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Key message
Figures
Health and environment context
Policy relevance and context
Assessment
Metadata
References
Further information
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This indicator presents mortality from road traffic injuries (RTIs) for people aged 0-24 years, extracted from the WHO health for all mortality database (1). Data for injury rates and for the number of injured per motor vehicle in the age group is taken from the UNECE database (2). These data are analyzed taking the environment and health context and the policy relevance into account. An assessment of the situation in the WHO European Region is provided. |
Key message | |
High rates of injuries and fatalities persist across the Region with large health inequalities among the countries. Children are especially vulnerable to road traffic due to their specific physical circumstances. The heavy injury burden to the pedestrians and cyclists calls for measures to ensure safety and healthy mobility of children and young people. The achievements of some countries indicate that it is feasible to reduce mortality and that RTI need to receive a strong response at all levels of the society. |
Figures | |
Presentation of data Fig. 1 shows the standardized death rates (SDR) for RTIs in people aged less than 25 years for countries in the WHO European Region of more than one million inhabitants. SDRs are the average of data of the most recent three years. The very low mortality rates of some countries in Caucasus and Central Asia may be related to a low level of motorization and underreporting. Fig. 2 presents the standardized road traffic injury rates for the age group by mode of transport. It shows the injury rates of passengers of cars, pedestrians and cyclists and motorcyclists and moped riders. Cases in the “other” category refer to unknown mode of transport and in majority of cases are caused by incomplete health system reports. With the exception of Slovenia it is a negligible part of the injury rate. It should be noted that practices of data collection und reporting differ among countries and so is the definition of an injured person. Fig. 3 displays the number of injured people aged 0-24 per motor vehicle. It provides an indirect indication of the magnitude of the necessary road safety improvements in the countries. Fig. 1. Standardized death rates (SDR) for road traffic injuries in children and young people aged 0-24 years. SDR: average of the most recent three years available.  *TFYR Macedonia = The former Yugoslav Republic of Macedonia Source: WHO health for all mortality database, May 2008 (1). Fig. 2. Standardized road traffic injury rates of children and young people aged 0-24 years. Population: 2004, deaths and injured: 2003 or 2004.  Source: UNECE statistical database, May 2008 (3). Fig. 3: Children and young people aged 0-24 years injured from road traffic accidents per motor vehicle, 2003 or 2004.  Source: UNECE statistical database, May 2008 (3). Download Excel sheet with Figure Data Rationale RTIs are the third leading cause of death of people aged 0-24 in the WHO European Region. Mortality is largely preventable through concerted efforts of institutions and civil society and through implementation of effective measures which tackle leading risk factors and enable creating a comprehensive and safe road traffic system. The indicator reflects the impact and effectiveness of measures aimed at reducing RTIs. |
Health and environment context | |
About 100 children and young people aged 0-24 years die from RTIs in the WHO European Region every day. As many as 33% of all deaths from RTIs occur to young people aged 15-24 years and around 5% to children aged 0-14 years. Children and young people are particularly vulnerable to road traffic injuries as they have different physical and psychological characteristics than adults. Children aged less than ten years have a limited ability to cope with traffic and are disproportionately represented in deaths involving pedestrians. They are more at risk in conditions of heavy or fast traffic, limited visibility, or when a driver’s attention is focused away from pedestrians and cyclists. In the event of an accident, children are particularly vulnerable. Their head-to-body ratio increases the risk of head injury, and their height increases the likelihood that vital body parts are hit when collisions occur. Further, RTIs lead to post-traumatic stress disorder in up to 33% of the children. Of drivers and riders of motorcycles incurring RTIs, a disproportionate number are young people. This is due to a combination of limited experience, a tendency to engage in risky behaviour and a greater vulnerability to the effects of alcohol especially among young males. 80% of 0-24 years-old people involved in crashes are males (3). Some risk factors play in combination with socio-economic determinants which further exacerbates the adverse effects on health. For instance delay in detecting the crash and difficulty in rescue influence the post-crash outcome of injuries. Not fastening seat belt and wearing no helmet influence the severity of a crash (4). Environmental conditions are believed to contribute significantly to RTIs in Europe, with the attributable mean fraction estimated at 25%. For RTI mortality, 35% (44 000 deaths annually) may be attributed to environmental conditions (5). It points to the importance of addressing land use policies and practices. Particular important environmental factors that contribute to road safety are road design, urban structure and density, the matching of road design and vehicles, street lighting and signs, and road maintenance. There is evidence for effective interventions to reduce RTIs and to ensure healthy mobility. For example, traffic calming measures especially in built-up areas are highly effective. Speeding is the major risk factor for road crashes. A 5% increase in average speed leads to a 20% increase in road traffic mortality. Mandatory helmet laws raise the helmet-wearing rate to more than 90%. Wearing a helmet decreases the risk and severity of injuries by about 72% and decreases the mortality by 39%. Another highly effective road traffic safety measure is the random breathe testing leading to a reduction by about 40% of alcohol-related road traffic mortality (6). |
