1. 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.

2.  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

3. 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

4. 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,
177  India 238,
176  Brazil 46,
175  Indonesia 38,
174  Nigeria 35,
173  United States 34,
172  Russia 27,
171  Pakistan 25,
170  Iran 24,
169  Thailand 24,
168  Ethiopia 23,
167  Democratic Republic of the Congo 22,
166  Vietnam 22,
165  Bangladesh 21,
164  Tanzania 16,
163  Mexico 15,
162  South Africa 13,
161  Kenya 12,
160  Myanmar 10,
159  Egypt 10,
158  Philippines 10,
157  Uganda 10,
156  Sudan 9,
155  Mozambique 8,
154  Colombia 8,
153  Saudi Arabia 7,
152  Malaysia 7,
151  Morocco 6,
150  Iraq 6,
149  Ghana 6,
148  Turkey 6,
147  Madagascar 6,
146  Cameroon 6,
145  Japan 5,
144  Angola 5,
143  Malawi 5,
142  Argentina
141  Yemen 5,
140  Ukraine 5, [17]
139  Burkina Faso 5,
138  Ivory Coast 4,
137  South Korea 4, [12]
136    Nepal 4,
135  Niger 4,
134  Libya 4,
133  Peru 4,
132  Zimbabwe 3,
131  Kazakhstan 3,
130  Poland 3,
129  Mali 3,
128  Senegal 3,
127  Rwanda 3,
126  Italy 3,
125  Sri Lanka 3,
124  Zambia 3,
123  Germany 3,
122  Bolivia 3,
121  France 3,
120  Uzbekistan 3,
119  Guinea 3,
118  Ecuador 3,
117  Chad 3,
116  Dominican Republic 3,
115  Guatemala 2,
114  Benin 2,
113  Tunisia 2,
112  Somalia 2,
111  Cambodia 2,
110  Chile 2,
109  Togo 2,
108  Canada 2,
107  Jordan 1,
106  Romania 1,
105  United Kingdom 1,
104  Spain 1,
103  Sierra Leone 1,
102  Taiwan 1, [16]
101  Tajikistan 1,
100  Eritrea 1,
99  Central African Republic 1,
98  Liberia 1,
97  Honduras 1,
96  Paraguay 1,
95  El Salvador 1,
94  Belarus 1,
93  Australia 1,
92  Papua New Guinea 1,
91  Kyrgyzstan 1,
90  Congo 1,
89  Lebanon 1,
88  United Arab Emirates 1,
87  Greece 1,
86  Laos
85  Mauritania
84  Azerbaijan
83  Nicaragua
82  Oman
81  Turkmenistan
80  Cuba
79  Portugal
78  Hungary
77  Belgium
76  Serbia
75  Bosnia and Herzegovina
74  Costa Rica
73  Czech Republic
72  Kuwait
71  Bulgaria
70  Mongolia
69  Lesotho
68  Netherlands
67  Uruguay
66  Namibia
65  Armenia
64  Gambia
63  Georgia
62  Botswana
61  Guinea-Bissau
60  Austria
59  Republic of Moldova
58  New Zealand [10]
57  Croatia
56  Panama
55  Gabon
54  Slovakia
53  Qatar
52  Jamaica
51  Lithuania
50  Swaziland
49  Israel
48  Sweden
47  Finland
46  Djibouti
45   Switzerland [13][14][15]
44  Latvia
43  Macedonia
42  Singapore
41  Denmark
40  Trinidad and Tobago
39  Ireland
38  Timor-Leste
37  Mauritius
36  Guyana
35  Slovenia
34  Cape Verde
33  Bhutan
32  Norway [11]
31  Solomon Islands
30  Bahrain
29  Suriname
28  Estonia
27  Belize
26  Montenegro [7]
25  São Tomé and Príncipe
24  Cyprus
23  Bahamas
22  Fiji
21  Luxembourg
20  Vanuatu
19  Saint Lucia
18  Samoa
17  Malta
16  Barbados
15  Iceland
14  Maldives
13  Dominica
12  Saint Vincent and the Grenadines
11  Seychelles
10  Tonga
9  Andorra
8  Antigua & Barbuda
7  Cook Islands
6  Kiribati
5  Marshall Islands
4  Federated States of Micronesia
3  Palau
2  San Marino
1  Monaco 4

