Commentary: Status of Road Safety in Asia

Abstract

Assess the status of road safety in Asia and present accident and injury prevention strategies based on global road safety improvement experiences. Discuss the way forward by indicating opportunities and countermeasures that could be implemented to achieve a new level of safety in Asia.
Review and analyses of data in the literature, among others from the World Health Organisation (WHO) and World Bank and review of lessons learned from best practices in high-income countries. Estimation of costs due to road transport injuries in Asia and review of future trends in road transport.
Data on the Global and Asian road safety problem and status of prevention strategies in Asia as well as recommendations for future actions. The total number of deaths due to road accidents in the 24 Asian countries, encompassing 56% of the total world population, is 750.000 per year (statistics 2010). The total number of injuries are more than 50 million, of which 12% are hospital admissions. The loss to the economy in the 24 Asian countries is estimated to around 800 billion US$ or 3.6% of GDP.
This paper clearly shows that road safety is causing large problems and costs in Asia with an enormous impact on the well-being of people, economy and productivity. In many of the Asian low- and middle-income countries the yearly number of fatalities and injuries is still further increasing. Vulnerable road users (pedestrians, cyclists and motor cyclist combined) are particularly at risk. Road safety in Asia should be given rightful attention, including taking powerful, effective actions. This review stresses the need for reliable accident data, since there is a large underreporting in the official statistics. Reliable accident data are imperative to determine evidence based intervention strategies and monitor the success of these interventions and analyses. On the other hand, lack of good high quality accident data should not be an excuse to postpone interventions. There are many opportunities for evidence-based transport safety improvements, including measures concerning the five key risk factors: speed, drunk-driving, not wearing motorcycle helmets, not wearing seat-belts and not using child restraints in cars, as specified in the Decade of Action for Road Safety 2011-2020. In this commentary, a number of new additional measures are proposed which are not covered in the Decade of Action Plan. These new measures include separate roads or lanes for pedestrians and cyclists, helmet wearing for e-bike riders, special attention to elderly persons in public transportation, introduction of emerging collision avoidance technologies in particular automatic emergency braking (AEB) and alcohol locks, improved truck safety focussing on the other road user (including blind spot detection technology, under-ride protection at the front, rear and side and energy absorbing fronts) and improvement of motorcycle safety concerning protective clothing, requirements for advanced braking systems, improved visibility of motorcycles by using day-time running lights and better guard rails.

Full text

Full Terms & Conditions of access and use can be found at
http://www.tandfonline.com/action/journalInformation?journalCode=gcpi20
Download by: [217.211.250.212] Date: 17 August 2016, At: 09:20
Traffic Injury Prevention
ISSN: 1538-9588 (Print) 1538-957X (Online) Journal homepage: http://www.tandfonline.com/loi/gcpi20
Commentary: Status of road safety in Asia
Jac Wismans, Ingrid Skogsmo, Anna Nilsson-Ehle, Anders Lie, Marie Thynell
& Gunnar Lindberg
To cite this article: Jac Wismans, Ingrid Skogsmo, Anna Nilsson-Ehle, Anders Lie, Marie Thynell
& Gunnar Lindberg (2016) Commentary: Status of road safety in Asia, Traffic Injury Prevention,
17:3, 217-225, DOI: 10.1080/15389588.2015.1066498
To link to this article: http://dx.doi.org/10.1080/15389588.2015.1066498
View supplementary material
Accepted author version posted online: 06
Jul 2015.
Published online: 06 Jul 2015.
Submit your article to this journal
Article views: 299
View related articles
View Crossmark data

TRAFFIC INJURY PREVENTION
, VOL. , NO. , –
http://dx.doi.org/./..
COMMENTARY
Commentary: Status of road safety in Asia
Jac Wismansa, Ingrid Skogsmoa, Anna Nilsson-Ehlea,AndersLie
b, Marie Thynellc, and Gunnar Lindbergd
aSAFER Vehicle and Traffic Safety Centre at Chalmers University, Gothenburg, Sweden; bSwedish Transport Administration and Chalmers University,
Gothenburg, Sweden; cSchool of Global Studies, University of Gothenburg, Sweden; dInstitute of Transport Economics (TØI), Oslo, Norway
ARTICLE HISTORY
Received  March 
Accepted  June 
KEYWORDS
safety; restraints;
countermeasures; serious
injuries; NCAP; regulations;
epidemiology; road users
ABSTRACT
Objectives: The objective of this article is to assess the status of road safety in Asia and present accident
and injury prevention strategies based on global road safety improvement experiences and discuss the way
forward by indicating opportunities and countermeasures that could be implemented to achieve a new
level of safety in Asia.
Methods: This study provides a review and analyses of data in the literature,including from the World Health
Organization (WHO) and World Bank, and a review of lessons learned from best practices in high-income
countries. In addition, an estimation of costs due to road transport injuries in Asia and review of future trends
in road transport is provided.
Results: Data on the global and Asian road safety problem and status of prevention strategies in Asia as well
as recommendations for future actions are discussed. The total number of deaths due to road accidents in
the 24 Asian countries, encompassing 56% of the total world population, is 750,000 per year (statistics 2010).
The total number of injuries is more than 50 million, of which 12% are hospital admissions. The loss to the
economy in the 24 Asian countries is estimated to around US$800 billion or 3.6% of the gross domestic
product (GDP).
Conclusions: This article clearly shows that road safety is causing large problems and high costs in Asia,
with an enormous impact on the well-being of people, economy, and productivity. In many Asian low-
and middle-income countries, the yearly number of fatalities and injuries is increasing. Vulnerable road
users (pedestrians, cyclists, and motorcyclists combined) are particularly at risk. Road safety in Asia should
be given rightful attention, including taking powerful, eective actions. This review stresses the need for
reliable accident data, because there is considerable underreporting in the ocial statistics. Reliable acci-
dent data are imperative to determine evidence-based intervention strategies and monitor the success of
these interventions and analyses. On the other hand, lack of good high-quality accident data should not be
an excuse to postpone interventions. There are many opportunities for evidence-based transport safety
improvements, including measures concerning the 5 key risk factors: speed, drunk driving, not wearing
motorcycle helmets, not wearing seat belts, and not using child restraints in cars, as specied in the Decade
of Action for Road Safety 2011–2020. In this commentary, a number of additional measures are proposed
that are not covered in the Decade of Action Plan. These new measures include separate roads or lanes
for pedestrians and cyclists; helmet wearing for e-bike riders; special attention to elderly persons in public
transportation; introduction of emerging collision avoidance technologies, in particular automatic emer-
gency braking (AEB) and alcohol locks; improved truck safety focusing on the other road user (including
blind spot detection technology; underride protection at the front, rear, and side; and energy-absorbing
fronts); and improvements in motorcycle safety concerning protective clothing, requirements for advanced
braking systems, improved visibility of motorcycles by using daytime running lights, and better guardrails.
