European status report on road safety. Towards safer roads and healthier transport choices

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3 Europen sttus report on rod sfety Towrds sfer rods nd helthier trnsport hoies

4 Astrt This report presents the sttus of rod sfety in the WHO Europen Region nd provides seline ssessment of how fr 49 ountries hve ome in implementing the reommendtions of the World report on rod trffi injury prevention. In the Region, rod rshes result nnully in 12 deths, 2.4 million injuries nd gret eonomi urden, whih my e up to 3% of ountry s gross domesti produt. Rod trffi injuries re the leding use of deth mong people 5 29 yers old. Vulnerle rod users suh s pedestrins, ylists nd users of motorized two-wheelers onstitute 39% of ll rod trffi injury ftlities, with pedestrins eing more t risk in the estern prt of the Region. Countries differ gretly in mortlity rtes for rod trffi injuries; the verge in low- nd middle-inome ountries is twie tht in high-inome ountries. Countries poliy responses in providing rod sfety for their itizens hve differed. This report proposes the following res of tion: nrrow the gp etween ountries with the lowest nd highest mortlity rtes; provide etter protetion for vulnerle rod users; develop well-resoured multisetorl rod sfety strtegy in eh ountry; design nd enfore omprehensive legisltion; nd develop nd implement helthier trnsport poliies. In ddition, ountry profiles on the urrent sttus of rod sfety re presented for the 49 prtiipting ountries. Keywords Aidents, trffi sttistis nd numeril dt Aidents, trffi eonomis Sfety mngement orgniztion nd dministrtion Wounds nd injuries prevention nd ontrol Europe ISBN Suggested ittion: Europen sttus report on rod sfety: towrds sfer rods nd helthier trnsport hoies. Copenhgen, WHO Regionl Offie for Europe, 29. Address requests out pulitions of the WHO Regionl Offie for Europe to: Pulitions WHO Regionl Offie for Europe Sherfigsvej 8 DK-21 Copenhgen Ø, Denmrk Alterntively, omplete n online request form for doumenttion, helth informtion, or for permission to quote or trnslte, on the Regionl Offie we site ( purequest). World Helth Orgniztion 29 All rights reserved. The Regionl Offie for Europe of the World Helth Orgniztion welomes requests for permission to reprodue or trnslte its pulitions, in prt or in full. The designtions employed nd the presenttion of the mteril in this pulition do not imply the expression of ny opinion whtsoever on the prt of the World Helth Orgniztion onerning the legl sttus of ny ountry, territory, ity or re or of its uthorities, or onerning the delimittion of its frontiers or oundries. Dotted lines on mps represent pproximte order lines for whih there my not yet e full greement. The mention of speifi ompnies or of ertin mnufturers produts does not imply tht they re endorsed or reommended y the World Helth Orgniztion in preferene to others of similr nture tht re not mentioned. Errors nd omissions exepted, the nmes of proprietry produts re distinguished y initil pitl letters. All resonle preutions hve een tken y the World Helth Orgniztion to verify the informtion ontined in this pulition. However, the pulished mteril is eing distriuted without wrrnty of ny kind, either express or implied. The responsiility for the interprettion nd use of the mteril lies with the reder. In no event shll the World Helth Orgniztion e lile for dmges rising from its use. Text editing: Dvid Breuer Design nd lyout: L IV Com Sàrl, Le-Mont-sur-Lusnne, Switzerlnd Cover murl: Artist, John Skrs; photogrphy of murl: Cludi Auertin-Vedov/Studio Southwest Printed y Servizi Tipogrfii Crlo Colomo, Rome, Itly Mde possile through funding from Bloomerg Philnthropies.

5 Contents Aknowledgements Foreword Exeutive summry v vi vii 1. Introdution Rod trffi injuries: helth priority Rising inequlity in the Region Rod trffi injuries nd other trnsport-relted helth effets Interntionl institutionl response Why this survey? Ojetives Struture of the report 7 2. Methods 9 3. Findings Gret inequlity in ftl nd non-ftl rod trffi injuries in the Region Very mny non-ftl injuries Vulnerle rod users re t risk Helth informtion systems need to e improved The eonomi osts of rod trffi injuries Led geny nd ntionl strtegy on rod sfety More ountries need ntionl strtegy for rod sfety Expenditure on rod sfety vries gretly, nd this expenditure is fr less thn the osts of rod trffi injuries Legisltion on nd enforement of risk ftors Speed ontrol needs to e improved nd more widespred Controlling drink driving is priority Wering helmets There is muh room for improvement in wering set-elts nd using hild r restrints Better legisltion nd enforement re needed Rod sfety mngement Better trnsport nd urn poliy to improve moility nd rod sfety Other spets of rod sfety mngement Conlusions Key fi ndings Key tions Referenes Country profiles 35 iii

6 Annexes 137 Annex 1. Explntory notes for Annexes Annex 2. Inditors explored in the questionnire developed for the Glol sttus report on rod sfety 142 Annex 3. Generl informtion, vehiles, rod trffi deths nd proportions of rod user deths y type nd rod trffi injuries for ountries in the WHO Europen Region 144 Annex 4. Mortlity rtes for rod trffi injuries per 1 popultion y gross ntionl inome per person in the WHO Europen Region, Annex 5. Smple ojetives from ntionl strtegies implemented in ountries in the WHO Europen Region 147 Annex 6. Estimted eonomi osts of one deth in seleted ountries in the WHO Europen Region 149 Annex 7. Drinking nd driving lws, enforement nd rod trffi deths ttriuted to lohol in ountries in the WHO Europen Region, Annex 8. Set-elt nd hild restrint lws, enforement nd wering rtes in ountries in the WHO Europen Region, Annex 9. Speed limit lws nd enforement in ountries in the WHO Europen Region, Annex 1. Helmet lws, enforement nd wering rtes in ountries in the WHO Europen Region, Annex 11. Rod sfety mngement, strtegies nd poliies in ountries in the WHO Europen Region 156 Annex 12. Prehospitl post-rsh re systems in ountries in the WHO Europen Region, Annex 13. Ntionl dt oordintors nd survey respondents in ountries in the WHO Europen Region 161 iv EUROPEAN STATUS REPORT ON ROAD SAFETY