5. 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

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

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

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

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 9

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 10

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 11

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 12

13. 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

14. 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

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

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

17. 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
2  Norway 3.1 n/a [11]
3   Switzerland [13][14][15]
4  Finland
5  Sweden
6  United Kingdom
7  Spain
8  Netherlands
9  Iceland
10  Japan
11  Denmark
12  Germany
13  Malta 6.8 n/a
14  Austria
15  Australia
16  Italy 7.3 n/a
17  France
18  Ireland
19  Andorra 7.9 n/a
20  Czech Republic
21  Cyprus 9.2 n/a
22  Canada
23  Slovenia
24  Israel
25  Belgium
26  Luxembourg 10.7 n/a
27  Estonia 11.8 n/a
28  New Zealand [9] [10]
29  Greece 12.6 n/a
30  United States
31  Portugal 13.7 n/a
32  Slovakia 13.7 n/a
33  Palau 14.1 n/a
34  Poland 15.8 n/a
35  Lithuania 16.1 n/a
36  Barbados 16.9 n/a
37  Bulgaria 17.2 n/a
38  Armenia 18.2 n/a
39  Maldives 19.5 n/a
40  Bahrain 19.6 n/a
41  Antigua & Barbuda 20 n/a
42  Singapore 20.2 n/a
43  South Korea [12]
44  Hungary 20.7 n/a
45  Croatia 21.1 n/a
46  Federated States of Micronesia 24 n/a
47  Argentina 24.3 n/a
48  Latvia 24.8 n/a
49  Belize 26 n/a
50  Uruguay 28.5 n/a
51  Malaysia
52  Montenegro 31.1 n/a [7]
53  Romania 31.4 n/a
54  Saint Vincent and the Grenadines 31.7 n/a
55  Belarus 32.9 n/a
56  Kuwait 34.2 n/a
57  Serbia 34.5 n/a
58  Ukraine 35.3 n/a [17]
59  Mauritius 35.6 n/a
60  Bahamas 36 n/a
61  Indonesia 36.7 n/a
62  Turkey 37.3 n/a
63  United Arab Emirates 38.2 n/a
64  Costa Rica 38.4 n/a
65  Panama 38.4 n/a
66  Cook Islands 40.2 n/a
67  Mexico 43 n/a
68  Seychelles 43 n/a
69  Dominica 44.7 n/a
70  Macedonia 49.1 n/a
71  Suriname 49.7 n/a
72  Qatar 50.9 n/a
73  Chile 51.1 n/a
74  Russia 53.4 n/a
75  Georgia 54 n/a
76  Vietnam 55 n/a
77  Brazil 57.5 n/a
78  Fiji 58.9 n/a
79  Trinidad and Tobago 58.9 n/a
80  Jamaica 61.7 n/a
81  Republic of Moldova 61.8 n/a
82  Lebanon 64.8 n/a
83  Laos 67.5 n/a
84  Sri Lanka 70.9 n/a
85  Thailand 74.6 n/a
86  Bosnia and Herzegovina 76.7 n/a
87  Azerbaijan 83 n/a
88  Colombia 83.3 n/a
89  Oman 85.3 n/a
90  Kiribati 86.9 n/a
91  Mongolia 88.4 n/a
92  Botswana 91.6 n/a
93  Iran 92.7 n/a
94  Dominican Republic 94.9 n/a
95  Tonga 98.1 n/a
96  Peru 99.3 n/a
97  Kazakhstan n/a
98  China n/a
99  Cambodia n/a
100  Turkmenistan n/a
101  Guatemala n/a
102  Paraguay n/a
103  Saudi Arabia n/a
104  Kyrgyzstan n/a
105  Libya n/a
106  India n/a
107  Liberia n/a
108  Cuba n/a
109  South Africa n/a
110  Philippines 135 n/a
111  Marshall Islands n/a
112  Egypt n/a
113  Iraq n/a
114  Jordan n/a
115  Tunisia n/a
116  El Salvador n/a
117  Nicaragua n/a
118  Bhutan n/a
119  Samoa n/a
120  Ecuador n/a
121  Gabon n/a
122  Namibia n/a
123  Bolivia n/a
124  Morocco 209 n/a
125  Mauritania n/a
126  Cape Verde 229 n/a
127  Solomon Islands 240 n/a
128  Myanmar n/a
129  Pakistan n/a
130  Timor-Leste n/a
131  Vanuatu 300 n/a
132  Burkina Faso n/a
133  Tajikistan n/a
134    Nepal n/a
135  Zimbabwe n/a
136  Yemen n/a
137  Ghana n/a
138  Lesotho n/a
139  Chad 497 n/a
140  Nigeria n/a
141  Kenya n/a
142  Zambia n/a
143  Guinea-Bissau n/a
144  Ivory Coast n/a
145  Uganda n/a
146  Guyana n/a
147  Senegal n/a
148  Angola 992 n/a
149  Gambia n/a
150  Bangladesh n/a
151  Honduras n/a
152  Congo 1063 n/a
153  Tanzania n/a
154  Papua New Guinea n/a
155  Malawi n/a
156  Mali n/a
157  Cameroon n/a
158  Niger n/a
159  Mozambique 1507 n/a
160  Swaziland n/a
161  Saint Lucia n/a
162  Eritrea n/a
163  Sierra Leone n/a
164  Sudan n/a
165  Madagascar 2963 n/a
166  Rwanda n/a
167  Togo n/a
168  Central African Republic n/a
169  Somalia n/a
170  Ethiopia n/a
171  São Tomé and Príncipe n/a
172  Democratic Republic of the Congo n/a
173  Benin n/a
174  Guinea n/a
175  Monaco - n/a
176  Djibouti n/a n/a
177  Taiwan n/a n/a [16]
178  Uzbekistan n/a

