1.3. Understanding the Global Road Trauma Crisis

Authors #

Dr Judy Fleiter, The George Institute for Global Health 

Emeritus Professor Barry Watson, Queensland University of Technology 

Reviewers #

Dr Prerana Arora Singh, Nirwan University Jaipur 

David Cliff, Global Road Safety Partnership 

 

Acknowledgements #

Margie Peden, The George Institute for Global Health 

This chapter is dedicated to Dr Margie Peden (1962 – 2026), a champion of global road safety efforts and a pioneer in evaluating and documenting the global road trauma burden and crisis. Between 2000-2017, Margie coordinated the Unintentional Injuries Prevention unit at the World Health Organization. During this time, she was the executive editor of the World report on road traffic injury prevention (2004) and the World report on child injury prevention (2008) and coordinated the World Health Organization contributions to the Bloomberg Initiative for Global Road Safety and the first three global status reports on road safety.

Abstract  #

This chapter outlines the scale and nature of the global road trauma burden, including road fatalities and serious life-changing injuries which have ongoing personal, economic and societal consequences. There is significant discrepancy in how road trauma is experienced across the world, with low- and middle-income countries experiencing higher fatality rates than high-income countries. More than 90% of all road fatalities occur in low-income and middle-income countries, despite having only 48% of the world’s registered vehicles. Despite deficiencies in global crash fatality and serious injury data, it is clear that theburden of road trauma is influenced by regional, country-income level, and socio-demographic factors. This chapter describes the relative contribution of road crashes to the global burden of injury and discusses a range of factors contributing to the global road trauma crisis. The key recommended action areas from the Global Plan for the Second Decade of Action 2021-2030 are discussed (multimodal transport and land-use planning, safe road infrastructure, safe vehicles, safe road use, and post-crash response), with particular relevance to addressing road safety in the context of issues facing many LMICs. The chapter concludes with discussion on road safety as a global development issue and some contemporary challenges to improving road safety outcomes. 

1. Introduction #

Together with the preceding chapter which outlines key moments in the history of road safety, this chapter is designed to provide a foundation for the Body of Knowledge (BoK). The chapter outlines the scaleand nature of the global road trauma burden and discusses the impact of that burden across a variety of socio-demographic, regional, road use, and country income level categories, drawing primarily on data produced in the series of global status reports on road safety published by the World Health Organization (WHO). It describes deficiencies in road crash fatality and serious injury data, the relative contribution of road crashes to the global trauma burden of injury and provides information to compare the road trauma burden with harm caused by other disasters and hazards. This chapter also provides information on contemporary road safety challenges, including some that are particularly relevant to the low- and middle-income (LMIC) country context.

2. Scale and nature of the road safety problem  #

As described in the preceding chapter, the immense scale of the global road trauma burden started to gain attention throughout the 1990s, and international organisations drew attention to the problem through a series of publications and actions. The World Report on Road Traffic Injury Prevention (WHO, 2004) reported that: 

“road traffic injuries are a major but neglected global public health problem, requiring concerted efforts for effective and sustainable prevention. Of all the systems that people have to deal with on a daily basis, road transport is the most complex and the most dangerous. Worldwide, the number of people killed in road traffic crashes each year is estimated at almost 1.2 million, while the number injured could be as high as 50 million – the combined population of five of the world’s large cities. The tragedy behind these figures regularly attracts less media attention than other, less frequent but more unusual types of tragedy. What is worse, without increased efforts and new initiatives, the total number of road traffic deaths worldwide and injuries is forecast to rise by some 65% between 2000 and 2020, and in low-income and middle-income countries deaths are expected to increase by as much as 80%”. (p.3)

The trend in road traffic fatalities continued to rise to an estimated 1.35 million fatalities in 2016, and has declined over time. The number of people injured is more difficult to quantify, but it has been estimated that up to 50 million people worldwide are injured in road crashes annually (WHO, 2021). The trauma burden from road crashes is far-reaching and includes a broad range of physical, psychological and functional harms experienced by individuals or populations as a consequence of road crashes, including fatal and non-fatal injuries, disability, and their ongoing personal, economic, and societal consequences (McClain-Nhlapo et al.; WHO, 2016). 

Accurately assessing the full scale of harm from road crashes is challenging because of deficiencies in estimated global crash fatality data and the lack of serious injury data. Both issues have led to substantial under-reporting of deaths and injuries (Harrison et al., 2023; WHO, 2023). Fatality information cited in the WHO Global Status Reports is not taken directly from police records but is derived from modelling that supplements government-reported figures with higher-quality health/hospital data or, where unavailable, with covariates from surveys and published sources. This approach has revealed stark discrepancies: in 2016, under-reporting of road fatalities was estimated at 84% in low-income countries, 51% in middle-income countries, and 11% in high-income countries. These findings highlight that even death counts, the most reliable component of road safety statistics, are systematically underestimated worldwide. The gap widens dramatically when serious injuries are considered, with reporting rates often falling below 50% (Wambulwa  et al., 2019). 