7 Aknowledgements Mny interntionl experts nd WHO stff hve ontriuted to developing this report. WHO grtefully knowledges the ontriutions mde to this report y the following people. Frneso Zmon, Dinesh Sethi nd Frnes Rioppi wrote the report. Dinesh Sethi nd Frneso Zmon provided oordintion for developing it. Frneso Zmon onduted the sttistil nlysis nd ompiled ountry profi les. Frneso Mitis provided omments on drfts nd ontriuted to setions of the report. Mnuel Gllitto provided dministrtive support. Rimm Kuznetsov provided dministrtive support, ontriuted to ompiling ountry profi les nd sttistil nnexes nd helped in otining photogrphs. Niolett Di Tnno helped in otining photogrphs. Mri Chrny helped with editing drfts nd ontriuted to setions. Luigi Migliorini nd Ttin Kolpkov provided support nd ommented on drfts. Tmitz Toroyn, Mrgie Peden nd Etienne Krug provided support for the oordintion of the projet nd ommented on drfts. Kidist Brtholomeos helped with dt proessing. Alison Hrvey ontriuted to the ountry profi les. Melekidzedek Khyesi nd Mtts-Ake Belin ommented on drfts. Steven Luwers helped to otin photogrphs. The following externl peer reviewers provided very helpful omments: Dinesh Mohn, Indin Institute of Tehnology, Delhi, Indi; Mrí Seguí-Gómez, University of Nvrr, Pmplon, Spin; Elizeth Towner, University of the West of Englnd, Bristol, United Kingdom; nd Hether Wrd, University College London, United Kingdom. Country-level dt ould not hve een otined without the invlule support of: the heds nd stff of WHO ountry offi es; the ntionl dt oordintors (Annex 13); ll respondents nd ttendees of the onsensus meetings in ountries (Annex 13); nd government offi ils who lered the informtion for inlusion in the report. The report lso enefi ted from the ontriutions of the following people: Dvid Breuer, who edited the report; grphi designers from L IV Com Sàrl, who produed the design nd lyout; Ttin Alekseev, for informtion used in Box 9 on The hppy rod of hildhood; John Skrs, rtist for the murl reprodued on the over nd griously on lon from Wellnd Centennil Seondry Shool, Ontrio, Cnd; nd Cludi Auertin-Vedov/ Studio Southwest for the photogrph of the murl. Finlly, the World Helth Orgniztion wishes to thnk Bloomerg Philnthropies for its generous fi nnil support for the development nd pulition of this report. v

8 Foreword Rod trffi injuries re mjor puli helth prolem in the WHO Europen Region nd use the premture deths of some 12 people every yer. They re the leding use of deth in hildren nd young dults ged 5 to 29 yers. In ddition to these deths, out 2.4 million people re estimted to e so seriously injured s to require hospitl dmission eh yer. This is strin on the resoures of helth systems s they strive to provide qulity emergeny trum servies while fed with other ompeting priorities. In ddition to the pin nd suffering experiened y the fmilies of loved ones, rod trffi injuries use sustntil eonomi loss to soiety: up to 3% of the gross domesti produt of ny given ountry. The evidene tht rod trffi injuries n e prevented is ompelling, whih mkes the urrent sitution ll the more uneptle. Countries tht hve invested in rod sfety for mny dedes hve shown tht effetive strtegies n redue the size of the loss. Muh of the evidene for effetive prevention is summrized in the World report on rod trffi injury prevention nd the ompnying Preventing rod trffi injury: puli helth perspetive for Europe, whih were lunhed on World Helth Dy 24. These reports nd the ompnying dvoy tivities helped to rise glol wreness of the prolem nd lled on poliy-mkers nd prtitioners to tke evidene-sed tion ginst this leding use of deth nd disility. Further, the ontents of these reports informed the methodology used in WHO glol ssessment of rod sfety. The present pulition uses stndrd survey methodology, llowing poliy-mkers for the fi rst time to mke thorough ssessment of the rod sfety sitution in 49 prtiipting ountries. It provides n importnt seline for the progress mde in implementing the tions proposed in the World report on rod trffi injury prevention. It provides oth regionl overview nd detiled ountry profi les. It shows tht mny ountries in the Europen Region use multisetorl strtegies tht hve onsistently lowered the mortlity from rod trffi injuries. Yet this hievement is uneven ross the Region nd the higher mortlity rtes suggest tht mny low- nd middle-inome ountries need to mke stronger effort to mke rods sfer for their itizens. The pulition lso highlights the plight of vulnerle rod users, espeilly pedestrins in the est of the Region nd motorized two-wheelers in the south. By providing seline ssessment of wht hs een done in ountries, this pulition ims to moilize efforts in the whole Region nd highlights future tions to fi ll the gps. These tions onsist of oth helthier trnsport poliies nd multisetorl evidene-sed strtegies to prevent this leding use of deth nd disility. Tkling rod sfety is n investment in helthier nd more equitle future for our itizens. Mr Dnzon WHO Regionl Diretor for Europe vi EUROPEAN STATUS REPORT ON ROAD SAFETY

9 Exeutive summry Key findings In 24, the World Helth Orgniztion (WHO) nd the World Bnk jointly lunhed the World report on rod trffi injury prevention. The report provided evidene on the mgnitude of the urden of rod trffi injuries nd on how to tkle rod sfety nd reommended severl tions for ountries to implement. In 28, WHO undertook projet to ssess the sttus of rod sfety glolly nd to determine whether ountries re implementing the reommendtions of the World report on rod trffi injury prevention. The survey used stndrdized method with questionnire dministered to representtives of the helth, trnsport, justie nd edution setors, demi nd nongovernmentl orgniztions. The projet hs led to the pulition of the Glol sttus report on rod sfety, whih provides glol results nd regionl reports from eh of the six WHO regions. This pulition reports in detil on the results from 49 prtiipting ountries in the WHO Europen Region. The survey hs provided numerous key fi ndings for the Region. Lrge-sle prolem Annully, rod rshes result in lmost 12 ftlities nd 2.4 million injuries in the Region. Rod trffi injuries represent the leding use of deth mong dolesents nd young dults. Gret inequlity in ftl nd non-ftl rod trffi injuries in the Region Mortlity rtes for rod trffi injuries differ widely etween ountries in the Region, with rtes eing twie s high in low- nd middle-inome ountries s in high-inome ountries. Mortlity rtes in the Commonwelth of Independent Sttes (CIS) re up to four times higher thn those of the rdi ountries. Trends hve een flling in mny high-inome ountries ut not in low- nd middleinome ountries, mny of whih re in the CIS. Vulnerle rod users re t risk Pedestrins, ylists nd users of motorized two-wheelers onstitute 39% of ll deths in rod rshes. They re more likely to e more seriously injured. The proportion of pedestrins involved in rod rshes is highest in CIS ountries. High vehile speeds nd urn design ple these rod users t inresed risk. Costs of rod trffi injuries severely urden ountries eonomies The helth servie osts of treting the people injured nd disled y rod rshes re very high s re the osts orne y fmilies, ommunities nd soiety t lrge due to forgone prodution. The eonomi urden of rod rshes is s muh s 3% of gross domesti produt. Ntionl strtegies on rod sfety often fil to set mesurle trgets Aout one third of the ountries surveyed do not hve ntionl, multisetorl strtegy on rod sfety. Even the ountries tht do re not lwys le to set mesurle trgets tht n e properly monitored nd evluted. vii

