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224Natural and human-made disastersSafety is oftencompromised byinformal transportoperators…Road crash injury islargely preventableand predictable…owned minibuses, trucks or cars have filled the transportgap, often without adequate regulation and consideration ofsafety measures. Examples of informal or semi-formal transportsinclude the matatu in Kenya (minibuses); Manila’sjeepneys (remodelled trucks); the dolmus of Istanbul(minibuses); the dala dala of Tanzania (minivans); the tro-troof Ghana (minivans); the Haitian tap-tap (remodelled trucks);and the molue (large buses, locally known as ‘movingmorgues’) and danfo (minibuses, locally referred to as ‘flyingcoffins’) in Nigeria. 35 Safety is often compromised by informaltransport operators due to competition, lack ofawareness or flagrant violation of traffic rules, and poorvehicle maintenance. 36PREVENTING ANDMITIGATING LOSS FROMTRAFFIC ACCIDENTSTraffic accidents and subsequent loss are the products ofhuman behaviour, but also of urban planning and design,both of which are amenable to development policy.Preventing and mitigating the impact of traffic accidentsrequires interventions to address the multiple risk factorsunderlying those accidents (see Box 9.2). This sectionexplores contemporary policies to reduce traffic accidentsand improve road safety, in general. These include transportand urban planning; the promotion of safe behaviour;improvement of accident response and recovery; improvementsin traffic accidents data collection; trafficmanagement and building institutions; and enhancing awarenessof road safety. Other aspects of transport safety that donot touch upon urban planning or social and economic development,such as vehicle design, safety standards and hospitalcapability, are not discussed in detail.The WHO recommends that the severity and consequencesof injury from traffic accidents can be controlled byacting on four fronts: reducing exposure to risk; preventingroad traffic accidents from occurring; reducing the severityBox 9.5 Reducing road traffic injuries: The experience ofhigh-income countries (HICs)Fatalities from road traffic accidents rose rapidly in high-income countries (HICs) during the1950s and 1960s, following rapid motorization, eventually peaking in the 1970s. Since the 1980sand 1990s, injuries have been reduced in many HICs by as much as 50 per cent despite continuedtraffic growth. This has been attributed to a shift from focusing on ‘behaviour’ alone tosafety systems such as good road and vehicle design and traffic management. A combination ofmeasures has been taken by HICs to reduce road injuries, including:Safe road users: enforcement of laws to moderate the behaviour of drivers, such as speedlimits, drink-driving laws, seat belt-use laws and helmet-use laws, have been very effective.Safer vehicles: improvements in vehicle design have improved the chances of survival inmotor vehicle crashes.Safer road infrastructure: engineering measures such as signs, lane separation, pedestriancrossings and traffic-calming measures have helped to reduce road traffic causalities.Source: Commission for Global Road Safety, 2006of injury in the event of an accident; and reducing the consequencesof injury through improved post-accident care.High-income countries have successfully reduced injuriesfrom traffic accidents by adopting such multifaceted policyapproaches (see Box 9.5). Policies targeting a single mode oftransportation, although effective, need to be supplementedby interventions addressing related factors that reduce roadsafety. For instance, Box 9.6 describes the experience oftransport safety reform targeting minibus taxis in Kenya. It isnot unusual for such reforms to be met with resistance fromthose with a vested interest in the status quo. In cities andcountries where the transport sector has political andeconomic clout, change can be very slow.The need for innovative and dedicated work to reducemortality and injury from traffic accidents worldwide hasbeen widely recognized by the international community. TheWHO’s proposed seven-point plan for understanding andreducing road traffic accidents may be an appropriate startingpoint in the global fight against traffic accidents: 371 Road crash injury is largely preventable and predictable– it is a human-made problem amenable to rationalanalysis and counter-measures.2 Road safety is a multi-sectoral and public health issue –all sectors, including health, need to be fully engaged inresponsibility, activity and advocacy for road crash injuryprevention.3 Common driving errors and common pedestrian behaviourshould not lead to death and serious injury – thetraffic system should help users to cope with increasinglydemanding conditions.4 The vulnerability of the human body should be a limitingdesign parameter for the traffic system, and speedmanagement is central.5 Road crash injury is a social equity issue – the aimshould be equal protection to all road users since nonmotorvehicle users bear a disproportionate share ofroad injury and risk.6 Technology transfer from high-income to low-incomecountries needs to fit local conditions and shouldaddress research-based local needs.7 Local knowledge needs to inform the implementation oflocal solutions.Improving road safety through transport andurban planningThe urgent need to address transport and road safetyconcerns in cities is evident; yet, several challenges remain.Rapidly growing megacities are especially constrained in thisregard; but medium-sized and small urban centres shouldnot be neglected either. It is particularly important to focuson medium-sized centres, given that these are the citieswhere future population growth may be most rapid in aggregateand where planning now can potentially avoid some ofthe problems being experienced by the largest cities.Recent work on medium-sized cities in Asia shows thepotential for coordinating urban and transport planning tosimultaneously address road safety, air pollution and pro-