Introduction
Recent publications from the World Health Organization
(WHO 2013)andtheInstituteforHealthMetricsandEvalua-
tion (IHME)–World Bank (2014)estimatethatworldwidesome
1.3 million people die yearly due to injuries in road accidents,
and many more are injured, often with long-term disabilities as
a consequence. This tragedy aects in particular those entering
their most productive years (IHME/World Bank 2014;WHO
2013). The number of road trac injuries is increasing in low-
and middle-income countries while it is stabilizing or decreasing
in many high-income countries (IHME/World Bank 2014). For
CONTACT Jac Wismans jac.wismans@chalmers.se SAFER Vehicle and Traffic Safety Centre at Chalmers University, SE- , Gothenburg, Sweden.
Managing Editor David Viano oversaw the review of this article.
Supplemental data for this article can be accessed on the publisher’s website.
the 2015 scal year, low-income economies are dened by the
World B a n k as th o s e wit h a g r oss nat i o n al in c o m e per c a p i t a of
$1,045 or less in 2013 and middle-income economies are those
with a gross national income per capita of more than $1,045 but
less than $12,746 (World Bank 2015). The rapid motorization
in many developing countries without timely introduction of
accident and injury prevention strategies is the main reason for
this. The world vehicle eet, which was about 1 billion in 2010,
is estimated to double by 2020, and this increase particularly
occurs in developing countries (International Road Assessment
Programme [iRAP] 2008).
©  Taylor & FrancisGroup, LLC

218 J. WISMANS ET AL.
The Asian Environmentally Sustainable Transport (EST) Ini-
tiative, which is a joint initiative of the United Nations Centre for
Regional Development and the Ministry of the Environment–
Japan, was launched in 2004. It aims to build a common under-
standing across Asia on the essential elements of a sustainable
transportsystemandtheneedforanintegratedapproachatlocal
and national level to deal with multisectorial environment and
transport issues (United Nations Centre for Regional Develop-
ment 2010). Road safety is one of the core elements within the
Asian EST initiative. Currently, the following 24 Asian coun-
tries, representing 56% of the world population, are partici-
pating in the Asian EST initiative: Afghanistan, Bangladesh,
Bhutan, Brunei, Cambodia, People’s Republic of China, Indone-
sia, India, Japan, Republic of Korea, Lao PDR, Malaysia, The
Maldives, Mongolia, Myanmar, Nepal, the Philippines, Pakistan,
the Russian Federation, Singapore, Sri Lanka, Thailand, Timor-
Leste, and Vietnam.
This article aims to review and summarize the most recent
and relevant information on the global safety problem. Particu-
larattentionwillbegiventotheAsianESTcountriesandacci-
dent and injury prevention strategies based on experience and
eectiveness in developed countries will be presented. Status of
implementation and indication for new opportunities to prevent
road accident death in Asia will also be discussed.
This article is based on a report (Wismans et al. 2014)pre-
pared for the 8th Regional EST Forum in Asia in Colombo,
November 19–21, 2014, with the theme “Next Generation Solu-
tions for Clean Air and Sustainable Transport—Towards a Live-
able Society in Asia.” The methodology used for this study
included a review and analyses of data in literature, among
others from the WHO and the World Bank; review of lessons
learned from best practices in high-income countries; estima-
tion of costs due to road transport injuries in Asia; and review
of future trends in road transport.
The road safety problem
In 2004, the WHO and the World Bank jointly launched the
World Report on Road Trac Injury Prevention (Peden et al.
2004). The report identied, among others, the need for accu-
rate, reliable accident data systems in order to allow countries
to develop evidence-based road safety strategies and noted that
in many low- and middle-income countries, systematic eorts
to collect road trac data are not well developed yet. In order
to assist countries in setting up good accident data systems,
the WHO, together with some of its partners, developed a
road safety manual concerning accident databases (WHO 2010)
that contains detailed background on how to set up new acci-
dent database systems, strategies for improving data quality and
strengthening the performance of systems already in place, as
well as country-specic examples.
Since the launch of the WorldReportonRoadTracInjury
Prevention (Peden et al. 2004), 2 global status reports on road
safety have been published by the WHO (2009,2013). In these
reports, data that were collected with the help of dierent sectors
and stakeholders in each country are presented. For details on
the methodology for collecting the data, refer to WHO (2013).
The accident data included in the 2013 report concern the year
2010. For 2015, a third status report is planned.
Data presented in 2014 by the Global Road Safety Facility
at the World Bank in cooperation with the Institute for Health
Metrics and Evaluation (IHME/World Bank 2014)arebasedon
the GlobalBurdenofDiseases,Injuries,andRiskFactorsStudy
2010 (GBD 2010;see:Lozanoetal.2012,Vosetal.2012,Mur-
ray et al. 2012 and Salamon et al. 2012). The data are for the
same year (2010) as the WHO (2013)statusreport.TheGBD
2010 quantied the comparative magnitude of health loss due
to 291 listed diseases and injuries, including direct consequences
of disease and injury and risk factors for 20 age groups and also
covered both sexes. It produced estimates for 187 countries and
21 regions and assessments of the burden of road injuries.
Global fatalities and injuries
The WHO (2013) study estimates about 1.24 million road fatal-
ities in the world annually in 2010. The IHME/World Bank
(2014) estimates are slightly higher: almost 1.33 million deaths
duetomotorizedtransport.
Deaths due to road accidents are just the tip of the iceberg.
Nonfatal injuries are much more dicult to record and mea-
sure than fatal injuries. The reasons for this include diculties
in dening the severity of injuries and availability of good hos-
pital data linked to police data (see IHME/World Bank 2014;
IRTAD-OECD/ITF 2010;WHO2013). This is particularly true
for pedestrians and cyclists, who in many cases are completely
unreported.
The GBD 2010 data analyzed in the IHME/World Bank
(2014) study represent the rst attempt to quantify data on non-
fatal injury on a global level. For the year 2010, the number of
injured persons worldwide due to road accidents was estimated
to be 78.2 million persons needing medical care, of which 9.2
million requiring a hospital admission. These hospital admis-
sions were dened as “injuries that would have required at least
an overnight hospital stay if adequate access to medical care had
been available to the victims” (IHME/World Bank 2014; p. 44).