10 Enforement of lws on vehile speed, drink driving nd use of set-elts, hild r restrints nd helmets is unstisftory in mny ountries Mny ountries hve indequte legisltion to ontrol speed in urn res, drink driving nd the use of helmets (for riders of motorized twowheelers), set-elts nd hild r restrints. Even well-designed legisltion hs no effet if it is not properly enfored. In most ountries in the Region, the urrent enforement of speed ontrol, drink driving nd use of helmets, setelts nd hild r restrints is reported s not eing effetive enough. Poliies on wlking nd yling nd puli trnsport servies re not lwys ftored into strtegies on rod sfety nd on trnsport systems Only one third of the ountries re implementing ntionl poliies on oth puli trnsport nd wlking nd yling. Even fewer ountries hve introdued mesures to etter mnge privte r use. This is of onern given the potentil ill helth ssoited with physil intivity nd environmentl hrm. Reommendtions for tion Bsed on these fi ndings, the following res of tion re proposed, uilt on those proposed in the World report on rod trffi injury prevention. Inequlity in rod trffi injury deths should e nrrowed More ttention needs to e given to rod sfety throughout the Region. Some highinome ountries hve shown sustined politil ommitment nd developed innovtive strtegies nd tehnologies for reduing rod trffi deths nd serious injuries. Countries with poorer rod sfety reords need to tke up this experiene. Vulnerle rod users need etter protetion Governments need to protet ll rod users nd not neglet the needs of pedestrins, ylists nd riders of motorized two-wheelers. Rod sfety stkeholders need to work together to implement evidene-sed tion to gurntee etter protetion, espeilly in low- nd middle-inome ountries. More ountries need well-resoured multisetorl rod sfety ody to tke forwrd strtegy for sfety Suh ody should involve ll stkeholders in developing multisetorl strtegy tht lerly designtes responsiilities nd uthority s to who should do wht, where nd when. Better entment nd enforement of legisltion on rod sfety ould sve lives Governments need to ensure tht omprehensive lws over the min risk ftors of speed, drink driving nd use of helmets (for riders of motorized two-wheelers), set-elts nd hild r restrints. Enforement of suh legisltion needs to e improved. This requires well-puliized enforement mpigns, pereived ertinty of eing pprehended nd severity nd promptness of punishment for violtions. Mny ountries need to put this winning omintion in ple. Sustinle trnsport poliies present lrge untpped opportunity for helth nd environmentl gins Sustinle trnsport poliies represent n importnt opportunity for ontriuting to hieving other puli helth nd environmentl gols. More ountries viii EUROPEAN STATUS REPORT ON ROAD SAFETY

11 ould rep the multiple enefits of investing in poliies tht promote puli trnsport, yling nd wlking. Lnd-use nd trnsport poliies tht enourge suh modes of trnsport will provide multiple helth gins y reduing injuries, deresing respirtory illness, preventing nonommunile disese through physil tivity nd mitigting the negtive effets of limte hnge. Mking rods sfer for vulnerle rod users will help to enourge greter moility with wlking nd yling. One wy of hieving this is y implementing trnsport poliies tht integrte rod sfety with environmentl nd helth onerns. The report provides 49 ountry profi les on rod sfety tht inlude dt olleted in the survey nd n serve s tool for ssessing the rod sfety sitution nd stimulting dete nd tion ntionlly nd n t s seline for future referene, ssessment nd monitoring. ix

12 Photo Istokphoto

13 1 Introdution 1.1 Rod trffi injuries: helth priority Rod trffi injuries re mjor puli helth prolem in the 53 ountries of the WHO Europen Region. The nnul deth toll from rod trffi injury is estimted to e 129 ording to WHO s Glol Burden of Disese projet for 24 (Tle 1) (1). In ddition, rod rshes injure more thn 2.4 million people eh yer (2). The prolem is espeilly severe for people ged 5 29 yers, for whom rod trffi injuries re the leding use of deth (Tle 1). Mles re more likely to die thn femles from rod trffi injury; they mke up three fourths of rod trffi deths (3 5). Underlying these strk sttistis ut less well desried re the mny more who suffer temporry or permnent disility from their injury nd the fmilies emotionlly devstted y the loss of loved ones. Mny people my e driven into poverty y the loss of fmily redwinner or y the prolonged helth nd soil re required for people with disilities (6). The osts of re nd rehilittion re onsiderle, nd soietl osts hve een estimted t up to 3% of gross domesti produt (GDP) (7,8). Nevertheless, mny effetive preventive strtegies exist, nd mny Europen ountries re mong the sfest in the world (2). There is therefore potentil to tke up the hllenge nd redue the urden of rod trffi injuries y pplying lessons of good prtie. A good strtingpoint for this is to understnd the seline sitution, whih is one purpose of this report. Photo WHO P Virot 1

