Policies to promote safe mobility and transport for children: fact sheet No. 2.5, May 2007

This indicator gives a snapshot of the existence, implementation and enforcement of specific national policies to promote safe mobility and transport for children in the Region, as assessed by national experts. The policy data encompass legislative, licensing and educational action. Road traffic injuries (RTIs) are the leading cause of death in children and young people aged 5–24 years, but are preventable if a range of evidence-supported policies are implemented and enforced. Over 50% of reporting countries have legislation and regulations in place to improve road traffic safety among children and young people. In a number of countries, the high indicator score shows a political commitment to improve road safety, although there is scope for improvement across the Region. RATIONALE Degree of implementation of policies aimed at preventing road traffic injuries in children and young people Policies to promote safe mobility and transport for children FACT SHEET NO. 2.5 · MAY 2007 · CODE: RPG2_Traf_A1 KEY MESSAGE This summary is based on data on 10 road traffic safety policies specifically aimed at children and young people. Data were drawn from an Environment and Health Information System (ENHIS-2) project survey of national experts dealing with transport safety policies in 27 countries in the WHO European Region in 2005–2006 (see below under Geographical coverage). Information on the health and environment context and policy relevance and an assessment of the situation in the WHO European Region is provided. Fig. 1. Implementation of 10 policies* aimed at preventing road traffic injuries in children and young people in selected European countries, 2006 Note. Serbia and Montenegro became two separate Member States of WHO in September 2006. In this fact sheet the data refer to the period before that date and relate to the then entity of Serbia and Montenegro (Serbia). Portugal Malta Slovenia Croatia Spain Romania France Sweden Slovakia Poland Finland Estonia Czech Republic Italy Lithuania Hungary Bulgaria Austria Netherlands Greece United Kingdom (England) Belgium Armenia Serbia and Montenegro (Serbia) Albania Georgia Uzbekistan 0 2 4 6 8 10 12 14 16 18 20 Score * See below under Descrip- tion of data. The total score for degree of imple- mentation is the sum of the scores for each policy: 0 = no policy; 1 = partly implemented or enforced; 2 = substantially imple- mented or enforced. Number of policies clearly stated and substantially enforced and implemented Number of policies clearly stated, partly implemented or enforced Number of policies not existing, not clearly stated Total score Fact sheet 2.5 22.05.2007 20:56 Uhr Seite 1 PRESENTATION OF DATA Figure 1 shows the total score for implementa- tion of the 10 policies in the reporting coun- tries. A higher index reflects wider scope and comprehensiveness of the policies. Where European Union (EU) legislation sets the regu- latory framework, for example on safety belts, similar policies are present in each country. Figure 2 shows the overall level of implemen- tation/enforcement reported for each policy in the countries. The most widely enforced regu- lations cover seat belt use and safety helmets for motorcyclists. Policies with the most limit- ed coverage are legislation on the use of bicy- cle helmets and rear-facing seats for children aged under three years. HEALTH – ENVIRONMENT CONTEXT RTIs are a major public health problem, espe- cially for children. Key risk factors include speeding, driving under the influence of alco- hol, under- or incorrect use of seat belts and child restraints (1), failure to use helmets on motorcycles and bicycles, poor road design and roadway environment, unsafe vehicle design (especially car fronts), under-enforce- ment of road safety standards and poor enforcement of road safety regulations (2,3). An increasingly dangerous pedestrian environ- ment often encourages greater use of cars, which leads to higher volumes of motorized traffic and greater risks to pedestrians. Young drivers are over-represented in certain types of crash, including single-vehicle acci- dents, loss-of-control accidents, accidents involving excessive speed and/or alcohol use and accidents when the driver is tired, at night and at weekends. Crashes when seat belts are not worn and passengers are young often involve young drivers (4). As such, adolescents are a group who would benefit greatly from the introduction of effective road safety policies. Effective measures for reduction of RTIs exist and have been reviewed by the World report on road traffic injury prevention (2). Approaches include legislation on, for example, the setting and enforcing of speed limits, and programmes seeking to raise awareness and influence atti- tudes and behaviour. Measures include the incorporation of safety features into land