The Moscow and Brasilia Declarations on road safety – a parallel between two moments in health

Pavarino Filho, Roberto Victor

doi:10.1590/1413-812320152112.15942016

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Article • Ciênc. saúde colet. 21 (12) • Dec 2016 • https://doi.org/10.1590/1413-812320152112.15942016 copy

The Moscow and Brasilia Declarations on road safety – a parallel between two moments in health

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Two high-level multisectoral global conferences on road traffic safety (Moscow, 2009 and Brasilia, 2015), held under the auspices of the United Nations, adopted formal declarations on both occasions. Given the potential of these documents to establish positions, propose guidelines, policies and legal frameworks, this paper compares these charters, in order to identify the emphases, expectations and horizons indicated at each moment, highlighting their health-related items. We describe the WHO's involvement with road safety, considering the ways this relationship signaled the health sector's connection with the theme. We present both conferences and their respective declarations, comparing health issues addressed. We conclude that Brasilia reinforces Moscow and, in addition to contributions expected from the health sector (data, notification, post-trauma care), the implications of the sector have increased, particularly with regard to health promotion, the call for intersectoral collaboration, equity and sustainability aspects, influenced by the United Nations 2030 Agenda.

Key words
Traffic accidents; Public Health; Epidemiology; Health Promotion; Sustainable Development Indicators

	Moscow Declaration	Brasília Declaration
Understanding of the traffic morbidity and mortality issue	– Public health problem. Ref.: Par. 3.	– Development and public health issue. – Causes of road traffic deaths and injuries linked to social determinants. Ref.: PP3
Annual estimated costs of accidents mentioned:	– US$ 65 billion. Ref.: Par. 5.	– US$ 1.85 trillion. Ref.: PP6.
Causes and Responsibilities	– Risk factors. – Claim governments'' important role. Refs.: Par. 7; Enc. 2.	– Risk factors. – Governments and their leaders have “primary responsibility”. – It is inappropriate and insufficient to focus only road users as the sole cause of road traffic accidents. Refs.: PP13, PP15.
Risk	– Word mentioned once. – Presents the main risk / protection factors: speed; drinking and driving, seat belt, children restraint systems; helmets. – Old vehicles without maintenance or safety devices; infrastructures that do not protect pedestrians; lack of or insufficient supervision and attention to trauma. Ref.: Par. 7.	– Word mentioned 11 times. – Added to factors mentioned in Moscow: medical conditions and medications that affect safe driving; fatigue; use of narcotics, psychotropic drugs and psychoactive substances; cell phones and other electronic and text messaging devices; visual distractions on the roads. Refs.: PP22, PP23, OP3, OP4, OP9.
Vulnerable road users	– Mention representation in middle- and low-income countries and the importance of infrastructure. – Mentions child and elderly vulnerability. Refs.: Par. 4, 7; Enc. 4.	– Vulnerability is physical and socioeconomic. – Women added to child and the elderly in public transport. – States urged to promote, adapt and implement road safety policies to protect vulnerable population. – Mentions UN legal instruments for the theme. – Specific mention to motorcyclists in developing countries. Refs.: PP18, OP16, OP18, OP19.
Equity	– Points impacts on most significant segments in less developed countries, but does not directly mention equity.	– Mentions three times the disproportionate condition of exposure of the most vulnerable and relationship of traffic injuries / deaths with poverty cycle. Refs: PP18, PP19, OP11, OP17.
Inclusion	– Recommends the implementation of infrastructure for all, particularly for vulnerable people (mentions the elderly, children, pedestrians, cyclists, motorcyclists and people with disability). Refs.: Enc 4.	– Claims access for people with disabilities and other users with reduced mobility to the physical environment of roads, road traffic environment and transport in urban and rural areas. – Recurring reference to “all road users.” – Reference to the condition of those outside the vehicle – Reference to the participation of employers and workers in public policies to reduce work-related road traffic accidents Refs.: PP18; OP13; OP14; OP22.
Training, skills Development and Education	– Mentions training integrated to development strategies for transport and qualification of personnel in post-accident care – References only to skills training Refs.: Par 14; Enc11	– Develop / strengthen skills in international cooperation; in post-accident care, encouraging government / agencies to qualify staff – Share best practices, lessons learned, knowledge transfer. – Addressing the risk factors should be through awareness, advocacy, campaigns, social marketing, educational and training programs. – Educational and training programs should be comprehensive, inclusive and evidence-based – Continuing education context, with periodic testing to encourage responsible behavior of all road users, in order to create a peaceful circulation and social environment, as well as raising awareness on risk factors. Refs.: PP23, PP30, OP19, OP23, OP24, OP25, OP27.
Goals, indicators and monitoring	– Recommends ambitious, but feasible goals. Ref.: Enc.3.	– Invites the WHO to strengthen the standardization of definitions, indicators and reporting and recording practices. – Encourages the WHO, employees and stakeholders concerned to facilitate the development of national, regional and global goals and definition / use of indicators for road traffic-related ODS. – Need for countries to establish and / or strengthen monitoring of serious road traffic injuries. Refs.: PP10, OP7, OP29.
Health and Traffic	– Road traffic injuries referred to as major public health problem. – Health is part of a crosscutting issue. – Mention to timely access to emergency care. Refs.: Par. 3, 19; Enc. 11.	– Specific paragraph for the subject. – Refers to the reduction of road traffic deaths / injuries and improved health results. – Refers to the role of health and universal coverage systems. – Mentions prehospital, hospital, posthospital comprehensive care and reintegration of road traffic accidents victims; – Mentions the positive impacts on public health resulting from Investments in road safety. – Correlates protection and promotion, safety of pedestrians and cyclists mobility with the broad improvement of health, in particular, non-communicable diseases and injuries. – Refers health at work on road safety issues, with particular attention to professional drivers. – Refers to outpatient and hospital guidelines, appropriate legislation and qualification of access to comprehensive health care. – Highlights paragraph for timely rehabilitation and social reintegration, including world of work and providing Support to victims / families. – Claims means of environmentally sound transport, especially public and non-motorized transport for public health. – Healthy lifestyle referenced in the emphasis on its interrelationship with road safety. – Health services directly related to improving the quality of systematic and consolidated data collection. – Invites the WHO to strengthen the standardization of definitions, indicators and reporting and recording practices, including on road traffic-related deaths, injuries and risk factors, in order to produce comparable information. Refs.: PP4; PP25 OP7; OP6; OP11 OP22 OP23, OP25, OP26.

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