CE Research Report: Road Traffic Safety

By vicky_cox @ 2022-03-07T12:45 (+61)

This report is the result of Charity Entrepreneurship’s research to identify the most promising charities to start in the area of global health and development. Improving road traffic safety is one of our top ideas for 2022. A new organization operating in this space would focus heavily on policy and advocacy work in the countries where these issues are most neglected. 

We are currently accepting applications to our 2022 Incubation Program, through which we hope to launch this charity along with others that will focus on aid quality advocacy, postpartum family planning, tobacco taxation, and EA Meta. The 2022 Incubation Program will take place from late June to late August. The deadline to apply is March 31, 2022. We provide a 2-month, full-time, cost-covered training program (online), cash stipends to cover living expenses, considerable funding (of up to $175,000), and a wide range of ongoing support. Visit our website to learn more. 

The CE team is happy to answer any questions you may have about the following research report, and we welcome critical feedback and conversation.

Health and Development Policy – Road Traffic Safety

Author: Vicky Cox
Review: Sam Hilton and Melanie Basnak
Date of publication: January 2022
Research period: 2021

Thanks to Zakariyau Yusuf for his assistance with the early research for this report, and to Antonia Personette and Urszula Zarosa for their contributions. We are also grateful to the experts who took the time to offer their thoughts on this research.

For questions about the content of this research, please contact Vicky Cox at vicky@charityentrepreneurship.com. For questions about the research process, please contact Sam Hilton at sam@charityentrepreneurship.com

Executive summary

Legislation is a commonly used tool to reduce road traffic injuries and fatalities in high-income countries. However, legislation is often lacking in low- and middle-income countries and, as a result, these countries disproportionately bear the global burden of road-related injuries and deaths.

We evaluated legislation across 5 key risk areas – speeding, drink-driving, helmet use, seat belt use, and child restraint use – and found that speed limits and seat belt legislation look to be the most promising [1]. Therefore, this report will focus on speeding, speed limits, and seat belt use (both improving existing seat belt legislation to ensure it extends to all occupants and introducing new legislation in countries where it is currently non-existent).

There is strong evidence that speed is a key risk factor in road traffic injuries and fatalities, and that speed limits can reduce speeding. A meta-analysis of 98 studies explored the relationship between average speed and the incidence of road-related injuries and fatalities and created a formula that can be used to calculate the expected reduction in injuries/fatalities as a result of a change in speed (as the expected effectiveness depends on the speed before and after). For example, when speed is reduced from 100 km/h to 90 km/h, the number of fatal accidents is reduced by 34.4%. A meta-analysis of 51 studies found that speed limits reduce average speeds by 25% of the change in speed limit [2].

There is also strong evidence that seat belt use reduces road-related injuries and deaths. A meta-analysis of 30 studies found that wearing a seat belt can reduce fatalities among front-seat occupants by 40-50% and among rear-seat occupants by up to 25%.

Moreover, there is good evidence that advocacy leads to policy change. Looking at 84 case studies of advocacy in this space across the globe, we found an average success rate of ~48%, with 40 of 84 campaigns resulting in policy change in an average of 2.6 years.

Mandatory seat belt use, for all occupants, and appropriate speed limits are both extremely cost-effective interventions. Our cost-effectiveness analysis yielded an estimated cost (in USD) per DALY equivalent [3] of

when considering both charity and government costs.

However, there are still some important concerns around these interventions. Experts caution that enforcement of road traffic safety legislation is poor. Even if we were to see policy change in this space in countries where appropriate legislation is currently lacking, it would not necessarily mean that anything would actually change in practice. Moreover, although there does not appear to be substantial industry opposition to road traffic safety legislation, the population might not like it, which could make policy change more difficult. There is also some risk in interventions that increase the cost of car use relative to the cost of motorcycle use, as they could lead to increased mortality if road users switch from cars to motorcycles and appropriate motorcycle legislation is not in place.

Overall, our view is that policy work to improve or introduce new road traffic safety legislation is an idea worth recommending to future charity founders.

1     Introduction

This report has been produced by Charity Entrepreneurship (CE). CE’s mission is to cause more effective charities to exist in the world by connecting talented individuals with high-impact intervention opportunities. We achieve this goal through an extensive research process and our Incubation Program. In 2021, our research process focused on the top policy and advocacy interventions within global health and development. 

Advocacy to introduce new and/or improved road traffic safety laws was chosen by CE research staff as a potentially promising intervention within this category. This decision was the result of a 9-month process designed to identify interventions that were most likely to be high-impact avenues for future charity entrepreneurs. This process began by listing nearly 250 ideas and gradually narrowing down, examining them in more and more depth.

In order to assess how promising interventions would be for future charity entrepreneurs, we use a variety of different decision tools such as group consensus decision-making, weighted factor models, cost-effectiveness analyses, quality of evidence assessments, case study analysis, and expert interviews.

This process was exploratory and rigorous, but not comprehensive – we did not research all 250 ideas in depth. As such, our decision not to take forward a charity idea to the point of writing a full report should not be seen as a view that the idea is not good.

2     Background

The intervention explored in this report is the introduction of road traffic safety legislation to reduce road traffic injuries and fatalities. While most high-income countries have regulations, many low- and middle-income countries (LMICs) do not and therefore disproportionately bear the burden of road-related deaths and injuries. For example, the World Health Organization’s 2018 global status report on road safety identified that the risk of a road traffic death in low-income countries is more than 3 times higher than in high-income countries (with an average death rate of 27.5 deaths per 100,000 in low-income countries vs. an average death rate of 8.3 deaths per 100,000 in high-income countries), even though only 1% of the world’s registered vehicles can be found in low-income countries (whereas 40% can be found in high-income countries) (World Health Organization, 2018).

Speed limits are an integral component of a comprehensive speed management strategy, crucial to reducing fatal and serious crash risks. However, as of 2018, only 95 countries had appropriate speed limits in urban areas. Crucially, the presence of these best practice laws is much less common in middle- or low-income countries than in high-income countries: 37% and 13% in middle- and low-income countries, respectively, compared to 50% in high-income countries. 

Seat belt use is a highly effective means of reducing road traffic injuries and deaths. Despite this, adequate seat belt legislation is still surprisingly uncommon, with only 105 countries adopting best practice and mandating the use of seat belts by both front- and rear-seat occupants. Only 7% of countries with seat belt laws meeting best practice are low-income. 

