Deaths in road traffic – a grossly underemphasized public health problem Leonard Evans President-Emeritus, ITMA (International Traffic Medicine Association) Bloomfield Hills, Michigan, USA Wed. 31 Oct, 2018 9:00 am ITMA 2018 Thank you, I am truly happy to be here on my 3rd trip to Brazil. Previous May 1994 (13th Iaatm) and Oct 1998 (Brasilia) But unfortunatelly, the subject, which is the focus of our ITMA meeting, is not a happy one - deaths and injuries in traffic.

 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 2

WHO has estimates of fatalities for 178 countries (data for 2013) 178 China 261,367 180 India 238,562 179 Brazil 46,935 178 Indonesia 38,279 177 Nigeria 35,621 176 United States 34,064 175 Russia 27,025 174 Pakistan 25,781 173 Iran 24,896 172 Thailand 24,237 171 Ethiopia 23,837 170 Vietnam 22,419 169 Democratic Republic of the Congo 22,419 168 Bangladesh 21,316 167 Tanzania 16,211 166 Mexico 15,062 3

WHO has estimates of fatalities for 178 countries (data for 2013) Rank Fatalities Country Total fatalities Year, data source latest year (standard source: figures by WHO report)[4] data from 2013) (adjusted/estimated The WHO report 2015,[2] 178  China 261,367 2013 177  India 238,562 2013 176  Brazil 46,935 2013 175  Indonesia 38,279 2013 174  Nigeria 35,621 2013 173  United States 34,064 2013 172  Russia 27,025 2013 171  Pakistan 25,781 2013 170  Iran 24,896 2013 169  Thailand 24,237 2013 168  Ethiopia 23,837 2013 167  Democratic Republic of the Congo 22,419 2013 166  Vietnam 22,419 2013 165  Bangladesh 21,316 2013 164  Tanzania 16,211 2013 163  Mexico 15,062 2013 162  South Africa 13,273 2013 161  Kenya 12,891 2013 160  Myanmar 10,809 2013 159  Egypt 10,466 2013 158  Philippines 10,379 2013 157  Uganda 10,280 2013 156  Sudan 9,221 2013 155  Mozambique 8,173 2013 154  Colombia 8,107 2013 153  Saudi Arabia 7,898 2013 152  Malaysia 7,129 2013 151  Morocco 6,870 2013 150  Iraq 6,826 2013 149  Ghana 6,789 2013 148  Turkey 6,687 2013 147  Madagascar 6,506 2013 146  Cameroon 6,136 2013 145  Japan 5,971 2013 144  Angola 5,769 2013 143  Malawi 5,732 2013 142  Argentina 2013 141  Yemen 5,248 2013 140  Ukraine 5,099 2012[17] 139  Burkina Faso 5,072 2013 138  Ivory Coast 4,924 2013 137  South Korea 4,777 2014[12] 136    Nepal 4,713 2013 135  Niger 4,706 2013 134  Libya 4,554 2013 133  Peru 4,234 2013 132  Zimbabwe 3,985 2013 131  Kazakhstan 3,983 2013 130  Poland 3,931 2013 129  Mali 3,920 2013 128  Senegal 3,844 2013 127  Rwanda 3,782 2013 126  Italy 3,753 2013 125  Sri Lanka 3,691 2013 124  Zambia 3,586 2013 123  Germany 3,540 2013 122  Bolivia 3,476 2013 121  France 3,268 2013 120  Uzbekistan 3,240 2013 119  Guinea 3,211 2013 118  Ecuador 3,164 2013 117  Chad 3,089 2013 116  Dominican Republic 3,052 2013 115  Guatemala 2,939 2013 114  Benin 2,855 2013 113  Tunisia 2,679 2013 112  Somalia 2,664 2013 111  Cambodia 2,635 2013 110  Chile 2,179 2013 109  Togo 2,123 2013 108  Canada 2,114 2013 107  Jordan 1,913 2013 106  Romania 1,881 2013 105  United Kingdom 1,827 2013 104  Spain 1,730 2013 103  Sierra Leone 1,661 2013 102  Taiwan 1,604 2016[16] 101  Tajikistan 1,543 2013 100  Eritrea 1,527 2013 99  Central African Republic 1,495 2013 98  Liberia 1,448 2013 97  Honduras 1,408 2013 96  Paraguay 1,408 2013 95  El Salvador 1,339 2013 94  Belarus 1,282 2013 93  Australia 1,252 2013 92  Papua New Guinea 1,232 2013 91  Kyrgyzstan 1,220 2013 90  Congo 1,174 2013 89  Lebanon 1,088 2013 88  United Arab Emirates 1,021 2013 87  Greece 1,013 2013 86  Laos 971 2013 85  Mauritania 952 2013 84  Azerbaijan 943 2013 83  Nicaragua 931 2013 82  Oman 924 2013 81  Turkmenistan 914 2009 80  Cuba 840 2013 79  Portugal 828 2013 78  Hungary 765 2013 77  Belgium 746 2013 76  Serbia 735 2013 75  Bosnia and Herzegovina 676 2013 74  Costa Rica 676 2013 73  Czech Republic 654 2013 72  Kuwait 629 2013 71  Bulgaria 601 2013 70  Mongolia 597 2013 69  Lesotho 584 2013 68  Netherlands 574 2013 67  Uruguay 567 2013 66  Namibia 551 2013 65  Armenia 546 2013 64  Gambia 544 2013 63  Georgia 514 2013 62  Botswana 477 2013 61  Guinea-Bissau 468 2013 60  Austria 455 2013 59  Republic of Moldova 437 2013 58  New Zealand 398 2017[10] 57  Croatia 395 2013 56  Panama 386 2013 55  Gabon 383 2013 54  Slovakia 360 2013 53  Qatar 330 2013 52  Jamaica 320 2013 51  Lithuania 320 2013 50  Swaziland 303 2013 49  Israel 277 2013 48  Sweden 272 2013 47  Finland 258 2013 46  Djibouti 216 2013 45   Switzerland 216 2016[13][14][15] 44  Latvia 205 2013 43  Macedonia 198 2013 42  Singapore 197 2013 41  Denmark 196 2013 40  Trinidad and Tobago 189 2013 39  Ireland 188 2013 38  Timor-Leste 188 2013 37  Mauritius 158 2013 36  Guyana 138 2013 35  Slovenia 132 2013 34  Cape Verde 130 2013 33  Bhutan 114 2013 32  Norway 112 2017[11] 31  Solomon Islands 108 2013 30  Bahrain 107 2013 29  Suriname 103 2013 28  Estonia 90 2013 27  Belize 81 2013 26  Montenegro 65 2016[7] 25  São Tomé and Príncipe 60 2013 24  Cyprus 59 2013 23  Bahamas 52 2013 22  Fiji 51 2013 21  Luxembourg 46 2013 20  Vanuatu 42 2013 19  Saint Lucia 33 2013 18  Samoa 30 2013 17  Malta 22 2013 16  Barbados 19 2013 15  Iceland 15 2013 14  Maldives 12 2013 13  Dominica 11 2013 12  Saint Vincent and the Grenadines 9 2013 11  Seychelles 8 2013 10  Tonga 8 2013 9  Andorra 6 2013 8  Antigua & Barbuda 6 2013 7  Cook Islands 5 2013 6  Kiribati 3 2013 5  Marshall Islands 3 2013 4  Federated States of Micronesia 2 2013 3  Palau 1 2013 2  San Marino 1 2013 1  Monaco 0 2013 4

