Reducing traffic fatalities requires reliable data followed by science-based policies Leonard Evans President, Science Serving Society President-Emeritus, International Traffic Medicine Association (ITMA) Bloomfield Hills, Michigan USA Sunday 30 July 2017

 1.2 million people killed each year on the world’s roads Harm from traffic  1.2 million people killed each year on the world’s roads  Victims mainly healthy, young  Injures >> fatalities  Property-damage only >> injures Since beginning of motorized traffic ~ 2 billion traffic crashes 2

Bow of Titanic – 3.8 km under Atlantic Ocean. Photographed 2 Sept. 2000 by Leonard Evans 3

Scene from 2000 Chinese movie The Road Home, (director Zhang Yimou) 4

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Summarizes what science has taught about traffic safety 6 6

Scientific study needs data By far, most reliable data is for fatalities Even though death just tip of iceberg in numbers, much attention is devoted to it I recently searched web for Chinese traffic fatalities 7 7

crashes Downloaded 2017-07-03 https://www.statista.com/statistics/276260/number-of-fatalities-in-traffic-accidents-in-china/

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Traffic Injury Prevention: (2015) 16;565–570 Chinese Traffic Fatalities and Injuries in Police Reports, Hospital Records, and In-Depth Records from One City Traffic Injury Prevention: (2015) 16;565–570 Authors: Jun Qiu Ji-Hong Zhou Liang Zhang Yuan Yao Dan-Feng Yuan Jian-Guo Shi Zhi-Ming Gao Lin Zhou Zheng-Guo Wang Leonard Evans 10

Objective: To estimate number of deaths on China’s roads Approach : Two unrelated studies 1. Analyzed data from 210 military hospitals throughout China 2. Examine in-depth crash records from one city (Chonqqing) Conclusion: This study, in agreement with earlier research, implies > 200,000 annual traffic deaths in China 11

WHO has estimates of fatalities for 180 countries (data for 2013) Rank Fatalities 180 China 261,367 172 Iran 24,896 179 India 238,562 171 Thailand 24,237 178 Brazil 41,059 170 Ethiopia 23,837 177 Indonesia 38,279 169 Congo 22,419 176 Nigeria 35,621 168 Vietnam 175 USA 34,064 167 Bangladesh 21,316 174 Russia 27,025 166 Tanzania 16,211 173 Pakistan 25,781 165 Mexico 15,062 12

Illustrative examples from 180 countries R = Traffic fatalities per 100,000 vehicles Rank R 2 Finland 4.4 San Marino 1 fatality, R = 1.8 Capital: San Marino Population: 31,781 (2015) World Bank

Illustrative examples from 180 countries R = Traffic fatalities per 100,000 vehicles Rank R 2 Finland 4.4 3 Sweden 4.7 5 UK 5.1 8 Netherlands 6.0 16 Australia 7.3

Illustrative examples from 180 countries R = Traffic fatalities per 100,000 vehicles Rank R 2 Finland 4.4 3 Sweden 4.7 5 UK 5.1 8 Netherlands 6.0 16 Australia 7.3 30 USA 12.9

Illustrative examples from 180 countries R = Traffic fatalities per 100,000 vehicles Rank R 2 Finland 4.4 51 Malaysia 29.9 3 Sweden 4.7 67 Mexico 43.0 5 UK 5.1 75 Russia 53.4 8 Netherlands 6.0 98 China 104.5 16 Australia 7.3 108 India 130.1 30 USA 12.9 131 Pakistan 283.9

Big problem – more than 200,000 annual deaths on China’s roads How can this number be reduced? Science can provide answers High priority is reliable data Two recommendations 17

1 Create data-collecting agency  Goal - accuracy and completeness  USA data set FARS is good model  40+ years of ongoing improvement  Free, comprehensive, and simple on web 18

2 Create traffic-safety research institute  Goal – highest quality objective scientific research  Ongoing guaranteed support by government, but largely independent of government  Evaluate safety programs (implementation and evaluation must be kept separate)  Make solicited and unsolicited science-based recommendations  Best model is SWOV in the Netherlands 19

Include data thru 2015

Fatalities in a given year Maximum yearly fatalities Because fatalities reach a maximum, we can define a simple ratio: Fatalities in a given year Maximum yearly fatalities  Dimensionless (no units)  No arbitrary assumptions  Depends ONLY on fatalities  Plot* how this ratio varies in time after maximum is reached ------------- *on logarithm scale, and x100 to express as % 26

Data from International Road Traffic and Accident Database (IRTAD) Original file has data for 32 OECD jurisdictions Use data from same 26 countries as in my 2014 AJPH paper This requires excluding 6 countries (e.g. Iceland with 16 fatalities) 27

43 years later 64.3% of max (35.7% drop) maximum value 54,589 in 1972 43 years later 64.3% of max (35.7% drop) year fatalities 1972 54,589 2015 35,092

Compare USA decline to 64.3% with declines in other 25 countries, introduced in alphabetical order

US is extreme outlier having far worse safety than any of the 25 other countries

If we accept that IRTAD data are valid: Number of countries Criterion 16 20,000+ fewer USA deaths if USA matched their decline 9 C All 9 still reduce deaths by larger percent than USA 1 F Uniquely, the worst (USA) 26 59 59