use and transport planning; setting and enforcing appropriate speed limits; enactment of laws requiring seat belts and child restraints for all motor vehicle occupants; enactment of laws requiring cyclists and drivers of motorized two-wheelers to wear helmets; enactment of legislation setting blood alcohol concentration limits for drivers; and revision of the road infrastructure to improve traffic safety and to provide safer cycling and pedestrian routes and traffic calming. The most effective contribution to safer mobility and transport is to strengthen all links in the chain from the possible crash scene to the health facility. The wide range of interventions requires coor- dinated action by institutions and authorities in a number of sectors such as transport, pub- lic health, police, finance, education, land use and environment, with the participation of civil society, including the private sector, pro- fessionals, the media and nongovernmental organizations. In particular, infrastructural or transport authorities should be more involved with developing and implementing effective measures. This complexity requires a clear assignment of responsibilities among relevant institutions at national and local level (5), as well as multisectoral action, long-term politi- cal commitment and the allocation of appro- priate human and financial resources (2). POLICY RELEVANCE AND CONTEXT The increasing evidence of the significant impacts on the environment and health of unsafe transport supports the need for effec- tive action to address transport-related issues at national and international levels. Sustain- able transport enables the adoption of meas- ures to promote cleaner and safer means of transport, such as walking and cycling. Road safety is a cornerstone of policies promoting sustainable transport (6). In 2004, the United Nations (UN) General Assembly accepted a resolution on improving global road safety, which mandated WHO to coordinate road safety efforts across the UN system (7). In the same year, WHO launched world and European reports on road traffic injury prevention (1,8) and the World Health Assembly passed resolution WHA57/10 urg- ing Member States to: • integrate traffic injury prevention into public health programmes; • assess the real burden of RTIs; • implement a national strategy on prevention of RTIs; • designate a single national focal point for pre- vention of RTIs, and facilitate multisectoral collaboration between different ministries; • raise awareness about risk factors, in partic- ular the effects of alcohol abuse; • take specific measures to prevent and control mortality and morbidity from road traffic crashes, and to evaluate the impact of such measures; • enforce existing traffic laws and regulations and work with schools, employers and other organizations to promote road safety educa- tion to drivers and pedestrians; • legislate for and strictly enforce the wearing of helmets by motorcyclists, and make mandatory both the provision of seat belts by car manufacturers and the wearing of seatbelts by drivers (9). In 2005, the UN General Assembly adopted a second resolution on road safety inviting member states to: implement the recommenda- tions of the World report on road traffic injury prevention, participate in the First United Nations Global Road Safety Week, and recog- nize the third Sunday in November of every year as the World Day of Remembrance for Road Traffic Victims. In 2002, a high-level meeting on transport, environment and health adopted the Trans- port, Health and Environment Pan-European Programme (PEP) to bring together and focus the activities of the UN Economic Commission for Europe and the WHO Regional Office for Europe on a number of key priority areas selected in the course of an intergovernmental preparatory process. These priorities and related action aim to: foster greater integration of environmental and health aspects into transport policy, address issues related to Fig. 2. Implementation of the 10 policies in the reporting countries (%), 2006 2 – Existing, clearly stated and substantially enforced and implemented 1 – Existing, clearly stated, partly implemented or enforced 0 – Not existing, not clearly stated Source: ENHIS-2 project countries and countries volunteering data. Fact sheet 2.5 22.05.2007 20:56 Uhr Seite 2 urban transport, and promote a shift towards more sustainable modes of transport. In addressing these priorities, the PEP pays spe- cial attention to the needs of the countries in eastern and south-eastern Europe, the Cauca- sus and central Asia, as well as ecologically sensitive areas (10). In 2004, the Fourth Ministerial Conference on Environment and Health adopted the Chil- dren’s Health and Environment Action Plan for Europe, which includes four regional pri- ority goals to reduce the burden of environ- ment-related diseases in children. One of the goals (RPG II) aims to reduce mortality