WHO has estimates of fatalities for 178 countries (data for 2013) Rank Fatalities 178 178 China 261,367 180 India 238,562 179 Brazil 46,935 178 Indonesia 38,279 177 Nigeria 35,621 176 United States 34,064 175 Russia 27,025 174 Pakistan 25,781 173 Iran 24,896 172 Thailand 24,237 171 Ethiopia 23,837 170 Vietnam 22,419 169 Democratic Republic of the Congo 22,419 168 Bangladesh 21,316 167 Tanzania 16,211 166 Mexico 15,062 5

WHO has estimates of fatalities for 178 countries (data for 2013) Rank Fatalities 178 China 261,367 6

WHO has estimates of fatalities for 178 countries (data for 2013) Rank Fatalities 178 China 261,367 177 India 238,562 7

WHO has estimates of fatalities for 178 countries (data for 2013) Rank Fatalities 178 China 261,367 177 India 238,562 176 8

WHO has estimates of fatalities for 178 countries (data for 2013) Rank Fatalities 178 China 261,367 177 India 238,562 176 Brazil 46,935 9

WHO has estimates of fatalities for 178 countries (data for 2013) Rank Fatalities 178 China 261,367 177 India 238,562 176 Brazil 46,935 175 Indonesia 38,279 174 Nigeria 35,621 10

