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John Halstead

Road Traffic Injuries: how effective is prevention?

Most of us have seen the aftermath of numerous road accidents and many of us will have been in one ourselves, but we are likely to underestimate the sheer scale of the devastation caused by road traffic injuries (RTIs). In 2010, according to the Global Burden of Disease Study, RTIs killed around 1.33 million people worldwide [4] – more than 

, ahead of diseases like tuberculosis [9].

Global years of life lost ranks with 95% Uncertainty Intervals for the top 25 causes in 2010 [4]

 of people killed in the wars in Iraq and Afghanistan over the last decade. In addition, between 20 and 50 million people are estimated to be disabled or injured each year.[5] 

, with 80% of road traffic deaths but only 52% of the world’s registered vehicles.[7] Perhaps surprisingly, half of all road deaths are among pedestrians, cyclists and motorcyclists.[7]

Looking to the future, as low and middle income countries develop and more people are able to afford motorised transport, 

the number of road deaths is likely to increase

. The WHO projects that road deaths will overtake HIV/AIDS and diarrheal disease as a cause of death by 2030.[9]

Attribution of fatal road traffic injuries by road user group in sub-Saharan Africa and in South East Asia [1]

The annual global economic costs of RTIs are estimated at 

, though the WHO says this figure may be a considerable underestimate.[5] Moreover, in many countries road safety efforts go underfunded.

As a consequence of the startling problem of RTIs, the UN General Assembly proclaimed a Decade of Action for Road Safety (2011-2020).[6] However, today less than 10% of the world population has comprehensive legislation on all five key risk factors for road safety: speed, drink-driving, helmets, seat belts and child restraints.[7]

Increase in the percentage of world population covered by comprehensive legislation on five key road safety risk factors 2008-2011 [7]

significant room for improvement at the policy level

 try to provide information for policymakers on which interventions produce the most human benefit for our buck. These estimates can guide us towards general areas in which there is potential for high levels of charity cost-effectiveness.

DCP2 and WHO CHOICE give very different estimates of the cost-effectiveness of road safety interventions implemented by governments. Professor Adnan Hyder, Director of The International Injury Research Unit, John Hopkins (IIRU-JH), who was involved in both the DCP2 chapter and the WHO CHOICE paper, told us that this is chiefly because they answered different questions. For WHO CHOICE the question was: what must be spent per DALY averted if there is no good legislation and no social momentum? In contrast, DCP2 asked: what must be spent per DALY averted if there is already good legislation and a supportive social environment? The results are as follows.[1, 3]

The chart below summarises the difference:

The following three interventions are assessed by only one source:

Drink driving legislation and enforcement - WHO CHOICE: $2236 in Sub-Saharan Africa and $2731 in South East Asia.

Seat belt legislation and enforcement - WHO CHOICE: $4579 in Sub-Saharan Africa and for $2502 in South East Asia.

Which estimate is most helpful for our purposes?

If the DCP2 figures can be matched by any charities, that would make them serious contenders to be amongst our recommended charities. If the WHO CHOICE estimates are more applicable, then road safety charities are much less effective than our recommended charities.

Which estimate should guide us? There are a number of factors to consider. Firstly, it is not immediately clear which of the questions by DCP2 and WHO CHOICE is more relevant for our purposes here. On the one hand, governments rather than road safety charities would bear most of the costs of sustaining the interventions over time a ten year period, but on the other, some of the areas in which the most promising road safety charities operate – South East Asia and Africa – to a large extent lack a supportive regulative and social framework.

the cost-effectiveness of road safety charities will be somewhere between the DCP2 and WHO CHOICE estimates

. A cost-effectiveness projection of a programme recently implemented by the road safety charity Bloomberg Philanthropies may be instructive. The study projects that the intervention would save a year of life for around $300, which is around a fifth as cost-effective as our recommended charities. [2]

All of this said, the most important thing to note here is that the existing data appears to be very limited. Esperato et al note that the available academic articles on cost-effectiveness exhibit four main weaknesses:

These are (1) not focusing on a specific intervention, (2) not having specific baseline data, (3) not having a control group (i.e., counterfactual), and (4) not adjusting for potential confounders.[2]

For example, only two of the effectiveness studies they found accounted for the counterfactual by having a control, and only one study accounted for potential confounders. Given that Esperato et al engaged in such a wide-ranging literature view, this should make us have serious doubts about the robustness of any existing cost-effectiveness estimates of road safety interventions in the developing world. WHO CHOICE and DCP2 also seem to be working with very limited developing world data.

In sum, we do not yet have reason to completely rule out road safety charities, but we should be suspicious about claims that they could rival our currently recommended charities. Unless a road safety charity presents strong evidence showing the high cost-effectiveness of their activities, we ought not to recommend them.