We recommend reducing existing speed limits to 50 km/h in urban areas in countries where limits currently exceed this number. For seat belt use, we recommend both improving existing legislation and introducing new legislation. Existing legislation can be improved in countries where it is currently only mandated to wear seat belts as the driver and front-seat passenger, as this requirement could be extended to rear-seat passengers. New legislation where it is currently lacking would mandate that all occupants must wear a seat belt.

We have also explored the promise of “country advocacy” as an approach where, rather than advocating for a specific idea such as reducing speed limits or using seat belts, a campaign group could work in a single country and advocate for a package of policy changes. This approach also looks promising and should be considered by the co-founders of this charity when deciding on an approach, especially if they feel like they have a particular advantage when working in one specific country.

3     Theories of change

The theory of change for advocating for reduced speed limits and new or improved seat belt legislation is illustrated in this section. We consider the necessary activities and outputs by the campaigning organization and the required behavior change from both the government and the public. We also highlight the key assumptions being made in this theory of change.

The theory of change for this intervention could be as follows [4]:


The key assumptions, corresponding to each step (i.e., “→”) in the theory of change, are [5] [6]:

We note two ways that this intervention could be approached:

4     Geographic assessment

The geographic assessment was done in two stages. First, we looked at where existing organizations are working and what they are doing. This information will later be used as an input in the formal geographic assessment as a measure of neglectedness (the greater the number of organizations already working in a country, the less neglected the problem is in that country and, therefore, the less promising it is to start a new organization in). Second, we conducted the formal geographic assessment with the aim of finding the top priority countries for starting a new nonprofit.

4.1   Where existing organizations work

The organizations that we were able to identify in this mapping are those on the larger side. It is likely that we have missed many small organizations working in the space in various countries.

Most road traffic safety organizations do not seem to be focused (only) on advocacy and instead put forward other efforts such as road design, infrastructure, education, and enforcement. Those that are focused on advocacy are quite dispersed between different risk areas.

We highlight below the organizations that are working on advocacy and where they operate:

(AIP Foundation, n.d.)

From this mapping, it seems that the work of Bloomberg Philanthropies and the work of AIP Foundation in Vietnam and Thailand is most relevant, as they are focusing on the same risk areas that we recommend for a new organization.

4.2   Geographic assessment

To assess which countries could be promising for a new organization to work in, we completed a more formal geographic assessment with all countries that do not currently have appropriate legislation across all 5 risk areas [7](this captures countries without any legislation as well as countries whose legislation is not currently adequate). 

We focused on countries that had a DALY burden of >10,000 DALYs per year from road traffic injuries. We chose the most promising countries based on a calculation to determine the total number of DALYs that could be averted by working in that country, taking into account the following:

Based on this geographic assessment, we found that the most DALYs could be averted through the following legislation:

Then, we performed cost-effectiveness analyses on these laws. When choosing locations, we picked countries where the expected enforcement was adequate. In practice, this means that when looking for countries where seat belt legislation can be improved, for example, we would not choose a country whose enforcement of existing seat belt legislation is rated 4 or below in WHO’s global status report (and we first focus on countries where enforcement is good; that is, rated 8/10 or greater) (World Health Organization, 2018).

5   Quality of evidence

5.1   Evidence for these interventions preventing injuries and deaths

Speeding and speed limits

A meta-analysis of 98 studies by Elvik, Christensen, and Amundsen (2004) created the “Power Model of Speed,” which calculates the expected reduction in fatalities and injuries as a result of a change in speed (Elvik, Christensen, and Amundsen, 2004). This study seems like the accepted method for estimating the effects of speed changes on injuries and fatalities.

A meta-analysis of 51 studies, completed in the 2nd edition of The Handbook of Road Safety Measures, found that speed limits reduce average speeds by 25% of the change in speed limit. For example, in practice, this means that when the speed limit is changed by 10 km/h, average speed changes by about 2.5 km/h (Elvik et al., 2009).

Seat belts

A meta-analysis of 30 studies, completed in the 2nd edition of The Handbook of Road Safety Measures, found that wearing a seat belt can reduce fatalities among front-seat occupants by 40-50% and among rear-seat car occupants by up to 25% (Elvik et al., 2009). It seems that the results of this meta-analysis have become the consensus in the space, as these are the numbers that are quoted by the World Health Organization, the UN, road traffic safety organizations, and governments when writing their own reports on road traffic safety.

5.2   Evidence that advocacy leads to policy change in this space

Looking at 84 case studies of advocacy in this space across the globe [8], we found that previous advocacy efforts have been quite successful. The average success rate was ~48%, with 40 of 84 campaigns resulting in policy change in an average of 2.6 years (the overall range of time taken to achieve success was 1-8 years). Most of the organizations that led these campaigns were relatively large, but there are a few examples of small auto-clubs achieving policy change by following steps outlined in a toolkit for policy change from FIA Foundation. You can see the specific steps taken by these organizations in Annex 1. 

Of the remaining 44 case studies, we have classified 42 as still in progress. These campaigns have been in progress for an average of 3.9 years (the overall time range of campaigns still in progress is 2-7 years). 2 campaigns appear to be defunct after seeing no success in an average of 3.5 years. 

You can find all of the case studies used in Annex 1. 

Opposition

There does not appear to be substantial industry opposition to road traffic safety legislation. The most likely source of opposition is the car users who will be affected. If the population dislikes the proposed policy changes, advocacy may be more difficult and/or the policy change may be less likely to happen. However, it could also be the case that, rather than preventing the law from being passed, those who are opposed may just need more strict enforcement than the average road user to actually change their behavior.

5.3   Evidence of compliance with/enforcement of road safety legislation

We can find evidence of compliance/enforcement through two different avenues:

How countries rank their enforcement of legislation

When evaluating the status of road traffic safety legislation in each country for its global status report, the World Health Organization asked a group of +/-8 respondents from different sectors (health, police, transport, NGOs, or academic) to rate the enforcement of legislation in their country. The World Health Organization defines “good” enforcement as an average rating of 8/10 or greater, and we extend this definition as follows: “okay” enforcement is a rating of 5-7 out of 10, and “poor” enforcement is 4 or lower (World Health Organization, 2018). 