WHO has estimates of fatalities for 178 countries (data for 2013) Rank Fatalities 178 China 261,367 177 India 238,562 176 Brazil 46,935 175 Indonesia 38,279 174 Nigeria 35,621 173 11

WHO has estimates of fatalities for 178 countries (data for 2013) Rank Fatalities 178 China 261,367 177 India 238,562 176 Brazil 46,935 175 Indonesia 38,279 174 Nigeria 35,621 173 USA 34,064 12

WHO has estimates of fatalities for 178 countries (data for 2013) Rank Fatalities 178 China 261,367 177 India 238,562 176 Brazil 46,935 175 Indonesia 38,279 174 Nigeria 35,621 173 USA 34,064 172 Russia 27,025 171 Pakistan 25,781 13

WHO has estimates of fatalities for 178 countries (data for 2013) Rank Fatalities 178 China 261,367 170 Iran 24,896 177 India 238,562 169 Thailand 24,237 176 Brazil 46,935 168 Ethiopia 23,837 175 Indonesia 38,279 167 Congo 22,419 174 Nigeria 35,621 166 Vietnam 173 USA 34,064 165 Bangladesh 21,316 172 Russia 27,025 164 Tanzania 16,211 171 Pakistan 25,781 163 Mexico 15,062 14

Illustrative examples from 178 countries R = Traffic fatalities per 100,000 vehicles

Illustrative examples from 178 countries R = Traffic fatalities per 100,000 vehicles Rank R 2

