Toxic complacency

How can we be so complacent about 3000 deaths and 30 000 serious injuries every day as a result of road traffic crashes (p 1107)? That's about the same number of deaths and many more injuries than resulted from the attack on the World Trade Centre happening every day, year after year. Why is there not worldwide demand for action rather than ignorance, indifference, and evasiveness?

One reason is that the deaths and injuries happen every day. They are “business as usual.” And they are scattered. We can't see 3000 corpses in one place. The deaths happen mostly in the poor world to the powerless—to children and those too poor to afford a car or even a bus ride. We in the rich world behave as if we are not at risk. But we are wrong. The average person in a developed country has a one in a hundred chance of being killed in a road traffic crash and a one in three chance of being injured (p 1110).We are addicted. We can't imagine life without our cars, so we pollute our environment, concrete over our countryside, and ignore the carnage. Just like addicts we cannot stop ourselves despite the harm.

Vested interest is also at work. Concerted action by motor manufacturers could reduce pedestrian deaths dramatically, but they oppose many of the innovations that would be necessary. The manufacturers are not yet seen as pariahs—as are tobacco manufacturers—but they might be wise to take the lead in reducing deaths and injuries rather be forced by external forces to take action.

Roger Browning explains on p 1165 why he was shaken out of his complacency. His daughter was killed in a road crash. He and his wife were changed forever, but “save for the impact on the immediate family, a death or injury on the road changes nothing. No one notices. A train or aircraft crash prompts massive, costly efforts to avoid repetition. A death on the road barely makes the local newspaper.” Browning is now a trustee of RoadPeace, a charity for road traffic victims, and is convinced that our perception of the car will alter. Generations from now people will look back and wonder how we allowed things to get so out of hand.

This theme issue on the global toll from road traffic crashes will be part, we hope, of raising consciousness about the scale of the problem and the complete inadequacy of the response. Several research studies deepen our understanding of road crashes, but generally there is far too little research for such a major problem. One important lesson is that improvement will come not from educating pedestrians on road safety but from changing the whole environment (p 1129). We need better design of roads and cars and a shift from car use to walking, cycling, and public transport. As this issue rams home, this is a major—but largely neglected—public health issue.