2 Public health need and practice
The rate of deaths and serious injuries from road collisions has been declining over recent decades (by about 4% per year in all ages and 9% in children). However, unintentional injury is still a leading cause of death among children and young people aged 1–14 (Audit Commission and Healthcare Commission 2007) and nearly half (44%) of those deaths in England and Wales are transport-related (Office for National Statistics 2009).
In 2009, 65 young people aged under 15 were killed and 18,307 were injured on the roads in Great Britain, 2267 of them seriously. Of those killed or seriously injured, 1507 (65%) were pedestrians. Cyclists (381) and car passengers (380) made up the bulk of the remainder (that is, cyclists and car passengers each accounted for around 16% of the total) (Department for Transport 2010a).
The most commonly used statistics on children injured in collisions come from 'Road casualties Great Britain'. This is based on STATS 19. However, 'Road casualties Great Britain' notes that: 'although STATS 19 is the most detailed and useful source of information on road casualties at national level, it is not a complete or perfect dataset' (Department for Transport 2009). It also notes that other estimates, based on the national travel survey, give a total number of casualties around three times the number recorded in STATS 19.
The number of people killed or seriously injured on the road increases with age. There is a noticeable increase between ages 10 and 11, which coincides with the move to secondary school and probably with increasingly unsupervised travel.
In 2008, 65% of children or young people killed or seriously injured were boys. This higher rate in boys is seen in all modes of transport (except for car passengers, where girls account for 54% of those killed or seriously injured).
Overall, population-based casualty rates for England are better than the European Union (EU) average. However, this rating masks poorer figures for pedestrians (Department for Transport 2008).
There are other people besides casualties whose health is affected in less apparent ways. People can be traumatised by near misses, or avoid activities or opportunities because of danger (real or perceived) on the roads. These opportunities include walking or cycling, meeting friends and family and other types of recreation, as well as the freedom to develop independence.
In recent decades, children's exposure to danger from various modes of road transport has changed considerably. By 2003, the average mileage travelled as a car occupant had increased by 70% compared with 1985. The average mileage walked had declined by 19%, and the average cycled had declined by 58% (Sonkin et al. 2006).
A Play England survey (2007) suggests that children now spend less time playing outside – 71% of adults played outside in the street or area close to their homes every day when they were children, compared with only 21% of children today.
Most traffic casualties among children and young people occur in urban rather than rural areas (2073 compared with 734 among those aged 0–15 years in 2008). In addition, the percentage of pedestrian casualties is higher in urban compared to rural settings (73% compared with 36% in 2008) (Department for Transport 2010b).
In urban settings, most casualties (74%) are on minor roads (Department for Transport 2010). Younger children (aged up to about 8) tend to be injured on streets close to their home. As they get older (around 11 and above) they tend to be injured further from home, and on busier roads, reflecting their increasing licence to travel independently. Boys tend to be given greater independence at an earlier age (Towner et al. 2005) and so this shift occurs at a younger age for boys.
Among young people aged under 15, the likelihood of dying as a car occupant is 5.5 times higher if their parents are unemployed than if they have managerial or professional jobs. This ratio exceeds 20 among pedestrians and cyclists. Similarly, more than one quarter of child pedestrian injuries happen in the most deprived tenth of wards (Greyling et al. 2002).
The largest factor resulting in this difference in death rate is exposure to danger rather than behaviour (Edwards et al. 2006). People from lower socioeconomic groups are more likely, for example, to live in neighbourhoods with on-street parking, high-speed traffic and few or no off-street play areas.
National data, such as those reported in 'Road casualties Great Britain' (Department for Transport 2009), do not routinely feature information on the characteristics of the casualty other than age and sex. Information on ethnicity, for instance, has generally come from a small number of local studies which frequently focus on one ethnic group.
A report by the Department of the Environment, Transport and the Regions (2001) states that surveys suggest that there is a higher pedestrian casualty rate among children (age range not stated) from Asian backgrounds than non-Asian peers in the same area. Other groups may be similarly affected but have not been systematically studied.
Factors before, around the time of and after a collision can all help determine whether someone is injured (and how badly) or killed in a road collision. These include: traffic speed, safety training and road surface; use of devices such as anti-lock brakes; use of seatbelts, airbags and other car design features; and the response of emergency services.
Approaches to preventing collisions (primary prevention) focus on altering the behaviour of road users (or the vehicle, if emergency action is required). The former, for example, might include educating people about road dangers or introducing engineering measures to restrict vehicle speed. The latter might include anti-lock brakes or anti-skid road surfaces (Racioppi et al. 2004). Approaches to reducing the severity of injury (secondary prevention) include car design and provision and the use of safety devices.
The logical place to start in considering road injuries is with primary prevention.
It's also worth bearing in mind that when someone feels very safe, this can alter their behaviour so that the actual risk becomes higher than might have been expected. (An example of this 'risk compensation' would be driving faster in a car with anti-lock brakes.).
Road design has a key influence on speed (Department for Transport 2007). 'Excess and inappropriate' speed contributes to around 30% of fatal crashes in high-income countries (World Health Organization 2004).
Higher speeds reduce the time available for people to react and increase the severity of collisions. Vulnerable road users (cyclists and pedestrians) are at particular risk: pedestrians have a 90% chance of surviving car crashes at speeds below 30 kph but a less than 50% chance at speeds of 45 kph (Racioppi et al. 2004).