Illustrative examples from 178 countries R = Traffic fatalities per 100,000 vehicles Rank R 2 Norway 3.1  San Marino – 1 fatait Country Road fatalities Road fatalities Total fatalities Year, data source per 100,000 per 1 billion latest year (standard source: motor vehicles[4] vehicle-km[5] (adjusted/estimated The WHO report 2015,[2] figures by WHO report)[4] data from 2013) 1  San Marino 1.8 n/a 1 2013 2  Norway 3.1 n/a 112 2017[11] 3   Switzerland 3.6 3.6 216 2016[13][14][15] 4  Finland 4.4 4.8 258 2013 5  Sweden 4.7 3.5 272 2013 6  United Kingdom 5.1 3.6 1827 2013 7  Spain 5.3 7.8 1730 2013 8  Netherlands 6 4.5 574 2013 9  Iceland 6.1 4.7 15 2013 10  Japan 6.5 8 5971 2013 11  Denmark 6.7 4 196 2013 12  Germany 6.8 4.9 3540 2013 13  Malta 6.8 n/a 22 2013 14  Austria 7.1 5.8 455 2013 15  Australia 7.3 5.2 1252 2013 16  Italy 7.3 n/a 3753 2013 17  France 7.6 5.8 3268 2013 18  Ireland 7.6 3.9 188 2013 19  Andorra 7.9 n/a 6 2013 20  Czech Republic 8.5 13.9 654 2013 21  Cyprus 9.2 n/a 59 2013 22  Canada 9.5 6.2 2114 2013 23  Slovenia 9.5 7.6 132 2013 24  Israel 9.7 5.3 277 2013 25  Belgium 10.7 7.3 746 2013 26  Luxembourg 10.7 n/a 46 2013 27  Estonia 11.8 n/a 90 2013 28  New Zealand 12.2 8.7[9] 398 2017[10] 29  Greece 12.6 n/a 1013 2013 30  United States 12.9 7.1 34064 2013 31  Portugal 13.7 n/a 828 2013 32  Slovakia 13.7 n/a 360 2013 33  Palau 14.1 n/a 1 2013 34  Poland 15.8 n/a 3931 2013 35  Lithuania 16.1 n/a 320 2013 36  Barbados 16.9 n/a 19 2013 37  Bulgaria 17.2 n/a 601 2013 38  Armenia 18.2 n/a 546 2013 39  Maldives 19.5 n/a 12 2013 40  Bahrain 19.6 n/a 107 2013 41  Antigua & Barbuda 20 n/a 6 2013 42  Singapore 20.2 n/a 197 2013 43  South Korea 20.6 15.6 4777 2014[12] 44  Hungary 20.7 n/a 765 2013 45  Croatia 21.1 n/a 395 2013 46  Federated States of Micronesia 24 n/a 2 2013 47  Argentina 24.3 n/a 5619 2013 48  Latvia 24.8 n/a 205 2013 49  Belize 26 n/a 81 2013 50  Uruguay 28.5 n/a 567 2013 51  Malaysia 29.9 12.6 7129 2013 52  Montenegro 31.1 n/a 65 2016[7] 53  Romania 31.4 n/a 1881 2013 54  Saint Vincent and the Grenadines 31.7 n/a 9 2013 55  Belarus 32.9 n/a 1282 2013 56  Kuwait 34.2 n/a 629 2013 57  Serbia 34.5 n/a 735 2013 58  Ukraine 35.3 n/a 5099 2012[17] 59  Mauritius 35.6 n/a 158 2013 60  Bahamas 36 n/a 52 2013 61  Indonesia 36.7 n/a 38279 2013 62  Turkey 37.3 n/a 6687 2013 63  United Arab Emirates 38.2 n/a 1021 2013 64  Costa Rica 38.4 n/a 676 2013 65  Panama 38.4 n/a 386 2013 66  Cook Islands 40.2 n/a 5 2013 67  Mexico 43 n/a 15062 2013 68  Seychelles 43 n/a 8 2013 69  Dominica 44.7 n/a 11 2013 70  Macedonia 49.1 n/a 198 2013 71  Suriname 49.7 n/a 103 2013 72  Qatar 50.9 n/a 330 2013 73  Chile 51.1 n/a 2179 2013 74  Russia 53.4 n/a 27025 2013 75  Georgia 54 n/a 514 2013 76  Vietnam 55 n/a 22419 2013 77  Brazil 57.5 n/a 46935 2013 78  Fiji 58.9 n/a 51 2013 79  Trinidad and Tobago 58.9 n/a 189 2013 80  Jamaica 61.7 n/a 320 2013 81  Republic of Moldova 61.8 n/a 437 2013 82  Lebanon 64.8 n/a 1088 2013 83  Laos 67.5 n/a 971 2013 84  Sri Lanka 70.9 n/a 3691 2013 85  Thailand 74.6 n/a 24237 2013 86  Bosnia and Herzegovina 76.7 n/a 676 2013 87  Azerbaijan 83 n/a 943 2013 88  Colombia 83.3 n/a 8107 2013 89  Oman 85.3 n/a 924 2013 90  Kiribati 86.9 n/a 3 2013 91  Mongolia 88.4 n/a 597 2013 92  Botswana 91.6 n/a 477 2013 93  Iran 92.7 n/a 24896 2013 94  Dominican Republic 94.9 n/a 3052 2013 95  Tonga 98.1 n/a 8 2013 96  Peru 99.3 n/a 4234 2013 97  Kazakhstan 101.4 n/a 3983 2013 98  China 104.5 n/a 261367 2013 99  Cambodia 107.2 n/a 2635 2013 100  Turkmenistan 107.8 n/a 914 2009 101  Guatemala 114.7 n/a 2939 2013 102  Paraguay 114.7 n/a 1408 2013 103  Saudi Arabia 119.7 n/a 7898 2013 104  Kyrgyzstan 127.3 n/a 1220 2013 105  Libya 128.2 n/a 4554 2013 106  India 130.1 n/a 238562 2013 107  Liberia 133.4 n/a 1448 2013 108  Cuba 133.7 n/a 840 2013 109  South Africa 133.9 n/a 13273 2013 110  Philippines 135 n/a 10379 2013 111  Marshall Islands 141.8 n/a 3 2013 112  Egypt 148.7 n/a 10466 2013 113  Iraq 151.2 n/a 6826 2013 114  Jordan 151.4 n/a 1913 2013 115  Tunisia 154.4 n/a 2679 2013 116  El Salvador 163.7 n/a 1339 2013 117  Nicaragua 164.3 n/a 931 2013 118  Bhutan 167.2 n/a 114 2013 119  Samoa 171.9 n/a 30 2013 120  Ecuador 183.8 n/a 3164 2013 121  Gabon 196.4 n/a 383 2013 122  Namibia 196.4 n/a 551 2013 123  Bolivia 205.2 n/a 3476 2013 124  Morocco 209 n/a 6870 2013 125  Mauritania 228.7 n/a 952 2013 126  Cape Verde 229 n/a 130 2013 127  Solomon Islands 240 n/a 108 2013 128  Myanmar 250.8 n/a 10809 2013 129  Pakistan 283.9 n/a 25781 2013 130  Timor-Leste 295.8 n/a 188 2013 131  Vanuatu 300 n/a 42 2013 132  Burkina Faso 328.1 n/a 5072 2013 133  Tajikistan 374.9 n/a 1543 2013 134    Nepal 399.8 n/a 4713 2013 135  Zimbabwe 429.8 n/a 3985 2013 136  Yemen 436.6 n/a 5248 2013 137  Ghana 443.1 n/a 6789 2013 138  Lesotho 474.8 n/a 584 2013 139  Chad 497 n/a 3089 2013 140  Nigeria 615.4 n/a 35621 2013 141  Kenya 640.7 n/a 12891 2013 142  Zambia 670.9 n/a 3586 2013 143  Guinea-Bissau 751.9 n/a 468 2013 144  Ivory Coast 828.9 n/a 4924 2013 145  Uganda 836.8 n/a 10280 2013 146  Guyana 864.4 n/a 138 2013 147  Senegal 956.4 n/a 3844 2013 148  Angola 992 n/a 5769 2013 149  Gambia 998.7 n/a 544 2013 150  Bangladesh 1020.6 n/a 21316 2013 151  Honduras 1021.7 n/a 1408 2013 152  Congo 1063 n/a 1174 2013 153  Tanzania 1073.7 n/a 16211 2013 154  Papua New Guinea 1306.5 n/a 1232 2013 155  Malawi 1310.4 n/a 5732 2013 156  Mali 1352.5 n/a 3920 2013 157  Cameroon 1385.1 n/a 6136 2013 158  Niger 1491.1 n/a 4706 2013 159  Mozambique 1507 n/a 8173 2013 160  Swaziland 1667.4 n/a 303 2013 161  Saint Lucia 2103.3 n/a 33 2013 162  Eritrea 2171.5 n/a 1527 2013 163  Sierra Leone 2414.2 n/a 1661 2013 164  Sudan 2872.8 n/a 9221 2013 165  Madagascar 2963 n/a 6506 2013 166  Rwanda 3521.1 n/a 3782 2013 167  Togo 3653.4 n/a 2123 2013 168  Central African Republic 4336.5 n/a 1495 2013 169  Somalia 4480.5 n/a 2664 2013 170  Ethiopia 4984.3 n/a 23837 2013 171  São Tomé and Príncipe 5454.5 n/a 60 2013 172  Democratic Republic of the Congo 6405.4 n/a 22419 2013 173  Benin 8177.2 n/a 2855 2013 174  Guinea 9462.5 n/a 3211 2013 175  Monaco - n/a 0 2013 176  Djibouti n/a n/a 216 2013 177  Taiwan n/a n/a 1604 2016[16] 178  Uzbekistan n/a 3240 2013