Given these data limitations, the most viable method for approximating the scale of serious injuries is to relate them to fatalities, which are comparatively better captured. Estimates vary across contexts: the World Bank and other studies have suggested a ratio of around 10 serious injuries per fatality as a baseline, while systematic reviews of population health data point to 20:1, and in some high-income countries estimates rise as high as 50:1. Analysis of 23 Organisation for Economic Co-operation and Development (OECD) member countries places the mean at 46 injuries per fatality, with approximately six serious injuries per fatality, though the upper range extends to 31 serious injuries per death when using the MAIS3+ (Maximum Abbreviated Injury Scale) severity definition. In LMICs, the ratios are even higher, with estimates ranging from 1:4 to 1:66 depending on whether hospitalised cases or broader injury measures are used. Applying corrections for fatality under-reporting (30–50%) to OECD averages suggests that a working ratio of approximately 15:1 between serious injuries and fatalities is a reasonable global estimate (Wambulwa et al., 2019; OECD/International Transport Forum [ITF], n.d.). These ratios are not definitive because they vary with motorisation rates, trauma care systems, and the extent of reporting biases. However, they provide a necessary corrective mechanism to address reliance on recorded fatalities. By linking injury counts to more reliable fatality estimates, countries can begin to quantify the otherwise hidden burden of serious injuries, improving their ability to allocate resources, design evidence-based interventions, and more accurately assess the true human and economic costs of road crashes.

Monitoring of road crash fatalities has been at the forefront of global road safety activities, with significant proportions of research and policy work focused almost exclusively on deaths. This is understandable, given the greater certainty of fatality reporting, the profound human cost of death, and the ability of fatality data to command public and political attention. However, this focus has come at the expense of road crash serious injuries, which occur in far greater numbers and carry substantial economic and social costs. The actual burden of serious injuries remains unknown in many countries due to systemic weaknesses in reporting, varying definitions of severity, and the absence of comprehensive trauma registries. While the recording of fatalities is imperfect, the under-reporting of serious injuries is far worse, meaning that reliance on official data alone presents a profoundly incomplete picture of road trauma (Wambulwa et al., 2019).

Despite these difficulties with data, a series of status reports published by the World Health Organization since 2009 documents changes in fatalities, injuries, and road safety-related legislation and provides a snapshot of individual country performance over time (WHO, 2009). More information about data trends for regions and individual countries and can be found from the WHO Road Safety Data application that is freely available (see Figure 1). vernment-reported figures with higher-quality health/hospital data or, where unavailable, with covariates from surveys and published sources. This approach has revealed stark discrepancies: in 2016, under-reporting of road fatalities was estimated at 84% in low-income countries, 51% in middle-income countries, and 11% in high-income countries. These findings highlight that even death counts, the most reliable component of road safety statistics, are systematically underestimated worldwide. The gap widens dramatically when serious injuries are considered, with reporting rates often falling below 50% (World Bank, 2019).  

Given these data limitations, the most viable method for approximating the scale of serious injuries is to relate them to fatalities, which are comparatively better captured. Estimates vary across contexts: the World Bank and other studies have suggested a ratio of around 10 serious injuries per fatality as a baseline, while systematic reviews of population health data point to 20:1, and in some high-income countries estimates rise as high as 50:1. Analysis of 23 OECD countries places the mean at 46 injuries per fatality, with approximately six serious injuries per fatality, though the upper range extends to 31 serious injuries per death when using the MAIS3+ (Maximum Abbreviated Injury Scale) severity definition. In LMICs, the ratios are even higher, with estimates ranging from 1:4 to 1:66 depending on whether hospitalised cases or broader injury measures are used. Applying corrections for fatality under-reporting (30–50%) to OECD averages suggests that a working ratio of approximately 15:1 between serious injuries and fatalities is a reasonable global estimate (World Bank, 2019; OECD/ITF, n.d.). These ratios are not definitive because they vary with motorisation rates, trauma care systems, and the extent of reporting biases. However, they provide a necessary corrective mechanism to address reliance on recorded fatalities. By linking injury counts to more reliable fatality estimates, countries can begin to quantify the otherwise hidden burden of serious injuries, improving their ability to allocate resources, design evidence-based interventions, and more accurately assess the true human and economic costs of road crashes. 

