Neglected Global Epidemics: three growing threats imported with improved safety features such as rollover protection. Third, countries need effective trauma response systems in order to transport and treat victims without delay and to rehabilitate them. Rapid, efficient, emergency response systems can reduce morbidity and mortality. Quality rehabilitation care should be incorporated as part of a comprehensive plan to care for the injured(36) Improving road safety requires strong commitment by governments to establish, finance and sustain road safety programmes. Collaboration with other stakeholders- global, national and local -will accelerate progress and contribute to the development of more sustainable forms of public and private transport. Countries can begin with a commitment to gather more assessment data and build a comprehensive database to monitor and evaluate national plans. As the knowledge base on road traffic injuries expands, there is greater scope for col laboration between countries and across disciplines and agencies. This collaboration will b a key element in shaping a rapid response to the epidemic, especially in poorer countries, and in ensuring a reduced impact on the global environment. Because the burden of such injuries and deaths falls disproportionately on poor countries, it is important to pursue the goal of global safety equity, in which all persons have equal access to the means of assuring safety. To achieve this, these countries will need to build infrastruc ture and human resource capacity, and will look to developed countries for assistance. Gov ernments can be encouraged to view road safety and protection from injury as an important contributor to sustainable economic, social and environmental development and to mobilize the necessary forces for effective prevention of an epidemic that, while largely hidden today, rill become increasingly visible unless action is taken to control it. Integrating road safety with broader policies In most countries, the most insidious impact of road transport is air pollution, which causes public concern in both rich and poor countries. Estimates of the impact of air pollution health indicate that this concern is justified. In Austria, France and Switzerland the number of deaths related to air pollution from traffic is twice the number of deaths from traffic acci dents(23). In addition, gases that cause climate change -a quarter of which come from transport ( 24)-are expected to contribute to extreme weather events including floods and droughts, and changes in the habitat of disease vectors such as mosquitoes, with major health consequences(37) Current transport patterns have many other consequences to health(22), including perv Qve annoyance induced by traffic noise; adverse effects on rates of cardiovascular disease, betes, obesity and some cancers by discouraging the use of safe cycling and walking fo transport(38); and constraints on the development of neighbourhood support networks. ox 6.4 A low-cost road safety strategy: speed bumps in Ghana Road traffic crashes are a serious problem in Ghana, where the fatality reduce kinetic energy (which causes injuries and deaths on impact)as rate per 10 000 vehides is about 30-40 times higher than that in high- well as increasing the time to collision, thereby preventing crashes. income countries. As excessive speed on interurban highways and in The use of speed bumps and rumble strips has been effective on built-up areas has been identified as one of the key factors contributing Ghanaian roads. During the 16-month period between January 2000 to crashes, speed bumps have been installed at some crash-prone and April 2001, traffic crashes were reduced by 35%, fatalities by 55% locations on the highways, in order to lower the speed of vehicles and and serious injuries by 76%. These speed-reducing measures also improve the traffic environment for other road users such as pedestri. succeeded in eliminating certain kinds of crashes and improving pedes. ans and cyclists. Low-cost rumble strips have been installed on the main trian safety Accra-Kumasi highway at a collision hot spot. Lower vehicle speedsNeglected Global Epidemics: three growing threats 99 imported with improved safety features such as rollover protection. Third, countries need effective trauma response systems in order to transport and treat victims without delay and to rehabilitate them. Rapid, efficient, emergency response systems can reduce morbidity and mortality. Quality rehabilitation care should be incorporated as part of a comprehensive plan to care for the injured (36). Improving road safety requires strong commitment by governments to establish, finance and sustain road safety programmes. Collaboration with other stakeholders – global, national and local – will accelerate progress and contribute to the development of more sustainable forms of public and private transport. Countries can begin with a commitment to gather more assessment data and build a comprehensive database to monitor and evaluate national plans. As the knowledge base on road traffic injuries expands, there is greater scope for col￾laboration between countries and across disciplines and agencies. This collaboration will be a key element in shaping a rapid response to the epidemic, especially in poorer countries, and in ensuring a reduced impact on the global environment. Because the burden of such injuries and deaths falls disproportionately on poor countries, it is important to pursue the goal of global safety equity, in which all persons have equal access to the means of assuring safety. To achieve this, these countries will need to build infrastruc￾ture and human resource capacity, and will look to developed countries for assistance. Gov￾ernments can be encouraged to view road safety and protection from injury as an important contributor to sustainable economic, social and environmental development and to mobilize the necessary forces for effective prevention of an epidemic that, while largely hidden today, will become increasingly visible unless action is taken to control it. Integrating road safety with broader policies In most countries, the most insidious impact of road transport is air pollution, which causes public concern in both rich and poor countries. Estimates of the impact of air pollution on health indicate that this concern is justified. In Austria, France and Switzerland the number of deaths related to air pollution from traffic is twice the number of deaths from traffic acci￾dents (23). In addition, gases that cause climate change – a quarter of which come from transport (24) – are expected to contribute to extreme weather events including floods and droughts, and changes in the habitat of disease vectors such as mosquitoes, with major health consequences (37). Current transport patterns have many other consequences to health (22), including perva￾sive annoyance induced by traffic noise; adverse effects on rates of cardiovascular disease, diabetes, obesity and some cancers by discouraging the use of safe cycling and walking for transport (38); and constraints on the development of neighbourhood support networks. Box 6.4 A low-cost road safety strategy: speed bumps in Ghana Road traffic crashes are a serious problem in Ghana, where the fatality rate per 10 000 vehicles is about 30–40 times higher than that in high￾income countries. As excessive speed on interurban highways and in built-up areas has been identified as one of the key factors contributing to crashes, speed bumps have been installed at some crash-prone locations on the highways, in order to lower the speed of vehicles and improve the traffic environment for other road users such as pedestri￾ans and cyclists. Low-cost rumble strips have been installed on the main Accra-Kumasi highway at a collision hot spot. Lower vehicle speeds reduce kinetic energy (which causes injuries and deaths on impact) as well as increasing the time to collision, thereby preventing crashes. The use of speed bumps and rumble strips has been effective on Ghanaian roads. During the 16-month period between January 2000 and April 2001, traffic crashes were reduced by 35%, fatalities by 55% and serious injuries by 76%. These speed-reducing measures also succeeded in eliminating certain kinds of crashes and improving pedes￾trian safety