Considering the number of 1.33 million deaths in 2010 due to
road accidents, the resulting ratio between fatalities, hospital
admissions, and other injuries based on these GBD 2010 esti-
mates would be 1:7:52. The number of injuries reported in the
IHME/World Bank (2014) study are higher and more precise
than the earlier injury data reported by the WHO in various
reports (20–50 million).
Fatalities and injuries in Asia
Table A1 (see online supplement) summarizes the number of
deaths caused by road accidents in 2010 in the Asian EST coun-
tries derived from dierent sources. The 2010 population of each
country is included (WHO 2013). Also shown are the number
of nonfatal injuries (hospital admissions and total number of
injuries) based on IHME/Wold Bank (2014).
The total number of estimated deaths by WHO (2013)and
IHME/World Bank (2014), respectively, has the same order of
magnitude—around 750,000—but large dierences within some
individual countries can be seen between these 2 sources: up to a
factor 2 or more in countries like Afghanistan, Bangladesh, and
Pakistan.WhencomparingtheWHOandIHME/WorldBank
data with the ocial country data, the estimated total number

TRAFFIC INJURY PREVENTION 219
of deaths for the 24 Asian EST countries is more than twice the
value from ocial sources, indicating high underreporting. This
in particular appears to be the case in Afghanistan, Bangladesh,
Pakistan, Myanmar, India, and China. In China, for example,
the ocial country statistics are provided by the national traf-
c police. But China also has a nationally representative sample
registration system (the Disease Surveillance Points [DSP] sys-
tem) that uses verbal autopsy to monitor causes of death and
a national death registration system (IHME/World Bank 2014).
TheIHME/WorldBank(2014) study showed an underreporting
of more than 300% for the ocial country data when compared
to the DSP-based data (so only one quarter of all road accident
deaths in the DSP-based data are included in the ocial Chinese
country statistics).
Regarding injuries, the total number in the 24 Asian EST
countries is more than 50 million, of which 12% are hospital
admissions. This means that 66%, or two thirds, of all injuries
worldwide occur in Asian EST countries, whereas the region’s
total population is 56% of the world population (IHME/World
Bank 2014).
FromtheIHME/WorldBank(2014)data,thetotalnumberof
deaths (in percentages) in the Asian EST region for the various
transport modes has been calculated. Pedestrians are the largest
single category, with 35% of all deaths, followed by vehicle occu-
pants,with30%.Vulnerableroadusers(pedestrians,cyclists,
and motorcyclists combined) make up 60% of the deaths due
to road accidents.
Road safety and economic impact
In addition to the invaluable human tragedy, trac accidents
are a huge loss for the economy. These costs can be divided into
direct economic costs, indirect economic costs, and value of life
per se (Elvik 2000).
The direct economic costs are more or less visible, as medical
costs, legal and emergency service costs, and property damage
costs. Medical treatment will for some patients continue over
many years, in the worst cases over their whole lifetime, and
it is necessary to estimate the present value of future medical
treatments. These costs are a visible burden to the economy but
constitute in general only around 10% of the total accident cost
(Department of Transport 2012).
The indirect economic cost of accidents consists of the value
to society of goods and services that could have been produced
by the person if the accident had not occurred. The value of a
person’sproductionisassumedtobeequaltothegrosslabor
cost, wages, and additional labor costs paid by his employer. The
losses of an accident will continue over time up to retirement
and will grow with a growing economy over time. However, the
weight of the later years will be smaller because a discount rate
willbeusedinthecalculations.Toaccountforthelostlifespan
due to premature mortality, the number of years of life lost is
measured as the dierence between expected lifetime and actual
age when the accident occurred. Years of life lost will thus mea-
sure the number of lost productive years if it is adjusted for local
retirement age. For the Asian EST countries these costs have
been calculated to be US$81 billion or 0.4% of gross domestic
product (GDP) in 2010 for fatalities only, as described in detail
by Wismans et al. (2014).
Additionally, the human tragedy comes with a cost above the
loss of economic resources. People value their safety for more
subtle reasons than their lost production capacity. This value of
reduced accident risk may be expressed as a value of statistical
life (VSL). In most countries, this value is the dominant element
in the valuation of accidents. With a focus on the welfare of the
individual, VSL is estimated as the individual’s willingness to pay
for a small risk reduction, which is summed up to one “statisti-
cal life.” VSL can be based on labor market observations (Vis-
cusi and Aldy 2003) or responses to questionnaires (Jones-Lee
1976). A vast literature on methodology and metastudies exists
(de Blaeij et al. 2003; Miller 2000; Viscusi and Aldy 2003), con-
cluding that although the methodology is not awless, it is more
appropriate than the alternatives. For the Asian EST countries
these costs have been calculated to be US$250 billion or 1.1% of
GDP in 2010 for fatalities only based on a VSL of 70 ∗GDP per
capita as described in detail by Wismans et al. (2014).
Thecostofseriousinjuriesisbasedonavalueofserious
injury of 17 ∗GDP per capita (iRAP 2008), which results in a
total cost of US$485 billion. Adding the cost for fatalities and
the cost for serious injuries, the value of prevention to the econ-
omy in the Asian EST countries is estimated to around US$800
billion or 3.6% of GDP for accidents in 2010 only (see Wismans
et al. [2014] for details).
In addition to these economic costs, trac accidents are also
a serious workplace hazard and may represent 30–50% of work-
place fatalities depending on the region and whether or not com-
muting is included (Adriazola-Delgado et al. 2010). These work-
place fatalities include road accidents with various forms of driv-
ing, including professional transport, driving during work hours
(for example, truck, bus, and van drivers as well as salespeople),
workers on the road (for instance, road maintenance crews), and
commuting to work. Note that many of these workers are also
the only breadwinner in a family.
Road injury prevention strategies and
achievements in Asia
Probably the rst systematic approach concerning accident and
injury prevention strategies was the so-called Haddon matrix
(Haddon 1968). It caused a shift from an almost exclusive focus
on trying to improve driver behavior to a more comprehensive
approach. The Haddon matrix identies 3 phases—pre-event,
event, and post-event—as sequential phases within a crash event
as well as 3 components: human (behavior and tolerance), vehi-
cle, and infrastructure (environment). This approach has led to
many successful safety improvements within all elements of the
matrix. Recognized limitations of this model are that neither the
concept of exposure nor the importance of interactions between
the elements of the matrix are addressed (Thomas et al. 2013).