Monitoring of road crash fatalities has been at the forefront of global road safety activities, with significant proportions of research and policy work focused almost exclusively on deaths. This is understandable, given the greater certainty of fatality reporting, the profound human cost of death, and the ability of fatality data to command public and political attention. However, this focus has come at the expense of road crash serious injuries, which occur in far greater numbers and carry substantial economic and social costs. The actual burden of serious injuries remains unknown in many countries due to systemic weaknesses in reporting, varying definitions of severity, and the absence of comprehensive trauma registries. While the recording of fatalities is imperfect, the under-reporting of serious injuries is far worse, meaning that reliance on official data alone presents a profoundly incomplete picture of road trauma (World Bank, 2019). 

Despite these difficulties with data, a series of status reports published by the World Health Organization since 2009 documents changes in fatalities, injuries, and road safety-related legislation and provides a snapshot of individual country performance over time. More information about data trends for regions and individual countries and can be found from the WHO Road Safety Data application that is freely available (see Figure 1).  

The 2009 Global Status Report provided ‘baseline’ information from 178 countries using data collected via a 2008 survey and the overall findings were: 

• annually, more than 1.2 million people die each year on the world’s roads, with between 20 and 50 million more suffering non-fatal injuries; 
• in most regions of the world, road traffic injuries are increasing; 
• low-income and middle-income countries have higher road traffic fatality rates (21.5 and 19.5 per 100 000 population, respectively) than high-income countries (10.3 per 100 000); and 
• more than 90% of global road fatalities occur in low-income and middle-income countries, which have only 48% of the world’s registered vehicles. 

The most recent global status report (2023) used data collected in 2021 and confirmed that road crashes remain an acute problem in LMICs, still accounting for more than 90% of all fatalities worldwide (WHO, 2023). The 2023 report noted that global road traffic deaths had decreased slightly since publication of the previous report (2018), from 1.25 million to 1.19 million people per year (WHO, 2018a). 

As already discussed, fatalities are only one aspect of road trauma. Life-altering injuries and the consequences of an associated disability must also be considered in assessing the personal, economic and societal impact of road crashes, as well as policy responses to them. Economic impact considerations must include the cost of post-crash response, provision of hospital and rehabilitation services (acute and ongoing), insurance costs, and loss of productive working life. The WHO estimated that the burden of non-fatal road traffic injuries on lost productivity, globally, is greater than the burden attributable to fatal injuries (McClain-Nhlapo et al., 2024). A common method to estimate this impact is Disability-Adjusted Life Years – DALY – with one DALY representing the loss of one year of full health. This metric can be separated into Years of Life Lost (YLL; i.e., the loss from a premature death), and Years Lived with Disability (YLD; i.e., the loss from living with a disability that was caused by the injury) (Lin, 2016; McClain-Nhlapo et al., 2024). Examples of injury-related, ongoing costs associated with disability from road traffic crashes can be found in the country case studies provided in a recent World Bank publication (see McClain-Nhlapo et al., 2024). Apart from these immense human costs, the 2023 Global Status Report (WHO) noted that road crashes cost most countries 3% of gross domestic product and also provided updated information across a range of socio-demographic and road use indicators, as summarised below.

2.1 Road user type  #

The group representing the highest proportion of all global road fatalities was 4-wheel vehicle occupants at 30%, followed by pedestrians (23%), powered 2- and 3-wheeler users (21%), and cyclists (6%). The remaining 20% of fatalities represented occupants of vehicles carrying more than 10 people, heavy goods vehicles, and ‘other’ users (including powered personal micromobility options such as e-scooters) and ‘unknown’ user types. The proportion of overall fatalities within each of these road user groups varies across regions of the world.  For instance, as seen in Figure 2, powered 2- and 3-wheeler uses represent the greatest number of road fatalities in the South-East Asia Region and Region of the Americas (48% and 28%, respectively), whereas occupants of 4-wheelers are proportionately higher in the European Region (49%) and Eastern Mediterranean Region (33%).  

2.2 Age, sex, and ethnicity #

Road traffic injuries were the leading cause of death for children and young adults aged 5–29 years and the 12th leading cause of death when all ages were considered. The burden of road traffic injuries among children falls overwhelmingly in LMICs, at 97% (United Nations Children’s Fund [UNICEF], 2022). Two thirds of global road traffic fatalities occurred among people of working age (18–59 years), and 19% occurred in people aged 60+ years. In general, road and vehicle design has not considered the unique physical and developmental needs of children (e.g., reduced visibility in the road environment due to smaller stature, and reduced cognitive capacity compared to adult road users which can mean inability to appropriately assess safe crossing distances speed of approaching vehicles).  