Illustrative examples from 178 countries R = Traffic fatalities per 100,000 vehicles Rank R 2 Norway 3.1 3 Switzerland 3.6

Illustrative examples from 178 countries R = Traffic fatalities per 100,000 vehicles Rank R 2 Norway 3.1 3 Switzerland 3.6 5 Sweden 4.7

Illustrative examples from 178 countries R = Traffic fatalities per 100,000 vehicles Rank R 2 Norway 3.1 3 Switzerland 3.6 5 Sweden 4.7 8 Netherlands 6.0

Illustrative examples from 178 countries R = Traffic fatalities per 100,000 vehicles Rank R 2 Norway 3.1 3 Switzerland 3.6 5 Sweden 4.7 8 Netherlands 6.0 10 Japan 6.5

Illustrative examples from 178 countries R = Traffic fatalities per 100,000 vehicles Rank R 2 Norway 3.1 3 Switzerland 3.6 5 Sweden 4.7 8 Netherlands 6.0 10 Japan 6.5 30 USA 12.9

Illustrative examples from 178 countries R = Traffic fatalities per 100,000 vehicles Rank R 2 Norway 3.1 3 Switzerland 3.6 5 Sweden 4.7 8 Netherlands 6.0 10 Japan 6.5 30 USA 12.9

Illustrative examples from 178 countries R = Traffic fatalities per 100,000 vehicles Rank R 2 Norway 3.1 67 Mexico 43.0 3 Switzerland 3.6 5 Sweden 4.7 8 Netherlands 6.0 10 Japan 6.5 30 USA 12.9 43 14 53.4 17 57.5 19 104.5 34 130.1 42 283.9 92

