Towards a global framework for transport, health and health equity.

This study derives a generalised global framework for transport, health and health equity, based on a synthesis of 94 urban transport and health frameworks. The framework emphasises factors related to health equity, which are generally ignored in existing conceptual frameworks on the relationship between transport and health. While some factors such as travel behaviour were included in most reviewed frameworks, climate change and other macro-level factors were included in less than a quarter of frameworks, and health equity was included in less than 10%. We developed a framework that includes key framework components identified by a scoping review, as well as addressing important gaps. This framework can be utilized to inform work on transport, health and health equity by different agencies such as the World Health Organization. It can be used to guide health sector engagement with transport issues to lead to healthier and more equitable transport decision-making globally.

Global road safety 2010-18: An analysis of Global Status Reports.

BACKGROUND: Road traffic injuries (RTIs) pose a significant health burden with 1.35 million individuals dying on the world's roads annually. Nearly a decade ago, based on agreed road safety indicators, global commitments were encouraged to dramatically reduce this burden as part of the United Nation's Decade of Action for Road Safety 2011-2020. METHODS: The analysis was based on global level data from three Global Status Reports on Road Safety published by the World Health Organization in 2013, 2015, and 2018. A total of 161 countries that consistently reported statistics for all three reports were included in the analysis. Descriptive analyses, t-test, Wilcoxon rank-sum test, and Spearman's rank correlation were performed to evaluate past and current trends in road traffic deaths and countries' progress in achieving key road safety indicators. RESULTS: We found no significant decline in global road traffic death rates from 2010 to 2016 and in fact, death rates increased in low-income countries (LICs) and the African Region. Death rates were highly dependent on income level of the country, with deaths higher in low- and middle-income countries (LMICs) when compared to high-income countries (HICs). We found that the strength of enforcement of speed laws and child restraint laws increased from 2011 to 2017. However, we did not find a correlation between enforcement of the five key prevention policies (speeding, drink-driving, seatbelts, helmets, and child restraints) and death rate. In terms of advancement in achieving key road safety indicators, there was slow progress in adopting most of the recommended policies and practices based on the five pillars (road safety management, safer roads and mobility, safer vehicles, safer road users, and post-crash response). CONCLUSION: Despite global efforts during the past decade, road traffic deaths remain disproportionally high in LMICs and African countries as shown by global reports, and progress in achieving global road safety indicators is slow. Countries need to greatly accelerate the implementation of interventions proven to reduce RTIs in order to meet the goals of the second Decade of Action for Road Safety.

Positioning Africa's public health doctoral students to lead societal transformation and development.

The public health context is becoming increasingly more complex requiring highly trained professionals equipped with knowledge, competencies and tools to address or transform current and future challenges. Doctoral degree training offers an opportunity to build the capacity to detect and respond to such dynamic health challenges. In this paper, we discuss how Africa's public health doctoral students can be better positioned for the different career pathways to provide leadership on complex health and development challenges. Public health PhD graduates can take up careers in academia, civil service, private sector and civil society, among others. To thrive in these pathways, PhD training should equip them with knowledge, skills and competencies in leadership, creativity and social competence among others. To produce career-ready PhD graduates, there is need to rethink training curricula to build critical skills for diverse career pathways, introduce students to entrepreneurship, and enhance linkages between universities and industry. Experiential learning, exposure to networks and partnerships, postdoctoral programmes and mentorship and exchange programmes can further equip PhD students with key knowledge, skills and competencies. For students to position themselves for the different careers, they ought to plan their careers early, albeit with flexibility. Students should build their soft skills and embrace technology among other transferable competencies. By identifying potential career pathways and being positioned for these early, Africa can produce transformative PhD students on a path for success not just for themselves but for society at large, including in new environments such as that created by COVID-19.

Content analysis of reported activities of the United Nations Road Safety Collaboration Members during the Decade of Action for Road Safety 2011-2020.