There are relatively few road safety charities and of the major ones than exist, many of them are quite young. We looked at a range of traffic charities and have concluded that 

though none should be recommended now, three may be worth assessing again in a few years’ time

The International Road Assessment Program (iRap)

iRap engages in a range of activities, including inspecting high-risk roads and developing star ratings, safer roads investment plans and risk maps. They also track road safety performance so that funding agencies can assess the benefits of their investments.

 of prospective road infrastructure projects across the world. They suggest that some government projects can avert a death or serious injury for less than $200. However, these are cost-effectiveness assessments of government projects, not of donating to iRap itself. So far as we know, they have yet to perform a cost-effectiveness assessment of their own work and they did not respond to our queries about their own cost-effectiveness. Nonetheless, there work appears to be potentially high impact. It would be worth enquiring again in a one or two years to see if they have performed any cost-effectiveness analyses of their own work.

The AIP Foundation is an Asian NGO which has a five pillar approach to road safety: programmes targeted at vulnerable road users; public awareness education; legislative advocacy; helmet production; and research monitoring and evaluation of their efforts.

AIP Foundation has various impressive achievements so far. In 2007, they combined legislative advocacy and public awareness education to successfully push for mandatory motorbike helmet laws in Vietnam. This has undoubtedly saved many lives. Nellie Moore, their Junior Monitoring & Evaluation Manager, told us that, by their own estimates, as a result of the programme, $2.6bn was saved, 412,200 road injuries were avoided and 20,600 fatalities were prevented in Vietnam. If this is accurate, then AIP Foundation is potentially very cost-effective. It spent nearly $2.5m in 2013. If we assume it spent $2m every ten years with the sole consequence of a mandatory helmet law in Vietnam which saved 20,600 lives, then their activities would have saved a life for $970. This is around half the cost offered by our recommended charities.

However, there are a number of caveats. Firstly, they have yet to do a rigorous cost-effectiveness study of their own work. Ms Moore told me they are carrying two out at present, which should both be ready by next year. Secondly, it is not clear whether the helmet legislation would have happened anyway without the efforts of AIP Foundation. Thirdly, Vietnam might have been a particularly good opportunity for motorbike helmet intervention, which could not be matched in other countries.

There is, then, reason to be cautious around claims about the cost-effectiveness of AIP Foundation, but nevertheless to be optimistic about the good it does. We recommend returning to this charity in one or two years to look at the outcomes of its cost-effectiveness assessments.

Amend operates in Africa and according to the WHO “the interventions promoted by Amend are perfectly in line” with those being promoted by the WHO.

Amend’s Director Jeffrey Witte provided helpful information when asked about cost-effectiveness. Overall, the message was that at the moment we simply do not know enough to reach a verdict about the cost-effectiveness of interventions in the developing world. He said that there are very few or zero papers which prove to a standard publishable in a peer-reviewed journal that any intervention has reduced RTIs in Africa (or anywhere else in the developing world). However, in January, Amend is to embark on a two year project funded by the FIA Foundation to perform a rigorous evaluation of the impact of their infrastructure programme on injury rates.

Amend’s scientific focus is certainly to be commended and it would be worth looking again at them in a few years’ time.

RTIs are a huge and growing problem across the world. However, what data there is at the moment suggests that it is unlikely that any road safety charity could rival our currently recommended charities. Moreover, there is very limited data on the cost-effectiveness of road safety interventions in the developing world. Some charities operating in the area are promising and we ought to return to assess them again in a few years’ time. For now however, we cannot recommend any road safety charities.

Road Traffic Injuries: Assessing The Global Burden And Charities Working In The Area (PDF)

, Giving What We Can's comprehensive report into Road Traffic Injuries

Chisholm, D., H. Naci, A. A. Hyder, N. T. Tran, and M. Peden. “Cost Effectiveness of Strategies to Combat Road Traffic Injuries in Sub-Saharan Africa and South East Asia: Mathematical Modelling Study.” BMJ 344, no. mar02 1 (March 2, 2012): e612–e612. doi:10.1136/bmj.e612.

Esperato, Alexo, David Bishai, and Adnan A. Hyder. “Projecting the Health and Economic Impact of Road Safety Initiatives: A Case Study of a Multi-Country Project.” Traffic Injury Prevention 13, no. sup1 (2012): 82–89

Jamison, Dean T., World Bank, and Disease Control Priorities Project. Disease Control Priorities in Developing Countries. 2nd ed. New York: Oxford University Press ; Washington, DC, 2006

Lozano, Rafael, Mohsen Naghavi, Kyle Foreman, Stephen Lim, Kenji Shibuya, Victor Aboyans, Jerry Abraham, et al. “Global and Regional Mortality from 235 Causes of Death for 20 Age Groups in 1990 and 2010: A Systematic Analysis for the Global Burden of Disease Study 2010.” The Lancet 380, no. 9859 (December 2012): 2095–2128. doi:10.1016/S0140-6736(12)61728-0

Peden, M., Richard Scurfield, David Sleet, Dinesh Mohan, Adnan A. Hyder, Eva Jarawan, and Colin Mathers. 

