Patricio V Marquez

                          February 22, 2025

“He went to him and bandaged his wounds, pouring on oil and wine. Then he put the man on his own donkey, took him to an inn and took care of him."

– Parable of the Good Samaritan, New Testament, Luke 10:34 

Introduction

The Fourth Global Ministerial Conference on Road Safety, held in Marrakech, Morocco, from February 18-20, 2025, marked a significant milestone in the global effort to enhance road safety. Under the theme "Commit to Life", the conference brought together government officials, policymakers, industry leaders, and civil society to assess progress, set new priorities, and strengthen commitments to reducing road traffic injuries and fatalities. As the first Ministerial Conference on Road Safety hosted in Africa, it underscored the region’s growing influence in shaping global road safety policies and solutions.

The Marrakech Declaration: A Call to Action

Ministers from 100 countries endorsed the Marrakech Declaration for Global Road Safety, urging governments to prioritize road safety politically, ensure sustained funding, and accelerate efforts to halve road deaths by 2030, in alignment with the United Nations Decade of Action for Road Safety 2021-2030 and the Sustainable Development Goals (SDGs).

The declaration emphasized cross-sector collaboration, particularly between health, transport, and environmental ministries, and advocated for policies promoting safe, green, and equitable mobility, such as walking, cycling, and public transportation. It also called for increased technical support, technology transfer, and research into emerging technologies like artificial intelligence to enhance road safety.

Morocco's leadership in road safety was recognized during the conference, particularly with the launch of the Mohammed VI International Road Safety Award, reaffirming the country's commitment to global road safety initiatives.

The Health Sector’s Role in Road Safety

As the world reaches the midpoint of the Second Decade of Action for Road Safety (2021-2030), the urgency to achieve the ambitious goal of halving road traffic fatalities and serious injuries by 2030 has intensified. With an estimated 1.19 million lives lost annually—approximately 3,300 deaths per day—road safety remains one of the most pressing global public health challenges, whose social and economic implications extend well beyond the transport sector.

While transportation policies and law enforcement are critical, here I argue that the health sector plays a crucial role in preventing road injuries and fatalities. Through data collection and surveillance, public policy development, education and advocacy, emergency medical care, and research, healthcare professionals can contribute to drive meaningful improvements in road safety worldwide.  Let me explain as follows:

1. Data Collection and Surveillance

Effective road safety strategies depend on accurate data. Health facilities, particularly emergency departments, are invaluable sources of information on road traffic injuries (RTIs). By systematically collecting and analyzing data on RTI incidence, severity, and causes, health professionals can identify risk factors and inform policy decisions.

For example, India’s Road Traffic Injuries Surveillance System gathers real-time crash data, enabling authorities to implement targeted interventions in high-risk areas. Similar surveillance systems worldwide help policymakers refine road safety strategies based on evidence.

2. Policy Development and Cross-Sector Collaboration

As highlighted in a 2019 The Lancet Commission report, law is a powerful yet often underutilized and poorly understood tool for advancing global health. When leveraged effectively, legal frameworks can drive transformative public health improvements. By working in close partnership, public health lawyers and health professionals can become key advocates for evidence-based legislation that safeguards public health and safety.

In the realm of road safety, health sector specialists have a critical role to play—not only in advocating for stricter speed regulations, improved vehicle safety standards, and enhanced pedestrian protections but also in fostering cross-sector collaboration. To maximize the impact of legal interventions, they must engage with transportation authorities, law enforcement agencies, and urban planners to ensure that road safety remains a central policy priority.

This requires a multifaceted approach, including the development and implementation of robust legal instruments, strengthening legal and institutional capacities, and enacting essential reforms. Equally important is a steadfast commitment to upholding and enforcing the rule of law. By integrating legal strategies into road safety initiatives, health professionals can contribute to reducing traffic-related injuries and fatalities, ultimately creating safer and more sustainable communities.

3. Population-based Prevention and Public Education

The overall objective of preventive strategies is to prevent the occurrence of RTIs by changing related behaviors and lifestyles, environmental factors, and their social and economic determinants in an entire population. The main argument for these interventions is that they target a high proportion of the population at risk of RTIs; 70 percent or the majority of the population.

Healthcare professionals, as trusted voices in communities, can lead public education campaigns that raise awareness about the dangers of speeding, distracted driving, drunk driving, and non-compliance with safety measures such as seatbelt and helmet use.

Successful campaigns like South Australia’s "Arrive Alive" use mass media messaging and community engagement to promote safer driving behaviors. When paired with strong policy enforcement, these initiatives drive meaningful behavioral change.

4. Advocacy for Safer Vehicle Design

Healthcare professionals can influence vehicle safety regulations by advocating for protective designs that safeguard both occupants and pedestrians. Key measures include:

Impact Absorbing Hoods: Also known as "pop-up" or "active" hoods, these are designed to mitigate the severity of head injuries when a pedestrian is struck. The collision of the pedestrian's head to the automotive hood is the main reason for fatal injuries in pedestrian to vehicle impacts. These hoods are typically made from materials or incorporate structures that allow them to crumple safely under impact.  They can include energy absorbers, shock cones, and shock-absorbing rubber pads. 

