A systems approach: An essential tool for effective road crash injury prevention is the adoption of a systems approach to — identify problems; formulate strategy; set targets; monitor performance.

Road safety efforts must be evidence-based, fully-costed, properly resourced and sustainable. In the United States of America...William Haddon Jr inspired safety professionals when he talked about road transport as an ill-designed, “man-machine” system needing...systemic treatment. He defined three phases of the time sequence of a crash event — pre-crash, crash and post-crash — as well as the epidemiological triad of human, machine and environment that can interact during each phase of a crash. The resulting nine-cell Haddon Matrix models a dynamic system, with each cell of the matrix allowing opportunities for intervention to reduce road crash injury.

This work led to substantial advances in the understanding of the behavioural, road-related and vehicle-related factors that affect the number and severity of casualties in road traffic. The “systems” approach seeks to identify and rectify the major sources of error or design weakness that contribute to fatal and severe injury crashes, as well as to mitigate the severity and consequences of injury. Building on Haddon’s insights, a wide range of strategies and techniques for casualty reduction have since been tested internationally, through scientific research and empirical observation. The strategies...include interventions — to reduce exposure to risk; to prevent road traffic crashes from occurring; to reduce the severity of injury in the event of a crash; to reduce the consequences of injury through improved post-collision care.

This systemic approach to interventions is targeted and carried out within a broader system of managing safety. Building capacity for systemic safety management is a long-term process that in high-income countries has developed over an extended period of motorization and the growth and reform of institutions. In low-income and middle-income countries, systemic safety management is generally weaker, and needs to be strengthened...

While progress has been made in many highly motorized countries, the practical realization of the systems approach remains the most important challenge for road safety policy-makers and professionals. At the same time, there are plenty of examples of the mistakes that highly-motorized nations have made in attempts to improve safety. ..

Such mistakes include — the failure to adopt strategies or interventions based on evidence; expenditure on ineffective but easy policy options; a focus on the mobility of vehicle-users at the expense of the safety of vulnerable road-users; insufficient attention to the design of traffic systems and insufficient professional scrutiny of the detail of traffic safety policy. The errors also included those of omission, as opportunities to prevent deaths and injuries by measures such as the design of better vehicles and less hazardous roadsides, and improving trauma care systems, were in many cases missed.

Developing institutional capacity: The development of traffic safety policy involves a wide range of participants representing a diverse group of interests. In many countries, responsibilities for road safety are spread over different levels of government with policy being decided at local, national and international levels. In the US...responsibilities are split between the federal government and the individual states...