A consistent trend over time is that males are disproportionately impacted and are typically three times more likely to be killed in road crashes than females. Importantly, there are differences in the ways that crashes impact men and women, with contemporary discourse recognising the need for policy makers, practitioners, and advocates to consider equity, gender and accessibility issues when seeking to understand and tackle the road trauma burden in its entirety. For instance, historically, vehicle safety technologies (e.g., crash test dummies), were based on male characteristics only, creating potentially greater risk to women in the event of a crash (Afesojaye et al., 2022). Additionally, there are specific circumstances unique to women, girls, and people with a disability that create a range of challenges associated with safely mobility options. These challenges include lack of access to public transport within a safe walking distance and greater reliance on public transport among women, which can expose them to unwanted attention, harassment, and assault. Additionally, unsafe infrastructure options such as lack of safe passage for pedestrians, particularly in LMICs, can emphasise inherent inequities across age, sex, and ability levels (Afesojaye et al., 2022; UNICEF, 2022). 

Discrepancies in road trauma rates are also evident when ethnicity is considered, particularly in regard to First Nations populations (Crump et al., 2019; Williams et al., 2022). For instance, in Australia, Aboriginal and Torres Strait Islander people are three times more likely to die in a road crash when compared to other Australians. They are also disproportionately over-represented in pedestrian and passenger fatalities (Möller et al., 2025; National Road Safety Strategy, n.d.). A similar situation can be found in New Zealand, where road traffic injury rates were found to increase across various measures of socio-economic disadvantage, and in particular, road traffic injury risk was highest among Māori people of all ages and among children with Pacific ethnicity (Hosking et al., 2013).

2.3 Country income level differences and regional differences #

​​​There is great disparity in road fatalities across geographic regions and country income levels. The majority of fatalities (92%) occur in upper-middle, lower-middle, and low-income countries combined. Relative to the size of the vehicle fleet and road network, a disproportionately high number of fatalities occur in low-income countries (13% of global road fatalities), compared to high-income countries (8%). Figure 3 demonstrates these discrepancies across country income levels relative to population, paved inter-urban roads and registered vehicles.

Using WHO regional categories, the discrepancy across regions is clear from the figures shown below, with the South-East Asia region recording the highest absolute number and proportion of fatalities:

• South-East Asia Region: 330 222 deaths; 28% of global burden
• Western Pacific Region: 297 733 deaths; 25% of global burden
• African Region: 225 482 deaths; 19% of global burden
• Region of the Americas: 144 090 deaths; 12% of global burden
• Eastern Mediterranean Region: 125 781 deaths; 11% of global burden), and
• European Region: 62 670 deaths; 5% of global burden.

Since 2010, most regions have experienced reductions in road fatalities. However, the African region is the exception to this trend, with a 17% increase in the number of deaths since 2010 (WHO, 2023).

2.4 Future projections #

The global community has adopted an ambitious target – to reduce road traffic deaths and injuries by at least 50% by 2030. This is the target outlined in the Global Plan for the Second Decade of Action for Road Safety 2021-2030 (WHO, 2021). Meeting that ambitious target requires urgent and concerted action. As mentioned earlier, the 2023 Global Status Report noted that road traffic injuries were estimated to be the 8^th leading cause of death when all age groups were considered and are predicted to become the seventh leading cause of death by 2030 (WHO, n.d.). Together, these projections and the ambitious global target (50% reduction by 2030) highlight the critical need for action.

2.5 Relative contribution of road crashes to global trauma and burden of injury #

The impact of road trauma is considerable, when compared with other causes of death and injury. The information below provides context for comparison across other forms of harm. Data contained in the 2021 Global Burden of Disease study, published by the Institute for Health Metrics and Evaluation, reports trends in the leading causes of disease burden (i.e., the cumulative impact of loss of healthy life due to illness, injury, and dying prematurely) and projections of the future burden to 2050 (IHME, 2024). In 2010, road traffic injuries were the 6th leading cause, after neonatal disorders, ischemic heart disease, stroke, lower respiratory infections and diarrheal diseases (IHME, 2024). In 2020, road traffic injuries were listed as the 9th leading cause of disease burden worldwide, after neonatal disorders, ischemic heart disease, stroke, COVID-19, lower respiratory infections, chronic obstructive pulmonary disease, diabetes, lower back pain and diarrheal diseases (IHME, 2024). 

In 2021, COVID-19 had shifted to first ranking position, followed by ischemic heart disease, neonatal disorders, stroke, lower respiratory infections, chronic obstructive pulmonary disease, diabetes, other COVID outcomes, lower back pain, with road traffic injuries at position 10 (IHME, 2024, see Figure 4).

