Traffic crashes take the lives of hundreds of people-many in their prime years-every day in Latin America and the Caribbean. Safety advocates say these tragedies are not just "acts of fate" but foreseeable events that can be prevented with increased public awareness and better public policy.
Parents of children killed in the Tragedy of Santa Fe organized to memorialize the victims and to improve traffic safety throughout Argentina.
In October 2006, a group of high school students from Buenos Aires were returning from a field trip to a rural school, where they had met and shared experiences with students from very different, less privileged backgrounds. On a highway in the province of Santa Fé, a truck collided head-on with their van. Nine of the students, aged 15 to 17 years, died in the crash, along with their teacher and two bus drivers.
The truck driver had stopped at a bar to watch the Clásico, a match between Argentina's two biggest soccer clubs. When he got back behind the wheel of his truck, his blood alcohol level was nearly three times the legal limit for noncommercial drivers (truck drivers are not legally allowed to drink at all in Argentina).
But other factors contributed to the crash. The truck driver was not properly licensed. The bus driver tried to swerve, a witness said, but there was no shoulder along the road.
"The cause wasn't just a man who got drunk," says Lucila de la Serna de Bravo, whose son Benjamin died in the crash. "There were many causes. This is a major international road ... yet it didn't even have a shoulder."
Some might have ascribed the terrible loss of young lives to a cruel twist of fate. But Benjamin's mother sees it differently. For her and the other parents who lost their children, the "Santa Fé Tragedy" could have and should have been prevented.
"Many of these tragedies, these deaths on our highways, are totally preventable. They are not accidents. They are not acts of fate," says de la Serna. She and other parents formed a group, Family and Friends of the Victims of the Santa Fé Tragedy, to try to prevent similar tragedies. They are pushing new, improved legislation on traffic safety and calling for better enforcement of existing laws. "Through our organization, we are working to get people to value and respect life," says de la Serna.
Road crashes result from risky behaviors and environmental factors that can be reduced through public policy interventions.
Throughout Argentina, some 4,000 people die every year on the roads, according to official figures, and 20 times that number are injured. But compared with other Latin American and the Caribbean countries, Argentina does not even rank in the top ten in traffic fatality rates. On an average day across the region, traffic crashes kill 350 drivers, passengers, cyclists, and pedestrians and injure 3,000 more. For young people from 5 to 29, road crashes are one of the top two causes of death in the region.
At the global level, more than 1.2 million people die annually and 20-50 million are seriously injured in traffic crashes, according to the World Health Organization (WHO). Nine out of 10 traffic deaths occur in low- and middle-income countries. WHO estimates rates will rise more than 65 percent worldwide in the next two decades, increasing fastest in the developing world and claiming more lives than malaria, tuberculosis, or HIV/AIDS.
The growing problem compelled the United Nations General Assembly to hold discussions on road safety for the first time in its history in 2004. It passed a unanimous resolution to improve road safety and called on member governments to treat the problem as a public health issue. In April 2007, the first U.N. Global Road Safety Week was held on April 23-27 to raise awareness of the importance of the problem, particularly among young people. Among the delegates was 20-year-old Argentine Malén Ecker, who survived the tragic Santa Fé crash that killed her younger brother Federico.
To drive home the idea that traffic injuries and deaths are preventable, experts eschew the term "accidents" in favor of "crashes." The idea is that road crashes are the predictable result of risky behaviors and environmental factors that can be reduced through public policy interventions. These include blood-alcohol limits and mandatory seat belt use but also better design and maintenance of roads and sidewalks, graduated licensing programs for new drivers, and better enforcement of speed and other traffic laws, among others.
"It's not just one thing that factors into road safety," says Eugenia Rodrigues, an expert on road safety at the Pan American Health Organization (PAHO). "We recommend putting different sectors to work at the same time-civil society together with government and the health professions."
WHO's World Report on Road Traffic Injury Prevention (2004) points to a handful of key risk factors at play in the vast majority of traffic crashes and injuries. They include high speed, alcohol consumption, young age of drivers and passengers, lack of seat belt and helmet use, lack of child safety seats, and inadequate design of roads and walkways. Also important, the report says, are driver distraction (think cell phones) and driver fatigue.
Reducing these key risk factors should be the focus of efforts to reduce traffic injuries and deaths, the experts say. With regard to infrastructure, a number of low-cost road alterations can increase safety, including building speed bumps into roads, creating rotaries, and providing separate paths for bicyclists and pedestrians. Other recommended actions range from getting more people out of cars and onto public transit systems, to requiring that cars, trucks, and child car seats meet higher safety standards.
Rodrigues and other experts point to a number of places in the Americas where measures such as these have produced real improvements in traffic injury rates.
One such case is Bogotá, Colombia, where a series of actions helped cut traffic deaths by more than half between 1995 and 2005. Among the key measures were:
In addition to these, the city's new TransMilenio bus transit system has had a significant impact on safety. Pedestrian incidents on Bogotá's busy Avenida Caracas declined from 832 in 1995 to 4 in one year as a result of this new system. Overall, car crashes dropped throughout the city from 1,387 in 1995 to 246 in 2005. The system's safety features include dedicated bus lanes, pedestrian overpasses, better lighting, and improved visibility for cars and walkers.
Through these and other measures, Colombia reduced the number of road deaths nationwide from 8,900 in 1998 to 5,400 in 2006, a decline of 39 percent.