Pedestrian Detection Systems: These systems utilize cameras, radar, or a combination of sensors to identify pedestrians in a vehicle's path. When a potential collision is detected, these systems can alert the driver and, if necessary, automatically apply the brakes to prevent or lessen the impact. 

Crash-Avoidance Technologies: These technologies encompass a range of systems designed to prevent collisions or reduce their severity, such as:

• Automatic Emergency Braking (AEB): Detects imminent collisions with vehicles or pedestrians and applies brakes   automatically.
• Lane Departure Warning (LDW): Alerts drivers when they unintentionally drift out of their lane.
• Blind Spot Detection: Monitors areas alongside the vehicle that are not visible to the driver and provides warnings if another vehicle is present.

Incorporating these technologies into vehicle design has been shown to significantly enhance safety, reducing pedestrian injuries and fatalities.

5. Promotion of Interventions to Deter Drunk and Distracted Driving

Drunk driving is an important risk factor for all road users, and young drivers aged 18–25 are particularly at risk of crashing. As blood alcohol concentration (BAC) increases, so does the likelihood of crashing, particularly above a BAC of 0.04 grams per deciliter (g/dl).  Distracted driving involves engaging in any activity that takes the driver's attention away from operating a vehicle. This behavior significantly increases the risk of motor vehicle crashes, endangering not only the driver but also passengers in the vehicle and unsuspecting vulnerable road users, such as pedestrians, cyclists, and innocent bystanders.

The health sector can play a pivotal role in advocating and supporting interventions designed to address these behavioral risks. Key strategies include:

Fiscal Measures: 

Hiking tax rates to increase the price of alcoholic beverages is one of the most cost-effective and cost-saving approaches to reducing alcohol consumption and harm. Alcohol taxation and pricing policies have public health and economic benefits: 1) control of alcohol consumption and public health problems caused by alcohol consumption, including those caused by drunk driving, 2) prevention of drinking initiation, and 3) tax revenue generation.  

Hence, the public health goal for taxing alcohol beverages is to limit the harm caused by alcohol consumption, including RTIs, either by reducing or preventing increases in the overall average consumption per person. 

Ignition Interlock Devices (IIDs):

These are breathalyzer-equipped devices installed in vehicles to prevent operation by drivers with blood alcohol concentrations (BAC) above a preset limit. Studies indicate that IIDs can reduce repeat offenses by approximately 70% during the period they are installed. Moreover, data from Mothers Against Drunk Driving (MADD) reveals that, over a 12-year span, IIDs have prevented more than 3 million attempts to drive while intoxicated.

Sobriety Checkpoints:

The goal of sobriety checkpoints is to deter drinking and driving by systematically stopping drivers for assessment of alcohol impairment, thus increasing the perceived risk of arrest for alcohol-impaired driving. The checkpoints are conducted at predetermined locations where law enforcement officers stop vehicles to assess driver impairment. When implemented fully, sobriety checkpoints are well publicized, highly visible, and regularly conducted. 

Sobriety checkpoints, which were first introduced during the 1930s in Scandinavia, have become popular worldwide, with some countries allowing for all drivers who are stopped to be given a breath test. Research demonstrates that sobriety checkpoints can lead to a median reduction of 20% in alcohol-related crashes.

Public support for sobriety checkpoints is also high, as suggested by the findings of a nationally representative survey in the United States that showed that 73% of responders supported the use of checkpoints in their community.  

Driving While Intoxicated (DWI) Courts:

Based on the drug court model, DWI courts are specialized courts dedicated to changing the behavior of DWI offenders through intensive supervision and treatment. A dedicated DWI court provides a systematic and coordinated approach to prosecuting, sentencing, monitoring, and treating DWI offenders. Prosecutors and judges in DWI courts specialize in DWI cases.

A DWI court’s underlying goal is to change offenders’ behavior by identifying and treating their alcohol misuse problems and by holding offenders accountable for their actions. By addressing the underlying issues contributing to impaired driving, DWI courts have been shown to reduce recidivism rates significantly.

Preventing Distracted Driving: 

This requires a multifaceted approach that combines governmental action, technological advancements, and individual responsibility. By addressing the issue from multiple angles, a safer driving environment can be created to reduce the risks associated with driver distraction.  

As highlighted in the 2024 European Road Safety Observatory Distraction report, there are effective measures against distracted driving, which include: strict enforcement of bans on the use of handheld devices, including through the use of smart cameras; building rumble strips into road infrastructure; awareness campaigns; driver education through licensing; and in-vehicle technology that warns or intervenes when departing from a lane or approaching too close to a vehicle in front.

6. Strengthening Emergency Response and Trauma Care as Integrated Elements of the Health System

While prevention remains the cornerstone of road safety, improving emergency medical response and trauma care is critical in reducing fatalities and long-term disabilities resulting from road crashes, limiting the severity and suffering from injuries, and ensuring optimal functioning of the survivors and their reintegration into the community.