Looking at the average rating for enforcement in all countries that participated in the 2018 global status report for each risk area, we see that, on average, the enforcement for each law is “okay”:

(World Health Organization, 2018)

This average was calculated by extracting the information from the WHO’s status report, compiling it in a spreadsheet, and taking the mean.

Statistics on enforcement

The World Health Organization’s global status report also lists statistics on the enforcement of legislation for seat belt laws in terms of the average usage rates (World Health Organization, 2018) [9]. The data for seat belt legislation is as follows:

6     Expert views

6.1   Summary of views

Unfortunately, we only managed to speak with 2 experts in this area (one of whom was only contacted through a short email exchange). Both of these experts worked at existing road traffic safety organizations that operate primarily in Africa.

Both experts cautioned that it is difficult to make progress in this area when working in Africa because enforcement of road traffic safety laws is very poor due to corruption. Therefore, even if new or improved legislation were to pass, it might not actually lead to change. 

The experts had mixed views on whether a new organization should work in this space. One suggested that we should support local organizations instead of creating a new one. The other suggested that there is a lot of work still to be done in this space, so a new organization could be helpful - however, they suggested that this new actor work on the enforcement of existing laws rather than the creation or improvement of legislation.

6.2   Our takeaways

The main takeaway from these expert interviews was that enforcement is particularly important when considering the impact of road traffic safety legislation. 

Because of this consideration, we ensured that when modeling the estimated impact of new or improved legislation in cost-effectiveness analyses, the expected enforcement of legislation was used as a discount on the total number of DALYs averted. We based this number on the enforcement of existing road traffic safety legislation in countries similar to the country being modeled (or the enforcement of existing road traffic safety legislation in the country being modeled, if appropriate). Also, when evaluating where improvements could be made to existing legislation, we took into account expected enforcement during country selection. We will not recommend working in a country where we expect enforcement to be poor [10].

7     Cost-effectiveness analysis

Our cost-effectiveness analyses model policy changes in example countries. These  were chosen as they had the highest impact ceiling for the policy being considered, as calculated in our geographic assessment. This criterion does not necessarily mean that these are definitely the best countries for these interventions, as it does not consider contextual factors (eg., co-founder fit) or the fact that it may make more sense to begin work in a smaller country when the charity is first starting out.

Using the cost-effectiveness of alcohol taxation (modeled in 2020 with a cost per DALY equivalent of $96) as the bar for policy interventions to meet to be considered promising, the following road traffic safety policy changes look most promising:

PolicyExample countryTotal DALYs averted (if campaign is successful)Total DALYs averted (expected)Economic benefits

Charity cost per DALY equivalent


 

Charity + government cost per DALY equivalent
Ensure legislation requires rear-seat passengers to wear a seat beltEgypt121,27757,752

$402,237,129

(or equivalent to 17,699 DALYs)

$17$90
Introduce legislation requiring drivers and both front- and rear-seat passengers to wear seat beltsMexico [11]108,06851,462

$560,287,444

(or equivalent to 20,261 DALYs)

$19$48
Lower speed limits to 50 km/h (without traffic calming) [12]Brazil680,079323,854

$3,308,757,022

(or equivalent to 146,933 DALYs)

$3$42


 We also found that “country advocacy” could be a promising approach. A charity would work in a country with high avertable road traffic deaths and injuries to improve its legislation across all relevant risk areas. We completed two cost-effectiveness analyses in example countries (Egypt and Brazil) evaluating this approach.

Example countryTotal DALYs averted (if campaign is successful)Total DALYs averted (expected)Economic benefits

Charity cost per DALY equivalent


 

Charity + government cost per DALY equivalent
Egypt1,431,595649,757

$5,050,932,649

(or equivalent to 222,250 DALYs)

$6$59
Brazil681,853324,120$3,368,984,352 (or equivalent to 149,607 DALYs)$5$79


 These cost-effectiveness analyses model two sources of impact: health and income. These variables are described below using the illustrative example of a seat belt use policy change in Egypt that improves existing laws by requiring rear-seat passengers to wear a seat belt. All cost-effectiveness analyses use similar inputs, which can be found and are explained in the models linked above.

7.1   Health effects

The health effects of legislation requiring rear-seat passengers to wear a seat belt are defined in terms of total DALYs averted annually following policy change. To calculate this number, we used the following inputs:

Using these inputs, we calculated an estimate for the total number of DALYs potentially averted each year. Then, to estimate the overall impact of the charity over its lifetime, we also used the following:

We then converted the health effects into monetary terms. The monetary value of averting a DALY is assumed to be equal to 2.8 times the per capita income in Egypt. This is based on GiveWell’s estimates of the trade-offs people are willing to make between income and health (GiveWell, 2019). 

7.2   Income effects

The World Health Organization has estimated that the economic impact of road traffic injuries is approximately 3% of GDP (World Health Organization, 2015a) [13]. We discount this estimate by the percentage of road traffic injuries that are from motor vehicles (estimated to be 53% in Egypt, taking an average of WHO’s and GBD Compare’s numbers (GBD Results Tool, n.d.; World Health Organization, 2018)) to get a more accurate estimate of the impact of a rear seat belt law.

7.3   Costs

Our analysis of charity costs was very simple, and was largely based on the costs modeled in our alcohol taxation cost-effectiveness analysis from 2020. We held these costs constant throughout all of the cost-effectiveness analysis models made this year. 

Our analysis of government costs was more complex and was based on the costs of, for example, previous campaigns to increase seat belt use and the estimated costs of employing additional traffic police. We took an average of the following three inputs:

8     Implementation

8.1   Talent

Speed limits and seat belt legislation is not a prohibitively complex area, so it should not be difficult to find talent capable of working on these issues. The main complexities may derive from ensuring the enforcement of legislation once it has been amended or introduced, but it is unlikely that talent would be a limiting factor to overcoming these issues.  

8.2   Access

Information

There has been significant work done on road traffic safety legislation in the past, so there is information available on what works and what does not work as well as toolkits for making progress in the 5 main risk areas.  

There is a lack of up-to-date information on current legislation enforcement levels. So far, the World Health Organization’s global status report is the only reliable source that has been found, and this report only comes out every 4 years. Additionally, the information contained is not always up-to-date. For example, the 2018 global status report includes information on the helmet wearing rate in Australia from 1997 (World Health Organization, 2018).

Government

We have purposefully avoided modeling or recommending work in countries where we expected working with the government to be especially difficult, such as Afghanistan or the Democratic Republic of Congo. 