14 Tle 1. Numer of deths for leding uses y ge group in the WHO Europen Region, 24 Rnk 4 yers 5 14 yers yers 3 44 yers yers 7+ yers Totl Perintl uses 87 5 Lower respirtory infetions 34 5 Dirrhoel diseses 32 4 Congenitl nomlies 25 8 Meningitis 536 Upper respirtory infetions 3 Drowning 247 Rod trffi injuries 174 HIV/AIDS 166 Endorine disorders 165 Poisoning 114 Fire 18 Leukemi 97 Heptitis B 95 Inflmmtory hert diseses 78 Epilepsy 73 Violene 69 Iron-defiieny nemi 68 Flls 66 Heptitis C 56 Rod trffi injuries 418 Drowning 243 Lower respirtory infetions 193 Leukemi 168 Congenitl nomlies 139 Self-inflited injuries 128 Lymphoms, multiple myelom 7 Epilepsy 65 Violene 64 Cererovsulr disese 59 Endorine disorders 59 Poisoning 56 Flls 53 Wr nd onflit 47 Upper respirtory infetions 43 Fire 43 Meningitis 39 Nephritis nd nephrosis 35 Inflmmtory hert diseses 27 Dirrhoel diseses 26 Soure: The glol urden of disese: 24 updte (1). Rod trffi injuries 39 3 Self-inflited injuries 29 5 Violene 14 9 Poisoning 14 1 HIV/AIDS 71 Tuerulosis 7 Drowning 657 Ishemi hert disese 461 Cererovsulr disese 438 Leukemi 425 Cirrhosis of the liver 38 Wr nd onflit 37 Flls 359 Drug use disorders 31 Inflmmtory hert diseses 274 Lower respirtory infetions 273 Epilepsy 231 Nephritis nd nephrosis 22 Congenitl nomlies 212 Lymphoms, multiple myelom 29 Ishemi hert disese 56 9 Self-inflited injuries 41 Poisoning 33 6 Rod trffi injuries 33 2 Tuerulosis 28 9 Cirrhosis of the liver 27 4 Cererovsulr disese 23 Violene 22 6 HIV/AIDS 13 7 Inflmmtory hert diseses 1 7 Brest ner 1 3 Trhe, ronhus, lung ner 1 2 Lower respirtory infetions 94 Drowning 9 Flls 79 Drug use disorders 75 Stomh ner 68 Colon nd retum ner 55 Fires 53 Alohol use disorders 52 Ishemi hert disese Cererovsulr disese Trhe, ronhus, lung ner 19 9 Cirrhosis of the liver Colon nd retum ner 83 5 Brest ner 75 2 Stomh ner 65 4 Self-inflited injuries 57 5 Chroni ostrutive pulmonry disese 54 6 Poisoning 52 3 Lower respirtory infetions 46 8 Hypertensive hert disese 45 1 Dietes mellitus 42 8 Inflmmtory hert diseses 39 8 Pnres ner 39 1 Rod trffi injuries 36 5 Tuerulosis 33 6 Mouth nd orophrynx ner 33 3 Lymphoms, multiple myelom 27 3 Liver ner 27 1 Ishemi hert disese Cererovsulr disese Chroni ostrutive pulmonry disese Trhe, ronhus, lung ner Colon nd retum ner Lower respirtory infetions Hypertensive hert disese 13 7 Alzheimer nd other types of dementi Dietes mellitus 16 7 Stomh ner 82 Prostte ner 77 1 Brest ner 72 5 Inflmmtory hert diseses 68 6 Nephritis nd nephrosis 53 1 Pnres ner 51 6 Lymphoms, multiple myelom 44 7 Flls 44 6 Bldder ner 43 1 Cirrhosis of the liver 41 1 Liver ner 35 5 Ishemi hert disese Cererovsulr disese Trhe, ronhus, lung ner 37 7 Colon nd retum ner Lower respirtory infetions Chroni ostrutive pulmonry disese Cirrhosis of the liver Hypertensive hert disese 179 Brest ner Dietes mellitus Stomh ner Self-inflited injuries 15 5 Alzheimer nd other types of dementi Rod trffi injuries Inflmmtory hert diseses Poisoning 17 Prostte ner 97 3 Pnres ner 93 3 Perintl uses 87 6 Nephritis nd nephrosis EUROPEAN STATUS REPORT ON ROAD SAFETY

15 Photo WHO R Kuznetsov 1.2 Rising inequlity in the Region The urden of rod trffi injuries is unequl in the Region. Wheres mortlity rtes from rod trffi injuries hve delined overll in the Region, this is in strk ontrst to the Commonwelth of Independent Sttes (CIS 1 ), whih hve the highest rtes (Fig. 1). In the CIS, mortlity rtes peked in the erly 199s nd, fter n initil fll, re liming gin. This differs from the Europen Union (EU), where rtes re flling, mking the gp even wider (9,1). Even the EU hs gret inequlity, with the rdi ountries (Denmrk, Finlnd, Ielnd, rwy nd Sweden) hving fr lower deth rtes thn the Blti ountries (Estoni, Ltvi nd Lithuni) nd those of southern Europe. In the Region, the ge groups most t risk s pedestrins re hildren nd older people, nd young mles re most t risk s r oupnts or riders of motorized two-wheelers (2,7,11). Soioeonomi determinnts re importnt, nd even high-inome ountries in Europe hve desried widening gp, with the hildren of deprived fmilies t muh greter risk thn the hildren of ffl uent fmilies (12,13). Exposure to hzrdous trffi situtions in unsfe environments nd unsfe vehiles nd less ess to sfety equipment nd emergeny trum servies re some of the ftors tht put lower-inome people t greter risk. Further, mny ountries in Europe hve undergone politil nd eonomi trnsition, nd rod infrstruture, vehile sfety nd regultory prties hve not kept up with motoriztion (14). In ddition, risk ftors suh s lohol nd speed need to e tken into ount (4). 1 CIS ountries onsisted of Armeni, Azerijn, Belrus, Georgi, Kzkhstn, Kyrgyzstn, Repuli of Moldov, Russin Federtion, Tjikistn, Turkmenistn, Ukrine nd Uzekistn t the time the dt were olleted. 3

16 Fig. 1. Mortlity rtes from rod trffi injuries per 1 popultion, WHO Europen Region, CIS nd EU, Europen Region CIS EU-27 Mortlity rte per 1 popultion Those 27 ountries tht now mke up the EU. Yer Soure: Europen Helth for All dtse (1). Photo Istokphoto 1.3 Rod trffi injuries nd other trnsport-relted helth effets Rod trnsport is essentil to humn nd soietl development euse people nd goods need to move nd ess needs to e provided to jos, edution, helth re nd other servies nd menities. However, it lso exposes people to the risk of rod trffi injuries, nd the numer of deths due to rod trffi injuries would ontinue to inrese if left unheked (15). This would dd to the urden of other trnsport-relted helth effets suh s respirtory illness nd the ill helth relted to physil intivity nd limte hnge. For exmple, the level of trnsport-relted ir pollution is mjor puli helth onern in most ountries in the Region, where ir pollution ontriutes to similr numer of deths to those rising from rod trffi injuries (16). In ddition, trnsport-relted emissions of gses tht use limte hnge my ontriute to extreme wether events with hrmful effets on humn helth (17). There re other effets on helth, inluding pervsive nnoyne indued y rod trffi noise nd onstrints on the development of neighourhood support networks. By disourging the use of sfe yling nd wlking for trnsport, this ontriutes to rdiovsulr disese, dietes nd oesity. These disproportiontely ffet urn poor people, living in res with higher levels of pollution nd fewer options for sfe physil tivity (18 2). 4 EUROPEAN STATUS REPORT ON ROAD SAFETY