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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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
2  Norway 3.1 n/a [11]
3   Switzerland [13][14][15]
4  Finland
5  Sweden
6  United Kingdom
7  Spain
8  Netherlands
9  Iceland
10  Japan
11  Denmark
12  Germany
13  Malta 6.8 n/a
14  Austria
15  Australia
16  Italy 7.3 n/a
17  France
18  Ireland
19  Andorra 7.9 n/a
20  Czech Republic
21  Cyprus 9.2 n/a
22  Canada
23  Slovenia
24  Israel
25  Belgium
26  Luxembourg 10.7 n/a
27  Estonia 11.8 n/a
28  New Zealand [9] [10]
29  Greece 12.6 n/a
30  United States
31  Portugal 13.7 n/a
32  Slovakia 13.7 n/a
33  Palau 14.1 n/a
34  Poland 15.8 n/a
35  Lithuania 16.1 n/a
36  Barbados 16.9 n/a
37  Bulgaria 17.2 n/a
38  Armenia 18.2 n/a
39  Maldives 19.5 n/a
40  Bahrain 19.6 n/a
41  Antigua & Barbuda 20 n/a
42  Singapore 20.2 n/a
43  South Korea [12]
44  Hungary 20.7 n/a
45  Croatia 21.1 n/a
46  Federated States of Micronesia 24 n/a
47  Argentina 24.3 n/a
48  Latvia 24.8 n/a
49  Belize 26 n/a
50  Uruguay 28.5 n/a
51  Malaysia
52  Montenegro 31.1 n/a [7]
53  Romania 31.4 n/a
54  Saint Vincent and the Grenadines 31.7 n/a
55  Belarus 32.9 n/a
56  Kuwait 34.2 n/a
57  Serbia 34.5 n/a
58  Ukraine 35.3 n/a [17]
59  Mauritius 35.6 n/a
60  Bahamas 36 n/a
61  Indonesia 36.7 n/a
62  Turkey 37.3 n/a
63  United Arab Emirates 38.2 n/a
64  Costa Rica 38.4 n/a
65  Panama 38.4 n/a
66  Cook Islands 40.2 n/a
67  Mexico 43 n/a
68  Seychelles 43 n/a
69  Dominica 44.7 n/a
70  Macedonia 49.1 n/a
71  Suriname 49.7 n/a
72  Qatar 50.9 n/a
73  Chile 51.1 n/a
74  Russia 53.4 n/a
75  Georgia 54 n/a
76  Vietnam 55 n/a
77  Brazil 57.5 n/a
78  Fiji 58.9 n/a
79  Trinidad and Tobago 58.9 n/a
80  Jamaica 61.7 n/a
81  Republic of Moldova 61.8 n/a
82  Lebanon 64.8 n/a
83  Laos 67.5 n/a
84  Sri Lanka 70.9 n/a
85  Thailand 74.6 n/a
86  Bosnia and Herzegovina 76.7 n/a
87  Azerbaijan 83 n/a
88  Colombia 83.3 n/a
89  Oman 85.3 n/a
90  Kiribati 86.9 n/a
91  Mongolia 88.4 n/a
92  Botswana 91.6 n/a
93  Iran 92.7 n/a
94  Dominican Republic 94.9 n/a
95  Tonga 98.1 n/a
96  Peru 99.3 n/a