It could be the case that countries lacking comprehensive road safety legislation, such as Egypt, may be more difficult to make progress in for an unknown reason. One instance could be that these governments are in fact difficult to collaborate with on road safety, leading to the current lack of progress in these countries. This is an untested hypothesis, but should be kept in mind when selecting a country to work in.

8.3   Funding

EA funding

Road traffic safety seems like a cause that Effective Altruists would be open to funding.

The best case that can be made for this claim is that Zusha was a GiveWell standout charity (GiveWell, n.d. a). Zusha! Road Safety Campaign is an initiative by Georgetown University that distributes stickers to public service vehicles, primarily buses, that inform passengers of road traffic safety risks and encourage them to speak up and urge drivers to drive more safely if they are speeding, for example. Zusha received $70,071 in 2020, $112,478 in 2019, and $109,328 in 2018 from money moved by GiveWell (GiveWell, n.d. b) [14].

Non-EA funding

Bloomberg Philanthropies and FIA Foundation are the biggest funders in the space. 

Bloomberg has committed an additional $240 million of funding for road traffic safety from 2020-2025. This almost doubles the amount of funding it has contributed in the space so far from around 2010, which totals $260 million. It seems like it would be especially interested in funding advocacy on speed limits, as in its announcement of the additional funding, it states the following: “Speed is the most critical risk factor, but there has been little progress on speed management” (Bloomberg Philanthropies, 2020). It is focused on work in 15 countries: Argentina, Bangladesh, Brazil, Colombia, Ecuador, Ethiopia, Ghana, India, Malaysia, Mexico, Uganda, and Vietnam.

FIA Foundation spends approximately $7 million each year on road traffic safety (Bella Dinh-Zarr, 2013). FIA Foundation funds work similar to that which this new organization will be working on. It has funded the following organizations in the past: AIP Foundation, Amend, Fundación Gonzalo Rodríguez, EASST, and local automobile clubs, all of which have worked on advocacy for new or improved legislation at some point. 

Open Philanthropy also reports that “government aid agencies (such as USAID or the UK’s DFID [now FCDO​​]) and development banks, such as the World Bank, support some work on road safety as well” (Open Philanthropy, 2013), but it is not clear how much it contributes.

Focusing on the policy work of existing organizations in the road traffic safety space, they have some interesting funders from which this new organization may be able to also receive support. For example:

Please note that this is not a comprehensive list of non-EA funding.

8.4   Scale of the problem

Our cost-effectiveness analyses currently focus on implementation in one example country. However, as many countries are yet to align with best practice on road safety legislation, there is scope for expanding to other countries, potentially significantly increasing impact.  

Our geographic assessment identified 42 other countries where speed limits in urban areas are currently above 50 km/h, with 25 of these having an impact ceiling of over 10,000 avertable DALYs, and 8 of these with an impact ceiling of over 100,000. Therefore, there seems to be a significant amount of further work to be done on this issue.

For seat belt use, our geographic assessment identified 21 other countries where rear-seat passengers are currently not required to wear seat belts. 5 of these have an impact ceiling of over 10,000 annual avertable DALYs, though none with an impact ceiling of over 100,000 aside from Egypt. Our geographic assessment also identified 7 other countries that are completely lacking any seat belt regulation, with 5 of these having an impact ceiling of over 10,000 annual avertable DALYs, and 1 having an impact ceiling of over 100,000 (though this is Afghanistan, in which it would currently be very difficult to work). Therefore, there is some further work to be done on this issue, but it seems like speed limits are more scalable. 

8.5   Neglectedness

Work in this space is quite neglected. Although there are quite a few organizations operating in this space, their work is spread across the 5 risk areas as well as projects like road design and enforcement. 

As noted in our geographic assessment, the work of Bloomberg Philanthropies in Argentina, Bangladesh, Brazil, China, Colombia, Ecuador, Ethiopia, Ghana, India, Malaysia, Mexico, Philippines, Tanzania, Uganda, and Vietnam and the work of AIP Foundation in Vietnam and Thailand is most relevant, as they focus on the same risk areas that we recommend a new organization work on.

8.6   Externalities

There will likely be positive social outcomes such as life expectancy, life satisfaction, education, child mortality, and others due to the economic impacts of this intervention: money will no longer be lost due to road traffic injuries and deaths and so can be redirected to other things. Note that this is not unique to road traffic safety; it would be the case with any public health issue.

There is some risk in interventions that increase the cost of car use relative to the cost of motorcycle use. Such interventions could lead to increased mortality if road users switch from cars to motorcycles in countries where appropriate motorcycle legislation is not present.

8.7   Macro-level considerations

Why are governments not making these policy changes themselves?

There are no countries completely lacking road traffic safety legislation (World Health Organization, 2018). However, most countries do not have comprehensive legislation that follows all of the best practice recommendations of the World Health Organization. This is partly because the World Health Organization’s definition of best practice legislation evolves over time. A country that previously met the standards for comprehensive legislation may fall short in current global status reports due only to changing recommendations and not any change in their legislation for the worse (World Health Organization, 2018; World Health Organization, 2015b).

It could also be the case that once legislation exists in some form, governments are less compelled to further improve upon it as they are constantly juggling many different public health issues. As a result, what they may see as small changes to legislation are under prioritized. 

In the case of some legislation–in particular, child restraint laws–it may just be the case that this sort of law-making lags behind other risk areas across the world. So, we may expect some countries to not yet have child restraint legislation if they have only recently made progress in other risk areas. For example, in the UK, seat belt legislation was introduced in 1983 (BBC, 1983) but child restraint laws were lacking until 2006 (Mockett, 2017). 

It may also be the case that road traffic safety policy is politically unpopular, especially as the enforcement methods are likely to be unwelcome - for example, citizens may dislike speed cameras or speed bumps. 

There is also some concern, raised by experts, that traffic policing can lead to corruption (though we have attempted to select countries where this is less likely to be the case).

Is there reason to think that these policies will have no effect in the long run?

There is little evidence that looks at the long-term impact of road traffic safety legislation, but the evidence that could be found positively updated us. 

For example, in Georgia, although front seat belt use did spike immediately at 95% following policy change, use stabilized at around 70% 8 years after the legislation was amended (EASST, 2019a). That is, the effect does decrease in the long run, but not to no effect. You can see more evidence of a similar effect in Annex 2. To try to capture this stabilization when modeling the cost-effectiveness of these policy changes, we used the stabilized usage rate (eg., 70% for seat belt use in Georgia) instead of the spiked usage rate where available. 

