Road Traffic Injuries & Deaths: A Global Perspective

Road traffic collisions are the 8th leading cause of death and one of the most burdensome causes of injury world-wide. In particular, it is the leading cause of death for children and young adults aged 5-29. The Public Health Insight Podcast examines road traffic deaths and injuries from a global perspective, some differences between developed and developing countries, and introduces the United Nations Sustainable Development Goals (SDGs) geared towards road safety.

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[00:00:00] Sully: Public health is a population-based field of science focused on preventing disease and promoting health. Every week, we will be engaging in interactive discussions and analyses of the latest public health issues affecting you and your communities all around the world. This is the Public Health Insight podcast.

[00:00:24] Leshawn: My name is Leshawn, and I'm here with Wil, Ben, Sully, Linda, and Gordon. 

[00:00:29] Ben: Before we move on its important to note that the views expressed in this podcast are our own and do not represent any of the organizations we work for or affiliated with. 

[00:00:38] Leshawn: The global status report on road safety 2018 by the World Health Organization, highlighted that there are about 1.35 million road traffic related deaths in 2016, and this number continues to rise each year. 

[00:00:52] That means every day around 3,700 people are dying on roads globally, along with tens of millions of people who are [00:01:00] injured. Although world leaders have expressed commitment to the reduction of road traffic deaths by 2020 through the sustainable development goals, little progress has been made. 

[00:01:10] In this episode, we will examine the global burden of road traffic deaths and injuries. So as you've just heard, I'm not too sure that many people are aware of how many road traffic related deaths and injuries occur globally each year. So for me personally, I was actually shocked when reading this report.

[00:01:27] Um, so to establish context and the bigger picture, let's begin by discussing the overall global burden of road, traffic, deaths, and injuries to really drive home the point that this is indeed a public health issue worth highlighting. So what do you guys think about the report that you read and maybe how you felt about some of these jarring stats? 

[00:01:47] Linda: Well, personally, I was shocked too, because I was unaware that the number was so high. And when I go in my car and I drive to the grocery store or to go to work, I [00:02:00] expect to make it home safely. It doesn't often occur to me that there's much of a risk involved. And maybe that's the issue that my risk perception is so low, because what we're seeing is that road traffic deaths are a leading cause of death and injury too. So yeah its shocking. 

[00:02:20] Ben: Yeah. One thing I noticed and one thing I was curious about is what are these numbers before the implementation of seatbelts worldwide, or even within this report? How many countries be it, low or middle income, still use, um, seatbelts or have the proper enforcement of seat seatbelt policy, and whether that affects the numbers.

[00:02:37] Leshawn: Yeah, that, that's definitely an important fact. I think when it comes to other countries developed countries or developing countries, they have different regulation and enforcement methodologies that they have in place. So I think there's going to be differential outcomes based on that. 

[00:02:51] Gordon: One thing I'll add too is when we think of preventable deaths or premature mortality in public health, [00:03:00] we often think of it being as a result of, you know, diseases.

[00:03:04] So whether it's substance use, uh, diabetes or even infectious diseases. And we often channel our resources in that way to prevent early deaths from those kinds of things. But in the context of road traffic deaths, it being ranked the eighth leading cause of death globally, I think that was a bit of a surprise for me, and it probably will be a bit of a surprise for our listeners as well. 

[00:03:33] Leshawn: Yeah. So, um, I'm kind of wondering now why, why is that a surprise? Why doesn't this issue get more shine?

[00:03:39] Gordon: Think part of it is it's almost become an acceptable risk to using the road or, you know, whether you're driving a car or you're on the sidewalk, it's, it's kind of become an acceptable risk in a sense where, um, these things happen and there's nothing we can really do about it. So it's a natural human instinct to not kind of worry [00:04:00] about things that we can't control. That's probably a partial explanation for why it doesn't get as much attention. 

[00:04:06] Ben: I agree, Gordon, I think as a society, we tolerate a certain amount of debts and unfortunately road safety is going to be a part of it because we're so accustomed to, you know, using vehicles as transportation.

[00:04:17] And it's part of our culture and looking at, you know, Canada and my experience traveling to Sri Lanka over there, you would have really busy streets, like similar to those videos you would see of India where there's like 20 different things happening at once. And then the culture there is, oh, you just got to Jay walk through it.

[00:04:33] And you're like, how do I even attempt to do this? And it's like, oh, you'll figure it out. We'll adapt. So instead of enforcing road safety laws, to make sure everything is safe, it's more along the lines that we just have to adapt to this and figure it out. And then there's this unspoken rule between the driver and the pedestrian of, um, right of way. But nothing is like actually tangible. 