97  Kazakhstan n/a
98  China n/a
99  Cambodia n/a
100  Turkmenistan n/a
101  Guatemala n/a
102  Paraguay n/a
103  Saudi Arabia n/a
104  Kyrgyzstan n/a
105  Libya n/a
106  India n/a
107  Liberia n/a
108  Cuba n/a
109  South Africa n/a
110  Philippines 135 n/a
111  Marshall Islands n/a
112  Egypt n/a
113  Iraq n/a
114  Jordan n/a
115  Tunisia n/a
116  El Salvador n/a
117  Nicaragua n/a
118  Bhutan n/a
119  Samoa n/a
120  Ecuador n/a
121  Gabon n/a
122  Namibia n/a
123  Bolivia n/a
124  Morocco 209 n/a
125  Mauritania n/a
126  Cape Verde 229 n/a
127  Solomon Islands 240 n/a
128  Myanmar n/a
129  Pakistan n/a
130  Timor-Leste n/a
131  Vanuatu 300 n/a
132  Burkina Faso n/a
133  Tajikistan n/a
134    Nepal n/a
135  Zimbabwe n/a
136  Yemen n/a
137  Ghana n/a
138  Lesotho n/a
139  Chad 497 n/a
140  Nigeria n/a
141  Kenya n/a
142  Zambia n/a
143  Guinea-Bissau n/a
144  Ivory Coast n/a
145  Uganda n/a
146  Guyana n/a
147  Senegal n/a
148  Angola 992 n/a
149  Gambia n/a
150  Bangladesh n/a
151  Honduras n/a
152  Congo 1063 n/a
153  Tanzania n/a
154  Papua New Guinea n/a
155  Malawi n/a
156  Mali n/a
157  Cameroon n/a
158  Niger n/a
159  Mozambique 1507 n/a
160  Swaziland n/a
161  Saint Lucia n/a
162  Eritrea n/a
163  Sierra Leone n/a
164  Sudan n/a
165  Madagascar 2963 n/a
166  Rwanda n/a
167  Togo n/a
168  Central African Republic n/a
169  Somalia n/a
170  Ethiopia n/a
171  São Tomé and Príncipe n/a
172  Democratic Republic of the Congo n/a
173  Benin n/a
174  Guinea n/a
175  Monaco - n/a
176  Djibouti n/a n/a
177  Taiwan n/a n/a [16]
178  Uzbekistan n/a

30. 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

35. 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

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 36

37. 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

40. 37,461 in 2016

41. 37,461 in 2016 (68% of max.)
44 years after maximum

43. maximum value 54,589 in 1972

44. 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

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

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

48. Cut fatalities in half

53. 32.0

60. 22.8