Policy relevance and context | |
Strong political commitment and evidence-supported policies are required for the adoption of a comprehensive approach to road safety. Indicators based on mortality from RTIs support policy evaluation by providing benchmarks and setting a baseline against which progress can be monitored over time. Measuring the expected positive impact of an action in connection with estimating society’s costs of road traffic mortality helps to implement effective policies. In 2001, the European Commission released the Transport White Paper, which proposed the goal to save yearly 25.000 lives on European roads by 2010 (8). The primary objectives are harmonization of traffic rules and their enforcement, standardization of high level safety technology in every new vehicle, improvements of infrastructure and emergency medical services, and the implementation of a detailed crash database. In 2004, the Fourth Ministerial Conference on Environment and Health adopted the CEHAPE (Children’s Environment and Health Action Plan for Europe) (7). One of the goals aims to reduce RTIs and to ensure safe conditions which also facilitate more physical activity among children. It advocates the strengthened implementation of measures including adequate speed limits as well as education for drivers and children, and enforcement of the corresponding legislation. |
Assessment | |
The magnitude of the death rates of children and young people due to road traffic injuries in the WHO European Region is unacceptably high. RTIs are the third leading cause of death among the age group. Every year there are about 32 000 road traffic fatalities among 0-24 year-old children and young people within the Region. Approximately four-fifths of those deaths occur among young people aged 15-24 years (9). RTIs in children and young people have a high burden of disease due to the considerable number of years of life lost to premature mortality, and the often severe and lifelong disability in survivors. This, accompanied by the devastating impact on the lives of victims and their families and the loss in productivity, results in high costs to society: estimates suggest that RTIs cost about 2% of gross domestic product (10). The estimated yearly costs of road traffic fatalities of children and young people aged 0-24 years in the WHO European Region are 38 billion dollars. (The estimation includes the following cost elements: Value of a statistical life calculated through WTP approach, net lost production and administrative costs weighted by the countries’ GNI, medical and hospital costs weighted by the countries’ costs per day of hospitalization. The sources of the underlying data are UNECE and WHO databases.) Fig. 1 shows a large inequality in health between countries. Geographically, the highest death rates occur in the eastern part of the WHO European Region with exception of the south-east countries. Among the EU-countries, the north has lower mortality than the south (fig. 1). The very low mortality rates of children and young people aged 0-24 years reported by some countries are most likely related to socioeconomic factors such as fewer motor vehicles per capita and to underreporting. Large differences in the RTI mortality in the age group can be seen also in countries with similar socioeconomic backgrounds, pointing out the significant room for improvement of RTI prevention policies. Extremely high mortality rates occur in the Russian Federation, Lithuania and Kazakhstan. As it is seen in fig. 2 those countries have relatively low injury rates in the age group, signalizing a very high severity level of crashes. Reducing the high toll these countries require infrastructural improvement especially in the field of road conditions, safety technology of motor vehicles and emergency medical service. Vice versa, some countries with below-average mortality rates like for instance Austria, Germany and the United Kingdom have a high injury rate because of a low level of crash severity. It can be interpreted as a sign of effective safety equipments in motor vehicles and health system performance in particular regarding the emergency medical service and intensive care. The standardized injury rate of children and young people aged 0-24 years represented in fig. 2 gives an insight of the real burden of road traffic crashes. The number of death only represents the tip of the iceberg. On the average 35 injuries happen per fatality. Many people suffer from long-term consequences of RTI. This data should be interpreted with caution. The number of road traffic injuries in this particular age group is even stronger affected by underreporting than the fatality number. Fig. 2 presents the injury rate by mode of transport. Unsurprisingly passengers of cars account for the largest part of road traffic injuries in a lot of the countries due to the extensive use of cars. The proportion of injured motorcyclists and moped riders differs a lot among the countries, see fig. 2. It is particularly high among the southern countries of the Region like Greece, France, Spain and Portugal. Pedestrians and cyclists are disproportionally represented. An approach to road traffic safety has to put the vulnerable road users like them especially among children and young people in the centre. Bicycle lanes and safe areas to play are effective measures to ensure safety. It is also very important to provide safe routes to school for children. Unsafe roads deter parents from allowing their children to walk or cycle to school. A co-lateral benefit is that cycling and walking to school increases children’s level of physical activity. Hence road safety measures aimed at safe routes to school also help to decrease excess body weight and obesity of children and adolescents which is the major risk factor for chronic diseases. An exemplary approach is the “Walking School Bus” or the “Bicycle Train” which is implemented in many countries of the WHO European Region. Fig. 3 delivers insight into socioeconomic determinants of road traffic crashes. It shows that most countries with very low injury rates have an extremely high number of road