17 Tken together, these trnsport-relted helth effets dd to the high urden nd ost of rod trffi injuries, strengthening the se for implementing sustinle trnsport strtegies to redue suh illnesses nd osts. Arguments for ddressing rod sfety should therefore tke into ount the dditionl non-injury helth enefi ts suh tions would ring (Box 1). Conversely, more sustinle trnsport strtegies tht promote wlking nd yling need to ddress the issue of sfety for these vulnerle rod users (2). As response to the onern out the environmentl nd helth threts of limte hnge, speed-redution poliies tht im to redue greenhouse gses will lso mke rods sfer (Box 2). Box 1. Addressing rod sfety s prt of sustinle trnsport poliy The Trnsport, Helth nd Environment Pn-Europen Progrmme (THE PEP) ddresses rod sfety s key ftor in overll poliies on sustinle trnsport systems. In terms of helth effets, this hs the dditionl ontriution of promoting trnsport poliies tht, in ddition to rod sfety, lso work towrds reduing emissions of noise nd ir pollutnts nd providing onditions tht promote wlking nd yling. THE PEP promotes strtegies developed to improve rod sfety tht lso tke into ount these other helth effets to deliver multiple helth enefi ts. Suh roder pprohes re more osteffetive investments thn those fousing on single helth outome. For exmple, mintining speeds elow 3 km/h to redue deth or serious injury sves on oth the osts of voided injuries nd lso on the osts resulting from ill helth due to ir pollution, noise nd the rrier effet of fer of unsfe rods, whih prevents wlking nd yling. Soure: THE PEP Trnsport, Helth nd Environment Pn-Europen Progrmme (21). 1.4 Interntionl institutionl response Rod sfety hs moved up the politil gend in reent yers, nd intergovernmentl odies hve lunhed severl poliy inititives (23,24). The lunh of the World report on rod trffi injury prevention y WHO nd the World Bnk on World Helth Dy 24 (4) refoused ttention on the plight of vitims of rod rshes nd proposed multisetorl nd evidenesed pproh to preventing rod trffi injury (see elow). A ompnion pulition Preventing rod trffi injury: puli helth perspetive for Europe (2) ws lso relesed tht desries the urden of rod trffi injuries nd urges tion in the ontext of trnsport poliies in the WHO Europen Region. World Helth Assemly resolution WHA57.1 on rod sfety nd helth lls upon Memer Sttes to moilize puli helth tion to redue the urden of rod trffi injuries. These tions require multisetorl response from trnsport, justie, helth, industry nd ivil soiety. Box 2. Speed redution nd trnsport demnd mngement eyond rod sfety: opportunities for multiple enefits The EU energy nd limte pkge trgets 2% overll redution in greenhouse gses y 22 nd highlights the need for the trnsport setor to ontriute tively. In the EU, growing trnsport volumes hve rised emissions y 27% etween 199 nd 26 (exluding the interntionl vition nd mrine setors) (22). Reduing speed y enforing speed limits nd using intelligent speed ssistne devies n ontriute to reduing CO 2 emissions nd sving lives. The sme pplies to poliies to mnge the demnd for trnsport. Interestingly, these mesures re inresingly fetured in the portfolio of poliies onsidered s prt of the strtegy to redue emissions of greenhouse gses, noise nd ir pollutnts (22). The United Ntions Generl Assemly hs pssed severl resolutions lling on governments to ddress the glol rod sfety issue (Box 3). WHO Regionl Committee for Europe resolution RC55/R9 on the prevention of injuries provides puli helth frmework for prevention in the Europen Region. Further, the United Ntions Eonomi Commission for Europe, the Interntionl Trnsport Forum nd the 5

18 Orgnistion for Eonomi Co-opertion nd Development ll undertke work on rod sfety. The EU Europen Rod Sfety Ation Progrmme (25) urges the EU ountries to hlve rod rsh ftlities y 21 ompred with 2 through omintion of mesures, inluding etter vehile sfety with oth tive nd pssive mesures, improving rod infrstruture nd sfer rod user ehviour through liensing, regultions nd enforement. At the ntionl level, there hve een innovtive pprohes suh s the Zero Vision pproh in Sweden (Box 4). 1.5 Why this survey? To ddress the stte of glol rod sfety nd to evlute whether Memer Sttes hve implemented the reommendtions of the World report on rod trffi injury prevention (4) (Box 5), WHO undertook projet on glol sttus report on rod sfety. This survey ssesses whether tions proposed in the World report on rod trffi injury prevention re eing implemented in 178 ountries. The Glol sttus report on rod sfety (5) ws lunhed on 15 June 29 in New York. Six regionl reports hve lso Box 3. United Ntions Generl Assemly resolution A/Res/62/244 on improving glol rod sfety Photo WHO O OHnlon The United Ntions resolution on improving glol rod sfety in Mrh 28 reffi rms the importne of ddressing glol rod sfety nd invites Memer Sttes to prtiipte in developing the Glol sttus report on rod sfety (5). It lso welomes the offer y the Government of the Russin Federtion to host the United Ntions Ministeril Summit on Rod Sfety in Mosow in 29. The Summit ims to ring together delegtions of ministers nd representtives working on trnsport, helth, edution, sfety nd trffi -relted lw enforement issues (23). Ministers from ll Memer Sttes will hve n opportunity to disuss progress in implementing the reommendtions developed y the World report on rod trffi injury prevention (4) nd the United Ntions Generl Assemly resolutions on improving glol rod sfety. The Summit will e n opportunity for Memer Sttes to exhnge informtion nd est prties. Further, if the delegtes dopt the proposed Dede of Ation, this will prove to e further tlyst for hnge. Box 4. The Zero Vision pproh The Zero Vision envisges future in whih no one is killed or seriously injured on the rods nd originted in Sweden. The min tenet of the Zero Vision poliy is the elief tht humn filure is inevitle. It emphsizes the priniple tht speed nd sfety re not trdle. This mens tht poliy-mkers must do everything within their ontrol to ensure tht rod rshes do not result in ftlity or serious injury. The poliy hs thus foused on developing rod infrstruture design to mitigte the onsequenes of rod rshes nd on mesures to redue the trnsfer of energy on impt, minly y limiting speed. The pproh now hs strong foothold in Sweden s ntionl rod sfety system nd hs een dopted y other Europen ountries. The new design of some of the rods llows for greter sfety nd moility. Finlly, lthough Zero Vision does ple gret responsiility on rod uilders nd mngers, it still reognizes the importne of other pprohes nd, mong other things, works to improve vehile sfety nd legisltion. Soure: Rioppi et l. (2). 6 EUROPEAN STATUS REPORT ON ROAD SAFETY