New approaches like the “Vision Zero” in Sweden (Breen
et al. 2008;Johansson2009) and the “Safe System” approach
(OECD/ITF 2008) view the trac system more holistically. A
full Safe System approach to road trauma requires that the crash
energy in an accident is low enough to prevent (serious) injuries,
recognizes that humans will always make mistakes in trac,
and requires system designers to provide a transport system that
supports the highest level of safety possible (OECD/ITF 2008).
Other important elements are formulating road safety strategies,

220 J. WISMANS ET AL.
educating society to recognize road trac safety, setting targets,
and monitoring performance.
High-income countries have shown a continuous decline in
death rates in the past 2 decades. In Europe, the number of
road fatalities in 1990, which was around 75,000, dropped more
than half, to 35,000, in 2009 (European Commission 2010). In
the 2011 White Paper—Roadmap to a Single European Trans-
port Area (European Commission 2011), the European Union
aims at a further reduction of 50% of road fatalities from 2011
until 2020 and for 2050 to move close to zero fatalities. This
“zero vision” goal should be achieved by new intelligent safety
technologies, applying improved safety testing, education and
promotion of use of safety equipment, and, in particular, atten-
tion to vulnerable road users (pedestrians, cyclists, and motor-
cyclists) through safer infrastructure and new vehicle technolo-
gies (European Commission 2011).
The achievements in road safety improvement in Europe
and in many other high-income countries have in particular
also been achieved by implementation of requirements for vehi-
cle safety, including the regulations developed by the United
Nations Economic Commission for Europe World Forum for
Harmonization of Vehicle Regulations and the introduction of
consumer test rating programs (New Car Assessment Programs,
NCAPs). See Wismans et al. (2014) for an introduction and
overview of United Nations (UN) regulations and NCAP pro-
grams worldwide, including the role of Global NCAP. The UN
regulationsshouldbeseenasasetofminimalperformance
requirements. They are applied in many high-income coun-
tries, but implementation in other countries is still limited. In
an NCAP, the protection oered by a vehicle or a component
is rated by means of a star rating system and compared with
the performance of other vehicles or safety systems. Test sever-
ity and/or requirements are often more demanding than for UN
regulations.TheprimeobjectiveofNCAPsistostimulatecon-
sumers to buy the safest vehicles and safety equipment and to
encourage industry to develop safer designs. The eectiveness
of NCAP has been shown in various studies in which good cor-
relation between EuroNCAP scores and injury outcome in real-
world accidents could be demonstrated both for occupant and
pedestrian protection (Kullgren et al. 2010;Strandrothetal.
2011,2014). Further studies into the cost-eectiveness of the
introduction of consumer testing programs are recommended
in particular in low- and middle-income countries.
Decade of action for road safety 2011–2020
The United Nations Road Safety Collaboration (UNRSC) was
established in 2004, recognizing the need for the UN system
to support eorts to address the global road safety crisis. The
WHO was invited to coordinate the road safety issues within
theUNsystem(WHO2011). The rst milestone was the launch,
in cooperation with the World Bank, the WorldReportonRoad
Trac In jury Preve ntion (Peden et al. 2004).
In 2010 The United Nations General Assembly declared the
decade 2011-2020 as the Decade of Action for Road Safety
(United Nations 2010). The main objective of the plan was to sta-
bilize global road accident fatalities until 2020 and then reduce
theforecastedlevelsofglobalroadfatalitiesbyincreasingroad
Tab le  . Summary of important actions within the  pillars of the global plan for
the decade of action for road safety (WHO ).
Pillars Important activities
: Road safety
management
Establishment of a national lead agency
Establishment of a national road safety plan
with safety targets and budgets Setting up
monitoring systems for accident data and
other indicators of safety improvement.
: Safer roads
and mobility
Elimination of high-risk roads by  Safety
impact assessments as part of all planning and
development decisions Speed management
and speed-sensitive design of the road
network Ensuring work zone safety Set
minimum safety ratings for new road
investments that ensure the safety needs of all
road users Encouragement of education and
research and development in the field of safe
road infrastructure
: Safe vehicles Implementation of UN vehicle safety regulations
and NCAPs. Recommendations for inclusion of
technologies such as ESC and ABS.
Discouragement of import and export of new
or used cars that have inferior safety levels
Increased research into safety technologies
designed to reduce risks to vulnerable road
users Encouragement of managers of
governments and private sector fleets to
purchase vehicles that offer advanced safety
technologies and high levels of occupant
protection
: Safe road
users
Implementation (if not done yet) and
enforcement of laws and/or standards
concerning maximum speed, drunk driving,
and the usage of helmets, seat belts, and child
restraints, combined with public
awareness/education concerning these risk
factors Introduction of policies and practices
to reduce work-related road traffic injuries in
the public, private, and informal sectors
Establishment of graduated driver licensing
systems for novice drivers
: Postcrash
response
Implementation of a single countrywide
telephone number for emergencies
Development of hospital trauma care systems
Early rehabilitation and support to injured
patients Encouragement of research and
development into improving postcrash
response
safety improvement activities at national, regional, and global
levels.
Based on the Safe System approach, the Commission for
Global Road safety dened 5 pillars for a road safety policy
framework, which were used later in the Global Plan for the
Decade of Action for Road Safety 2011–2020 (Commission for
Global Road Safety 2009). Table 1 shows these 5 pillars from the
Global Plan together with important activities within each pillar.
Furthermore, within the Plan for the Decade of Action for
Road Safety, 5 key risk factors have been identied for which
global introduction and enforcing of legislation would b e impor-
tant: speed, drunk driving, not wearing motorcycle helmets, not
wearing seat belts, and not using child restraints in cars. Back-
ground on the introduction and eectiveness of measures con-
cerning these 5 risk factors can be found in the following 4 “best
practice guides” developed by WHO and its partners: (1) speed
management, (2) drinking and driving, (3) helmet use, and (4)
use of seatbelts and child restraints (UNRSC 2015). A system-
atic overview of the eciency of measures concerning these 5

TRAFFIC INJURY PREVENTION 221
Tab le  . Relative risk for different BAC levels (Wismans et al. ).
BAC (%) Relative risk
.–. .
.–. .
.–. .