Illustrative examples from 178 countries R = Traffic fatalities per 100,000 vehicles Rank R 2 Norway 3.1 67 Mexico 43.0 3 Switzerland 3.6 74 Russia 53.4 5 Sweden 4.7 8 Netherlands 6.0 10 Japan 6.5 30 USA 12.9 43 14 53.4 17 57.5 19 104.5 34 130.1 42 283.9 92

Illustrative examples from 178 countries R = Traffic fatalities per 100,000 vehicles Rank R 2 Norway 3.1 67 Mexico 43.0 3 Switzerland 3.6 74 Russia 53.4 5 Sweden 4.7 77 Brazil 57.5 8 Netherlands 6.0 10 Japan 6.5 30 USA 12.9 43 14 53.4 17 57.5 19 104.5 34 130.1 42 283.9 92

Illustrative examples from 178 countries R = Traffic fatalities per 100,000 vehicles Rank R 2 Norway 3.1 67 Mexico 43.0 3 Switzerland 3.6 74 Russia 53.4 5 Sweden 4.7 77 Brazil 57.5 8 Netherlands 6.0 98 China 104.5 10 Japan 6.5 30 USA 12.9 43 14 53.4 17 57.5 19 104.5 34 130.1 42 283.9 92

Illustrative examples from 178 countries R = Traffic fatalities per 100,000 vehicles Rank R 2 Norway 3.1 67 Mexico 43.0 3 Switzerland 3.6 74 Russia 53.4 5 Sweden 4.7 77 Brazil 57.5 8 Netherlands 6.0 98 China 104.5 10 Japan 6.5 106 India 130.1 30 USA 12.9 43 14 53.4 17 57.5 19 104.5 34 130.1 42 283.9 92 43 14 53.4 17 57.5 19 104.5 34 130.1 42 283.9 92