19 een developed, nd this pulition desries the survey nd its results in the WHO Europen Region. This report is primrily intended for Europen poliymkers nd prtitioners onerned with rod sfety nd moility from diverse setors suh s helth, trnsport, justie nd lnd use. 1.6 Ojetives This pulition desries the stte of rod sfety in Europen Memer Sttes y using stndrdized methods. The ojetives of the projet were: to ssess the sttus of rod sfety in Europen Memer Sttes s mesured ginst ore set of rod sfety inditors; to defi ne the gps in rod sfety ntionlly nd in the WHO Europen Region; to help ountries identify the key priorities for intervention; to stimulte rod sfety tivities t ntionl level; nd to provide seline to monitor progress in the future. 1.7 Struture of the report This report hs two min prts. The fi rst prt riefly desries the key findings in the Europen Region nd their implitions. After disussing the methods, key fi ndings of the min report re presented s follows: dt on ftl nd non-ftl injuries; eonomi osts of rod trffi injuries; led geny nd ntionl strtegy on rod sfety; Box 5. Reommendtions of the World report on rod trffi injury prevention The World report on rod trffi injury prevention (4) lls for systems pproh to rod sfety tht exmines the omponent prts of the system (infrstruture, vehile nd rod user) in developing strtegies for prevention. To help ountries hieve progress in rod sfety, the report provides six universl reommendtions. Identify led geny in government to guide the ntionl rod trffi sfety effort. Assess the prolem, poliies nd institutionl settings relting to rod trffi injury nd the pity for rod trffi injury prevention in eh ountry. Prepre ntionl rod sfety strtegy nd pln of tion. Allote fi nnil nd humn resoures to ddress the prolem. Implement speifi tions to prevent rod rshes, minimize injuries nd their onsequenes nd evlute the impt of these tions. Support the development of ntionl pity nd interntionl oopertion. legisltion on nd enforement of risk ftors; nd rod sfety mngement. These re followed y onlusions nd key tions. This pulition inludes detiled ountry profi les of rod sfety for eh of the 49 prtiipting ountries with some explntory notes on methods. Eh two-pge ountry profi le tultes dt otined in the survey ssessing rod sfety ntionlly nd sets seline for future follow-up. Ntionl experts, reserhers nd poliy-mkers n use the profi les s resoure for ountry-speifi tion nd studies. Country profi les n e used for interntionl omprison, ut there re limittions due to differenes in definitions, surveillne, osting nd other methods etween ountries. Annexes 3 12 provide results for eh ountry for most of the vriles. 7

20 Photo WHO M Peden

21 2 Methods A self-dministered questionnire ws developed using the ontent of the World report on rod trffi injury prevention (4) s sis for seleting items. An interntionl pnel of experts dvised on the questionnire design for the survey nd the dt olletion methods. The questionnire ws used: to ollet dt on the urden of injuries, exposure to risk nd vehile nd infrstruture stndrds; to defi ne the institutionl frmework for rod sfety; to gther informtion on the eonomi osts of rod trffi injuries; to reord legisltion nd the enforement of mesures to ontrol some of the min risk ftors suh s speed, lohol nd sfety equipment; to identify rod sfety mngement; nd to desrie pre-hospitl re. Annex 2 desries the inditors in more detil. Fig. 2 shows the methods for dt proessing. The helth or trnsport ministries nominted ntionl dt oordintors in the 49 responding Memer Sttes (92% of the Region s Memer Sttes). Eh ntionl dt oordintor ws trined in the stndrd methods nd filitted onsensus meeting of multisetorl group of up to eight rod sfety experts. The methods stipulted tht experts e seleted from the helth, trnsport nd enforement setors, nd memership y demi nd nongovernmentl orgniztions ws enourged. Eh respondent ws sked to fi ll in the questionnire efore the meeting nd then disuss eh nswer t the onsensus meeting so tht eh ountry would hve one offi il response. Dt olletion ommened in Mrh 28 nd ws ompleted in Septemer 28. The Regionl Dt Coordintor vlidted the dt in onsulttion with the ntionl dt oordintor, nd fi nl ompleted questionnire ws greed on. These dt were then used for proessing nd inlusion in the report. Annex 13 lists the ntionl dt oordintors nd expert pnels. Annex 3 lists the prtiipting ountries, together with relevnt demogrphi, eonomi nd development inditors. Fig. 2. Methods of the survey Glol nd regionl oordintion Ntionl dt oordintor in eh ountry Group of 6 8 respondents omprising multisetorl group ministries (suh s helth, polie nd trnsport), nongovernmentl orgniztions nd demis Ntionl onsensus meeting One ntionl dt set Glol nd Europen sttus reports 9

22 Photo WHO M Peden

23 3 Findings 3.1 Gret inequlity in ftl nd non-ftl rod trffi injuries in the Region The study shows tht 12 people die nnully in rod rshes in the Region, onfirming other estimtes (1). The mortlity rte from rod trffi injuries in the Region is 13.4 per 1 popultion, lower thn the glol rte of 18.8 per 1 popultion (4). However, there is gret inequlity in the Region, s shown y the mortlity rtes in Fig. 3 1 (these dt hve een modelled for some ountries to orret for differenes in defi nition nd ompleteness). The rte in low- nd middle-inome ountries is 18.7 per 1 popultion, twie s high s tht in high-inome ountries (7.9 per 1 popultion). The rdi ountries hve some of the lowest mortlity rtes in the Region nd in the world (verge 5.7 per 1 popultion). In ontrst, the verge mortlity rte in CIS ountries (21.8 per 1 popultion) is nerly four times higher. Kzkhstn hs y fr the highest mortlity rte in the Region (3.6 per 1 popultion), followed y other CIS ountries suh s the Russin Federtion (25.2 per 1 popultion) nd Kyrgyzstn (22.8 per 1 popultion). Among the EU ountries, Lithuni nd Ltvi hve the highest mortlity rtes (22.4 nd 17.9 per 1 popultion respetively). Most ountries in the western prt of the Region hve downwrd trends, s the grphs presenting trend dt in the ountry profiles show. However, suh deresing trends re not onsistent mong ountries in the estern prt of the Region, where mortlity rtes re inresing or remin unhnged. Men ount for 8% of young dult ftlities. The risk mong young dults ged 2 24 yers is fi ve times greter in Estoni nd Lithuni thn in rwy. Similrly high mortlity rtes mong young dults re reported in the southern prt of the Region, in suh ountries s Croti, Greee, Montenegro nd Sloveni. The Russin Federtion, Ukrine nd Kzkhstn mke up 23% of the popultion of the Region ut ount for 43% of the regionl urden of rod trffi ftlities. With its 36 vitims, 2 the Russin Federtion hs the highest deth toll in numers in the Region. 1 Annex 3 presents the numer of ftlities djusted for the 3-dy defi nition of rod trffi deth nd the modelled mortlity rtes. Annex 1 presents detiled informtion on the modelled dt. 2 The Russin Federtion reported vitims dying within 7 dys of the rsh; is 2 The the djusted Russin Federtion numer of reported vitims dying within vitims 3 dys dying (see within Annex 7 dys 1). of the rsh; is the djusted numer of vitims dying within 3 dys (see Annex 1). 11

