Systemic inequalities in road safety outcomes across high income countries and lessons from intervention approaches

Abstract

Background

Road safety inequality refers to the systematic and avoidable differences in road safety exposures and health outcomes among various demographic groups, influenced by social, economic, environmental, and structural factors.

Method

A narrative review approach was employed, integrating a systems perspective to examine the interplay of social, economic and environmental factors. Literature searches were conducted across academic databases and grey literature, over the last 15 years yielding 42 sources after applying exclusion criteria. The review was guided by research questions focusing on demographic and geographic disparities, the underlying risk factors, and the effectiveness of interventions.

Results

Findings highlight that most studies concentrate on risk factors rather than interventions. Key risk factors, especially for the young as pedestrians and cyclists, included living in hazardous built environments with high traffic levels and being more exposed to antisocial and illegal driving behaviour. For interventions the evidence suggests the need for multifaceted interventions supported by multi-agency efforts. Effective communication, community engagement, and recognition of broader systemic issues were critical for intervention success.

Conclusions

The review underscores the importance of integrating road safety within wider social and environmental strategies to maximize co-benefits. System-wide interventions targeting young pedestrians and cyclists, are recommended. Future research should address gaps in understanding the multifaceted nature of road safety inequalities and develop comprehensive, scalable interventions.