OBJECTIVE: Several activities were planned for the Decade of Action (DOA) for Road Safety 2011-2020, covering key policies and interventions on road safety. Knowledge of the activities implemented by key actors is currently lacking in the literature. This study answers the question: what activities were implemented during the DOA by the United Nations Road Safety Collaboration (UNRSC) members? DESIGN: The study used content analysis techniques to extract and analyse information from five United Nations Secretary General's reports, which summarise the activities reported by UNRSC members. SETTING: The primary setting for this study are 116 countries in which activities supporting the DOA were conducted. OUTCOME MEASURES: Frequency of themes and subthemes that emerged from reported activities are identified and cross-tabulated by year of report, country level of income, geographical region and organisation type. RESULTS: Over the entire DOA, establishment of institutions and lead agencies as well as the development of national strategies featured prominently under the theme of management. This theme was steadily reported across regions, country income level and organisation type. Workshops, training and major events regarding road safety increased in frequency of reporting throughout the decade as did developing and promoting the basic road and vehicle systems supportive of road safety. It is further noted that other key activities like infrastructure and behaviour change that are required for a balanced approach to road safety policy were also attended to by various organisations. Activities related to road safety enforcement and post-crash response as well as activities in low-income countries appeared to be less reported. CONCLUSION: The wide range of activities reported by UNRSC members over the entire DOA need to be sustained and evaluated in years to come if they are to have a significant impact on reducing road traffic deaths and injuries at national and international levels.

Bold actions needed to improve civil registration data for road traffic deaths.

Persisting problems of underreporting and poor quality of road traffic mortality data exist. Bold and sustained actions need to be undertaken by countries to improve civil registration data collection and reporting. Countries need to implement three specific actions to improve civil registration and vital statistics data systems and/or road traffic injury data collection:Ensure that civil registration and vital statistics systems produce high-quality cause of death data by working with the health sector to improve medical certification of cause of death and statistical coding in line with the International Classification of Diseases.Adopt a consistent definition of a road traffic death for use in police databases, particularly in countries with incomplete civil registration and vital statistics data, where police data are the most reliable source of informationLink data sources - including civil registration records, police data, health records, insurance data - to improve official road traffic fatality estimates while ensuring the privacy of individual identification.

Save LIVES technical package: 22 interventions that could make a difference.

The Save LIVES: a roadsafetytechnical package was produced and launched in May 2017 by the WHO to support road safety decision makers and practitioners in their efforts to significantly reduce the number of road traffic deaths in their countries. This Special Feature explains the process used to develop the package and how and why the 22 interventions were included. It concludes by encouraging researchers and practitioners to tailor their road safety packages to their own realities by following five practical steps.

Time to prioritise safe walking.

This study draws on information from two recently published documents on pedestrian safety and global status of road safety to draw attention to the need to prioritize safe walking in planning and policy at local, national and international levels. The study shows that each year, more than 270 000 pedestrians lose their lives on the world's roads. The study argues that this situation need not persist because proven pedestrian safety interventions exist but do not attract the merit they deserve in many locations. The study further shows that the key risk factors for pedestrian road traffic injury such as vehicle speed, alcohol use by drivers and pedestrians, lack of infrastructure facilities for pedestrians and inadequate visibility of pedestrians are fairly well documented. The study concludes that pedestrian collisions, like all road traffic crashes, should not be accepted as inevitable because they are, in fact, both predictable and preventable. While stressing that reduction or elimination of risks faced by pedestrians is an important and achievable policy goal, the study emphasizes the importance of a comprehensive, holistic approach that includes engineering, enforcement and education measures.

Pattern of pedestrian injuries in the city of Nairobi: implications for urban safety planning.

