Rethinking Road Safety Through a Broader Public Health Approach

Steffel Ludivin Feudjio Tezong | IRF Young Professional Programme Leader

I am a transport specialist working across Africa and internationally, where I support governments, development partners and research centres in designing safer, healthier and more sustainable transport systems. This article reflects my belief that road safety should be viewed not only through the lens of crashes, but as a broader public health challenge.

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Road safety has long been measured primarily by fatalities and serious injuries. Every year, around 1.19 million people lose their lives on the world’s roads, making road traffic injuries the leading cause of death among young people aged 5–29 years [1]. These figures have rightly driven global action, from the Second Decade of Action for Road Safety to the Sustainable Development Goals [2,3]

Yet I believe we are still counting only part of the problem.

The more I work in transport, the more I wonder whether road safety has become too focused on crashes alone. A transport system can harm health long before, or without, a collision. Polluted air, traffic noise and environments that discourage walking and cycling quietly contribute to chronic disease and premature death, yet they rarely feature in road safety discussions.

This is not an argument for paying less attention to crashes. It is an argument for broadening our ambition. If transport systems are designed to protect human life, then success should be measured not only by the crashes they prevent, but also by the healthier, cleaner and more active communities they create.

The Health Burden Usually Overlooked

The problem is not that we lack evidence. It is that we continue to view these health impacts in isolation. Physical inactivity is treated as a public health issue, air pollution as an environmental issue, and traffic noise as an urban nuisance. I would argue they are all, at least in part, road safety issues because they are shaped by the same transport systems.

Take physical inactivity. When streets feel unsafe or inconvenient for walking or cycling, people naturally rely more on motorised transport, even for short trips. The result is a more sedentary lifestyle, physical inactivity, that contributes to around 3.2 million deaths each year, including 2.6 million in low- and middle-income countries, and increases the risk of cardiovascular disease, diabetes and other non-communicable diseases [4-6].

The same streets expose people to air pollution. Road transport is a major source of particulate matter and nitrogen oxides, accounting for around 15% of direct global CO₂ emissions [7]. The consequences are measured not only in emissions, but also in hundreds of thousands of premature deaths each year, with children among the most affected [8]. Notably 1 in 10 child asthma cases is linked to road traffic air pollution [9].

Then there is traffic noise, perhaps the most overlooked consequence of car-dependent mobility. More than 30% of the world’s population is exposed to excessive road traffic noise, increasing the risk of sleep disturbance, hypertension, cardiovascular disease and poorer mental well-being [10]. In the EU, road traffic noise affects one in five people, contributing to 9,000 premature deaths and 36,000 new cases of ischaemic heart disease each year, alongside widespread annoyance and sleep disturbance [11].

We often accept this as the unavoidable cost of mobility. It isn’t. It is the consequence of how we choose to design and manage our streets.

These problems may appear different, but they share the same origins: streets designed primarily for moving vehicles rather than protecting people. Once we recognise that, the conversation changes. Road safety is no longer just about preventing crashes; it becomes about designing transport systems that improve health, quality of life and environmental sustainability.

One Investment, Multiple Health Benefits

If these health burdens share common causes, they also share common solutions.

For too long, road safety, public health and climate action have been treated as separate conversations. I believe that is one of our biggest mistakes. Many of the interventions that make transport systems safer also make them healthier, cleaner and more inclusive.

Take speed management. We know that a 1% increase in average speed leads to approximately a 4% increase in fatal crashes [12]. Yet lower speeds do far more than save lives. They also reduce emissions and traffic noise. Studies from Belgium and Germany found that reducing speed limits can lower CO₂ and nitrogen oxide emissions by up to 25%, while research from Zurich showed significant reductions in road traffic noise after urban speed limits were reduced from 50 km/h to 30 km/h [13-15].

The same is true for walking, cycling and public transport. Safe infrastructure encourages people to leave their cars behind, reducing emissions while making physical activity part of everyday life [16-18].The health gains are substantial: active commuting reduces all-cause mortality by 9% and cardiovascular mortality by 15% [19]. The World Health Organization estimates in a study in Accra that investments in walking and cycling infrastructure could save 33,000 lives over 35 years and generate USD 15 billion in health benefits [20].     

What strikes me is that we continue to justify these investments one benefit at a time. A cycle lane is treated as a cycling project. A lower speed limit is presented as a road safety measure. Public transport is viewed as a mobility service. In reality, each achieves all of these objectives at once.

Perhaps this is the shift road safety needs most. Instead of asking how transport policies can reduce crashes, we should ask how they can improve health. When viewed through that lens, sustainable mobility is no longer just a transport or climate objective, it becomes one of the most effective public health strategies available.

From Theory to Practice

This vision is already becoming reality. Cities around the world are showing that investments in sustainable mobility can improve safety, health and environmental quality at the same time.

Bogotá is one of the strongest examples. Investment in its CicloRutas network increased cycling while reducing bicycle-related deaths and injuries, lowering household transport costs and avoiding an estimated 36,600 tonnes of CO₂ emissions each year [21,22]. In Berlin, reallocating road space from motor vehicles to pedestrians and cyclists significantly reduced residents’ exposure to harmful nighttime traffic noise [11].      