[00:04:56] Sully: Yeah. And because people normalized it [00:05:00] and got to adapt to it. I think that death would be just an inevitable thing, responsible governments and institutions as a consequence would think that solving for these problems are first pointless and second expensive. So like ideologically speaking, it's problematic.

[00:05:19] Ben: Yeah. And then you have to look at, um, the governments as well. Like for example, if you want your local government, in whatever country, and we're going to be talking more about my, um, middle income or low income. If you want them to come and fix the road or set up a safe road, how long is that going to take realistically versus me, who I have to cross this road every single day to either get to work, et cetera, I'm just going to go and figure it out.

[00:05:43] And then by the time the government comes in, it's not an issue anymore to me, even though it is in the grand scheme of things, but there's a disconnect between what is actionable, and then what is realistic.

[00:05:53] Gordon: Yeah. And I think part of the reason also to put a ribbon on it, it lies in which countries are affected the most [00:06:00] right in middle income countries are disproportionately affected as they have 90% of the world's road traffic that's.

[00:06:06] So like with everything else with the bowl, uh, and, and, you know, malaria and diseases that affect the most vulnerable populations in the world that we're living in. Those tend to get less attention because all the resources are concentrated in to the high-income countries, which are doing the best on these indicators.

[00:06:26] Linda: And also I think in low and middle income countries, perhaps their priority is alleviating, you know, diseases like diseases of poverty or, you know, malnutrition or something like that. And so perhaps if they get funding from high-income countries, it's not going to go towards road safety. It's going to go towards medication for let's say malaria or something.

[00:06:47] So it's hard to prioritize road safety when you have other disease burdens as well. 

[00:06:54] Ben: Yeah. And it's also hard to, it's harder to conceptualize from a healthcare perspective because as Gordon mentioned earlier, we're so [00:07:00] focused on diseases and health care specific problems, those first seven that come before road safety, it almost seems like road safety is more of an infrastructure or urban development problem. So it's kind of, there's a disconnect between that conversation. 

[00:07:13] Linda: Except we're trying to push the message that road safety is achievable and that deaths due to road accidents are preventable and it is part of public health. 

[00:07:25] Leshawn: Yeah, exactly. And I think we, as public health professionals have to kind of reiterate on the point and watch our kind of terminologies that we use when we're talking about, um, these traffic related deaths.

[00:07:39] A lot of the times people bring up the term accidents, but in fact, um, this kind of brings up the idea that, you know, it wasn't anyone's fault and these things weren't preventable. So we have to kind of move ahead with our terminology and maybe fine tune it more so that people understand that it's not something out of your [00:08:00] control.

[00:08:00] There can be steps in place to mitigate these things and minimize damages. 

[00:08:05] Gordon: Yeah, that's a, that's a great point, Leshawn for sure. In, in injury prevention, it's a challenge to kind of frame, you know, certain issues that can result in trauma, um, or even death in a way that convinces someone that the event that led up to that was a preventable event.

[00:08:21] And by calling it an accident, like you said, it takes away the kind of urgency to put effort into looking at it from a holistic perspective and prevent it from happening in the future. So, putting it into perspective, that should be one of the key focuses of the folks in health promotion. 

[00:08:39] Leshawn: Yeah. That's a great point.

[00:08:40] Because as we'll see later, we're going to be talking about vision zero, which actually brings this to the forefront in terms of the terminology used. They want to make sure we move away from the term accident and kind of ensure that everyone understands these things are preventable. 

[00:08:55] Gordon: Let's go back to, there was a point in the, um, report [00:09:00] where, um, you know, it was mentioned that there's, there were 1.35 million road traffic deaths in 2016, um, which is an increase from two decades ago from, you know, from the early two thousands. Um, however, they were saying that, um, the overall, uh, rate per 100,000 population, uh, remained relatively constant. 

[00:09:23] So I was wondering why is it important to even make that distinction? Should we not only just care that the number went up from 2000 to 2016 and not really care about how much the rate increase or what is the rate anyway? 

[00:09:36] Linda: I think it's important to look at the rate though, because it shows that something is working because if the rate was increasing, then we know, okay, the problem is definitely getting worse, but the rate is relatively constant, so, it's not getting worse. It's not getting better, but it's not getting worse. So perhaps that shows that the prevention efforts are working to kind of maintain [00:10:00] the rate of death. 

