1].
- Cummings P, Rivara FP, Olson CM, Smith KM. Changes in traffic crash mortality rates attributed to use of alcohol, or lack of a seat belt, air bag, motorcycle helmet, or bicycle helmet, United States, 1982–2001. Inj Prev. 2006;12:148-54. http://dx.doi.org/10.1136/ip.2005.010975 pmid: 16751443
- The Global Burden of Disease: country profiles. Seattle: Institute for Health Metrics and Evaluation; 2013.
- Ma S, Tran N, Klyavin VE, Zambon F, Hatcher KW, Hyder AA. Seat belt and child seat use in Lipetskaya Oblast, Russia: frequencies, attitudes, and perceptions. Traffic Inj Prev. 2012;13 Suppl 1:S76-81. http://dx.doi.org/10.1080/15389588.2011.645382 pmid: 22414131
- Ma S, Li Q, Zhou M, Duan L, Bishai D. Road traffic injury in China: a review of national data sources. Traffic Inj Prev. 2012;13 Suppl 1:S57-63. http://dx.doi.org/10.1080/15389588.2011.633945 pmid: 22414129
- Barffour M, Gupta S, Gururaj G, Hyder AA. Evidence-based road safety practice in India: assessment of the adequacy of publicly available data in meeting requirements for comprehensive road safety data systems. Traffic Inj Prev. 2012;13 Suppl 1:S17-23. http://dx.doi.org/10.1080/15389588.2011.636780 pmid: 22414124
- Híjar M, Pérez-Núñez R, Santoyo-Castillo D, Lunnen JC, Chandran A, Celis A, et al. Attitude change in youths after being exposed to different road safety interventions in two Mexican cities. 2013;44 Suppl 4:S4-10. http://dx.doi.org/10.1080/15389588.2011.636780 pmid: 22414124
- Bachani AM, Branching C, Ear C, Roehler DR, Parker EM, Tum S, et al. Trends in prevalence, knowledge, attitudes, and practices of helmet use in Cambodia: results from a two year study. Injury. 2013;44 Suppl 4:S31-7. http://dx.doi.org/10.1016/S0020-1383(13)70210-9 pmid: 24377776
- Bhalla K, Li Q, Duan L, Wang Y, Bishai D, Hyder AA. The prevalence of speeding and drink driving in two cities in China: a mid project evaluation of ongoing road safety interventions. Injury. 2013;44 Suppl 4:S49-56. http://dx.doi.org/10.1016/S0020-1383(13)70213-4 pmid: 24377780
- Tetali S, Lakshmi JK, Gupta S, Gururaj G, Wadhwaniya S, Hyder AA. Qualitative study to explore stakeholder perceptions related to road safety in Hyderabad, India. Injury. 2013;44 Suppl 4:S17-23. http://dx.doi.org/10.1016/S0020-1383(13)70208-0 pmid: 24377773
- Hyder AA, Allen KA, Peters DH, Chandran A, Bishai D. Large-scale road safety programmes in low- and middle-income countries: an opportunity to generate evidence. Glob Public Health. 2013;8:504-18. http://dx.doi.org/10.1080/17441692.2013.769613 pmid: 23445357
- Department of the Federal Road Safety Inspectorate [Internet]. Indicators of road safety. Moscow: Ministry of Interior; 2012. Available from: http://www.gibdd.ru/stat/ [cited 2013 October 1]. Russian.
- Hyder AA, Allen KA, Di Pietro G, Adriazola CA, Sobel R, Larson K et al. Addressing the implementation gap in global road safety: exploring features of an effective response and introducing a 10-country program. Am J Public Health. 2012;102:1061-7. http://dx.doi.org/10.2105/AJPH.2011.300563 pmid: 22515864