traffic injuries per motor vehicle. This signifies an urgent need for road safety measures. An indirect indication of the magnitude of the necessary road safety improvements is provided by fig. 3. Especially countries in transition like Kyrgyzstan, Kazakhstan, Croatia, the Russian Federation and the Republic of Moldova have a very high number of injuries per motor vehicle because they underwent rapid motorization. Their infrastructure developments and regulatory controls lag behind (9). The health risk per every motor vehicle could be reduced by improving the safety conditions of roads and vehicles. In order to create a healthy environment on the roads of the WHO European Region it is essential to learn from the experiences of other countries and to scientifically review the effectiveness of policies. Particularly high risk groups like male adolescents should be taken into account. It is proven that a lot of lives can be saved through better enforcement of speed limits, strict driver license tests, reducing driving under the influence of alcohol, mandatory helmets for two-wheelers, mandatory seat belts in cars and car-free areas where a lot of children live (9). Comprehensive strategies are important as the road traffic system is very complex. A good example of a successful approach to evidence-based road traffic safety is the Swedish Vision Zero project which gets a lot of international attention (11). It includes a wide range of measures such as the installation of roundabouts to calm traffic, median barriers on highways, 30 km/h speed limits in built-up areas, clearing the roadside areas of potential dangerous objects such as trees, mandatory daytime running lights, mandatory cycle helmets for children under the age of 15 and in-depth studies of all fatal collisions. As a result, the Swedish SMR of children and young people has more than halved during the last 15 years. It indicates that it is feasible to reduce mortality despite a high level of motorization. This is a clear sign of a positive future development of the burden of RTIs in the WHO European Region. |
Metadata | |
Name: Mortality from road traffic injuries in children and young people Definition: Children’s mortality from road traffic accidents Code: RPG2_Traf_E1 Data source Data on SDR from transport accidents come from the WHO health for all mortality database (November 2007 edition). It is labelled as “Standardized death rates, Transport accidents, per 100 000” (1). The source of data used for fig. 2 and fig. 3 (absolute numbers of injured and killed per transport type, motor vehicles and population of the age group under consideration) is UNECE statistical database (2). Description of data It should be noted that some countries have stopped reporting mortality data on motor-vehicle traffic injuries. The indicator on transport accidents is a proxy that allows a more comprehensive and up-to-date comparison to be made at the European level, although it should be understood that it includes deaths occurred in other types of transport accident (for example, railway and aviation). It is defined as including: ICD-9 BTL codes: B47; ICD-9 codes: 800–848; ICD-10 codes: V01–V99; ex-USSR 175 list: 160–162; ICD-10 Mortality Condensed list 1: 1096; EUROSTAT list of 65 causes: 60). The injury rate includes persons who sustained one or more serious or slight injuries, but also persons who died immediately or within 30 days as a result of the crash. It should be noted that practices of data collection und reporting differ among countries and so is the definition of injured person. For example, Netherlands define an injured person as being hospitalized after the crash. The presentation includes WHO European Region countries with more than 1 million inhabitants. Method for indicator calculation The indicator represents the SDRs of children and young people aged 0–24 years who died as a result of transport accidents per 100 000 population. The age-standardized death rate is calculated using the direct method and standard WHO European population structure. Mortality rates have been calculated by the WHO Regional Office for Europe using the data on deaths by cause/age/sex and mid-year population by age/sex, annually reported to WHO by Member States. Three years averages of the SDRs have been calculated in order to smooth out short term fluctuations. Geographical coverage Albania, Armenia, Austria, Azerbaijan, Belarus, Belgium, Bulgaria, Croatia, the Czech Republic, Denmark, Estonia, Finland, France, Georgia, Germany, Greece, Hungary, Ireland, Israel, Italy, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, the Netherlands, Norway, Poland, Portugal, Republic of Moldova, Romania, the Russian Federation, Slovakia, Slovenia, Spain, Sweden, Switzerland, Tajikistan, The former Yugoslav Republic of Macedonia, Turkmenistan, Ukraine, the United Kingdom and Uzbekistan. Period of coverage Mortality rates show the average of the last three years available, as reported in the WHO health for all mortality data-base, November 2007 version. Data from 1980 to 2006 is obtained in the database. Frequency of update Annually. Data quality It should be noted that mortality rates (and in particular injury rates) for some countries may be biased due to underreporting, especially in the central Asian republics, the Caucasus countries and some countries in the Balkans region. Since health data recording and handling systems and practices vary between countries, so do the availability and accuracy of data. Some countries are not able to ensure exact coding of underlying causes and complete registration of all deaths and injuries. In certain cases under-registration of deaths may be as high as 20%, and this must be borne in mind when making comparisons between countries. This problem can be further aggravated by a lack of sufficiently accurate population estimates used as the denominator when calculating indicators. The problems are caused by lack of surveillance through severe socio-economic difficulties and armed conflicts in some countries (1). |
References | |
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Authors: Regina Waldeyer, Christian Gapp, Dafina Dalbokova, WHO European Centre for Environment and Health, Bonn, Germany. |