Pedestrians are overrepresented in road traffic injuries and deaths in Nairobi, the capital city of Kenya, yet little research has been done to provide better understanding of the characteristics of pedestrian injuries. This paper presents the data obtained from road traffic injury admissions to Kenyatta National Hospital (KNH) over a 3-month period starting from 1 June to 31 August 2011. A total of 176 persons involved road traffic injuries in Nairobi were admitted to KNH during this period. Pedestrians comprised the highest (59.1 %) proportion of road traffic injury admissions, followed by motor vehicle passengers (24.4 %) and motor cyclists (9.7 %). Bicyclists and drivers accounted for 5.1 and 1.7 %, respectively. Cars (39.4 %) were the leading category of motorized four-wheeler vehicles that were involved in collisions with pedestrians, followed by matatus (35.5 %). Seventy percent of pedestrians were hit while crossing the road, 10.8 % while standing by the road, and 8.1 % while walking along the road. The highest proportion of pedestrian crashes occurred on Saturdays (25.5 %) and Sundays (16.7 %). Most of the pedestrian injuries (67.7 %) affected the limbs. The paper argues that safety of pedestrians should be a priority in road safety efforts in the city of Nairobi. Urban road safety planners should adopt existing cost-effective interventions to improve the safety of pedestrians such as area-wide traffic calming to limit the speeds of motor vehicles to 30 km/h, providing sidewalks for pedestrians, traffic calming in residential neighborhoods, people-and-not-car-oriented urban road designs, traffic education, and enforcement of traffic regulations.

Pattern of road traffic injuries in Lublin County, Poland.

BACKGROUND: Road traffic injury patients admitted to 35 hospitals in Lublin region. OBJECTIVE: To describe the pattern of road traffic injuries in Lublin county, Poland. METHODS: Review of medical records for the period from January 2004 to December 2005. RESULTS: Pedestrians accounted for the largest share of the Road traffic crash (RTC) injury cases (35.8%) and 46.4% of deaths. The highest mortality was observed in motorcycle occupants (7.1%) and victims with abdominal injuries (9.8%). Vulnerable road users represented 71.4% of all RTC deaths, with mortality 5.8%. Early transfers accounted for 82.5% of cases. Mortality in early transfers is 4 times higher than in late transfers. CONCLUSIONS: Poland ranks as one of the worst European countries in terms of severity and fatal outcomes of road traffic injuries. Groups of road users in Poland at the highest risk are pedestrians, cyclists, children and young male drivers. The highest mortality rate occurs among road users affected by multiple trauma and head/vertebral column injuries. Alleviation of consequences of road traffic injuries in Poland may be achieved by coordinated efforts and collective responsibility of government, central level agencies, rescue team members and community groups.

Road traffic injuries in Kenya: magnitude, causes and status of intervention.

Road traffic crashes exert a huge burden on Kenya's economy and health care services. Current interventions are sporadic, uncoordinated and ineffective. This report offers a descriptive analysis of secondary data obtained from a variety of published literature and unpublished reports. Over three thousand people are killed annually on Kenyan roads. A four-fold increase in road fatalities has been experienced over the last 30 years. More than 75% of road traffic casualties are economically productive young adults. Pedestrians and passengers are the most vulnerable; they account for 80% of the deaths. Buses and matatus are the vehicles most frequently involved in fatal crashes. Characteristics of crashes vary considerably between urban and rural settings: pedestrians are more likely to be killed in urban areas, whereas passengers are the majority killed on intercity highways that transverse rural settings. Road safety interventions have not made any measurable impact in reducing the numbers, rates and consequences of road crashes. Despite the marked increase in road crashes in Kenya, little effort has been made to develop and implement effective interventions. Impediments to road traffic injury prevention and control include ineffective coordination, inadequate resources and qualified personnel, and limited capacity to implement and monitor interventions. There is need to improve the collection and availability of accurate data to help in recognising traffic injury as a priority public health problem, raising awareness of policymakers on existing effective countermeasures and mobilizing resources for implementation. Establishment of an effective lead agency and development of stakeholder coalitions to address the problem are desirable.