[00:10:01] Leshawn: Yeah. And it seems that from reading the report, um, one of their biggest calls to action was the fact that, sure, although these rates have probably stabilized over the last few years, um, one of the biggest things that we're missing out on is the potential to achieve that SDG goal and target that they, they wanted to have. So that's why it's still important because even though rates are, are still remaining constant, there are still people dying every day on the roads. And those are things that could be preventable.

[00:10:32] Gordon: Yeah. So for people who are in kind of new to, you know, public health, or public health related careers or education, um, rate per 100,000 population is often used when you need to standardize a certain indicator. Um, because two dif, two different countries can have, like, if you compare Canada and the United States, they have, the United States has about 10 times the number of people living in the country.

[00:10:58] So if you look at for something [00:11:00] like, for example, coronavirus cases, and you only look at the numbers while the United States have more people, so, they're more likely to have more numbers, but if you look at it as per 100,000 people that helps you to see and make comparisons across different countries. And this is why in the case of, um, road safety and road traffic related deaths and injuries, uh, when we're comparing, um, countries across all continents and have different sizes, it's important to put these numbers in context based on the sizes of those populations. 

[00:11:33] Wil: Uh, Gordon, I think that's a really good point. And if I can add, I think having the rate per 100,000 also allows, um, public health professionals to compare road related deaths with other cause of deaths, for example, homicide, um, death from alcohol or drug related incidents, um, suicide rates, this kind of thing.

[00:11:54] So that you don't just look at road injuries and deaths within a [00:12:00] vacuum, but you see how, you know, it's how it compares with other cause of death. 

[00:12:05] Gordon: Right. And that's important too, Wil, because like Sully said, when you're making the case to decision makers and policymakers. Um, premium per 100,000 population can help them make a comparison to see where to allocate resources as well. So that's a good point. 

[00:12:21] Leshawn: Yeah, even adding onto that, um, there've been a couple of economic analyses on road traffic injuries and deaths in low and middle income countries and even developed countries. So some, some of these estimates are pretty old and from the late 1990s, but this one report showed that road traffic injuries cost around 518 billion US worldwide and 65 billion US in low and middle-income countries.

[00:12:51] So that the stat also pushes further and says that these exceed the totals that these countries actually receive in developmental [00:13:00] assistance. Right. And to give even further stats, more recent stats actually. So in terms of crashes that occurred in 2017, the cost of medical care and productivity losses that are associated with such injuries and deaths from motor vehicle traffic crashes exceeded 75 billion in the US. 

[00:13:22] Gordon: Right and I think that's a good point too, because this episode is based on road traffic deaths and injuries.

[00:13:29] So we also have to account for things like, you know, the people that did survive. How much has their quality of life changed? Um, you know, the loss of productivity in terms of providing for their family, um, you know, you know, children being, um, disabled and missing out on fulfilling their potential in the future.

[00:13:47] So, and I know compared to the number of people that die from road traffic collisions and incidents in 2016 was 1.35 million. I believe um, the number of [00:14:00] injuries that occurred from road traffic was about 50 million. So there's even more people affected by the injuries directly. So that's a good point. 

[00:14:09] Ben: Yeah, it's such a a complex situation that it's hard to capture it without going really into it.

[00:14:15] Cause I'm also wondering, based off the economic analysis and the effective qualities and what not. So qualities would be a quality adjusted life years. So for example, if you were involved in a road traffic accident, you've survived, but you had a debilitative injury that would affect the quality of your life years that you have remaining because you would have, for example, decreased function, unable to work, et cetera.

[00:14:40] So back to my question is that it's, it's really hard to not be preventative because if you're able to prevent the action from even happening the collision per se, then you get a lot of bang for your buck. But if you would try and focus on interventions after the collision, for example, healthcare physio-therapy, et cetera, it's very [00:15:00] costly.

[00:15:00] Sully: Prevention versus treatment.

[00:15:01] Gordon: Yeah. Well, in terms of levels of prevention, that would be more like primary prevention would be before it even happens in secondary, you know, would be more like harm reduction from driving. Um, and then tertiary would be, you know, it already happened and how can we best help the people that are affected, so. 

[00:15:20] Leshawn: As mentioned in the report, road traffic is the eighth leading cause of death for all age groups. So what categories are ahead of it? Some probably well-known diseases. 

[00:15:31] Gordon: Yeah, I would say for sure, you'd probably have the cardiovascular diseases up there and you'd probably have things like diabetes, and I would say some cancers

[00:15:41] Ben: Yeah, like lung cancers 

[00:15:43] Linda: Alzheimer's and dementia as well. 

