Road Management Strategies to Reduce Health Impacts
Communities should implement comprehensive traffic safety enhancements through both street-scale and community-scale urban design policies, including traffic calming measures, improved pedestrian infrastructure, and Complete Streets policies, as these interventions have demonstrated effectiveness in increasing physical activity and reducing obesity-related morbidity. 1
Primary Traffic Safety Interventions
The Community Guide provides sufficient evidence supporting the implementation of specific traffic safety measures that directly impact population health through increased physical activity and reduced injury risk 1:
Engineering and Infrastructure Modifications
Traffic calming measures are essential first-line interventions that should include 1:
- Speed tables and traffic circles to reduce vehicle speeds
- Raised crosswalks and textured pavement for pedestrian safety
- Improved street lighting to enhance visibility and reduce crime-related deterrents to physical activity 1
- Infrastructure projects specifically designed to increase safety of pedestrian street crossings 1
These interventions work by creating physical barriers that force motorists to slow down while simultaneously making pedestrians and cyclists more visible and protected 1.
Complete Streets Policy Implementation
Local governments must adopt formal Complete Streets policies that include at minimum one of these evidence-based elements 1:
- Specification that "all users" encompasses pedestrians, bicyclists, transit vehicles/users, and motorists of all ages and abilities
- Creation of comprehensive, integrated, connected networks rather than isolated improvements
- Application to both new construction and retrofit projects, covering design, planning, maintenance, and operations
- Direction to use latest and best design standards with measurable performance outcomes 1
The policy framework matters because it ensures systematic rather than ad hoc implementation across all road projects 1.
Broader Road Safety Framework
Multi-Component Approach
Beyond traffic calming, effective road safety requires addressing 2:
- Enforcement mechanisms for traffic regulations, particularly excessive speed, alcohol-impaired driving, and violations of pedestrian/cyclist rights
- Vehicle roadworthiness standards and inspection programs
- Post-crash medical care systems to reduce injury severity and mortality 2
The integrated approach is necessary because road accidents have complex, multi-factorial causes that have remained relatively constant over time despite technological advances 2.
Evidence Quality Considerations
A critical caveat: The vast majority (96%) of road safety evidence comes from high-income countries, with only 1.4% from low- and middle-income countries 3. Additionally, 293 of 322 systematic reviews on road safety interventions were rated as low quality 3. This means interventions proven effective in high-income settings may not translate equally well to other contexts and should be piloted and evaluated locally 3.
Health Impact Mechanism
The connection between road management and health operates through multiple pathways 1:
Physical activity promotion: Enhanced traffic safety removes barriers (real or perceived) that deter walking, running, and cycling, thereby increasing population-level physical activity 1. Persons living in neighborhoods with higher traffic safety demonstrate measurably higher physical activity levels 1.
Injury and mortality reduction: Direct trauma prevention through reduced crash frequency and severity 2. Road traffic injuries cause 1.35 million deaths annually worldwide, with 20-50 million severe injuries requiring long-term treatment 2.
Quality of life improvements: Reduced fear of crime through better lighting, decreased social isolation through walkable neighborhoods, and enhanced community engagement 1.
Implementation Priority
Start with policy adoption before infrastructure investment 1. Establishing a Complete Streets policy creates the framework that ensures all subsequent road projects incorporate safety elements systematically rather than requiring separate advocacy for each project 1.
Common Pitfalls to Avoid
- Piecemeal implementation: Installing speed bumps on one street without network-wide planning reduces effectiveness 1
- Ignoring maintenance phase: Policies must cover ongoing operations and maintenance, not just initial construction 1
- Lack of enforcement: Infrastructure alone is insufficient without traffic law enforcement, particularly for speed and impaired driving 2
- Failure to measure outcomes: Policies should establish measurable performance standards to enable evaluation and adjustment 1
Supporting Organizational Structure
Communities should establish multi-stakeholder coalitions involving government agencies, health professionals, transportation departments, community organizations, and private sector partners to coordinate obesity prevention and road safety efforts 1. These coalitions provide the organizational capacity to implement and sustain complex, multi-sectoral interventions that individual agencies cannot accomplish alone 1.