Illustrative examples from 178 countries R = Traffic fatalities per 100,000 vehicles Rank R 2 Norway 3.1 67 Mexico 43.0 3 Switzerland 3.6 74 Russia 53.4 5 Sweden 4.7 77 Brazil 57.5 8 Netherlands 6.0 98 China 104.5 10 Japan 6.5 106 India 130.1 30 USA 12.9 129 Pakistan 283.9 14 Mexico rate 14 times Norwegian Country Road fatalities Road fatalities Total fatalities Year, data source per 100,000 per 1 billion latest year (standard source: motor vehicles[4] vehicle-km[5] (adjusted/estimated The WHO report 2015,[2] figures by WHO report)[4] data from 2013) 1  San Marino 1.8 n/a 1 2013 2  Norway 3.1 n/a 112 2017[11] 3   Switzerland 3.6 3.6 216 2016[13][14][15] 4  Finland 4.4 4.8 258 2013 5  Sweden 4.7 3.5 272 2013 6  United Kingdom 5.1 3.6 1827 2013 7  Spain 5.3 7.8 1730 2013 8  Netherlands 6 4.5 574 2013 9  Iceland 6.1 4.7 15 2013 10  Japan 6.5 8 5971 2013 11  Denmark 6.7 4 196 2013 12  Germany 6.8 4.9 3540 2013 13  Malta 6.8 n/a 22 2013 14  Austria 7.1 5.8 455 2013 15  Australia 7.3 5.2 1252 2013 16  Italy 7.3 n/a 3753 2013 17  France 7.6 5.8 3268 2013 18  Ireland 7.6 3.9 188 2013 19  Andorra 7.9 n/a 6 2013 20  Czech Republic 8.5 13.9 654 2013 21  Cyprus 9.2 n/a 59 2013 22  Canada 9.5 6.2 2114 2013 23  Slovenia 9.5 7.6 132 2013 24  Israel 9.7 5.3 277 2013 25  Belgium 10.7 7.3 746 2013 26  Luxembourg 10.7 n/a 46 2013 27  Estonia 11.8 n/a 90 2013 28  New Zealand 12.2 8.7[9] 398 2017[10] 29  Greece 12.6 n/a 1013 2013 30  United States 12.9 7.1 34064 2013 31  Portugal 13.7 n/a 828 2013 32  Slovakia 13.7 n/a 360 2013 33  Palau 14.1 n/a 1 2013 34  Poland 15.8 n/a 3931 2013 35  Lithuania 16.1 n/a 320 2013 36  Barbados 16.9 n/a 19 2013 37  Bulgaria 17.2 n/a 601 2013 38  Armenia 18.2 n/a 546 2013 39  Maldives 19.5 n/a 12 2013 40  Bahrain 19.6 n/a 107 2013 41  Antigua & Barbuda 20 n/a 6 2013 42  Singapore 20.2 n/a 197 2013 43  South Korea 20.6 15.6 4777 2014[12] 44  Hungary 20.7 n/a 765 2013 45  Croatia 21.1 n/a 395 2013 46  Federated States of Micronesia 24 n/a 2 2013 47  Argentina 24.3 n/a 5619 2013 48  Latvia 24.8 n/a 205 2013 49  Belize 26 n/a 81 2013 50  Uruguay 28.5 n/a 567 2013 51  Malaysia 29.9 12.6 7129 2013 52  Montenegro 31.1 n/a 65 2016[7] 53  Romania 31.4 n/a 1881 2013 54  Saint Vincent and the Grenadines 31.7 n/a 9 2013 55  Belarus 32.9 n/a 1282 2013 56  Kuwait 34.2 n/a 629 2013 57  Serbia 34.5 n/a 735 2013 58  Ukraine 35.3 n/a 5099 2012[17] 59  Mauritius 35.6 n/a 158 2013 60  Bahamas 36 n/a 52 2013 61  Indonesia 36.7 n/a 38279 2013 62  Turkey 37.3 n/a 6687 2013 63  United Arab Emirates 38.2 n/a 1021 2013 64  Costa Rica 38.4 n/a 676 2013 65  Panama 38.4 n/a 386 2013 66  Cook Islands 40.2 n/a 5 2013 67  Mexico 43 n/a 15062 2013 68  Seychelles 43 n/a 8 2013 69  Dominica 44.7 n/a 11 2013 70  Macedonia 49.1 n/a 198 2013 71  Suriname 49.7 n/a 103 2013 72  Qatar 50.9 n/a 330 2013 73  Chile 51.1 n/a 2179 2013 74  Russia 53.4 n/a 27025 2013 75  Georgia 54 n/a 514 2013 76  Vietnam 55 n/a 22419 2013 77  Brazil 57.5 n/a 46935 2013 78  Fiji 58.9 n/a 51 2013 79  Trinidad and Tobago 58.9 n/a 189 2013 80  Jamaica 61.7 n/a 320 2013 81  Republic of Moldova 61.8 n/a 437 2013 82  Lebanon 64.8 n/a 1088 2013 83  Laos 67.5 n/a 971 2013 84  Sri Lanka 70.9 n/a 3691 2013 85  Thailand 74.6 n/a 24237 2013 86  Bosnia and Herzegovina 76.7 n/a 676 2013 87  Azerbaijan 83 n/a 943 2013 88  Colombia 83.3 n/a 8107 2013 89  Oman 85.3 n/a 924 2013 90  Kiribati 86.9 n/a 3 2013 91  Mongolia 88.4 n/a 597 2013 92  Botswana 91.6 n/a 477 2013 93  Iran 92.7 n/a 24896 2013 94  Dominican Republic 94.9 n/a 3052 2013 95  Tonga 98.1 n/a 8 2013 96  Peru 99.3 n/a 4234 2013 97  Kazakhstan 101.4 n/a 3983 2013 98  China 104.5 n/a 261367 2013 99  Cambodia 107.2 n/a 2635 2013 100  Turkmenistan 107.8 n/a 914 2009 101  Guatemala 114.7 n/a 2939 2013 102  Paraguay 114.7 n/a 1408 2013 103  Saudi Arabia 119.7 n/a 7898 2013 104  Kyrgyzstan 127.3 n/a 1220 2013 105  Libya 