24 Fig. 3. Mortlity rtes from rod trffi injuries per 1 popultion, WHO Europen Region, High-inome ountries Low- nd middle-inome ountries Kzkhstn Russin Federtion Kyrgyzstn Lithuni Ukrine Montenegro Turkmenistn Ltvi Georgi Belrus Slovki Repuli of Moldov Greee Estoni Polnd Sloveni Tjikistn Alni Armeni Croti Turkey WHO Europen Region Bulgri Azerijn Romni Hungry Czeh Repuli Bosni nd Herzegovin Portugl Cyprus Belgium Ielnd Seri Uzekistn Itly Spin Irelnd Austri Frne Finlnd MKD Germny Isrel United Kingdom Sweden rwy Switzerlnd Netherlnds Mlt Sn Mrino Inome levels re those defi ned y the World Bnk. Deths per 1 popultion Modelled mortlity rtes. Annex 1 presents detils on modelling. MKD is the Interntionl Orgniztion for Stndrdiztion revition for the former Yugoslv Repuli of Medoni; this is used in fi gures throughout this pulition. 12 EUROPEAN STATUS REPORT ON ROAD SAFETY

25 3.2 Very mny non-ftl injuries Every yer 2.4 million people re injured in rod rshes in the Region. Thus, for every ftlity out 2 people re injured. Compring this t the ountry level, the rtio of non-ftl injuries for every ftlity rnges from 8 in the United Kingdom to 8 in the Russin Federtion nd 4 in Ukrine (see Annex 3 nd ountry profiles). This my e due to gross underreporting of non-ftl rod trffi injuries in some ountries ut lso euse of wide inonsistenies in how ountries defi ne injuries. Some ountries defi ne rod trffi injuries s ll those requiring tretment in emergeny deprtments, wheres other ountries lssify injuries s those requiring hospitliztion. Despite the lrge numer of non-ftl injuries, little is known out the temporry nd permnent onsequenes of these injuries. Due to the osts of helth re, soil welfre pyments, prodution loss nd the lrge numer of injuries, the osts of non-ftl injuries tend to e higher thn the osts of ftlities t the ountry level. 3.3 Vulnerle rod users re t risk Vulnerle rod users, inluding pedestrins, ylists nd users of motorized two-wheelers, re t greter risk of serious injury in rod rshes euse they do not hve protetive shell. Fig. 4 shows the distriution of deths y rod user tegories for the Europen Region, the CIS nd the EU. For the Region s whole, vulnerle rod users ount for 39% of rod trffi deths. This is slightly less thn the glol fi gure of 46% (5). The distriution of vulnerle rod users within the Region differs notly. In the EU, the lrgest proportions of vitims re motorized two-wheeler riders nd ylists. Greee, Mlt, Cyprus, Itly nd Frne hve the highest proportions of deths of motorized two-wheeler users mong vitims of rod rshes, exeeding 1 in 4 deths (Annex 3). This is prtly euse of the greter use of motorized twowheelers in these ountries, espeilly in urn res, nd euse the liensing ge for drivers is less thn 18 yers (26,27). The CIS hs the highest proportion of pedestrin ftlities: 37% of ll rod deths. Ukrine, Tjikistn nd Kyrgyzstn hve the highest shres of pedestrin vitims in the Region (56%, 44% nd 43%, respetively). One reson is the ft tht urn design in mny CIS ities dtes k to when motorized trffi ws very limited nd professionl drivers did most driving. Improvements in rod infrstruture, driver trining nd enforement hve filed to dpt to the inrese in motoriztion. The needs of Fig. 4. Distriution of rod trffi injury deths y rod user tegory, WHO Europen Region, CIS nd EU Europen Region CIS EU Other (2%) Unspeified (5%) Oupnts, fourwheelers (53%) Unspeified (1%) Other (1%) Oupnts, fourwheelers (5%) Pedestrins (18%) Other (2%) Oupnts, fourwheelers (57%) Pedestrins (28%) Cylists (6%) Cylists (3%) Pedestrins (37%) Riders, motorized two- or three-wheelers (8%) Riders, motorized two- or three-wheelers (1%) Riders, motorized two- or three-wheelers (17%) 13

26 vulnerle rod users hve not yet een properly tken into ount. For exmple, most CIS ountries still hve urn speed limits of 6 km/h (see setion 3.7.1). This finding is refleted somewht in Fig. 5, showing tht the proportion of pedestrins killed inreses s the gross ntionl inome per person dereses. This is prtly explined y greter exposure s pedestrins in low- nd middle-inome ountries, whih rely less on r trnsport, ut lso euse of less investment in infrstruture nd other mesures promoting pedestrin sfety thn in high-inome ountries. Fig. 5. Pedestrins s proportion of totl rod trffi deths, y gross ntionl inome per person, WHO Europen Region 6 UKR Pedestrins s proportion of totl rod trffi deths 5 TJK ARM KGZ ALB BLR AZE RUS MDA LVA LTU POL MAT MKD SVK ISR GEO BUL BIH SRB HUN MNE CRO TUR KAZ EST CZH CYP POR ROM SVN GRE SPA ITA GER FRA BEL UNK SMR IRE AUT NET FIN SWE ICE SWI NOR Gross ntionl inome per person (US dollrs) The Interntionl Orgniztion for Stndrdiztion ronyms re used in this fi gure: ALB: Alni; ARM: Armeni; AUT: Austri; AZE: Azerijn; BEL: Belgium; BIH: Bosni nd Herzegovin; BLR: Belrus; BUL: Bulgri; CRO: Croti; CYP: Cyprus; CZH: Czeh Repuli; DEU: Germny; EST: Estoni; FIN: Finlnd; FRA: Frne; GEO: Georgi; GRE: Greee; HUN: Hungry; ICE: Ielnd; IRE: Irelnd; ISR: Isrel; ITA: Itly; KAZ: Kzkhstn; KGZ: Kyrgyzstn; LVA: Ltvi; LTU: Lithuni; MDA: Repuli of Moldov; MKD: The former Yugoslv Repuli of Medoni; MLT: Mlt; MNE: Montenegro; NET: Netherlnds; NOR: rwy; POL: Polnd; POR: Portugl; ROM: Romni; RUS: Russin Federtion; SMR: Sn Mrino; SPA: Spin; SRB: Seri; SVK: Slovki; SVN: Sloveni; SWE: Sweden; SWI: Switzerlnd; TKM: Turkmenistn; TUR: Turkey; TJK: Tjikistn; UKR: Ukrine; UNK: United Kingdom. Gross ntionl inome per person is from World Bnk dt for 27. Moving forwrd to protet vulnerle rod users A mximum urn speed limit of 5 km/h should e set. Lol uthorities should e empowered to lower the speed limit in residentil res to 3 km/h. Polie need to stritly enfore speed limits. Comprehensive lws requiring helmet use for ll riders of ll motorized two-wheelers need to e pssed nd enfored. Town plnners nd rod engineers need to invest in infrstruture suh s pedestrin-only zones, trffi-lming mesures, upgrding mrked pedestrin rossings, pedestrin ridges nd underpsses nd yle lnes. Photo WHO S Luwers 14 EUROPEAN STATUS REPORT ON ROAD SAFETY