By 2022, road injuries were ranked at position 9 (one position higher than the previous year) after ischemic heart disease, neonatal disorders, stroke, lower respiratory infections, diabetes, chronic obstructive pulmonary disease, COVID-19, and lower back pain. The projection for 2050 is that road injuries will have fallen to the 13th leading cause of the global disease burden.

2.6 Comparison with other disasters #

The scale of the health burden from transportation-related incidents is significant, especially when compared with harm caused by other disasters and hazards (e.g., climate and weather, geophysical, and biological). The most recent World Disasters report to include transport-related disasters and hazards showed the scale of the burden. Transportation incidents (air, boat, train and road) represented the second largest proportion (24%) of disasters and hazards globally, after flooding (27%) (International Federation of Red Cross and Red Crescent Societies [IFRC], 2020; see Figure 5). It is acknowledged that road-related incidents are not the only transportation mode represented in the ‘transport accidents’ category in the human-induced disasters contained in the 2020 report. However, the scale of the harm associated with motorised human movement is significant.

3. Factors contributing to the global road safety crisis, with particular relevance to low- and middle-income countries (LMICs) #

As noted earlier, the largest burden of road trauma is in LMICs and, the global community adopted the ambitious target of reducing road traffic deaths and injuries by at least 50% by 2030 through the Global Plan for the Second Decade of Action for Road Safety 2021-2030 (WHO, 2023). Therefore, significant progress in reducing road-related deaths and injuries in LMICs is imperative if that target is to be met. The Global Plan outlined steps needed to achieve that target. It also recommended five action areas for all countries to focus on: 1) Multimodal transport and land-use planning, 2) Safe road infrastructure, 3) Safe vehicles, 4) Safe road use, and 5) Post-crash response. Each area is briefly discussed below, with particular relevance to addressing road safety in the context of issues facing many LMICs. Additional information on each topic can also be found in relevant chapters throughout the Road Safety BoK.

3.1 Multimodal transport and land-use planning #

Urbanisation has significantly contributed to the way we live, work, and move. More people are becoming city dwellers each year. It is estimated that by the 2050s, 2.5 billion people will be added to current city populations across the world, with most of this urbanisation occurring in Asia and Africa (WRI Ross Center for Sustainable Cities, 2024). This shift in the human landscape also brings changes and challenges to other aspects of society including employment, health care, education, social welfare, social mobility and transportation, as well as related increases in noise, light and air pollution.  Increasingly dense urban spaces, with the legacy of car-centric design, provide challenges to creating urban spaces that are conducive to safe and equitable mobility options (Global Designing Cities Initiative, 2016; ITF, 2020).

Rapidly increasing rates of motorisation, particularly in LMICs, are another challenge to improving road safety outcomes. Increased personal vehicle ownership brings greater personal mobility with increased access to services, recreation, employment, health care and general freedom of movement, but can also be accompanied by increased traffic congestion, pollution and exposure to road crashes. The Global Plan for the Second Decade of Action 2021-2030 calls for appropriate land use planning to consider travel demand management, transport mode choice, and the provision of safe and sustainable journeys for all, particularly for the healthiest and cleanest transport modes: walking, cycling and public transport – noting that these three transport modes are often the most neglected, especially in LMICs (WHO, 2021).

3.2 Safe road infrastructure #

The provision of roads and roadsides that are designed to eliminate or mitigate risks for all road users is critical. Safe and appropriately designed road infrastructure also facilitates movement from one transport mode to another (e.g., walking to public transport hub), and can enhance accessibility and equity to the transport network, especially for people with disabilities. As highlighted earlier in this chapter, unsafe infrastructure options, such as lack of safe passage for pedestrians, can emphasise inherent inequities across age, sex, and ability levels (Afesojaye et al., 2022; UNICEF, 2022).

The most recent Global Status report (WHO, 2023) noted that emphasis generally remains on building roads for the ever-increasing motor vehicle fleet, rather than accommodating other forms of road use, especially walking, cycling, and public transport. The report also highlighted that many new roads being constructed in LMICs do not meet recognised safety standards. The International Road Assessment Programme (iRAP) works globally, in partnership with governments, road authorities, mobility clubs, development banks, NGOs and research organisations to:

• inspect high-risk roads and develop Star Ratings, Risk Maps and Safer Roads Investment Plans
• provide training, technology and support that will build and sustain national, regional and local capability
• track road safety performance so that funding agencies can assess the benefits of their investments.