[00:15:45] Gordon: But you know, there's only seven more ahead of it.

[00:15:47] So there's not, it's not a long conversation as we're finding out that road traffic it is indeed in the top 10, for leading causes of death, so, still a shocker.

[00:15:57] Leshawn: Yeah, exactly. And [00:16:00] specifically it's the leading cause of death for children and young adults aged five to 29 years of age. And in the report, Dr. Tedros, who's the director general of the WHO he states the following: "no child should die or be seriously injured while they walk, cycle or play. We must return our streets to our children. They have the right to feel safe". 

[00:16:26] Gordon: Wow. This kind of even brings up the social equity piece. Right? You imagine that children in kind of more lower income neighborhoods in developed countries and in developing countries in general would be disproportionately affected because the areas that they have to, to walk to school or play are less safe than some of the richer kind of neighborhoods. Right. Because the neighborhoods would probably be designed more safely and such and such. So, um, we haven't touched on it too much in this episode, but we're sure that when [00:17:00] you know this episode, we're talking about the, looking at it from a global perspective.

[00:17:04] But when, if we take a microscope and look at it from, you know, more, uh, neighborhood to neighborhood, you know, regions and countries to other regions and countries, we'll probably see some, even more shocking numbers about which populations are more effective,

[00:17:18] Leshawn: I guess that brings me to the question, why, why children?

[00:17:21] Why are these children being affected more by these road traffic related incidents? 

[00:17:27] Ben: My guess would have to be probably related towards education. For example, in middle to low income countries may be the most, um, the closest school nearby is only accessible by a bus that takes only X amount of people.

[00:17:42] Again, I'm going back to my India Sri Lanka example. Cause I've been there is that, cause you'll see buses just filled to the brim with people. And it's not even like everyone's seated inside it's people are, are holding onto the sides or they're up on top they are, they're hanging on. And it's because that's the only transportation to get [00:18:00] them to school or to work.

[00:18:00] That's the only opportunity there. So you're putting people in a more riskier situation because of what Gordon mentioned is that their social inequities in place, 

[00:18:08] Leshawn: I don't know if you guys had a chance to watch that video that I posted, but um, in the video by the WHO it showed a report, um, I think they, she was in Thailand and she was kind of showing, um, showing a school and how at the start of the day children are walking and crossing streets that are crowded with motorcycles and other vehicles.

[00:18:30] And there's no safe crossing. And this happens at the beginning of school and when they leave school and the chances of a collision are greatly increased because there's no kind of safety, precautions or mechanisms in place. And you could see these kids just, you know, waving their hand in the air to kind of cross with the motorcycle coming full speed at them.

[00:18:51] So it was definitely very illuminating 

[00:18:54] Wil: I think the issue with that though, I mean, um, I, I kinda have a question going off your point [00:19:00] Leshawn. It's done. I mean, it's, it's an interesting, um, I guess observation, but I don't, I still don't see how it kind of explains why children are more effective because it's like, you know, like what's at its core, what's the reason what's causing, uh, children and young, young adults, um, in between the age of 15 and 29, why are they disproportionately affected by, um, road injuries? And that's more than an adult because I feel like if let's say, if you're in a developing country, and if, you know, if everyone in that society is all facing the same issues of inequality, um, you know, access to transportation, um, the lack of properly, safely planned communities, things like that.

[00:19:46] If everyone in the community is subject to the same kind of environment, then what's your, why is there that distinction between the ages? 

[00:19:53] Gordon: Yeah. Just if you look at it from just a developmental or biological perspective, when a child sustains [00:20:00] trauma, um, they're more likely to be injured because their musculoskeletal system hasn't fully developed.

[00:20:05] And then, you know, we, we saw from the report also, or maybe another report that, um, head injuries, um, from road traffic collisions or incidents are the leading reason for why someone dies. So if you think of the undeveloped brain, if children fall or versus an adult, the child is more likely to be more seriously injured and die and, or get injured.

[00:20:31] So that's one of the explanations to, um, why a child disproportionately dies from a road traffic incident. What, what would help answer your question even more, Wil, is we don't know of the kind of road traffic collisions that don't result in any serious injury or death, we don't know if children are having more encounters with people on vehicles. And I think that would be something we'd have to look into.

[00:20:57] Leshawn: Right. And we just got to remember as [00:21:00] well, um, the reason I also did bring up that example is to also highlight the fact that often times, children aren't the ones behind these vehicles, a lot of the times, right? They're not old enough to drive.

