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NEWS: John Zarocostas Deaths from road traffic injuries will nearly double to 2.4 million a year unless safety measures are strengthened BMJ 2009; 338: b2464 [Full text]

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Vehicle danger and active life styles in our communities

Ediriweera Desapriya, Deborah Susges, Sayed Subzwari   (20 June 2009)

The ups and downs of global road safety

Tony H. Reinhardt-Rutland   (26 June 2009)

Vehicle danger and active life styles in our communities 20 June 2009
Ediriweera Desapriya, Research Associate Department of Pediatrics, University of British Columbia, V6H 3V4, Deborah Susges, Sayed Subzwari Send response to journal: Re: Vehicle danger and active life styles in our communities	Currently, global initiatives promoting active lifestyles encourage more people to walk and cycle. This will increase the number of pedestrians and cyclists on roads, corresponding to increased human exposure to vehicle danger. Without intervention, this may result in increased incidence of pedestrian and cyclist fatalities and injuries, thereby countering the positive health effects of the active lifestyle initiatives. This number may easily exceed the current World Health Organization (WHO) estimates provided by John Zarocostas. When examining literature on the recent shift in the global vehicle fleet to include more light truck vehicles (LTVs) and the associated increase in risks to pedestrians and cyclists, we need to highlight vehicle danger as a socially modifiable risk factor for obesity and other diseases of physical inactivity. There should be open discussion of the worldwide obesity epidemic by providing information linking changes in the built environment, specifically the increasing injury risk to vulnerable road users posed by LTVs and vehicular traffic, to changes in physical activities in an effort to curb the physiological and psychological suffering associated with obesity and other diseases of physical inactivity. Competing interests: None declared
The ups and downs of global road safety 26 June 2009
Tony H. Reinhardt-Rutland, Reader in Psychology University of Ulster BT52 1SA Send response to journal: Re: The ups and downs of global road safety	It is important that we are reminded of the scale of the global problem concerning road casualties. However, in most - if not all - countries road deaths tend to fall as the road transport system expands (1). The implication is that global road deaths must steadily reduce over the coming years as more and more countries develop sophisticated road systems. The reality is of course not quite so simple. Road deaths may be reduced for a number of reasons that are not desirable. These include (a) the development of sophisticated trauma-care, problematic because of the enormous resources such care demands, and (b) congestion: speed must be substantially reduced. We know that speed plays a crucial role in casualty outcomes: the likelihood of mortality increases in line with the fourth power of vehicle speed (2). Furthermore, it is worth reminding ourselves of how persistent bad behaviours can be. In Britain, various governments have enacted legislation to control speeding and to outlaw drink-driving for well over 70 years. Yet these problems remain to be fully tackled by the UK's Department for Transport (3). Finally, on the issue of safety engineering: official bodies and their representatives seem to have difficulty in recognising that the benefits are often double-edged. For motorists, the safety advantage of seatbelts may be eroded because the safety advantage is converted into a performance advantage, specifically the ability to decelerate later in the event of a near-miss (4). This, of course, has the unfortunate consequence of introducing an extra element of danger for non-drivers: if we wish to promote walking, cycling and public transport - the latter is generally best accessed by walking or cycling - then such side-effects of safety engineering present substantial obstacles. REFERENCES (1) Evans L. (2001). Traffic safety and the driver. New York: Von Nostrand Reinhold. (2) Finch, D.J., Konmpfner, P., Lickwood, C. R., & Maycock, G. (1994). Speed, speed limits and accidents. Project Report 58. Crowthorne UK: TRL. (3) Department for Transport (2009). A safer way: consultation on making Britain's the safest in the world. London: TSO. (4) Wilde, G.J.S. et al (2002). Does risk homeostasis theory have implications for road safety? British Medical Journal, 324, 1149-1152. Competing interests: None declared