and morbidity from injuries, including from RTIs, and to ensure the provision of safe conditions which also facilitate more physical activity among children (11). In 2005, the WHO Regional Committee for Europe adopted a resolution on the prevention of injuries in the Region (EUR/RC55/R9) (12). This urged Member States to give high priori- ty to the prevention of violence and uninten- tional injury by: developing national action plans and surveillance, strengthening capacity to address injuries, promoting research on and implementation of effective interventions for prevention and care of victims; and supporting the network of national focal persons for vio- lence and injury prevention. The EU 2001 Transport White Paper sets out an ambitious action programme from 2001 to 2010 aiming to reducing road fatalities by 50% by 2010 (13). In 2003, this target was repeated in the European road safety action programme, which introduced the concept of shared responsibility (14). The Working Party on Accidents and Injuries set up by the European Commission (EC) Directorate-General for Health and Consumer Protection to support road safety from a pub- lic health point of view published a final state- ment in 2005 with strategies for action and road safety. This advises that prevention action should be focused on vulnerable users, capacity-building, and inclusion in pro- grammes for health promotion, delivery of health care and evaluation (3). Overall, the prevention of injuries and cre- ation of a safer Europe are of high public health priority in European policy-making, as emphasized by EC Communication of 23.6.2006 on Actions for a Safer Europe and the adoption by the European Parliament in December 2006 of a Council Recommenda- tion on the prevention of injury and the pro- motion of safety (15,16). This recommends Member States to: (i) develop a national injury surveillance and reporting system; (ii) set up national plans for preventing accidents and injuries and initiate interdepartmental cooper- ation; and (iii) ensure that injury prevention and safety promotion is introduced systemati- cally into the vocational training of health care professionals. ASSESSMENT Twenty-seven of the twenty-eight countries reported action under national policies to pro- mote safe mobility and transport for children. Legislation for child safety belt usage is includ- ed in road safety legislation and regulations and is to a large extent enforced and imple- mented. Most countries enforce the wearing of safety belts. Malta, Slovakia and the United Kingdom (England) have specific regulations covering the use of seatbelts. Legislation ensur- ing that children aged under 13 years ride on the back seats of cars is less widely implement- ed and enforced, and the majority of countries have no policy requiring seated children to face backwards until the age of three years. Only Portugal fully enforces this policy. Legislation covering the wearing of safety hel- mets when riding in motorcycles is included in traffic laws and regulations in almost all reporting countries. Only 10 countries, how- ever, legislate for the wearing of safety helmets by children for cycling, and of these, only sev- en (the Czech Republic, Croatia, Finland, Malta, Portugal, Romania and Sweden) sub- stantially implement and enforce the legisla- tion (in Portugal this legislation only applies to child passengers on bicycles). This is an impor- tant area for coordinated action: children are exposed to dangerous traffic situations when cycling and preventive action should be taken to ensure that they are safe when cycling. About 75% of countries have speed limits in areas where children may come into contact with traffic, but only around 54% substantially implement and enforce them. Further enforce- ment is required, and attention should focus particularly on the extension of areas where the speed limit is below 30 km/h as well as the setting of speed limits in urban areas, which remain at 60 km/h in some countries. Scientific consensus suggests this should be reduced (17,18). Traffic safety education is included in school curricula in many countries, frequently as part of legislation on education. In some instances it is part of traffic safety law. However, evi- dence suggests that education is not effective in isolation and must be part of a comprehen- sive package of road safety policies. Graduated licensing for new drivers is regulat- ed by legislation on traffic, specifically in acts covering drivers’ licences, for example, in Aus- tria, Malta, Slovakia and Sweden. Countries with special regulations for traffic education and graduated drivers’ licences have usually created these policies recently. Overall, legislation and regulations on road safety were developed earlier in the countries belonging to the EU before May 2004 (EU15) than in the new member states and in other areas of the WHO European Region. For