[00:21:11] And so the people that are in the cars who are more likely to be older adults or not children are going to be probably the safe ones in a collision that occurs on a pedestrian. 

[00:21:23] Linda: I think it's also important to highlight that within that five to 29 age gap around like 15, 16 is when you know, teenagers do learn how to drive.

[00:21:33] And so a new driver you're less skilled. And so maybe unable to like your reflexes may not be as sharp as someone who maybe has been driving for longer. And so I know we've mostly been talking about being on the pedestrian side of this 5 to 29 year old risk group, but I think it's important to consider, uh, teenagers and new drivers, um, within that group being behind the wheel and may also engage in more [00:22:00] risky behavior as well. That's also could be part of it. Yeah. 

[00:22:03] Ben: But there's also like a second part to that as well, because I know we're talking about the 5 to 29 years old range, but to play devil's advocate to that point, Linda is that older drivers are, older drivers are more careless or more riskier because they have this perceived sense of skill, right? Like we see that individuals have been driving for 30 to 40 years. Yeah. You could say that they're more experienced and more likely to not make mistakes, but there also is a chance that they're more careless. 

[00:22:32] Linda: I agree, but I think that their carelessness will impact a younger driver who may not be expecting that like the younger driver, maybe following the rules, but in someone who may be more careless then the younger person gets impacted.

[00:22:45] Gordon: I think a big thing with this here is, we've seen that developing countries have a disproportionate burden. And we're kind of using partly our experience with the, you know, being in Canada or North America, which is more developed [00:23:00] where we have more rules and regulations about you can drive when you're, you know, X age and you, you know, your blood alcohol must be zero and stuff.

[00:23:08] Some countries don't have those rules and regulations. So that behaviors of that age group in Canada might not necessarily be applicable to that same age group, living in different countries, developing countries. But I also want it to say, um, even if you look at it from just a logical perspective, um, if you compare it to the older age group where they have more comorbidities children, five, five to 29 are less likely to die from something like Alzheimer's diabetes than older adults.

[00:23:39] So if you look at it from that perspective, Um, it's usually something more unexpected that would be more likely to take their life. And that's why compared to other diseases road traffic injuries or deaths are going to be higher as a portion of the pie for children versus people who are older 

[00:23:58] Leshawn: Globally, we see that [00:24:00] cyclists on the road represent around 26% of all deaths.

[00:24:04] Those who use two wheelers or three wheelers around the world represent about 28% of deaths. Cars make up 29% of deaths. And the other 17% are on an unidentified road users. But what we find is that these deaths occur disproportionately amongst those vulnerable road users, as I just mentioned. And it seems that in many low and middle income countries, um, have the most are a higher proportion of these vulnerable road users.

[00:24:36] Gordon: Yep. That's exactly right. Um, if you imagine, uh, developing country, um, that doesn't really have proper road infrastructure. It's probably going to be easier to navigate with a two or three Wheeler right. In the smaller streets. And then we already, we already, you know, we beat the point home about, uh, developing countries, being more disproportionately affected by road [00:25:00] traffic, deaths and injuries.

[00:25:01] And it then makes sense, given the, the proportion of the types of vehicles available, and those are being used in those countries, this is what would come, come from the data. 

[00:25:12] Leshawn: Exactly. And you, we also have to remember that the, the prominence of the vulnerable road users may not be able to afford the safest vehicles with, which are, I guess, the four wheel or the Jeep, the trucks, or 

[00:25:27] even older cars.

[00:25:28] Right. There's probably, yeah, I did not. The newer cards with the safety features etc. 

[00:25:32] Ben: And even building the roads. I mean, we have roads where after a few kilometers, the, um, the surface of the road would be , Uh, irregular. So once you, once you drive over it, it makes like a certain distinct sound that kind of like wakes you up if you're on long road trips.

[00:25:46] Right. And if that's not available because the infrastructure is there, the government's not supporting that in these countries, then that's obviously a factor that's not going to help in terms of preventing road collisions. 

[00:25:55] Linda: And in some places too. Like I know in Ghana, for example, sometimes when you're driving, [00:26:00] it's like a free for all.

[00:26:01] So if you're more aggressive than you're going to get to go, but if you're one of these more vulnerable road users, and let's say you don't have a bike lane or a designated space for you already, you're more at risk. 

[00:26:13] Ben: Yeah. And it's unfortunate because you, aggressiveness is the culture. Aggressiveness means my right of way, and I'll be able to keep myself safe.

