WMA Statement on Traffic Injury

Adopted by the 42^nd World Medical Assembly, Rancho Mirage, CA., USA, October 1990
and revised by the 57^th WMA General Assembly, Pilanesberg, South Africa, October 2006
and by the 67^th WMA General Assembly, Taipei, Taiwan, October 2016 

PREAMBLE

Serious injuries and mortality in road collisions are a public health problem with consequences similar to those of major diseases such as cancer and cardiovascular disease. Worldwide, about 1.2 million persons are killed each year on the roads, and an additional 20-50 million are injured. By 2020, road traffic injuries are expected to be the third largest contributor to the global burden of disease and injury.

In addition to the immeasurable personal and social price paid by road crash victims and their relatives, traffic injury has a significant economic impact. The economic costs of traffic injury and disability, including emergency and rehabilitative health care, costs of disability and disability adjusted life years (DALYs), amount to 1% of the GDP of poorer countries and 1.5-2% of wealthier countries. Much of this burden is borne by the health sector.

Road injuries continue to increase in many countries, particularly in low- and middle-income nations which currently account for 85% of all road traffic deaths, and are the second leading cause of death among youth worldwide.

Most traffic injuries could be prevented by better countermeasures. Combating traffic injury is the shared responsibility of groups and individuals at the international, national, and community levels, including governments, NGOs, industry, public health professionals, engineers and law enforcement personnel.

Speed is widely recognized as the most important determinant of road safety, affecting both the likelihood that a crash will occur and the severity of a crash. On average, an increase in speed of 1 km/h is associated with a 3% higher risk of a crash involving injury and a 5% higher risk of serious or fatal injury.

However, efforts to decrease road crashes and injury also require a “systems approach” that recognizes and addresses the many factors that contribute to the risk of traffic crashes and resulting injury, including human, vehicle and road design variables.

Preventing traffic injury requires addressing the social determinants of health—the social, economic, environmental, and political factors in society that influence a population’s health. Low- and middle-income countries, where there is less safe infrastructure, fewer minimum standards on vehicle safety, and poorer quality emergency care, experience the greatest number of traffic injuries. In this way, human, vehicular and environmental factors interact before, during and after a collision. Intervention at each of these stages will help reduce crashes and injury. Effective intervention requires public education as well as professional involvement in the fields of engineering, law enforcement and medical care.

Pre-collision intervention is aimed at preventing crashes and reducing risk factors. Examples include preventing drivers from driving when fatigued (especially drivers of heavy vehicles), distracted or under the influence of drugs or alcohol. Necessary policies may include prohibiting the use of hand-held cellular phones and night curfews or graduated licensing for young drivers. Pre-collision intervention also includes setting vehicle design standards that ensure that vehicles are roadworthy and cannot be driven at excessive speeds. Other interventions include setting and enforcing appropriate speed limits, installing speed cameras, and optimizing road design and layout to prevent crashes.

A second level of intervention is aimed at preventing or reducing injury during the crash. Such interventions include: enforcing the use of seat belts and child restraints; requiring helmets for cyclists; manufacturing vehicles equipped with safety devices and crash-protective design; lowering and enforcing speed limits; and removing heavy, rigid objects such as concrete or metal dividers, light posts and abutments from the sides of roads.

Post-crash intervention is aimed at maximizing life-saving and injury-reducing treatment and includes improved pre-hospital and emergency trauma care and rehabilitation.

RECOMMENDATIONS

1. The WMA supports the findings and key recommendations of the WHO’s 2015 Report on road traffic injury prevention and calls for their implementation by its member National Medical Associations and their governments and relevant bodies.
2. Physicians must view traffic injury as a public health problem and recognize their responsibility in fighting this global problem.
3. National Medical Associations and their member physicians should work to persuade governments and policy makers of the importance of this issue and should assist in adapting empirical and scientific information into workable policies.
4. National Medical Associations and physicians should be key players in public education and should include road safety in health promotion activities.
5. Physicians should be involved in the collection and analysis of data regarding road crashes and concomitant injuries, including injury surveillance systems.
6. Physicians should work toward changing the public attitude of road travel, including pressing for improved public transportation, bicycle paths and proper sidewalks to encourage less car use and the adoption of healthier options such as walking and cycling.
7. Physicians should address the human factor and medical reasons for road crashes, including, but not limited to, the use of prescription drugs or medical conditions that may impair driving ability, and explore ways to prevent and reduce the severity of injuries.
8. Physicians should lobby for the implementation and enforcement of the measures listed above, which have been shown to decrease the risk and severity of vehicle crashes, and the evaluation of their impact.
9. National Medical Associations and their member physicians should encourage the research and development of improved training systems and medical care at all stages, including effective communication and transport systems to locate and evacuate the victims, emergency medical care systems to provide life-saving first aid services, and expert trauma and rehabilitative care, and should lobby for increased resources to help provide these services.