Road traffic accidents are now the second leading cause of death among young people – with young men most at risk. Nearly three times more young men than young women are killed or injured on roads every year. Globally, 1.2 million people are killed on roads every year and up to 50 million more are injured and remain disabled for life.

Nearly 90,000 people die each year on India's roads.

Around 85% of deaths from road traffic crashes occur in developing countries – costing them between 1–1.5% of their annual GNP. Without action, and with the growing number of cars on the roads in thriving new middle-income countries like India and Brazil, road deaths and disabilities are likely to rise still further.

Through the eyes of road campaigner Harman Sidhu, who is himself a paraplegic after a road crash, this special Life programme looks at the current situation in both countries – and reviews what positive steps are being taken to confront this serious health issue.

Harman Singh Sidhu, paraplegic after a road accident, now runs ArriveSafe computer driver training.

India has just one per cent of the world’s vehicles but ten per cent of the world’s traffic crashes.

Thirty-six year-old Harman Sidhu was the victim of a road crash ten years ago. It left him confined to a wheelchair. “Chaos like this is killing nearly ninety thousand people and crippling or disabling more than300,000 every year. This is having a major impact on the social and economic situation of our country.”

To find out just how great that cost is, Harman goes to St Stephen’s Hospital in Delhi to meet its Head of Orthopaedics, Dr Matthew Varghese. He says: “For every person that is killed, about fifteen to thirty other major injuries and about eighty times are the minor injuries. So you can calculate the volume of the problem and you can calculate the economic burden to the society.”

Dr Matthew Varghese, orthopaedic surgeon and roads campaigner.

There is a severe social impact too, as Dr Varghese points out: “In India, for example, where we have no social security, no insurance and the majority of people that are working in the society are in the unorganised sector… What is the consequence? The consequence is this person has no falling back mechanism on any of these support systems in case of an accident. Now the moment you have a major crash, a major accident, what happens? They don’t have the resources. So what do they do? They take loans. And the moment such a below-poverty family takes a loan, that family is done for next one or two generations, straightaway.”

Road crashes cost India over seven billion dollars. Globally, they cost low- and middle-income countries more than they get in development aid.

Cows are an added hazard on India's crowded city roads.

One problem is that India doesn’t have things many other countries just take for granted, like clear road signs. But it isn’t just road signs - India still has no National Traffic Code. By law, drivers are required to have ten hours of lessons, and sit a basic, practical test to get a driving licence. Some States, like Delhi, also have theory tests but there’s no standard system nationwide. Practical driving tests are held on the nearby road – by examiners who stand at the side of the road.

Nearly three hundred new vehicles are pouring onto Delhi’s roads every day. As everywhere in Asia, most are three-wheelers and motorbikes - with motorcyclists most likely to be involved in crashes. Motorcycle helmets are compulsory for motorcyclists - protecting their heads. But in Delhi the law now exempts Sikhs, and women - who are mostly pillion passengers - leaving them more vulnerable. And while India’s road laws maybe lax - what about people who are seen to break them.

Minna Saran, the mother of road crash victim Nishit Saran, says: “The people who are not abiding by the law, why aren’t they punished for it? Till there’s a human cry they get away with it. The police said they’d never seen a worse accident than that. But where was the police? Where were the lights? And what has been done ever since?

Minna Saran, road accident victim's mother.

The State of Haryana has one of the highest rates of road traffic crashes in India. Harman has created a special computer software package with information on the highway code and a test for prospective drivers. “We are basically designing educational content which will be used by different police units and by the public to educate themselves and get ready for the theoretical tests.”

Amitabh Singh Dhillon, Police Superintendent IPS, Ambala District, Haryana, says: “It promises to revolutionise the scene because it is very easily replicated on a standardised basis. And we’re hoping ... to repeat it in 21 districts in Haryana.”

A road safety expert group has submitted a new bill to the Ministry of Transport. It proposes a coordinated, national road-safety board, responsible for data collection, and prevention measures such as reducing speeding and drink driving. It’s now under review.

India is not alone. Other countries also experience huge increases in deaths and injuries as they build new roads and import new vehicles. Speeding, drink driving, lack of seatbelts and helmets and inadequate enforcement are common.

Harman travels to Sao Paulo - the richest State in Brazil – to see how they are managing. Nineteen million people live in the city, which is struggling to cope with 500 new vehicles on the roads a day.

Brazil has an advantage over India - it does have a national traffic code, passed in 1997. Initially the new code brought down the death toll - but not for long. Thirty-five thousand Brazilians die in road crashes and almost half a million are injured every year.

Every day, 25 'motorboys' are injured on Sao Paulo's roads.

And Sao Paulo has the highest number of crashes in the country - around twenty five thousand every year. And, as in India, motorcyclists, pedestrians and cyclists are the main victims. The phenomenon of motorboys, as they are known, exploded onto Sao Paulo’s streets ten years ago when unemployment was high. Now, they compete for space on the city’s massive network of roads and expressways. Every day twenty five motorcyclists are injured - at least one dies.

The Hospital das Clinicas - the largest in the city - receives around six hundred road crash victims every month. One in five are spinal injuries – the majority young men. Most spend months in hospital and years in rehabilitation.

Edimilson Alves de Oliveira was going to work on his motorbike and a bus made an illegal turn and crashed into him. It changed Edimilson’s life. “Now I am dependent on everyone for everything.”

Glaucia Loureiro Redondo, an architect, was walking with her daughter and husband on the footpath and a car hit her from behind. She had multiple fractures on the right side of her body and head injury. She says: “We know alcohol is the cause of many accidents in Brazil. Drunk drivers cause many crashes. In my case I don’t remember because I was unconscious but the police said the driver was very, very drunk and he couldn’t remove the car from the sidewalk.”

Among 14 to 26 year olds, drink driving and speeding account for three quarters of car accident deaths on Brazil’s roads. Diza Gonzaga set up Vida Urgente after her son, Thiago, lost his life in a late night driving crash. Over three thousand volunteers have joined her, using the breathalyser test in bars, to spread the message that alcohol and driving don’t mix.

Vida Urgente volunteers offer breathalyser tests in Sao Paulo's bars.

She explains: “Our symbol is a butterfly, the green one is given to those who past the test to say they are safe to drive you and those over the alcohol limit receive a red one with the phrase ‘I’ve drunk everything, and I want someone to drive me’ and then we look for someone to drive them safely.”

As Brazilians continue to migrate to the cities in search of work, more and more neighbourhoods are springing up next to the dangerous, high-speed expressways leading into city centres. Every day, twenty-one pedestrians are run over, and two die. Eduardo Daros fights for the rights of pedestrians on Sao Paolo’s roads: “The first priority should be to pedestrians, the second to public transport, and third priority to services - less priority to cars. Our avenues have cars that are driven at sixty – sixty-five kilometres per hour and the pedestrian can’t cross. There is no zebra crossing, there’s a bus stop on one side and the other side, but no zebra crossing in the middle. And then how does the pedestrian get into the bus? They don’t get there by parachuting - they get by walking!”

Like India, Brazil has multiple agencies responsible for traffic safety. The Ministries of Cities, Justice and Transport all share responsibilities for implementing the national traffic code – including enforcement. Giving all agencies a role but making one responsible for overall national road safety, similar to other successful systems elsewhere, is in Harman’s view, the priority.

Harman concludes: “It is very important that both these countries have a central agency that is only responsible for road safety - since this is not a small thing. It is taking a major part of the GDP and has an enormous social cost.”

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