Over . .
risk factors, based on an analysis of 117 studies from the inter-
national literature, can be found in TØI (2012). According to this
study, a reduction in the speed limit with 10 km/h from an ini-
tial limit of 90, 80, or 70 km/h reduces the number of fatalities by
14% and severe injuries by 9%. The relative risk of being under
the inuence of alcohol compared to a sober driver is summa-
rized in Tab l e 2, showing that even very low blood alcohol con-
tent (BAC) levels results in an increased risk by a factor 2. The
best estimate of the eect of helmet usage is a reduction in fatal
accidents of 44% and severe injuries of 49%. For wearing seat
belts, the probability of a fatal outcome is reduced by 40–50% in
the front seat of the car and by 25% in the rear seat. The eect
on reduction in child fatalities, if a child seat is used properly, is
55% for forward-facing seats and 71% for rearward-facing seats.
Social acceptance of measures, considering the variety in eco-
nomic and geographical dierences of Asian countries, is impor-
tant. For instance, in the case of wearing helmets for riders in
one of the hottest locations in the world, not only material prop-
erties of the helmet in high-temperature environments have to
be addressed but how user-friendly and comfortable helmets
are for riders. For example, in The Transportation Research and
Injury Prevention Programme at the Indian Institute of Tech-
nology (Delhi, India), research on helmet use in a warm climate
has been carried out. Dierent solutions have been developed,
including more open models and the use of alternative, more
aordable materials. Furthermore, to spur social recognition of
trac safety, continuous education of the younger generation in
particular should receive high priority.
Status of road safety measures in Asia
The WHO (2013) provides an overview of the road safety mea-
sures, including implementation of measures concerning the
5 risk factors and implementation of safety laws/standards in the
24 Asian EST countries. A number of the ndings in this report
are presented in Table A2 (see online supplement) and summa-
rized below.
Speed
All countries have some kind of maximum speed laws like max-
imum speeds in city centers. The eectiveness of enforcement
of speed laws was rated by respondents on a scale from 0 to 10,
where 8 and above is good. Only South Korea rated enforcement
asan8and4countriesrateditasa7(Cambodia,Japan,Sin-
gapore, and Vietnam). Countries like Afghanistan, Bangladesh,
India, Pakistan, the Philippines, and Thailand, however, showed
alowscoreof3.
Drunk driving
Laws concerning drunk driving exist in all countries except
Afghanistan and the Maldives. In 5 countries, no BAC levels
are specied: Bangladesh, Indonesia, Nepal, Pakistan, and the
Philippines. The overall eectiveness of enforcement concern-
ing drunk driving was rated by 21 of the countries on a scale
from0to10(seeTableA2)withhigh(8andhigher)ratings
in Brunei, China, Japan, and Singapore and low ratings (3 and
below) in 9 of the Asian EST countries, including India.
Helmets
All countries except Afghanistan have helmet laws for motor-
cycles and most countries control the quality of a helmet by a
helmet standard, except Bangladesh, Laos, the Maldives, Mon-
golia, Nepal, and Timor-Leste. Without adequate laws, the risk
of counterfeit helmets without sucient protection increases.
Thehelmetsuserateisavailablefor11countries(WHO
2013) and appears to be high (75% and more wearing rate)
in Indonesia, Laos, Malaysia, the Philippines, Sri Lanka, and
Vietnam.
Seat belts
The use of seat belts in the front seat is required in all Asian EST
countries except Afghanistan and Myanmar. Only 13 countries
require seat belts to be worn in the back seat. The eectiveness
of enforcement of seat belt use was rated high (8 and higher) in
Indonesia, the Philippines, Singapore, and South Korea and low
(3 and below) in 7 countries, among others in China and India,
with a rating of 2. Actual gures are also available for about 10
countries (WHO 2013). They are high (more than 75% wear-
ing rate) for drivers in Japan, Malaysia, the Philippines, Russia,
South Korea, and Sri Lanka and low in India (27% use rate for
drivers) and Pakistan (only 4% for drivers). For Thailand, the
seatbeltuserateis61%fordriversandforChinanodataare
available in the WHO (2013)report.
Child restraint systems
Child restraints are required in 8 countries. No information is
available from the WHO (2013) report on the eectiveness and
enforcement of child restraint laws in the Asian EST countries.
National road safety programs
Most countries have national road safety programs, except the
Maldives, Mongolia, Nepal, and Sri Lanka. Furthermore, 13
countries have specied national targets on reduction of death
due to road accidents. Only Japan, South Korea, and the Philip-
pines have also set targets for reduction of nonfatal injuries
(WHO 2013).
UN regulations
Most low- and middle-income Asian EST countries have not
implemented the UN regulations. As a result, there are many
cars produced and sold in these countries that are substandard
in comparison with the UN’s minimum safety requirements.
AccordingtoGlobalNCAP(2014), of 65 million new passenger
carsbuiltlastyear,onethirdwouldnotpasstheUNregulations

222 J. WISMANS ET AL.
for front and side crash tests (UN Regs. 94 and 95) and do not
have antilock brake systems (ABS) and electronic stability con-
trol (ESC) systems tted.
NCAP
NCAP programs have been implemented in Japan and South
Korea for quite some time. More recently they have also been
introduced in China (C-NCAP) and Malaysia, Singapore, and
the Philippines (Asian NCAP). India is considering includ-
ing an NCAP program (BNVSAP, Bharat New Vehicle Safety
Assessment Programme). The Global New Car Assessment Pro-
gramme (Global NCAP) was launched in 2011 to share best
practicesandsupportNCAPssettingupnewtestprograms.
ASEAN NCAP was set up by the Malaysian Institute of Road
Safety Research with support of Global NCAP. Note that NCAP
test programs worldwide do not always have the same test meth-
ods and assessment criteria.
Examples of good practices
There are many good examples of successful road safety projects.
Most of them share at least 4 characteristics:
•a challenging goal,
•recognition of the multistakeholder involvement needed,
•the importance of having a common understanding of the
problemathand,and
•a shared will to transfer the insights into hands-on actions.
This calls for sustainable partnerships involving the civil soci-
ety sector, local or national government to put ecient social
change into practice via legislation, and business, which can
catalyze implementation and contribute a focused eciency of
action. The need is expressed well, for example, by the World
Bank in its review of road safety activities in China (World Bank
2008). For an overview of examples of good practices and prac-
tical guidelines to develop road safety projects, see the publi-
cations developed jointly by multiple partner agencies of the
UN Road Safety Collaboration on the UNRSC website (UNRSC
2015). One specic example concerns the iRAP (2015), which
assesses roads (including the maintenance condition) all over
the world and aims to signicantly reduce road casualties by
improving the safety of road infrastructure. Its activities include
inspecting high-risk roads and developing star ratings, safer
roads investment plans, and risk maps. Rating of a road means
that a protocol-based safety assessment is made resulting in
assigning the road design 1 (worst) to 5 (best) stars.