9 Conclusion

Overall, our view is that policy work to improve or introduce road traffic safety legislation is an idea worth recommending to future charity founders. In particular, we recommend interventions across two risk areas:

  1. Reducing existing speed limits to 50 km/h in urban areas in countries where limits currently exceed this number.
  2. For seat belt use, we recommend both improving existing legislation and introducing new legislation.
    1. Existing legislation can be improved upon in countries where it is currently only mandated to wear seat belts as the driver and front seat passenger. This requirement would be extended to rear-seat passengers.
    2. New legislation would introduce regulations mandating that all occupants must wear a seat belt.

Thank you for taking the time to read this report. 

Visit https://www.charityentrepreneurship.com/ to learn how you can launch this intervention through our Incubation Program.

Annex 1 - Case Studies
Summary

AIP foundation

Vietnam

Helmets - new law - success in 8 years (1999-2007)

(Goldman, 2017)

Seat belts (improving law) and child restraints (new law) - still in progress (2019-present)

(AIP Foundation, 2019a)

Speed limits - improved law - success in 2 years (2018-2020)

(BMJ, 2019; AIP Foundation, 2019b) 

Thailand

Speed limits - improving law - still in progress (2015-present)

(World Health Organization, 2018)

Cambodia

Helmets - improved law - success in 3 years (2011-2014)

(FIA Foundation, n.d. a)

Myanmar

Helmets - improving law - still in progress (2018-present)

(AIP Foundation, 2018; AIP Foundation, 2019c; AIP Foundation, n.d.)


EASST

Georgia

Seat belts - improved law - success in 4 years (2007-2011)

(EASST, 2016)

Child restraints - improved law - success in 2 years (2018-2020)

(EASST, 2018; FIA Foundation, 2020)

Azerbaijan

Child restraints - new law - still in progress (2014-present)

(EASST, 2019c)

Kyrgyzstan

Child restraints - new law - still in progress (2019-present)

(EASST, 2019b)

Mongolia

Child restraints - new law - success in 2 years (2016-2018)

(Baasankhuu, 2017; Mongolia - EASST, 2019)

Fundación Gonzalo Rodríguez

Chile

Child restraints - improved law - success in 4 years (2012-2016)

(FIA Foundation, n.d. b) - Note that information was taken from the linked report, which is written in Spanish. 

Uruguay

Child restraints - improved law - success in 5 years (2007-2012)

(FIA Foundation, n.d. b) - Note that information was taken from the linked report, which is written in Spanish.

Argentina

Child restraints - improved law - success in 2 years

(FIA Foundation, n.d. b) - Note that information was taken from the linked report, which is written in Spanish.

FIA Foundation

Mexico

Child restraints - improved law - success in 1 year (2016-2017)

(FIA Foundation: Natalie Draisin, Avi Silverman; and Fundación Gonzalo Rodriguez: Florencia González, Florencia Lambrosquini, Mathías Silva, and Federico Zugarramurdi, 2018) 

UAE

Child restraints - improved law - success in 1 year (2016-2017)

(FIA Foundation: Natalie Draisin, Avi Silverman; and Fundación Gonzalo Rodriguez: Florencia González, Florencia Lambrosquini, Mathías Silva, and Federico Zugarramurdi, 2018) 

Paraguay

Child restraints - improving law - still in progress (2016-present)

(FIA Foundation: Natalie Draisin, Avi Silverman; and Fundación Gonzalo Rodriguez: Florencia González, Florencia Lambrosquini, Mathías Silva, and Federico Zugarramurdi, 2018)  

Sri Lanka

Child restraints - new law - success in 1 year (2020)

(FIA Foundation, n.d. c)

Amend

Côte d’Ivoire, Malawi, Mozambique, Namibia, Senegal, Tanzania, and Zambia

Speed limits - improved law - 6/7 successes in 2 years

(Amend, 2019) 

Bloomberg - 2010-2019

Information regarding the specifics and timelines of Bloomberg’s many campaigns and resulting policy changes were time-prohibitive to obtain, as their campaign information is relatively vague and dispersed. It may not be possible to locate it at all. 

However, more general information was found (Bloomberg Philanthropies, 2020):

Annex 2 - How long does impact last?

Vietnam - new helmet law

(World Health Organization, 2015b) 

Georgia - improved seat belt law

References

AIP Foundation (2018). Available at: https://www.aip-foundation.org/aip-foundation-hosts-first-helmet-handover-ceremony-at-mandalay-primary-school/ (accessed 16 December 2021).

AIP Foundation (2019a). Available at: https://www.aip-foundation.org/aa-vietnam-and-aip-foundation-bring-child-car-safety-training-to-parents-in-hanoi/ (accessed 16 December 2021).

AIP Foundation (2019b). Available at: https://www.aip-foundation.org/circular-31-milestone-of-change-occurs-in-vietnam-with-removal-of-fixed-speed-limits/ (accessed 16 December 2021).

AIP Foundation (2019c). Available at: https://www.aip-foundation.org/three-target-schools-in-mandalay-region-selected-for-safety-delivered-phase-ii-2019-2020/ (accessed 16 December 2021).

AIP Foundation (n.d.). Available at: https://www.aip-foundation.org/what-we-do/where-we-work/vietnam (accessed 16 December 2021).

Amend (2019) Three-Year Child Road Safety Project in Africa Final Execution Report. Available at: https://drive.google.com/file/d/1VGU6vdawGFJ_S6dtkNcHN0fY40gdxRV-/view (accessed 6 January 2022)

Azerbaijan - EASST (2019). Available at: https://www.easst.co.uk/country/azerbaijan/ (accessed 16 December 2021).

Baasankhuu N (2017) #UBeSafe Road Safety Campaign. Available at: https://events.development.asia/system/files/materials/2017/05/201705-ubesafe-road-safety-campaign.pdf.

BBC (1983) British drivers ordered to belt up, 1983. 24 January. BBC. Available at: https://www.bbc.co.uk/archive/british-drivers-face-new-seatbelt-law-1983/zhwyscw#:~:text=The%20wearing%20of%20seatbelts%20for,force%20on%2031%20January%201983.&text=The%20debate%20about%20making%20front,attempts%20to%20make%20it%20law.