27 3.4 Helth informtion systems need to e improved Although ll ountries surveyed ollet dt on rod trffi injuries, the qulity of these dt vries. Seven ountries (14%) do not hve redily ville si sttistis on the sex nd ge of vitims or trend dt on ftlities nd nnot provide ny dditionl informtion esides deth. Further, uniformity of terms is limited. For exmple, 1 of 49 ountries pply defi nitions different from the interntionl stndrd of rod rsh deths s those ourring within 3 dys, ut insted use deth t the sene or within 7 dys of the rsh (Annex 3). Similrly, 1% of deths in CIS ountries re not tegorized y rod user type. This mkes interntionl omprisons diffi ult. Even mong ountries with good dt, there re disrepnies etween helth setor dt from deth ertifi tion nd hospitliztion ompred with polie reports. Moving forwrd to improve informtion systems Adopt the 3-dy definition of rod trffi ftlity ross different setors throughout Europe. Improve dt linkge etween helth, the trnsport setor nd polie. Stff trining is needed to ensure tht dt olletion, nlysis nd dissemintion re timely nd urte. Photo Istokphoto 15

28 3.5 The eonomi osts of rod trffi injuries Rod trffi deths nd injuries hve vst osts. Dt re olleted using severl methods, ut 14 of the ountries use similr method. 31 This shows tht the eonomi urden per person of rod trffi injuries vries gretly ross the Region nd is usully higher in ountries with higher inome (Fig. 6). There ould, however, still e differenes in interpreting 3 Gross output method: the ost omponents n e divided into the osts of resoures onsumed euse of rsh (property dmge osts, helth re osts nd dministrtion osts) nd osts resulting from loss of future output (sene from work, long-term disility or deth). Eonomi osts reported y ountries were djusted for infl tion using 27 s se yer nd onverted into euros t the exhnge rte on 31 July 28. defi nitions. This limits the reliility of omprison etween ountries. Although these re rough estimtes, their gretest vlue is in ompring within-ountry osts of rod trffi injuries with expenditure on strtegies for prevention (see setion 3.6.2). The estimted eonomi urden of rod trffi injury rnges from.4% to 3.1% of GDP. Some ountries lso reported estimted osts per deth in n ttempt to express the ost of humn life in monetry terms (Annex 6). Fig. 6. Costs (in euros) of rod trffi deths nd injuries per person, gross output method, seleted ountries in the WHO Europen Region Switzerlnd Ielnd rwy Itly Germny Czeh Repuli Isrel Frne Polnd Estoni Ltvi Slovki Belrus MKD Costs (in euros) Dt hve een djusted for infl tion, pplying, where neessry, proper infl tion or disount rte nd using 27 s the se yer. Conversion to euros ws performed using the exhnge rte of 31 July 28. Moving forwrd to improve osting More ountries in Europe need to ondut ntionl osting studies on rod rshes. These should inlude oth diret nd indiret osts. Stndrdized definitions nd methods re needed to mke dt more omprehensile nd omprle. Photo Istokphoto 16 EUROPEAN STATUS REPORT ON ROAD SAFETY

29 3.6 Led geny nd ntionl strtegy on rod sfety More ountries need ntionl strtegy for rod sfety A led geny on rod sfety hs een proposed s eing importnt for oordinting multisetorl response (4). Ninety per ent of the ountries surveyed hve led geny (Tle 2). Generlly, these re either interministeril odies or operte within single ministry. In the ltter se, lmost ll the led genies operte within the trnsport ministry, exept for CIS ountries, where the led genies operte within the interior ministry. strtegy. For exmple, ll EU ountries hve greed to implement the 5% redution in rod trffi injury deths y 21 ompred with 2 s highlighted in the Europen Rod Sfety Ation Progrmme (25). Hving suh trget hs proven to e useful stimulus for tion, nd mid-term review (29) onluded tht ountries needed more onerted tion to hieve the redution in mortlity. However, mny other ountries in the Region do not hve esily mesurle trgets (Annex 5), reting diffi ulty in monitoring nd evluting implementtion. Further, some ntionl strtegies do not hve ler udgets inditing how ertin tivities will e funded. Isrel s ntionl strtegy (3) presents good exmple of udget pln (Box 7). Only 76% of the ountries surveyed hve multisetorl nd multidisiplinry strtegy on rod sfety, s reommended y the World report on rod trffi injury prevention (4). One qurter either hve no strtegy or hve strtegy tht does not engge other prties. Fewer lownd middle-inome ountries thn highinome ountries hve multisetorl strtegy or funded rod sfety geny (Tle 2). Box 6 presents n exmple from rwy s Ministry of Trnsport nd Communitions, whih effetively oordintes rod sfety efforts through intergeny tivities nd joint plnning. Setting short- nd long-term trgets using mesurle inditor helps rod sfety genies nd odies in mesuring nd monitoring the implementtion of Tle 2. Led geny nd ntionl strtegy on rod sfety y ountry inome level High inome Low nd Totl middle inome n % Led geny Interministeril Within government Other geny Totl Ageny funded Countries with geny Ntionl strtegy, formlly pproved , not endorsed Multiple Totl