Assessing the Impact of Road Safety Agencies and Health Systems in Traffic Outcomes Across 146 Countries, 1994-2012

Background: Road safety policies (RSPs) have emerged worldwide. Yet, while an important group of RSPs have been regarded as necessary to reduce traffic crashes and their consequences, the impact of others remain inconclusive. To advance knowledge on this debate, this article focuses on the potential effects of two RSPs: i) road safety agencies (RSAs) and ii) health systems (HS). Methods and data sources: Cross-sectional longitudinal data corresponding to 146 countries from 1994 to 2012 are analyzed using regression models to account for the endogeneity of RSA formation, including fixed effects and instrumental variable designs. A global dataset compiling information from multiple sources, including the World Bank, and the World Health Organization is built.Results: RSAs are associated with a decrease of traffic injuries in the long-term. This trend is only observed in developed countries. HSs decrease traffic fatalities in the long-term by 5% (95% Confidence interval (CI) 3% to 7%), and traffic crashes severities in the midterm. Across OECD countries, HS is not associated with traffic injuries variation, but is associated with a decline in traffic severities. The effects of well-developed HSs change direction over time. For about eight years of HS investment in OECD countries, traffic severity rates improved.Conclusion: While some authors have theorised that RSAs institutions may fail to reduce either traffic injuries or fatalities, our work however captured a long-term effect in RSAs performance when targeting traffic injury outcomes. That well-developed HSs have been effective in decreasing traffic fatalities and traffic crash severity rates, and ineffective in decreasing injuries, is consistent with the overall function that this type of policies fulfils. Results call for revisiting the specific mechanisms which explain why RSAs, and HSs seem effective in decreasing different traffic outcomes