Among those working to affect such changes is Fondo de Prevención Vial, a coalition formed by Colombia's largest insurers. The group works through public-private partnerships to create road safety surveillance systems; distribute information on road safety through print, radio and television ads; and improve road safety policies.
Francisco Fernandez, the group's executive director, says no single intervention can be credited with the Colombia's improved safety record. Rather, steady pressure on the issues has moved the numbers steadily downward.
"It's not one method; it's the permanence of the methods. The most important thing is the constancy of the message," he says.
"The focus has to be on prevention," says Simone Abib, a pediatric surgeon and board member of Criança Segura, a citizens' group that promotes child safety in Brazil. The group helped secure passage of new child safety seat standards in January 2007.
"It's difficult—people always think it will never happen to them. The most difficult thing to do with a human being is to change their behavior."
Abib knows the consequences for failing to act. As head of trauma education at São Paulo's Federal University Hospital, she's seen thousands of children stream through the hospital every year from road crashes. They come with abdominal trauma, head trauma, thoracic injuries, broken bones.
"I remember one 8-year-old boy, he was run over by a bus, and he had a hip bone fracture. He couldn't walk for months. I told him, my Christmas gift for you this year is to be able to walk," Abib says.
Many of the children she treats were struck by cars while walking on the side of a road. Sidewalks are nonexistent in many parts of Brazilian cities, especially in poorer areas. And many children are left unattended when their parents go to work.
As a result, traffic injuries are the leading external (non-disease) cause of death of children under 14 in Brazil. And for children who aren't killed, injuries from a car crash can become a life-long burden.
"In children, we have to think long term. When they're disabled, it's a huge loss for the children, for the family, and for society," Abib says.
As elsewhere in the developing world, the most vulnerable people on Brazil's roads and highways are those who share the road with cars: pedestrians, cyclists, and riders of micros, or buses. The majority of victims are young and male. The burden of these deaths and injuries falls heaviest on poor families, who can ill afford the medical costs or lost income. Overall, WHO estimates that road crashes cost countries around the world $518 billion each year, including the costs to social and economic development.
As in Argentina, tragic incidents can help galvanize public opinion about road safety and prompt needed changes. Family and Friends of the Victims of the Santa Fé Tragedy have organized public awareness campaigns, talking with the public, politicians, and the press. Its mission has been to change the hearts and minds not only of the Argentine public, but of its political class as well.
After meeting with the group (in March 2007), President Néstor Kirchner signed a national road safety accord that, among other things, stiffens penalties for drunk drivers, bans sales of alcohol near or along highways, and consolidates all driver's license and infraction information from throughout the country into a National Driver's License Registry. Drivers accumulate points for infractions and can lose or have their licenses suspended after multiple offenses. The accord has been ratified in several provinces and is awaiting approval in others.
Meanwhile, arguing that official statistics vastly understate road injuries and deaths, Argentina's National Ombudsman Office has joined with nongovernmental organizations to propose new legislation declaring a "road safety emergency" in the country. Their proposed package of measures includes stricter enforcement of traffic laws, the compilation of a national list of traffic crash hotspots, the inclusion of traffic safety instruction into school curricula, and the participation of private highway and toll concessioners in a National Program for Information and Dissemination on Road Accident Traffic Injury Prevention. Supporters are promoting the effort with the slogan "Because Life Matters."
Other PAHO member countries have also stepped up their efforts in recent years to improve road safety. Since 2005, Mexico has mounted prevention campaigns, drafted new road safety legislation, improved pre-hospital care for crash victims, and developed-in collaboration with PAHO-a "Road Safety Atlas" to help analyze and prevent traffic incidents nationwide.
Costa Rica, which has seen a 171 percent increase in the number of motor vehicles on its roads since 2000, has nevertheless managed to reduce traffic death rates by 17 percent in the same period through efforts focused on increasing seat belt use, improving driver training, enforcing of speed and alcohol restrictions, and raising awareness about pedestrian safety.
Still, major challenges remain, in the area of policy but even more in enforcement. In Paraguay, for example, 30 percent of all vehicles are unregistered, PAHO's Rodrigues points out. Even though Colombia's surveillance system has greatly improved, the information has yet to be integrated into the way police patrol the streets, Fernandez says.
For Rodrigues and other experts, what is most needed-and what is happening gradually-is a paradigm shift: a major change in public attitudes from viewing traffic deaths and injuries fatalistically to understanding that many things can be done to prevent them.
"Traffic accidents are not—it bears repeating—accidental," she insists.
But the testimonies of those who bear the psychological burden of road crashes are perhaps the most compelling arguments for prevention.
Diza Gonzaga of Porto Alegre, Brazil, says she and her husband stopped working when their son Thiago died in a crash a few weeks before his 18th birthday. Their daughter dropped out of school.
"Special days and moments are difficult for us to deal with: Christmas, birthdays, mother's day and going shopping. When we go to shop, we see the food that our son liked," she says. Their youngest son saw a therapist for several years. "We can't measure emotional problems," Gonzaga says. "They are more severe than physical damage."
Lucila de la Serna of Argentina echoes those feelings, saying the loss of her son Benjamin changed her life forever.
"You divide your life into two parts: a 'before' and an 'after'. We know it has no end, the pain."