The World Health Report 2003 interventions has been carried out in developed countries, and more research is needed on their effectiveness in developing countries. Renewed efforts are under way to increase world wide awareness of the problem and its solutions and to encourage the introduction of road safety policies and practices. Several countries are using integrated strategies to deal with traffic risks and enhance the benefits of transport and land use policies to promote physica activity and cohesive projects for community development(25) The epidemic of road traffic injuries in developing countries is still in its early stages, but it threatens to grow exponentially unless there is swift action to counter it(26). Low-income and middle-income countries already bear the brunt of 90% of the disability-adjusted life years(DALYs)lost to road traffic injuries and deaths. While fatality rates in high-income countries are declining, they are rapidly accelerating in the developing world, especially in Asia(27). The problem is so severe that, by 2020, road crash injuries are likely to represent the third leading cause worldwide of DALYs lost(28). By then, road traffic deaths are expected to increase by 92% in China and 147% in India, with an average increase of 80% in many other developing countries(29) In addition to the unacceptable human toll, the global economic cost of road crashes has been estimated at about USS 518 billion annually, of which the developing country share is about US$ 65 billion(27). Countries struggling for economic development clearly cannot afford such losses, which have a significant impact on national health care systems. Injuries account for approximately one-third of the acute patient load in many hospitals in lor income and middle-income countries, and between 30% and 86% of all trauma admissions (30); road traffic injuries constitute the majority of such admissions Although more than 3000 people are killed each day, full recognition of the scale of the prob lem is obscured because road crashes usually cause only a few deaths at a time and generate little press coverage, contributing to the hidden nature of the epidemic of road traffic inju ries In contrast to some other epidemics, road traffic injuries are largely influenced by decisions and choices at both policy and individual levels, which means that the problem is amenable to control. Vehicles in developing countries are known to have a far more lethal impact than those in highly motorized countries-by as much as 200-fold in some cases(27). As the number of cars increases rapidly in developing countries, the roads are becoming signifi cantly more dangerous; in the same way that the increased vehicle usage can be forecast, so can the expected deaths and injuries for vulnerable road users. a global commitment to bring Box 6.3 Tobacco and schoolchildren in the Western Pacific Region Alarmingly high rates of tobacco use and exposure to second-hand smoke The desire to stop smoking was expressed by up to 87% of child among schoolchildren aged 13-15 years in the Western Pacific Region smokers in China and 85% in the Philippines, and not less than 62% of are revealed by data from the first group of countries within the Region all the children in the survey. These figures indicate an urgent need for to complete the Global Youth Tobacco Survey. Many of these children interventions that target children and adolescents, to empower them to started smoking before the age of 10, and an overwhelming majority reject tobacco. For those already addicted, cessation strategies appro- want to quit but are unable to do so because of nicotine addiction. priate to this age group are imperative. In addition, there is a dear and The survey involved China, Fiji, the Northern Mariana Islands, Palau, pressing need for effective r to ensure that children and young the Philippines and Singapore. It found that in some parts of China, people are protected from the effects of second-hand smoke exposure etween 20% and 40% of children started smoking before they were To protect children properly, WHO urges governments to establish com- 10 years old, compared with 14% in the Philippines, about 22% in Fiji prehensive tobacco control programmes that adhere to the principles and Singapore, and 31-32 in Northern Mariana Islands and Palau. outlined in the Framework Convention on Tobacco Control Overall, between 35% and 65% had been exposed to others'smoke at96 The World Health Report 2003 interventions has been carried out in developed countries, and more research is needed on their effectiveness in developing countries. Renewed efforts are under way to increase world￾wide awareness of the problem and its solutions and to encourage the introduction of road safety policies and practices. Several countries are using integrated strategies to deal with traffic risks and enhance the benefits of transport and land use policies to promote physical activity and cohesive projects for community development (25). The epidemic of road traffic injuries in developing countries is still in its early stages, but it threatens to grow exponentially unless there is swift action to counter it (26). Low-income and middle-income countries already bear the brunt of 90% of the disability-adjusted life years (DALYs) lost to road traffic injuries and deaths. While fatality rates in high-income countries are declining, they are rapidly accelerating in the developing world, especially in Asia (27). The problem is so severe that, by 2020, road crash injuries are likely to represent the third leading cause worldwide of DALYs lost (28). By then, road traffic deaths are expected to increase by 92% in China and 147% in India, with an average increase of 80% in many other developing countries (29). In addition to the unacceptable human toll, the global economic cost of road crashes has been estimated at about US$ 518 billion annually, of which the developing country share is about US$ 65 billion (27). Countries struggling for economic development clearly cannot afford such losses, which have a significant impact on national health care systems. Injuries account for approximately one-third of the acute patient load in many hospitals in low￾income and middle-income countries, and between 30% and 86% of all trauma admissions (30); road traffic injuries constitute the majority of such admissions. Although more than 3000 people are killed each day, full recognition of the scale of the prob￾lem is obscured because road crashes usually cause only a few deaths at a time and generate little press coverage, contributing to the hidden nature of the epidemic of road traffic inju￾ries. In contrast to some other epidemics, road traffic injuries are largely influenced by decisions and choices at both policy and individual levels, which means that the problem is amenable to control. Vehicles in developing countries are known to have a far more lethal impact than those in highly motorized countries – by as much as 200-fold in some cases (27). As the number of cars increases rapidly in developing countries, the roads are becoming signifi￾cantly more dangerous; in the same way that the increased vehicle usage can be forecast, so can the expected deaths and injuries for vulnerable road users. A global commitment to bring Box 6.3 Tobacco and schoolchildren in the Western Pacific Region Alarmingly high rates of tobacco use and exposure to second-hand smoke among schoolchildren aged 13–15 years in the Western Pacific Region are revealed by data from the first group of countries within the Region to complete the Global Youth Tobacco Survey. Many of these children started smoking before the age of 10, and an overwhelming majority want to quit but are unable to do so because of nicotine addiction. The survey involved China, Fiji, the Northern Mariana Islands, Palau, the Philippines and Singapore. It found that in some parts of China, between 20% and 40% of children started smoking before they were 10 years old, compared with 14% in the Philippines, about 22% in Fiji and Singapore, and 31–32 % in Northern Mariana Islands and Palau. Overall, between 35% and 65% had been exposed to others’ smoke at home. The desire to stop smoking was expressed by up to 87% of child smokers in China and 85% in the Philippines, and not less than 62% of all the children in the survey. These figures indicate an urgent need for interventions that target children and adolescents, to empower them to reject tobacco. For those already addicted, cessation strategies appro￾priate to this age group are imperative. In addition, there is a clear and pressing need for effective measures to ensure that children and young people are protected from the effects of second-hand smoke exposure. To protect children properly, WHO urges governments to establish com￾prehensive tobacco control programmes that adhere to the principles outlined in the Framework Convention on Tobacco Control