Bella Dinh-Zarr T (2013) A conversation with T. Bella Dinh-Zarr on August 2, 2013 about developing world road safety. Available at: https://files.givewell.org/files/conversations/FIA%20Foundation%209-3-13%20(public).pdf.

Bloomberg Philanthropies (2020) Bloomberg Philanthropies commits additional $240 million to prevent global road traffic deaths. Available at: https://www.bloomberg.org/press/bloomberg-philanthropies-commits-additional-240-million-to-prevent-global-road-traffic-deaths/ (accessed 16 December 2021).

BMJ (2019) Slow Zones, Safe Zones in Vietnam - Injury Prevention: Editor’s Blog. Available at: https://blogs.bmj.com/injury-prevention/2019/08/28/slow-zones-safe-zones-in-vietnam/ (accessed 16 December 2021).

EASST (2016) Case study from Georgia: increasing seat belt use. Available at: https://www.easst.co.uk/case-study-from-georgia-increasing-seat-belt-use/ (accessed 16 December 2021).

EASST (2018) Promoting the use of car-seats to cut road risk for children in Georgia. Available at: https://www.easst.co.uk/promoting-the-use-of-car-seats-to-cut-road-risk-for-children-in-georgia/ (accessed 16 December 2021).

EASST (2019a) 10 Years of Saving Lives: Road Safety Capacity Building and Development. Available at: https://www.easst.co.uk/wp-content/uploads/2019/04/EASST-10-year-impact-report-web-1.pdf.

EASST (2019b) Campaign leads to increases in seat belt wearing rates in Bishkek. Available at: https://www.easst.co.uk/campaign-leads-to-huge-increases-in-seat-belt-wearing-rates-in-bishkek/ (accessed 16 December 2021).

EASST (2019c) Then and Now: increasing the use of child restraint systems in Azerbaijan. Available at: https://www.easst.co.uk/then-and-now-increasing-the-use-of-child-restraint-systems-in-azerbaijan/ (accessed 16 December 2021).

Elvik, Christensen, and Amundsen (2004) Speed and road accidents: an evaluation of the Power Model. Available at: https://www.toi.no/publications/speed-and-road-accidents-an-evaluation-of-the-power-model-article17882-29.html (accessed 16 December 2021).

Elvik et al. (2009) Vehicle Design and Protective Devices. In: The Handbook of Road Safety Measures. Emerald Group Publishing Limited, pp. 543–731. Available at: https://www.emerald.com/insight/publication/doi/10.1108/9781848552517 (accessed 16 December 2021).

FIA Foundation (2020) Annual report 2020. Available at: https://www.fiafoundation.org/about-us/annual-report-2020 (accessed 16 December 2021).

FIA Foundation (n.d. a) New law, success for Cambodia helmet campaign. Available at: https://www.fiafoundation.org/blog/2014/december/new-law-success-for-cambodia-helmet-campaign (accessed 16 December 2021).

FIA Foundation (n.d. b) Learning from Chile’s Child Restraint System policy success. Available at: https://www.fiafoundation.org/blog/2021/march/learning-from-chile-s-child-restraint-system-policy-success (accessed 16 December 2021)

FIA Foundation (n.d. c) Auto club leads new child safety legislation in Sri Lanka. Available at: https://www.fiafoundation.org/blog/2020/april/auto-club-leads-new-child-safety-legislation-in-sri-lanka (accessed 16 December 2021)..

FIA Foundation: Natalie Draisin, Avi Silverman; and Fundación Gonzalo Rodriguez: Florencia González, Florencia Lambrosquini, Mathías Silva, and Federico Zugarramurdi (2018) Streets for Life: Safe and Healthy Journeys for the Children of Latin America and the Caribbean. Available at: https://www.fiafoundation.org/media/596964/streets-for-life-en-print.pdf.

GBD Results Tool (n.d.). Available at: https://gbd2017.healthdata.org/gbd-search?params=gbd-api-2017-permalink/a87fc19b9c86749eab0a954ac6a14c1d (accessed 16 December 2021).

GiveWell (2019) Steady-state Fortify Health iron fortification CEA [June 2019]. Available at: https://docs.google.com/spreadsheets/d/1epyGHcuM9A7YjtddVpEPByBs_lxFY5fh1FQbVLlPneA/edit#gid=171561146 (accessed 6 January 2022)

GiveWell (n.d. a) Georgetown university initiative on innovation, development, and evaluation — zusha! Road Safety Campaign - June 2018 version. Available at: https://www.givewell.org/charities/zusha-road-safety-campaign-June-2018-version (accessed 16 December 2021).

GiveWell (n.d. b) GiveWell’s impact. Available at: https://www.givewell.org/about/impact (accessed 16 December 2021).

Goldman L (2017) Head First: A Case Study of Vietnam’s Motorcycle Helmet Campaign. Available at: https://www.fiafoundation.org/media/461104/aipf-10-year-helmet-law-report-final_r5_single.pdf.

Harris GT and Olukoga IA (2005) A cost benefit analysis of an enhanced seat belt enforcement program in South Africa. Injury prevention: journal of the International Society for Child and Adolescent Injury Prevention 11(2): 102–105. Available at: https://www.researchgate.net/publication/7931510_A_cost_benefit_analysis_of_an_enhanced_seat_belt_enforcement_program_in_South_Africa

Mockett, A. (2017) The history of the child car seat, OSV. Available at: https://www.osv.ltd.uk/the-history-of-the-car-seat/ (Accessed: 5 January 2022).

Mongolia - EASST (2019). Available at: https://www.easst.co.uk/country/mongolia/ (accessed 16 December 2021).

Open Philanthropy (2013) Traffic safety in low- and middle-income countries. Available at: https://www.openphilanthropy.org/research/cause-reports/traffic-safety (accessed 16 December 2021).

Seat-belts and child restraints (n.d.). Available at: https://www.who.int/roadsafety/publications/Seat-beltsManual_EN.pdf (accessed 23 December 2021).

The Decision Lab (2021) The COM-B Model for Behavior Change. Available at: https://thedecisionlab.com/reference-guide/organizational-behavior/the-com-b-model-for-behavior-change/ (accessed 6 January 2022)

World Bank (n.d.) Cairo Traffic Congestion Study - Final Report. Available at: https://documents1.worldbank.org/curated/en/495131468038082604/pdf/886540v20ESW0w0on0Study0Long0Report.pdf.