128.2 n/a 4554 2013 106  India 130.1 n/a 238562 2013 107  Liberia 133.4 n/a 1448 2013 108  Cuba 133.7 n/a 840 2013 109  South Africa 133.9 n/a 13273 2013 110  Philippines 135 n/a 10379 2013 111  Marshall Islands 141.8 n/a 3 2013 112  Egypt 148.7 n/a 10466 2013 113  Iraq 151.2 n/a 6826 2013 114  Jordan 151.4 n/a 1913 2013 115  Tunisia 154.4 n/a 2679 2013 116  El Salvador 163.7 n/a 1339 2013 117  Nicaragua 164.3 n/a 931 2013 118  Bhutan 167.2 n/a 114 2013 119  Samoa 171.9 n/a 30 2013 120  Ecuador 183.8 n/a 3164 2013 121  Gabon 196.4 n/a 383 2013 122  Namibia 196.4 n/a 551 2013 123  Bolivia 205.2 n/a 3476 2013 124  Morocco 209 n/a 6870 2013 125  Mauritania 228.7 n/a 952 2013 126  Cape Verde 229 n/a 130 2013 127  Solomon Islands 240 n/a 108 2013 128  Myanmar 250.8 n/a 10809 2013 129  Pakistan 283.9 n/a 25781 2013 130  Timor-Leste 295.8 n/a 188 2013 131  Vanuatu 300 n/a 42 2013 132  Burkina Faso 328.1 n/a 5072 2013 133  Tajikistan 374.9 n/a 1543 2013 134    Nepal 399.8 n/a 4713 2013 135  Zimbabwe 429.8 n/a 3985 2013 136  Yemen 436.6 n/a 5248 2013 137  Ghana 443.1 n/a 6789 2013 138  Lesotho 474.8 n/a 584 2013 139  Chad 497 n/a 3089 2013 140  Nigeria 615.4 n/a 35621 2013 141  Kenya 640.7 n/a 12891 2013 142  Zambia 670.9 n/a 3586 2013 143  Guinea-Bissau 751.9 n/a 468 2013 144  Ivory Coast 828.9 n/a 4924 2013 145  Uganda 836.8 n/a 10280 2013 146  Guyana 864.4 n/a 138 2013 147  Senegal 956.4 n/a 3844 2013 148  Angola 992 n/a 5769 2013 149  Gambia 998.7 n/a 544 2013 150  Bangladesh 1020.6 n/a 21316 2013 151  Honduras 1021.7 n/a 1408 2013 152  Congo 1063 n/a 1174 2013 153  Tanzania 1073.7 n/a 16211 2013 154  Papua New Guinea 1306.5 n/a 1232 2013 155  Malawi 1310.4 n/a 5732 2013 156  Mali 1352.5 n/a 3920 2013 157  Cameroon 1385.1 n/a 6136 2013 158  Niger 1491.1 n/a 4706 2013 159  Mozambique 1507 n/a 8173 2013 160  Swaziland 1667.4 n/a 303 2013 161  Saint Lucia 2103.3 n/a 33 2013 162  Eritrea 2171.5 n/a 1527 2013 163  Sierra Leone 2414.2 n/a 1661 2013 164  Sudan 2872.8 n/a 9221 2013 165  Madagascar 2963 n/a 6506 2013 166  Rwanda 3521.1 n/a 3782 2013 167  Togo 3653.4 n/a 2123 2013 168  Central African Republic 4336.5 n/a 1495 2013 169  Somalia 4480.5 n/a 2664 2013 170  Ethiopia 4984.3 n/a 23837 2013 171  São Tomé and Príncipe 5454.5 n/a 60 2013 172  Democratic Republic of the Congo 6405.4 n/a 22419 2013 173  Benin 8177.2 n/a 2855 2013 174  Guinea 9462.5 n/a 3211 2013 175  Monaco - n/a 0 2013 176  Djibouti n/a n/a 216 2013 177  Taiwan n/a n/a 1604 2016[16] 178  Uzbekistan n/a 3240 2013

Focus is on fatalities — by far, the most reliable data How can Brazil’s 46 thousand annual deaths be reduced?  Scientific analysis of problem - requires quality data  Learn from other countries USA experience is unique 30 30

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 Advantages over traditional measures:  Dimensionless (no units)  No arbitrary assumptions  Compares each country’s performance to its own past  Depends ONLY on fatalities 35

Data from International Road Traffic and Accident Database (IRTAD) Original file had data for 32 OECD jurisdictions Use data from same 26 countries as in my 2014 AJPH paper 36

Data from International Road Traffic and Accident Database (IRTAD) Original file had data for 32 OECD* jurisdictions Use data from same 26 countries as in my 2014 AJPH paper *Brazil not included – I suspect reliable long time series is unavailable 37

37,461 in 2016

37,461 in 2016 (68% of max.) 44 years after maximum

maximum value 54,589 in 1972

Dropped to 68% of max 44 years after reaching max maximum value 54,589 in 1972 Dropped to 68% of max 44 years after reaching max

for 25 other countries, compare declines from their maxima to US decline to 68%

for 25 other countries, compare declines from their maxima to US decline to 68% Introduce countries in order of increasing safety

Cut fatalities in half

32.0

22.8