The iRAP assessment methodology provides safety assessments based on a star-based road safety scoring system from 0 to 5 stars (least safe to most safe). A 3-star road is generally recognised as the minimum acceptable rating for roads (new and old). Across all country-income levels, only 21% of roads in 82 countries attained a 3-star or higher rating when considering pedestrians, powered two- and three-wheelers, cyclists and passenger vehicles (WHO, 2023). This result presents a large challenge as well as a great opportunity to improve global road safety through improvements in road infrastructure.

3.3 Safe vehicles #

Gorham et al. (2022) provided a comprehensive discussion of the key development and safety issues relating to increasing motorisation rates, noting two major issues of concern with increasing demand of vehicle stock in LMICs: 1) the importation of second-hand vehicles that are often of substandard quality, and 2) the proliferation of ownership and use of powered two-wheelers (PTWs) which includes motorcycles, mopeds, scooters, and electric bikes (also known as e-bikes). Vehicle importation laws and policies influence the overall makeup of the vehicle fleet in every country. Between 2015-2018, the European Union, Japan, and the United States of America were the largest exporters of used light duty vehicles, representing 99% of all exports. The majority (70%) of these second-hand vehicles were exported to LMICs, with Africa importing the largest proportion (40%), followed by Eastern Europe (24%), Asia-Pacific (15%), the Middle East (12%) and Latin America (9%) (United Nations Environment Programme [UNEP], 2020). In many countries, a lack of regulation on imported vehicles, and limited or lack of vehicle safety standards, means that imported used vehicles create additional challenges to improving road safety outcomes and to controlling vehicle-related pollution and associated impacts on air quality (Gorham et al., 2022; Wegman et al., 2017). The WHO (2023) reported that 79 countries had no vehicle safety legislation and that only 35 countries had laws mandating all five core areas of vehicle safety equipment (seat belts and seat belt anchorages, front and side impact protection, electronic stability control, pedestrian protection, and braking systems).

The growing global motorcycle market is driven by factors such as increasing demand for affordable and efficient mobility options, especially in urbanised areas (WHO, 2022). PTWs offer essential family transport options and livelihood opportunities (e.g., motorcycle taxis) in many LMICs.  It is expected that the popularity of electric motorcycles will further accelerate, particularly in sub-Saharan Africa, although Asia remains the dominant market in motorcycle sales (Bezabeh et al., 2022; Smith et al., 2025). The most recent global status report reported that more than half of all road fatalities are among those most vulnerable on the road – pedestrians, motorcyclists and cyclists (WHO, 2023).  As such, the increasing trends in motorisation, especially in PTW and the importation of substandard quality vehicles, offers an increasing and alarming challenge for road safety, but also offers opportunities for action (WHO, 2022).  

3.4 Safe road users #

As documented and monitored in the global road safety status reports, not all countries are at the same point on the continuum of creating a safe road system. For example, laws pertaining to managing behavioural risk factors (e.g., non-use of restraints and helmets, speeding, impaired and distracted driving) are not consistent across countries or regions. The most recent global status report (2023) reported that 140 countries had legislation that meets WHO best practice guidelines (see Figure 6) for at least one of the five key behavioural risk factors (speeding, drink driving, and the non-use of motorcycle helmets, seat belts and child restraint systems). However, only seven countries had best practice legislation addressing all five (see Figure 7). To highlight the lack of attention to those most vulnerable on the road, consider the prevalence of legislation for child restraint systems (CRS) globally. The safety value of CRS is clear, and yet only 36 countries reported having laws that meet WHO best practice for CRS (WHO, 2023). Additionally, standards for safety products, such as child restraints and helmets, are not always present or well implemented (Global New Car Assessment Programme [GlobalNCAP], 2015; Griffiths et al., 2021; Smith et al., 2025), representing opportunities for improvement.

Implementation of behavioural interventions, such as those mentioned above, including appropriate enforcement of relevant laws, is inadequate in many countries. These implementation gaps also provide opportunities for improvement, especially in light of technological advancements such as automated enforcement options.

3.5 Post-crash response #

When a crash occurs, the responsiveness of post-crash care is time-critical and can be the difference between life and death. Many components are represented in appropriate post-crash response including: the initial alert signal (e.g., emergency call for assistance at the roadside), treatment at the scene and during transportation to hospital, followed by inpatient care and then post-hospital rehabilitation services and support. The justice and legal systems can also be considered as part of the post-crash response and play supportive roles in terms of ensuring financial and psychosocial protections for road crash victims (WHO, 2016). 

