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Despite strong advocacy, the UN Decade of Action for Road Safety (2011-2020) is ending with most low- and middle-income countries (LMICs) no closer to the Sustainable Development Goals target of reducing traffic mortality by half. In contrast, most high-income countries (HICs) have seen large benefits in recent decades from large-scale safety interventions. We aimed to assess how much LMICs would benefit from interventions that address six key risk factors related to helmet use, seatbelt use, speed control, drink driving, and vehicle design for safety of occupants and pedestrians. We use a comparative risk assessment framework to estimate mortality and health loss (disability adjusted life years lost, DALYs) that would be averted if these risks were reduced through intervention. We estimate effects for six countries that span all developing regions: China, Colombia, Ethiopia, India, Iran, and Russia. We find relatively large benefits (27% reductions in road traffic deaths and DALYs) from speed control in all countries, and about 5%-20% reductions due to other interventions depending on who is at risk in each country. To achieve larger gains, LMICs would need to move beyond simply learning from HICs and undertake new research to address risk factors particularly relevant to their context.

Road traffic crashes in China kill in excess of 250,000 people annually, more than any other country in the world. They are the fourth leading cause of premature death in the country and are responsible for 2.4% of the burden of non-fatal health loss in the country. Interventions to curb speeding and drunk driving are being implemented in the cities of Suzhou and Dalian since late 2010. We evaluated the ongoing effect of these activities through five roadside surveys, seven rounds of observational studies, and analysis of crash statistics in the two cities. We find that thus far, the prevalence of speeding has not reduced in either city with the notable exception of one site in Dalian, where the percentage of speeding vehicles declined from nearly 70% to below 10% after an interval-based speed enforcement system was installed. The broader deployment of such speed control technologies across China and other countries should be explored. Roadside alcohol testing suggests that prevalence of drunk driving (i.e. BAC >20 mg%) declined from 6.4% to 0.5% in Suzhou and from 1.7% to 0.7% in Dalian during the monitored time period. However, the measured prevalence rates are very low and should be validated against estimates based on hospital studies. Roadside interviews suggest that the population of both cities is already highly sensitized to the risks associated with drunk driving and speeding. Crash statistics from the two cities do not show appreciable declines in injuries and fatalities as yet. However, the possibility of substantial underreporting in crash statistics sourced from traffic police poses a severe threat to monitoring progress towards road safety in Suzhou, Dalian and across China. There is an urgent need for China to invest in a reliable road traffic injury surveillance system that can provide information for describing key risk factors, evaluating the impact of safety policies, and benchmarking achievements., (Copyright © 2013 Elsevier Ltd. All rights reserved.)