World Health Organization (2008) Global Status Report on Road Safety: Time For Action. Available at: http://apps.who.int/iris/bitstream/handle/10665/44122/9789241563840_eng.pdf.

World Health Organization (2011) Egypt: a national decade of action for road safety 2011-2020. Available at: https://apps.who.int/iris/bitstream/handle/10665/116693/dsa1229.pdf?sequence=1.

World Health Organization (2015a) Executive Summary - Global Status Report on Road Safety, 2015. Available at: https://www.who.int/violence_injury_prevention/road_safety_status/2015/Executive_summary_GSRRS2015.pdf.

World Health Organization (2015b) Global Status Report on Road Safety 2015. Genève, Switzerland: World Health Organization. Available at: https://www.afro.who.int/publications/global-status-report-road-safety-2015

World Health Organization (208) Global Status Report on Road Safety 2018. Genève, Switzerland: World Health Organization. Available at: https://www.who.int/publications/i/item/9789241565684

  1. ^

    Why did we rule out other risk areas? 

    • Helmets - We wanted to focus our efforts on countries with a sufficiently high DALY burden (>10,000 DALYs). We found that only 8 countries without existing legislation met this bar. Based on a quick BOTEC of the DALYs that could be averted through the introduction of a new helmet law in these countries (taking into account estimated reduction in fatalities and expected enforcement), we found that 5 of these countries no longer met this bar. This left us with 3 countries, 2 of which seemed politically intractable (Afghanistan and Somalia). As there was only 1 country left above the bar, we ruled out helmets as a focus, as it was not very scalable.
    • Drink-driving and child restraint use - focusing on these risk areas did not look as cost-effective based on our cost-effectiveness analyses (using $96/DALY equivalent as our bar for cost-effectiveness).
  2. ^

    For example, ​​when the speed limit is changed by 10 km/h, average speed changes by ~2.5 km/h.

  3. ^

     We use DALY equivalent here as this includes both health and economic impacts, though the health impacts are the dominant factor.

  4. ^

    COM refers to the capability, motivation, and opportunity for change from the COM-B model for behavior change (The Decision Lab, 2021).

  5. ^

     In countries where road quality and vehicle quality is low, driving speeds may be fairly slow even without appropriate speed limits.

  6. ^

    In the most promising countries identified for work on seat belt legislation (Egypt, Vietnam, Pakistan, Mexico, and Bangladesh), seat belts and seat belt anchorages are required for the front- and rear-seats in both new and imported cars. This should be a consideration for any future country selection. Information on vehicle standards can be found here: https://extranet.who.int/roadsafety/death-on-the-roads/#vehicles

  7. ^

    The 5 key risk areas identified by the World Health Organization are speeding, drink-driving, helmet use, seat belt use, and child restraint use.

  8. ^

    Unlike in other sections of the report, we have included case studies across all 5 risk areas here (not just for speed limits and seat belt use).

  9. ^

    Note that the WHO does not have anything similar for speeding.

  10. ^

    In practice, this means that when looking for countries where seat belt legislation can be improved, we will not choose a country whose enforcement of existing seat-belt legislation is rated 4 or below in WHO’s global status report (and we will prioritize countries where enforcement is good; that is, rated 8/10 or greater).

  11. ^

    When looking purely at the DALY burden, Afghanistan actually looks like the most promising country for this intervention. However, a new charity would find it very difficult to work in Afghanistan, so Mexico was modeled instead as the country with the second highest DALY burden.

  12. ^

     Traffic calming includes building speed bumps and using speed cameras to help enforce the new, lower speed limit. We evaluated speed limits with and without traffic calming measures, but due to the increased government costs of traffic calming, this intervention looks more promising without.

  13. ^

    We used the global average economic impact instead of the specific estimated economic impact of road traffic injuries in the country being modeled due to lack of data for some countries and because the economic benefits are more speculative, so we thought there was a case for keeping this number constant.

  14. ^

    Note that GiveWell did not remove Zusha as a standout charity, rather, it discontinued the "standout charity" designation in October 2021. More information about this can be found at the following link: https://blog.givewell.org/2021/10/05/discontinuing-standout-charity-designation/.

Ramiro @ 2022-03-07T13:55 (+13)

Thanks, I'm a big fan of CE and always enjoy reading your reports. But I also miss reading something about what you rule out in your brainstorm phase - which I think could be entertaining and enlightning. I understand this would take a bit of your time, and that your focus is on selecting areas for your incubation programme, but it could help other people evaluate their own cause areas and possible projects.

For instance, you considered (and did not recommend for incubation) three interventions regarding contraception in 2020, and it made me super curious about what other interventions you considered in this area (even if just for a minute), why you ruled them out (maybe it's just because there was no evidence), what you'd think about other polemical interventions in this area (e.g., advocacy concerning family planning, or preventing adolescent pregnancy, or abortion laws, or sex ed, etc.)...

vicky_cox @ 2022-03-11T10:38 (+7)

To add to what Sam said - we are also planning on publishing the other health and development policy ideas that we did full, deep-dive reports on but didn't end up recommending on our website and at least one of these, our report on air quality, will also be published on the forum!

weeatquince @ 2022-03-11T10:11 (+6)

[I work for CE as Director of Research] 

Hi Ramiro – really good point. We will try to get more of our lists of ideas out into the EA realm, keep your eyes on the forum.

(Unfortunately I can't promise a list of ideas from the 2020 work on family planning as that was before my time and the staff who worked on that has now left, but hope to get some other ideas lists up online)

ClareDonaldson @ 2022-03-08T17:22 (+12)

Thanks CE team! I was chatting to a driver here in Freetown today about this. He thought that enforcement would be a big barrier (as you say in the summary). It's common for drivers to pay bribes to police officers - for example, if you're caught drink-driving, apparently you can usually pay some money and then continue on your way. You can even buy a driving license without taking any kind of driving test.
 
He also said that they don't have a law about wearing a  motorcycle helmet at the moment because of ebola and covid making it unsafe to share a helmet? 

vicky_cox @ 2022-03-11T10:49 (+5)

Hi Clare - thanks for your response! Yeah, I do think enforcement really is the main concern for this intervention, and the experts we spoke with also mentioned that bribes are common in the areas where they have worked (mainly Sub-Saharan Africa).