These cities remind us of something important: the greatest returns come from interventions that solve several problems at once. Safer streets become cleaner streets. Lower speeds reduce both crashes and noise. Walking, cycling and public transport improve health while reducing emissions.

I believe this is where road safety must evolve. For decades, we have measured success by the crashes we prevent. That will always matter, but it is no longer enough. A transport system should also be judged by whether it encourages people to walk, breathe cleaner air, enjoy quieter neighbourhoods and move safely throughout their lives.

Looking beyond the crash does not weaken the road safety agenda; it strengthens it. It asks us to stop thinking only about surviving our journeys and start thinking about the kind of lives our transport systems make possible.

Perhaps the safest transport systems are not simply those that prevent crashes, but those that help people live longer, healthier and better lives.

References

[1] World Health Organization. (2023). Global status report on road safety 2023. https://www.who.int/teams/social-determinants-of-health/global-status-report-on-road-safety-2023

[2] UN. The 17 Sustainable Development Goals (SDGs). https://sdgs.un.org/goals

[3] WHO. UN decade of action for road safety 2021-2030. https://www.who.int/teams/social-determinants-of-health/safety-and-mobility/decade-of-action-for-road-safety-2021-2030

[4]  An, R., Shen, J., Yang, Q., & Yang, Y. (2020). Impact of built environment on physical activity and obesity among children and adolescents in China : A narrative systematic review. Journal of Sport and Health Science, 8(2), 153–169. https://doi.org/10.1016/j.jshs.2018.11.003 

[5] Wang, H., Dai, X., Wu, J., Wu, X., & Nie, X. (2025). Influence of urban green open space on residents ’ physical activity in China. 2019, 1–12.https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-7416-7 

[6] World Health Organization. (2019). Physical inactivity. https://www.who.int/data/gho/indicator-metadata-registry/imr-details/3416

[7] Hannah Ritchie. (2020) – “Cars, planes, trains: where do CO2 emissions from transport come from?” https://ourworldindata.org/co2-emissions-from-transport

[8] Anne Gulland. (2018). Road traffic kills 350,000 children a year. https://www.telegraph.co.uk/

[9] Achakulwisut, P. et al. (2016). Global , national , and urban burdens of paediatric asthma incidence attributable to ambient NO₂ pollution : estimates from global datasets. https://doi.org/10.1016/S2542-5196(19)30046-4

[10]  Chenzhi Cai, Cheuk Ming Mak, and Xuhui. (2019).Analysis of urban road traffic noise exposure of residential buildings in hong kong over the past decade. doi: 10.4103/nah.NAH_36_18.

[11] European Environment Agency. (2020). Environmental noise in Europe. https://www.eea.europa.eu/publications/environmental-noise-in-europe

[12] The International Transport Forum. (2018). Speed and Crash Risk Speed and Crash Risk. https://www.itf-oecd.org/speed-crash-risk

[13] Coensel, B. De. (2011). Assessment of the impact of speed limit reduction and traffic signal coordination on vehicle emissions using an integrated approach. https://doi.org/10.1016/j.trd.2011.06.001 

[14] Kunkler, J., Braun, M., & Kellner, F. (2021). Speed Limit Induced CO 2 Reduction on Motorways : Enhancing Discussion Transparency through Data Enrichment of Road Networks. https://doi.org/https://doi.org/10.3390/su13010395 

[15] Brink, M., Mathieu, S., & Rüttener, S. (2022). Lowering urban speed limits to 30 km / h reduces noise annoyance and shifts exposure – response relationships : Evidence from a field study in Zurich. Environment International, 170(October), 107651. https://doi.org/10.1016/j.envint.2022.107651 

[16] Victoria Transport Policy Institute (2013). Evaluating Active Transport Benefits and Costs: Guide to Valuing Walking and Cycling Improvements and Encouragement Programs. https://trid.trb.org/view/1262285 

[17] International Society for Physical Activity and Health. (2020). Eight Investments That Work for Physical Activity. www.ISPAH.org/Resources

[18] Buehler, R., Kuhnimhof, T., Bauman, A., & Eisenmann, C. (2019). Active travel as stable source of physical activity for one third of German adults : Evidence from longitudinal data. https://doi.org/10.1016/j.tra.2018.09.022

[19] Dutheil, F., Pélangeon, S., Duclos, M., Vorilhon, P., & Mermillod, M. (2020). Protective Effect on Mortality of Active Commuting to Work : A Systematic Review and Meta ‑ analysis. Sports Medicine, 50(12), 2237–2250. https://doi.org/10.1007/s40279-020-01354-0 

[20] World Health Organization. (2020). Health and economic impacts of transport interventions in Accra, Ghana. https://www.who.int/publications/i/item/9789240017306

[21] World Health Organization. (2020).Cyclist safety: an information resource for decision-makers and practitioners. https://www.who.int/cyclist-safety-an-information-resource 

[22] Development Asia. (2016). A Strategy for Creating a Bicycle-Friendly City https://development.asia/case-study/strategy-creating-bicycle-friendly-city