[00:26:22] But if you end up finding someone else is also aggressive, then you know, that culture breeds a collision. 

[00:26:28] Sully: I want to recall my, uh, personal experience regarding, uh, traffic and the dangers that come with that

[00:26:42] Ben: Sully's a great driver. 

[00:26:44] Sully: Yeah, I'm great, don't worry about it. My time back in Syria. I remember my mom not allowing me to cross the road to like a certain age. I think it was like grade five when I'm, when I was allowed. So with my [00:27:00] upbringing, I was fortunate enough that I was protected, but you know, a lot of people just follow like risky behavior thinking that it's normal and, uh, it just leads to preventable deaths.

[00:27:13] Gordon: That's a good point, Sul, , because if you even think of your experience compared to other people's experience, um, I'm sure there's some in some developing countries. Children have to go start going to work when they're very, very young. Right? So if you think of the risks that we would have, where we're either at school or home, when we're, you know, a lot of people who grew up in Canada or North America or whatever, or any other developed countries compared to, um, a poor developing country where, the, the child is expected to go out before they're 10 to, you know, to get work. They're going to have more exposure to being impacted by a road road incidents. Right. So if you look at that alone, that could be, that could also explain Wil's question earlier about the increased vulnerability specifically, uh, for [00:28:00] children. 

[00:28:00] Linda: Even not just going out to work, but even just crossing the street as your regular, going out to, to just do errands or just be a kid outside here or in Canada, anyway, we're taught, you know, push the button at the crosswalk and look both ways and wait for cars to stop and then cross it's like ingrained into your brain.

[00:28:21] Um, but again, my experience going to Ghana. I would be waiting to cross the street and my family would be like, let's go, what are you doing? You just cross, just cross. And I'm like, wait, I'm not used it as it's very much a cultural shift.

[00:28:34] And so I think, I mean, we haven't gotten to this point yet, but if we, if, when we get to the point of talking about what to do about this, it's more than just, you know, putting signs and enforcing it. But it's also like changing the cultural behavior or cultural practices surrounding, um, road safety. And I think that might be the bigger challenge. 

[00:28:55] Gordon: And then the people living in developing countries, you [00:29:00] know, some of them have backyards and then some people living in other countries don't have backyards for children to play, um, end up playing their nearest street. Car comes near the sidewalk or whatever other area. And you know, a lot of people die that way. 

[00:29:15] Leshawn: Yeah, it's a, it's a great point that you guys mentioned and thank you for sharing those personal experiences. And I think these are some of the points that we highlighted are some of the reasons why the UN found this to be an important issue and why they decided to include it, and adopt, um, road safety into the SDGs, which are the sustainable development goals. So specifically in SDG number three and SDG number 11, SDG three looks to half the number of global deaths and injuries from road traffic crashes and SDG 11 looks to provide safe, affordable, accessible, and sustainable transport systems for everyone, improve road safety, and expanding public transit. [00:30:00]

[00:30:00] And so there's also a special attention to the needs of vulnerable individuals, women, children, persons with disabilities and older individuals. So this step, this movement, the acknowledgement to have road safety embedded in the SDGs was an important milestone in terms of global road safety, because it really defined it and kind of confirmed it as an essential health need. You know, a global issue. Yeah, yeah. 

[00:30:30] Gordon: Not to belabor the point, but if you think of something, um, something like road safety, which we're going to get into in the next episode. Uh, requires a ton of investment to infrastructure, um, from, you know, of course you can have the seatbelt wearing and not, you know, no drinking and driving and those kinds of policies, but before you even, not before even if you get there, but a huge part of it is just having [00:31:00] roads that are just safe to drive on safely.

[00:31:02] Right. So I think there's just, these goals very optimistic. Um, but, the, the road infrastructure part of it that requires a significant investment has me a bit worried. 

[00:31:15] Linda: Right. And I think that's why we keep making this distinction between low-income countries and high-income countries are developing and developed because the evidence shows that there is an association between, um, road traffic deaths and the income level of a country, because it requires such an investment.

[00:31:34] And, um, we don't address that investment piece in the capacity of a country to meet that need like financially. Uh, then we're missing a huge factor. 

[00:31:46] Leshawn: Our discussion highlighted that road traffic deaths and injuries are a huge economic and social burden globally, and are often not talked about as much as many of the other leading causes of death, such as diabetes, strokes, and ischemic heart [00:32:00] diseases.

[00:32:00] In the next episode, we'll be talking about the importance of leadership, policy, and best practices as a means of tackling road traffic deaths and injuries. 

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