As mentioned in the report we have tried to somewhat get around this issue in our country selection by selecting countries that seem to have good enforcement of other road traffic safety laws (either from eg. the percentage seat-belt or helmet wearing rate or from the average rating given to the enforcement mechanisms of that country by different stakeholders of that country). This definitely isn't totally bypassing the issue, though, and these numbers can only tell us so much. This is definitely the limitation of the desktop research we do and we will stress the importance of country scoping visits to the founders of this charity so they can better get a sense of what things are like on the ground and hope that they can find a country where these enforcement issues seem surmountable. 

Re the motorcycle helmet law: That's interesting! We did consider motorcycle helmet laws but ultimately ruled them out in favour of speed limits and seat belt laws as they seemed more scalable (a bigger issue in more countries).

Larks @ 2022-03-08T07:00 (+8)

Looking at the 'costs' section, it seems to only consider costs to the government. But we should also consider costs to individuals of decreasing speed limits. 

The largest of these is probably longer travel times; the entire purpose of roads is to travel from one place to another quickly! This is potentially a very large cost, and should be fairly tractable for you to estimate: look at the average length of time spent commuting, calculate how much longer journeys will take, and multiply by the average wage for motorists. 

There are also other costs, in particular from the required increase in traffic stops. You note the cost of hiring more enforcement officers, but not the the stress of getting pulled over - most people are not used to getting arrested. Because officers typically have a lot of discretion in who they pull over, and what ticket they write, enforcement can be uncertain, arbitrary and unfair. Additionally, they can be dangerous: when approaching a car the policeman has none of the typical situational cues they use to evaluate a situation. They can't see the person's body language ahead of time, and weapons are easy to conceal. At some point they are probably going to ask the driver to reach into the glove compartment, which is a not uncommon place to store a firearm. 

ClareDonaldson @ 2022-03-08T17:12 (+11)

A couple of observations related to your points from Freetown, Sierra Leone (I'm not too sure if this would be similar to the locations considered here). First, there are lots of traffic jams. My journey times are _much_ more heavily dependent on the amount of traffic than speed limits. It's pretty rare that there's open, good-enough roads to get up speed (but when there are, drivers go pretty fast). Second, the police pull drivers over regularly - usually for no reason other than to check the driver's license (as far as I can tell). It's common that the police ask for money regardless of whether you have your license (e.g. it's easy to say they saw you breaking some rule - the driver can't do anything other than argue or pay up).

vicky_cox @ 2022-03-11T11:19 (+9)

Hi, thanks for your comment and apologies for the somewhat belated response! 

On increasing travel times - yeah I think this is a really interesting point and something that we didn't consider when modeling the CEA. I think it may be best to discount the income effects of this intervention as a result of this. After a quick Google search, I have found some data on this from the UK - "Each 1 mph reduction in average traffic speed costs the UK economy in excess of £1Bn in lost productivity through extended journey times" (https://www.abd.org.uk/press-release-hes-proposed-motorway-speed-limit-reduction-to-60mph-borders-on-economic-vandalism/). This suggests the impact could be quite significant, though as the World Health Organization found that the economic impact of road traffic injuries is approximately 3% of GDP, I think the economic impacts would still be net-positive. 

Clare's point on traffic jams is an important consideration here, both for your point and for the promise of this intervention - if drivers are never getting up to the speed limit, then decreasing them looks less promising. This was a concern we were aware of, but we felt unable to address from our desktop research, but this is something we will highlight to the founders of this organization, and it is something that they will be able to assess when doing country scoping visits. 

Perhaps these considerations make advocacy on seat-belt legislation look more promising than advocacy to reduce speed limits. This would be good to pass on to the potential founders so that they can weigh up these considerations.

On the stress of getting pulled over by the police, I am not sure I can comment usefully on this as I don't know too much about it, but thanks for raising the concern, and thanks Clare for the insight from Sierra Leone.

DevonFritz @ 2022-03-07T14:19 (+7)

Thanks for this report!

Question on externalities of setting speed limits: Is there anything in the data on the opportunity cost of extra time in the car on productive hours worked by people who take longer to e.g. get to their jobs?

vicky_cox @ 2022-03-11T11:21 (+9)

Hey Devon, thanks for your comment!

As you can see above, Larks raised a similar concern in their comment. After a quick Google search, I have found some data on this from the UK - "Each 1 mph reduction in average traffic speed costs the UK economy in excess of £1Bn in lost productivity through extended journey times" (https://www.abd.org.uk/press-release-hes-proposed-motorway-speed-limit-reduction-to-60mph-borders-on-economic-vandalism/). This suggests the impact could be quite significant and could give us reason to reduce the economic impacts that are currently being modeled to account for this lost productivity. However, as the World Health Organization found that the economic impact of road traffic injuries is approximately 3% of GDP, I think the economic impacts would still be net-positive.

PeterMcCluskey @ 2022-03-08T18:13 (+2)

How much of this will become irrelevant when robocars replace human drivers? I suspect the most important impact of safety rules will be how they affect the timing of that transition. Additional rules might slow that down a bit.

vicky_cox @ 2022-03-11T11:30 (+7)

Hi Peter, thanks for your comment! 

I must admit I have not really thought about this before, but intuitively it still seems important to have appropriate road safety legislation like speed limits in place even if it is robocars following them rather than human drivers. In fact, I could see it as important to have appropriate speed limits in place before the introduction of robocars in case robocars are programmed to drive faster than is safe as a reflection of a too high speed limit.

I think the use of seat belts is still a good norm to have, even if robocars will drive safer than human drivers.  

I'm not sure whether this would affect the timing of the transition, but if the robocar was going to be programmed with a speed limit anyway then lowering the speed limit doesn't seem like it would slow down the transition (not sure on this though).

PeterMcCluskey @ 2022-03-11T18:40 (+1)

I expect speed limits to hinder the adoption of robocars, without improving any robocar-related safety.

There's a simple way to make robocars err in the direction of excessive caution: hold the software company responsible for any crash it's involved in, unless it can prove someone else was unusually reckless. I expect some rule resembling that will be used.

Having speed limits on top of that will cause problems, due to robocars having to drive slower than humans drive in practice (annoying both the passengers and other drivers), when it's safe for them to sometimes drive faster than humans. I'm unsure how important this effect will be.

Ideally, robocars will be programmed to have more complex rules about maximum speed than current laws are designed to handle.