Vertical 3D Gold
|
The Road Traffic Injury Epidemic in the Developing World
A Role for Orthopaedic and Trauma Surgeons
The Unseen Epidemic
Beginning in the 1970s, road safety improvements in North America, Europe, Japan, Australia, and New Zealand resulted in significant reductions in the rates of motor vehicle fatalities. Control of drunk driving, the mandatory use of child-restraint devices and seat belts, and improvements in passive protection, such as airbags, have further reduced the number of deaths and the severity of injury. The situation is quite different, though, in the developing world where a growing number of accidents on the roads have caused the problem to reach epidemic proportions. In the highly motorized countries, the occupants of cars are the primary victims of traffic accidents. In the developing, newly motorizing countries, the majority of deaths and injuries are sustained by vulnerable road users such as pedestrians, bicyclists, motorcycle and scooter riders, and passengers on public transportation. They travel together on the same roads with buses, trucks, and cars, in a chaotic traffic stream. Mismatched collisions between the unprotected humans and the heavy vehicles cause frequent death and serious injury, even at lower speeds. Unlike the developed countries where cars are the predominant mode of private transportation, in the newly motorizing countries, more affordable motorcycles and scooters are being purchased and are joining the unregulated traffic stream in large numbers. The resulting explosive 16-18% vehicle growth rate in many Asian countries will lead to doubling of the fleet in five years and a trebling in eight years, causing even more severe problems. Not separating the various road users, sparse traffic safety laws, inadequate police enforcement, absence pre-hospital emergency care, and limited resources for acute hospital and rehabilitative care are additive factors explaining the frequency of accidents and their devastating consequences.
The Size and Significance of the Problem
Annually, 800,000 people die and 10-15 million are injured or permanently disabled from accidents on the world’s roads. Under- reporting of injuries is common in the developing world and these estimates may represent only half the true number. Seventy five percent of the fatalities and injuries occur in the developing world and the problem is growing. A five year study, published in 1996, entitled "The Global Burden of Diseases and Injury" by researchers from the Harvard School of Public Health and WHO examined the relative significance in terms of death and disability of the major health conditions and projected changes between 1990 and 2020. A startling finding of this report was the prediction that road traffic accidents would move from ninth place to third place on the list as a cause of worldwide death and disability. In this position, it would be exceeded only by heart disease and unipolar major depression. By comparison, War will rank eighth and HIV tenth. In its 1998 annual report, The International Federation of Red Cross and Red Crescent Societies (IFRC) recognized road traffic accidents as a major global health problem, equal in magnitude and seriousness to wars and natural disasters. They recommend that this global epidemic requires urgent attention.
The Economic Impact
The World Bank estimates that the annual cost of traffic accidents in the developing countries is 100 billion US dollars. As the combination of all forms of foreign loans and aid totals 60 billion US dollars, it is clear that road traffic accidents are seriously undermining economic and social development in these countries. The trauma victims are often young males who are the workers and wage earners in their families. When they are killed or disabled, there is a profound effect on their entire family. In some countries, unfavorable customs and laws do not provide for the widows of those killed and the accident leads also to the break- up of the family. To lessen the human suffering and decrease the negative economic influence of road traffic accidents, in 1999 the World Bank Group and IFRC formed the Global Road Safety Partnership (GRSP) . Under the framework of the World Bank - Business Partners for Development - this collaborative initiative brings together business, government, and civilian societies to conduct focused projects and safety campaigns.
A Role for Orthopaedic and Trauma Surgeons
Severe musculoskeletal injuries are common in vulnerable road users such as pedestrians and cyclists. Sequelae of these injuries are often the principal determinant of disability and economic losses for the survivors of road traffic accidents. As primary care givers for these devastating injuries, orthopaedic and trauma surgeons can have a pivotal role in the control of the global road safety problem. Because its membership represents 103 countries, and improving education and patient care in the developing countries have always been part of its mission, SICOT has established a Trauma Committee to work on the problem of road traffic injury reduction. The GRSP has agreed that the SICOT Trauma Committee should serve as their principal interface with the world orthopaedic community. The committee will also play a lead role with this problem on behalf of the Bone and Joint Decade 2000-2010. The Committee will develop initiatives in both prevention and treatment. Improvement of surveillance systems to allow collection of accurate, standardized information on accidents, fatalities, and injuries is a priority. The number of education programs, which transfer useable knowledge on prevention and treatment from the developed to the developing countries, must be increased. Surgeons must also be recruited to volunteer through the International Center for Orthopaedic Education in programs such as Orthopaedics Overseas and World Orthopaedic Concern. Efforts must be made to procure medical supplies and education material for emerging nations. Descriptions of successful road safety programs in developing countries must be collected and shared through the GRSP to encourage best practices. In addition, the world orthopaedic community must support their colleagues in developing countries in their efforts to advocate the priority of road safety to their governments. As witnesses to the carnage, they can attest to the unnecessary pain and suffering endured. Their moral authority and prominence as influential members of society will allow them to be powerful advocates for change.
A nucleus of orthopaedic and trauma surgeons, from a variety of countries, who have previously worked on the problem of road safety has been assembled to form the SICOT Trauma committee. Because of the global and expanding nature of the road safety problem, the Committee must be expanded. Although this Committee is operating under the auspices of SICOT, membership in this organization is not initially necessary for participation.
The goal is the development of a network of activists, with representatives in all countries, who will work together to control the epidemic.
If you are experienced in working with your government on road traffic injury control or would like to become involved, your help is needed on the Bone and Joint Decade and SICOT Trauma Committee- World Bank Global Road Safety Partnership Collaboration
Please contact me to express your interest in serving.
Bruce D Browner, MD
Member International Bone and Joint Decade Steering Committee
Chairman SICOT Trauma Committee
Professor and Chairman, Department of Orthopaedic Surgery
University of Connecticut Health Center
10 Talcott Notch Rd.
Farmington, CT 06034-4037
USA
(860)679-6655
(860)679-6649 FAX
e-mail: browner@nso.uchc.edu
|
|