example, Hungary has had traffic policies and regulations aimed at reducing the risks for children since 1975, Serbia and Montenegro (Serbia) since 1988 and Lithuania since 2002. The lower RTI mortality rates reported by sev- eral of the EU15 may, therefore, reflect a com- paratively longer-term investment in road safe- ty. If so, the effects of more recent policy devel- opments in other countries should become vis- ible in the coming years. This indicator only considers policies focused specifically on children and young people. Many policies for the general population, such as those on drink-driving, also benefit children and young people. The indicator should be interpreted cautiously: a high score does not necessarily mean that the most effective package of preventive policies is in place. In the medium to long term, the ulti- mate assessment of the effectiveness of a policy is represented by outcome indicators, such as trends in RTIs and the resulting deaths. DATA UNDERLYING THE INDICATOR Data source Experts working in environment and public health institutions dealing with transport safe- ty policies in ENHIS-2 countries and countries volunteering information (see below under Geographical coverage). Description of data This indicator was developed in collaboration with the Child Safety Action Plan, a project of the European Child Safety Alliance (EURO- SAFE). The 10 policies under scrutiny are: 1. children to sit in EU-approved child safety seats in passenger vehicles (up to age 12 years or by weight, although the type of seat required obviously varies with age); 2. children to wear safety belts when riding in passenger vehicles; 3. children aged under 13 years to ride on the back seats of cars; 4. children to face backwards (if seated) until the age of three years; 5. child cyclists to wear safety helmets; 6. legislation prohibiting/limiting child pas- sengers on motorcycles; 7. children riding on motorcycles to wear safety helmets; 8. speed limit systems (such as traffic calming and 30 km/hr speed limits in residential areas or in areas where there are many children) specifically aimed at protecting children in areas where they are present (schools, playgrounds, etc.; 9. traffic safety education (including pedes- trian education) compulsory in the school curriculum; 10. graduated licensing for new drivers. The underlying data and descriptive informa- tion on the level of implementation and enforcement of the 10 policies are given in ENHIS-2 database. Fact sheet 2.5 22.05.2007 20:56 Uhr Seite 3 Method of calculating the indicator This indicator is computed as the sum of scores given to 10 policies. The score for each policy has a range from 0 to 2: 0 = no policy, 1 = existing legislation, clearly stated and par- tially implemented or enforced, 2 = existing legislation, clearly stated and substantially implemented or enforced. Geographical coverage ENHIS-2 project countries (Austria, Bulgaria, the Czech Republic, Estonia, Finland, France, Greece, Hungary, Italy, Lithuania, the Nether- lands, Poland, Portugal, Romania, Slovakia, Slovenia and Spain) and countries that volun- teered information (Albania, Armenia, Bel- gium, Croatia, Georgia, Malta, Serbia and Montenegro (Serbia), Sweden, the United Kingdom (England) and Uzbekistan). Period of coverage Snapshot, 2005–2006. Data quality The final score of this composite policy indica- tor needs to be interpreted with care. Countries with the same indicator score do not necessari- ly have the same policies and the same level of implementation. In addition, since the defini- tions are semi-quantitative, it is difficult to get a precise assessment of the actual implementa- tion and coverage of the programmes. Because of these limitations, it is equally important to examine each of the indicator’s components in addition to the overall score when interpreting results and drawing conclusions. For example, the effectiveness of policies resulting in reduced speeds or use of seatbelts/child restraints is far more important than that of education. Yet, this different “effectiveness weight” is not reflected in the computation of the indicators. Furthermore, high scores in this indicator should not be confused with the achievement of a better overall safety performance, which is ultimately defined by outcome indicators such as mortality and morbidity. Direct comparisons of scores between countries without examining the individual components are discouraged. References 1. Javouhey E et al. Are restrained children under 15 years of age in cars as effectively protected as adults? Archives of Disease in Childhood, 2006, 91:304–308. 2. World report on road traffic injury prevention. Geneva, World Health Organization, 2004 (http://www.who.int/world-health-day/2004/infomaterials/world_report/en/, accessed 9 April 2007). 