Future trends
Thetransportofpeopleandgoodsintheworldwillundergo
many changes the next 20–30 years due to increases in urban-
ization and increased environmental concerns, changes in use
of transport modes and mobility needs, shortage of natu-
ral resources, strong application of Intelligent Transportation
Systems solutions, changing views on private car ownership
etc. Two important linked trends and changes will be dis-
cussed here: The shift in transport paradigm and future safety
technologies.
Shift in transport paradigm
The global car and road system will continue to develop. Sev-
eral countries and cities are slowly shifting focus from planning
for the car society to instead make plans for low-carbon mobil-
ity based on a multitude of modes of transport. A large part of
travel in certain areas is made on public transport and by non-
motorized means of mobility. These modes will have to be fur-
ther developed, modernized, designed, regulated, managed, and
controlled by authorities in order to meet the safety require-
ments and to be more secure. In many countries in Southeast
Asia it is often the case that informal public transport, footpaths,
and roads are not designed or maintained accordingly, hence
impeding walkability and access for low-income families. Street
lights are often missing; cars and heavy vehicles drive too fast,
etc. Therefore, a greater responsibility for making nonmotorized
and/or informal means of mobility safe will be part of the next
generation of transport policies.
Goods transport is an important cause of unsafe conditions
because growing cities have an increased requirement for goods
distribution and waste management. Research shows that intro-
ducing new logistics planning resulting in more ecient and less
intrusive transport operations signicantly increases safety and,
atthesametime,decreasescongestionandCO
2emissions.
Theincreasingnumbersoftravelersinthesystemsoftrans-
port and on roads imply a range of new and old issues that have
to be addressed by authorities. Examples include city planning,
the design of safe streets and intersections for all road users, and
secure public transport infrastructure. It is foreseen that a mix of
heterogeneous measures, some of them building on smart tech-
nology, are needed to improve safety together with behavioral
and attitudinal changes to assume a shared responsibility for
the enormous amount of traveling in what is called the Asian
Century. The transport behaviors of road users from all socioe-
conomic groups, ages, and sexes need to be surveyed and the
results integrated in a comprehensive national trac and trans-
portplanningbasedontheprinciplesofroadsafety.
Future safety technologies
Among the trends in the fast development of technology, there
are 2 trends that will inuence the research roadmaps and future
vehicles, especially in high-income countries:
•introduction of more sustainable vehicles using alternative
propulsion systems and
•vehicle automation, ultimately leading to fully automated
drivingwherethedrivermaybeoutoftheloopattheend.
More sustainable and lighter vehicle
New propulsion system (like electric vehicles) in conjunction
with weight and size reduction will lead to new vehicle architec-
tures that pose new challenges concerning vehicle safety, such
as protection of occupants in crashes with signicantly heavier
vehicles. The electrication trend is also aecting pedal cycle
design. Bicycles are increasingly becoming partially electried
and this is likely leading to elevated speeds for this vulner-
able road user category and consequently higher injury risk.
The lightweight trend will also result in increased popularity of
ultralight vehicles, for which no safety requirements yet exist.

TRAFFIC INJURY PREVENTION 223
Automated driving
The automotive community has achieved signicant progress in
the development of automated vehicles in conjunction with fast
developments in the eld of intelligent transport systems tech-
nology. There are also new players outside the traditional auto-
motive sector entering the eld. In addition to many technical
issues, there are several other questions to sort out, such as how
to secure a net safety benet from automated trac and whether
developing countries can benet from these developments. Dif-
ferent levels of automated driving can be distinguished. Sev-
eral organizations have proposed denitions for the levels of
automation in automated driving like NHTSA (2013). The lev-
els vary from 0 (no automation) to 4 (fully self-driving automa-
tion). Currently several systems are already commercially avail-
able,suchasadaptivecruisecontrol,lane-keepingassist,and
autonomous emergency braking (AEB), which are all examples
of level 1 automation; that is, the stage of driver assistance. Some
of these systems would oer signicant benet in developing
countries due to their safety potential. This is particularly true
for emergency braking in case of a potential crash with a vul-
nerable road user. Tests with automated vehicles and/or driving
on all levels are conducted worldwide, but the question remains
when automation will be widely available in consumer vehi-
cles. To have automated vehicles drive safely and eciently on
public roads, numerous challenges have to be resolved, includ-
ing behavioral, legal, social, and technological aspects. Auto-
mated driving is expected to have signicant safety benets, but
although its ultimate aim is a 100% reduction of accidents, there
certainly will be some crashes and injuries remaining.
The way forward in Asia
How countries have approached auto mobility is not only about
building roads and providing fuel. It also includes responsibil-
ity for adverse eects. The political system will have to assume
responsibility and develop protective measures because experi-
ence shows that market forces will not develop such measures
on their own. The various political levels (provinces, federal
states, cities, municipalities, and so on) have to take responsi-
bility and establish institutions that eectively engage in trac
safety issues. Such ambitions are in line with the denition of
sustainable transport.
Progress in the area of road safety in high-income coun-
tries was made possible because of important eorts in capac-
ity building, research, and the development of knowledge in the
area of trac safety. Studies of local conditions and the rea-
sons why accidents take place made it possible to develop ways
to reduce them. However, without a long-term commitment
to improve conditions on the road, political will, policy, and
planning, it would have been impossible to achieve safer roads.
There need to be institutions and human resources together
with a budget that pays for the work; otherwise, such develop-
ment does not take place. It has taken decades to build capacity
and implement policy and planning in developed countries. The
challenges to improve road safety in developing countries are
even much larger. This is due, among others, to the absence of
adequate infrastructure, unplanned urbanization taking place,
lack of a legal regulatory framework, and a strong increase in
motorisation.
Vision Zero has gained major support in highly motorized
countries. The basic concepts behind Vision Zero have global
validity. In every development of the road transport system the
targetcanbetoabsorbhumanerrors.Keyistocontrolenergy
transfer to the human body to safe levels. Speeds and designs
should have this in focus. Another cornerstone of Vision Zero
is the shared responsibility. Any organization inuencing the
design and use of the road transport system can contribute to
road safety. The management system standard ISO 39001 (ISO
2012) can be an important guide for many organizations. A Safe
System is the evident target for developing countries as well for
already motorized countries.