WHO | World Report on Road Traffic Injury Prevention.

WHO | Global Plan for the Decade of Action for Road Safety 2011-2020.

WHO | Global Status Report on Road Safety 2013.

WHO | Investing in Health Research and Development.

WHO | Projections of Mortality and Causes of Death, 2015 and 2030.

Sam Hilton

How I organise a growing chapter in a big city in less than 30 minutes a month.

Starting a local group is really easy to do, a lot of fun and you meet some amazing people. And of course you can have a huge huge impact on the world by encouraging people to do good and to think more carefully about how they do good.

I started organising regular Giving What We Can social events in London in the summer of 2013. I had for a while been helping organise irregular events, then, one day, I thought why not try something a little different. I arranged an evening at a pub with a friend, created a Giving What We Can social Facebook event and invited anyone who I thought might be interested. It went well and I have been creating infrequent social events ever since.

I recently came to the rather surprising realisation that the Giving What We Can London group was growing quite fast. This was particularly curious because for quite a while I had been putting in less than 30 minutes a month. Essentially the only organising I had been doing was taking the responsibility to choose a time and place for a social event and posting this on Meetup.com and Facebook about once a month.

Now perhaps it is just chance that the group has grown of late, some twist of fate or flimsy whim of the gods. But either way it was suggested that I write my tips down on paper (well screen). The recipe below describes how I have organised things in London. Everywhere is different but I hope some of this is useful to someone.

The rest of the article from hereon in has been cross-posted to the EA Wikipedia so that others can add their advice. So to see the most up-to-date version go 

–––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––

How to run a local Giving What We Can chapter in a minimal amount of time

Starting a local group is very high value and very easy. This page is aimed at non-students living in a city that does not already have a Giving What We Can group, who may not have much time to put into growing a group but who will be in the same city for a prolonged period of time. This post does not set out the ideal way to run a local group but sets out how to run and grow a group if optimising for investing a minimal amount of time.

 for a social event and invite friends of yours who you think might be interested. Have at least one friend who can definitely come, so if your event is not popular you are not sitting alone for an evening. Choose a time (e.g. evening/weekend) and place (e.g. pub/bar/café/arts centre/etc) that people should be able to make.

Well done - you have started a local group!! It should take about 20 minutes to organise a first event. Once this is done you can use Facebook to create future events and automatically invite all the same people by going to the first event on Facebook and clicking " ••• " then clicking "copy event".

Building a group – get an online presence

Create a Meetup.com group and/or create a Facebook group and/or start and email list and/or find other places online to post events.

 It is useful to have an online platform which can gradually grow in membership and from which events can be publicised. A good online platform (I 

) will help your group grow without you having to do extra work or publicity. Posting about each event in more places will help your group grow faster but will take some a little bit of extra time on a regular basis to copy and paste across the event details. Giving What We Can London posts all events on Meetup and on Facebook. See below for more advice on different online platforms.

 See below for advice on running events. Make sure events are posted on all the sites that you are using (Facebook/Meetup/etc).

Effective Altruism and Giving What We Can London Facebook group

Once you have an online platform that people can join and be invited to events, then you can start publicising it. Below are some very simple quick easy ways of publicising your group:

 Encouraging people who turn up to bring friends and to add people to the online groups is crucial.

Let the Effective Altruism community know that you exist.

. Maybe even add the occasional post on to the 

. Tell the people who run other groups whose members might be interested about your group. Ideally tell them about a specific relevant upcoming event. People to tell would be local groups for: Less Wrong, students, philosophy, charity, atheist and humanists, religions, RESULTS, etc.

Trying something slightly different every few months is low cost and will allow you to gradually work out what works best in your city. You can experiment with:

Different ways of describing the event. Etc.

And that is it – SUCCESS – you should now have a growing thriving local group. And none of the steps above should have taken you very long to do.

Remember, you can spread this work out over as much time as needed. In London this whole process was spread out over about a year and took a small amount of time each month. Alternatively you can take a single evening to kickstart the process and do all of the above steps at once.

Below is more advice to make sure that events run smoothly and that the group does not fail.

Additional tips – Choosing online platforms

 has a cost but it has really helped the EA London group grow. It may not work for your city but it is likely to be worth trying. Keep the description snappy, make sure you add lots of popular “labels” so that your event will be found.