The term emergency medical services (EMSs) has evolved from referring to a simple transportation system (ambulance service) to an interconnected pre-hospital and facility-based medical care system. But, as I previously discussed in a blog post, post-crash care is often an overlooked yet essential component of comprehensive road safety strategies.  Timely emergency response, high-quality trauma care, and comprehensive rehabilitation services play a pivotal role in reducing mortality and disability rates following traffic crashes.  

Saving lives after a motor vehicle crash hinges on a well-resourced, efficiently coordinated emergency care system that can provide the right intervention at the right time. The speed and quality of emergency response directly influence patient outcomes.

Response time encompasses several critical phases:

• Call Handling: The time when an emergency call is received to when an alert is raised.

• Team Dispatch: The period from the alert being issued to the moment an emergency medical team is deployed.

• Travel to Scene: The time taken for emergency teams to reach the crash site.

The concept of the “golden hour” underscores the importance of medical intervention within the first hour following a traumatic injury, as it significantly improves survival rates and long-term health outcomes. In high-income countries such as the United Kingdom and the United States, average emergency response times range between 7–8 minutes, while European Union nations typically maintain times under 12 minutes. However, in many rural areas of low- and middle-income countries (LMICs), delays in emergency response—often due to inadequate infrastructure, lack of trained personnel, and resource constraints—result in significantly higher fatality rates.

Optimizing on-scene care is equally crucial. Emergency responders must strike a balance between ensuring proper initial stabilization of the patient and minimizing delays in transport to a healthcare facility where advanced medical intervention can be administered. Studies on the economic impact of emergency medical services reveal that reducing response times not only lowers fatality rates but also improves outcomes for nonfatal cases, reducing long-term disabilities and associated healthcare costs. And, a global study estimates that enhancing trauma care systems could save as many as 200,000 lives annually in LMICs.

Strengthening emergency response systems in the health sector is, therefore, an urgent priority for mitigating the health and economic burdens of road traffic injuries. This requires targeted investments in infrastructure, advanced training for emergency personnel, better coordination between healthcare facilities, and the integration of digital technologies such as GPS-enabled dispatch systems to optimize response times. By prioritizing these improvements, countries can significantly enhance their capacity to save lives and improve post-crash recovery outcomes.

Also, as in many countries rehabilitation services are in short supply, their strengthening needs to be considered as part of health system development efforts, particularly to help RTIs victims avoid lasting disabilities and reintegrate into their life activities. 

7. Research and Evaluation

Ongoing research is crucial for assessing the effectiveness of road safety interventions and ensuring that policies are evidence-based. A good example is a study conducted in Taipei on the impact of the Neighborhood Traffic Environment Improvement Program. This initiative introduced pedestrian-friendly measures such as designated green pedestrian paths, adjusted no-parking zones, and additional speed limit and stop/slow signs in lanes and alleys.  Using staggered policy rollout and administrative traffic accident data, researchers found that the program led to a 5% reduction in daytime traffic accidents and an 8% decrease in injuries, while nighttime incidents remained unaffected. The program’s success during the day was largely attributed to the enhanced visibility of green pedestrian paths under natural daylight, which increases pedestrian awareness and driver caution.

These findings underscore the cost-effectiveness of simple yet impactful safety measures, such as clearly marked pedestrian lanes, in enhancing road safety—especially in densely populated urban environments with high volumes of motorcycles and mixed traffic. By encouraging pedestrian use of designated spaces and reducing vehicle encroachment, such interventions contribute to lowering RTIs rates.

To effectively achieve road safety targets, therefore, it is essential to prioritize resources for interventions that have been empirically validated. A global synthesis of road safety research has demonstrated that well-evaluated programs can inform decision-making beyond intermediate outcomes (e.g., changes in awareness or behavior) and contribute to measurable reductions in road traffic injuries (RTIs).

By investing in robust research and evaluation, the health sector can play an important role in contributing to guide road safety policies. Evidence-based insights can help policymakers and program managers identify, refine, and scale up interventions that deliver real impact—ultimately contributing to safer roads for all.

Towards A Holistic Approach to Road Safety

The Fourth Global Ministerial Conference on Road Safety in Marrakech has underscored the critical role of the health sector in advancing global road safety. The health system bears the primary burden of RTIs and is responsible for the treatment and recovery of the victims. Therefore, it should take an active role in the prevention of RTIs and deaths to contribute to the achievement of the ambitious goal of halving road traffic fatalities and serious injuries by 2030.  

The Marrakech Declaration's emphasis on cross-sector collaboration aligns with the health sector's capabilities to influence and implement effective road safety measures. By integrating health perspectives into transportation policies, leveraging technological advancements, and fostering community engagement, the health sector can contribute to make significant progress in reducing road traffic injuries and fatalities.

As we move forward, it is imperative to translate the commitments made in Marrakech into actionable strategies. This requires sustained political will, adequate funding, and continuous evaluation of implemented interventions. By doing so, we can create safer roads and healthier communities worldwide, fulfilling the objectives set forth in the Decade of Action for Road Safety 2021–2030.

 

Source of Images:

Image 1: Poster of Fourth Global Ministerial Conference on Road Safety in Marrakech, downloaded from conference documents.

Image 2: "Accident on the city road at night", photo by Jaromir Chalabala (Shutterstack Photo ID343682648)