AlthoughmanyAsianESTcountrieshavemadegreat
progress, the potential for improved trac safety is high. If all
countries were to give high priority to implementing the most
relevant and eective activities in the Global Plan for the Decade
of Action for Road Safety, substantial further improvements
could be made. This in particular holds for addressing the 5 risk
factorsincludedintheGlobalPlan.
UNRSC is planning to update the Global Plan for the Decade
of Action in 2015. For an overview of a complete list of recom-
mendations for new activities in the Global Plan, see Wismans
et al. (2014). Here we shall highlight a few of the new topics rele-
vant for the Asian EST countries and taking advantage of recent
technological developments and research ndings.
Pedestrians and cyclists
Theambitionshouldbethatvulnerableroaduserscanmove
safely inside as well as outside urban areas. Separate roads or
laneshavebeenproventobesuccessfulinmanycountries.The
views of pedestrians as well as the pedestrian’s perceived safety
may vary signicantly in dierent parts of the world. Neverthe-
less, a person walking in trac should not have to worry about
falling, being injured, run over, or assaulted. Furthermore, in
many countries, a strong increase in the usage of e-bikes (electri-
cally supported bikes) can be observed, allowing higher speeds
than regular bikes. Helmet use for e-bike riders should be con-
sidered compulsory in order to change the trend of increasing
fatalities and injuries seen among pedal bicyclists. The success-
ful introduction of helmet wearing in many countries has shown
that the helmet not only protects in accidents with other vehicles
but also in single bicycle accidents.
Elderly persons
Keeping a high degree of mobility at an older age is essential
for the individual’s continued quality of life, and movements in
trac should be absent from worries for assault, harm, or injury.
Generally, members of this growing and heterogeneous group
are more fragile and spend more time in trac as pedestrians
andbicycliststhanotheragegroups.Thisneedstobetakeninto
account in, for example, public transportation and its associated
stops, access routes, and vehicles.
Collision avoidance technologies
In addition to the technologies recommended in the Global
Plan (primarily ABS and ESC), emerging technologies should

224 J. WISMANS ET AL.
be considered, in particular AEB and alcohol locks, which oer
interesting opportunities in developing countries. This holds
for passenger cars as well as trucks, buses, and motorcycles. It
shouldberealized,however,thatimplementationofsuchacci-
dent avoidance and other future safety technologies depends on
the regional situation in each country. In other words, the local
situation should be carefully analyzed before the introduction of
such new technologies.
Truck safet y
The Global Plan recommendations concerning trucks focus on
safe operation of trucks only. Much more can and has to be done
on the vehicles themselves, including visibility of other road
users; introduction of blind spot detection technology; under-
run protection at the front, rear, and side; and energy-absorbing
fronts for collisions with other road users (compatibility), and,
in particular, for Vulnerable Road Users (VRU) collisions.
Motorcycle safety
The Global Plan focus is on helmets only. However, much more
can be done; for example, promotion of protective clothing,
requirements for advanced braking systems on motorcycles,
measures that improve the visibility of motorcycles like daytime
running lights (Yuan 2000), and well-designed guardrails that
help mitigate the eect of an impact rather than making it more
severe (APROSYS 2009).
Conclusions
This article clearly shows that road safety is causing large prob-
lems and high costs in the Asian EST countries with an enor-
mous impact on the well-being of people, the economy, and pro-
ductivity. In several of the Asian EST low- and middle-income
countries, the yearly number of fatalities and injuries is increas-
ing, whereas in many high-income countries worldwide these
numbers are decreasing. Vulnerable road users (pedestrians,
cyclists, and motorcyclists combined) are particularly at risk.
The above gures and the material throughout the article
justifythatroadsafetyinAsiashouldbegivenrightfulatten-
tion, including taking powerful, eective actions. It stresses the
need for reliable accident data, which are imperative to deter-
mine evidence-based intervention strategies and monitor the
success of these interventions and analyses. Still, lack of good
high-quality accident data should not be an excuse to postpone
interventions. There are many opportunities as shown in this
article.
Improved road safety can only be reached when introduced
measures and actions are applied, respected, or observed. The
need for persistent promotion of measures already at hand is
obvious; even when data clearly point out the eects of dierent
measures, there are other studies showing that a high percent-
age of accidents and injuries are associated with the nonuse or
lack of enforcement of the measures. Bicycle helmets, seat belts,
speed limits, and optional safety equipment at vehicle purchases
are some examples.
Funding
This study was funded by Chalmers University in Gothenburg, Sweden.
References
Adriazola-Delgado et al. Michelin Challenge Bibendum.AchievingZero
Work-Related Road Deaths Road Safety Task Force; 2010. Available
at: http://www.challengebibendum.com/publication/White-Paper-
For-Safe-Roads-in-2050
APROSYS (Advanced PROtection SYStems). Final Report for the Work
on Motorcyclist Accidents (SP4). Molinero, Cidaut, 2009. Available at:
http://docplayer.net/6143131-Ap-90-0004-nal-report-for-the-work-
on-motorcyclist-accidents-sp4-project-no-fp6-plt-506503-aprosys.
html
Breen J, Howard E, Bliss T. An Independent Review of Road Safety
in Sweden. Swedish Road Administration; 2008. Available at:
https://online4.ineko.se/trakverket/Product/Detail/44643
Commission for Global Road Safety. Make Roads Safe - a decade of
action for road safety. 2009. Available at: http://www.afoundation.
org/media/44212/decade-of-action-report-2009.pdf
de Blaeij A, Florax RJ, Rietveld P, Verhoef E. The value of statistical life: a
meta-analysis. Accid Anal Prev. 2003;35:973–986.
Department of Transport. Reported Road Causalities in Great Britain.
2012. Available at: https://www.gov.uk/government/uploads/system/
uploads/attachment_data/le/244913/rrcgb2012-02.pdf.
Elvik R. How much do road accidents cost the national economy? Accid
Anal Prev. 2000;32:849–851.
European Commission. Towards a European Road Safety Area: Policy Ori-
entations on Road Safety 2011–2020. Brussels, Belgium: Author; 2010.
Europe an Commiss ion. White Paper—Roadmap to a SingleEuropean Trans-
port Area—Towards a Competitive and Resource Ecient Transport Sys-
tem. Brussels, Belgium: Author; 2011.
