The Future of Road Safety: Challenges and Opportunities

Centennial Issue
Population Health

Policy Points:

  • Traditional approaches to addressing motor vehicle crashes are yielding diminishing returns. A comprehensive strategy known as the Safe Systems approach shows promise in both advancing safety and equity and reducing motor vehicle crashes.
  • In addition, a range of emerging technologies, enabled by artificial intelligence, such as automated vehicles, impairment detection and telematics hold promise to advance road safety.
  • Ultimately, the transportation system will need to evolve to provide the safe, efficient, and equitable movement of people and goods without reliance on private vehicle ownership, towards encouraging walking, bicycling and the use of public transportation.

As Elizabeth Milbank Anderson was establishing the foundation for the Milbank Memorial Fund in the beginning of the twentieth century, Henry Ford was refining the design of the Model T Ford, an invention which would revolutionize personal transportation in the United States.1,2 In the century that has followed, the Milbank Quarterly has been at the forefront of brokering practical knowledge to decision makers about health policy for protecting and enhancing the health of populations. The relevance of the publication’s mission to the prevention of motor vehicle crashes injuries, which is a leading cause of death and disability in the United States and globally, remains pressing.3

Injuries persist as a leading cause of death worldwide. Globally, intentional and unintentional injuries are responsible for approximately 4.4 million deaths annually, eclipsing the number of deaths caused by HIV, TB, and malaria combined.4 Motor vehicle crashes are responsible for 1.35 million injury deaths each year worldwide and are the leading cause of death for those aged 5–29 years. Crash victims are overwhelmingly male, with three quarters (73%) of all road deaths occurring among young males under the age of 25 years.5

Crash deaths and injuries disproportionately burden low- and middle-income countries. More than 90% of road deaths occur in these nations, despite their accounting for about 60% of the world’s vehicles.6 More than half of global road deaths are among vulnerable road users, which include pedestrians, cyclists, and motorcyclists. An additional 20 to 50 million people suffer nonfatal injuries, with many incurring a lifelong disability as a result of their injury.5

The scale of the problem at a population level is vast, yet, road deaths present a paradox: each crash is experienced as an individual, isolated event. The systemic causes of crashes are often overlooked or ignored, and a narrative is constructed around the unique circumstances surrounding each crash. Victims and their families often suffer alone, and the actual scale of the burden is difficult to appreciate. Economic analyses estimate the cost of crashes to be equivalent to 3% of Gross Domestic Product for most countries,5 but the true toll of the physical and psychological burden to individuals, families, communities, and society is unfathomable.

Open Access


  1. Fox DM. The significance of the Milbank Memorial Fund for policy: an assessment at its centennial. Milbank Q. 2006;84(1):5-36.
  2. Purdy KW, Foster CG. History of the automobile. Britannica Encyclopeida; 2010. Accessed March 15, 2023.
  3. Centers for Disease Control and Prevention. WISQARS Leading Causes of Death Reports, 1981–2020. Accessed June 18, 2022.
  4. World Health Organization. Injuries and violence: Key facts. Published March 19, 2021. Accessed March 16, 2023.
  5. World Health Organization. Road traffic injuries: Key facts. Published June 20, 2022. Accessed June 29, 2022.
  6. World Health Organization. Global status report on road safety 2018. Geneva, World Health Organization; 2018. Accessed March 16, 2023.


Ehsani JP, Michael JP, and MacKenzie, EJ. The Future of Road Safety: Challenges and Opportunities. Milbank Q. 2023;101(S1): 613-636.