If we accept that IRTAD data are valid: Number of countries Grade Criterion 16 B- 20,000+ fewer USA deaths if USA matched their decline 9 C All 9 still reduce deaths by larger percent than USA 1 F Uniquely, the worst (USA) 26 Perhaps B to 7 of these with declines that, if USA had matched, then 25,000 fewer USA deaths 60 60

If we accept that IRTAD data are valid: Number of countries Grade Criterion 16 B- 20,000+ fewer USA deaths if USA matched their decline 9 C All 9 still reduce deaths by larger percent than USA 1 F Uniquely, the worst (USA) 26 61 61

If we accept that IRTAD data are valid: Number of countries Grade Criterion 16 B- 20,000+ fewer USA deaths if USA matched their decline 9 C All 9 still reduce deaths by larger percent than USA 1 F Uniquely, the worst (USA) 26 62 62

If we accept that IRTAD data are valid: Number of countries Grade Criterion 16 B- 20,000+ fewer USA deaths if USA matched their decline 9 C All 9 still reduce deaths by larger percent than USA 1 F Uniquely, the worst (USA) 26 63 63

If we accept that IRTAD data are valid: Number of countries Grade Criterion 16 B- 20,000+ fewer USA deaths if USA matched their decline 9 C All 9 still reduce deaths by larger percent than USA 1 F Uniquely, the worst (USA) 26 64 64

If we accept that IRTAD data are valid: Number of countries Grade Criterion 16 B- 20,000+ fewer USA deaths if USA matched their decline 9 C All 9 still reduce deaths by larger percent than USA 1 F Uniquely, the worst (USA) 26 * * 7 for 2011 data! In Just 4 years, from 2011 to 2015, USA sank further compared to other countries 65 65

US policy does not just ignore science, it aggressively denies science 66

Most basic scientific findings can be summarized as: 67 67

Most basic scientific findings can be summarized as:  Vehicle factors are important 68 68

Most basic scientific findings can be summarized as:  Vehicle factors are important, but less important than roadway factors 69 69

Most basic scientific findings can be summarized as:  Vehicle factors are important, but less important than roadway factors  Roadway factors are important 70 70

Most basic scientific findings can be summarized as:  Vehicle factors are important, but less important than roadway factors  Roadway factors are important, but less important than driver performance factors 71 71

Most basic scientific findings can be summarized as:  Vehicle factors are important, but less important than roadway factors  Roadway factors are important, but less important than driver performance factors  Driver performance factors are importantctors 72 72

Most basic scientific findings can be summarized as:  Vehicle factors are important, but less important than roadway factors  Roadway factors are important, but less important than driver performance factors  Driver performance factors are important, but less important than driver behavior factorsfactors 73 73

USA has obsessively focused on vehicles USA priorities are not random - they are almost perfectly opposite to where benefits are greatest USA has obsessively focused on vehicles And continues to focus narrowly on vehicles and other technological factors I suggested, in AJPH, that the: National Highway Traffic Safety Administration would be better named the National Highway Vehicle Safety Administration 74

Big message To reduce traffic deaths requires science-based policies This requires  Reliable data  “Disinterested” quality analysis 75

More evidence that driver behavior is central comes from examining year-to-year changes in USA traffic fatalities 76

[2000; -0.04, 0.5]

r2 = 0.442

Some shocking photographs! 86

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Most recent study Weather and Fatal Crashes Involving Large Numbers of Vehicles, Journal of Safety Research, 2016, (final steps of review), Ying Wang, Liming Liang and Leonard Evans Background Lots of anecdotes, zero quantitative evidence Objective To quantify how weather affects the occurrence of crashes involving large numbers of vehicles 100

1990-12-11: 99 cars and trucks crash on a foggy stretch of I-75 in TN: 12 fatalities 101

● ~8 fatal crashes per year in USA involving > 10 vehicles Very rare events ● ~8 fatal crashes per year in USA involving > 10 vehicles ● < 1/year involving > 27 vehicles ● So use ALL FARS data ● 40 years, 1975-2014 ● More than 1½ million fatal crashes 102

CONCLUSIONS ● Fatal crashes involving >35 vehicles are most likely to occur in snow or fog 103

CONCLUSIONS (continued) ● Fatal crashes in rain are ~3 times as likely to involve > 10 vehicles as in good weather ● Fatal crashes in snow ~23 times as likely to involve > 10 vehicles as in good weather ● Fatal crashes in fog are ~35 times as likely to involve > 10 vehicles as in good weather 104

CONCLUSIONS (use > 20 vehicles, not 10) ● Fatal crashes in rain are ~6 times as likely to involve > 20 vehicles as in good weather ● Fatal crashes in snow ~158 times as likely to involve > 20 vehicles as in good weather ● Fatal crashes in fog are ~171 times as likely to involve > 20 vehicles as in good weather 105

Comparing safety performance of countries with reliable data offers insights into best ways to reduce harm in traffic To do this we first examine the long term trend in one country, the USA 106

The Netherlands had 570 traffic deaths in 2015 This is 15.2% of The Netherlands’ all time high of 3,506 in 1972 If US total had fallen to 15.2% of its high, US total in 2015 would be 8,268 (26,824 below 35,092 observed) More than 20,000 additional Americans are killed annually because US fails to match decline in Netherlands (or 15 other countries) 108 108