3. Kisser R, Körmer C, Sector M, eds. Action for the public health sector to improve road traffic safety. Final Statement March 2005. Brussels, European Commission, Task Force on Road Safety of the Working Party on Accidents and Injuries, 2005 (http://ec.europa.eu/health/ph_information/implement/wp/injuries/docs/road_safety_en.pdf, accessed 10 April 2007). 4. Engström I et al. Young novice drivers, driver education and training: literature review. Linköping, Statens Väg-och transportforskningsinstitut (VTI) [Swedish National Road and Transport Research Institute], 2003. 5. Communication from the Commission. Saving 20 000 lives in our roads. A shared responsibility. Luxembourg, Office for Official Publications of the European Communities, 2003 (COM(2003) 311 final; http://ec.europa.eu/transport/road/library/rsap/rsap_en.pdf, accessed 10 April 2007). 6. Sethi D et al. Injuries and violence in Europe. Why they matter and what can be done. Copenhagen, WHO Regional Office for Europe, 2006 (www.euro.who.int/document/E88037.pdf, accessed 7 April 2007). 7. United Nations General Assembly Resolution A/RES/58/289 on improving global road safety. UN, 2004 (http://www.unece.org/trans/roadsafe/docs/A-RES-58-289e.pdf). 8. Racioppi F et al. Preventing road traffic injuries: a public health perspective for Europe. Copenhagen, WHO Regional Office for Europe, 2004 (http://www.euro.who.int/document/e82659.pdf, accessed 10 April 2007). 9. World Health Assembly resolution WHA57.10 on road safety and health. Geneva, World Health Organization. 2004 (http://www.who.int/gb/ebwha/pdf_files/WHA57/A57_R10-en.pdf, accessed 10 April 2007). 10. Transport, Health and Environment Pan-European Programme - The PEP. Transport-related health effects with a particular focus on children. Geneva, World Health Organization and United Nations Economic Commission for Europe, 2004 (http://www.unece.org/doc/ece/ac/ece.ac.21.2002.9.e.pdf, accessed 10 April 2007). 11. Children’s Environment and Health Action Plan for Europe. Fourth Ministerial Conference on Environment and Health, Budapest, 23–25 June 2004 (EUR/04/5046267/6; http://www.euro.who.int/document/e83338.pdf, accessed 16 March 2007). 12. WHO Regional Committee for Europe resolution EUR/RC55/R9 on Prevention of injuries in the WHO European Region. Copenhagen, WHO Regional Office for Europe, 2005 (http://www.euro.who.int/Governance/resolutions/2005/20050922_1, accessed 10 April 2007). 13. White Paper. European transport policy for 2010: time to decide. Luxembourg, Office for Official Publications of the European Communities, 2001 (http://ec.europa.eu/transport/white_paper/documents/doc/lb_texte_complet_en.pdf, accessed 10 April 2007). 14. Communication from the Commission. European road safety action programme. Halving the number of road accident victims in the European Union by 2010: a shared responsibility. Brussels, European Commission, 2003 (COM(2003) 311 final, 2003; http://ec.europa.eu/transport/roadsafety_library/rsap/com_2003_0311_en.pdf). 15. Communication from the Commission to the European Parliament and the Council on Actions for a Safer Europe. Brussels, European Commission, 2006 (COM(2006) 328 final, 2006; http://ec.europa.eu/health/ph_determinants/environment/IPP/documents/com_328_en.pdf, accessed 10 April 2007). 16. Council Recommendation on the Prevention of Injury and the Promotion of Safety. Brussels, European Commission, 2006 (COM(2006) 329 final; http://ec.europa.eu/health/ph_determinants/environment/IPP/documents/com_329_en.pdf, accessed 10 April 2007). 17. Towner E et al. What works in preventing unintentional injuries in children and young adolescents? An updated systematic review. London, Health Development Agency, 2001 (http://www.nice.org.uk/page.aspx?o=502353, accessed 10 April 2007). 18. Elvik R. Area-wide urban traffic calming schemes: a meta-analysis of safety effects. Accident Analysis and Prevention, 2001, 33(3):327-336. Further information European Child Safety Alliance [web site]. Amsterdam, European Association for Injury Prevention and Safety Promotion, 2007 (www.childsafetyeurope.org, accessed 13 April 2007). WHO European Centre for Environment and Health. Mortality from road traffic injuries in children and young people. Copenhagen, WHO Regional Office for Europe, 2007 (ENHIS-2 fact sheet No. 2.1). Authors: Sara Farchi, Public Health Agency of Lazio region, Rome, Italy; Eva Kunseler, National Public Health Institute, Kuopio, Finland. © 2007 World Health Organization All rights reserved. The views expressed do not necessarily represent the decisions, opinions or stated policy of the European Commission or the World Health Organization. For further information, see the web site of the WHO European Centre for Environment and Health, Bonn www.euro.who.int/ecehbonn. World Health Organization · Regional Office for Europe Scherfigsvej 8 · DK-2100 Copenhagen Ø · Denmark · Tel.: +45 39 17 17 17 · Fax: +45 39 17 18 18 · postmaster@euro.who.int · www.euro.who.int Fact sheet 2.5 22.05.2007 20:56 Uhr Seite 4