Inadequate post-crash response in many countries is hindering progress towards reducing fatalities and injuries. Areas to be addressed to enhance post-crash survivability include the lack of a universal access number (free call), first responders, hospitals, trained medical staff, rehabilitation services and ongoing training and capacity associated with these vital services (Delaney et al., 2024; WHO, 2018b). For instance, the 2023 Global Status Report on Road Safety indicated that only 97 countries reported having access to single or multiple emergency care service numbers that guarantee total country coverage for emergency response (WHO, 2023). An additional 18 countries reported having a single call number, but without national coverage. Certification of medical practitioners also requires attention – only 35 countries reported having national laws mandating the training, licensing or other certification processes for first health responders. These figures underscore the importance of enhancing post-crash responses to provide road crash victims with a better chance to survive. 

The body of evidence about what improves road safety outcomes across the many related disciplines and professions is large and growing. Answers to many of the challenges to preventing road crashes already exist (e.g., Global Road Safety Facility, 2022a; WHO, 2017). Yet in many instances, there is a lack of will by decision makers to establish appropriate laws and policies, and to implement them appropriately. In part, this may be due to the lack of prioritisation of road safety at the highest level until the 21st century. The need for senior leaders to act is evidenced by continued urging of the global road safety community through avenues including global ministerial conferences on road safety and associated declarations, UN global road safety resolutions, and UN Decades of Action for Road Safety. The previous chapter provided an outline and timeline of the development of these global initiatives.

4. Road safety as a global development issue and the global community’s response to improving road safety #

As described in the chapter on the history of road safety developments, awareness of the need to reduce the harm caused by road crashes has evolved over many decades. The attention given to this issue by governments has varied and, as noted above, the global road safety community continues to urge action at the highest level. 

During the 21^st century, road safety outcomes have been increasingly framed in terms of development and sustainability issues. At the turn of the century, the global community focussed its development efforts on widescale poverty reduction through the UN adoption of the Millenium Development Goals. Contained within the eight goals was the desire by world leaders in 2000 to “spare no effort to free our fellow men, women and children from the abject and dehumanizing conditions of extreme poverty” (United Nations, 2015a, p. 2). For fifteen years, efforts were centred around poverty reduction, universal primary education, gender equality and empowerment of women, reduced child mortality, improved mental health, combatting HIV, malaria and other diseases, environmental sustainability, and creating global partnerships to enhance development. 

As that fifteen-year period ended, attention turned to furthering the global development effort. In 2015, an expanded, ambitious development plan was announced: Transforming our world: The 2030 Agenda for Sustainable Development (United Nations, 2015b). This agenda contains 17 Sustainable Development Goals (SDGs) and 169 targets and highlights a broad range of areas that require urgent attention to ‘shift the world onto a sustainable and resilient path’ (p. 3), focussed around the core principles of: people, planet, prosperity, peace and partnership.

The goals are interlinked; improvements in one can assist with improvements in others. Importantly, for the first time, road safety was explicitly mentioned in the global development agenda and appears in two of the 17 goals:

• Goal 3.6: By 2020*, halve the number of global deaths and injuries from road traffic accidents.
• Goal 11.2: By 2030, provide access to safe, affordable, accessible and sustainable transport systems for all, improving road safety, notably by expanding public transport.

*Note that when the goals were developed in 2015, the timeline for achieving Goal 3.6 was 2020. In keeping with other timeframes contained in the development agenda, that goal now has a revised 2030 timeline.

A range of other SDGs have direct links to the road safety and safe mobility narrative. For example, 

• SDG 11.3: By 2030, enhance inclusive and sustainable urbanisation and capacity for participatory, integrated and sustainable human settlement planning and management in all countries.

Goals relating to gender equity (Goal 5), affordable and clean energy (Goal 7), decent work and economic growth (Goal 8), reduced inequalities (Goal 9), climate action (Goal 13) and partnerships for the goals (Goal 17) can all be linked to efforts to enhance road safety outcomes (e.g., see the Australasian College of Road Safety (ACRS) Policy Position Statement: Climate Change and Road Safety, 2023). This collective recognition of the need to reduce road trauma and the need to provide appropriate transport options offers opportunities for renewed impetus for action by all countries. Goal 17 encourages strong international partnerships and collaborations to ensure that the SDGs are met. These collaborations and partnerships include significant financial and capacity building contributions by philanthropic funders (e.g., Bloomberg Philanthropies, Fédération Internationale de l’Automobile [FIA] Foundation, Fondation Botnar) and the United Nations Road Safety Fund (UNRSF) that was launched in 2018. The UNRSF channels financial contributions towards scalable projects that extend their influence beyond borders, aiming to create safer roads and save lives regionally and globally. It targets low-and middle-income countries, with a focus on legislative gaps and domestic funding for road safety. 