Global NCAP. Global NCAP Fleet Safety Guide and Safer Car Purchasing
Policy 2014–2015. 2014. Available at: http://www.globalncap.org/wp-
content/uploads/2013/07/gncap_brochure_lr.pdf.
Haddon W Jr. The changing approach to the epidemiology, prevention,
and amelioration of trauma: the transition to approaches etiologi-
cally rather than descriptively based. Am J Public Health. 1968;58:
1431–1438.
Institute for Health Metrics and Evaluation/World Bank. Transport for
Health: The Global Burden of Disease from Motorized Road Transport.
Seattle, WA, and Washington, DC: Author; 2014.
International Road Assessment Programme. TheTrueCostofRoad
Crashes—Valuing Life and the Cost of a Serious Injury. 2008. Avail-
able at: http://www.irap.net/en/about-irap-3/research-and-technical-
papers.
International Road Assessment Programme. 2015. Available at:
http://www.irap.net/en/about-irap-2/safety-inspections.
IRTAD-OECD/ITF. Reporting on Serious Road Trac Casualties—
Combining and Using Dierent Data Sources to Improve Understanding
of Non-fatal Road Trac Crashes. International Trac Safety Data and
Analysis Group (IRTAD), 2010. Available at: http://www.international
transportforum.org/irtadpublic/pdf/Road-Casualties-Web.pdf.
ISO 39001, Road trac safety (RTS) management systems - Requirements
with guidance for use. 2012.
Johansson R. Vision Zero—implementing a policy for trac safety. Saf Sci.
2009;47:826–831.
Jones-Lee MW. The Value of Life: An Economic Analysis. Chicago, IL: Uni-
versity of Chicago Press; 1976.
Kullgren A, Lie A, Tingvall C. Comparison between Euro NCAP test results
and real-world crash data. Trac Inj P rev. 2010;11:587–593.
Lozano RL, et al. Global and regional mortality from 235 causes of death
for 20 age groups in 1990 and 2010: a systematic analysis for the Global
Burden of Disease Study 2010. The Lancet. 2012;380:2095–2128.
Miller TR. Variations between countries in values of statistical life. JTransp
Econ Policy. 2000;34:169–188.
Murray CJL, et al. Disability-adjusted life years (DALYs) for 291 diseases
and injuries in 21 regions, 1990-2010: a systematic analysis for the

TRAFFIC INJURY PREVENTION 225
Global Burden of Disease Study 2010. The Lancet. 2012;380:2197–
2223.
NHTSA. U.S. Department of Transportation releases policy on auto-
mated vehicle development [press release]. NHTSA; May 30, 2013.
Available at: http://www.nhtsa.gov/About+NHTSA/Press+Releases/
U.S.+Department+of+Transportation+Releases+Policy+on+Automa
ted+Vehicle+Development
OECD/ITF. Towards Zero—Ambitious Road Safety Targets and the
Safe System Approach. 2008. Available at: http://www.internationalt
ransportforum.org/Pub/pdf/09CDsr/PDF_EN/TowardsZero.pdf
Peden M, Scur eld R, Sleet D, et al. Wor l d R e p o r t o n R o a d Tr ac
Injur y Prevention. Geneva, Switzerland: World Health Organization;
2004.
Salomon J, et al. Common values in assessing health outcomes from dis-
ease and injury: disability weights measurement study for the Global
Burden of Disease Study 2010. The Lancet. 2012;380:2129–2143.
Strandroth J, Rizzi M, Sternlund S, Lie A, Tingvall C. The correlation
between pedestrian injury severity in real-life crashes and Euro NCAP
pedestrian test results. Tra c Inj Pr e v. 2011;12:604–613.
Strandroth J, Sternlund S, Lie A, et al. Correlation between Euro NCAP
pedestrian test results and injury severity in real-life crashes with
pedestrians and bicyclists in Sweden. Stapp Car Crash J. 2014;58:213–
231.
Thomas P, Morris A, Talbot R, Fagerlind H. Identifying the causes of road
crashes in Europe. Paper presented at: 57th AAAM Annual Confer-
ence, September 22–25, 2013.
TØI(InstituteofTransportEconomics).Handbook of Road Safety Mea-
sures [in Norwegian]. Oslo, Norway: Author; 2012. Available at:
http://tsh.toi.no/les/trakksikkerhetshandboken.pdf
United Nations Centre for Regional Development. Environmentally Sus-
tainable Transport for Asian Cities: A Sourcebook.Reved.Nagoya,
Japan: Author; 2010.
United Nations Resolution 64/255, Improving global road safety, 74th ple-
nary meeting 2 March 2010.
United Nations Road Safety Collaboration. 2015. http://www.who.int/
roadsafety/publications/en/.
ViscusiWK,AldyJA.Thevalueofastatisticallife:acriticalreviewofmarket
estimates throughout the world. JRiskUncertain. 2003;27:5–76.
Vos T, et al. Years lived with disability (YLDs) for 1,160 sequelae of 289
diseases and injuries, 1990-2010: a systematic analysis for the Global
Burden of Disease Study 2010. The Lancet. 2012;380:2163.2196.
Wismans J, Skogsmo I, Nilsson-Ehle A, Lie A, Thynell M, Lindberg
G. Implications of road safety in national productivity and human
development in Asia. Paper presented at: Eighth Regional EST
Forum in Asia; November 19 to 21, 2014; Colombo, Sri Lanka.
Ava ila ble at: http://www.uncrd.or.jp/content/documents/22698EST-
P4_Wismans.pdf.
Wor l d B an k . China Road Trac Safety—The Achievements, the Challenges,
and the Way Ahead. Beijing, China: China and Mongolia Sustainable
Development Unit (EASCS), East Asia and Pacic Region; 2008.
World Bank. 2015. Available at: http://data.worldbank.org/about/country-
and-lending-groups.
World Health Organization. Global Status Report on Road Safety: Time for
Action. Geneva, Switzerland: Author; 2009.
World Health Organization. Data Systems, a Road Safety Manual for
Decision-makers and Practitioners. Geneva, Switzerland: Author; 2010.
World Health Organization. Global Plan for the Decade of Action for
Road Safety, 2011–2020. Geneva, Switzerland: Author; 2011. Avail-
able at: www.who.int/roadsafety/decade_of_action/plan/plan_english.
pdf.
World Health Organization. Global Status Report on Road Safety 2013, Sup-
porting a Decade of action. Geneva, Switzerland: Author; 2013.
Yuan W. The eectiveness of the “ride-bright” legislation for motorcycles in
Singapore. Accid Anal Prev. 2000;32:559–563.