Review www.thelancet.com Vol 367 Month xx, 2006 1 In 2002, an estimated 1·2 million people were killed and 50 million injured in road-traffic crashes worldwide, costing the global community about US$518 billion. 1 The International Federation of Red Cross and Red Crescent Societies has described the situation as “a worsening global disaster destroying lives and livelihoods, hampering development and leaving millions in greater vulnerability”. 2 Without appropriate action, road-traffic injuries are predicted to escalate from the ninth leading contributor to the global burden of disease in 1990 to the third by 2020. 3,4 Acknowledging its enormous effect on the global community, WHO designated “road safety” as the theme for world health day in April, 2004. A comprehensive report on road-traffic injury prevention 1 was released by WHO and the World Bank on the same day, and an unprecedented plenary session of the UN General Assembly devoted to the global crisis of road crashes followed, culminating in a resolution that challenged all governments to address road safety as a matter of urgency. 5 As a result of this resolution, a coordinating mandate was conferred on WHO, leading to the establishment of a UN road safety collaboration, a working group of 42 agencies committed to tackling road safety. These agencies are working within a common framework on a range of joint projects to address road safety. These projects encompass activities relating to data collection and research (including the establishment of a database of road-safety legislation), provision of technical support (including production of a series of how-to manuals), advocacy and policy, accessing financial support (including the launch in December, 2004, of a global road-safety initiative—a 5-year, US$10 million project, including a partnership of seven private-sector companies), and improving cooperation in partner organisations (including production of a resource entitled The United Nations Road Safety Collaboration: a handbook of partner profiles). 6 As a result of the efforts of the collaboration, the UN General Assembly passed a new resolution on road safety on Oct 26, 2005, commending WHO for its role as a coordinator on road-safety issues within the UN system; and inviting Member States to implement the recommendations of the WHO and World Bank 2004 report on prevention of road-traffic injuries. The Assembly also asked the UN regional commissions and WHO to jointly organise the first UN Global Road-Safety Week (April 23–26, 2007); and requested that Member States and the international community recognise the third Sunday in November of every year as the World Day of Remembrance for Road-Traffic Victims. 7 This high-level political attention has resulted, in a large part, from a concerted global effort to compile available evidence and examine the scientific basis for road-traffic injury prevention. 1,8 Recognising that road crashes are a major public-health burden— (particularly in low-income and middle-income countries)—that is predictable, and, importantly, preventable, was a major achievement of the WHO and World Bank report. 1,9,10 However, the report also identified substantial shortcomings in present knowledge, particularly in relation to the burden and effectiveness of interventions in low-income and middle-income countries. In this Review, we aim to summarise the characteristics of the rise in road-traffic injuries and present an evidence- based approach to prevent road-traffic crashes. Our Review uses the substantial work undertaken by international experts contributing to the 2004 world report and data published since that time. We particularly highlight gaps Lancet 2006; 367: pg–pg Injury Prevention Research Centre, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand (S Ameratunga PhD); Centre for Population Health, National Institute of Public Health, Cuernavaca, Mexico (M Hijar PhD); and The George Institute for International Health, University of Sydney, Sydney, New South Wales, Australia (Prof R Norton PhD) Correspondence to: Assoc Prof Shanthi Ameratunga s.ameratunga@auckland.ac.nz Road-traffic injuries: confronting disparities to address a global-health problem Shanthi Ameratunga, Martha Hijar, Robyn Norton Evidence suggests that the present and projected global burden of road-traffic injuries is disproportionately borne by countries that can least afford to meet the health service, economic, and societal challenges posed. Although the evidence base on which these estimates are made remains somewhat precarious in view of the limited data systems in most low- income and middle-income countries (as per the classification on the World Bank website), these projections highlight the essential need to address road-traffic injuries as a public-health priority. Most well-evaluated effective interventions do not directly focus on efforts to protect vulnerable road users, such as motorcyclists and pedestrians. Yet, these groups comprise the majority of road-traffic victims globally in low-income and middle-income countries, and consequently, the majority of the road-traffic victims globally. Appropriately responding to these disparities in available evidence and prevention efforts is necessary if we are to comprehensively address this global-health dilemma. Search strategy and selection criteria For this review we identified studies from electronic databases (Cochrane databases, MEDLINE, EMBASE, and CINAHL), and by hand-searching peer-reviewed journals in the injury field (in particular, Injury Prevention, Injury, Journal of Trauma, Accident Analysis and Prevention, Injury Control and Safety Promotion, and Traffic Injury Prevention). We also found relevant studies in the 2004 world report on road-traffic injury prevention, in bibliographies of content-specific articles and reports, and from sources of information identified by the authors, colleagues, and partners in the Road Traffic Injuries Research Network. The identified sources included documents published in non-peer-reviewed formats, which provided useful otherwise inaccessible data pertaining to low-income and middle-income countries. Articles specifically cited were selected for their relevance in addressing the key objectives of the report.