Other important contributions to advance global road safety are made through multilateral development banks. Established in 2009, the Multilateral Development Banks’ Road Safety Working Group consists of 10 member institutions that support LMICs in their road safety financing needs. This working group works to harmonise investments in road safety, adopt common approaches among its members, and scale up financing in order to maximise impact (Global Road Safety Facility, 2025). 

Access to data is essential to track progress against road safety goals and targets. Reliable data collection, management and use require sustained investment as well as appropriately skilled personnel to enable data to inform road safety interventions and monitor their outcomes. At the global level, monitoring key road safety performance indicators is necessary to determine progress on the 2030 Agenda for Sustainable Development. Road Safety Observatories (RSO) play an important role in this regard. A network of regional RSOs serves as a global forum on improving road safety data, policies and practices and promotes collaboration between the various observatories including from Africa (ARSO), Europe (ERSO), Ibero-America (OISEVI), Asia and Pacific (APRSO), Western Balkans (WBRSO), Arab Integrated (AIRSO) and Eastern Partnership (EaPRSO). This regional approach is viewed as a mechanism to provide economies of scale and an opportunity for joint efforts to improve road safety data collection and develop data-related evidence-based policies and practices in the implementation of the SDGs.

5. Ongoing challenges #

The final part of this chapter discusses some of the challenges associated with sustained road safety improvements. As already discussed, there is a history of insufficient emphasis and attention by governments of many countries, despite the specific inclusion of road safety in the global development agenda since 2015. The lack of priority given to addressing road safety improvements, including in countries where it has previously been a priority issue, represents a key challenge for all road safety professionals and all communities (Hyder et al., 2022). Finding ways to keep road safety on the agenda is a role for all practitioners, policy makers, non-government organisations, and citizens.

Funding is another significant challenge to sustainable road safety improvements. This challenge is linked to the lack of government priority discussed above and the subsequent underinvestment in road safety (FIA Foundation, 2024). Substantial investments are needed to reach the 2030 targets. In many countries, a reliance on philanthropic funding and the failure of governments to integrate road safety investment into existing road and traffic management budgets, as well as into enforcement mechanisms has led to insufficient financial resourcing (Global Road Safety Facility, 2025). More catalytic financing that seeks to multiply investment impact by encouraging additional investment, and in particular, investment to create positive social and environmental impacts is needed (McInerney et al., 2024; Silverman et al., 2024). Private sector investment has played an important role in financing road safety, but more can be done. There is opportunity to create links between private sector financing and the development agenda to capitalise on the momentum within the sustainable finance movement and create synergies between road safety, sustainable mobility options, and climate outcomes (FIA Foundation, 2024; World Bank, 2022).

Another challenge impeding progress is the many widely held misperceptions about the benefits of improving road safety outcomes. One example is the belief that road crashes are ‘the inevitable collateral damage arising from economic development’ (Watson, 2016, p. 4). This misperception might contribute to the lack of governmental priority and funding seen in many countries. Another widely held misperception relates to the desire to manage speeds across the road network which can be misunderstood as a mechanism that will drastically increase travel times and create detrimental economic impacts. The Global Road Safety Facility created an online resource to provide evidence to refute many of these widely held myths and misperceptions, particularly those relating to managing speeds (Global Road Safety Facility, 2022b). Beliefs and misperceptions such as those outlined above can be difficult to overcome and require evidence to support alternative views. Evidence-based interventions with solid evaluation outcomes can assist in meeting this challenge. 

To date, the body of evidence has largely been generated by research conducted in HICs. This situation presents the final challenge discussed in this chapter – the need to build research capacity in LMICs and then translate that capacity into quality research outputs to guide improvements (Hyder et al., 2022). This could provide insights and solutions associated with factors influencing safety outcomes that are specific to the LMIC context. For instance, in HICs:

“there has been a long history of responding to the road safety problem that has impacted on institutional arrangements, road user behaviour and the culture of road use. However, the lessons learned and good practice from high-income countries will not necessarily transfer easily or automatically to low- and middle-income countries, due to the different cultural, institutional and social conditions existing in those countries… the type of traffic, the mix of road users, and the kinds of road crashes that occur in low- and middle-income countries differ significantly from those in high-income countries. The uneven socio-economic landscapes mean technologies and policies cannot be applied without adaptation.”(Watson, 2016, p. 6).

Partnerships offer great promise in exchanging ideas and providing the environment where learnings can be shared across countries, irrespective of country-income. The final SDG (Goal 17) highlights the need for strong international partnerships and collaborations to ensure that all development goals are met. Enhancing capacity building opportunities across all aspects of road safety, including across the road safety profession, is necessary and important. The role of road safety professionals cannot be underestimated in addressing current deficiencies and identifying positive solutions to the challenges outlined in this BoK. 

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