 (not a Facebook page) lets people add their friends to the group and events turn up on people’s Facebook newsfeed. If you create a Facebook group add anyone who you think would be interested and then when you create future events create them from the Facebook group so people in the group are automatically invited.

 Consider looking for other websites where events are posted. For example Eventbrite or Time Out or Yelp. Try googling “how to meet new people in [city]” or “finding interesting events in [city]” and seeing what websites appear prominent.

Effective Altruism and Giving What We Can London Facebook group (click About to see the description. Feel free to copy and paste this)

Additional tips – Preparing for an event

If trying to run a group with minimal time and effort a simple social event is the easiest to organise. People turn up when they want and discuss whatever takes their fancy, often including effective altruism.

 In London we tend to meet at 7pm on a weekday evenings. Increase the regularity of events as the group grows. In London we started off with events every few months, then every other month, then every month, and now a few times a month. As the group grows having a fixed time for events (Eg. 1st Tuesday of each month) can help people plan around them.

 In London we tend to meet in a centrally located pub. The ideal location will be somewhere cheap, without background music, with some vegetarian/vegan foodstuffs where space can be pre-booked.

 People are more likely to attend events and enjoy events more if each event has a specific theme. It helps give people something to discuss and a reason to talk about Effective Altruism topics as well as educating people about the key questions that underpin the EA movement. Put a list of interesting questions in the event description. (Optionally print of some articles that are connected to the theme. This can help spark interest and conversation but can also be a sizeable time sink.)

 Remember that your target audience for the description is not people who turn up every week but the people most likely to be persuaded to turn up with a good event description (i.e. new people or people who have only attended once). Be welcoming. Describe something about effective altruism. Add a phone number so people can find you. Make it clear that people can turn up at any time.

 The main benefit here is for people who have been brought along by a friend or by word of mouth and are keen to sign up on Facebook / Meetup / etc. A small piece of paper with a short explanation of effective altruism and a link to any Facebook / Meetup / etc groups would suffice.

 (with Isha Datar Director of New Harvest) (Theme: Lab grown mean)

Under the influence @ the Shakespeare's Head

Effective Altruism - Awesomely Fun Christmas Social

, friendly, hospitable, nice and so on. Talk to the new people. Explain effective altruism. Smile.

 from attendees as to how they found the event.

 Feedback has suggested that it is useful to walk about at the half way point of an event and say: 

“Hi everyone. Sometimes at events like this people end up talking to the same person or group of people the whole evening and wish they had met more of the wonderful people here. So I want to suggest that you move about, now or in a few minutes. Just saying this to prompt you or to give you an excuse to get up and move around and meet more people”

 to any offensive or off-putting behaviour.

At first you do have to turn up to your own events – although once you have a few regulars this is a relatively easy task to pass on to someone else if you need to.

 Most EA groups that have fizzled out have done so because the leaders have had limited success at growing the group, have felt disheartened and given up. To avoid this: 

Aim low and you will not be disappointed.

Be aware of the huge potential benefit of EA outreach. Read haste consideration and do a back of the envelope calculation.

Have fun. Make sure you enjoy the events. Do not get stressed organising things - organise things at your convenience. Finding a co-organiser may help.

Put less time into running the group (see below).

Problem: Feeling like this is a sub-optimal use of time.

 Put less time in but keep events going. Eg have events every 2 months. Copy and paste the same event description for each event. Organise them at your convenience (oh I am meetup up with a friend that evening anyway so I can make it an EA event and invite others). If people ask for more events then suggest they organise them. If necessary try to hand over (see below).

 can be difficult (without significant effort). If you think there is a high chance that you will leave a town in less than a year then maybe don’t start a group like this. Ask lots of people and pressure them into helping. Write a very detailed handover note with everything you can think of.

Problem: Feeling like this is a sub-optimal use of money.

) and I can pay for the cost of a meetup group. Or maybe ask Giving What We Can (

). Remember 1 Meetup account can host 3 groups.

 Bigger groups grow faster – if the group is not growing you could try some of the additional things to do with extra time that are listed below. If you can or find someone to organise one big event – such as a famous talker that may be all the group needs.

Additional tips – Things to do with extra time

 A single big well publicised event can help group the group significantly. In London we had Peter Singer come and talk to a crowd of 400 and this helped the group take off (

. As the group leader your main time sink after creating (and attending) the event each month or so will be responding to emails form people who are interested in Giving What We Can. The easy thing to do is to ignore these or send a standard message to people. Being polite and responding to individual emails is likely to be a useful way to spend extra time.

 With more time your experiments into how best to run the group can be bigger and more rigorous. You can trial different kinds of events or having a to do list with tasks that anyone can take on or sending a personal message to new members and so on.

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Road Traffic Injuries: how effective is prevention?

How I organise a growing chapter in a big city in less than 30 minutes a month.

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