Simon Hendel

CARS, trucks and bikes are essential to our daily lives, our productivity and our independence. Yet they are inextricably linked to one of the major health challenges of our time.

The WHO reveals some staggering statistics. At least 1.2 million people worldwide will die on roads this year. A further 50 million people will be severely disabled. About half will be “vulnerable road users” — pedestrians, cyclists and motorcyclists.

Most of those killed or injured will be young adults and the majority will be men. Unsurprisingly, low- and middle-income countries will shoulder most of the burden — 91% to be precise, despite having only 50% of the world’s motor vehicles.

Five major risk factors for road traffic injury have been identified — speed, drink-driving, and not using helmets, seat belts and child restraints — yet only 7% of countries have adequate laws to address them.

Road traffic crashes (RTCs) aren’t like other public health problems, such as cancer or cardiovascular disease, as they happen suddenly with no prolonged exposure.

A motor vehicle is the vector and the disease is major trauma.

No other vector is so interwoven in our daily lives. Cigarettes aren’t essential for people to get to work, and fatty foods aren’t indispensible for doing the shopping. The other key difference is that RTCs are almost entirely preventable — no one is genetically predisposed to a car crash.

And therein lies the rub. How do you make safer something as ubiquitous as driving or being a passenger in a motor vehicle? More so, how do you promote interest in a problem as banal as a car crash?

You can’t contain road traffic injury like you can an infectious outbreak, nor does it conjure the same newsworthy terror as a village overcome by some new haemorrhagic virus.

That’s not to say that significant efforts are not being made. The UN decade of action for road safety is framed by five pillars — road safety management, infrastructure, safe vehicles, road user behaviour and post-crash care.

As part of this decade of action, 33 900: The Australian Road Safety Collaboration has been formed to facilitate greater industry collaboration and promote improved road safety.

As clinicians, we naturally focus on the clinical problem. But those of us who treat car crash victims know that it’s impossible to ignore the public health aspects, including the way services are organised.

Australia’s response to road trauma is world-leading. In Victoria, the state with the densest road network in Australia, actual road deaths have reduced by 70% since 1970 and, when road trauma results in serious injury, the likelihood of death has halved since 2001.

Both of these tremendous achievements have not happened in isolation or by chance. This goal has only been realised through collaborative and aggressive legislation around safer road behaviours and the introduction of an integrated trauma system.

Yet the burden remains enormous.

As with many things, Australia is lucky when it comes to road traffic crashes. This is not to take away from the cost of road trauma to individuals affected by it, but to contrast the robustness of our clinical and sociopolitical response with the reality in the rest of the world.

People injured on the road in Australia will by-and-large receive world-class care. From the publicly funded retrieval services delivering intensive care at the roadside to the therapists assisting injured people to rehabilitate, the system is impressive — including safer roads to begin with.

Globally, RTCs cost US$518 billion or 1%–3% of gross national product per country. In low- and middle-income countries the cost is US$65 billion, which is greater than the total amount received in development assistance. That’s a lot of money, especially when road use is ever increasing

RTCs aren’t like other public health problems. They are largely preventable and rarely just bad luck.

However, there is one similarity — ignoring the problem won’t help to solve it.

 

Dr Simon Hendel is an anaesthesia fellow, an associate of the Centre for International Health at the Burnet Institute and completing a fellowship in aeromedical retrieval in remote North Queensland. Professor Russell Gruen is a general and trauma surgeon at The Alfred in Melbourne, professor of surgery and public health at Monash University and director of the National Trauma Research Institute.